Body Image and Mental Health

Kevan Jones Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Mr Kevan Jones (North Durham) (Lab)]

I begin by agreeing totally with the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron): the debate is important. Last week we had a debate on mental health; we have two this week, one here today and one in Westminster Hall on Thursday afternoon on the Mental Health Act 1983. That is good because the more we talk about mental health issues, the more we normalise them. The hon. Lady is right. I have been a Member of the House for more than 18 years, and it has changed. The more we talk, the better. She makes a very good point.

Ministers are going into the twilight zone at the moment; seeing whether they are going to come out of the reshuffle. I add my thanks to the Minister to those of my hon. Friend the Member for Dewsbury (Paula Sherriff). The Minister has been a passionate advocate for mental health and she deeply cares about it. We know when a Minister gets it, and she does. I hope that she survives whatever happens over the next few days. The other thing that is unusual and does not get a great deal of publicity is the fact that she is prepared to work across party and across the House, and to listen to alternative viewpoints. I wish to put that on the record.

I pay tribute to the Mental Health Foundation for its excellent report. I know that the Minister was at the launch. I think it was the first time that body image and mental health had been brought together. The hon. Member for East Kilbride, Strathaven and Lesmahagow talked about eating disorders, and the stark facts that come out of the report should concern us all.

It is important to say that it is not just young people who are affected. As my hon. Friend the Member for Dewsbury said, 20% of the adult population in the UK feel ashamed of their body image and 34% feel down about it. In some cases, that will not lead to mental health problems, but in a lot of them it will. If people have anxiety about their body image, it leads to related conditions.

According to the report, 34% of young people feel upset about their body image and 31% feel ashamed of it. We cannot insulate young people from society—we should not even attempt to do so. Living in society can be difficult and challenging at times, and young people face the added pressure of social media.

[Ruth Jones (Newport West) (Lab)]

I thank my right hon. Friend for making such a positive speech in this important debate. Does he believe that social media and advertising have a significant impact on young people, and does he agree that the Government need to take more vigorous steps to ensure that young people are protected from images that can lead them to form negative views of their own body?

[Mr Kevan Jones]

I completely agree with my hon. Friend. I will go on to speak about the role of advertising because, as she will know, it has changed. When we were growing up, adverts were in magazines or on television. Now, they are accessible to young people 24 hours a day, seven days a week on smartphones and tablets. That has changed the pressure on young people, as is highlighted in the Mental Health Foundation’s excellent report.

Before I come on to advertising, I will touch on the issue of cosmetic surgery, which the Minister raised. Members may want to know why I am interested in the subject. It is down to a force of nature, my constituent Dawn Knight, whom the Minister has met. Unfortunately, several years ago a cosmetic procedure on her eyes led to the horrific situation that she can no longer close her eyelids. As the hon. Member for East Kilbride, Strathaven and Lesmahagow said, such procedures are not easily reversible. It is not like someone changing their hair colour and not liking it. The procedure has had a devastating effect on Dawn’s life. I pay credit to her, because she has been determined to campaign on this issue. I know that she has met the Minister on a number of occasions to highlight the dangers of cosmetic surgery.

The Minister referred to regulation. I have been calling for regulation in this area for five years. I do not think there is a lack of political will, and certainly not from this Minister, but I am told that the Department of Health and Social Care is so scarred by the Health and Social Care Act 2012 that it does not want to bring forward any more health-related legislation. I say to Ministers that they must. This is the wild west because there is no regulation.

The Minister rightly warned people not to go abroad for such procedures, because standards are not high. Sadly, I have to say that they are not very high in this country either. Dawn’s case and the cases of numerous women that Dawn has documented over the years show that surgery that takes place in this country is sold like a commodity. It is not sold as something that could threaten or change people’s lives; it is sold like any other product. I am sorry, but it is not like any other product. Some of these procedures are very dangerous and can result in death.

The problem is the way the industry is structured. There are groups that give the impression that they employ surgeons and that they are hospitals. One that I have spoken about on behalf of Dawn and other victims—that is what I call them—is the Hospital Group. One would think that it is a hospital that employs surgeons and nurses, but it is not. It is a sort of marketing facility company that has a hospital and flies in surgeons from Europe, sometimes on a daily basis. They fly in, operate and fly out again. The aftercare treatment is non-existent in some cases. As Dawn’s case shows, when people try to sue the individual, they find that their indemnity insurance does not cover the resulting legal case.

What we need is a properly regulated system. The fly-in, fly-out surgeons need to be banned. I am sorry, but it is not acceptable. People say, “We have the General Medical Council,” but that is another of my hobby-horses. It is an organisation that is ripe for reform. The Government have promised reform of how the GMC operates, but they have not brought legislation forward. We need legislation to reform it because, as I will say in respect of another organisation in a minute, I am never a great fan of self-regulation. I was one of those who campaigned to take regulation away from the Law Society. Self-regulation has clearly failed. Nearly five years on from her complaint against the doctor, Dawn Knight is still fighting. It is not a user-friendly process for anyone to get redress for their complaint and we need to address that as a matter of urgency.

Cosmetic surgery is advertised and sold like any other commodity. There used to be two for one offers on Facebook and elsewhere—buy one procedure and get another procedure free. There were time-limited offers. Those should all be banned; they should not be allowed at all, because some of those procedures are very dangerous and people are often not aware of the dangers. I would argue that such a ban is part of the regulation we need. This is not a multimillion-pound industry, but a multibillion-pound industry and it is exploiting people’s poor body image.

Before anyone had any type of cosmetic surgery, I would insist that they had a mental health assessment. Not only should the risks of the surgery be explained, but we should question whether people actually want the procedure.

Advertisers use “Love Island” to promote the idea of young women having procedures to enhance their appearance. That reinforces the image that somehow there is a perfect body to be had, but also the idea that these procedures are risk free. Having spoken to Dawn and other victims of cosmetic surgery, I know that these are not risk-free procedures. In many cases, they lead to mental health problems afterwards during the recovery process.

As the Minister rightly said, the ones who pick up the tab are us—the taxpayers. Not only do we pick up the bill for the correction of the surgery when these organisations fold themselves into new companies and go into bankruptcy, meaning that people cannot get any redress; we also pay for the mental health services for those individuals afterwards.

I say again that we need more regulation of advertising. The Advertising Standards Authority is a toothless tiger. The Mental Health Foundation’s report says that last year the ASA upheld a complaint against the producers of “Love Island” for promoting cosmetic surgery as part of the advertising package around the show. But anyone who has dealt with the ASA will know that it is slow and that it is not proactive. One of the report’s recommendations is that it should be proactive in looking at adverts in advance to ensure that they are pre-screened before they go out. Again, though, that involves self-regulation, and it does not work.

I accept that we have a Government at the moment who do not like regulation and who want to strip it out. We are possibly going to get more of that nonsense over the coming months from the new Prime Minister, but I take the clear view that the state needs to protect people when they are being exploited. On cosmetic surgery, I take the clear view that people who want to have cosmetic surgery have the right to choose what to do with their money, but they should have a fully informed choice rather than being pressured by glossy advertising.

Online advertising and body image have already been raised in the debate. We have heard about the way in which adverts and other images are photoshopped and that this is somehow a positive thing that every young person should look forward to. The Minister also mentioned Botox and fillers. Those procedures are not cosmetic surgery in the sense of people going under the scalpel, but I would argue that they are equally in need of regulation because of the appalling effects when things go wrong. According to some adverts, people can simply go along in their lunch hour and have a Botox or filler treatment and then walk away in the afternoon, but those are medical procedures. They are advertised on social media and elsewhere, but Botox is a prescription drug, and it is interesting that people seem to have access to it even though they have no qualifications at all. No qualifications are needed for injecting someone. Madam Deputy Speaker, I could inject you with Botox this afternoon—not that you need it—without any qualifications or training whatsoever. The Minister was right to say that the problem with the way in which social media algorithms work is that anyone who enters the term “Botox” into a Facebook search, for example, will then be bombarded by adverts not only for Botox and fillers but for training courses on how to administer them. People can actually sign up for those courses in order to earn money.

The only regulation around this is Facebook. Dawn Knight has raised the matter directly with Facebook, but I understand that the only thing anyone can do is to say to Facebook that they no longer want this on their feed and take it down. I have written to Sir Nick Clegg, who has now gone off to live with the beautiful people in California, to ask him why Facebook is carrying those kinds of adverts and bombarding vulnerable people with adverts for Botox and other fillers. Those adverts have no disclaimers about risk, and there is no quality control over the individuals offering the services. As the Minister said, they could be people in hairdressers and other such places. Well, I am sorry, I know Facebook is earning money from those adverts, but it should ban them. I know that the vulnerability of young people is a matter of concern for the Minister, for Dawn Knight and for me. They could be getting access to these procedures without knowing the risks, and they are being targeted by the social media companies. I am waiting to see what response I get from Sir Nick Clegg and the beautiful people in California. Hopefully, they will take some action against this.

This is a serious issue, not just in terms of the way people are personally affected; it costs the taxpayer money when cosmetic surgery goes wrong and when people need mental health support. We also need regulation. We are all focused on Brexit at the moment, and perhaps this is another area that will not be addressed over the next few months. I hope that that is not the case, and I know that the Minister will continue to argue for this reform, as she has already done in Government. I also know that my constituent, Dawn Knight, will not leave this issue alone. I will not do so either, because people are putting themselves at risk and it is the duty of the Government to take action in Parliament to protect individuals when they need it. There is a lot of pressure on young people when it comes to body image. All I would say to those young people today is this: think positively, and be kind to yourself.

[Wera Hobhouse (Bath) (LD)]

It is a real honour to speak in this debate, and I regret that not many people are here to participate in it, but as we know, today is today. Even though I have only recently become a Member of Parliament, I echo the comments about what a pleasure it has been to work with the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), and I hope that she will continue in her post.

We have talked about many issues, and I want to pick up on what has been said about the cynicism with which advertising exploits vulnerable people. I will be speaking mostly on eating disorders, and many victims of eating disorders already have a massive problem, even before they go online. If they then order slimming pills online, for example, they will be bombarded by adverts persuading them to buy even more, which they then do. That is nothing short of exploitation, and we need to be alert to that.

We are all ultimately affected by our body image. People might say to me, “Well, you look all right”, but we all think, “Well, this could be better and that could be better.” We all want to please the people around us and ourselves when it comes to what we look like, and that is nothing new. It is only unusual or harmful when it so negatively affects us that it is the only thing that guides our lives. There is a certain intolerance surrounding having to have a particular look, and that is where the real danger lies. People feel they have to look a particular way rather than feeling that it would be fun to look this way or that way and to be playful with what they look like. Instead, they are being shoehorned into a particular image, and anyone who does not fit that image can be badly affected and develop serious mental health problems, including eating disorders. I have been campaigning on the particular issue of eating disorders and mental health.

