Jim Shannon (Strangford) (DUP) - Hansard
5 Sep 2019, 3 p.m.

I beg to move,

That this House has considered hernia mesh in men.

I have brought this issue to the House because, to be truthful, I was not aware of this problem among men. I am well aware of the hernia mesh issue for women, and have represented their viewpoint for a number of years in this House and back home, where the Northern Ireland health service has responsibility. I asked for this debate after a number of gentlemen came to see me some months ago—I will give a little background on that in a few minutes.

I thank the Backbench Business Committee for selecting this topic for debate. Back in July I accepted its offer of this first Thursday back, even though I know it is the graveyard shift, unless there is a three-line Whip in the main Chamber. Given today’s one-line Whip, many Members have returned home after everything that has happened in the last two days. None the less, I am very pleased to bring this matter to Westminster Hall. I am also pleased to see the Minister in her place. This will be a hat-trick of debates for her—one yesterday and two today. I look forward to her response.

I raised this issue after a meeting I had with some men in Northern Ireland. My party colleague and health spokesperson in the Northern Ireland Assembly, Paula Bradley, who represents North Belfast, initially made me aware of the issue. My hon. Friend the Member for Upper Bann (David Simpson) also brought it to my attention, as he had met constituents to discuss the matter. It is only over the past nine months that I have been aware of it. The men I met that day were aged between 30 and about 55. I understand that in Northern Ireland some 400 men have had problems, and the number across Great Britain will be even higher. They outlined their experiences and the difficulties that they attributed to hernia mesh. I thought that their problems should be considered in this place, as those problems have been replicated throughout the United Kingdom.

The matter has been brought to the attention of the Department of Health and Social Care. The hon. Member for Linlithgow and East Falkirk (Martyn Day), the Scots nats spokesperson, is aware of the issue and will offer his experience. I will not steal his speech, but I understand he will tell us a wee bit about what he has experienced personally and about the health service in Scotland. I am also pleased to see the shadow spokesperson, the hon. Member for Washington and Sunderland West (Mrs Hodgson), in her place.

I urge that serious consideration be given to an investigation, on the same scale as the Australian investigation, and that action be taken after the findings are collated. Australia took action, and I hope the Minister will assure me that the Government will do the same. I promised my constituents and those 400 men across Northern Ireland who have had problems with hernia mesh that I would raise awareness in this House because, unfortunately, we do not have a functioning Northern Ireland Assembly so cannot raise the issue there.

In November 2018, the Health Issues Centre undertook social research to investigate adverse health experiences among Australian men and women who had undergone a medical device implant. The research was product non-specific, to identify any devices that demonstrated a pattern of failure. Many hernia operations are successful. In our job as elective representatives, people do not tell us how good things are; they tell us their complaints. Therefore, we do not always hear about the successful hernia mesh implants, but we certainly hear about the problems.

The issue was highlighted on the “Victoria Derbyshire” programme on 26 December 2018. A spokesperson from the Royal College of Surgeons said that hernia mesh complications “affect more than 100,000” people. They went on to say:

“It is clearly tragic if even a single patient suffers horrible complications from any type of surgery, not just hernia operations. Unfortunately the nature of surgery in general, not just mesh surgery, carries with it an inherent risk of complications which surgeons will always seek to assess, and will discuss with patients according to their individual clinical circumstances before surgery takes place.

It is important to make a distinction between groin hernia, the most commonly carried out repair and other forms of abdominal wall repair where a hernia has arisen, for example, in an incision or scar after a previous operation. These are more difficult and the complications rates are much higher.

A recent 2018 study found that both mesh and non-mesh hernia repairs were effective for patients and are not associated with different rates of chronic pain. The Victoria Derbyshire programme is right to point out how a minority of hernia mesh operations are associated with complications. However, it is also important to stress that such complications range dramatically from minor and correctable irritations to the more serious complications highlighted in its programme. Complications can also occur with non-mesh hernia repairs, and by not operating on a hernia at all. It is extremely important that patients are given the full picture by surgeons, regulators, and the media.”

A large number of studies have looked at the available treatments, but unfortunately we do not have all the appropriate information. The spokesperson continued:

“There have already been a number of scientific studies looking at the use of different types of mesh in hernia and we should continue to review the evidence and patients’ experiences to make sure the right advice is given and the right action is taken. Along with the regulatory authorities, we will continue to listen to patients’ experiences. Patients suffering complications or pain need help, not silence.”

That is very important and we must underline that point. They continued:

“There must also be an ongoing review of the data to make sure that previous studies have not missed any serious, widespread issue. It remains vital that surgeons continue to make patients aware of all the possible side effects associated with performing a hernia repair.”

Those gentlemen came to see me earlier this year to tell me that they were not aware of the complications. I will give an example a little later. I do not want to criticise surgeons because they are under incredible pressure, but people have told me that they were not aware of the ins and outs and relevant information, so I believe there is a case to answer.

The Health Issues Centre inquiry specifically focused on people who had suffered a hernia, to better understand the nature and the impact of adverse outcomes. Over a period of four weeks, 183 respondents reported hernia mesh-related injury across a range of brands and of categories of hernia. Several serious problems with hernia mesh implants arose, too. It is hard sometimes to explain the physical, emotional and mental effect. The people I met were very clear that in the vast numbers of cases that they knew of, there were several serious problems. The vast majority of respondents—87% of them—did not feel that they were given enough information before their treatment to give informed consent. Indeed, they were never told about the risks and the impacts. They were not aware of any problems.

A senior member of the Conservative party—I will not mention his name—told me yesterday, “I have had a hernia mesh implant, but mine was successful.” Many are successful, but we should highlight those that are not. Some 91% of respondents suffer ongoing post-operative chronic pain as well as other health impacts. For example, some of the men that spoke to me have had serious bouts of depression and allergic reactions. Only 8.7% of respondents said that they had had successful treatment to address the problematic outcome of the operation.

Past cases of mine have involved women who have had mesh operations, which are intimate operations. I have had cases of ladies who have been unable to work or keep relationships going. They have been unable to cope with life, so the impacts of hernia mesh when it goes wrong are very real.

Men represented some 70% of the respondents to the survey. Those figures are from Australia, of course, but I just want to illustrate the matter. I will move on to the United Kingdom, but those figures are relevant.

Years ago in Northern Ireland a man developed a limp four years after surgery. People told him, “We have experienced pain as a result of similar surgery.” Damien Murtagh, who lives in Banbridge and has given me permission to tell his story, has been left with a limp as a result of his operation six years ago. He said:

“For years no one could tell me what is causing this pain. I can no longer ride my bike, go fishing, I work part-time”,

because of the chronic pain and the effect it has had on his lifestyle. He continued:

“The pain in the lower stomach and groin area makes me feel physically sick. I have no private life.”

It has been difficult for him to maintain relationships with other people. The issues caused off the back of the surgery are genuine and life changing.

I find it odd that this surgery can create such problems. I am not a medical professional. I can make no judgment about the operations, but I can ask whether they should continue without the assurance that every possible investigation has been carried out into the prolonged side effects. The patients should know, at every stage, the potential implications if the operation does not go as planned.

Figures specific to the United Kingdom also outline the problem. In a survey of 653 people, 18.8% said that they had developed antibiotic-resistant infections as a result of mesh complications. A person’s general health can go down dramatically. Some 40% of respondents described their pain levels at worst to be 10 out of 10. Usually, 10 out of 10 means someone is doing well, but in this case it means they are not and that they are in severe pain. In addition, 85.6% of respondents said that they could not sleep because of the pain. The men told me that their sleep patterns had been destroyed. They are in constant, nagging pain that never leaves them. When it gets to that stage and someone’s personal life is so affected, we have to look very seriously at the issue.

The problems of lack of information are not specific to Australia. Some 91.7% of respondents were not even told that they would be getting a mesh implant. Some did not even know what was happening. They went for the operation and knew there would be a repair job; they accepted that, but they were not aware of the implications. Some 96.2% said they were not shown the mesh implant that they were about to be given, while 91.7% were not told that the mesh implant was made of plastic, and 98% said they were not told the size of the mesh implant. When it comes to serious operations—in most cases it is probably a minor operation, but it has the potential to change lives—we need to make sure that patients are aware of such things.

Patients feel that they are not being told the risks of the surgery and the potential issues. We understand that that is partly because a decision is made when the patient is open and the need dictates the method; sometimes a decision has to be taken when the operation is at an advanced stage and it might not be possible to let the person know. I understand the pressures that surgeons and their staff are under, but I feel that an essential part of the care is an understanding of what to expect, and that can make a difference to the outcome. It would certainly have made a difference to the 400 men in Northern Ireland who have experienced problems. It would certainly have changed their lives if they had known about the implications for them. None the less, we find ourselves in a very difficult position, and they find themselves physically, mentally and emotionally changed. For some of them, their relationships have broken down as well.

Informed consent is fundamental to any surgery. I had three minor operations in 2017 and, to be honest, I would have signed any paper just to get the operations over because the pain was so extreme. At the end of the day, you sign the paper and you understand. In my case, it was a straightforward operation on the three occasions.

I mentioned Damien from Banbridge earlier. Outlining his case could help people make the all-important decision to go ahead with surgery, knowing that there could possibly be some serious downsides, although not in every case. That would be a more ideal situation for the patients, rather than being struck with post-operation issues without having been aware of the risks. At least they would know that they had taken the risk, not the surgeon, who they might feel had hidden the risk from them. It is a natural reaction. It is not pointing the finger or judgmental. I stress again that in no way can I ever accuse surgical teams of deliberately withholding information from their patients.

In an ideal world, post-operative problems would not exist and the NHS and private hospitals, which some patients are transferred to, would be able to shape the surgery in such a way that the pain that many patients cite would not occur. Problems created by surgery have knock-on effects. Physical problems quickly become mental problems. If Members had heard the stories of the gentlemen I met, they would understand where the mental problems come from. The pain is absolutely unbearable. Many experience depression as a result of surgery. They all cite anxiety, panic attacks and nightmares, and—this is serious—some people hear things that are not there. It clearly affects them mentally.

I congratulate and thank the men for making their information and backgrounds known. I also thank my colleagues from my own party who took the time to let me know about their individual cases. When we hear their stories, we clearly see how their lives have been changed.

