Tobacco Packaging

Kevan Jones Excerpts

Friday 12th July 2013 Commons Chamber

[Anna Soubry]

I agree.

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

It is a first for this Government to determine policy by waiting to see what the Australians do. What time period will there be for the consultation? Has the Minister’s position on this issue, and that of her colleague the Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter), changed?

[Anna Soubry]

I have absolutely no problem whatsoever with waiting to see what happens with the introduction of the legislation in Australia. The hon. Gentleman knows that the aim of standardised packaging is to dissuade young people from taking it up.

[Mr Jones]

How long?

[Anna Soubry]

I am answering the hon. Gentleman’s first question first, after which I will move on to the next one. That is the aim of the introduction of standardised packaging. If a good experiment is up and running that will produce evidence, what could be a more sensible thing for Government to do? As to the length of time, I cannot answer that question, because we have to wait and see the evidence as it emerges. I thought that we might see some sort of change quite quickly in Australia, but we have not seen it yet; I am surprised about that. I am afraid it is a case of “How long is a piece of string?” We have to wait and see how the evidence emerges.

Health and Care Services

Kevan Jones Excerpts

Wednesday 3rd July 2013 Commons Chamber

[Grahame M. Morris]

That is an excellent point. I am sure that Members across the Chamber will have experience of that. On Friday gone, we had a crisis meeting of the county MPs and senior politicians in my local authority area of County Durham to determine how to cope with a further tranche of cuts. The situation is becoming serious. It is said that the allocations have been ring-fenced, but the local authorities’ discretionary spend is all being absorbed into social care and expenditure for children and the elderly, and there is very little room for manoeuvre.

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

Will my hon. Friend give way?

[Grahame M. Morris]

I will give way to my hon. Friend.

[Grahame M. Morris]

Okay—

[Mr Jones]

Will my hon. Friend give way?

[Grahame M. Morris]

Am I allowed to give way to my hon. Friend, Madam Deputy Speaker?

[Grahame M. Morris]

With all due respect, Madam Deputy Speaker, I know that my hon. Friend was at the same meeting as me on Friday, and he will probably have a relevant point to make about that, so if you do not mind, I will give way to him.

[Mr Jones]

With respect to the Deputy Speaker, the point I wanted to make was that at the meeting last Friday we were told that Durham county council has to take £210 million out of its budget. Does my hon. Friend think that areas such as ours, which has a growing elderly population, will face more pressure than some others?

[Grahame M. Morris]

Absolutely. The pressures are becoming intolerable. Some of our great northern cities, such as Liverpool and Middlesbrough, seem to be shouldering a disproportionate share of the cuts, and it is a difficult task to try to balance the budgets and deliver the services that people require. There has been a discussion about whether the councils are in a position even to deliver their statutory requirements.

As the right hon. Member for Charnwood said, the NHS has been set productivity targets of 4% per year, as the Government seek to make savings of £20 billion over the lifetime of this Parliament. As the report identifies, the Government believe that those savings can be made in part by prioritising competition over co-operation. I find that questionable, and we need a cost-benefit analysis of the consequences in regard to the value for money of outsourcing. There has been a lot of criticism of PFI schemes, and questions have been asked about whether they provide value for money for the public purse. To date, efficiencies have largely been achieved by freezing staff salaries and cutting the tariffs paid to NHS providers. Neither of those is sustainable, and both fail to meet the spirit, if not the letter, of the Nicholson challenge.

There are signs of falling morale in the NHS, and that is due in no small part to the Government’s attacks on pay, pensions and conditions of service. It is not helpful that Ministers seek to blame NHS staff for problems caused by the Government’s cuts and reforms. These are not the innovative changes that we need to see from a restructured NHS. In the main, we are seeing the picking of low-hanging fruit. Some of the cuts are rash and damaging, and they are being made to satisfy the Government’s need for cuts across the board.

I understand that the current Secretary of State for Health has joined his predecessor in receiving a vote of no confidence from the health care professionals at the British Medical Association conference. I only hope that the next Secretary of State for Health will seek to work with health care professionals, not against them.

The NHS Confederation’s survey of NHS chief executives indicated that 74% of respondents believed that the NHS’s financial situation was either the worst they had ever seen or “very serious”. Despite the Government’s claim to have ring-fenced funding, which has been called into question, NHS executives are not confident that the situation they face is good for their organisations or their patients, with 85% expecting things to get worse in the next fiscal year.

