Public Administration and Constitutional Affairs Committee

Eleanor Laing Excerpts

Thursday 2nd February 2017 Commons Chamber

[Mr Jenkin]

I am most grateful to the Minister for his question and for the fact that he has personally appeared at the Dispatch Box today with his opposite number from Her Majesty’s Official Opposition. I know that his presence here underlines the commitment of the Secretary of State to this programme of change.

I very much welcome the shared programme of work to which my hon. Friend refers, but, in taking evidence for this particular report, we found that there was some dislocation between the various bodies involved in it. We conclude that it is only Ministers, and probably only the Secretary of State, who can draw this together to ensure that there is a coherent strategy and a plan, which is what we emphasise in this report.

Finally, my hon. Friend refers to legislation in passing, but I hope that valiant efforts are being made in that regard. Perhaps something can be included in Her Majesty’s Loyal Address later this year. I must point out that it is not just about statutorily underpinning the independence of HSIB, but the safe space to which he refers and on which he thanks the Committee for its contribution. The safe space has to be legislated for. Without legislation, there is no safe space. The AAIB, the Marine Accident Investigation Branch of the Department for Transport and equivalent bodies could not possibly function unless they can provide people with protection, so that those people can come and talk openly and off the record about what has happened. That has transformed the safety culture in other areas, and it is the transformation that we need in the health service. I leave with the Minister the word “legislation” echoing in his ears, and I very much look forward to making further progress with him on these matters.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

The House is grateful to the Chair of the Public Administration and Constitutional Affairs Committee for bringing his report before the House this afternoon and for taking questions.

Provision of Cervical Screening

Eleanor Laing Excerpts

Friday 27th January 2017 Commons Chamber

[Paula Sherriff]

I absolutely agree. I definitely expect the Minister, at least, to partake in such activity.

I thank Jo’s Cervical Cancer Trust for the work that it does all year round towards the eradication of this disease. It has been my pleasure to work with it, through the auspices of the all-party group, on issues to do with access to cervical screening, and I look forward to doing so again in the future.

I am glad that the Minister is sitting down, as I would also like to break with my habit in this House by giving a word of praise for current Government policy. As almost all cervical cancers are caused by persistent human papillomavirus—HPV—I welcome the Government’s commitment to the HPV vaccination programme, even though I feel that its effect could be amplified with compulsory sex and relationships education in our schools.

Successive Governments have developed a successful cervical screening programme and, to their credit, this Government have maintained it. It is responsible for saving an estimated 5,000 lives a year. That is to be applauded, but it should not be taken for granted. Recent years have seen a drop in cervical screening coverage, and this risks an increase in the incidence of cervical cancer and the danger of further unnecessary deaths when we have been very close to making a breakthrough. We need to be vigilant if we are to maintain the progress we have already made and make up further ground in tackling the disease.

Even with the progress that we have made on screening, some 3,000 people a year are diagnosed with cervical cancer, and an astonishing 890 a year people die of it. The figures for 2015-16 show that the coverage in England sits at 72.7% of eligible women, which is the lowest for 19 years. This is in spite of the so-called Jade Goody effect, when the TV star’s death from cervical cancer in 2009 resulted in 400,000 more women getting screened. Sadly, that effect has now been completely reversed. The numbers of screenings have been falling year on year, and they now stand at 3% lower than they were in 2011. Screening coverage rates across all age groups are falling.

I cannot stress strongly enough how significant and worrying these statistics are. They mean that more than a quarter of women in this country are leaving themselves open to a cancer that can be prevented, but that can easily be fatal if left undetected. As we all know, the general rule of cancer is that early diagnosis leads to a better prognosis, and cervical cancer is no different. The later the diagnosis, the poorer the health outcomes, and the more invasive and personally costly the treatment options. It benefits everyone involved if cervical cancer can be prevented, or detected and treated early.

Let me address one of the groups with the least coverage: young women. Women are invited for smear tests from the age of 25, but new research by Jo’s Cervical Cancer Trust has shown that more than a quarter of women in the 25 to 29 age bracket are too embarrassed to attend one. Shockingly, the same research also suggested that 70% of young women did not believe that smear tests could reduce a woman’s risk of cervical cancer. Let me be clear: they absolutely can. We know that 75% of cervical cancers can be prevented from developing through regular smear testing, yet more than 220,000 of the 25 to 29-year-olds invited for a test in England in the past year did not attend.

The research found several other causes for concern, including the fact that 24% of young women were unable to recognise a single symptom of cervical cancer, and that only just over half of them recognised that bleeding outside of periods was a symptom. That is the most common symptom of cervical cancer. Additionally, fewer than half knew that smear tests look for pre-cancerous cells, and almost a quarter incorrectly thought that the test was for ovarian cancer.

This problem is not unique to the younger generation. The 25 to 29 age group remains the group with the lowest coverage, but the 45 to 49 age group has seen the fastest decrease in coverage in recent years. Women over 50 display a similar tendency to put off or ignore smear testing, with a third having delayed or not attended their test. A shocking one in 10 have delayed for more than five years. This is particularly disconcerting because women aged 50 to 64 are the most likely to receive an advanced stage diagnosis, with half of those being stage 2 or later. As I mentioned earlier, this means more invasive treatment and risks poorer outcomes.