This debate is important for millions of people across the country, and I hope that we can set an example today by honestly exploring the issues. In fact, I think we already have. In a culture that is obsessed with image, we must talk more openly about the impact that body image scrutiny has on our mental health. It has been said before that we are focusing too much on how we look, rather than on who we actually are as people and what we can bring to the table, whether we are short or tall, male or female. That is one of the obsessions of our society: we are always thinking about what we look like, rather than about who we actually are.

For the past year, I have been campaigning for better treatment for eating disorders. Speaking openly about such conditions is more important than ever, because early identification and intervention are key. Mental health conditions thrive in the shadows and are protected by our ideas about what is and is not appropriate to talk about. Eating disorders have a reputation, and sufferers who do not fit cultural stereotypes are often afraid to speak out or, worse still, are refused help.

[Mr Kevan Jones]

The popular image of eating disorders is that they mainly affect young women, but does the hon. Lady agree that young men and people of all ages are increasingly likely to be affected?

[Wera Hobhouse]

The right hon. Gentleman is absolutely right, and that has been explored in several debates on eating disorders. We are somewhat hemmed in by stereotypes, and I wonder whether our age is particularly prone to that. We think eating disorders are a particular thing, so for a long time they have been a problem for young girls, but they affect people of all ages, and men increasingly. As we have explored today, body image and mental health are not gender-specific, but men suffer in silence more, because they are much less likely to talk about things, and subsequently they seek help a lot later, which can be dangerous. In fact, it is well known that the highest number of suicides is among men between the ages of 18 and 25, because men—this is a cultural stereotype that we can hopefully overcome—just do not talk about their body image, anxieties and mental health as much as women.

Research by the Mental Health Foundation published last March shows how common it is to have body image concerns, and we have heard many other statistics today. One in five UK adults have felt anxious or depressed about their bodies in the past year, and that anxiety can turn into long-term mental health problems, such as eating disorders. Across the country, eating disorders affect 1.25 million people, which is probably a conservative estimate. My work in this area supports that suggestion, and the sufferers I have met come from a range of different backgrounds, but they are united by their dissatisfaction with, and need to control, their body image. The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) has already talked powerfully about that.

Of course, eating disorders are far more complex than stress over body image. They are serious conditions that ruin, define and, all too often, end lives. However, the seeds of emergent eating disorders can often be spotted in stress or anxiety about body image. For the more than 1 million people who were identified as having an eating disorder, the outlook is not good. On average, it takes 85 weeks between someone realising they have an eating disorder and that individual receiving treatment. That lost time can be the difference between full recovery and living with a permanent disability or disorder. The Government targets introduced to limit child waiting times for eating disorder treatments were a positive step, but thousands of adults across the UK need the same measures. We need to consider the waiting times for adult sufferers of eating disorders, and I know that the Minister has already looked into that.

Understanding eating disorders better is key to improving treatment. Many sufferers still report being turned away and refused referral, because doctors have told them that they are not thin enough to be treated for an eating disorder—I know that the Minister has talked to Hope Virgo, who has been running the “Dump the Scales” campaign—but an eating disorder is not just about someone’s body mass index. By talking about eating disorders, especially in the context of body image, we can start to grasp how damaging that can be. We must educate everyone, from sufferers’ families to doctors, about the many different forms that such conditions can take and how best to treat them. Eating disorders have the highest mortality rate of any mental health condition, and our mental health policy must reflect that. This is a crisis, but we are not treating it as such.

Early intervention is key. Schools, doctors and support workers must be equipped with the tools to identify when body image concerns are becoming dangerous. Furthermore, we must change the cultural conversation around body image, which can be done on many levels. As we have already heard today, social media companies have a responsibility to police the content on their websites, ensuring that anything that actively incites self-harm is taken down. Eating disorders are on the rise, and many adult sufferers are failing to receive the early intervention they so desperately need. We must do better for those suffering in silence and start having a conversation about body image, mental health and the awful reality of life with an eating disorder.

--- Later in debate ---

[Jackie Doyle-Price]

I shall not detain the House for too long, because I think it has heard enough from me for one day. I thank Members for their generous comments, even if they might be career-limiting.

In this debate, however, there is consensus across the House. We all fully recognise the problems that we face and the need for decisive action to tackle them. I will certainly continue to work with all Members to do exactly that, because this is too important and—I make this observation—the people out there expect us to work together more often than not. Such subjects should not be a political football, and it is too important to ensure that we are tackling harms.

The hon. Member for Dewsbury (Paula Sherriff) made the observation that the debate might not be as well attended as previous ones, but to be fair we have had many such debates in this space. Many Members, even if not present this afternoon, clearly have a keen interest. I am utterly at one with her when she expressed her concern about a context in which we have normalised unrealistic body image. Such images have become so normalised that it will take a lot of effort to address it. She also referred to the incident of the lady who, sadly, died as a result of accessing a Brazilian butt lift from a surgeon in Turkey. Unfortunately, she is not the only such person from this country. It is the most dangerous cosmetic procedure that can be undertaken and, as a consequence, is banned in this country. None the less, despite the ban, people are still bombarded with images and with adverts for where they can seek the procedure. That brings home the fact that we need to do much more to make people aware of the risks.

Many Members referred to the influence of advertising, and I am afraid that those organisations that profit from hosting advertising ought to have a duty of care and ensure that the material they carry does not expose people to harm. I therefore welcome the engagement that the right hon. Member for North Durham (Mr Jones) is undertaking with Facebook on exactly that. It is not good enough for social media providers to retreat to the defence of, “Well, we are a liberated platform, regulated by our users.” Where they become a vehicle for things that will cause harm, those social media providers have a duty of care to the people who use their platforms. We must all continue to challenge them on that issue.

We have had lots of references to “Love Island”. Collectively, perhaps we ought to challenge use of the term “reality TV”, because it is not reality TV; it is fantasy TV. [Hon. Members: “Hear, hear.”] So that might be the outcome of today’s debate—let us all talk about fantasy TV from now on, because such programmes promote lifestyles that are not normal or achievable. Let us do that.

[Mr Kevan Jones]

Will the Minister challenge the producers of a show such as “Love Island” to produce a series with real people in it, rather than one with the image that they are trying to portray now?

[Jackie Doyle-Price]

I could give that challenge, but the sad thing is that I do not think that any of us would watch that—although I do not think that many of us watch it now. Frankly, I like my dramas gritty and real. Ultimately, ITV broadcasts “Love Island” because it attracts many viewers—many of them among the most vulnerable group we are talking about. Again, ITV should be much more responsible, although the show is one of its biggest earners. I just regret the fact that we have become such a nation of voyeurs, and we all need to reflect on that point.

It is interesting that, because the people in these so-called reality TV shows are not known to us—they are not celebrities—we do not really see what we are doing to them in these circumstances. I do not know whether any hon. Members used to watch “Big Brother”, but there was an occasion when a contestant on “Celebrity Big Brother” effectively had a meltdown on TV. The public reaction then was very different; I think it seemed more real to people because it was a celebrity and the public were invested in them. That illustrates just how pernicious these so-called reality TV shows are, with their anonymous celebrities. These people suddenly become very exposed, and we have seen the outcome for some people’s mental health when they re-enter the real world. I know that ITV has reflected on some of those risks, but there is much more to do. As I said, let us start calling them fantasy shows.

The hon. Member for Dewsbury also mentioned the whole issue of body-shaming online. We have accepted as normal some really unpleasant behaviour online. I always use the example of drinking and driving. It did not matter that drinking and driving was made illegal; it was only when it became socially unacceptable that people really stopped doing it. We need to get to that stage when it comes to how people behave online. Again, this happens because people do not see others as real people online. When people make abusive comments online, it is because they feel that they are able to. That has got to stop and we need to lead the way.

The hon. Lady also asked what it takes to make the social media companies actually do something about this. In the context of suicide content, it took a death—and it should not take a death. With regards to other content, I suspect that it will also take deaths to get these companies to do something. That really is not good enough. I pay tribute to those who are brave enough to share their experiences of self-harm and suicide as a result of what they have seen online, because they are really helping us to drag the social media companies to where they need to be.

The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron)—I never pronounce it right—articulated the fact that this area is an artificial world that becomes more and more intense. When we start using the internet and looking at things on social media, we do find ourselves dragged into a deeper and deeper world of “like” content, and it is easy to cease to be objective in those circumstances. We have certainly seen that with regard to self-harm and anorexia sites; it is just constant. The journeys that some people have been through are akin to grooming. People can find themselves being groomed by online content by sheer accident. Given that context and given how we use devices these days, it is not difficult to see why people are becoming much more exposed to such risks. Safe ways of using the internet—using iPads and so on to access content—has to be central to any education we give children about looking after themselves because that level of intensity clearly causes harm.

The hon. Members for East Kilbride, Strathaven and Lesmahagow and for Bath (Wera Hobhouse) talked about eating disorders, the clinical pathways available and out-of-area places, all of which are issues that really bother me. It has to be said that we have done well on children’s access to help with eating disorders—and I think it was right to do so because if we can tackle these issues early with children, we are tackling eating disorders—but it has highlighted the risks that exist when children cease to be children and become adults. The level of service is not as good when people enter adulthood, particularly through the whole period of transition, and that in itself can cause harm. We have heard about Hope Virgo’s #DumpTheScales campaign and the fact that different clinical standards are being applied for children and adults. That is clearly something that we really need to fix and it is a key priority for me.

I also fully recognise the danger of out-of-area placements for people with eating disorders. Part of people’s recovery has to be the relationships that they have with family and friends. I have seen that very clearly with children and young people. Generally, we need to reduce the number of out-of-area placements for people with acute mental health issues, including eating disorders, but I will not be satisfied until we have no out-of-area placements at all. Having people long term in beds in hospitals is not good for their mental health. Clearly, there are cases where there is a need for intensive treatment and we need to do that, but over time, out-of-area placements really should not be a thing.

The right hon. Member for North Durham, as usual, brought to the debate his very well-informed knowledge of this subject. I join him in paying tribute to Dawn Knight and all the campaigning she has done. She has not been shy about sharing the devastating impact of what she did, telling her story of how she just wanted to enhance her appearance and the result has been absolute hell. Neither is she shy about sharing exactly what the impact will be on the NHS as a consequence of the treatment she has had to have to put it right.

This whole area of cosmetic surgery is growing very quickly, and people are quite naive in thinking that perhaps the more money they spend on a procedure, the better it is going to be. Nothing could be further from the truth, because there are the least virtuous of people in this space. As the right hon. Gentleman says, this is the wild west. These people are profiteers. Part and parcel of enabling people to protect themselves in this environment is to really talk about the risks. There are some absolute cowboys out there. The story that Dawn tells about trying to sue the practitioner who undertook her procedure shows that that is frankly impossible. When people want to become engaged in activity that is borderline criminal, they find ways of making sure that they cannot be held to account for it. Whatever our instinctive view about people’s choice, self-regulation and so on, where there is clear evidence of harm, the Government should act. We really must look at this more seriously. I am happy to continue speaking to Dawn and to the right hon. Gentleman about that.