There is no doubt—the figures are there in the report—that the NHS is facing the biggest financial challenge for a generation, as a result of unprecedented demographic changes, an increasing demand for health and care services, co-morbidities, and people living longer with chronic illnesses such as diabetes and dementia. The Nuffield Trust has warned that, unless we improve the way in which services are delivered, growing care needs will result in a shortfall of up to £29 billion a year in NHS funding by 2020.

The NHS faces new challenges in the 21st century. The last Labour Government corrected the chronic under-investment following 18 years of the previous Conservative Government. Investment in the NHS trebled under Labour. We built more than 100 new hospitals, replaced much of the ageing infrastructure, and developed the new walk-in centres, primary care centres and a new generation of modern community hospitals. There were extended GP opening hours, and more doctors and nurses than ever before.

--- Later in debate ---

[Priti Patel (Witham) (Con)]

I welcome today’s debate and I, too, want to pay tribute to my right hon. Friend the Member for Charnwood (Mr Dorrell) for his comments. He clearly made some strong and valid points about expectations of the NHS and the required pre-requisite of expectation management. Yes, the debate is about funding and finance, but it is also about some of the significant challenges we face as a society and a country because of our changing demographics and our ageing population.

I pay tribute to the Government for prioritising investment in the NHS and in health and social care and for committing to increase spending on the NHS and health to more than £115 billion for the next comprehensive spending review period. I also welcome the measures they have introduced to focus resources on the front line and in particular to clamp down on NHS bureaucracy—my hon. Friend the Minister will know my views on that. I believe that the importance of making £20 billion of bureaucratic and efficiency savings should not be underestimated.

As we have heard, increasing demand on services requires more spending, but targeted specifically at the front line. In my constituency, a scandalous deficit in health care provision built up while Labour was in power as resources were soaked up by NHS bureaucracy. Across the former East of England strategic health authority, the number of senior managers doubled between 1997 and 2009 from 1,300 to 2,700.

[Mr Kevan Jones]

Does the hon. Lady think that there has been any sense whatever in the top-down reorganisation? I know that in many areas managers have taken large redundancy payments from primary care trusts only to be re-employed weeks later by GP commissioning groups.

[Priti Patel]

The answer to the hon. Gentleman’s question is yes. In the east of England, and certainly in Essex, there have been significant changes. The change to the structure has been specifically welcomed because resources are now going to the front line, which, for my constituents, is the most important thing.

The numbers of administrators and managers grew vastly in the PCTs that used to cover my constituency. I am afraid that we did not have one PCT—we had several. The number of managers and senior managers at the Mid Essex primary care trust and its predecessor trust increased tenfold from 10 to 102, while at the North Essex primary care trust the number went up from 25 to 84. By the time the Labour party was kicked out of office by the British public, the proportion of administrative staff had risen to one third, and between those two PCTs something like £25 million was spent on management costs alone—money that could have been much better spent on providing front-line services to my constituents and to constituents elsewhere in Essex and across the eastern region.

Although bureaucracy increased, health service provision in Witham town suffered as NHS managers completely neglected the area in favour of spending money elsewhere. As a result, Witham town’s GP surgeries are bursting at the seams. Almost 30,000 patients are registered across four practices with just 13.5 full-time equivalent GPs. That means that there are 2,200 patients registered per GP, nearly 50% more than the national average of 1,500 patients per GP.

My constituents report that they are struggling to register with a GP and are facing insufferable delays in getting appointments. One wrote to me, saying:

“Two doctors’ surgeries in Witham have refused to take me on, because the books are closed for new patients.”

Another said that they

“waited 12 days for an appointment with my GP. In the end, I was diagnosed with appendicitis.”

Unfortunately there will only be more such cases, exacerbated not just by our changing demographics but by housing growth, which creates greater pressures on existing practices. On Witham’s Maltings Lane estate, 1,700 new homes will be built, increasing the local population by more than 4,000. Other sites have been identified for development over the next decade, quite rightly bringing new homes and affordable homes to my constituents.

When Labour was in power, opportunities to bring in new medical facilities through section 106 agreements and other funding arrangements were completely spurned by the PCT managers, who neglected and ignored the situation and the strains of a growing population in the community. New GP practices could have been opened and new facilities to provide treatments and assessments could have been brought in to save my constituents from travelling to Chelmsford, Colchester or even Braintree, which involves considerable distances. That demonstrates how patients in my constituency were not being put first. It was bureaucracy that was being put first by the army of bureaucrats in charge of running the local NHS in my part of Essex at that time.

