NHS Hysteroscopy Treatment

Debate between Jackie Doyle-Price and Barbara Keeley

Tuesday 31st January 2023 Westminster Hall

[Jackie Doyle-Price (Thurrock) (Con)]

It is a pleasure to serve under your chairmanship, Sir Mark. I wish I could say it was a pleasure to follow the hon. Member for West Ham (Ms Brown). I have genuinely enjoyed working with her on this subject for quite some years. But it is not a joy to follow her in this debate, because it is frustrating that we are still having the same discussion. It feels like groundhog day; it has been four years since I ceased to be the Minister responsible for this issue.

The hon. Member for West Ham reminds me that I started the moves towards the women’s health strategy, and established the women’s health taskforce, exactly because of the stories that she tells. It was very clear to me, when I started to look at this subject, that ultimately all the female Members of Parliament who are present have had terrible experiences at the hands of the NHS. We are very good at looking out for ourselves. If that has happened to us, then it is something that is being repeated for women up and down the land. It is something that we must address properly.

At the heart of what the hon. Member for West Ham is talking about is the principle of informed consent. Informed consent is the underpinning principle of our NHS. The stories that the hon. Member has outlined this afternoon show negligence around consent. They show women being referred for what is an investigatory procedure, not a treatment, without any proper consideration as to what they need to understand before consenting to such a procedure. The truth of the matter is that women find themselves undergoing a procedure in terrible pain before they even know what is happening to them. In 21st-century Britain, that is not acceptable.

We have made a lot of progress on centring women when we look at health, and ceasing to treat them as walking incubators for babies. We are human beings and we need to have our needs properly considered when we consent to treatment. We now have a women’s health strategy, which shows we have made some progress.

However, the hysteroscopy procedure has not received the attention that it deserves. Although two thirds of women who have the procedure go through it with less pain than in the cases we have heard today, a third of women experience terrible pain. That this is not properly explained to them is appalling. I have heard cases where women are just told to take some paracetamol before they go in and there will be no problem. For those women who do experience pain, as the hon. Member for West Ham has outlined, it is very severe. We must ensure that we have proper, well-understood protocols that govern how this procedure is managed, and how women are engaged in it.

The hon. Member for West Ham draws a parallel with mesh implants, and I think that is absolutely right. Again, the issue of informed consent was missing in many of those cases. We found that the mesh treatment was being routinely recommended to women after childbirth, women were not having any risks explained to them, and then, low and behold, they were suffering debilitating problems for the rest of their lives. As we roll forward with the women’s health strategy, we must stress-test exactly how much information we are giving to women, so that we can make informed consent an absolute reality.

The truth is, our wombs are not just here to incubate babies; they are part of us. The women here will have all had to go through invasive examinations internally. They are not very nice experiences. I do not know about anyone else, but when I have to do that I have an out-of-body experience where I zone out of what is happening to me. These women cannot do that, because they are suddenly visited with terrible pain. They cannot zone out of the fact that somebody is fishing around between their legs; they are living that, and that is an absolute trauma—a trauma that will stay with them for the rest of their life, notwithstanding the other side effects that they experience.

The women’s health strategy has alluded to some of those aspects, but I do not think it has taken up the issue with sufficient seriousness. It talks about the need for conversations about pain relief before a hysteroscopy procedure, but it needs to be a lot more than that: people need to be given sufficient information to enable them to decide whether or not they even want that examination. As many as 10% of women suffer with problem periods, fibroids and the kinds of conditions that would lend to them having such an investigation, but we need to be able to make that informed choice—“Is it really going to make a difference?” Frankly, if you are 71 years old, what difference is it going to make? All it is going to do is establish the cause of the bleeding. You might be better off managing that condition, because if there is going to be no end of treatment following the hysteroscopy, the whole thing is absolutely pointless, with a substantial degree of risk.

I am pleased to hear that the Royal College of Obstetricians and Gynaecologists is updating its best practice guidelines. I ask the Minister to consider inviting the women’s health ambassador, Lesley Regan, to carry out a proper stress test of everything around this issue. I had the pleasure of working with Lesley when I invited her to co-chair the National Women’s Health Task Force: she brings considerable expertise, including as a gynaecologist who is a woman. The truth is that far too many gynaecologists are male, and with the best will in the world, I do not think they are ever going to understand, let alone care about, the degree of pain that is being administered to their patients. I am really pleased with that appointment: Lesley is a fantastic advocate for women’s health, but I would like her to look at this issue properly so that we have a good set of ideas, advice and principles to help women make informed choices, and to make the medical profession understand exactly what difficulty this procedure involves for some women.

I invite the Minister to put that advice alongside some advice about healthy periods generally. Women need to be encouraged to take ownership of their gynaecological and menstrual health, but again, they can only do that with sufficient information. We will not avoid situations where women rock up to hospital for an appointment and, the next thing they know, find themselves on the trolley in stirrups without properly understanding what is happening to them unless everyone understands what good menstrual health looks like; what the alert factors are for some of the conditions that might invite a hysteroscopy examination; and what potential treatment might follow.

The hon. Member for West Ham has outlined the painful experiences that some people have had, but we all need to understand exactly what is involved in a hysteroscopy. It is an internal examination of the womb, which is undertaken by the insertion of a camera through the cervix. We know from the evidence that the hon. Lady and I have examined that women who have not had children are particularly affected by pain. If we think about what that procedure involves, it seems like a no-brainer that women who have not had children would suffer more pain, so again, I cannot get my head round the negligence with which women are referred for this procedure without proper consideration of the pain involved.

[Barbara Keeley]

I want to emphasise this aspect of the issue, based on what I was told by my constituent: the leaflet did not mention that the procedure can be stopped if the patient is unable to tolerate it. Can the hon. Lady think of another medical procedure that is run without anaesthetic on that basis—that it can be stopped if the patient cannot tolerate the pain? There are not many other examples.

[Jackie Doyle-Price]

No, and the interesting thing is that, in theory, a patient should be able to stop anything. That is what informed consent should be about. Again, it illustrates the relationship that we have with our health service. We naturally defer to medical professionals. We assume that they know better than us, and perhaps that is where we need to alter our relationship. These are human beings; they are not gods.

We need to be empowered to take more agency and ownership of how we approach these things. Listen to the description by the hon. Member for West Ham of Julie removing her hearing aids: there is no way that she was in control of that situation. How can a patient make informed consent and have the ability to stop something that is causing them significant distress and trauma in those circumstances? As I mentioned, it is extremely painful, especially for those women who have not had children.

We know that some women are just told to take paracetamol before they arrive, and there is a massive discrepancy from organisation to organisation when women try to exercise their ability to choose whether they have a general anaesthetic. In some cases, women are told that that is not really the best thing for them; in others, as we have heard, that elective choice was made quite easily. To me, that brings a real worry that too many in our medical establishment are not giving their patients the respect that they deserve. That is something that we really need to change in the culture of our NHS. It is all about behaviours, ultimately; we need to look at how we can encourage better behaviours towards patients throughout the system.

In the short time that I have left, I will make some specific asks of the Minister. I have mentioned that I would like her to invite Lesley Regan to properly stress-test this, but we need a proper risk assessment tool for each woman undertaking the procedure, so that both they and the medical professionals they are dealing with can make an informed choice on whether they are more or less likely to suffer the substantial pain that has been outlined in the debate. I also invite the Minister to consider the work of Baroness Cumberlege in “First Do No Harm”. One of the themes running through that work—and again, I mentioned mesh earlier—was the absence of informed consent. One of the conclusions we drew was that we need a proper patient’s voice to be able to stress-test those incidents where there is widespread poor practice in the NHS.

Ultimately, the NHS is a producer-driven system. We have care pathways that are very much process driven and not practitioner or patient driven, frankly. We must help practitioners to help themselves by empowering patients, because they need to have that mutual understanding on the same level. I invite the Minister to consider properly the establishment of a patient commissioner so that we have somewhere to refer these incidents of widespread poor practice.

We have outlined today the serious harm being done to women put through the procedure without appropriate care. That is doing real harm, and if we are going to have an NHS that works for all patients, we need to address incidents such as this extremely quickly.

Mental Health Act 1983

Debate between Jackie Doyle-Price and Barbara Keeley

Thursday 25th July 2019 Westminster Hall

[Jackie Doyle-Price]

On mixed-sex wards specifically, I cannot tell my right hon. Friend what the proportion is, but we are ensuring that the guidance on sexual safety on mental health wards is being rolled out. I will write to him specifically on that, if he will indulge me.