Clearly, we need to look at the whole issue of dermal fillers. It is classed as a medical device and therefore is not on prescription, but ultimately something is being injected into the face, so we need to make sure that we are doing something about regulation. The right hon. Gentleman mentioned the role of the GMC. As he says, Botox is a prescription drug, but it is clearly being administered by people who are not practitioners. Both the GMC and the Nursing and Midwifery Council have an obligation to uphold their regulatory standards. If someone is using their prescribing power irresponsibly and not being present when the product is administered, then action should be taken, and I shall expect those bodies to do that.

[Mr Kevan Jones]

I agree with what the Minister says, but if we look at some of the adverts—for example, on Facebook—there is no way that people who are signing these prescriptions can actually be present. Her Department should look at this area, because there are clearly people signing prescriptions and then either selling them on for a profit or giving them to people to make money out of these procedures.

[Jackie Doyle-Price]

I am grateful to the right hon. Gentleman for amplifying that point, because we must do that. We give very clear indications that we expect the NMC and the GMC to deal with this. However, we must also send a message to people out there that people will get these adverts about how to become a dispenser of dermal fillers and think that that is all they need to do, having no idea that they are committing a criminal offence. We need to educate them as well.

I will end there, because, as I say, I feel like I have been the Government at the Dispatch Box today. I look forward to continuing discussions with all Members present, who I know care very deeply about this. It is something that we really must tackle as a matter of urgency.

Question put and agreed to.

Resolved,

That this House has considered body image and mental health.

Children and Mental Health Services

Kevan Jones Excerpts

Tuesday 16th July 2019 Westminster Hall

[Mr Kevan Jones (North Durham) (Lab)]

I thank the hon. Member for Burton (Andrew Griffiths) for securing this debate. It is important because the simple way to change attitudes around mental health in this country is to talk about it. The more we do it in Parliament, the better. I pay tribute to all those, including charities such as Rethink Mental Illness, that have made a real step change in the way that we consider mental health in this country. I also give credit to the Minister. She obviously does not know what will happen next week with the change in Prime Minster, but she has been a great champion for mental health in not only doing the work that she does, but caring about it. Sometimes we get a Minster who simply goes through the motions, but this Minister cares deeply about the subject and has made a real difference.

The point about finance is important in mental health. That point has been made over the years not only in respect of adult services, but in respect of children’s services, and it has been made again today. Having the proper workforce is also important. I do not want to relegate those two issues because they are very important in this debate, but the other thing that often does not get spoken about is having a proper pathway into a service, which is a mess at the moment, partly as a result of reorganisations in the health service. We have also had cuts to local authorities and they can no longer afford to fund voluntary sector organisations. Sure Start centres have been cut, and the cuts are having an impact on people’s access to services.

I pay tribute to CAMHS. They get a bad name, but they are trying their best in the impossible job that we give them. We have to try and turn down the pipeline of people going into CAMHS services. The only way we can do that is if we have a proper triage system before going into CAMHS, so that people know whether they can get help elsewhere. We often over-medicalise mental health conditions. The Tees, Esk and Wear Valleys mental health trust in my area has a good pilot that pays for a psychiatrist to sit in a GP’s surgery so that a mental health professional can triage cases as they come in. I do not want to criticise GPs, but they are not mental health professionals. They should have a mental health professional who can triage the cases that need to go through to CAMHS or other adult mental health services and then they can try to help the others.

We need a local network of support organisations, whether it is the voluntary sector, as the hon. Member for Burton rightly pointed out, or others that do fantastic work. He put his finger on the issue of how we tender for mental health services. I am sorry, but the ones that I speak to in County Durham have contracts that are too big and they do not have the capacity to take them on, but they do valuable work in the community. In some cases, it is a way of taking pressure off the pipeline going into CAMHS and adult mental services. Parents want to know where to go, so we need signposts and pathways so that people do not wait 12 months or longer to get into CAMHS, thinking that will somehow answer their questions.

[Andrew Griffiths]

I thank the right hon. Gentleman for giving way and for his great speech. Does he agree that one of the reasons why they tender in that way is because they want to have a uniform approach across the whole country? In reality, if someone wants access to a service, people understand the local charity and are much more aware of it, and more likely to go to it for that very reason.

[Mr Kevan Jones]

I do agree. In my experience the best local examples of mental health support are what is being done by local charities, most of which, frankly, run on a shoestring. They do not ask for huge amounts of money. I think it would be cost-effective for the taxpayer if we directed services into that, but we need that joined-up system. If we do not have it, we can pour as much money as we like into the system and it will not work.

I want to mention one last thing—students’ mental health, which is being highlighted in universities. Will the Minister contact Northumbria University, which is doing innovative work on using new technology to track students and highlight those who are vulnerable? I saw it a few weeks ago on a visit to the university. It is a new model, which could have implications nationally, and I think it is worth looking at. I will finish by just saying, let us keep on talking about this subject.

Public Health: County Durham

Kevan Jones Excerpts

Wednesday 12th June 2019 Westminster Hall

[Mr Kevan Jones (North Durham) (Lab)]

I beg to move,

That this House has considered public health in County Durham.

It is a pleasure to serve under your chairmanship, Mr Owen. I am pleased to have secured this debate, but it is unfortunate that we have to have a debate on public health to highlight the effects that the Government’s cuts have on one of the poorest counties in our nation. I thank the men and women of the NHS, those who work in public health for the county council, and the voluntary and community sectors, which are part of the matrix of support for delivering in County Durham not only general healthcare, but, importantly public health.

In recent years, there has been debate about Government funding not just in health, but in local government and other areas. That debate starts from the premise that everywhere is the same, so a fair funding formula spreads the jam evenly around the country, but I am sorry—that is just not the case. Deprivation and need are factors that must be taken into consideration. In local government funding, fire service funding and police funding, need and poverty have been removed as determinants.

County Durham is a large rural county of 525,000 people. It faces some unique issues on health, partly because of the legacy of the county’s industrial past of coalmining and heavy industry, which means a high incidence of diseases associated with those industries, such as respiratory diseases, which put particular demands on the health service.

We also have a legacy of rapid deindustrialisation in the 1980s, when the hearts of many of the coalmining and steel communities across County Durham were ripped out by the policies of the Thatcher Government. That legacy remains in terms of hopelessness, drug and alcohol abuse, obesity and smoking, as well as the poverty that goes with all that. Previously, I have described County Durham as a rural county with urban problems, but those urban problems are sometimes ignored because of County Durham’s rurality.

We also have a growing elderly population. In the period to 2035, the number of people aged 65-plus will rise by 31%, and the number of people aged 85-plus will rise by 82%. That puts particular demand on the health service at all levels, in both the community and the acute sectors. Life expectancy in Durham is 78.3 years for men and 81.4 years for women. I will mention two other counties, and allude to the reasons for doing that later in my remarks: in Surrey, life expectancy is 81.5 years for men and 84.8 years for women, while in Hertfordshire, it is 81 years for men and 84.2 years for women.

The figures for healthy life expectancy, which indicates the age at which people develop serious health concerns, are even worse. In County Durham, they are 58.9 years for men and 58.7 years for women, whereas in Surrey, they are 68.3 years for men and 68.7 years for women, and in Hertfordshire, 64.9 years for men and 65.9 years for women. People in County Durham who get long-term health issues get them sooner than people in more affluent areas, which leads to demand on our health service. We are always told by the Government that we need to stop people using the health service to reduce the demand placed on it, but unless we tackle some of the underlying causes of the problem that pressure will continue.

Responsibility for public health funding was transferred from the Department of Health and Social Care to local government in 2013-14. I supported that move because public health is best delivered locally. The budget devolved to County Durham in 2013-14 was £40.5 million, based on the assessment of health needs by the primary care trust, which was abolished under the same legislation that introduced the transfer of responsibilities. To give credit to County Durham, it has used that money effectively, with services commissioned both directly by the county council and externally by private and third-sector organisations.

As with many things, however, devolution of responsibility for public health came with a sting in 2016, when the budget was reduced by 12.8%. That was part of George Osborne’s strategy, in a host of areas, to devolve money locally and tell the local authority to decide where the cuts would come. He could then stand back and say, “That decision has to be made locally.” But that misses the point. By sleight of hand, he sought to give the idea that somehow he had no responsibility for the cuts when he had top-sliced the budgets.

To be fair to County Durham, its public health priorities were the right ones to tackle. The funding was directed towards the control of tobacco and cessation of smoking, teenage pregnancies, obesity and weight reduction, mental health—an issue close to my heart—and improved dental services. I do not know whether the Minister is aware of this, but when I was first elected in 2001, certain areas of my constituency had no access to dental services at all. That has changed—not since 2010, I hasten to add, but certainly under the last Labour Government.

County Durham also targeted drug and alcohol addiction. I give it credit for the work that it has done on that. In the light of the recent confessions of the Conservative party leadership contenders, I think that they could take note of the available drug and alcohol services. However, unlike those middle-class people who have confessed to drug use, the young people we are talking about will not go on to glittering careers in the media or elsewhere. They will be pushed into a cycle of poverty and desperation at local level, and will add to our shared tax burden, because their demand on health, police and other services will increase. I always look at public health as an investment in our local communities to ensure not only that we have good public health outcomes, but that we reduce demand elsewhere in the system.

[Helen Goodman (Bishop Auckland) (Lab)]

Before my right hon. Friend moves on to the next section of his speech, I want to congratulate him on securing this important debate. What shocks me is the fact that in Woodhouse Close in my constituency, the healthy life expectancy is 10 years lower than that in Barnard Castle, yet those two places are only 10 miles apart. The notion of cutting public health funding seems grotesque.

[Mr Jones]

My hon. Friend is correct. She highlights that example in County Durham, but there are many more between the more affluent areas and the pockets of poverty. They have been there since the 1980s and they need to be addressed. I am passionate about this issue; the idea that where someone lives should determine how long they live, in a wealthy country such as ours, is wrong. We should be able to tackle that in this day and age.

The new funding formula, ironically called the fair funding formula—trades description comes to mind—is based on the premise, pushed mainly by a lot of Conservative Members, that somehow the needs of individuals in health and other areas are the same across the nation. That is just not the case. The methodology put forward by the Ministry of Housing, Communities and Local Government means that County Durham will lose 38% of its existing budget—that is £18 million a year. It is the worst loser in this process, because the dedicated, ring-fenced public health budget is being abolished. It is being pushed in terms of the business rate retention scheme, which concerns me because it means that there will be areas where councils—I will refer to two in a minute—that get a budget increase will have no duty at all to ring fence that money and put it into public health. That is a retrograde step.