In the United Kingdom study, 27.6% of respondents had been formally diagnosed with a mental health condition such as PTSD, which can affect people in many different ways, and 4.7% said that they had self-harmed because of mesh complications. That is probably off the back of the depression and the pain that becomes almost unbearable. I never realised just how much pain can affect people. I met a lady who had a problem following an operation—it was nothing to do with hernia mesh. The pain was so bad that she asked for her right knee to be taken off to remove the pain. Doing that removed the pain, because that is where the pain was, but it was a dramatic step to take, so when people start to self-harm, as some have said they have, because of the mesh complications, we must take serious cognizance of what has happened.

Some 24.3% of respondents had psychotherapy or counselling as a result of mesh complications. Again, the counselling was to try to stop them self-harming, and to help them to deal with a physical, surgical problem that would be long-term. Almost half of respondents—43.6%—revealed that they had suicidal thoughts, which underlines their clear anxiety and the importance of doing something; and 4.7% had tried to take their own lives. Unfortunately, nearly every day of the week we elected representatives deal, in our offices, with people suffering depression and anxiety, whatever the reasons may be. We understand what drives people to the brink of despair. It can be money issues, marital problems, family issues or a physical problem, as in the case we are considering. The figures reveal the dark reality of post-operation life for many of the respondents, and reinforce the urgency of the issue, which needs to be addressed as soon as possible. That is why I have brought the matter to the House for consideration, and it is why the Backbench Business Committee was pleased to provide an opportunity to highlight it. Many complications surround the issue of hernia mesh surgery, and there is a need to give urgent attention to solving them. The figures more than reinforce that point.

I mentioned the effect on families. The gentlemen who came to see me and my colleague, Paula Bradley MLA, on the occasion I spoke of, were able to tell me something about that. More often than not, when someone is sick or ill or having problems they are not the only one travelling that road; their wife or partner and family travel it with them, so there are also family issues. Post-operation care is prevalent among the issues, and 33.1% of respondents in the UK survey said that their partner was now their carer. When we get married we know it is for better or for worse—and sometimes a partner becomes a carer. Clearly that is a great responsibility for them. Three per cent. of respondents said that they had to put their parents into a retirement home as a result of mesh complications and problems with the surgery. People would obviously have loyalty and feel a duty to try to look after them, so that tells me, and should tell everyone present in the Chamber, that clearly the problem affects all the family. If one suffers, all suffer.

I have been told that there are clear problems associated with mesh implants that need to be addressed. We are dealing with issues, following the surgery, that people believe are related to it. They include adverse mental health issues and the fact that 78.4% of people experience depression—more than three quarters of the people in question. For the people I met, depression was clearly now a part of life. Some had stopped work altogether. Family relationships had broken down; they were no longer able to hold them together. Some 40.7% of respondents said that their child acted as a temporary carer. I know the good things that many children do for parents and perhaps siblings, but whenever a child, growing up, who should be enjoying childhood and focusing on their education, must be a temporary carer, there are clearly issues to address. Some men cannot have children after surgery, as some of the men I met told me. That is another issue that means we need to hasten an investigation.

There is also a need to address the issue of post-operative pain that lasts many years. I understand that what I have said is perhaps topical and anecdotal. The hon. Member for Linlithgow and East Falkirk (Martyn Day) will tell the House about some of the cases, but it is clear to me from meeting the men I have mentioned, and from the evidence that I have seen, that some hernia mesh operations in men have led to serious physical problems. That is why I have brought the matter forward today for consideration. It is the reason for this debate in Westminster Hall today.

We need a governmental investigation, and there must be a directive to do that, and funding to enable it to happen. That is why I look to the Minister. I hope that we will get a helpful response. I hope that in the future all the post-operation issues with hernia mesh surgery can be resolved. I hope that the NHS will receive appropriate funding to tackle mental health issues caused by the surgery. I am very pleased that in the Chancellor’s statement yesterday he reaffirmed the commitment to spending on health—I think it was £34 billion. Is the Minister in a position to suggest that some of that money could be focused on enabling the investigation to happen, and getting the data to try to address the issue? The mental health issues can never be ignored, any more than the physical ones. Perhaps the NHS will be able to improve the surgery process so that patients will not have to cope with being left in serious pain for years and perhaps for ever afterwards.

Now that the issue has been raised it is important that it gets the attention that it deserves and that the problems are tackled. I again ask the Minister—and she knows I do so respectfully and sincerely—whether we can start the process of answering the questions and providing empirical data on the side effects of hernia mesh in the United Kingdom. I know that her responsibility is to the mainland, but the inquiry will have to start somewhere, and I hope that it starts here.

Martyn Day (Linlithgow and East Falkirk) (SNP) - Hansard
5 Sep 2019, 3:27 p.m.

It is a pleasure to serve under your chairmanship today, Mr Hanson. I am grateful to the hon. Member for Strangford (Jim Shannon) for introducing the debate. He has a brought number of debates to the House over the years, and I have learned an immense amount about issues that I did not know about. This, however, is one of which I have had some personal experience. Indeed, in my personal life since I have been in Parliament I have had two such hernia mesh operations—in my case, both successful. However, 2015 and 2018 are well within the timeframe that the hon. Gentleman highlighted, in which people have developed complications. So far, touch wood, everything has gone fine.

Hernias are fairly common operations. They usually go without any problem, but not everyone has the same experience, and I am grateful to the hon. Gentleman for highlighting the issue as it affects men. Health issues are, of course, devolved in Scotland, and the Scottish National party Scottish Government have a strong record of ensuring that no one suffers unduly from mesh. In 2014, the SNP Government requested a suspension of the use of medical mesh by the NHS in Scotland, pending safety investigations, and in 2015 the Cabinet Secretary for Health and Sport, Shona Robison, apologised to women who had been left in severe pain by such operations. Between 2009 and 2016, the number of women receiving mesh surgery in Scotland fell from 2,267 to just 135.

An independent review published in March last year in Scotland made eight recommendations—notably that surgical mesh implants should be used only after all other appropriate alternatives have been exhausted. Scotland’s chief medical officer accepted those recommendations in full.

The hon. Member for Strangford mentioned people not being told adequately about the potential complications. I have to be honest: having been through the process myself, I probably agree. We were told some things, but a patient suffering from a hernia is more concerned about when they will get their operation and be able to get back on with their life, so they probably do not pay appropriate attention to what is a fairly minor risk. Perhaps that risk needs to be emphasised to people, or they need to be reminded at a later stage in the process; as I know from experience, it can take a while after having seen the consultant to get the operation.

Although health is devolved, the regulation of mesh is a reserved matter. We therefore call on the UK Government urgently to review its effects and to legislate accordingly. Although regulation of these devices is reserved, we really need a UK-wide clinical audit database for recording device identifiers. We were pleased with the review of the guidelines for mesh following the finding by the National Institute for Health and Care Excellence that the evidence for the long-term efficacy of vaginal mesh implants was inadequate in quantity and quality, but we would like to see a review of the use of mesh to repair hernias.

Scottish Government officials are working with UK colleagues to consider the possibility of an automated implant registry, which would allow unique device identifiers to be entered on the patient’s electronic record. The SNP hopes that Ministers will be willing to work with their counterparts in the devolved Administrations and consider a UK-wide summit on that issue.

It is imperative that the highest possible standards for mesh are maintained. EU regulation 2017/745 on medical devices will change mesh implants for long-term or permanent use from class IIb to class III devices, meaning they are generally regarded as high risk. Those regulations will not take effect until 2020, after the date on which the Government desire to leave the EU. How will important EU regulations to monitor the use of devices across EU territories be implemented or reflected in UK law and regulation after Brexit? I reiterate that it is important that we maintain the highest possible standards, and I look forward to the Minister’s comments on that.

When I saw the title of the debate, I knew my Whips would be in touch because I had personal experience; having missed various other engagements while waiting for my operations, I knew I could not get out of doing this. In some parts I feel more mesh than man, but as I say, so far, so very successful.

The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries) - Hansard
5 Sep 2019, 3:41 p.m.

It is a pleasure to serve under your chairmanship, Mr Hanson. I was alarmed when you walked in, because I think you have held more ministerial posts than anyone else in the House of Commons—or you are pretty close to holding the record, anyway. So to have you in the Chair, judging me as a Minister, is quite daunting.

I thank the hon. Member for Strangford (Jim Shannon) for bringing up this important debate. You always bring debates to the Chamber that you are heartfelt and passionate about. That is so important. It is a delight to be opposite the hon. Member for Washington and Sunderland West (Mrs Hodgson). We have both been in this place for 15 years, and I know that you also bring the same passion and same commitment. You always speak from your heart. We might be a bit similar in that way.

Ms Dorries - Hansard
5 Sep 2019, 3:42 p.m.

Of course, Mr Hanson. I am amazed that after 10 years in the Chair I make these mistakes—it is because I am nervous. I am delighted to serve opposite the hon. Lady; it will be great.

This is a serious subject. It is incredibly important to hear the voices of patients who have suffered as a result of inguinal hernia mesh repair operations, because without allowing those patients to be heard, we cannot move forward to find solutions to deal with this issue. I will go off-piste from my speech, because there has been some conflation during the debate of vaginal mesh repair for the purpose of urinary incontinence and inguinal mesh repair for an inguinal hernia. The two operations are entirely different and have completely different outcomes. Vaginal mesh repair is for urinary incontinence. Inguinal mesh repair is for hernia, and without repair, there is a possibility of death. That is because of the pattern of development of an inguinal hernia. It is due to a break in the muscle wall. The hernia is a part of the bowel that comes through the muscle wall, and it can quickly strangulate and develop into peritonitis. The result of that can be death.

Ms Dorries - Hansard
5 Sep 2019, 3:57 p.m.

We will take that question away. I will come back to the hon. Gentleman, because that is a detailed question with more complexity in it than I could answer today. For those people who suffer from pain, is it alleviated by the steroid and local anaesthetic injection? Are those numbers just people who present back once with pain, or do they go on to have chronic long-term pain, and, as the hon. Member for Washington and Sunderland West says, come back three or four years later? Some drilling down into that data is needed.

Work is under way both within and independent of Government to improve safety and how we listen to patients, in order to gather the information to work with. In July, we launched the patient safety strategy, which sets out the direction of travel for future patient safety. It was developed through speaking to not just staff and senior leaders but, importantly, patients from across the country. As much as it looks at system improvements, such as digital developments and new technologies, it also looks at culture, so that the NHS becomes ever more an organisation with a just culture of openness to concerns, whether they are raised by patients, family members or staff. Concerns of all kinds should be welcomed, valued and acted on appropriately.