[Barbara Keeley]

An important point is that Matthew Leahy phoned the police to report the rape, but they concluded that it was part of his delusion—that was the reason they gave for not taking action. In the case of Whorlton Hall, the police also did not act on reports of assault, although assault was clearly going on. The Minister needs to take that problem up with the Policing Minister. It is not acceptable that what someone says is ignored if they are autistic or detained under the Mental Health Act 1983, because the level of sexual assault is disturbing, as my hon. Friend the Member for Bermondsey and Old Southwark (Neil Coyle) said.

[Jackie Doyle-Price]

That is an excellent point, and it plays into a general prejudice that people who are in detention are just an inconvenience to be managed. In the context of Sir Simon’s review, the whole ethos that any reform we make should be about empowering patients brings with it obligations to challenge other aspects of the system, not just the care providers. The hon. Lady is right to say that I need to take that up with the Policing Minister, which I will do as part of rolling out our preparations for the White Paper. I understand the hon. Lady’s lack of confidence when I say that the White Paper can be expected before the end of the year, but that is certainly my ambition, notwithstanding the fact that I know she has been waiting rather a long time for another paper that she was promised.

I can reassure the hon. Lady on the extent of the work that Sir Simon has done and the engagement we have had, especially with service users. Rather like the hon. Member for Bermondsey and Old Southwark, those service users shared with us their personal experiences, often reliving significant distress. Given that they have participated and that we have raised their expectations, we would, to be frank, be letting them down if we did not address that. I do not think that would be in any way forgivable, so, as long as it is on my watch, we will be pushing ahead.

As the hon. Member for Bermondsey and Old Southwark said, we are dealing with legislation passed in 1983, so although this appears to be a once-in-a-generation opportunity to reform this legislation, I hope that that is not the case. The situation is probably more symptomatic of the fact that we have not given this matter as much attention as it deserves, but clearly that has changed. The world has changed in terms of how we debate mental health, and that is welcome. Chiming in with the discussion we have had today, I am keen that we take this matter forward with consensus.

I pay tribute to the leadership that Sir Simon has shown in this review. As well as not ducking the controversial aspects of examining the legislation, he has engaged in dialogue and dealt with them in such a way that it is accepted that Members, peers, service users and professionals need to consider them. I am incredibly grateful for what he has done.

We talk more about mental ill health now, but when it comes to severe mental illness—the hon. Member for Bermondsey and Old Southwark spoke about schizophrenia —that is something that reveals incredible prejudice in people. As we have heard, if someone is able to manage their condition, they can live a full and independent life, but the key is being able to manage the condition with the appropriate support. We still have a lot to do in educating the public and society about the real impact of severe mental illness.

There are so many issues, but I will try to address them all in the time I have. The hon. Member for Bristol East (Kerry McCarthy) asked about out-of-area placements for people with autism and learning disabilities. I must say that this is something that really bothers me. Far too many people remain in institutional care and in out-of-area placements, and nowhere is that more true than in the field of learning disabilities and autism.

It is interesting, once we dig under the issue, to see that we have been very successful in getting people with learning disabilities out of in-patient care and into the community. However, that has been matched by a bigger increase in the number of people with autism finding their way into in-patient care. That tells me—I do not think this will be a surprise to anyone in the Chamber—that we are not doing enough to diagnose autism early enough, and as a consequence we are not equipping people with the skills to be able to live independently.

The ultimate result is that we end up putting people in in-patient care. Quite often, those people are forgotten about and it becomes very expensive to keep them there, so not only are we failing people by not having services for them early enough, but we are adding significant cost to the taxpayer and, frankly, doing harm, because the longer those people stay in in-patient care, the more their ability to live independently diminishes. As far as I am concerned, that is a major failing that we need to address.

[Jackie Doyle-Price]

I agree with every word that the hon. Lady says. One of our expectations of the new mental health support teams that we are rolling out into schools is that they will be able to work with schools and to spot people who might be in trouble. She is right that, with girls particularly, autism is under-diagnosed, and by the time the challenges start to have an impact on mental health, it is much more difficult to give people appropriate support. Early diagnosis is key.

I am pleased that we are now setting up a unit within the Department of Health and Social Care to look at neurodiverse conditions and what more we can do to improve service provision for them. I am also pleased that NHS England shares my concern about this and that we can expect more work on it, but there remains a lot to do and I do not shirk from admitting that.

[Barbara Keeley]

There is also the financial difficulty that my hon. Friend the Member for Bristol East (Kerry McCarthy) referred to. Private hospitals that autistic people and people with learning disabilities end up in tend to be very expensive—we know that the placements can be as much as £730,000 a year. The answer is to fund placements in the community. Years ago, when we were moving people out of long-stay mental health institutions, there was a dowry system. The Government do not have a dowry system to help with this, so Transforming Care failed because there was no mechanism to transfer funding from the NHS, which is taking the hit on cost, to cash-strapped local authorities. If local authorities are to continue being cash-strapped, and I hope they are not, some mechanism is needed there. My party has pledged to put in £350 million a year of transfers to make that happen. Does that idea recommend itself to the Minister? I know she is bothered about this.

--- Later in debate ---

[Jackie Doyle-Price]

It is a fantastic school. It was amazing how the principle of mental wellbeing ran through the whole school from walking in to the point where the kids pick up a sticker that reflects their mood and put it on the whiteboard, so straightaway the teacher could look out for those who were feeling a bit distressed. The other amazing thing was the teaching assistants, who instead of being based in each classroom all had specialisms and did lots of one-to-one activities outside the classroom. Even more importantly, there was a facility to reach out to parents pre-birth—obviously families tend to go and see schools. I was hugely impressed, and that goes to show how we should be encouraging innovation and imagination with regards to these services. In fact, it is probably the poster organisation to show that mental health is not everybody else’s problem; it is all our problem. The ability for such engagement in school is fantastic, so well done Charles Dickens Primary School.

Members will be pleased to know that Sir Simon Wessely has worked with the sector, and interest groups in the sector, in coming up with his proposals. I am also in regular dialogue with them to discuss the principles. In the spirit with which we all approach reform of the Mental Health Act, we obviously want to keep people safe, so there needs to be the power for potential detention, but most importantly we need to protect the rights of patients and empower them. That is the principle that I really want to underline.

[Barbara Keeley]

We have moved past the point of discussing people with autism and learning disabilities. I take on board the Minister’s concern, but I wonder whether she could answer my question. Under a reformed Mental Health Act, is she looking at—or minded to look at—changing how people with autism are included as if they have a mental health condition? That is important to a lot of people, and Sir Simon did not rule on it.

[Jackie Doyle-Price]

We need to look at issues about autism in the round. The hon. Lady is right that it is currently treated as a mental health issue for the reasons outlined by the hon. Member for Bristol East: it is not diagnosed until a mental health issue materialises. That is really the issue. I would like us to use the 10th anniversary of the Autism Act 2009 to reboot our approach to ensuring that we are looking out for people with autism. In a way, we must go through the same journey with autism and learning disabilities as we have with mental health. That does not really answer the question from the hon. Member for Worsley and Eccles South.

[Barbara Keeley]

It is about the legislation.

[Jackie Doyle-Price]

As far as legislation is concerned, ultimately people with autism who are suffering from mental ill health will be detained under the Mental Health Act. Perhaps we ought to pick up how that interacts with other legislation as we develop the White Paper. The overlap is a clear problem.

I have paid tribute to Sir Simon Wessely. We are all about making sure that our reforms deliver genuinely person-centred care. We should be removing coercion and control as far as we can.

My hon. Friend the Member for Plymouth, Moor View (Johnny Mercer) talked about Georgi Lopez, who addressed the all-party group and whom I had the pleasure of meeting. She tells a compelling story about her contrasting experiences. She readily concedes that on one occasion being detained under the Act was the best thing that could have happened to her, but on another occasion it did her genuine harm. In fact, Members who read Frank Bruno’s book will find exactly the same story. It is almost as if once someone is on that pathway and under detention, they will always be seen through that prism. We need to tackle the underlying prejudice. People who are suffering from mental ill health are vulnerable; they are not an inconvenience. Any services provided by the state need to be working with them to support them, not to do them harm.