County Durham has achieved a lot: smoking is 22% down and teenage pregnancy is down to a level that is no longer statistically different from national averages. That certainly was not the case when I was first elected in 2001. We have made great strides getting cardiac mortality down from 31 deaths per 100,000 in 2001 to 5.7 deaths per 100,000 by 2015. A lot of effort has gone into addressing suicide rates, particularly among men. That is a credit to multi-agency work, including the police, the voluntary community sector and others. We have a good-news story in the sense that we have a good partnership-working approach in County Durham, yet the Government want to take that budget away.

People ask, “Why can’t it be made up from elsewhere in the council budget?” This is a county council that has had its budget slashed by nearly £240 million since 2010. It is due to lose another chunk of funding under the so-called local government funding formula. The scandalous situation, and the reason I mentioned Surrey earlier, is that, while County Durham will have its budget cut by 38%, Surrey County Council’s budget will be increased by £14.4 million a year, and Hertfordshire’s by £12.6 million a year. It cannot be right—I will give some reasons in a minute—that money is being moved from deprived areas such as County Durham in the north-east to some of the most affluent areas in the United Kingdom. The life expectancy and other figures that I mentioned earlier are not comparable. That is not a fair way of distributing that money.

It is not just County Durham that is affected; the north-east loses some £40 million under the proposals, in some of the most deprived parts of this country. Gateshead, for example, loses 12.44% of its budget; Redcar and Cleveland loses more than 27%; South Tyneside, one of the most deprived parts of the region, loses 29%; and Sunderland loses 24%. That will not address health inequalities and stop people going into the health service; the cuts to the most deprived areas cannot be right.

There is a deliberate policy—not just here, but in other areas—of moving the central Government grants or funding formulas to benefit mainly Conservative-voting southern areas. That is the worst example of pork barrel politics. The Conservative party leadership contenders talk about one-nation conservatism. If this is one-nation conservatism, they can keep it. The cuts will have a direct effect on the ability of healthcare professionals to provide services. It is not acceptable to go backwards on smoking cessation and drug treatment.

What has been going on? The county council has lobbied; it has written to the Minister, met Public Health England and worked with other local authorities not just in the north-east but elsewhere, such as Blackpool Council, which is also affected. It has contributed to the fair funding review. It is not just politicians on the Labour county council; the health and wellbeing boards, the police and crime commissioner, and the local NHS trusts have all argued that this is not correct, because they see what is coming down the road. If these short-sighted cuts take place, the demand on local acute services will go up—exactly what the Government and NHS England want to avoid. That disjointed approach beggars belief.

What do we want in County Durham? We want and need a clear commitment to public health. That is referred to in the NHS forward plan, but with no funding commitment or power to ensure that local councils deliver good-quality public health. We need a form of funding that reflects need. We also need a clarification on timetable. I understand that a decision is being kicked right back to the spending review. When the spending review will take place, given the chaos in the Conservative party, I do not know.

There is real pressure on the county council and other bodies because they have to let contracts—the current contracts come to an end in March next year. If there is no clarification by the end of this year, that will not leave much time for those organisations not only to tender but to let those contracts. That will lead to a lot of organisations worrying about their future. A lot of public health is delivered by the local voluntary community sectors. They rely on that, and they do a fantastic job. We cannot have money deliberately moved to areas of prosperity. I challenge the Minister to conduct an impact assessment on the effects of the cuts, to highlight those effects.

It does not surprise me what the Government are doing because they have done it in every other area, particularly local government funding. I do not question the commitment of the Minister to good-quality public health, but there is a disconnect in relation to the funding formula and the Ministry of Housing, Communities and Local Government. On 7 January, I asked the Health Secretary directly about the issues concerning County Durham. He said:

“That is obviously not right. Indeed, there is a whole section of the plan on reducing health inequalities, which is extremely important.”—[Official Report, 7 January 2019; Vol. 652, c. 77.]

He might recognise the importance of public health, but MHCLG does not. That is not a very good example of joined-up government.

This is not charity; it is an investment, not just in the lives and wellbeing of individual constituents in County Durham but in the future of the country. Unless we tackle some of these health inequalities through good public health, our efforts to relieve the pressures on our health service will come to nothing. In a statement on exiting the EU, the Prime Minister, who will not be with us much longer as Prime Minister, said she wanted to work

“across all areas to make this a country that truly works for everyone, and a country where nowhere and nobody is left behind.”—[Official Report, 10 December 2018; Vol. 651, c. 25.]

If these cuts go through, those words will be pretty hollow, because County Durham will be left behind.

[Phil Wilson (Sedgefield) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Owen. I congratulate my hon. Friend—

[Mr Kevan Jones]

Right honourable.

[Phil Wilson]

He is my right hon. Friend, as he reminds me. I congratulate my right hon. Friend the Member for North Durham (Mr Jones) on securing this timely debate. He has been a real campaigner on this issue in County Durham for many years, and I know he takes a real interest in the public health issues we face in Durham.

The backdrop to the debate is this: we face cuts to public health provision in the north-east of England, primarily in County Durham, at the same time as we see a parade of candidates to be leader of the Conservative party, virtually all of whom want to cut taxes by billions of pounds. I am beginning to wonder where exactly the money will come from for any kind of public sector provision. Those claims of future tax cuts will probably end up being unfunded after Brexit, considering that the pot of tax money for the public sector will be reduced anyway.

As my right hon. Friend said, we may face cuts to public health services of around £18 million in Durham. I reiterate what he said about Surrey and Hertfordshire: under the new formula, there will be a £14.4 million increase for Surrey and a £12.6 million increase for Hertfordshire. That cannot be right when we consider the problems we have with health and healthcare provision in Durham. Sedgefield grew up, as a community, on coal. The number of men who worked down the collieries and are still alive today but have ailments related to that industry, such as lung disease and arthritis, just goes to prove that there is a requirement not to cut funding but to increase it.

If we look at random at some areas of health, we see that the figures for Sedgefield are worse than the national average in all of them. It has higher than the national average cases of dementia, patients on antidepressant drugs, patients on painkillers, asthma sufferers, people with high blood pressure, people with depression—the list goes on and on. We are talking about a formula devised by algorithm rather than by listening to what healthcare professionals say the county needs. People in Durham can expect to live a decent life in good health for seven years less than people in Surrey and nine years less than people in Hertfordshire.

Great strides have been made over the years in the use of the public health grant in County Durham. For example, the smoking rate has reduced from 22% to 14%. However, smoking during pregnancy is still an issue and still above the national average. About 20% of the people who live in Durham—I think that is about 114,000 people—are under 19. They should all be due some kind of safeguarding provision. If the cuts go ahead, will we have the health visitors to provide that? The cuts will affect the safeguarding of young people. If drug and alcohol services are reduced, the police will have to deal with an even greater problem of rising crime.

The chief executive of the Tees, Esk and Wear Valleys NHS mental health trust came to see me about the cuts a couple of weeks ago. Because of cuts to public health, fewer and fewer health visitors and school nurses are going to schools and people’s homes. Because that provision is not there, the trust has to see people it would not otherwise have seen because they would have been seen at home or school. Its provision for people with mental health problems is being put under more and more stress. The cuts are impacting on services other than those provided through public health funding.

One thing for which public health services have mandatory responsibility is health visiting services for those under the age of five. The breastfeeding initiation rate in County Durham is 59%, compared with 74% in England as a whole. Health visitors play a pivotal role in helping and encouraging women to continue to breastfeed their babies until they are at least six months old. Public Health England guidance acknowledges:

“Mothers who are young, white, from routine and manual professionals and who left education early are least likely to breastfeed.”

Cutting the public health grant to an area in which many women fit that profile and which is already way behind on breastfeeding rates would once again penalise an area with real need.

Then we have obesity. In the fight to keep the population healthy and active, healthy weight is of core importance to the public health agenda. An estimated 14% of adults on GP registers across the Sedgefield constituency are obese, with the figure in some areas as high as 19%. Five of the 15 neighbourhoods with the highest rates of obesity are in County Durham. In the south-east, which may end up with increased public health provision, those rates are in single digits—around 8%, if not less. In Richmond Park, the figure is 3.6%.

The common theme in all this is that if we cut public health provision in our communities, other providers will be affected. Those providers, which otherwise would not have had to provide those services, will end up doing more and more. The mental health trust told me that case loads are skyrocketing for some of its workers. How, for example, will they be able to look after young people with mental health issues that are not picked up at school or in the home? Those young people will be passed along the road to mental health trusts, which will not be able to cope because they, too, face cuts. That needs to be addressed.

[Mr Kevan Jones]

Does my hon. Friend agree that, especially in mental health, the outcomes for an individual are better if we intervene early, at a young age, rather than leaving problems untreated for many years?

[Phil Wilson]

That is absolutely right, and that is an issue that the mental health trust raised. If those issues are picked up in the early years or when someone is still at school, they can be resolved. Leaving them just puts extra strain on the mental health trusts in the area.

I want to end on a positive note. I had some schoolchildren in Parliament yesterday from the primary schools in Ferryhill and Chilton. Cleves Cross Primary School in Ferryhill has a whole host of initiatives around mental health, eating properly and so on. Around the village, it is setting up edible walkways: instead of flower beds, it is planting vegetables, which people can pick when they mature. It is great that schools are coming up with those great initiatives, but if the same thing is to happen in schools across Country Durham, there needs to be central provision from public health services.

For wellbeing, there are initiatives to make sure that children have meals together with their families, and to ensure that if there are problems, other children and friends from school are invited along to share those meals. Such initiatives for those aged seven to 10 bode well for the future, and the public health service in Durham needs to look at them, but they must be funded.

We also need to think about how we develop best practice, so that we see such initiatives not just in Ferryhill and Chilton but in Consett, Barnard Castle, Durham city, Esh Winning and Easington—all over County Durham. There needs to be some strategy. As my right hon. Friend said, we need some kind of audit or impact assessment of what cuts to public health mean to areas like ours. What is the reasoning behind making cuts in Durham, where services are needed, and increasing funding in places such as Surrey and Hertfordshire, where they will not be?

--- Later in debate ---

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

May I say what a pleasure it is to serve under your chairmanship, Mr Owen? I thank my right hon. Friend the Member for North Durham (Mr Jones) for bringing forward this important debate. In 2013, there was a general welcome for the transfer of public health funding to local government, because it meant that public health and addressing public health issues could be integrated into the council’s service delivery objectives to better promote public health objectives.

On transfer, the grant to County Durham was £44.5 million, based on an assessment of health needs in the county by professionals—albeit one heavily influenced by the Government’s austerity programme. It is therefore extremely alarming that the Government now plan to move to determining the county’s grant level not on need but according to a new formula, under the huge misnomer of the “fair funding review”—it is anything but. The public health grant to County Durham will be reduced by a massive 38% while resources are transferred to more affluent areas of the country that have much better health outcomes. That is clearly madness and cannot be right.