We are also waiting to hear back from the independent medicines and medical devices safety review, which is led by Baroness Cumberlege. The review examines how the healthcare system has responded to concerns raised by patients and families around three medical interventions, one of which is vaginal mesh. To do so, the review has focused on meetings with a broad range of stakeholder groups; I think the hon. Member for Washington and Sunderland West may have attended one of those with her mother.

I close by acknowledging just how difficult the subject matter is. No one should suffer from chronic long-term pain without every effort being made to reduce it and find out why it occurs in the first place. This is not an easy subject for men who are suffering from ongoing pain to speak about. We know that men are always very reluctant to come forward and go to the doctors about anything. I pay tribute to the many impassioned contributions of the brave men who have allowed their stories to be told, who have visited their MPs and contributed, because men are not good at sharing information when it comes to their health.

As I mentioned earlier, however, it is vital that the use of mesh to treat hernias continues. It remains the best course of action for patients where the appropriate treatment pathway leads to surgery. As with all treatment, shared decision making should be central to this process. It is vital that we continually examine the evidence together on the best means of treatment. Decisions in healthcare are often about weighing potential benefits against risks, and I thank those in our healthcare system who strive always to offer us the best treatment possible.

Jim Shannon (Strangford) (DUP) - Hansard
5 Sep 2019, 4 p.m.

Thank you very much, Mr Hanson. I will certainly take no longer than three minutes. I had that advantage earlier on—I may have taken advantage of it, but there we are. Three minutes is more than enough.

First, I thank the hon. Member for Linlithgow and East Falkirk (Martyn Day) for his contribution. If we wanted a headline for the hon. Gentleman, it would be “More mesh than man” because of the number of operations he has had, if he does not mind me saying so.

Jackie Doyle-Price - Hansard

That highlights the importance of having a nominated person earlier in the journey. I do not disagree with my right hon. Friend, but he highlights the difficulty of our work to get the balance right between keeping someone safe and respecting their wishes. I fully anticipate that when we produce the White Paper on this issue, he and I will probably have another debate about it. It is important that we get it right, with the safety of the patient in mind while empowering them to make their own decisions.

I have already mentioned that we will end police stations being places of safety under the Act, and that will be included in any legislation. On equalities, we are working with the NHS to introduce the first ever race equality framework to ensure that mental health care providers work with local communities to improve the ways that patients access and experience treatment. An important point is that although we are concerned that under the Act there are far too many detentions of people from black and minority ethnic communities, it is possible that is partly because they find it difficult to access services. We need to address that properly.

To help to address that, we are also launching a pilot programme of culturally appropriate advocacy. Clearly, we will need to make that resource available to ensure that people have access to it. The review said that we need to learn a lot more about that whole issue, so we will work with the National Institute for Health Research, which will launch a call for research later in the year to give us more answers. Jacqui Dyer MBE is our Mental Health Equalities Champion, and she will play a leading role in taking forward the review’s recommendations on tackling the injustices faced by black and minority ethnic services users.

I have spoken for quite some time; I hope I have covered most of the aspects mentioned. On the issue of funding, I have probably bored everyone senseless by saying that we are determined to deliver a much-expanded service, and our focus must be on developing those community services. We have made resources available to do exactly that through the long-term plan, but that is not to say that the issue is not still challenging. However, I hope we will be able to do much more in the community for people with severe mental illness, so that we can treat them in the community rather than have them go into crisis care.

To illustrate that with an example, if we can get people out of beds and into the community, the ability to look after more patients is really stark, so it starts to pay for itself. I discussed that with a clinical director from the NHS, who said that if they remove three people from in-patient beds and have them in the community, the productivity is so much greater straightaway. We rely on good local leadership to crack that and make it happen.

I have covered most of the things I wanted to. I will just reiterate my thanks to all Members who have participated in a very good debate, and I look forward to having discussions on the White Paper as it develops.

Neil Coyle - Hansard
25 Jul 2019, 4:09 p.m.

I thank all colleagues for their comments and personal experience. When I worked at the National Centre for Independent Living, the charity ran Experts by Experience across social care. I hope that the Minister takes note of that—it sounds as if she is talking about involving survivors, service users and carers in future plans. I thank the Minister for her frank admission that we need to do more. Again, I thank all the organisations involved.

Some people are commenting online that too few of us are here in the Chamber, but lots of work goes on outside such debates as this one. For example, my hon. Friend the Member for Stockton North (Alex Cunningham) and my right hon. Friend the Member for North Durham (Mr Jones) referred to the all-party group on social work. The hon. Member for Plymouth, Moor View (Johnny Mercer) also works on mental health outside that group, and reference was made to the previous legislation of my hon. Friend the Member for Croydon North (Mr Reed).

I asked the Minister 10 things, I think, most of which were covered in her response, but I will follow up on some. On children’s access to mental health care, it is great to acknowledge the leadership of Charles Dickens Primary School in Southwark, but that 35% target is a national one, and it would be good to know from the Minister what more is coming in the system. On the principles in the independent review, she mentioned gratefulness, an indication about the principles, and she just touched on the advocacy issue. It is important to note that the piloting of the culturally appropriate advocacy is more limited in scope than the review intended, so it needs to be expanded to everyone, whether informally through in-patient care or to people detained. The model should be an opt-out one, which was the preference of the review.

The Minister confirmed that the White Paper will still be on time. My right hon. Friend the Member for North Durham talked about when legislation might appear, and perhaps the Minister will indicate that in correspondence. She touched on resources, the need to expand the service offer and how it pays for itself—how she is making the case for parity of resource allocation in the system would be good to know. She spoke positively about the nominated person and better involvement of nearest relatives, and that is really welcome. That person is of course chosen when someone is well—that is the key difference. No matter how ill someone becomes later on, or how badly they suffer delusions, the person whom the patient chose when well is important.

Earlier upstream interventions were mentioned by my hon. Friends the Members for Bristol East (Kerry McCarthy) and for Oldham East and Saddleworth (Debbie Abrahams), and others. The Minister commented that the high level of detention through not getting that right was a mark of failure. The spirit of the plans is to get that level down. It would be good to see more.

It was brilliant to hear about the custody cells, which will be included in any legislation. That is a brilliant commitment. On sexual assaults, I think that the response was that we need to learn more. I welcome the earlier campaign of the right hon. Member for New Forest East (Dr Lewis) to end mixed-sex wards, but such incidents are still occurring. More needs to be done, just as it does on the issue of deaths. There was a specific request for an inquiry, and it would be good to know the Minister’s view of that.

On standardised support and care, my hon. Friend the Member for Bristol East told us about the family of a child with autism having to make that decision on whether to travel. The Minister said that too many are in that position, and it is something that the CQC should look at. Given that the CQC may only gain the powers and resources that she mentioned through Government, I think a stronger case needs to be made for that.

On advance decisions, there were some positive comments but I will come to an end. The lyrics of “Karma Chameleon” were mentioned by the Minister, and Prime Ministers might “come and go”, but the people who need their lives transformed and who need better mental health care experience the outdated legislation every day. I hope that after the White Paper we will see real pace to deliver reform.

Question put and agreed to.

Resolved,

That this House has considered reform of the Mental Health Act 1983.

Chris Green (Bolton West) (Con) - Hansard
23 May 2019, 1:47 p.m.

I beg to move,

That this House has considered the matter of supporting clinical trials and the UK’s future clinical research capability.

It is a pleasure to serve under your chairmanship, Mr Hanson. I thank the Backbench Business Committee for granting time for this important debate on supporting clinical trials and the UK’s future clinical research capability.

This is an immensely important sector. Any generation wants its successor generation to be healthier and have a better standard of living, whether the treatments that are produced are life-enhancing ones or life-saving and life-protecting ones. That is increasingly important: there is an ageing population, not just in the UK but globally, so there is an increasing need for a variety of new treatments coming through the life sciences sector. Clinical trials play such a large part in that.

Monday was international Clinical Trials Day, marking the anniversary of the first clinical trial, conducted by surgeon’s mate James Lind on HMS Salisbury in 1747. Scurvy was a huge problem at that time, not just for the Royal Navy but for navies all over the world. Lind set up a clinical trial with 12 sailors who had scurvy, and in groups of two he administered cider, sulphuric acid, vinegar, seawater, oranges and lemons, and a spice paste washed down with barley water. The sailors who took citrus fruits made good progress, but the other participants did not make any progress, so Lind had evidence that citrus fruits worked to help those sailors recover from scurvy. Notably, there was a small, incremental improvement in the health of those sailors who drank cider; no doubt there are other, wider health benefits that come from cider, but it was a reasonably clear trial. Although it took many years, the Royal Navy later adopted the approach of compelling sailors to take lemon juice initially, and lime juice later on, to protect against scurvy. That is why American sailors began to call British sailors “limeys”.

Clinical trials have evolved substantially since that time. In 2017-18, there was a record number of participants and trials in the UK. It is so important, not just for people’s healthcare but for the life sciences sector of which clinical trials are such an important part, that Britain wants to maintain that position. People find fascinating, incredibly rewarding jobs in that sector.

As in all things, all sectors and all times, funding is of immense importance, and we have to ensure that our clinical research environment is properly funded in a number of different ways. My favourite part of the 2017 Conservative manifesto was the commitment to increase research and development spend in the UK from 1.7% to 2.4% of GDP by 2027. That is an important target, taking us up to the top quartile of OECD countries. The scientific community more broadly would like to see that increase as a stepping stone to a target of spending 3% of UK GDP on R&D. That would really enhance our position, which is world-leading at the moment; however, in an increasingly competitive world, we need to focus and enhance that contribution.

In the previous Parliament, I was a member of the Select Committee on Science and Technology, which was a very positive Committee. There was a huge amount of consensus across the party divide about the agenda that we wanted to set and pursue, and an important agenda to increase our R&D spend came out of that Committee. It was very positive to see that commitment in the 2017 Conservative manifesto; however, we have to deliver on it. At a time of funding challenges across all Departments and all areas, we have to maintain that level of investment.

It is important to recognise the Government’s commitment, outlined in the life sciences sector deal 2, with the Government working in conjunction with industry to strengthen further the environment for clinical research in the UK, and the infrastructure for the safe and responsible use of patient data through the digital innovation hub programme. We should also recognise the contribution that can be made to the continued development of the National Institute for Health Research, which should receive an uplift in line with the increases to funding through UK Research and Innovation, as recommended in the life sciences industrial strategy.