Our overall objective when we asked Sir Simon to look at the Act was to reduce the rising number of people detained under it. I hope that underlines the spirit with which we are approaching the inquiry. We also asked him specifically to address the disparities in how the Act is used, highlighting in particular the impact on black and ethnic minority groups, but also on women. It is of great credit to him that he went much further than that and led a full review of the entire Act. Again, that raises the expectations on me to deliver fundamental reform—but that is fine; it is what I am here to do. He did so with such speed, and having taken so many with him, that he has provided exactly the right conditions to approach reform.

Sir Simon built relationships with service users and carers, and I am riding on the back of them. I meet those people regularly to hear directly from them about their responses to his recommendations. We will continue with that. I have been struck by some of the experiences shared with me by service users and family members, which bring home how disempowering it can be. I often talk about the arrogance of medical professionals who, when someone turns up and says, “Fix me,” send them along. That dismissiveness can be more so in mental health than anywhere else. We need to ensure that we put in a regime that treats people with dignity and respect.

At the heart of this issue, the current Act has much too big a disempowering effect, which does too much to remove people’s autonomy and not enough to support their decision making and influence over their own care. It is dehumanising. We should look at detention as the last resort, because it does genuinely do harm. That is not to be critical: staff will act with the best of intentions, but a lot of it depends on culture. When Georgi Lopez shared her experiences, she talked about the two very different cultures of the organisations in which she was detained. When the CQC visits such places and assesses whether they are well led, it must assess the culture and whether patients are genuinely empowered.

I do not think we should duck the fact that sometimes we will have to detain people for their safety and that of others, but we need to ensure that we have the right guarantees in place. I am struck by something that Sir Simon always says: from the moment of detention, release planning should start there and then. A credible care plan is all about getting people back out and re-empowered. It should be based on consent and empowering the patient.

As has been mentioned, Sir Simon’s report contains 154 recommendations. I will work with the Ministry of Justice on a joint White Paper from both Departments, which will come forward by the end of the year. We have already started to implement the recommendations that we can, and I hope that Members are reassured by how, last week, the previous Prime Minister re-emphasised her commitment to making sure that we tackle the issues regarding black and ethnic minority detainees. I know she will continue to have a full interest in these issues from the Back Benches. I reassure the hon. Member for Worsley and Eccles South that if she sees no sign of a White Paper, she has a good ally on the Government Benches to hold the Government’s feet to the fire. I look forward to engaging with all hon. Members on those recommendations when we come forward with our White Paper, for which we should also consider the issues that have been highlighted during the debate.

As I have said, we want to modernise and ensure that people who are detained under the Act receive better care by improving patient choice and autonomy in their treatment. We will introduce statutory advanced choice documents to enable people to express, in advance of detention, their view on the care and treatment that works best for them.

It is important to talk about the role of family, because we have agreed that patients should be able to identify a nominated person who will have the power to look after their interests under the Act. At the moment, the next of kin is the default. I have heard compelling evidence from patients who have said that that is not always appropriate. Family members can often be a source of abuse or additional pressure and harm, so patients want to be able to nominate someone, which seems extremely sensible. I recognise that that will cause some controversy.

National Marriage and Mental Health Awareness Weeks

Debate between Jackie Doyle-Price and Barbara Keeley

Thursday 16th May 2019 Westminster Hall

[Jackie Doyle-Price]

That is a very good point. We can expect employers to start doing things when they can see a return for themselves. It is interesting also that, as we reach higher levels of employment and as an appropriately skilled workforce is harder to come by, employers see the advantage of giving more help and support to their staff in order to retain them and keep them productive. We look forward to seeing more of that. Certainly our work through “Thriving at Work” with Mind, Paul Farmer and Lord Stevenson is designed to share best practice and encourage more.

My hon. Friend also talked about the long waits for children’s mental health services, which the hon. Member for Worsley and Eccles South (Barbara Keeley) also talked about. We have to concede that, historically, children’s mental health services have been very poorly funded and supplied, and we are dealing with the aftermath of that now. Everyone knows the extent of our ambition to deliver much improved mental health services to children and young people. However, we still have to properly address the situation that we have inherited. We are playing catch-up, but we will push forward and make sure that children have access to services. The mental health support teams are the first point of contact for children, helping them look after their own wellbeing.

[Barbara Keeley]

One interesting point, which I did not make, from the piece of work that I referred to from yesterday is that placements for children and young people in private units of the type that I talked about are more expensive. They can be £500,000, £600,000 or £700,000 a year, whereas support in the community would doubtless not be as much as that. They would not be 200 miles away from the families, and they would have the support that they need.

[Jackie Doyle-Price]

I agree completely. The reason why we have so many children in out-of-area placements—which, as the hon. Lady says, are expensive—is that there has not been sufficient support in the community. Nor has it been available early enough to give the children support. They have been badly failed. It has done them harm and made them more ill. The issue of out-of-area placements is of massive concern to me. I am making it a personal priority to fix it. I am concerned that, because it is seen as a specialised area of commissioning for NHS England, it commissions a quantum of beds, but that is what leads to them being out of area, and children are referred to them. We all know that their recovery will be much better if they are in their support networks near their friends and families.

When the system works well, it is absolutely inspirational. I visited an intensive care unit in east London last year. A young lady had come out the other side, having gone in for treatment for self-harm and anorexia. She was very clear that being able to undergo treatment while still being able to attend school was crucial to her recovery. To me, that seems compelling. I am deeply unhappy at the extent to which out-of-area placements are still being used. I am afraid there will probably be a need for them until we can be properly confident in our community services to work more effectively, but I am sure we all agree that we need to tackle it as soon as we can.

I enjoyed listening to the observations of the hon. Member for Strangford (Jim Shannon) about what makes a happy marriage. He is right that hard work is a big part of it.

The hon. Gentleman also shared the length of marriage in his family. This year, my parents are celebrating 50 years of marriage. Having lived with them for 21 of those, I have to say that that is quite an achievement. Obviously, it takes real work. As he says, quite often we do not like our partners, but clearly, notwithstanding the difficulties, they give us comfort and security. Not having a support network to rely on, whether that is a partner, wider family or friends, makes life a lot more difficult. I recognise that some relationships will be rollercoasters. Pressures, such as financial debts, can cause untold difficulties in relationships. There will be times when people need support and we need to make it easy for them to ask for it. We have heard several references to organisations that try to give support to couples, such as Relate. A problem shared is a problem halved—we need to encourage more of that.

I was horrified by the story that the hon. Gentleman shared of the couple neither of whom wanted custody of their children. That suggests that they were the product of dysfunctional families, which is another thing to consider. If we leave children to grow up in dysfunctional families, they will repeat that experience. We need to try to do better to improve the quality of family relationships, because that would be good for society. When we look at the back stories of people who end up in prison, we see that there were no end of opportunities where they came into contact with the state, either at school or in other ways. That is a failure for us and we need to tackle it.

It is always a pleasure to listen to my hon. Friend the Member for South West Bedfordshire, who really is a social justice warrior. Again, he brought home clearly the effect of the state applying process to everything and forgetting the humanity of people. We need to be more sensitive about how we intervene supportively. The institutions and the way we organise society can be excessively intimidating and formal, which is not the way to deal with people who need more emotional support. We need to think carefully about what sort of agencies should do that. The beauty of schools, and directing support via schools, is that they are not intimidating or formal institutions. Parents and children have peer support there, over and above their actual attendance, from friends and other people attending and taking their children.

We need to look at the avenues for engagement with people and make sure that they are fit for purpose, and to recognise that all Departments have a role in that. We siloise that contact. Mrs Bloggs takes little Jimmy to school, has a nice relationship and feels that they are being supported, but when she goes to the Department for Work and Pensions, she is treated as an operational performance and it is dehumanising. That is where we need to be more joined-up in the support that we are giving to families. There is a lot to learn. State institutions rely on process to ensure uniformity and fairness, but that does not always lead to good outcomes.

As my hon. Friend said, Governments are expected to do everything, but for the reasons I have outlined they are not always best placed to do that. Sometimes, rather than inventing processes and grand programmes, we should look more actively at letting 1,000 flowers bloom. Where third-sector organisations bring value, we should look at directly commissioning more services from them. That is the case in respect of mental health, because not all support for people suffering mental ill-health is clinical. Quite often, they will benefit from support that just helps them to get through life. That is something that third-sector organisations can do well. I have challenged clinical commissioning groups to look more actively at what they can do, because they will be able to deliver more care by not always relying on clinical staff.