The public health team in County Durham has done a good job, despite facing the hugely complex health issues discussed in some detail by my right hon. Friend. The county has an industrial past of heavy industry that has left a huge legacy of negative health impacts on the local community. Despite that, and through use of the public health grant, public health professionals, to whom we all pay tribute this afternoon, have done much. They have reduced smoking prevalence and teenage conceptions, and they also provide excellent support for vulnerable families on health and wellbeing issues, including access to mental health services. Those positive changes will be very much put at risk by the massive reduction in funding. In fact, given the severity of the problems Durham faces, it should be given more funding, not less.

Public health professionals in Durham have to address not just the problems of our industrial legacy but high current levels of poverty, because proper regeneration of the county has not taken place as yet. For example, just one food bank said that it gave out 20,000 emergency food bank parcels in Durham last year. We are talking about massive levels of poverty. Almost a third of children in County Durham are being brought up in households affected by poverty. Increasingly, such households are those with parents in work, sometimes having to do multiple jobs just to make ends meet.

[Mr Kevan Jones]

Under the last Labour Government, my hon. Friend, along with my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson), pioneered a free school meals initiative. Is she alarmed that, as I learned yesterday, the national school breakfast programme, which costs only £12 million nationally and affects quite a few schools—primary schools in particular—in her constituency, my constituency and other parts of County Durham, has still not had its funding guaranteed for next year?

[Dr Blackman-Woods]

My right hon. Friend makes an important point, which I am sure my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) and I will take up in the coming weeks. That is an indication of how little the Government seem to be concerned about the children growing up in poor households.

Let us look at the Durham situation. The starkest indicator is the seven-year healthy life expectancy gap between females in Durham, currently at 59, and those in Hertfordshire, where it is 66, and Surrey, where it is 68. That gives rise to the question of why the Government are transferring resources from County Durham to Surrey and Hertfordshire. I know the Minister is new to her post, but it would be helpful to get an explanation of why the Government think that is a good idea, because we have not had one so far. The appalling health inequality is compounded by overall life expectancy figures, which for women are 81 in Durham compared with 84 for Hertfordshire and Surrey. There is a similar gap for men.

Let us look at other measures. Suicide rates in County Durham were above the national average, with 20.6 deaths per 100,000 of the population for males. On mental health, the rate of young people admitted to hospital because of self-harm is significantly above the national average. On alcohol, 33.8% of people in County Durham drink more than the low-risk guidelines recommended, and 290 people died due to alcohol-related problems last year. There were also 12,500 hospital admissions and 108 road traffic accidents. That suggests a significant problem that needs to be addressed.

Furthermore, the percentage of mothers smoking at the time of delivery is above regional and national averages. As my hon. Friend the Member for Sedgefield (Phil Wilson) made clear, breastfeeding rates are low, yet we know that it provides the best nutrition that babies and young children can get. Seven out of 10 adults in County Durham are overweight or obese, significantly more than the national average, and cardiovascular mortality rates are also higher than the national average.

I could go on with endless statistics, but we are making the point that County Durham is an area with high levels of disadvantage and poverty. It is below the national average on almost every public health indicator imaginable, yet what are the Government doing? They are not giving additional funds to address those problems and ensure that our services continue to improve; they are threatening to take money away.

The workforce would be significantly affected by this measure. There would be a significant reduction in the number of visits that health professionals could make and the universal work on emotional wellbeing would be removed. Instead, only higher level and more targeted work would take place, although we know that misses most of the families and individuals who would benefit from services. Other prevention priorities, including visits and programmes trying to address problems around smoking at the time of delivery, breastfeeding, unintentional injuries and obesity, would also be reduced. The service would have to focus on safeguarding, which would increase inequalities, and issues would be missed.

I could go on and on. We have already seen a massive reduction in services. For example, my constituency has no Sure Start centres operating, which means there is nothing in place to bring together services that could support very vulnerable families. Can the Minister look at that issue as well?

What do we want the Minister to do? The point was put forcefully by my right hon. Friend the Member for North Durham: we need a commitment from the Government to increasing public health funding in line with need; an extension to public health funding to be used in areas where the grant has been utilised effectively; and clarity on the timescale for decisions. We have already seen concern in County Durham about future funding, especially from the voluntary sector organisations that do much of the heavy lifting in terms of providing services to improve public health outcomes. The Government do not seem to be aware that funding for such organisations is often precarious and that they need some certainty from the Government to invest in staffing and services for the future.

The Government should certainly not be moving money from areas with the greatest health inequalities to those with the least health inequalities. They should be carrying out an impact assessment of any funding decision, so that we are really clear about what the impacts of that massive reduction of 38% in County Durham would lead to. As my right hon. and hon. Friends have said, this is an issue across north-east England. I look forward to hearing what the Minister will say to address this problem.

--- Later in debate ---

[Seema Kennedy]

I believe that local authorities and local communities are the right place for public health to be situated, because they best understand the needs of their communities.

[Mr Kevan Jones]

Will the Minister give way?

[Seema Kennedy]

May I just finish addressing the point made by the hon. Member for City of Durham? I also want to ensure I give the right hon. Gentleman, who moved the motion, time to wind up the debate. We recognise that there has been pressure on local authorities and we commend them for the work they have done. As I have said, we continue to review the position, and future spending levels will be decided as part of the spending review.

[Mr Jones]

I agree with the Minister that local communities are best placed to decide these things, but is she happy with the fact that under the new funding formula, there is no onus on local government at all to use money for public health?

[Seema Kennedy]

I think public health is ring-fenced, and local government does have to use the funding for that. We are reviewing the position, and we will look at all the evidence carefully in the upcoming spending review.

Across England, we are seeing examples of councils adopting new service models and commissioning more effectively and innovatively. Stakeholders often tell us, most recently through the review of commissioning sexual health and health visiting services, that councils are achieving better value for money while maintaining or improving outcomes in challenging financial circumstances.

However, we need to acknowledge that improving public health is about far more than the grant, and we know that spending more money does not necessarily improve outcomes. What we spend it on matters a lot. That covers all local government activity, including transport, planning, housing and the economy, all of which contribute to population health and wellbeing. The work that local government does on the ground through place-based approaches makes joining up those different factors easier, and the NHS long-term plan has a significant focus on prevention and reducing health inequalities.

We do not know what the outcome of the spending review will be, but I am committed to working closely with local government and other partners to build on the achievements of the past six years. We need to take action on a local, national and global level to meet the public health needs of the present and rise to the public health challenges of the future.

[Mr Kevan Jones]

I thank the Minister for that. She is a new Minister, so I will give her a word of advice: do not come to a debate and just read out a civil servant’s speech, as she did today. It is all right her saying that she recognises the importance of public health, but in her position she needs to be a champion for public health. If that means giving the Ministry of Housing, Communities and Local Government a kicking, she needs to do it. Without that, demand will increase on her Department of Health and Social Care and its budget.

I am sorry, but I just do not accept what the Minister says about efficiencies. No organisation can have 38% taken out of its budget through efficiencies while delivering the same thing. Morally, this policy, which is like Robin Hood in reverse—taking from the poor and giving to the rich—is just not acceptable. I expect her to be a champion for public health, because all the evidence from this country and internationally—not from politicians for party political points—is that early and proper direction of public health funding not only reduces demand on the health service but improves people’s lives.

It cannot be right that one of the most deprived parts of the UK—the north-east of England, and County Durham in particular—has its budgets and its council’s ability to provide public health services to its population reduced because of a funding formula put in place by this Government. Other areas, which I and my hon. Friends the Members for Sedgefield (Phil Wilson), for City of Durham (Dr Blackman-Woods) and for Washington and Sunderland West (Mrs Hodgson) highlighted, have far fewer health needs.

We cannot take need out of the funding formula and hide behind the NHS long-term plan. The plan has all good intentions in trying to address health inequalities, but that will not be done without proper investment. Since 2013, Durham County Council has proven—in very straitened circumstances, and not just in this area but in how it has administered its budgets—that it has been able to get efficiencies. However, there is a limit to that, and taking 38% out will not work. This is simply not fair, Minister. As someone who represents a northern constituency, she should recognise that.

On whether we will see any change from the new leadership of the Tory party, if the front-runner gets it I very much doubt that. My hon. Friend the Member for Sedgefield is correct: directing money to tax cuts for the wealthy will not mean a growth in public services. Public health is not a luxury; it is a vital part of a strategy not only to tackle inequality, but to tackle unfairness and to make people’s lives better.

I went into politics to make people’s lives better, as I am sure the Minister did. Her Government—I accept that it is not her Department, but the local government Department—are making people’s life chances worse. That cannot be right.

Question put and agreed to.

Resolved,

That this House has considered public health in County Durham.

Mental Health First Aid in the Workplace

Kevan Jones Excerpts

Thursday 17th January 2019 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

After yet another week of fractious and angry political discourse, what a pleasure it is to work with two honourable friends—I use that term advisedly—the hon. Members for Plymouth, Moor View (Johnny Mercer) and for Liverpool, Wavertree (Luciana Berger) on an issue of incredible importance. It is important that those watching or reading about this debate recognise that it is possible for right hon. and hon. Members to focus on important issues such as mental ill health, as well as fractious arguments over Brexit.

I thank the hon. Member for Plymouth, Moor View for what he said about his experience of OCD. Interestingly, OCD has also affected my family as our oldest son was diagnosed with it as a teenager. He has since spoken about his experience, and I speak with his authority and approval. What the hon. Gentleman said about the importance of people in his position speaking out about such conditions is important. I remember the moment when, as a teenager, Archie said to me, “Why I am the only person who is going mad?” For a parent to hear that from their child is awful and incredibly distressing, and it makes one realise what a teenager must be going through if that is how they feel about their situation. Of course that is an entirely false perspective, because one then realises that so many others are experiencing their own challenges, and when that realisation dawns, it makes it much easier for individuals to speak out. I thank the hon. Gentleman for what he said and for talking to the press about this issue, because cumulatively that makes a difference.

The Time to Change campaign has been incredibly powerful in helping to normalise mental ill health, and every time someone in a public position speaks out, it becomes a little easier for another teenager to seek help and not be frightened about opening up. I join the hon. Member for Liverpool, Wavertree in acknowledging the work of Natasha Devon, who is a great campaigner for mental health issues, and I thank Bauer Media and Mental Health First Aid England for championing this important cause.

On the cost of mental ill health, I wish to focus first on the cost to the individual, because it is often not recognised by those who do not experience it just how painful and disabling mental ill health can be. If someone is experiencing anxiety, depression or a condition such as OCD, their life is completely dominated by that. They often cannot enjoy life or be happy, and whenever we speak about the economic cost of mental ill health, we must focus on the most important thing, which is the cost to individuals of the ill health that so many experience.