By far the biggest risk factor in developing cervical cancer is not attending cervical screenings, but Jo’s Cervical Cancer Trust has found that attendance declines with age. The charity’s long-term modelling has shown that if screening coverage continues to fall at its current rate, incidences of cervical cancer will have increased by 16% among 60 to 64-year-olds, and by a shocking 85% among 70 to 74-year-olds, by 2040. If screening coverage falls by another 5%, the mortality rate among 60 to 64-year-olds will double.

Age is not the only determining factor of one’s likelihood of being screened. One area of particular concern is that only 78% of black and minority ethnic women knew what a cervical screening test was compared with 91% of white women. This fell to 70% when looking at Asian women alone. Worryingly, only 53% of BAME women thought that screening was a necessary health test. This needs to be addressed, both nationally and within those communities.

The anxieties that all women were found to have about being screened, including embarrassment, worries about taking their clothes off in front of a stranger or discomfort with their body in general, are all heightened in particular ethnic communities with certain cultural norms. I have heard examples of mothers in certain minority ethnic households intercepting NHS screening invitation letters, leading to distress among younger women, who may experience cultural pressure that they should have maintained their virginity. If such factors put young BAME women off getting screened, that exposes them to significant risk of the disease. Particular focus should be paid to ensuring that mothers in those communities appreciate the dangers of cervical cancer, and that such cultural norms are not worth risking their daughters’ lives over.

We must ensure that coverage does not continue to fall. Indeed, it must be raised to an acceptable level, but the current outlook is mixed. A new report by Jo’s Cervical Cancer Trust for this year’s Cervical Cancer Prevention Week found that local provision is confused. While there is some evidence of best practice among local authorities and clinical commissioning groups, almost half of local authorities and almost two thirds of CCGs in England have not taken steps to increase cervical screening attendance in the past two years. The report also found regional disparities. In Yorkshire and Humber, 65% of CCGs had taken steps to increase screening, compared with just 18% of CCGs in the west midlands and the north-east. Similarly, 78% of local authorities in the north-west have taken action compared with just 33% in the east midlands. Perhaps most shockingly of all, in London, where coverage lags behind the rest of the country at just two thirds of women, 20 out of 32 local authorities reported no activity at all towards increasing screening coverage. That has all the appearance of a postcode lottery. We risk coverage continuing to fall in some areas of England while other areas make progress. Nobody wants a situation in which someone’s likelihood of developing cervical cancer is determined in no small part by the area in which they live. The Government should play their part to ensure that improvement happens across the board.

What can be done? We must seek to make access to cervical cancer screening as easy as possible. Screening takes five minutes and can save a life. Great strides have been made in recent years in making another simple test—blood pressure—available at every opportunity, which has been remarkably successful. There is every reason to expect that we could do the same for cervical cancer screening. However, I fear that the Government have taken a step in the wrong direction in recent years. Cuts to sexual health funding have led to a significant reduction in the provision of cervical screening through sexual health services. Jo’s Cervical Cancer Trust found that screening is available to all women through sexual health services in less than a third of areas, which again points to a postcode lottery. That seems like a grave misstep when over a third of women in the 25 to 29 age group expressed a wish to access screening through such services, while one in five women over the age of 50 wanted more flexibly timed access to screening. My GP practice offers cervical screening only every Tuesday morning, making access difficult and deterring many women from going for an appointment. I hope that the Government will look again at how much their cuts to local government funding have affected sexual health services, particularly the accessibility of cervical screening.

We must also move with the times. In addition to the cultural issues about invitation letters that I mentioned earlier, the use of letters is now old fashioned. While I appreciate that many NHS services across the country now use text message reminders, we should ensure that reminders to come in for screening are, to the greatest possible extent, accessible in the format of the patient’s choice, be that text message or email. Digital accessibility is necessary in the modern world. We must also be cautious about the wording of the reminders. It has been brought to my attention that the current NHS literature sent out with reminders reads:

“It is your choice whether to have a cervical screening test or not. This leaflet aims to help you decide.”

I fail to see how that in any way contributes to the aim of urging as many women as possible to attend cervical cancer screening. We already know that far too many women across all age groups and ethnicities are already content to put it off for a potentially dangerous length of time. I implore the NHS to reconsider the wording of the leaflets and to include a greater degree of urgency, because the phrasing will undoubtedly have an effect.

You will note, Madam Deputy Speaker, that I might not have been my usual challenging self this afternoon. Because of the gravity of the issue at hand, I happily recognise where the Government are on the right path. The inclusion of a commitment to increase cervical cancer screening in the 2015 cancer strategy is particularly welcome, as is the Government’s commitment to HPV primary screening, the implementation of which could prevent at least 400 cases of cervical cancer a year.