There are also further considerations when it comes to funding, such as whether the UK will fully participate in the EU’s flagship framework programme 9. At the moment, we participate fully in Horizon 2020; we are committed until the end of that project, and to any ongoing research projects beyond the end of that programme. However, we do not yet know whether the United Kingdom will participate in Horizon Europe, either fully or partly, post Brexit. That is a huge concern to so many people from the scientific community, as it is for many sectors and industries, not only because we want investment in buildings and laboratories and the development of skills and talents in the UK but because we want to bring in people from abroad. People need that confidence. This is not just about funding, which is immensely important, but about the networks, the communications and the community that go with participating in that group.

I am certainly sympathetic to the idea that Brexit, no matter how well we deliver it, will be a challenging time for the United Kingdom and for organisations, whether in the charitable sector, business or academia. Delivering a healthy research clinical trials environment post Brexit will pose a challenge, and if we could make a commitment to—or at least express sympathy towards—our participation in Horizon Europe, the scientific community would appreciate being given that kind of confidence.

Funding is of great importance, and that topic may be further developed by other hon. Members present, but regulation is also an enormous priority for the UK. There is perhaps no other area like life sciences, clinical trials and the wider research community; it is such an international undertaking. Often, clinical trials are UK-only, but in many cases—especially those that deal with rare and very rare diseases, or with paediatrics—the potential population within the UK may be too small to deliver an effective trial. Nearly 30% of Cancer Research UK’s clinical trials involve an additional EU member state, showing the importance of international collaboration to that organisation. More widely, 50% of all UK cancer research is international.

The global direction of travel is towards the harmonisation of regulations and standards. The EU-UK relationship is of immense importance; it makes it easier and faster to set up trials, and to deliver on the conclusions of those trials. It would be useful if the Government could highlight what they were doing with regard to the clinical trials regulation, which is superseding the clinical trials directive. There is a concern in this. One concern that I have with the EU is that it can be slow to advance and assess what it has done, where it is and how it needs to move on. The clinical trials directive was first developed in 2001 and implemented in 2004. The decision to change and that the regulation should supersede the directive should have been taken in 2016, but there have been delays from that time. There is an ambition to deliver the regulation later this year, but there is concern as to whether that will be achieved. I appreciate that the Government’s position is that they will seek to fully participate in the regulation and adopt it wholly, but that is only part of what needs to be done.

Data from the trials will be collected in a variety of countries. While we may be able to contribute our data, there is no guarantee that we will be able to access that data in that international network post-Brexit. It is immensely important that we have certainty that we can use the portal post-Brexit and access the data to ensure that our scientific community has that information. It is an important part of providing confidence and a strong ongoing position for our research community.

Mobility of people is immensely important. It truly is a global undertaking to have an effective life sciences sector and the clinical trials that go with it. The people who contribute to the sector are very mobile. Our charitable sector is incredibly strong—stronger than it is in many other countries—and is a huge asset. We can go to any charitable organisation, business or university and see a wealth of talent that comes not only from the UK but especially from the EU. We also have people from America, Africa and Asia. We have people from across the world, but our close physical proximity to EU countries lends itself to a large number of people from the EU coming here.

We have to value our relationship with EU nation states. Post-Brexit, we want people to be able to go to EU countries, because people leaving the UK to go to France or Germany make an immense contribution to those countries. There is huge value in the sharing of ideas. When people perhaps come back later in their careers, they have that wealth of knowledge that they can bring with them, which may be lost if we do not allow and support mobility. There is particular concern over the £30,000 income threshold that people coming to the UK would have to meet. There is ongoing debate about the threshold and whether it will stand and suggestions on how it will be amended. It is worth noting that it is a challenge for post-doctoral researchers and their research technicians, who may not be above that threshold. The threshold is more of a challenge outside London and the south-east, and other parts of the country and other nations within our United Kingdom will see a greater impact. The Government need to consider that.

We need to re-examine the costly and burdensome visa process. In 2008, it was estimated that a five-year visa for a researcher with a partner and three children coming to the UK would cost more than £11,000. The same researcher and family could obtain a four-year French talent passport for a little over £1,000. We do not want the UK to have barriers to people coming here, participating and making an enormous contribution. Immigration is a very sensitive subject for the country as a whole. It is positive that in the two or three years since the referendum vote in 2016, tensions or concerns have come down ever so slightly. There still is significant concern, which is a problem, but when I talk to people and raise the UK’s current approach or possible approach to immigration, they have immense pride in seeing our country as a destination for some of the most talented scientists and technicians from the EU and the wider world. They want to come to the United Kingdom and make an immensely positive contribution. We should be proud about so much in our immigration system and the people who come here. We should make more of how strong the scientific community is in the United Kingdom.

In my closing remarks, I want to highlight and repeat that the United Kingdom has a long and proud history of being a world leader in clinical trials. Not only were we the first nation to conduct one but we should be proud of the wealth of talent involved and the scale of our clinical trials. The Government are doing the right thing and are going in the right direction. We are being immensely ambitious with what we are doing for the future of medical research, but there are obviously challenges in making that a reality. Getting the regulatory framework is important, as is the immigration system. The national health service is immensely important as an organisation, but it is not quite playing up to its strengths and its potential with its data. That data is an incredibly valuable asset that is of increasing value as time goes on, both in how it can be used and how clinical trials can be held. Practitioners can access that data to develop the next generation of drugs to save lives and to enhance our lives.

We are going in the right direction, but more needs to be done. There are concerns about Brexit, but we can deliver a good relationship with the EU and the rest of the world. It can be a positive thing. The Government need to set out a more robust position. Academia and business in the UK want that, and I especially thank the UK’s charitable research sector, which does such an immense amount of good work. I highlight and thank Cancer Research UK, Parkinson’s UK and Breast Cancer Care.

Marion Fellows (Motherwell and Wishaw) (SNP) - Hansard
23 May 2019, 1:54 p.m.

It is a pleasure to serve under your chairmanship, Mr Hanson. I congratulate the hon. Member for Bolton West (Chris Green) on securing this important debate. I particularly enjoyed his opening remarks on scurvy, and I thank him for reminding me about where the term “limeys” came from. He is obviously passionate and knowledgeable about this subject. I have quickly skimmed through some of the things he spoke about and, I have to say, I found very little to disagree with in his speech.

The hon. Gentleman said that Brexit will be challenging for many reasons, especially getting clinical trials properly conducted post-Brexit, particularly when, at the moment, no one knows what is happening. He pointed out something that had not crossed my mind: if we do not get those relationships right post-Brexit, the UK is too small a country to conduct positive and technically feasible trials in new and important areas.

The hon. Gentleman talked about the importance of harmonisation across Europe, and about something especially important to Scotland and to my party: the ability of people to move freely. We must take a European and a broader, transnational view at how much people working in the sector can bring to this country, and what UK nationals can bring back when they return from working abroad.

The hon. Gentleman also mentioned visa costs, another highly important issue for Scotland and the Scottish Government. Astonishingly, a visa for a researcher and their family can cost 11 times as much in this country as it would in France. That would be a no-brainer for a clinical researcher looking at where to go to further his or her career.

Clinical trials are essential for bringing new medicines to people. They test whether new treatments are safe and effective, and allow patients to access new medicines earlier. The UK regulatory environment for clinical trials is led by the Health Research Authority and the Medicines and Healthcare products Regulatory Agency. Wellcome, whose report I will mention later, found that more than 4,800 UK-EU clinical trials took place between 2004 and 2016. Around 40% of the trials currently run in the UK are being run with other member states. Clinical research supported by the National Institute for Health Research clinical research network has generated an estimated £2.4 billion and nearly 40,000 jobs. This is not an insignificant sector.

New legislation—the EU clinical trial regulation—will replace the EU clinical trials directive in 2020. Under the CTR, all trial applications, data and co-ordinated decisions from member states will be communicated through a single portal. Streamlined systems and communications will help to simplify compliance with the CTR, potentially saving researchers in the EU £600 million a year, as well as offering savings of £60 million a year to UK researchers.

Clinical trials are managed nationally in the UK by the MHRA, although some aspects of clinical trials are shared across the EU medicines regulatory network. For example, a clinical trial sponsor or legal representative for clinical trials in the EU should be based in the EU or European economic area. Currently, 40% of UK-based trials also have a site in the EU.

Wellcome’s report “Brexit and Beyond: Clinical trials” stated that the best option for trials is

“full UK participation in the EU clinical trials system”.

Wellcome found alternative options, but posited that all

“involve significant trade-offs that would have an impact on UK–EU clinical trials.”

The Scottish National party advocates a second EU vote. However, failing that, and failing full participation, the UK should meet its commitment to put the EU clinical trial regulation into law, and should remain aligned to the EU framework.

The UK Government stipulate that in the case of no deal, the MHRA would take on responsibilities currently undertaken through the EU system. However, Wellcome found that, even if the withdrawal agreement is voted through, which after the last few days seems impossible,

“the MHRA would not be able to lead on reviewing applications, a role known as being a ‘reporting Member State’.”

No deal would likely lead to significant uncertainty over the legal arrangements for clinical trials.

Brexit is already having a negative effect, with Reuters finding that the

“number of new clinical trials started in Britain last year was 25 percent lower than the average for 2009-16”.

It highlights Brexit as the reason for the fall in numbers. A total of 597 trials were initiated in Britain in 2017, against an average of 806 over the previous eight years. The UK Government have committed to exploring the option of full association to research and innovation programmes, but there are no guarantees of success.

Jonathan Ashworth - Hansard

I think the hon. Gentleman beat me three years ago, although I have just beaten him this year.

Jonathan Ashworth - Hansard
23 May 2019, 2:02 p.m.

I have not yet decided whether to run next year’s marathon, but should we decide to run, it would be great to have you running with us, Mr Hanson—or indeed the Minister.

Matt Hancock - Parliament Live - Hansard
4 Mar 2019, 6:20 p.m.

Access to radioisotopes is precisely through the aviation route—that is exactly what I said to the hon. Lady last time, and I say it to her again today.

Matt Hancock - Parliament Live - Hansard
4 Mar 2019, 6:20 p.m.

This is not linked to the Seaborne Freight contract; this is about ensuring that the contracts that are in place are able to deliver the unhindered supply of medicines in whatever Brexit scenario.

Mr Speaker Hansard
4 Mar 2019, 6:29 p.m.

Well, the Secretary of State has said what he has said, and colleagues will make their own assessment of it. I thank him for coming to the Dispatch Box.

Mr Speaker Hansard
4 Mar 2019, 6:30 p.m.