I greatly enjoyed listening to the hon. Member for Glasgow North (Patrick Grady). He is wearing a fetching tartan and I am jealous that we have only the green ribbons. I will think about how we can outdo the Scottish tartan for Mental Health Awareness Week next year. He reminded us that it has been quite a week for mental health and mentioned the axing of “The Jeremy Kyle Show”. The incident that preceded that axing is a wake-up call; it shows that dysfunctional families have become entertainment. What does that say about how we operate as a society? I hope this gives everybody an opportunity for some self-reflection; it is not something that we should use for entertainment.

[Barbara Keeley]

I wanted to refer to what the hon. Member for Glasgow North (Patrick Grady) said about detoxifying issues, which is important. The worst thing that I have read about “The Jeremy Kyle Show” is not that it focused on dysfunctional families, but that it set people against each other in an aggressive way, so it needed bouncers and security staff on hand to part people. The programme seems to have used a toxic formula, which is something that the House could look at through an inquiry, because that could persist in other types of filming. Clearly, it has had a tragic outcome, which, given the Minister’s brief, we have to take seriously.

[Jackie Doyle-Price]

I share that view. By definition, if people are making TV that is designed to be entertaining, it will be manipulative and exploitative. A good friend of mine went on “I’m a Celebrity…Get Me Out of Here!”—not the person who was an hon. Member, but someone else. He told me in great detail about how situations were manipulated to generate conflict. Because he is already a celebrity, he is resilient and well equipped for that, but we can imagine that for people who are not, and for whom being in the public eye is new, the risk of harm is significant. I understand that the Digital, Culture, Media and Sport Committee will be looking at the issue, and I welcome that inquiry. If someone switches on the TV, there will be any number of reality TV shows on—often because, in truth, they are cheap to make. Given their proliferation, perhaps we ought to have some standards that producers should respect.

Another example—this shows how much rubbish I watch on TV—is the axing of “Celebrity Big Brother” earlier this year, or perhaps last year, because of an incident between two celebrities on it. I think the public showed such revulsion because they were celebrities whom the public perceived they knew. If it had been the non-celebrity version and they were two strangers, I doubt that there would have been the same reaction. That tells us that, actually, we have all been manipulated by it. It is only when something terrible happens that we stand back and think, “Hang on a minute, we shouldn’t be doing this.” But here we are.

The hon. Member for Worsley and Eccles South made some very fair criticisms about the challenges to children and young people’s mental health. I agree that one of the reasons that we are where we are is that, historically, child and adolescent mental health services have been far less effective than they ought to have been. I watched the Sky film that the hon. Lady referred to, and I have to say that some of the practices that were referred to in it are utterly unacceptable.

I have been very clear with the CQC that institutions that apply restraint to the extent that the hon. Lady described are totally unacceptable, and it is now being much more aggressive in implementing inspections. We will hold organisations to account. In that respect, the Bill in the name of the hon. Member for Croydon North (Mr Reed) will be a great help. We are in the process of agreeing guidance to deliver that. It will require a real cultural change, but I often say that sunlight is the best disinfectant. The best led institutions are open about when they have to use restraint and fully document it; the worst do not report it at all, and that really has to change. That is something that the CQC challenges now when it visits organisations. I want the number not only out-of-area placements, but of in-patient placements more generally, to come down. That will be a mark of success and a sign that we really are investing in improved community services for our children and young people.

The hon. Lady also referred to the appalling extent to which the young lady in the film had come across people who had engaged in suicide and self-harm. I am pleased that we now have the Zero Suicide Alliance, which is led by the fabulous Joe Rafferty, the chief executive of Mersey Care. Our ambition is to have zero suicides as a consequence of any NHS-funded care. That was launched at the end of last year, and we need to use it as a tool to drive improvements in this area.

As the hon. Lady said, we have the mental health investment standards, whereby we expect local trusts and CCGs to spend more of their budgets on mental health. She suggested that funding should be ring-fenced. I have always felt that ring-fences can be seen as ceilings. However, we are committed, through the long-term plan, to ensuring that all local commissioners abide by those standards, which are a ring-fence in all but name. We are closer than we have been on that issue.

I again remind hon. Members about the troubled families programme, which has been dealing with 400,000 families. It will be revisited next year, and we would welcome any representations from hon. Members about how we can learn from it and improve how we help families with complex needs. Obviously, we need to develop better outcomes for all family members.

Coming back to Marriage Week, we know that good quality relationships are critical for all of us, as they add to our overall happiness. As my hon. Friend the Member for South West Bedfordshire said, some people do not necessarily want their relationship to be recognised as a marriage. None the less, we all benefit from stable, loving and supportive relationships. With my suicide prevention hat on, I will say that relationship breakdown is the biggest driver of suicide. That is another reason why we should always enable people to find help when they need it.

As far as the impact on children and their life chances is concerned, we know that by the age of five, almost half of children in low-income households have seen their families break apart, compared with only 16% of children in higher-income households. As my hon. Friend said, we must address that social injustice because when relationships break down, there is a risk of poor outcomes in the long run.

I see health visitors as very important partners—I always refer to them as my army. They are on the frontline, and their contact with people is less formalised. They are the one group of people who can engage with the entirety of the family. They look not just at the baby and mum, but at dad and the siblings, too. We need to take advantage of those interventions to do better for families in general.

We are spending £39 million on the reducing parental conflict programme, which is designed to reduce conflict between parents who are still together, and work with them to strengthen their relationship, exactly as my hon. Friend the Member for Congleton wants, to help them to stay together if that is what they want. We should also recognise that separation can sometimes be the best option, particularly if there are other factors involved that can cause distress for the children. Even in the event of a separation, continued co-operation and communication between parents and their children will give advantage to the child.

Although the Government will continue to support and champion marriage, we will not discriminate against other types of families who require our support. We will ensure that parents can access help when they need it, whether they are already married and need help to sustain their partnership, are not married and wish to improve the health of their relationship, or have chosen to separate.

I turn to what we are delivering through the NHS long-term plan. The improvement in perinatal mental health services will help us to engage people when they are at risk, assess people’s circumstances, give peer support and perhaps just make a decisive intervention at a time of real stress for families, where either the mother or the father becomes ill.

The theme of this year’s Mental Health Awareness Week is not marriage but body image. The two are not entirely unconnected, because how we think and feel about our bodies obviously affects how we engage with other people. Just as we need to get real and think about working harder, not everything will be ideal. We are not all going to have a marriage that is like a fairy tale 100% of the time, and we are not all going to look like Claudia Schiffer. That is okay—that is normal—and we just need to be aware of that.

It is worrying that, according to the Mental Health Foundation, 39% of children feel shame in relation to body image. We ought to think about the causes of that stark statistic. People are bombarded with images via social media, and so on, so we need to encourage parents to spend time with their children and make sure that children know what they can realistically expect. They cannot expect to look like the doctored images that they are being shown.

That comes back to the issue of quality time. Smartphones have been absolutely revolutionary for our society. Is it not fantastic that we can find information about anything we want and contact people at any time? However, face-to-face engagement, especially between parents and their kids, is really important. I pay tribute to Frankie & Benny’s, the restaurant chain, which has said that to encourage parents to speak to their children while they are having a meal, it will give them a discount if they hand their phone over.

We are so easily distracted by time spent on a phone. The first thing I do in the morning when I wake up, and the last thing I do at night, is to look at my phone. It is not very healthy, to be honest. We need to encourage our children to have a healthy relationship with their smartphones, and the same is true for ourselves. There is no substitute for some good parent-child conversation, and that does not need to take place via WhatsApp or text.

Broader mental health support is available to people who suffer from mental health problems. IAPT provides couples therapy for depression, which is available through the NHS. That directly helps relationships.

This debate has been interesting and thought provoking, and it has highlighted many issues that, although we may agree about them, we perhaps need to be more proactive about properly addressing. They are not the easiest things to deal with, because they are about human failings, but it is good to hear that so many colleagues are bothered about them and actively think about them.

Mental health problems can affect anyone, any day of the year. Those problems have a bearing not only on the wellbeing of the individual, but on marriages, relationships and children. We must continue to work together, across Government and with our partners, to address some of those issues. As a society, we all need to be more sensitive about the stresses of particular times, such as when people experience job loss, debt or relationship breakdown, to ensure that we give people appropriate support.