I will finish by asking several questions of the Government. Will the Minister commit to a national campaign to prioritise an increase in cervical screening attendance? How will the Government encourage co-operation between the different levels of the health service to ensure that we see cervical screening rates rising once again? Will the IT systems for HPV primary screening be up and running as planned, or will we experience unnecessary delays that could result in avoidable diagnoses? Will the Minister look at the quality and outcomes framework incentives for general practitioners to make sure that GP practices are really incentivised to improve cervical screening coverage? Finally, how do the Government intend to address problems with the accessibility of cervical cancer screening among particularly hard-to-reach groups, such as BAME women?

It is not unthinkable that we could see the effective eradication of cervical cancer if we take the necessary action. Although I applaud the Government’s existing programmes and their commitment to tackling cervical cancer, I hope that the Minister will take note of the research from Jo’s Cervical Cancer Trust—perhaps he will even work with it to identify where there are still gaps in provision—and take that action now.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Just before I call the Minister, I say to the hon. Lady that Jade Goody lived in my constituency. When she died, I wrote to her mother to say that her daughter’s death had not been in vain because it had drawn attention to the situation and had warned generations of women of the action that they must take to protect themselves and give themselves a chance.

I am shocked that the hon. Lady has drawn to the attention of the House this afternoon the fact that that has not been the case. I sincerely hope that her bringing this debate to the House this afternoon and the Minister’s attention to the points she has made—I am sure he is about to address them now—will reverse that situation.

NHS and Social Care Funding

Eleanor Laing Excerpts

Wednesday 11th January 2017 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Before I call the next speaker, it will be obvious to colleagues that a great many Members wish to speak this afternoon and that although the debate has advanced a long way in time, it has not advanced very far in the number of Members called. We therefore now have to have a time limit of 10 minutes. [Interruption.] I can see that there is some surprise about that; it is 10 minutes for the moment, but anyone who can do any arithmetic will be aware that it will have to be reduced later, so I suggest that Members start working on their speeches now.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The House was right to assume that 10 minutes per person is unsustainable. After the next speaker, I shall reduce the time limit to seven minutes. The House will be glad to know, however, that the time limit remains 10 minutes for Sir Simon Burns.

--- Later in debate ---

[Several hon. Members rose—]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I am afraid that this is rather unfair on those who have waited all day and have not yet spoken, but some Members have taken much more than seven minutes, and I must now reduce the time limit to five minutes.

--- Later in debate ---

[Simon Hoare (North Dorset) (Con)]

My hon. Friend is absolutely right about the need for a grown-up debate about integration and about learning from best practice. Does she share my concern that as Labour Members fan the flames of their artificial indignation, all they are doing is proving yet again that they are either unwilling, ill-equipped or ideologically—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Thank you. Jo Churchill.

[Jo Churchill]

I agree in that since we last debated this with the Opposition on 23 November, apart from asking for £700 million to be brought forward, they have put forward very little in the way of tangible plans. We are talking about everybody here, and just slinging bows and arrows across the Chamber will not get us to the solution we need.

If this is about money, why do some areas do better than others? It is actually about the allocation of resources and good leadership. I have received three letters about good healthcare. A resident in my constituency saw the GP on 28 October, the consultant on 8 November, and had their operation on the 29th. That was at my district general hospital that used the private facility locally to enhance the patient experience.

We need a long-term solution. I am pleased that the Prime Minister has spoken about tackling the difficulties of mental health. The right hon. Member for North Norfolk (Norman Lamb) has championed that and shares a mental health trust with me. I am pleased to see that another 49,000 people are being treated for cancer—that is something that I came to this place to champion—and another 822,000 people are receiving specialist cancer treatment. We have seen huge increases in demand, and we need to admit that we cannot just carry on. There have been advances in drugs, but we need to take into account comorbidities and an ageing population.

We need to understand what is wrong, and we will do that by having better data throughout the system. The Richmond Group wrote in support of my private Member’s Bill that information held in healthcare records has a huge potential to provide better care and improve health service delivery within the service. Paramedics have asked me for better access to data so that, when they find someone on the floor, they will know what meds they are on and what the most beneficial treatment would be. GPs want their information to flow through the system to help social care and the hospital sector. Pharmacies need to be able to read and write, and those working in social care need to be able to look at someone’s pathway. Patient outcomes should be the thing that we are all talking about, but we have to make decisions. At the centre of all this, we need to support those colleagues who are working above and beyond at this time. We need to behave in a grown-up, responsible way, just as they are, in caring for our NHS.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Philip Dunne)]

I am pleased to follow the hon. Member for Worsley and Eccles South (Barbara Keeley) and to be able to close this debate. I thank all 34 hon. Members for their contributions, some of whom—mostly those on the Government Benches—managed to rise above party politics and make some constructive comments.

I join my right hon. Friend the Secretary of State in thanking the 2.7 million staff working in our NHS and social care system. As the Prime Minister said earlier, we recognise that they have never worked harder to keep patients safe, with A&Es across the country seeing a record number of patients within four hours in one day last month.

Regrettably, after five and a half hours of debate and criticism from Labour Members, we have heard little, if anything, about how to provide solutions to the challenges that our A&Es face.

Once again, the Opposition have touted more funding as their only answer to solve public sector challenges. In fact, they have pledged to raise corporation tax eight times, promising an unspecified amount from an unspecified source. That will not help our NHS and it will not fool the public. There is much to do to protect the system and ensure a sustainable future, but it is this Government who have plans in place to get through this extremely challenging period and sustain the NHS for the future.