I think that the right hon. Gentleman’s question was more rhetorical than not, and there was not really a question mark at the end of it. I can only say, for my own part, that when discharging my duties to the best of my ability this morning, I was rather under the impression that the urgent question was about the cancellation of the contract on account of legal action and that it was to do with Seaborne Freight. It may be that my interpretation was notably eccentric, but I do not think so. I think I was pretty clear what it was about, and that my assessment was shared by the team that accompanies me at the 12 o’clock meeting on a Monday morning.

Stephen Barclay - Hansard
27 Jun 2018, 10:15 a.m.

I am keen to work with my hon. Friend on that, because the Government have prioritised their research and development budget, as I know from my time at the Treasury. A significant investment has also been made in health R&D. The NHS has an opportunity to combine its patient data with our world-leading universities and R&D to attract researchers, drive forward the most innovative approach on healthcare and translate that cutting-edge research into day-to-day care. That can be a frustration for our constituents; it is fine to have the research, but we need to roll it out to scale in a way that is meaningful for patients. The challenge of the Island’s geography is also a huge advantage to it. I do not know what percentage of its patients are taking part in research, but that may be an area for him to explore and for the Department to work with him on.

My hon. Friend also raised the potential of digital. He will be aware that the Secretary of State has asked Dr Eric Topol, one of the world leaders on the use of digital in healthcare, to undertake a report for the Department. My hon. Friend is right that rather than a patient having to be physically present in all instances, as was traditionally the case, there is scope to use digital much more for them to see a consultant online and for information to be sent digitally. I recognise that if the clinical commissioning group is in deficit, finding the headroom to invest in that technology becomes a trade-off and a challenge, but that is one of the opportunities that will be opened up by the Prime Minister’s investment in the NHS and it is an area that the 10-year forward view will specifically examine.

In terms of timing, the Island has a chance to look at how it can become a leader, what has been done with digital enablers and early adopters in the NHS, and in which areas it can lead on in technology. I will come on to the challenges of travel, but reducing the need for journeys is a more sustainable solution than seeking to subsidise them. Our starting point should be how we can use technology to reduce the need for as many journeys, rather than how we can subsidise more journeys. That offers significant scope.

On travel, I heard my hon. Friend’s remarks about the cost and its wider impact on families. There is a correlation with a separate debate we have had about car parking charges. Clearly, there are specific challenges related to travel, but as he also set out, it is quite complex, because there are already arrangements with the ferry companies and national schemes for subsidies and assistance that can be given to people who are financially challenged. It is a question of looking at how we can fit in with the existing schemes and what agreements can be reached with the companies concerned. I am happy to meet him to pick up on that specific point to better understand our current approach and what can be done, given the challenges. Again, the challenge of distance is not unique to the Island, but as he mentioned, there are certain features of travel to the Isle of Wight and the Scilly Isles that pose challenges.

As my hon. Friend will be aware, the NHS healthcare travel cost scheme provides financial help for travel costs for patients on low incomes who are referred. The scheme is part of the NHS’s low-income scheme, under which people are also entitled to free prescriptions and glasses. Under the scheme, the full cost of transport can be reimbursed by the NHS to eligible patients. Schemes are in place, but I hear the wider points that he has raised and I am happy to discuss them with him.

In short, my hon. Friend has set out that the Isle of Wight is ideally placed to be at the vanguard of the NHS’s approach as we move forward with the 10-year forward view, in embracing digital and integration and in looking at how to deliver place-based commissioning most effectively. There are some specific challenges with regard to its population and its geography in terms of travel. The interplay of those two things is another challenge in terms of efficiencies of scale and the services that are considered essential on the Island, which may be dealt with at a larger-population level elsewhere.

In the NHS more widely, as we move to a hub-and-spoke model and to more flexible population sizes, and as we look at place-based commissioning, the Isle of Wight has huge potential to be at the forefront, as my hon. Friend has set out. I am very happy to follow up this debate by meeting my hon. Friend, and to facilitate a discussion between him and NHS England, to ensure that we deliver what he has campaigned passionately for—the best healthcare for residents of the Island—and that the significant investment set out by the Prime Minister is maximised for his constituents.

The shadow Minister quite reasonably asked whether we were open to changes to the legislation. As he will be aware, the Prime Minister said to the NHS leadership in her remarks at the Royal Free Hospital that we are open to such suggestions if NHS leaders feel that changes are necessary. As part of the workings of the long-term plan, those leaders will need to look at what they need, and whether much of the integration—I know that the Mayor of Manchester supports the integration that is taking place in Manchester—can be done under existing legislation, or whether changes are needed, and if so, what those are. That will be part of the discussions with Simon Stevens and others in the weeks and months ahead.

Mr Seely - Hansard

Only to thank you for your chairmanship, Mr Hanson, and the Minister, the shadow Minister, and the officials for attending. Thank you so much.

Question put and agreed to.

Resolved,

That this House has considered the provision of healthcare on English islands.

Nigel Dodds (Belfast North) (DUP) - Hansard
16 May 2018, 4:42 p.m.

It is a pleasure to be here under your chairmanship, Mr Hanson. I congratulate the hon. Member for Pontypridd (Owen Smith) on securing this important debate and on the eloquent and cogent way that he set out the case for the fortification of flour with folic acid.

When the facts are set out and the evidence is adduced, it is a very compelling case. It is all the more surprising, when one hears the weighted evidence of the arguments in favour of it, that something has not yet been done in this country to ensure the mandatory fortification of flour with folic acid. The hon. Gentleman said that that has happened in many major countries across the world with vast populations. He mentioned Brazil, the United States and Canada; they are big countries with very strong regulatory regimes in which this practice has been carried out. Therefore, there have been multiple opportunities to have all the scientific evidence evaluated and to have all the upsides and downsides considered. It is very clear that the upsides are so massive that they require this country to follow suit. It is a shame that we are not yet in a position in this country to have mandatory fortification of flour.

It has been 27 years since the Medical Research Council published its research demonstrating that supplementing women’s diets with folic acid before the early stages of pregnancy reduced the chances of the pregnancy being affected by neural tube defects. That was in 1991. It was in 1990 that my son, Andrew, was born with spina bifida. Very soon after he was born, we became experts in the whole area of spina bifida: the reasons for it, how it develops and all the rest of it. Even back then, the great Professor Norman Nevin, who was an expert in the field in Belfast and did a lot of research, was a massive advocate for the mandatory fortification of flour, even before it was widely known about. He wanted to ensure that young parents who were planning to have children were better educated about the need to take folic acid and the general low levels of folates in the adult population and young people generally, because it was a massive problem and would store up big problems in future.

The reality is that as a result of not taking those measures, children are born with spina bifida or anencephaly. Children need not be born with those conditions if the parents have the right information and the mothers take folic acid at the appropriate time. The evidence shows, and it has been spelled out already, that it is too late once pregnancy has started. Many pregnancies are unplanned; many people even today, in 2018—never mind back in 1990 when my son was born—have no awareness of the need to take folic acid. They think it is something rather exotic—why on earth would they even consider such a thing? Even the name sounds a little strange.

People do not take the necessary steps and, as a result, children are born with severe disabilities. That presents great challenges to them, and often life-changing effects on their families. Often, as sadly was the case for my son, these children do not live a long life. Our boy died when he was eight years of age. In the process of his short but extremely rewarding and rich life, he underwent numerous procedures in hospital and numerous hospitalisations, sometimes lengthy. That had an impact on him, his family and his siblings.

The reality is that for all those children who are born with spina bifida and who live with it and are treated, many other children in the womb who are diagnosed with having a neural tube defect are never born. The hon. Member for Pontypridd and I recently hosted an excellent meeting in Portcullis House, which a lot of people attended. One of the things that came out of that was that, sadly, it appears that in this country we effectively deal with this problem simply by terminating foetuses that are diagnosed with a neural tube defect. That is how the vast bulk of these foetuses are treated.

It is a terrible thing that otherwise healthy babies and foetuses are in this situation as a result of a lack of action by society, successive Governments and by all of us, who have not done what other countries have done, which could be done at very little cost with no scientific downside, and which would reap enormous benefits for everybody. This is something that we need to take very seriously.

Over the years, my wife and I have done some work to try to educate people about the need to take folic acid. My wife, very bravely, did a number of television interviews when Andrew was alive. He even appeared on the television programmes. The process of education and telling people is not cutting through. It is not doing the job. It is not reaching the people it needs to reach at the time it needs to reach them, before they fall pregnant. We need to step up to the plate.

I will not repeat the scientific evidence, which has been laid out well by the hon. Gentleman and the groups that support this necessary move. There is a lack of understanding. People sometimes get nervous about the idea of adding things to food for public health purposes. I understand all that, but we already add things to flour and to water—we already make interventions where that is important and necessary. A lot of scientific evidence has been produced. I was struck that Professor Blakemore and the other experts who came to the event we held in Portcullis House said that, scientifically, absolutely nothing more needs to be proved or evaluated. All the evidence is there; we now require action on the basis of that evidence.

I simply add my voice to the plea for the Government to act on the advice of their own Scientific Advisory Committee on Nutrition and listen to the voices of all those who speak in favour of this measure. They should listen in particular to the voice of Shine which, as the hon. Gentleman rightly said, is a fantastic organisation that does tremendous work to help kids with spina bifida and hydrocephalus, and parents who have lost children. As I learned over those many years of intense engagement with clinicians and others, who often said, “Well, you tell us how Andrew’s feeling, because you know better,” parents do know. The Government need to listen to parents and potential parents—people who lost children in the womb or, totally understandably, felt unable to have a child with that condition.

This is a very important issue. It does not seem to me to be taken seriously enough, primarily because, relatively speaking, not a lot of children are born with spina bifida nowadays in the United Kingdom. As I said, I think that is partly because a lot of children with the condition are simply terminated in the womb. If it prevents even one or two children from being born with spina bifida who otherwise would have been born with the condition, this will have been a step well worth taking.

Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP) - Hansard
16 May 2018, 4:53 p.m.

It is a pleasure to serve under your chairmanship, Mr Hanson. I thank the hon. Member for Pontypridd (Owen Smith) for introducing this debate and for setting out the facts and the science so comprehensively. I entered the ballot to try to secure a debate on this topic, and I was unsuccessful in persuading the Leader of the House to allow a debate in Government time, so I am pleased that he came up trumps. I also thank both him and the right hon. Member for Belfast North (Nigel Dodds), who made an incredibly powerful speech, for hosting the recent Folic Acid Awareness Day event in conjunction with Shine. I was very sorry to miss that.