I am sure we can all agree that Marriage Week and Mental Health Awareness Week provide us with excellent opportunities to bring those subjects together. I am very grateful to my hon. Friend the Member for Congleton for bringing those subjects forward for debate.

Perinatal Mental Illness

Debate between Jackie Doyle-Price and Barbara Keeley

Thursday 19th July 2018 Westminster Hall

[Jackie Doyle-Price]

I agree and do not think the two points are in conflict. We need both—we need the wider package of support.

The theme we have been considering—of women not always being asked about themselves, and its being all about the baby—is not confined to the issue of perinatal mental health. Women face that across the board with respect to their health. The hon. Member for Worsley and Eccles South (Barbara Keeley) spoke about a women’s health strategy and women’s mental health. I co-chair a women’s mental health taskforce with the chair of Agenda, and in the coming weeks we will present our report on a year-long piece of work. It will have information about tools to enable the health service in general better to support women’s mental health. I am also doing more to raise the whole issue of women’s mental health, because I feel strongly that women are often disempowered in health settings. We need to give them the tools to take control of their own care and to feel empowered to engage in good conversations with medical professionals, to benefit their health.

We have heard anecdotal accounts of women’s experiences, and what has come across is the arrogant behaviour of some medical professionals. They see a large number of patients and they are not always sensitive to how best to communicate with certain individuals. We need that practitioner-patient relationship to work a lot better, particularly in the case of women. I am open to representations from everybody about what tool we can use.

The hon. Member for West Ham (Lyn Brown) is no longer in her place, but I have been impressed by her work on hysteroscopies with women. We are developing tools on that. I reassure all Members that women’s health and the way in which the national health service can better serve women are high on my agenda. I am not going to stand here and say that the world is perfect, but we have made perinatal mental health a priority in the five year forward view. We are midway through that review, so I should give Members an account of how far we have got and what more needs to be done.

To go back to 2010, the situation was really quite poor. Only 15% of localities had fully fledged specialist services in the community, and 40% of communities provided absolutely no service at all. People talked about a postcode lottery; clearly, we could not allow that to continue. We need to work towards universal provision. We are implementing the recommendations of the five year forward view for mental health taskforce, which reported in 2016. From 2015 to 2021, we are investing £365 million into perinatal mental health services. NHS England is leading a transformation programme to ensure that, by 2021, at least 30,000 more women each year are able to access specialist mental healthcare during the perinatal period. In May, NHS England confirmed that, by April next year, new and expectant mums will be able to access specialist perinatal mental health community services in every part of the country. We are making progress. The key to that is community provision.

[Barbara Keeley]

I asked the Minister a specific question: we are halfway towards the deadline for the 30,000 target—does she know how that target is going? Has there been an improvement of 15,000?

[Jackie Doyle-Price]

I will write to the hon. Lady with some detail on the figures, but the point is that the access is there. Obviously, it will take time to become embedded. We have a good direction of travel to deliver against that commitment and we will continue with that. Community-based provision is key, but we also need to ensure that there are sufficient specialist perinatal mental health beds in mother and baby units for particularly severe cases. NHS England has taken a more strategic approach to commissioning, so that there is a level of access that does not involve wide-scale moving out of area.

As ever with transformation programmes, change takes time, but we are on track to meet our commitments. We are investing £63.5 million this financial year to support the development of those specialist perinatal mental health community services across England. Our pace of change is to enable 2,000 more women to access specialist care. Last year that was exceeded, so we should maintain the pace that we planned in the five-year forward view.

I have visited one of the new in-patient mother and baby units in Chelmsford, where there are four new beds. That centre is expanding its capacity. As well as opening new centres, we are expanding the capacity of existing ones to give more support. In Devon, the trust opened a four-bed mother and baby unit in a reused space in April this year while the new unit is being built, so we still have that provision even though there is not the physical space. By the end of this financial year, we will have expanded the capacity of those beds by 49% since 2015 and there should be more than 150 beds available for mothers and babies in those units.

We are also expanding psychological therapy services, which successfully treat many women who experience common mental health conditions such as depression and anxiety disorders during the perinatal period. We have set an ambition for at least 25% of people with common mental health conditions to access services each year by 2020-21, including extending provision to ensure swifter access for new and expectant mothers. However, as we have heard today, getting perinatal mental healthcare right is not just about expanding specialist services in isolation. Many professionals in different parts of the health and care system are well placed to support women in the perinatal period. NHS England is working with partners to ensure that care for women is integrated and joined up effectively. More than £1 million was provided in 2017 to enable the training of primary care, maternity and mental health staff, to increase perinatal mental health awareness and skills.

NHS England has also invested in multidisciplinary perinatal mental health clinical networks, which will include GPs across the country to support that strategic planning, working across services to ensure that those wider services are in place. The role of GPs is central in identifying when someone is suffering from perinatal mental illness, and to ensure that those women are directed towards treatment. The role includes monitoring early-onset conditions, including pre-conception counselling, referring women to specialist mental health services, including access to psychological therapies, and specialist perinatal community teams where necessary.

I am aware of the NCT’s #HiddenHalf campaign; I am grateful for its campaigning on this important issue. The National Institute for Health and Care Excellence recommends post-natal checks for mothers and new-born babies. NHS England expects commissioners and providers of maternity care to pay due regard to the NICE guidelines. My hon. Friend the Member for South West Bedfordshire raised this issue and said that, since this was part of what we should expect from GPs, it seemed anomalous that so many mothers and babies were not getting such checks. We make clear to GPs what we expect of them, as part of their contract, but ultimately we rely on clinical commissioning groups to ensure that GPs deliver against the obligations that we expect of them. This is not the only case where this happens—many GPs are not delivering learning disability health checks either. We need to be clear with NHS England that we expect that obligation to be delivered.

--- Later in debate ---

[Jackie Doyle-Price]

I was coming to that—I was just dealing with the point made by my hon. Friend the Member for South West Bedfordshire.

Moving on from the NICE guidelines, we clearly expect GPs to do their part in identifying and supporting women. We are aware of the campaign, but any changes to GP contracting arrangements to specifically include the six-week check-up would need to be negotiated with the GP committee of the British Medical Association. Those negotiations are taking place and will be completed by September. I cannot give any firmer commitment than that, other than to say that we obviously want to see GPs make their contribution.

[Barbara Keeley]

I just want to reiterate what I said earlier: the Opposition support that campaign and would look at implementing it in government. I outlined that the NCT put a cost of £20 million on it. Clearly, the Minister could have that figure checked out, but it is balanced against the £1.2 billion extra cost to the NHS and social care of perinatal mental health problems in every one-year birth cohort. There really is a point here about investing to save further down the road.

[Jackie Doyle-Price]

I thank the hon. Lady for that. As she says, if we are talking about £20 million in a broader settlement, that clearly should be under consideration given the outcomes that could be achieved on the basis of the evidence we have seen. I am not negotiating the contract, but we will have the outcome of those negotiations in the not-too-distant future. Members on both sides of the Chamber expressed very clearly the view that they want GPs to be able to do more to support new mothers. That message has been well noted, and I thank Members for making it. They said they wished to give me as much as assistance as they could in my battles on these things, and they certainly made a very strong case.

I want to come back to health visitors. I am a firm believer that health visitors are uniquely placed to identify mothers who are at risk of suffering, or are suffering, perinatal mental health problems and to ensure they get the early support they need. In fact, I visited the Institute of Health Visiting only a couple of weeks ago and heard a moving story from a new mum who had gone through a mental health crisis. It is striking that she had experienced all the feelings we have talked about—she felt there was something wrong with her, she could not bond with her baby, and she got more and more depressed and withdrawn about it. The other interesting thing about that case was that it was dad who felt utterly powerless to do anything. Only their relationship with their health visitor enabled them both to reach out for help.

I am under no illusions about the importance of health visitors. I was privileged to meet so many fantastic advocates for them as part of the NHS’s 70th birthday. They are our eyes and ears in so many ways, and they are our intelligence network in tackling adverse childhood events. I am full of praise for the important job they do in supporting new parents and families through a child’s early years. I am really pleased about the success of the Institute of Health Visiting perinatal and infant mental health champions training programme. Those 570 champions play a crucial role in spreading good practice and early identification of mental health problems.