Alongside that, however, there is a significant cost to employers—not just private sector employers, but the public sector, charities and so forth. Health and Safety Executive data show that 57% of days off work through ill health are due to mental ill health of one sort or another, and not confronting that represents an enormous cost to employers. This is not just about time off work, because many people end up falling out of work and on to benefits, and others turn up to work but under-perform—the concept of presenteeism—because they are not feeling on top of their game, or because they are obsessed by anxieties or concerns that prevent them from performing their work responsibilities effectively.

Addressing mental ill health is a win-win-win for everybody, because this issue affects not just individuals, but employers and even the Government, who gain as a result of us taking it more seriously. If someone falls out of work because of mental ill health, they end up claiming benefits, and that is an enormous cost to the Government and also impacts on the NHS. Everybody benefits by us taking this issue more seriously. The question then is how best to achieve an advance. The hon. Member for Waveney (Peter Aldous) made a very important point when he said that we need to think carefully about how we frame that.

Under existing law, employers are under duties to protect the mental health and wellbeing of their workforce. The Institution of Occupational Safety and Health makes that point very strongly in its brief for this debate. It makes the point that under the Health and Safety at Work Act etc. 1974 and associated regulations, employers are under a duty to manage the psycho-social risk to their employees at work. There is also the duty under the Equality Act 2010 to make reasonable adjustments where people are suffering from some sort of disability, including mental ill health. I also applaud the Health and Safety Executive for the new guidance it issued in November 2018. For the first time, it includes a section on mental health. That is important. These are all advances worth acknowledging. I would also like to acknowledge the work of Paul Farmer and Lord Stevenson, which was commissioned by the Government. Their report “Thriving at Work” recommends mental health core standards for every employer.

None the less, the first aid legislation is very much framed in terms of physical health. It is very important to establish clearly in legislation—just as we did in the coalition Government, where we legislated for parity of esteem in the NHS—a very important principle for the workplace: an equality in the importance of both physical and mental health in the workplace. I want to stress that it is about much more than just mental health first aid, vital though that is—I totally endorse all the comments made by the hon. Member for Liverpool, Wavertree.

I want to highlight the potential risks, as the hon. Member for Waveney made clear, of not getting this right. There is a risk of the tick-box exercise, where an employer can just say, “Yes, we have trained someone up in mental health first aid. We’ve done nothing else, but we have ticked the box and therefore we have met the regulation.” That would be a failure for all of us if that was the outcome of this exercise.

The more fundamental point is that the approach we should be taking is about preventing ill health in the workplace. The whole focus should be on creating healthy workplaces, where people are treated with dignity and respect. It is vital that employees across the workforce have the opportunity to raise their awareness and understanding of mental health. Alongside that, however, we have to think about the causes of stress and anxiety in the workplace. Often, it is due to unhealthy workplaces, where people are not respected and where there is a bullying culture. Depressingly, we see that quite often in the NHS. That has to be confronted, because that is the cause of so many people feeling anxious, distressed and depressed as a result of what happens at work.

[Mr Kevan Jones (North Durham) (Lab)]

Does the right hon. Gentleman agree that there are very simple things companies can do—BT and quite a few others do this—to improve work-life balance? For example, they can ensure that people do not have to answer emails late at night or over weekends, or, when people have bereavements, they have a sensible bereavement policy that supports the individual, rather than just allows for a number of days for an individual to get over it.

[Norman Lamb]

That is an incredibly helpful intervention. I totally agree with the right hon. Gentleman. It is about getting the whole culture in the workplace right on flexible working, understanding that parents sometimes have responsibilities to their children and carers have responsibility for an elderly loved one. Not working ludicrous hours of the day and night is also incredibly important. How we achieve the legislative change is very important. It is vital that we raise awareness through mental health first aid, but we also need a fundamental focus on the prevention of mental ill health in the workplace.

In the remaining minutes, I want to focus on some of the things we did in the west midlands. After I was chucked out of the Department of Health by the electorate in 2015, I was asked to chair a commission on mental health in the west midlands. Our whole focus was on how to prevent mental ill health and take a more public mental health approach. We focused particularly on the workplace. We first focused on how to get people who had experienced mental ill health and had been out of work—often for years and years—back into work. Work is actually good for people. Meaningful work, where we gain a sense of dignity and self-respect, is really important. We are undertaking—with £8.5 million of Government support, I should say—a randomised control trial, applying a strong evidence-based approach called individual placement and support. We give people intensive support to get them ready for employment, get them into a proper job and then support them in that job. We are looking at how we can apply that in primary care, so we capture people earlier, and give them access to someone who can train them and support them for employment. We want to change the mind set of GPs, so they are not just thinking about the sickness of their patient but how they can help them to recover and get back into work—that is critical.

I hope that as a result of the randomised control trial, we will be able to learn lessons which we can then apply across the country. If we can get lots of people with severe and enduring mental ill health back into work, we will achieve something very significant. Sadly, at the moment this extraordinarily strong, evidence-based approach is the exception rather than the rule. Most people across the country do not get access to it. The Government have made a commitment to double the numbers, but that is still a very small proportion of the total. It needs to be expanded rapidly.

[Mr Kevan Jones]

Is the problem that mental wellbeing is not hardwired into Government policy? Some policies, for example Department for Work and Pensions work capability tests and others, actually work against individuals. Voluntary work is very useful in getting people back into work, but at the moment there are limits around what people can do while they are still on benefits. Does the right hon. Gentleman think that some flexibility on that would help this process?

[Norman Lamb]

I absolutely do. I was going to say, “Don’t talk to me about the work capability assessment, because it will get me very angry.” We need reform of the welfare system to help to facilitate people returning to work, rather than just treating them as second-class citizens, as it often does.

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[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Liverpool, Wavertree (Luciana Berger) on securing this debate, and I thank her for setting the scene so well. I thank right hon. and hon. Members from all parts of the Chamber for their valuable contributions. I echo the comments of others in the Chamber about what a joy it is to have a debate on a subject on which we can all agree. We agree on the strategy and the way forward. I am reminded of the programme I watch on a Sunday night—“Call the Midwife”. Perhaps others watch it, too. There is always a real tragedy at the beginning of the programme, but at the end, things always turn out well. I hope that Brexit turns out the same. We will see how it goes.

Most of us in the Chamber have a good understanding of the impact that mental health issues have on people’s emotional and physical state. In the short term, mental health problems alter personality traits and the behaviour of individuals. In the long term, they can lead to suicidal thoughts. In the worst-case scenario, they can eventually drive a person to commit suicide. There were 318 suicides registered in Northern Ireland in 2015, which was the highest since records began in 1970. People often have trouble coping with mental health issues, which of course will translate into their work life. Mental health cannot be compartmentalised. That is not the key to working and living with mental health problems.

[Mr Kevan Jones]

It is too tempting not to intervene on the hon. Gentleman. Is he aware—I am sure he is—that Northern Ireland has a particular issue? When I was a Minister in the Ministry of Defence, I was shocked to see that even though the violence of the troubles was 20 or 30 years ago, there is still a legacy of mental illness from those times.

[Jim Shannon]

The right hon. Gentleman has obviously had sight of my notes, because I was going to refer to that point later. He is absolutely right. The 30-year terrorist campaign has a legacy, and it affects us. I will mention that in my comments.

When I was first elected in 2010, I took in a new part of my constituency, Ballynahinch, which I very quickly found out had some serious problems in relation to suicides. They were mostly among young people, and unfortunately they seemed to be cluster suicides, if I can use that terminology. A number of young people took their lives, but the community very quickly reacted in Killyleagh and Ballynahinch. Church groups, community groups and interested individuals came together and addressed those issues. With Government Departments, they helped to reduce the level of suicides. It was particularly stressful to be confronted with that as an MP so early in his parliamentary term.

One in six workers suffer from anxiety, depression and unmanageable stress each year, causing 74% of people with a mental health problem to take more than a year out of work. In 2015, 18 million days were lost to sickness absence caused by mental health conditions. Mental health issues affect both the work and the lifestyle of countless people. Urgent action must be taken to educate employers about the difficulties that result from mental illnesses, mainly to help those who are struggling in the workplace but also to benefit those employers, for whom that may mean cost outlays. It follows that not only is a happier worker a more productive worker, but there should be a natural decrease in sickness periods. Other Members have mentioned that.

If employers are to take steps to promote and improve people’s wellbeing in their workplaces, they need to be able to identify an instance in which someone may be struggling with mental health problems, but it is not always easy to do so. I understand that, because I have talked to many people who seem to be smiley, jokey and happy, and may be the life and soul of the party, but when they go home they are very different. Sometimes we do not really know what is happening. In the workplace, there needs to be someone who can see through the façade to the real person underneath.

Some 49% of workers said that they would not be comfortable disclosing a mental health issue at work. Others in the workplace should be educated to ensure that they can recognise individuals who are dealing with such problems. They should be trained in mental health issues—and that should include mental health first aid—so that the workplace can become a positive environment.

Given that two in five employers admit that they have seen a rise in mental health problems, it is important for workplaces to foster a culture of support and openness for those needing help, making them feel reassured about seeking assistance from fellow employees. The Scottish Association for Mental Health, backed by the Scottish Government, has adopted a programme on physical activity. I can say with all honesty and sincerity that the Scottish Government, and their Health Department in particular, lead on health issues in general, including mental health issues. I know that the hon. Member for Glasgow South West (Chris Stephens) will probably mention this, but I think it important for us to recognise good practice wherever it may be, and I hope that we can replicate it in other parts of the United Kingdom of Great Britain and Northern Ireland. Better together, that is what I always say.

I believe that the Department for Work and Pensions must take the lead, and that all workplaces should be supplied with a mental health toolkit as standard practice. It should be issued not just to those who request it, but to all who are paying tax for a business. That could be modelled on the content of the current publications by Public Health England, Business in the Community and the Samaritans—what a good job they do to address these issues. Every one of us will know what really tremendous work they do in our constituencies, and I cannot praise the volunteers highly enough. To engage employers to participate in initiatives such as “Time to Change” and be educated further on the subject of mental health, there must be a move from the Department, and help must be garnered from it.

It has been suggested that as well as becoming involved with mental health organisations, companies should review their absence policies and make keeping-in-touch arrangements, as evidence suggests that 12.7% of all sickness absence days in the UK can be attributed to mental health conditions. There must be tools to enable employers to create an employee assistance programme. I have read research indicating that in the few businesses that use such a programme, 25% of employees say that their organisation encourages staff to talk openly about their mental health issues. Research shows that the more people do that, the easier it becomes to deal with their problems. We are always hearing that “it’s good to talk”, and that is so true, but many of the people we meet may not have anyone to talk to.