Both hon. Members mentioned Shine’s fantastic work, but let me mention another charity. I recently battled through the heat of the London marathon to raise funds for two charities, one of which was Spina Bifida Hydrocephalus Scotland. SBH Scotland is a fantastic charity based in Cumbernauld whose specialist staff work across Scotland and are committed to providing a lifetime of information, support and projects to all those affected by spina bifida, hydrocephalus and allied conditions. It, too, is a strong champion of mandatory fortification of flour with folic acid.

Like pretty much everyone else in the Chamber, I believe we are a long way past the point at which mandatory fortification became the right option. Intake of folic acid has been proven to reduce the number of pregnancies affected by neural tube defects, of which spina bifida is the most common. The Government themselves recommend that women who are planning a pregnancy or are within the first 12 weeks of their pregnancy should take a daily 400 microgram supplement of folic acid. However, only 31% of women take the correct dosage, and many do not begin until they are pregnant, when it is too late. We must keep in mind that 45% of pregnancies are unplanned—in those cases, there is no possibility to plan ahead. Overall, 75% of women of childbearing age across the UK are at increased risk of having a pregnancy affected by a neural tube defect due to having lower than the recommended level of folic acid.

There is no evidence to suggest that mandatory fortification would be anything other than beneficial, given that recent research, which the hon. Member for Pontypridd expertly set out, shows there is no longer a basis for setting an upper limit on folic acid intake. As we have heard, the argument is further strengthened by the experience in at least 81 countries, including the USA, Canada and Australia. Importantly, as I understand it, no country that has taken the step of mandating the fortification of flour has gone on to reverse it. It is clearly time for the UK to follow suit.

The issue is particularly pressing in Scotland, where proportionately more children are born with spina bifida than in other parts of the UK and folic acid levels are particularly low—lower than in the UK as a whole, which itself has low levels by international standards. As we have heard, the Scottish Government have supported compulsory fortification of flour for many years. Unfortunately, although power over the issue is devolved to Scotland, the advice from Food Standards Scotland is that realistically, given the way in which the flour and milling industries are structured, a response is better delivered UK-wide. That is what we unite to call for today.

The Holyrood Government, the Welsh Government, the Northern Ireland Department of Health, the Food Standards Agency, Public Health England, the British Medical Association, the Scientific Advisory Committee on Nutrition and all the royal colleges under the sun are on board. The science points overwhelmingly in favour of mandatory fortification, but surely, when we listen to the individuals and families affected by neural tube defects—spina bifida and allied conditions, of which the right hon. Member for Belfast North gave an example—that overwhelming case becomes undeniable. I hope that the Government listen to the science and to the families affected, and act quickly.

Mrs Sharon Hodgson (Washington and Sunderland West) (Lab) - Hansard
16 May 2018, 5:14 p.m.

It is a pleasure to serve under your chairmanship, Mr Hanson; I think it is the first time I have had such a pleasure.

I thank my hon. Friend the Member for Pontypridd (Owen Smith) for securing the debate and for his eloquent speech. As always, he showed his knowledge and passion on this important topic. I also thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), who speaks for the Scottish National party and mentioned that the Scottish Government have looked at this policy and, as I understand the situation, concluded that it was impossible to bring in fortified flour on a Scotland-only basis because of the fluid nature of the UK food industry and the very fluid nature of flour. I therefore think it is definitely time that the UK Government looked at this issue again.

I thank the right hon. Member for Belfast North (Nigel Dodds) for his brave and personal speech, and I thank my hon. Friend the Member for Newport East (Jessica Morden) and the hon. Members for Cumbernauld, Kilsyth and Kirkintilloch East (Stuart C. McDonald) and for Strangford (Jim Shannon) for their excellent contributions to the debate. Finally, I add my thanks to my hon. Friend the Member for Redcar (Anna Turley), who raised this matter last week during Health and Social Care questions.

As we have heard, this issue has been on the table for decades now, and it is only right that it continues to be brought up at every possible opportunity. The UK Government continue their policy of voluntary folic acid supplementation for women of childbearing age, despite the evidence and the fact that the latest National Diet and Nutrition Survey states that 91% of women of childbearing age have a red blood cell folate level below the level estimated to lower the risk of NTDs. I therefore ask the Minister what he is doing to encourage women of childbearing age to take folic acid supplements. Additionally, what steps is his Department taking to ensure that women of childbearing age even know that they should take those supplements?

Incidentally, this was something that I was aware of when I was having my children 25 years ago. We think things have moved on, but my young researcher in my office said that she only found out about it when she was researching for this speech. So, the message is not out there—not everybody knows this information. The voluntary approach means that, more often than not, those who do not need the supplements will take them, whilst those most at risk will miss out. Young mothers and those from the most socioeconomically deprived areas are least likely to take supplements. What steps are the Government taking to ensure that these groups of women are included and reached?

I am sure that it will not come as a surprise to the Minister that as many as 40% of pregnancies are unplanned, and that means that many women will not have been taking supplements during the crucial phase, just before or just after conception. It therefore makes sense for flour to be fortified with folic acid, to ensure that women get the nutrients that they need in order to reduce the risk of NTDs. That already happens in over 80 countries worldwide, including the United States, Canada and Australia.

Currently, no countries in the European Union fortify their flour with folic acid. However, there is no legislation preventing any of them from doing so. Given the UK’s research on this matter, I believe that they are waiting for us to lead the way, and as we have heard, I believe Scotland is probably doing just that. Why are the Government not therefore taking the opportunity to lead the way and reduce NTDs, not only in the UK but, in turn, across Europe? I understand and sympathise with concerns about adverse effects that this may have on the population. However, there really is no evidence to suggest that from other countries that have fortified their flour with folic acid for many years.

I also note the response of the Parliamentary Under Secretary of State for Mental Health and Inequalities from Health and Social Care questions last week:

“We have advice that if the intake of folic acid exceeds given levels, that can also bring health problems”.—[Official Report, 8 May 2018; Vol. 640, c. 537.]

However, the modelling undertaken by Food Standards Scotland in 2017 indicated that fortification at the recommended levels, with a capping of voluntary fortification and supplements, can achieve the reductions in NTD risk without increasing the number of people consuming the upper recommended limit. Has the Minister made any assessment of that finding, and could he stipulate where his advice is from? Finally, has the Minister’s Department made any assessment in the last five years of the benefits of fortifying flour with folic acid?

From this afternoon’s debate it is clear that there are benefits to the mandatory fortification of flour with folic acid. I really do hope that the Minister will take all of this away with him today back to his Department and reconsider this policy—unless, of course, he is going to announce that he is going to fortify flour forthwith.

The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine) - Hansard
16 May 2018, 5:21 p.m.

Thank you, Mr Hanson. Should that be the miller, Steve Brine? I like the notion from the shadow Minister that the European Union is waiting for us to lead. That is a new concept.

It is a pleasure to serve under your chairmanship for the first time, Mr Hanson. I congratulate the hon. Member for Pontypridd (Owen Smith) on securing the debate and I thank him for devoting it to an issue that I know he cares about. He works closely with Shine, which he mentioned and which was mentioned by others, and is based in his constituency. It does some fantastic work supporting people with spina bifida and anencephaly and their families. I have asked my officials to see if Shine will come in and see me as soon as possible. It is not a charity that I know, so I want to speak to and get to know its staff.

I hope I can reassure hon. Members a little bit—I suspect it will not be a lot—that the Government and those who provide us with expert independent advice are looking incredibly closely at all of this, as I will set out. I will say at the outset that I am sorry to disappoint the shadow Minister, but I cannot give the House an exclusive announcement today, I am afraid. However, I may be able to give some encouragement.

Part of the pregnancy advice currently provided to women is of course to take folic acid supplements. The consequences of folate deficiency in the general population are that pregnant women are at greater risk of giving birth to low birth-weight, premature babies with neural tube defects. Unless someone is pregnant or is thinking of having a baby, they should be able to get all the folate they need by eating a generally varied and balanced diet. Women who are trying to conceive, or who are likely to become pregnant, are advised to take a daily supplement of, we say, 400 micrograms of folic acid until the 12th week of pregnancy. They are also advised to increase their daily intake of folate by eating more folate-rich foods such as spinach and broccoli, which sounds lovely, and foods that are voluntarily fortified with folic acid such as, as has been said, a wide range of breakfast cereals.

As has been said by pretty much every Member who has spoken, around half of pregnancies are unplanned. Of those that are planned, it has been estimated that only half of all mothers take folic acid supplements or modify their diet to increase their folate intake. That is one of the main reasons behind the calls for mandatory fortification and is one of the reasons why the debate was called.

UK wheat flour is currently fortified with calcium, iron, niacin and thiamine in accordance with the Bread and Flour Regulations 1998—introduced under the last Labour Government—which apply in England, Scotland and Wales, with parallel regulations in Northern Ireland. This mandatory fortification is a domestic, not an EU, requirement and is done for public health reasons. It has the primary objective of restoring those nutrients lost during the milling process, with the exception of calcium, which is added in larger amounts than that lost.

To date, successive Governments have not considered that the mandatory fortification of flour with folic acid is the best way of protecting public health and have instead promoted the use of supplements as part of a wide range of pre and post-conception advice to women of childbearing age. That may be merely stating the obvious of where we have come from, but it does not necessarily need to mean where we are headed.

While it may appear straightforward to just add folic acid to the existing mandatory flour fortification measures, a problem that arises with the proposal to move from the current advice of taking a measured supplement is of how to ensure that women are able to assess their folate intake if getting it from foods made from flour instead. Women in the targeted age group may not eat the relevant products in sufficient quantities.

We also want to consider the population’s wider dietary advice, and to educate women to encourage them to achieve a greater folate intake by way of eating those folate-rich vegetables that I mentioned earlier, rather than relying on flour-containing foods, which may not be the best contributor to a balanced diet. It will be necessary to consider properly women’s consumption of all wheat flour-containing products to fully understand the impact of any mandatory fortification on diet and folate intake levels. Additionally, we are aware that the universal fortification of flour with folic acid may not be readily accepted by the general public, especially when the measure is intended to benefit only a specific section of the population.

The aforementioned Scientific Advisory Committee on Nutrition—SACN; it was indeed called COMA—is a committee of independent experts on nutrition that provides advice to Public Health England, for which I have ministerial responsibility, and other Government agencies and Departments across the UK. It has recently updated the evidence on folic acid in response to a request from Food Standards Scotland, which was prompted by Scottish Ministers expressing a desire to proceed unilaterally with the mandatory folic acid fortification of flour north of the border.