Some hon. Members raised concerns about the decline in the number of health visitors. There was a substantial increase in the run-up to 2015, and there has been a fall since. I am bothered about that, so I will look at how we can encourage local authorities to alter that situation, recognising that in some areas local leaders have realised that health visitors can do so much more to deliver better outcomes for their communities. Blackpool, for example, has substantially increased the number of visits. I am really looking forward to seeing the outcome of that work, so that we can encourage that good practice in other local authorities.

I reiterate my thanks to all Members for their thoughtful comments and questions, but I especially thank the hon. Member for Stockton South and my hon. Friend the Member for South West Bedfordshire for securing the debate. I am very proud of our direction of travel in delivering and transforming perinatal mental health services so that we ensure that more expectant and new mothers are able to access high-quality mental health support, but we should never be complacent about that. I look forward to continuing the transformation programme.

Social Care

Debate between Jackie Doyle-Price and Barbara Keeley

Wednesday 25th April 2018 Commons Chamber

[Jackie Doyle-Price]

The ruling from HMRC is clear that those on sleep-in shifts are still entitled to the minimum wage, so we are working out a solution to those historical liabilities. We are clear that we expect all employers to abide by the national minimum wage legislation, and I hope that that gives the hon. Lady some clarity on that point.

We can expect the Green Paper to be brought forward, but I also want to address what Members have said about the variation in quality and availability of provision. As has been said, local councils are responsible for responding to that, and the CQC has rated 81% of care services as good, but it is important that we work with those that are performing less well to achieve significant improvements so that everyone is entitled to the best possible care.

I was pleased to hear the contribution of my right hon. Friend the Member for Ashford (Damian Green). His philosophical approach perhaps reflects the amount of time that he has spent thinking about this topic. I associate myself with the comment made by him and several Members across the House about the fact that no one has an unblemished record when it comes to debates about social care. If we are genuinely to come up with a long-term solution, we need a spirit of consensus to take people with us, and people on both sides of the House need to remember that.

In conclusion, we have had a full debate and it will not be the last time that we debate this subject. We are now quite a way down the track when it comes to working up real proposals to bring genuine reforms of the social care system to equip ourselves for a world where life expectancy ends not at 70, but at 100. That will require significant change. We are stepping up to the challenge and will bring forward proposals in due course.

Question put and agreed to.

Resolved,

That this House notes that Government cuts to council budgets have resulted in a social care funding crisis; further notes that Government failure to deal with this crisis has pushed the funding problem on to councils and council tax payers and has further increased the funding gap for social care; is concerned that there is an unacceptable variation in the quality and availability of social care across the country with worrying levels of unmet need for social care; and calls on the Government to meet the funding gap for social care this year and for the rest of this Parliament.

[Barbara Keeley]

On a point of order, Mr Speaker. The motion that has just been unanimously agreed calls on the Government

“to meet the funding gap for social care”—

widely said to be £1.3 billion—

“this year and for the rest of this Parliament.”

Given that Ministers have agreed to the motion, can you advise when we might expect an announcement from the Government on this important agreement on social care funding?

Mental Health Act: CQC Report

Debate between Jackie Doyle-Price and Barbara Keeley

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

One of the things that we are doing in prioritising mental health is dealing with exactly that issue. We are having discussions with every part of the health community. We recognise that all the professional organisations have a role in spreading best practice, but we need to do that as well, and the CQC report—and the fact that we are undertaking these reviews so transparently—will help us to do it.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

Today’s report lays bare the problems that are at the heart of the Government’s short-sighted and incoherent approach to dealing with mental health issues. The CQC has found the system to be “under considerable pressure”, with no improvement in the areas of concern raised in previous reports.

Rather than taking a preventive approach to mental health treatment, the Government have made real-terms funding cuts which mean that more people are at risk of being detained and fewer detentions are being prevented. Crucially, those cuts are causing less restrictive alternatives for the community to be removed at the same time as the reductions in the number of beds for admissions. As the report tells us, the number of detentions under the Mental Health Act 1983 has risen by 36% since 2010, and between 2015 and 2016 it rose by more than 5,000. Will the Minister note that between 2000 and 2009 rates of detention fell, largely owing to investment in community services by the last Labour Government?

Recent research by the Royal College of Psychiatrists showed that mental health services have less money to spend on patient care in real terms than they did in 2012, and more than a quarter of clinical commissioning groups underspent their mental health budgets last year. The Government make many claims about the funds that they have pledged to mental health services—as the Minister has today—but it is clear that the money is not reaching the frontline. The CQC thinks that reform of mental health legislation on its own will not reduce the rate of detention, and reductions in mental health beds and community services are clearly contributing to the rise in the number of detentions. Is it not time to increase funding for mental health, and to ring-fence mental health budgets?

[Jackie Doyle-Price]

I repeat that we have increased mental health spending by £11.6 billion. The hon. Lady suggested that a quarter of CCGs are spending less than their allocations on mental health, but that is not the figure that I have. We believe that 85% of CCGs have increased their mental health expenditure in excess of their allocations, which does not chime with what she said about community services. It may give her some reassurance to know that from next year, NHS England will ensure that the mental health investment standard forms part of its planning guidance. [Interruption.] The hon. Lady says “Next year”, but, as I have said, 85% of CCGs are already meeting the standard, and those that are not are experiencing intervention from NHS England. We are satisfied that the 85%—and it will be 100% next year—are investing more in mental health services beyond their allocations.

I agree with the hon. Lady, and indeed with the CQC report, that the review of the Mental Health Act is not the entire answer. That is the reason for the CQC’s annual inspections, and we will act on its recommendations, but central to the work that Sir Simon Wessely is leading is identifying non-legislative action that we can take in order to make the system work better, and we are involved in many cross-Government initiatives that will enable us to do exactly that.

Oral Answers to Questions

Debate between Jackie Doyle-Price and Barbara Keeley

Tuesday 19th December 2017 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The recent Health Survey showed not only that unmet needs were most concentrated among people who are the most deprived, as we have just heard, but that 2.3 million older people, aged 65 and over, now have unmet care needs—2.3 million. Neither the care Minister in her recent statement nor the Chancellor in his Budget said anything about closing the funding gap for social care. Given that the Green Paper is only scheduled for next summer, what is the Health Secretary doing about the crisis in funding social care and meeting staggering levels of unmet needs?

[Jackie Doyle-Price]

The hon. Lady will be aware that, immediately following these questions, we will be having a statement on funding from the Secretary of State for Communities and Local Government. I remind her again that we have made an additional £9.25 billion available for social care over three years, but she is right that the long-term sustainability will be addressed by reform, which is why we are bringing forward the Green Paper. As to the figures on unmet needs, I simply do not recognise them. The entitlement to care is enshrined in the Care Act, and those rights are protected.

Social Care

Debate between Jackie Doyle-Price and Barbara Keeley

Thursday 7th December 2017 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I thank the Minister for giving me advance sight of her statement, but it is a woefully inadequate response to the Opposition day debate we held in this place on Wednesday 25 October and in no way addresses the motion passed by the House.

That motion called on the Government to note

“the Conservative Party’s manifesto commitment to a funding proposal for social care which would have no cap on care costs and would include the value of homes in the means test for care at home”,

and we called on the Government not to proceed with their commitment to those proposals. The Minister has today finally confirmed what many of us on the Opposition Benches suspected: they will not be proceeding with their plans to cap care costs by 2020, as legislated for by the House. This a shameful waste of taxpayers’ money. Over £1 million in today’s money was spent on commissioning the Dilnot review, and it was a waste of parliamentary time enacting the cap. It is no good for her to say that the Government are consulting on the cap. They consulted on this during the general election, and their proposals were rejected by the electorate. Meanwhile, very many people are still faced with the catastrophic costs of paying for their care.

The motion also called on the Government

“to remove the threat to withdraw social care funding from, and stop fines on, local authorities for Delayed Transfers of Care”.

During the debate, I talked about how Ministers had previously threatened councils with fines and further funding cuts to social care if targets for cutting delayed transfers of care could not be met—fines for targets that half of social services directors believe to be unrealistic. Will the Minister confirm that the Government have listened to the will of the House and will stop these fines, which merely threaten to make the crisis in social care worse?

The motion also called on the Government

“to commit to the extra funding needed to close the social care funding gap for 2017 and the remaining years of the 2017 Parliament.”—[Official Report, 25 October 2017; Vol. 630, c. 312.]