Such programmes not only help the individuals who are suffering with mental health problems, but benefit companies. Better mental health support in the workplace can save UK businesses up to £8 billion per year. If we do the job right we can save money, and so can the businesses, because they will have a happier and more productive workforce.

Three quarters of all mental health problems are established by the age of 24, when people are entering long-term careers. That is another factor that we should recognise at that early stage. As many as 300,000 people a year lose their jobs because companies are not sure how to provide the help and support that they need. In the past year, 74% of people have felt stressed as they have been overwhelmed or unable to cope owing to the demands of their career. Managers should be able to spot the signs of common mental health conditions, but that happens only when they receive dedicated training. Others have referred to the need for such knowledge of what is happening. Many managers are blind to, or uneducated about, the symptoms of mental illnesses, and it is all too easy in the busy working world to be consumed by a goal and not to see the elements that are in play around us. We would never send an engineer into a dangerous environment without the necessary training, so why should we assume that companies can automatically notice when an employee’s health is plummeting?

I am sure that you, Mr Deputy Speaker, are like the rest of us in this regard: we often eat at our desks. However, that does not mean that everyone else has to do it. We have to recognise that sometimes it is good to get away from our desks and go for a walk, and have our minds on other things for a time. The benefits of regular breaks and eating lunch away from desks, and creating a positive workplace state of mind, should be promoted to those who have a busy life and seek to cram things into every second at the risk of their mental health.

As we heard a moment ago from the right hon. Member for North Durham (Mr Jones), Northern Ireland in particular is struggling with the issue of mental health owing to a lack of resources. When compared with 17 other countries, Northern Ireland was shown to have the second highest rates of mental health illness, 25% higher than those in England. That is certainly largely due to 30 years of the troubles and the legacy of the terrorist campaign, but it is more than that. We must address those issues and do better in enabling people to lead high-quality lives with the tools to handle stress and daily life. A massive step in that regard would be creating mental first aid as standard in workplaces.

Workplace mental ill health costs employers about £26 billion a year, and many places are struggling to find the large amount of money that is needed to improve their awareness of mental health. A report for the NHS found that mental illness accounts for nearly half of all ill health in people younger than 65, and that only a quarter of people in need of treatment currently get it.

This is a health issue, but it is important for four Departments to come together with a strategy, because it is not just about health. It should also involve the DWP, the Department for Education and the Department for Business, Energy and Industrial Strategy. Companies need to be given more support and funds, as does the NHS to help those who are suffering in the long term, as it is currently unable to provide the materials needed. Action needs to be taken, because the number of sick days due to mental health issues is increasing rapidly owing to negative work environments: 89% of employees with mental health problems say that it affects their work lives hugely. That needs to change, for the betterment not only of business and the economy but of those who are struggling with mental health issues.

I look forward to the comments of both the Minister and the shadow Minister. I am convinced—as, I think, is everyone in the Chamber—that we shall hear a positive and helpful response from the Minister.

--- Later in debate ---

[Jackie Doyle-Price]

I can say that we are making progress, but I would prefer to write to the right hon. Gentleman with more details, if I may. I have seen some of that individual placement and support in operation, and it is hugely inspiring. In those mental health trusts that are giving one-to-one support, people are finding that the reward and discipline of going to work really does aid their recovery, even in some of the most challenging cases. I will write to the right hon. Gentleman with more information on that.

[Mr Kevan Jones]

Will the Minister liaise with colleagues in the Department for Work and Pensions? As I said to the right hon. Member for North Norfolk (Norman Lamb), voluntary work is a helpful access point for people who want to get back into work, and the current limitations on people being allowed to do certain voluntary work hinder some who want to take that route into work.

NHS Long-term Plan

Kevan Jones Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

My hon. Friend makes an important point. Things like the daily mile, which I have participated in, are an incredibly important part of this. Prevention is about public health and the whole NHS, but it is also about more than that. We talk a lot in the House about the rights that the NHS gives us—the right to care that is free at the point of use, according to need—but we also need to talk about the responsibilities that we have, including the responsibility to use the service wisely and the responsibility to ourselves and our communities to keep ourselves healthy. That part of the debate needs to continue and be strengthened, at the same time as ensuring that the NHS is always there for us.

[Mr Kevan Jones (North Durham) (Lab)]

Under the Government’s public health proposals, County Durham will lose 38% of its budget—or £19 million. The Secretary of State said that we should be listening to clinicians. Clinicians in County Durham are clear that they want that budget protected. Can he tell me what those clinicians are missing? Is it not a fact that this Government are quite clearly going to remove money from deprived areas such as County Durham, while more leafy areas, including Surrey, have an increase in their budgets?

[Matt Hancock]

That is obviously not right. Indeed, there is a whole section of the plan on reducing health inequalities, which is extremely important.

Mental Capacity (Amendment) Bill [Lords]

Kevan Jones Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Matt Hancock]

The hon. Lady is not quite right about the three-year period, because there are review points, meaning that it involves a twice-possible one-year extension, so she is not quite right about the relationship between that and what happens under the Mental Health Act. However, she makes an important point about the links between the Mental Capacity Act 2005, this Mental Capacity (Amendment) Bill and the mental health Bill that we propose to bring forward.

We considered putting the two Bills together, but we did not do that for two reasons. First, it would simply be a big Bill that included two separate regimes, and we would not want the full Mental Health Act powers to be applied across the board, and I think there is a broad consensus behind that. Secondly, the view of Sir Simon Wessely, who ran the review into the Mental Health Act, is that we need to get on with this while taking the time to get the Mental Health Act update right. Combining the two was seriously considered, and I considered it again when I became Health and Social Care Secretary and asked for further advice, but we came to this conclusion, which I hope the hon. Lady will support.

[Mr Kevan Jones (North Durham) (Lab)]

I do not disagree with Sir Simon Wessely’s conclusions about that, but the review does contain suggestions that could be transferred into this Bill. For example, the use of tribunals instead of the Court of Protection in some cases would make them a lot simpler, cheaper and better for the person involved.

[Matt Hancock]

The right hon. Gentleman is quite right. To start to deal with the serious number of cases that we need to make progress with, the interface between this Bill—hopefully on the statute book by then—and the Mental Health Act provisions will be considered as we develop the draft mental health Bill. The truth is that the current system causes unnecessary suffering, and the case for reform could not be more urgent. That is why we are bringing forward this Bill now. Age UK, the UK’s largest charity working with older people, says we have a crisis in the current system that is

“leaving many older people with no protection at all… If we lose this opportunity we’re unlikely to get another one in this Parliament and it is profoundly unfair on the older people and their families…to have to wait any longer…doing nothing is not an option.”

--- Later in debate ---

[Mr Kevan Jones (North Durham) (Lab)]

We judge a civilised society by how it treats its most vulnerable citizens, so getting this legislation right is vital. My hon. Friend the Member for Stockton North (Alex Cunningham) said, “There by the grace of God go we all,” and I agree: we could all find ourselves or family members involved in this. The right hon. Member for North Norfolk (Norman Lamb) raised the issue of the Cheshire West case, which demonstrates that we do need change because we have got people whose human rights are being denied at the moment. It is not the case, therefore, that we can just do this at our leisure.

Is the Bill flawed? Yes, in its current state it is, but change needs to happen among the voluntary sector and others and we need to put some principles behind this, and one of them must be putting the person at the centre of the legislation. We should also only use these measures where there are no alternatives; they should not be used as a recourse of first resort or for financial or convenience reasons.

The review of the Mental Health Act 1983 introduced the least restriction principle and that should be written into this Bill. It is also key to ensure that individuals and families not only know their rights, but have access to them. Also, the length of detention should be kept to a minimum, and certainly kept under regular review. The care plans of individuals must be kept up to date with the individual’s situation, too. The access of individuals and families to independent medical advocates must be a central part of this Bill as well, and if people do not have family or relatives an independent advocate should be appointed to them automatically. The possibility of conflicts of interest has been raised and I am not yet happy that this Bill addresses that. There are issues that need to be looked at. Referring to the Mental Health Act again, having second opinions is important; we must tighten that up in this Bill.

A lot of this could be covered in the code of practice. The Government have not yet produced that, and it needs to be produced before the Bill goes any further. It would also be important for it to be incorporated into the Bill.

Reference has been made to the interface with the review of the Mental Health Act. I have read it and know Simon Wessely, and he is clear in that report that he does not want this legislation held up, and he does not think that fusing the two Acts would be a way forward. He makes a suggestion on how to use the two Acts: for objection we use the Mental Health Act, and for not having capacity we use this mental capacity Act. He also deals with the issue of cases that cover both, offering some ideas around tribunals and judges and court protection. I would also like the Minister to address the issue around 16 and 17-year-olds and how this interplays with the Children Act 1989 which gives certain rights to parents.

The right hon. Member for North Norfolk said that the situation needed to change, because people are now being detained who are not having their human rights observed. I have to say that I agree with him, and that is why I cannot support the reasoned amendment. Throwing the Bill out at this stage would be a huge mistake. I plead with the Minister to look at a number of things. The delaying of the Committee stage that the right hon. Gentleman mentioned would be important, and I believe that we should extend the sittings of the Committee if we need to. We ought to take as much time as possible in Committee. With good will, we can get there.

Is the Bill perfect? No, it is not, and I am not happy with it as it is outlined, but we can get some changes into it. I know that the Minister is an advocate for the sector and that she is passionate about doing the right thing, and it is not beyond the wit of man or woman to get to where we should be. To throw the Bill out at this stage would be a mistake, because my fear is that it would not come back, owing to a lack of legislative time. That would mean that the legal crisis would continue. Also we would be missing an opportunity to change the legislation. We can make the necessary changes if the good will is there.

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[Gareth Snell (Stoke-on-Trent Central) (Lab/Co-op)]

I will be brief, as I am aware that others wish to speak.

The privilege we have as a Parliament is to defend liberty, so any action we take to seek to deprive a person of their liberty should always be weighed against their best interest. I was not greatly aware of the deprivation of liberty safeguards until the Bill was tabled and I received lots of representations from constituents who work in the social work sector. They are concerned that, although the Bill may be well meaning, it does not necessarily have at its heart protections for the best interests of the people to whom it might apply. I have always listened when a doctor tells me something is not right and I am unwell, and we should listen when a social worker tells us that the Bill’s provisions for depriving a person of their liberty fall short of their expectations.

My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) made two excellent points. First, if we are to take away a person’s liberty, there has to be no possibility that the process could be abused for whatever purpose. I fear that, in some of the arrangements for moving away from a local authority-based system to a responsible body, the potential exists, however small that potential may be, for an unscrupulous person who is not necessarily working in the best interest of an individual to exercise that power simply to maintain a business model in their own facility or care home. Such cases may be few and far between, but we have seen many situations across the country where one or two individuals have taken advantage of people in vulnerable situations, and I am not convinced that the Bill, as currently written, goes far enough to provide safeguards. [Interruption.] The Minister shakes her head, and it would be wonderful if she could address that in her summing up.