The Minister will understand the legacy of problems left to the town. I also pay tribute to him—like the Secretary of State, he has received a fair amount of correspondence and is well aware of the issues. One of the biggest challenges for the NHS today, with the increased investment that it has, quite rightly, received from the Government, is ensuring that the savings in bureaucracy that this Government are making are reinvested in providing new local health care services in Witham in particular. I hope that my hon. Friend will give a commitment to support our local efforts to increase health care provision in Witham, to ensure that my constituents of today and those of tomorrow, gained through new housing growth in particular, receive and benefit from a 21st century health care service.

With more money than ever being invested in the NHS, it is essential that those who are responsible for spending decisions and run our local NHS are also held to account. Accountability and transparency are key. We in the east of England have had from our ambulance trust the worst ambulance service in the country. It was run by a board of non-executive directors who failed to provide the trust with the leadership, skills and expertise required to address endless shortcomings and delays in ambulances attending to patients. Lives were put at risk, but despite the failures, a damning governance review and a “failing” report from the Care Quality Commission, the board bit the bullet and resigned only last Friday morning, following substantial pressure from MPs in the east of the region, including my hon. Friend the Minister, and a Westminster Hall debate last week. The situation was shameful and scandalous, because the board refused to go until the pressure became too much for them.

None of us can avoid the need for accountability and transparency. We have seen in Mid Staffordshire with the Francis review, in Cumbria, in the East of England with our ambulance trust, and now with the Tameside hospital trust—I think the chief executive resigned this afternoon—what can happen when NHS managers and directors get it wrong. They have to be accountable for their failures. Transparency is required. I recognise that the Government are taking this seriously and hope that at the end of the debate my hon. Friend the Minister will give details of steps that will be taken to remove failing directors and managers and, importantly, to replace them with people who have the skills and capabilities to put patients first and to deliver value for money. A huge amount of taxpayers’ money is used to pay for the NHS. It is only right and proper that all of us, including the public, should feel confident that the money is being well spent.

[Dr Phillip Lee (Bracknell) (Con)]

The nature of this debate is such that one can talk about anything to do with the NHS, be it local or national, in the context of the estimates of costs. The figures in the documents are immense—£1 billion here, £50 billion there; perhaps we need to plant some money trees in this country—and will only increase, as we all know. It has been interesting to listen to Members on both sides of the House this afternoon. Everybody accepts that demands are rising. Obesity is increasing—26% of adults are obese and the proportion is rising—and our population is ageing, so that by 2030 almost 25% of the population will be over 60. On top of that, there are advances in medical technology and the costs thereof to deal with—today’s cancer drugs can cost upwards of £5,000, £6,000 or £7,000 per month per patient.

Given those demands and costs, maintaining the current service will inevitably become nigh on impossible. I sense, even in the Chamber, and certainly outside it, that the public are beginning to realise that. I will say a few words about that before going local and discussing some of the things I have been suggesting in my region, and “region” is the key word here, rather than constituency.

The figures are really quite shocking. It has been suggested that by 2025 around 25% of the NHS budget will be spent on type 1 and type 2 diabetes alone. Only this morning a colleague told me that he had been diagnosed with type 2 diabetes. It affects all groups in society. Around 21% of the population smoke and around 28% of the adult male population drink too much—the figure is about 20% for women.

The number of prescriptions in 2009 was 886 million. The total cost of the NHS drugs budget in 2009 was between £13 billion and £14 billion, and it increases by £600 million each year. We are getting cleverer at inventing new drugs and classes of drugs, so I suspect that those costs will continue to increase, because it is human nature for someone to want the very best drug, the drug that will cure their cancer or extend their life.

Cases of dementia are set to double over the next 10 years, which will have a profound impact on health and social care. There will be a huge impact on the economy, as families will increasingly have to spend more time looking after the vulnerable, rather than going to work. The ramifications are immense.

I have detected some recognition in the Chamber today, particularly from my right hon. Friend the Member for Charnwood (Mr Dorrell), that there needs to be some cross-party agreement on this. I suspect that we will be arguing over the next 10 to 15 years about how we pay for health care. I have been brave enough to suggest that relying solely on general taxation to fund health care is not practical in the medium to long term. It is difficult politics—trust me, I saw my Twitter account explode at that point—but I think that we are likely to have a debate on that, and an argument, across the House, and that is as it should be.