At no point today has the Minister confirmed how the Government intend to enact the will of the House in meeting the funding gap—and of course, shamefully, there was no mention of social care in the recent Budget. Our social care system remains in a perilous state because of the cuts that this Government have chosen to make. The Care Quality Commission has told us that the social care system still remains at a “tipping point”. Will she now confirm that the Government will enact the will of the House and meet the funding gap?

The Minister in her statement addressed the Government’s decision to include the views of carers in the upcoming Green Paper and their failure to respond to the consultation of 6,500 other carers that has already taken place. As I mentioned in the debate, Katy Styles, a carer and a campaigner for the Motor Neurone Disease Association, contributed to that consultation and hoped that her voice would be heard. She told me:

“Not publishing the National Carers Strategy has made me extremely angry. It sends a message that carers’ lives are unimportant. It sends a message that Government thinks we can carry on as we are. It sends a message that my own time is of little worth.”

Will the Minister give more details on the scope of the carers action plan and reassure those 6,500 carers that their time was not wasted?

The Government announced recently, and the Minister confirmed today, that working-age people with disabilities would be consulted as part of a “parallel” workstream to the Government’s Green Paper consultation. Why a parallel workstream? This is an extremely short-sighted approach to reforming social care, and far from one that looks at the system in the round. Will she give us more details about the parallel workstream for working-age people with disabilities who have social care needs?

It is clear that only a Labour Government can deliver much-needed reform to our social care system. Over the coming months, we will also consult experts on how we can move from the current broken system of care to a sustainable service for the long term. We will look at funding options for social care in the long term, such as a new social care levy, an employer care contribution and wealth taxes. These experts will help to clarify our options for funding our planned national care service, and our approach will be underpinned by the principle of pooled risk, so that no one faces catastrophic care costs, as they do now or as they would have done under the Conservative party’s earlier dementia tax proposals.

[Jackie Doyle-Price]

The hon. Lady will not be surprised to hear that I did not agree with much of what she said, but I will address some of her points.

Fundamentally, we are setting out, as has long been established, how to get a longer-term, sustainable system for funding our social care. It is absolutely clear from our debates during the past year that, as far as the public are concerned, there is a real lack of understanding about how, at present, the cost of care has to be met by the person who requires it. That is what leads to catastrophic care costs, and the dementia tax that she keeps mentioning, and that is exactly what we are going to tackle by having a cap on the overall cost. In doing so, it is very important to take the public with us and to have a fully informed public debate. It does not matter how far we think we have had such a debate in this place when legislating in the past, because it is quite clear that the public do not understand this. [Interruption.] We are only going to get public consent for a long-term solution if we have a public debate that is handled with maturity, and so far we have not seen very much of that.

The hon. Lady raised the issue of carers, and she suggested that carers’ voices are not being heard in this debate. [Interruption.] I say to her that they very much are being heard. [Interruption.] She can sit there and chunter, or she can listen to the answer to the question. It is entirely up to her, but it is rather a waste of my time in coming to this place if I am just going to be talked over. [Interruption.]

Social Care

Debate between Jackie Doyle-Price and Barbara Keeley

Wednesday 25th October 2017 Commons Chamber

[Jackie Doyle-Price]

I could not agree more. I share my right hon. Friend’s support for the hon. Lady’s comments. There are still many opportunities to get working-age adults with disabilities into work. We have set ourselves a target of getting 1 million more people with disabilities into work, and we are very committed to doing that.

In response to the point made by the hon. Member for Worsley and Eccles South in her opening remarks, yes, much of the debate has focused on how we care for the elderly, but, as she and the whole House will be aware, support for working-age adults is becoming an increasingly big proportion of local authority spending in this area, and it is very important that we focus on it. Alongside the preparations we are making for consultation in the new year, we have a parallel work stream looking specifically at working-age adults, because some of the solutions will be similar and some will be different.

[Barbara Keeley]

It is very important that we have got to this point today, because very many organisations and individuals have been worried for months about that. In the Queen’s Speech and in letters the Minister has sent to me, the talk has been of a consultation on social care for older people. The wording needs to change if that is to encompass, as it should, working-age people with disabilities or learning disabilities. Let us stop focusing just on older people. If she would stop doing that in letters and we could have clarity on this, it would be helpful. I also wonder why there has to be a separate work stream.

[Jackie Doyle-Price]

There needs to be a separate work stream because it is connected to the desire to get more people into work, but the two programmes are working in parallel. As I said, today is a great opportunity to get that on the record. Certainly, it has been very much a focus of my conversations with voluntary groups in the sector.

--- Later in debate ---

[Jackie Doyle-Price]

I must make some progress, because I have taken many interventions. I do apologise.

Adult social care funding is made up of Government grant, council tax and business rates. The better care fund, which was announced in 2013, has further helped to join up health and care services so that people can manage their own health and wellbeing and live independently in their communities for as long as possible. The 2015 spending review introduced an adult social care precept that enabled councils to raise council tax specifically to support social care services. By 2019-20, that could raise up to £1.8 billion extra for councils each year. As a further boost to social care, the Chancellor announced in the Budget earlier this year that local authorities in England will receive an additional £2 billion for social care over the next three years. This year, £1 billion has been provided to ensure that councils can fund more care packages immediately. The additional money means that local authorities in England will receive an estimated increase of £9.25 billion in the dedicated money available for social care over the next three years. Statistics produced today show that spending on adult social care increased in real terms last year by 1.5% thanks, in part, to the precept.

[Barbara Keeley]

This is an important point. Our motion mentions the need to close the funding gap, which is not £1 billion but £1.9 billion. So £900 million is still not covered, and that is what councils are struggling with. The Minister makes the point about extra funding being raised from local taxation. Does she accept that there is still a funding gap, which means that people cannot be paid the national living wage? We are going to struggle all the way through winter unless the Government accept the existence of that gap and work to close it.

[Jackie Doyle-Price]

I do not accept that. Let us recognise that this has been hard in the past. We have made money available in recent years, but we know that local authorities have faced challenges. As one local authority put it to me, however, austerity has been the mother of invention, and I congratulate local authorities on the efforts that they have made. [Interruption.] That came from a local authority leader, and I agree that local authorities have shown considerable initiative by implementing savings. As for the national minimum wage, it is enforceable, so I do not accept the hon. Lady’s point at all.

[Barbara Keeley]

Does the Minister accept that the Government are providing less funding for social care than they were in 2010? She can check that with NHS Digital. The funding is less in real terms. It does not matter that it has increased this year because of the social care levy; it is less. Given the complexity of the issue and the growing demographic challenge, it is clear why we have this gap.

--- Later in debate ---

[Jackie Doyle-Price]

I reject the suggestion that there will be any kind of fine. The £22 million that the hon. Lady talks about will be retained for spending within Leicestershire. That funding has been allocated for a specific purpose, and where local authorities are not showing the improvement that we expect, we will work collaboratively with them and advise them how best to use that money.

Let me put on record exactly what we are going to do. There is significant variation in performance across local areas. We know that 41 health and wellbeing boards are collectively responsible for 56.4% of adult social care delayed transfers of care. That cannot be right, when other local authority areas have none. In particular, Newcastle has no adult social care delayed transfers of care, and if it can do that, other areas can as well, provided we have good partnerships and good leadership. I trust that I have demonstrated the extent to which the Government are supportive of the best performing systems where local government and the NHS are working together to tackle this challenge. However, we are clear that we must make much faster and more significant progress in advance of winter to help to free up hospital beds for the sickest patients and to reduce pressures on our A&E departments.

It is right that there should be consequences for those who fail to improve. Earlier this month, we wrote to all local authority areas informing them that if their performance did not improve, the Government may direct the spending of the poorest performers—it is not a fine—and we reserve the right to review allocations. It is important to note that the allocations will remain with local government to be spent on adult social care. It is not a fine; this is about making sure that public money delivers the intended outcomes.

[Barbara Keeley]

Is the Minister saying that revising an allocation is not a fine? When an allocation is revised—presumably downwards, not upwards—that is a fine.

[Jackie Doyle-Price]

I am sorry, but that is not the case. The money will be retained by local government, but we will direct the spending to achieve the outcome the money is intended to deliver. That is exactly what we should do as a Government, and it is how we ensure value for money.

The health and care system has committed staff and managers up and down the country who are working every single day to deliver the best outcomes for people.