In its most recent July 2017 report, SACN saw no reason to change its previous recommendations, made in 2006 and 2009, for mandatory folic acid fortification, to improve the folate status of women most at risk of NTD-affected pregnancies, provided that this is accompanied by restrictions on voluntary dietary fortification with folic acid. Again, this emphasises the need to fully understand all the sources of folate intake by women, to ensure that their health is protected as well as to protect their unborn children. The Wald paper, which is a new scientific paper published on 31 January this year in Public Health Reviews, has again raised this issue. However, the paper suggests that there should be no upper limit on folate intake, which would remove some of SACN’s concerns.

The Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment—COT—is another independent scientific committee that provides advice to the Government on, among other things, the safe upper levels for vitamins and minerals. The Wald paper was brought to the attention of COT by its chairman, and COT agreed to take forward for further consideration the issue of tolerable upper limits for folate. COT discussed a scoping paper in March this year and will have its first detailed discussion in July to see whether Wald’s analysis of the data is correct and whether the original tolerable upper level recommendation is not appropriate. COT will then receive a second paper in September considering all of that and is hoping to be able to report its findings towards the end of this year.

I wanted to put that on the record because it is the advice I have been given, but I have to say that, frankly, I am the Minister, and that is not good enough for me. I want it sooner than that, so I have asked COT to come and see me by the end of this month to explain itself and to see whether we can move forward more quickly.

To conclude, I am moved by the testimonies given today. The right hon. Member for Belfast North (Nigel Dodds) is a gentleman and an excellent parliamentarian, and his speech about his son, Andrew, cannot have been an easy one to make. I thank him for putting those personal things on the record in the way he did. There are many issues to consider, but I wholeheartedly agree with the sentiment of the debate. I will do my utmost as the public health Minister, working with other colleagues across Government—this impacts on other Departments as well—to work through the issues to give the best effect to the aim of the debate as soon as we possibly can.

Louise Haigh - Hansard
18 Apr 2018, 4:42 p.m.

I am glad that my hon. Friend raises that important point, because I am not able to address all the factors behind declining life expectancy. The British Medical Association raised that point this week, saying it is very concerned about the 5 million children growing up in poverty and the implications that that will have in the future on life expectancy.

Louise Haigh - Hansard
18 Apr 2018, 4:43 p.m.

My right hon. Friend is absolutely right: these are long-term issues, which need addressing. They are all the more heartbreaking because we have seen decades of progress, and we all assumed that that would only go in one direction; little did any of us imagine that we would see a rise in infant mortality in the sixth-richest country in the world. These figures are, quite frankly, inexcusable.

On social care, care homes in deprived communities often no longer receive enough to cover the costs of care, which inevitably compromises the quality that they are able to provide. For those in such communities who cannot afford private care homes, that reduction of quality, and in some cases the lack of any available residential care at all, has had a punishing effect.

All Members present will have received casework regarding those still in their homes in the community who rely on care packages. Their care is simply unacceptable, relying on care workers who are paid far too little and who often do upward of 25 care visits every single day. There is not a chance, even by unsustainably drawing on the boundless good will of those care workers, that visits could last for 30 minutes, as defined by official guidance. It is beyond the realms of possibility. Those millions of hours of lost contact time for the 470,000 vulnerable—predominantly elderly—people who use home care will have undoubtedly compromised their long-term care and support needs and the management of multiple conditions.

It perhaps should not be a surprise that the rise in mortality and the fall in life expectancy came from precisely that cohort—older women living alone in poorer areas. In many senses, they were the early-warning sign of the deeply troubling trend in increasing mortality. This cohort, more reliant than any other on a functioning, effective, compassionate state providing quality support, have been badly let down in recent years. It should be a source of national shame that elderly women in some of the most deprived areas of our country are living in isolation, not properly cared for, and are losing their lives because the state has not supported them. However, it is not just that cohort of women. Some 7% of the extra deaths in 2016-17 were of people aged between 20 and 60. Almost 2,000 more younger men and 1,000 more younger women have died than would have if progress had not stalled.

I am sure that the Minister cannot look at the evidence presented here today, or at the research undertaken over the past two years, and not want to take steps to tackle those shocking statistics and to prevent those lives from being cut short. It is therefore critical that Ministers and the Government take seriously the fall in life expectancy and the evidence behind the growth in mortality. Up to now, Public Health England has regrettably tried to attribute it to the greater prevalence of flu. However, as Loopstra noted in her report:

“If Public Health England’s attribution of rising mortality to cold weather and flu is correct, then it should lead to an elevation of mortality in regional swathes across the nation. However…trends have varied considerably across local authorities, with no apparent geographic patterning consistent with regional outbreaks.”

The rise in unexpected mortality and the concurrent fall in life expectancy represents a significant moment in the history of public health in this country, yet the Department of Health has so far rejected the call from public health professionals for an inquiry into the sharp rise in deaths. I repeat that call today, and ask the Minister to look very seriously at the evidence presented on the link between life expectancy and austerity.

I will end on the words of Danny Dorling and Stuart Gietel-Basten, who have undertaken so much of the research in this area:

“demography is not destiny. Projections are not predictions. There is no preordained inevitability that a million years of life need be lost…but only through politics comes the power to make the changes that are now so urgently needed.”

The Minister has that power in her hands, and there can be no more pressing question for her than to ask why the citizens of our country are dying sooner than they should. I hope she leaves no stone unturned in pursuit of that answer.

The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price) - Hansard
18 Apr 2018, 5:17 p.m.

It is a pleasure to see you in the Chair, Mr Paisley. I thank all hon. Members who have contributed. Clearly, we all want the best possible outcomes for all our constituents, and it is in that spirit that we approach this debate. I congratulate the hon. Member for Sheffield, Heeley (Louise Haigh) on securing the debate. I know her constituency well. Actually, looking at hon. Members opposite, I know the constituency of the hon. Member for Lewisham, Deptford (Vicky Foxcroft) well, also. That really brings into stark relief some of the issues we are talking about, because at the heart of the issue of life expectancy is the issue of inequality. I can speak from personal experience in my own constituency. The hon. Member for Washington and Sunderland West (Mrs Hodgson) talked about the differences between north and south, and rich and poor. Within my constituency there is a 10-year difference in life expectancy in the two-mile trip from the north of my constituency to the south, where it is poorest.

We are all acutely aware that inequalities lead to lower life expectancy. It would be a poor Minister for Health—indeed, a poor Member of Parliament or anyone involved in public life—who did not think that was important. It is important that we address it and we are determined to do so. I will run through some things, which tell a better story than the stark figures we have heard today. I will also address some of the points made about those figures, because I think it would be premature to draw too many conclusions at this stage about the causes of those and whether this is a long-term trend.

My hon. Friend the Member for South West Bedfordshire (Andrew Selous) also made some wise points. Ultimately, we can only spend what we collect from taxpayers. We are having an active debate on the extent of the funding we need to make available for health and social care. In this 70th anniversary year of the founding of the NHS, it is appropriate to focus on that. We will continue, notwithstanding the fiscal challenges that we face, to prioritise spending on health.

It is important to emphasise that this dip in life expectancy is not unique to the UK. We have seen it elsewhere in Europe. We need to be circumspect about drawing too much by way of conclusion.

The hon. Member for Washington and Sunderland West mentioned the Prime Minister’s speech. I want to supply the context of the Government’s approach against the background of that speech. The Prime Minister made it a priority to fight injustice and inequality. Ultimately, we know that by focusing actions on the people, communities and localities with the greatest needs, we will achieve the best health outcomes. As the hon. Lady said, we will also reduce long-term demand on the NHS and social care services, so it is smart to focus our strategy on tackling inequality.

We need to be honest about facing up to what the sources of inequality are. Sometimes, those will make us uncomfortable. One of the most disadvantaged groups in our society is those with learning disabilities. They will live 20 years less than the rest of us. For me, that is a very uncomfortable truth to live with. Successive Governments have tried to direct resources to help that group of people, but it is still not working. That leads to the realisation that this is as much about behaviour and leadership as it is about money.

Jackie Doyle-Price - Hansard
18 Apr 2018, 5:22 p.m.

The right hon. Gentleman knows that we have made tackling that a priority. It is too early to draw any conclusions. It is the case that poverty is a big source of inequality, but we need to do more work before drawing conclusions. Having developed the evidence, we will act. There is a reason that we have developed a national maternity safety strategy. There is a reason we are focusing resource on the perinatal phase, because we recognise it is critical. We will also continue to spend money on the healthy living supplements to give children a better start in life and to tackle some of those inequalities.

Mr Reed - Hansard
3 Nov 2017, 9:49 a.m.

I agree, and I very much hope that the Minister will make such a commitment today.

There are fears about unconscious bias in the mental health services. The Angiolini review, a very important review published earlier this week, notes how a disproportionate number of people from black, Asian and minority ethnic communities have died after the use of force in custody more generally. Black people are four times more likely to be sectioned than white people. If we look at the faces of the people who have died after severe restraint in a mental health hospital, we see many more young black faces than in the population as a whole. We need to understand the extent to which assumptions based on stereotypes are causing that, but to do so we need standardised data recording.

What the Bill proposes is simple, but it will make a big difference. It will standardise the way in which the data on every instance of the use of force are recorded, so that we can better understand where force is being used unnecessarily, and the extent of any bias and disproportionality in the system. It will improve arrangements between the police and mental health services, and require the police to wear body cameras when carrying out restraint, unless there are good operational reasons not to do so.

Mr Reed - Hansard
3 Nov 2017, 9:49 a.m.

My right hon. Friend is absolutely right. The idea of engaging with the Welsh Assembly as the Bill proceeds through this Parliament is an excellent one, and I hope to have his support in doing so.

Jackie Doyle-Price - Hansard
20 Jul 2017, 10:56 a.m.

The purpose of the consultation is to allow people to make their points about which Department should be chosen to oversee the inquiry, and then we will respond accordingly. All I can say is: please encourage people to participate in this consultation.

Jackie Doyle-Price - Hansard
20 Jul 2017, 10:57 a.m.

We need to understand exactly what the concerns are and we will only achieve that through dialogue. I can reiterate that we are here to listen to those concerns. Now that we have decided to go ahead with the inquiry, I want to make sure that we get it right.

Mr Speaker Hansard
11 Jul 2017, 1:58 p.m.