The shadow Secretary of State, the hon. Member for Leicester South (Jonathan Ashworth), spoke for about three quarters of an hour without making a single suggestion about how to solve the problems that face the NHS—not one. He should have stayed to listen—he may have done and I apologise if I did not pay enough attention to his presence in the Chamber.

The former Health Minister, the right hon. Member for Doncaster Central (Dame Rosie Winterton), asked specifically for community pharmacists to be paid for providing minor ailments services. I am pleased to be able to tell her that that is precisely what we are doing. The Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), was discussing that only this morning in Westminster Hall, and I regret to say that not a single Labour Member was present to hear what he had to say. [Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Surely the House wants to hear the Minister after this long debate—with courtesy.

[Mr Dunne]

We have heard a number of comments from Opposition Members—I am pleased to say that they were outnumbered in this Opposition day debate by Government Members—rehearsing some tired phrases to mislead the public over alleged increasing independent provision in the health service and also misrepresenting what my right hon. Friend the Secretary of State was saying in his remarks about A&E targets. Having said that, I wish to pay tribute to the hon. Member for Chesterfield (Toby Perkins), who is in his place, and the hon. Member for Workington (Sue Hayman), both of whom showed considerable personal courage in explaining the circumstances surrounding the death of each of their fathers, and they did so in an entirely honourable and sensible way, and I am grateful to them for sharing that experience.

I congratulate my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) on managing to get her son into hospital to have his appendix treated on Boxing day. As she said, that showed that that service was working well.

The Opposition sought to take the moral high ground in this debate. The hon. Member for Dewsbury (Paula Sherriff) challenged Government Members on whether they had visited hospitals over the Christmas period other than on an official visit. Her position was completely punctured by my hon. Friend the Member for Lewes (Maria Caulfield) who pointed out that she was doing a night shift between Christmas and new year in her role as a nurse—she was not on an official visit.

There have been some impressive contributions. I thank the Chair of the Select Committee on Health, my hon. Friend the Member for Totnes (Dr Wollaston), who was supportive of a more nuanced target for A&E, and for her calm and generally constructive comments, and my right hon. Friend the Member for Chelmsford (Sir Simon Burns) for his support for the success regime in Essex and for pointing out that it is not closing any of the three A&E departments in the hospitals there. I also thank my hon. Friend the Member for Crawley (Henry Smith), who made a very thoughtful speech and welcomed the opening of an assessment unit in Crawley to help to relieve pressure on the A&Es nearby. Finally, I thank my right hon. Friend the Member for Forest of Dean (Mr Harper) for another thoughtful contribution from the Back Benches.

Of course, the Conservative party and the Government recognise that our NHS faces the immediate pressures of the colder weather and the wider pressures of an ageing and growing population. There were nearly 9 million more visits last year to our A&Es compared with 2002-03—the year before the four-hour commitment was made. That is more than 2 million A&E attendances every month, and our emergency departments are now seeing, within the four-hour target, 2,500 more people every single day compared with 2010.

--- Later in debate ---

[Margaret Greenwood]

On a point of order, Madam Deputy Speaker—[Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. If Members wish to have conversations, they should go somewhere else. The hon. Lady is making a point of order.

[Margaret Greenwood]

The Minister told the House that there were no Labour Back Benchers in this morning’s debate on community pharmacies. In fact, he has inadvertently misled the House in that regard, because I was in Westminster Hall and I spoke in the debate, as was my hon. Friend the Member for Sefton Central (Bill Esterson), who also spoke in the debate. I just wanted to put the record straight.

[Madam Deputy Speaker]

I understand the hon. Lady’s point of order. It is not a matter for the Chair, but I understand why she wished to make the point.

[Mr Dunne]

rose—

[Madam Deputy Speaker]

It looks as though the Minister would like to say something further to that point of order.

[Mr Dunne]

Further to that point of order, Madam Deputy Speaker. To give the House complete clarity, I understand that two Labour Back Benchers were present and made minor interventions in the Westminster Hall debate, but there were no speeches or substantive contributions by those Labour Members.

[Madam Deputy Speaker]

I am sure that the House is grateful to the Minister for clarifying what he said in his speech, and to the hon. Lady for clarifying the position. The matter is now closed.

Health Service Medical Supplies (Costs) Bill

Eleanor Laing Excerpts

3rd reading: House of Commons & Report stage: House of Commons
Tuesday 6th December 2016 Commons Chamber

[Justin Madders (Ellesmere Port and Neston) (Lab)]

I beg to move, That the clause be read a Second time.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

With this it will be convenient to consider:

Amendment 8, in clause 1, page 1, line 14, at end insert—

“(2A) In exercising functions in relation to the controls on the costs of health service medicines, the Secretary of State must ensure that any payments made by manufacturers or suppliers to whom the scheme relates calculated by reference to sales or estimated sales of medicines are utilised solely for the purpose of reimbursing the NHS for expenditure on medicines and medical supplies.”

This amendment would confirm that the Secretary of State has a duty to reinvest rebates in improving access to new and innovative medicines and treatments.