Safeguarding Adults with Learning Disabilities

Debate between Jackie Doyle-Price and Barbara Keeley

Tuesday 17th October 2017 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Wilson. I join everyone else in paying tribute to the dignified and passionate way in which the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) outlined her case. It is truly heartbreaking. Lee’s mother is watching today. She put her trust in the institutions of the state to care for her son, and we failed her. It should never have happened, and for that I am truly, truly sorry. I give the hon. Lady and Bev my commitment that I will take lessons from this. I hope the hon. Lady will act as my conscience in ensuring that I do so. The issues highlighted across the Chamber today need to be acted upon, to ensure that we do our best by all our constituents.

I was struck by the way that the hon. Lady talked more generally about people with learning disabilities. It is, frankly, the reason we all get involved in politics—we get involved in politics when we see the state failing and to make sure we do the best for everyone in society and for the people we can see being failed. I do not think that any group is failed more than people with learning disabilities. They have potential and the ability to live independently, but all too often they have been parked. My hon. Friends the Members for Henley (John Howell) and for North Swindon (Justin Tomlinson) outlined examples of where, with some support, people with learning disabilities can lead very productive lives, but it requires support and investment. Sadly, that is not always forthcoming, and without it, they are very vulnerable, as this tragic case all too clearly illustrates. We owe it to them and to ourselves, in order to make the best of society, to do all we can to help people with learning disabilities to live independent lives.

We need to do more to tackle the whole issue of prejudice. The hon. Member for Newcastle upon Tyne North said she has been very persistent in trying to secure this debate, but perhaps it is fitting that the debate is happening in the middle of National Hate Crime Awareness Week. That is the perfect backdrop against which to address her case. It is fair to say that we are still early in the day when it comes to hate crime prosecution. There is slowness in reporting all hate crime, and suddenly people have become more aware.

People with learning disabilities are generally victims of quite widely held prejudice. It is not just the fact that they are targeted because of their disability; the agencies that should support them do not necessarily give them the support they need because of their disability. We have seen across the board, in so many examples of abuse, that particular social groups who are not the best at representing themselves do not always get a fair deal at the hands of the organisations that support them. We should look at that under the umbrella of hate crime, but it is slightly different; it is about prejudice more generally that we can all help to tackle. It is a very real inequality that we are tackling.

Central to our job as Members of Parliament is supporting people who have been victims of maladministration and who are not getting enough support from the state. In many cases, that is people with learning disabilities. I have always found that some of the most rewarding work I do as a Member of Parliament is in supporting people with learning disabilities. It is also the most inspiring, and it is great to see the enthusiasm that my hon. Friend the Member for North Swindon referred to.

Unfortunately the Minister for Disabled People, Health and Work, my hon. Friend the Member for Portsmouth North (Penny Mordaunt), is no longer in her place, but the fact that she was here is testimony to her support for this work. We are very keen that people with learning disabilities receive more attention. I give the hon. Member for Newcastle upon Tyne North that commitment, and we will continue to engage with her as this work develops.

I agree with the hon. Lady that people with learning disabilities are among the most vulnerable in our society, and it is the responsibility of all of us to protect them from risk. I will not pretend that we have got this perfect—there is a hell of a lot more to do. There has been significant progress in identifying and managing risk, but it is not consistent, and there are too many occasions when it just does not happen.

The hon. Lady articulated clear views on a specific case of hate crime. She will appreciate that that falls outside my bailiwick, but I will make a few observations, in so far as I can without treading on other Departments’ toes. As she said, the judge concluded that hate was not a factor in the motivation behind the crime. That is a matter for the courts, and it is for them to interpret, but I come back to the issue of prejudice. That case throws up a number of issues that we all need to be more vigilant about. We know that people with learning disabilities are very vulnerable to bad people, and bad people will find vulnerable people to prey on. I am aware that young women with learning disabilities are often preyed upon sexually, which is a real hidden issue that we need to think about. There is also the whole issue of modern slavery. People with learning disabilities are often subject to that. In this case, Lee was obviously being exploited financially by the people who murdered him.

[Barbara Keeley]

I did not manage to raise the very important point that my hon. Friend the Member for Newcastle upon Tyne North (Catherine McKinnell) raised about the fact that Lee Irving was labelled as difficult to help and classed as an adult who could choose a lifestyle, with such tragic results. That has echoes of other forms of abuse because, as my hon. Friend so clearly pointed out to us, his intellectual skills and reasoning were at 0.2% of those of adults of his age. Why were agencies saying that he could choose that awful lifestyle, which ended up having such a tragic result?

[Jackie Doyle-Price]

I totally agree with the hon. Lady. As she says, we have seen that in other cases of abuse. We can look at Rotherham and how the agencies behaved there. It is almost as if there is a view that, “He’s a bad ’un; he doesn’t deserve protection.” That is absolutely not the case. We need to be thinking about the person in a very person-centred way. It was very clear that Lee had a learning disability and did not have the capacity to act as an adult, yet he was treated as one. That is one of the real lessons of this case.

With specific regard to the requests of the family, the whole area of transition is certainly of concern to me. We see this issue in relation not just to learning disabilities, but to mental health. In both cases, families are often completely unable to influence support or care for their loved one; they are utterly powerless because they are in the control of institutions. We need to be learning the very clear lessons there.

We need to raise awareness of hate crime against people with disabilities. Too often, we look at hate crime through the prisms of race and gender. To be honest, we look at hate crime through those prisms because it is the victim of a hate crime who will raise it as such and, frankly, people with disabilities are in less of a position to do so. That said, things are getting better. As I said, it is early days for the offence and prosecution of hate crime, but I am told that in the past year the police have recorded an additional 5,558 disability hate crimes; the number is up by 53%. That suggests that people are more inclined to report it and that the police are more inclined to identify hate crime due to disability, but we continue to monitor the situation and see what else needs to be done to protect the vulnerable.

Health

Debate between Jackie Doyle-Price and Barbara Keeley

Monday 9th June 2014 Commons Chamber

[Jackie Doyle-Price (Thurrock) (Con)]

rose—

[Barbara Keeley]

rose—

[Mr Hunt]

I will give way to my hon. Friend because she is affected by Basildon hospital.

Transport (CSR)

Debate between Jackie Doyle-Price and Barbara Keeley

Thursday 25th November 2010 Westminster Hall

[Jackie Doyle-Price]

Thank you, Mr Gray. I have come to the end of the geographical comments. The point is that junction 30 is the place where so much traffic is impeded. It serves the Lakeside shopping centre and the port of Tilbury, which obviously needs access to transport goods around the country. About 92% of people travelling to the Lakeside shopping centre by car use that junction, and hon. Members will understand the impact of that volume of traffic. The traffic often spills on to the local road network and causes congestion, as well as going on to the M25 and, of course, the Dartford crossing.

We have a considerable number of local businesses which, as I mentioned, have an impact on UK plc. We must tackle junction 30 to enable south Essex to grow and business opportunities to expand. If I may crave your indulgence, Mr Gray, I will give two examples: the supply of Fairy liquid for the whole of Europe is made in my constituency, as is every jar of Hellmann’s mayonnaise. That needs to be transported around the country, and one can see the importance of West Thurrock as an industrial hub.

I have spoken with local businesses about the impact of junction 30 and congestion at the Dartford crossing on their business. Carpetright has its corporate headquarters at West Thurrock; 80% of the carpets that it supplies to the nation are cut on that site, generating £212 million. It told me that there are 3,500 lorry movements a year, which will have to attack the M25 via junction 30. It also estimates that 100 man hours a week are lost in traffic delays. Charles Gee, a local haulage firm, concludes that congestion around junction 30 and the Dartford crossing increases its fuel costs by £35,000 a year. That is the overall picture. I firmly believe that the congestion at junction 30, where the M25, the Dartford crossing and the A13 intersect, causes serious problems for local businesses and inhibits their opportunities to grow.

[Barbara Keeley]

The hon. Lady makes a strong case about junction 30 of the M25. Does she find it as puzzling as I do that, to take two congested stretches, the scheme that she mentions is shelved and does not go ahead, despite the strong case that she makes, but the totally unwanted scheme—the additional lane on the M60 that local people do not want at all—is to go ahead? I would generously offer up our scheme for the one that the hon. Lady wants.

[Jackie Doyle-Price]

I hope that the Minister was listening to the hon. Lady; I was struck by what she said. When I hear the business community in my constituency crying out for increased local investment and telling me that their biggest concern is the poor transport infrastructure, I am sure that such a plan would be welcome. It would be interesting to know why such a conclusion has been reached.