[Mr Kevan Jones]

Will my hon. Friend give way?

[Gareth Snell]

I am sorry, but I cannot give way.

My other area of concern is the independence of advocates. I am fortunate to have a family who can speak up if a relative were ever in such a situation, but there are countless people across the country who do not have somebody who can stand up for their best interest and represent what might be right for them. The Bill contains no provision properly to strengthen the independent advocacy rights and make them robust so that everybody who might be subject to the liberty protection safeguards is able to be represented and have their views considered, which is important. [Interruption.] The Minister is nodding, and I would welcome it if she offered some sort of guidance and further clarity on how the Bill will deliver that. From where I sit, from what I have read and from the evidence given to me by social workers, there are several holes in the Bill that do not stand up to scrutiny.

I suspect the Bill will get its Second Reading, and I hope several of those holes will be identified and considered in Committee. At the moment, my fear is that the Bill is well intentioned but simply does not bear scrutiny. There is therefore a potential for exploitative people to take advantage of vulnerable people and, as a Parliament, we must make sure to address that.

Gosport Independent Panel: Publication of Report

Kevan Jones Excerpts

Wednesday 20th June 2018 Commons Chamber

[Mr Hunt]

We do have to ask those questions, and we have to be able to respond to the concerns of my hon. Friend and his constituents about how we can be absolutely certain there will not be a closing of ranks. My experience, however, is that doctors are very quick to want to remove those of their number who are letting the profession down because this damages everyone’s reputation. There are some very difficult questions for the GMC and for the NMC. Because their processes took so long, I do not think they can put their hand on their heart and say that they have kept patients safe during that period.

[Mr Kevan Jones (North Durham) (Lab)]

The legislation regulating both doctors and healthcare professionals is now 35 years old. It is inefficient, outdated and—as I know from a constituency case in which the individual concerned is into the fifth year of her complaint to the GMC—not user-friendly for the complainant. The GMC and other healthcare professionals want change and the Secretary of State’s Department has already consulted on change, so will he give a guarantee that he will bring forward legislation to ensure that the system is not only effective, but effective for patients who make complaints?

[Mr Hunt]

The right hon. Gentleman is absolutely right: we have a regulatory landscape that is very complex, does not achieve the results we want, and forces regulators to spend time doing things they do not want to do and does not give them enough time for things they do want to do. Obviously, because of the parliamentary arithmetic, if we are able to get parliamentary consensus on such a change, that would speed forward the legislation.

NHS Long-Term Plan

Kevan Jones Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

I am happy to look again at that issue, which I have looked at in the past for my hon. Friend.

[Mr Kevan Jones (North Durham) (Lab)]

I welcome any new money for the NHS, but does the Secretary of State agree that prevention is better than cure? Durham County Council has had its public health budget cut every single year for the last eight years. Can he tell me how much of this new money will be going to public health, or is he now going to have another fight with the Treasury to get it to release more money for public health?

[Mr Hunt]

Today’s announcement is for NHS England’s core frontline services, but the right hon. Gentleman is right about the critical role of public health. Many of those services are delivered by the NHS, and we are very clear in what we are saying today and in a further announcement we will make in due course that there cannot be a transformation of the NHS without a proper emphasis on public health.

Mental Health Act: CQC Report

Kevan Jones Excerpts

Tuesday 27th February 2018 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend reached the nub of the issue in that final point. Commissioning is a matter for local commissioning groups. However, through the CQC report, the work that we are doing through the mental health investment standard and the scrutiny applied by NHS England, we are trying to ensure that there is a consistent application of good-quality services around the country. We find some centres of excellence and some areas in which the service is less patchy, but when it is less good it obviously leads to worse outcomes. We are determined to do our best to promote the best possible services throughout the country.

[Mr Kevan Jones (North Durham) (Lab)]

I welcome the Government’s outlawing of the use of police cells for those experiencing a mental health crisis, and I do not question the Minister’s commitment to improving the service, but the system is fragmented. There have been local authority cuts, including cuts in community services. The Health and Social Care Act 2012 leaves local commissioners to decide where the money goes, which has led to a confusing local picture and fragmentation. Do we not need to give people clear pathways out of hospital, and to ensure not only that the money goes to the right places, but that individuals know their rights and that local agencies know their responsibilities?

[Jackie Doyle-Price]

The hon. Gentleman’s point about people knowing their rights and providers and commissioners knowing their responsibilities is crucial to the whole issue, and I think it probably underlies the lack of parity of esteem hitherto. When it comes to the role of central Government, we want to continue to rely on local provision and local commissioning, but we also need to be clear about the standards of performance that people should be able to expect. We are being more transparent about where services are being delivered well and where they are being delivered less well, but I think the work that Sir Simon Wessely is doing will shine a light on exactly that, and will enable us to engage in a much more meaningful debate about what is appropriate.

Autism Community: Mental Health and Suicide

Kevan Jones Excerpts

Thursday 30th November 2017 Commons Chamber

[Dr Cameron]

That is an extremely important point. We must bear it in mind that for young people with autistic spectrum disorder, there is often a family-systemic approach, with carers are at the forefront of providing support, and they need the best resources possible.

I also thank the many citizens from across these isles who have contacted me to give their own poignant personal accounts. These accounts have been harrowing to read—and more harrowing for them to experience—and make us realise just how absolutely vital this debate is.

I also want to extend a personal warm welcome to the youth patrons up in the Gallery today representing Ambitious About Autism. Their recent campaign and research project, “Know your normal”, has been helping many people and raising important awareness. I pay specific thanks to the hon. Member for South Cambridgeshire (Heidi Allen) and the right hon. Member for Chesham and Amersham (Mrs Gillan), who have worked tremendously hard on this debate, on behalf of people with autistic spectrum disorder, through the all-party group over many years.

As a psychologist, I know that progress has been made on autism and mental health over the many years since I started in 1990, when waiting lists were extremely long—possibly a year and more—and services were very limited. However, much more must be done across the United Kingdom.

[Mr Kevan Jones (North Durham) (Lab)]

I accept the point that the hon. Lady is making, but I have to tell her that waiting lists in Durham are still two years long.

[Dr Cameron]

That is an excellent point, and that situation is clearly unacceptable. The Scottish Government and the United Kingdom Government are introducing waiting times initiatives across the United Kingdom. We are finding that the experience on the ground for young people with autism and their families, and indeed across the lifespan, is that, despite the waiting times initiatives, the waiting times that are expected to be in place are not the reality. We need to address that issue seriously.

--- Later in debate ---

[Mr Kevan Jones (North Durham) (Lab)]

I join right hon. and hon. Members in congratulating the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) on securing the debate, and thank the Backbench Business Committee for granting it. The hon. Lady pointed out, as did my hon. Friend the Member for Blaydon (Liz Twist), that the percentage of people who take their own life is nine times greater among people with autism than the general population. As my hon. Friend said, autism is linked to depression and anxiety.

I welcome the debate because it is another example of this House talking about mental health. People know that I think the more we talk about it, the better the debate gets. I think people should be congratulated on that. I place on the record my thanks to the charities and the army of volunteers who work with adults and children with autism, because they are unsung heroes.

I want to raise two points. One is about waiting times; the other, which the hon. Member for East Kilbride, Strathaven and Lesmahagow raised, is about how we develop pathways. In Durham, we currently have a two-year waiting list for autism diagnosis. I have tried to get to the bottom of why that is. It is only when you meet some of the parents of the young people that you see what a tragedy it is. The pressure on those families is so great that I suspect some are developing mental health issues. I am really concerned about the lost opportunity for those children, because everyone only gets one chance at education, and there are cases where children have been out of school for nearly a year, waiting for diagnosis. I am aware, as I think we all are, of the pressures that there are on child and adolescent mental health services and social services, but we must try to streamline the pathway to early diagnosis.

The hon. Member for Bexhill and Battle (Huw Merriman) spoke about schools. The most appalling thing I have seen is that a school excluded a child with autism, even though he had a diagnosis, because “he was too difficult”—and clearly affecting the league tables. We should monitor that, because it is a disgrace. Thankfully, the local authority stepped in and put that right, but the pressure on that parent and the child is unacceptable.

We are talking about mental health and a Health Minister will reply to the debate, but this issue is wider than just health. We have made great strides in terms of parity of esteem, and the point that the hon. Member for Berwick-upon-Tweed (Mrs Trevelyan) made is right. We are winning that battle. Now we need to win the next battle, and that is how we hardwire mental wellbeing into public policy. That is not just health; it is education, housing, social care, local authorities—

[Liz Twist]

And employment.

[Mr Jones]

And employment, as my hon. Friend says from a sedentary position.

There is another big problem that a lot of individuals with autism encounter. They go through the school system. Education finishes and they transition into work. I know of quite a few examples of this from my constituency. A lot of these young people, who are perfectly capable of engaging in some type of employment, seem to get lost in the system. The pathway that the hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned must therefore continue from diagnosis all the way through an individual’s life and involve a cross-section of services, not just health. To get that idea hard-wired into the system, the Government must make sure that, from Cabinet Committee level downwards, consideration of mental health and mental wellbeing forms part of the process of policy making in each Department. The last Labour Government did something similar with veterans.

[Kevin Brennan]

I am grateful to my hon. Friend for giving way, because I know that time is short. Does he agree that those Cabinet Committee-style discussions should involve ensuring that the Ministry of Justice and the Home Office understand the ways in which people with autism come into contact with the criminal justice system and understand the behaviours—such as stimming, which is often misinterpreted and ends up with people being arrested—that those individuals exhibit?

--- Later in debate ---

[Mr Jones]

I totally agree, because autism is not just a health issue. The hon. Member for Berwick-upon-Tweed made a very good point. How many times have we seen people reacting to a child in a supermarket kicking off, as it were, with no recognition of the fact that the child is on the autism spectrum or of the challenges that that poses for the parents? We need to hard-wire that idea in.

The Government also need to look at health funding. I accept that they have committed to more funding for mental health, but the system that was set up in the Health and Social Care Act 2012—I hate to come back to it—makes it more difficult for the money that goes in at the top to get to where it is needed on the ground. If I were a Health Minister, I would be completely frustrated by the fact that I was pushing a lever that was not connected to anything. Clinical commissioning groups and others are taking money that should be going to mental health and diverting it towards other priorities, which I accept they see as important.

I finish by again congratulating the hon. Member for East Kilbride, Strathaven and Lesmahagow and everyone who has spoken. The debate has allowed us to shine a spotlight on mental health again—that is a good thing—on autism, which is not widely understood in the broader community, and on the particular challenges faced by those on the autism spectrum who suffer from mental illness.