Amendment 9, in clause 5, page 4, line 5, at end insert—

“(7) Before making regulations under Clause 5 the Secretary of State must conduct a consultation on the potential effect of this clause on the maintenance of quality of those medical supplies, and seek representations from manufacturers, suppliers and distributors of medical supplies as part of the consultation.”

Government amendments 1 to 6.

Amendment 10, in clause 6, page 7, line 11, at end insert—

“(1A) Information provided by virtue of section 264A must be disclosed by the Secretary of State to persons listed in subsection (1)(a) to (i) at that person’s request.”

Government amendment 7.

[Justin Madders]

I rise to speak to new clause 1, which stands in my name; to amendment 8, which is in the name of my hon. Friend the Member for Burnley (Julie Cooper); and to the other amendments in the group. The Opposition do not oppose the Bill. Our proposals are a constructive attempt to help the Government to achieve their stated aims, and to close the growing gap between the UK’s record on developing new drugs and the ability of NHS patients to access them.

New clause 1 would put a duty on the Secretary of State to commission a review within six months of the Act coming into force, focusing on its impact on the pricing and availability of drugs and medical supplies; on research and development; and on the NHS’s legal duty to promote innovation. The pharmaceutical industry in this country employs more than 70,000 people, in predominantly high-skilled and well-paid jobs—just the sort of jobs Members on both sides of the House would want to encourage and see more of.

This country’s record in the pharmaceutical sector has been one of our great success stories, but we cannot take that success for granted, particularly because investment decisions are often taken by parent companies in other parts of the world. There is considerable unease in the sector about the relatively low take-up of new and innovative medicines by the NHS compared with that in comparable nations, and about the ongoing uncertainty surrounding the future of the European Medicines Agency. A number of major companies have based themselves here because of the EMA, and the worry is that they might wish to follow it if it relocates following Brexit.

The impact assessment for the Bill states, as we might expect, that there will be an impact on the revenue of the pharmaceutical sector, and that it could lead to a reduction in investment in research and development and consequent losses for the UK economy estimated at £l million per annum.

While we fully agree with what the Government seek to achieve with the Bill, we are mindful of the storm clouds on the horizon. We therefore believe that prudence requires that such a review takes place within a reasonable timeframe to ensure there are no unintended consequences and that we can remain confident that the pharmaceutical sector in this country will continue to be at the forefront. We face competition not only in Europe but from emerging nations such as Brazil and China. We also need to ensure that the NHS does not trail in the take-up of the new drugs. Worryingly, the Office of Health Economics studied 14 high-income countries and found that the UK ranked ninth out of those14 across all medicines studied.

Successive studies have demonstrated relatively low take-up of new medicines in the UK compared with other countries. That is bad for patients and bad for our pharmaceutical industry. The Bill therefore needs to achieve a balance. We need to ensure the best possible patient access to medication at the fairest price, but we also need to encourage the pharmaceutical industry to invest in research and development.

National Health Service Funding

Eleanor Laing Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Relevant documents: Letter from the Chair and members of the Health Committee to the Chancellor of the Exchequer, dated 26 October 2016, and the Chancellor’s response, dated 8 November 2016.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I advise the House that Mr Speaker has selected the amendment in the name of the Prime Minister.

Social Care

Eleanor Laing Excerpts

Wednesday 16th November 2016 Commons Chamber

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I inform the House that Mr Speaker has selected the amendment in the name of the Prime Minister.

Community Pharmacies

Eleanor Laing Excerpts

Wednesday 2nd November 2016 Commons Chamber

[Rachael Maskell (York Central) (Lab/Co-op)]

On a point of order, Madam Deputy Speaker. Has the Secretary of State for Environment, Food and Rural Affairs given notice of whether she intends to make a statement to this House in the light of today’s High Court judgment, which found against the Government for the second time on the matter of being in breach of air quality standards and putting in place an inadequate air quality plan? I am sure that you will appreciate the level of interest in the outcome of those proceedings, given that between 40,000 and 50,000 people in our country die prematurely each year as a direct consequence of the Government’s failure to reach those air quality standards.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I understand the hon. Lady’s concern about the matter and thank her for raising it, but she and her colleagues will understand that it is not a matter for the Chair. If she wishes a Minister to come to the House, the correct procedure is to submit a request for an urgent question. I am sure that if the hon. Lady believes that she has sufficient grounds for asking for an urgent question, she will submit a request and Mr Speaker will give it due consideration.

Young People’s Mental Health

Eleanor Laing Excerpts

Thursday 27th October 2016 Commons Chamber

[Huw Merriman (Bexhill and Battle) (Con)]

It is a great pleasure to follow the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—I hope I have got that correct.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. It is pronounced “Stray-ven and Lez-ma-hay-go”.

[Huw Merriman]

Thank you, Madam Deputy Speaker. I am suitably corrected and admonished at the same time. I am glad that you did not ask me to repeat that after you.

I particularly applaud the point that has been made about making this a cross-party matter on which we can all work together. As the young people have shown us in their fantastic report, working together will help to ensure that all voices are heard and recognised.