However, where we should not disagree is about the way health care is structured in this country. I think that for both parties—it is a plague on both houses—the introduction of the market into hospital health care and the use of private finance initiative contracts, particularly over the past 10 years, has made it extremely difficult to reconfigure hospitals in certain parts of the country, which is unfortunate.

I have also heard that the introduction of competition law and its possible implications with regard to reconfiguration is also looming large in the national health service. Government Front Benchers might want to look at that, because I am persuaded—I have spoken about this on many occasions—that in future we will need fewer acute hospitals but more community hospitals. The majority of care will increasingly be offered closer to home, or indeed in the home, but the clever stuff, such as the life-saving stuff shown in the television series that the BBC is currently broadcasting on Thursdays, cannot and will not be offered in the number of district general hospitals that we currently have. Anybody who thinks that it can be does not understand. I suggest that it is increasingly becoming good politics to save lives, not to defend the indefensible, and I think that Members on both sides of the House should reflect on that.

One example from that television series was a nasty accident involving a head-on collision 30 minutes north of Addenbrooke’s hospital. The injured did not go to the local hospital, which had recently opened, because it could not care for them; they went 30 minutes down the road to be treated at Addenbrooke’s. In other words, a hospital that had been built in the past few years was already not fit for purpose. We should reflect on that.

Reconfiguration is essential, and it has been shown—not least in respect of London stroke services—to save lives and improve care. That should be replicated across the country.

[Mr Kevan Jones]

The hon. Gentleman is speaking a lot of sense. The stroke unit in the north of County Durham has just been specialised, and the results are already showing the benefits, although in parts of the region there was a lot of opposition to the move.

Does the hon. Gentleman think that long-term health should be managed not only by doctors but by pharmacists and others, who can play a key role?

[Dr Lee]

I am pleased that services are improving in County Durham; as the hon. Gentleman knows, I have family roots in his part of the world that go back centuries. I am not persuaded of the role of pharmacies, although I am persuaded of the role of pharmacists. I distinguish between the two because I personally think that all GP surgeries should be dispensing drugs. I do not see why the taxpayer should be subsidising pharmacies.

It is no surprise to me that Boots was the biggest ever private equity buy-out in the history of British industry, given that the taxpayer is outside the front door: “Come here for your amoxicillin, and while you’re here you can get your shampoo, conditioner and royal jelly.” I am not convinced about the role of pharmacies in the longer term; pharmacists most certainly have a role and should be included. Community pharmacists should be checking drugs, particularly when patients have polypharmacy—when they have a multitude of medications, another pair of eyes is always appropriate.

To return to the reconfiguration, in my locality we have a number of district general hospitals. Historically, Bracknell itself has been under-served by acute services since it was created in the late ’50s or early ’60s. We have seen services diminish in the area for a variety of reasons and under Governments of both parties, and we are sensitive about that.

Before I was elected as Member of Parliament for Bracknell—I stress that it was before I was elected—I suggested as part of my campaign that we needed to close hospitals in the area and consolidate to improve clinical outcomes. I am not aware that my result at the election was adversely impacted by that. Having worked in the area as a GP for a number of years and looked after 50,000 patients, I guess that people trusted what I was saying, and I recognise that.

I was trying to argue that we could consolidate acute services on a single site and improve community hospital services in appropriate locations around the region. I stress the word “appropriate”, as the problem is often that, for a variety of legacy reasons, hospitals are in inappropriate locations. They are not often on motorways, but on land bequeathed before the war. In my part of the world, the Astor family bequeathed the land for Heatherwood hospital. The local farmer outside Slough bequeathed some land because his daughter was looked after well. People thought, “Okay, we’ll build a hospital in the middle of a farm field nowhere near the population that it seeks to serve.”

There is a legacy problem. There is some need to close and relocate, while in some parts current locations can be enhanced. In my locality, there is the problem with Heatherwood hospital. I must put on the record something bizarre that frustrates me. It is “blue on blue”; if I was in a defence debate, it would be called friendly fire. The Royal Borough of Windsor and Maidenhead has called for a judicial review of the relocation of a minor injuries unit just three miles down the road, would you believe, to Bracknell—an urban centre in a better location and away from a place opposite the Royal Ascot racecourse. That judicial review will delay the move and cost money. I find that baffling and bizarre. It is evidence of the problem that I guess all colleagues of both political colours experience in local politics with regard to health care and trying to change services for the improvement of clinical outcomes, because it is not about cost, although obviously that is a factor, but about improving clinical outcomes. That frustrates me, and I will certainly be dealing with it robustly in local terms. At the moment, it is in the best interests of the general public to have fewer acute hospitals.