Order. Just before I call the first speaker from the Back Benches, I should say that at this stage I have not imposed any formal time limit, but a substantial number of people wish to contribute. Therefore, I know that the hon. Member for Stratford-on-Avon (Nadhim Zahawi) will exercise a magnificent self-denying ordinance in the length of his oration.

Mr Speaker Hansard
11 Jul 2017, 1:58 p.m.

Do we really have to have it? I know what I am doing and am perfectly capable of handling the matter. If it is about the order of speeches—

Mr Speaker Hansard
11 Jul 2017, 1:58 p.m.

No, no. I do not need to be advised by the right hon. Gentleman on the handling of the debate. Let me just say that in so far as this was not clear, it was as a result of a failure of communication between the two Front-Bench teams. These matters should be sorted out between the Government and the Opposition, not with people yapping at each other across the Floor of the House or very close to the Speaker’s Chair. The Speaker is happy to give effect to what the two sides of the House want, within reason, but that was not made easy on this occasion, and I am seeking to address the matter by consensus. I know that the right hon. Gentleman means well and his offer of assistance is greatly appreciated, but I do not need to take him up on it on this occasion.

Mr Dunne - Hansard
11 Jul 2017, 2:22 p.m.

The hon. Lady, who has taken an active lead in encouraging inquiries, will want to make sure that we get it right. We will take the time that is necessary to consult colleagues and interested groups. Our intention is to be able to come back to the House as soon as practicable—I anticipate in the autumn.

Mr Dunne - Hansard
11 Jul 2017, 2:22 p.m.

We recognise that there is a legitimate interest for all constituent nations in the United Kingdom. As many of these incidents took place before devolution, we intend to consult devolved Governments.

Kevin Foster - Hansard
11 Jul 2017, 3:45 p.m.

The hon. Lady makes a powerful point. I am sure that the Minister will have heard it and will wish to consider, as part of the consultation, how the inquiry is structured and how the victims are represented. I can imagine, given the victims’ experience over the past 30 years, that they might have strong views on whether they should be represented by a state-appointed person or someone they know themselves. It is important that the way in which they are represented should be determined through consultation. I am sure that all points will be carefully considered to ensure that these people are represented appropriately.

In my constituency, three ladies have raised this matter with me constantly: Jean Hill, Michelle Digby and Margaret Murray. They have been determined to pursue the matter, to find answers and to reach justice. Even while I have been in the House for the Minister’s speech, Margaret has been in touch to ask when the compensation payments will be made, given that the forms were sent out over 12 months ago. It is important that we resolve all these issues as well as finding the answers to what happened 30 years ago.

I welcome the Minister’s statement today, and I congratulate the hon. Member for Kingston upon Hull North (Diana Johnson) on her pursuit of this matter and on securing the debate. I also congratulate my hon. Friend the Member for Worthing West (Sir Peter Bottomley), who has been diligent in pursuing these cases. I hope that those who have suffered for too long can finally get the answers that they deserve and have an absolute right to receive.

Mr Jonathan Djanogly (Huntingdon) (Con) - Hansard

The right hon. Gentleman is making a powerful case, and he has just mentioned a point that I was going to make. Many of the people who were badly affected have not been catered for to date. They include constituents of mine whose father was infected and who died. They ended up in a children’s home and their lives have been totally devastated, yet they are not within this process. They should be.

Mike Amesbury (Weaver Vale) (Lab) - Hansard
11 Jul 2017, 3:52 p.m.

I am also pleased to speak on this occasion with you in the Chair, Madam Deputy Speaker. Picking up on my right hon. Friend’s point, a constituent of mine called Michael from Runcorn wants justice, but he wants justice that involves all the families. He wants them to be engaged and to be able to shape this Hillsborough-style inquiry. I welcome the inquiry that the Prime Minister and the Minister have announced, but people are impatient for justice that is shaped by the victims.

Mr Dunne - Hansard
11 Jul 2017, 3:53 p.m.

Briefly. I remind the right hon. Gentleman, who is making some important points, that we intend to contact all the families who are in touch with us through the different schemes to alert them to today’s announcement, so that they will have the opportunity to contribute to our determination of the best form of inquiry. On the hon. Gentleman’s second point, it will be for the inquiry, once it is established, to determine how it engages with people, and those involved will be interested in any advice from Members or others.

Madam Deputy Speaker (Dame Rosie Winterton) - Hansard

Order. I do not want to impose a formal time limit, but I would ask Members to try to keep to four minutes. I will not then have to impose a formal time limit.

Maria Caulfield (Lewes) (Con) - Hansard

Will the right hon. Lady give way?

Ms Abbott - Hansard

I need to make some progress.

When the Home Secretary accuses people of scaremongering, she should explain why every stakeholder in policing is saying that there is an increasing problem with Government cuts to policing.

Amber Rudd Hansard
28 Jun 2017, 1:25 p.m.

The hon. Gentleman puts it so kindly—I am so keen to have a talk on that topic. I assume that the figures he is looking at are from 2010; I have been referring to the figures from 2015, which have been protected in cash terms and in real terms. I would welcome a visit from him—perhaps to my police Minister—so that we can go through the figures and reconcile his thoughts with mine. [Interruption.] I do not think we are going to do that across the House right now.

Amber Rudd Hansard
28 Jun 2017, 1:26 p.m.

I am afraid I do not particularly recall the day when the right hon. Gentleman stepped down, but I stand by what I said, which is that we are funding a significant uplift in the number of armed police. These officers are trained at a different level to those he oversaw as police Minister; they are much more effectively trained, to the high level required for counter-terrorism.

Huw Merriman - Hansard
28 Jun 2017, 3:13 p.m.

When I looked at the winter fuel allowance and the amount of money that we would put back into health as a result of the changes, I was concerned that, under Barnett, some of that money could end up funding Scotland, when Scotland already has the ability to make those decisions about funding. My concern is that as we devolve ever more powers to Scotland, we are not also asked to devolve ever more finance as well.

Let me come back to my main thread. With respect to social care, consensus and intergenerational fairness, I think that we should consider the ideas in my party’s manifesto. Those ideas were worthy of more thought than was afforded to them by the Opposition parties. I also found it incredibly distressing that our vulnerable constituents were receiving election literature through their letterboxes saying, “Under the Conservatives, you will be forced to sell your home in order to go into residential care.” That was put out by the Liberal Democrats, when, in fact, our manifesto was changing that current practice. They were completely misinterpreting the position—and, worse, to a group in our communities who are particularly vulnerable to that type of scare tactics.

Let me turn to pensions. Representing a constituency such as mine, I absolutely agree that we need to look after those on pensions, especially those who have been on fixed incomes and have not had much of a return over the past few years. It is true to say that the triple lock has ensured a 22% increase in pensions, whereas earnings have only risen by just over 7% and prices by only 12%. Again, we must look at intergenerational fairness and ask ourselves how we can ensure that, as well as equipping our elderly and retired constituents to ensure that they can continue with good means, we also look after those who will ultimately fund them.

I am absolutely delighted that this Government are pushing ahead with the consultation exercise. When it comes to contributions to social care, we should ask those who can afford it to take some form of individual responsibility. They should make those payments themselves; otherwise we will effectively see the taxpayer subordinated to those who end up inheriting under the system. Yes, I agree that those people have worked hard all their lives to create their nest egg and for their house, but ultimately I want to ensure that people have the best-quality social care, and that will not happen unless we reform it.

I ask all Opposition Members to think about intergenerational fairness, and to ask those people who can afford it to make more of a contribution, which means that those people starting off on the ladder, who have to think not only about buying a property but saving for their advanced age, have that opportunity as well. Without taking that type of adult decision, we will never get any further in reforming social care.

In my last 30 seconds, Madam Deputy Speaker—congratulations on your return—I make a plea on behalf of my schools. At a school hustings, at which there were candidates from all three parties, I told pupils that there was no point in getting something today, because they, more than any other generation, would have to pay for it tomorrow. Despite what has been said about our party’s popularity with the young, more people in that school voted for the Conservative candidate than any of the others, because they recognised that we have the policies to deliver for them, as well as for those who are retired.

Mrs Moon Hansard
28 Jun 2017, 3:20 p.m.

My right hon. Friend, having served as a Minister with responsibility for policing, will remember the inputs of the Ministry of Defence police in providing security and stability for much of our most important national infrastructure. Is he aware that there is to be a £12.5 million cut in Ministry of Defence policing in this year, which means that fewer armed police officers will be available to support Home Office police?

Mike Wood (Dudley South) (Con) - Hansard
28 Jun 2017, 3:27 p.m.

All Members will have their own examples of mental health casework. Often, those constituents will have attended an advice surgery or sent an email for help about a different problem entirely. It could be housing; it could be employment or welfare; it could even be a problem involving the criminal justice system. But it soon becomes clear, after a few questions and a little bit of probing, that the underlying problem is one of undiagnosed—or unsupported—mental illness.

Poor mental health weakens people’s life chances, and many of the effects of deprivation further aggravate the impact of mental illness. Sadly, an increasing proportion of cases from our surgeries involve children suffering from poor mental health. I welcome the Green Paper on children and young people’s mental health, and I am pleased that the Government have committed £1.4 billion for child and adolescent mental health services by 2020. That is absolutely the right thing to do. It will transform mental health treatment for children and young people. We all need to ensure that it is properly directed and spent in those areas where it was intended to be spent, because it is a shocking fact that one in 10 children in this country have a diagnosable mental health condition.

I am pleased that the Prime Minister launched the expansion of the mental health first aid training scheme in secondary schools yesterday. It is essential that we do more to deliver early intervention to support people’s mental health, rather than relying so heavily on acute mental health services once conditions have deteriorated, sometimes to the point of psychosis. It is the difference between treating an illness and just tackling the immediate symptoms—a distinction that would be so obvious for physical health that surely nobody would argue against its existence. That means ensuring that training for GPs allows them to identify mental health conditions in patients who present with a completely different illness, and ensuring that continuing professional development allows GPs to keep up so that more senior GPs also have the necessary understanding of mental health. It means securing access to successful programmes such as Improving Access to Psychological Therapies—introduced by the previous Government and continued by this one—and other talking therapies, where alternatives to drug-based treatments are appropriate.

I am pleased that the Mental Health Act 1983 is to be reformed. It was doubtless introduced with the very best of intentions and has certainly had many beneficial effects, but in too many cases the starting point seems to be that it treats people with mental illness as threats that need to be contained, rather than as patients who need treatment and support. Of course, there are times when people need to be detained, for their own protection or that of those around them, but then the focus must be on medical treatment rather than, effectively, imprisonment.