I thank the hon. Member for Dulwich and West Norwood (Helen Hayes)—her constituency is much easier for me to pronounce—for sponsoring the debate. I apologise for going back and forth from the Chamber, and perhaps I may explain to those who are watching why there are so few MPs on the Benches. My hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) said that it would be good to hold such debates during Government time, when Members may not be in their constituencies. Of course, Thursday afternoon is also a time when Bill Committees sit, so Government and Opposition Members are required to attend those Committees. I hasten to add that I should also be in a Bill Committee, but I was so determined to speak on this matter that I have come to the Chamber. It is probably for that reason that I will always be asking Ministers for more from the Back Benches, rather than being on the Front Bench and able to deliver those things myself.

I commend the 2015 Youth Select Committee report, and I particularly applaud the 90,000 young people—many more took part in the vote—who voted that mental health services for young people should be the priority concern. They are absolutely right to focus on this subject, and I submit that they are in the best position to give their opinion on it.

I similarly decided that the subject would be a chief priority for me when I was elected as an MP in East Sussex 18 months ago. The severity of this issue, particularly among young people, became all too apparent to me. I found—I still do—the stories of carefree, confident and happy lives being shut down as young people enter a dark world of fear, anxiety and isolation to be incredibly upsetting.

As a result of my concern, I chose this issue as the topic of my question when my name was first pulled out of the hat for Prime Minister’s questions. I told the then Prime Minister that I had spent an afternoon in the small town of Battle in my constituency visiting three families, each of whom had a child who had not been given the early-stage intervention that they expected from the child and adolescent mental health services. I asked the Prime Minister for more focus on early-stage treatment so that young people’s conditions do not become more acute.

Providing such services is not only our civic duty, but an economic and social imperative. When my constituents ask me why the roads in East Sussex are in a state, I explain that I recently secured £250,000 from our county team to fund just one year of acute mental health treatment for one constituent. Fixing people has to come before fixing holes in the tarmac. The phenomenon may not have existed so openly when many of my constituents were younger, but it is now a huge financial concern to my county council colleagues.

I firmly believe that too much pressure is being loaded on to people too young. Social media and the internet, as pioneering as they are, are a curse on wellbeing, and internet service providers must be forced to do more. Every young person should have the right to have their web history expunged. Cyber-bullying is at last being recognised as a crime, but every school must ensure that its pupils are aware of good internet practice and the sanctions for abuse. We also need to be aware that young people and children are accessing graphic images and media on the internet that they cannot understand, process or cope with.

In the report’s consideration of education, I absolutely commend the recommendation

“that the Government develop and introduce statutory levels of attainment for mental health education…Schools should have autonomy to deliver mental health education flexibly but must be able to demonstrate how pupils reach the attainment levels.”

May I suggest that in so doing the Government should ensure that the curriculum combines a consideration of social media and the internet with wellbeing training?

We also need training for our GPs. The situation is summed up perfectly by the experience of a young person that is detailed in paragraph 32 of the excellent report. It is essential that the GP does not diagnose a mental health condition, but merely refers the young person to a specialist. I know that mental health specialists find it frustrating if GPs diagnose a mental health condition when the specialist does not regard it as such. Once that badge is given to someone, it is difficult to remove it. Equally, brilliant local GPs, such as those in Battle who have helped my constituents in their surgeries, have championed young people and become their advocate. They are incredibly frustrated by the delay in early intervention in mental health services. I work closely with my local CAMHS team, and I have the highest regard for the many excellent specialists who do their best. However, I am worried that constituents face lengthy waiting times and that some have been passed from pillar to post when receiving treatment.

Building up trust is a key ingredient of successful diagnosis and treatment. I hear stories about young people finding the courage and trust to open up about their condition, only to find a new practitioner at the subsequent session. It disappoints me that the young person can then regress because of that change of personnel. I would like a commitment to giving treatment on a fixed one-to-one basis. If we can do that for maternity provision, surely we can do it for mental health treatment.

When I attended the launch of the mental health taskforce, I was buoyed by the commitment of the then Minister and the chief executive of NHS England to implement the excellent “Five Year Forward View”. I was cheered by the commitment to funds to ensure that our acute hospitals have adequate mental health expertise on A&E wards to deal with those who are hospitalised as a result of mental health issues, or who have such a condition in addition to a physical illness.

My concern was driven by the experience of a family in my constituency following a suicide attempt. The NHS staff did not have the ability to deal with the mental health condition, and my constituent, a young man in his teens, was forced to wait until CAMHS staff could make their way over from another town miles away. I understand the need for specialist treatment, but it strikes me that there is a need for a culture change across the entire NHS, and that all staff should be trained to understand mental health and provide a basic level of treatment. Specialisation in health is important, but if the NHS becomes over-specialised, it can lead to a lack of general involvement in such care for patients.

I welcome the news that the Government will fund 24/7 mental health provision in our hospitals, but I was alarmed at the suggestion by the chief executive of my local trust that the funding may not stretch far enough. I also want to ensure that that specific coverage will not mean that other NHS staff with the necessary technical understanding and empathy will feel that they are not empowered to assist those many hospital patients who need help with their mental healthcare, in addition to their physical wellbeing.

Ultimately, getting early-stage intervention right is a key part of achieving a proper diagnosis for people with a mental health condition. We should not misdiagnose young people who are suffering growing pains and need the coaching and guidance of family and friends to overcome the problems of adolescence. However, I have met too many young children who face a difficult future because their mental health condition was not treated at an early stage. Funding mental health treatment is a most important investment, not only for people’s welfare and wellbeing, but to enable these amazing young people to fulfil their hopes and dreams in their careers, and to make something of themselves and their country.

I applaud the amazing work of all of those in the British Youth Council, many of whom live in my county of East Sussex, who have done so much to produce this excellent report. Those young people are leading the charge to ensure that the nation supports all those who are affected by this terrible condition. We owe it to them, and to all young people, to deliver a better mental health service, and many of the report’s recommendations will do just that.

Baby Loss

Eleanor Laing Excerpts

Thursday 13th October 2016 Commons Chamber

[Antoinette Sandbach]

I want to pay a huge tribute to my colleagues, particularly the hon. Member for Lewisham, Deptford (Vicky Foxcroft). I know that it is incredibly hard when we sit in this place to decide whether we want to put something that is a deeply personal piece of our lives into the public domain. Any parent who is dealing with child loss deals with the same dilemma. Do they talk to their employers? Do they talk to their friends? Do they explain what has happened?

I therefore thank the hon. Lady and all other colleagues: the hon. Member for North Ayrshire and Arran (Patricia Gibson), my hon. Friend the Member for Banbury (Victoria Prentis), the hon. Members for Washington and Sunderland West (Mrs Hodgson) and for Glasgow North (Patrick Grady), and my hon. Friends the Members for Gower (Byron Davies) and for Colchester (Will Quince). We were not aware a year ago where this path would take us. I am grateful for the fact that we are breaking the silence about child loss. We need professionals in the NHS to break the silence about child loss, too. That way, we will get real change.

I certainly will join the wave of light on Saturday. There is a series of awards called the Butterfly awards whereby people can nominate good practice in their local hospitals, or a local blogger or small charity that has made a difference in this field. I urge hon. Members to think about nominating people they know for next year. I will be there, listening to the awards. I will certainly be lighting a wave of light candle, and I know that many others will, too.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Before I put the Question, I should like to commend everyone who has taken part in this extraordinary debate, many of whom have shown incredible courage in talking about sensitive personal issues. Those who criticise this Chamber and the way it works should pay a bit of attention to how powerful it is when it operates as a unique forum for national debate, and how effective it is when it operates at its best, as it has done this afternoon.

Question put and agreed to.

Resolved,

That this House has considered baby loss.

Hormone Pregnancy Tests

Eleanor Laing Excerpts

Thursday 13th October 2016 Commons Chamber

[Yasmin Qureshi]

My right hon. Friend is right. It is amazing how other countries reacted to the evidence. The medical association in the UK was first alerted by Dr Isabel Gal in 1967, a paediatrician who said that her research showed that there was a link between women who had taken the drug and deformities in babies. Her letters and her research were dismissed out of hand by Dr Inman, who headed the regulatory authority. In a letter the authority referred to her in a derogatory manner as a “pathetic eastern European woman”, completely ignoring what she had to say.

We know that other information was available. For example, in February 1969 a committee received a letter from a Dr Dean of the Royal College of General Practitioners, who stated that

“Primodos should be withdrawn from use”.

However, the chief scientist of that committee, Dr Inman, refused to support that and instead wrote to the manufacturer of the drug, Schering, stating that

“the opinion expressed by Dr Dean that Primodos should be withdrawn should not be taken into account. Some women deliberately use excessive doses of Primodos with the intention of ridding themselves of an unwanted pregnancy”.

We have heard that Norway and Sweden banned the drug in 1970.

Again the Committee on Safety of Medicines took no action. Similar notices were issued in Finland, Germany, the USA, Australia, Ireland and the Netherlands, but again the committee took no action. In fact, in 1974 a letter from Schering—from PGT Bye—stated that

“after discussion with the Committee on Safety of Medicines we agreed some time ago not to recommend for the use of pregnancy diagnosis. It is not recommended for early pregnancy since the possibility of virilisation of the female foetus cannot be excluded with certainty”.

Yet still the committee issued no warning.

A further letter stated that

“side effects cannot be reliably excluded”

and that

“Primodos should no longer be recommended for the diagnosis of pregnancy.”

Again the committee said nothing. There are countless such documents. One of our concerns is that panels should have sight of those documents and be given sufficient time to read them, because they must be looked at properly and not ignored.

In 1975 the Committee on Safety of Medicines issued its first warning, stating:

“A number of studies have shown a possible association between Hormone Pregnancy Tests and an increased incidence of congenital abnormalities.”

On 15 October 1975, 41 years ago, Dr Inman wrote:

“We are defenceless in the matter of the eight-year delay”.

In November 1977, eight years after the committee had first been alerted, an adverse reaction leaflet was issued to the medical profession, stating:

“Further results have now been published and the association is confirmed.”

I want to refer briefly to some of the documents, many of which were archived in Berlin and at Kew. Marie Lyon, who chairs the victims association, has painstakingly gathered the documents, and the panel has been informed of them. I want to pay particular tribute to Marie Lyon, who has been doing a considerable amount of work over the past five years. She has spent months and months working on the documents, travelling the length and breadth of the United Kingdom and visiting Germany. She has effectively been working alone, with no support from Government bodies or local authorities. She and the victims association have been on their own. The only support they have had has been from members of the all-party parliamentary group and the Members in the Chamber today who have been fighting their cause. I also want to thank Jason Farrell of Sky News, who has been instrumental in getting some of the documents from Berlin and having them translated.

Translation of the documents is another issue, because many of those that came from Berlin are in German, as is to be expected. I want to know whether all those documents will be translated into English for the panel, because clearly it cannot carry out the inquiry if they are in a different language. We need to know whether all the documents that the victims association has gathered will be looked at and presented to the panel and, if so, in what format? When I used to prepare a large case with thousands of pages, there was a way of presenting the evidence so that the jury could understand it. Will that be done for the inquiry? If not, why not?

The reason we are asking these questions is that I have tried to contact the chair of the panel, Dr Ailsa Gebbie, and written letters to her, asking her to answer numerous questions, and, to be honest, we have not received a satisfactory answer to any of them. If anything, Marie Lyon, who has observer status on the panel, has been put under what I would call a gagging clause, which means she cannot talk about anything, because if she did she would be criminally prosecuted.

One of the things I remember from our discussion with the Minister was that the purpose of the inquiry was to have transparency and openness. We accept that there is obviously a need for a degree of confidentiality when evidence is presented, but we need to know what is going on. We need transparency, because without it, what is the purpose of this?

One thing the Minister promised was that the inquiry would have the victims at its heart. Yet, how have the victims been treated in this inquiry, which has been going for over a year now? I got a letter from one of the victims who turned up, and it is so distressing. The victims were told they could come and speak for a few minutes. Some travelled for five or six hours across the country to get to the hearing. They were promised at least 15-minute slots, but some were given three minutes or five minutes. Nobody even spoke to them properly; they were just asked to get on with it and to say what they had to say.

Fortunately, the victims who gave evidence were not subject to the gagging clause, so we were able to find out a little about what happened on the one day that seems to have been allocated for the victims. The panel heard from a few of them, but it did not ask them any questions. They were not cross-examined; they were not asked for anything—they just had three minutes. One lady said she was devastated; it had taken her five hours to drive there, and she was given three minutes. The victims said they were sitting so far from the panel, where the microphones were, that they were not even sure the panel was hearing what they had to say.

How can an inquiry that has victims at its heart not take more than a day to listen to them and, when they turn up, give them just three minutes? That is why we are having this debate. Given the way this inquiry is going, I do not think that any of the Members of Parliament who are supporting and assisting the victims have any confidence in it. As in the Hillsborough inquiry and the sexual abuse inquiry, everybody accepts that it is all about the victims; it is not about protecting regulatory bodies or the scientific community—it is about the people who have been affected.

There is another thing the Minister said. Obviously, it goes without saying that any inquiry must be independent—the panel members must be independent. When I raised that in a letter to Dr Ailsa Gebbie, the chair, she said, “Well, we got the expert panel members just to declare that they had nothing to declare.” There was no independent vetting or investigation into the background of any of these people. We have to understand this: people in the medical community, scientists and people in the pharmaceutical companies often work with each other. People have been advisers or consultants to somebody, or they have gone from the pharmaceutical companies into medicine or hospitals. There is a community of people who are linked.

We do not have the resources, but our basic research has shown that one of the panel members, Laura Yates, put on her social media that she does not think that Primodos caused any defect. How can this person be part of the panel? Then we have information about Doctor Schaefer. This man has worked with the company concerned, so he is directly linked with Schering—and he is still on the panel. That is two people, just from our basic inquiry. We want to know from the Minister whether the panel members will be properly vetted to see whether they are really independent and to find out about their connections. Again, without that, we will not have any faith in the inquiry.

We have asked the inquiry how long it will go on and how many sessions it will hold. There has been no response—nothing. We have tried to find out for well over a year, but nobody knows what on earth is going on with this inquiry. That leads to another question for the Minister. How long is the inquiry going to carry on? How many days have been set aside for it? How many hours have been spent on the inquiry to date?

In addition, how have the experts been chosen? We do not even know by what methodology they have been chosen. There are about 15 people on the panel, but does it need that many? Who are they, and how relevant is their experience to what they are looking at?

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I am sure the hon. Lady will soon be drawing her remarks to a close, in the knowledge that many other Members wish to speak this afternoon. She has vastly exceeded the guideline length of time, but I will allow her a peroration.

[Yasmin Qureshi]

I was just coming to the end of my speech, Madam Deputy Speaker.

Lastly, we are very grateful that the inquiry has been set up, but we have genuine concerns about what is happening with it and where it is going. As has been said, at the end of the day, there is no point in having the inquiry if it does not look at the things that matter, one of which must be to provide an explanation of the regulatory failures and the cover-ups in the 1960s and 1970s.