Mental Health

Kevan Jones Excerpts

Thursday 16th May 2013 Commons Chamber

[Mrs Moon]

I am very aware of that research; the point I was about to make comes from it. The problem is that we often use the police as our first line in dealing with people with mental health problems, but they are not trained and equipped to carry out that role and function. We must do something about that. Otherwise, the person with the mental health problems is often dealt with as a disruptive element, and treated as if they are someone violent and aggressive, rather than someone who has a mental health problem. We must deal with that problem.

Words and anecdotes can be dangerous, particularly in the military. Research was published this week by the Defence Analytical Services and Advice agency on Falkland veterans. It found that 95 veterans had taken their own lives since the end of the conflict. That figure is lower than previously assumed, although each death is a tragedy for the individual and family involved. The research showed that, of the 26,000 mobilised, 255 died in conflict and 95 took their own lives, but 455 died of cancer. We sometimes forget that our armed forces community has problems we need to address that are not necessarily mental health problems.

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

I agree totally with my hon. Friend that each of those 95 people taking their own lives is an individual and family tragedy. My problem is that, in opposition, the Conservatives, including the Prime Minister, took the figure used prior to the research and quoted it freely, like confetti, to try to discredit what the Labour Government were doing for veterans’ mental health.

[Mrs Moon]

I tracked that figure back and found that it initially came from a story in the Daily Mail. That is how currency becomes fact.

[Mr Jones]

It was repeated by the Conservatives.

[Mrs Moon]

The repeating of such figures is the dangerous part as it places the perception in people’s minds. More dangerously, it goes into the minds of veterans, who then think, “I have served. I will have a mental health problem and post-traumatic stress disorder,” when the opposite is true. It is incumbent on all hon. Members to ensure that our work and the facts we share come from academically proven research. A study by Lord Ashcroft suggested that 92% of the public believe that all veterans will have a mental health problem, but research suggests that the opposite is true—that 90% do well.

We have had a 15-year report from the King’s Centre for Military Health Research, but we need a 20-year report showing the impact of the draw-down from Afghanistan and the increased numbers of veterans in the community.

In this debate on mental health, words can be dangerous—they can harm and create impressions in vulnerable minds. They can make people believe they have a problem they do not have, or that they have a problem that they can survive and grow from. Military mental health is robust. The transition to civilian life, alcohol misuse and reservists are risks that we must take seriously and tackle. The MOD will need to work more closely with the Department of Health. As people leave the armed forces and become civilians, civilian society organisations need to be equipped and ready to help. As civilians, we face the same problems together.

--- Later in debate ---

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

It is a pleasure to follow the hon. Member for Broxbourne (Mr Walker), whom I would call my hon. Friend.

I congratulate the Backbench Business Committee and the sponsors of this debate. Remarkably, this is the second debate on this subject in less than a year. I think we should have one every year in order to raise issues that affect many in the House and many of our constituents. Our last debate was on 14 June 2012, when I spoke about my depression and the hon. Member for Broxbourne spoke about his struggle with mental illness. We were both a little wary about what the reaction would be, but it has been nothing but positive, to the extent that he and I have become the Eric and Ernie of the mental health conference circuit. I leave it to you, Madam Deputy Speaker, and the House to discern which of us is Eric and which is Ernie. I have received well over 1,000 e-mails and letters, and I think one was negative, but so what? As I said last time, if people did not like me before I spoke last year, they are not going to like me now.

The most remarkable thing for me is that some people I thought I knew well have told me about their own mental illness. I want to pick out three. I will not name any individuals, and I pick them out only to demonstrate that mental illness and depression are equal opportunity conditions. It is not determined by social status, education or what someone does in life. The first was a chief executive of a large council whom I have know for many years. If she was here today, hon. Members would think her a confident and forthright individual, but speaking to her after the debate, I learned that she suffered terribly from post-natal depression.

The second person was the chief officer for a large European defence company. I am sure that some people in the House have met him several times. He is the last person hon. Members might think suffered from mental illness but, as he explained to me, 10 years ago he suffered from a bad bout of depression. The third person, remarkably, is a retired general I know. Others in the House will know him. I will not mention his name, but again he is not someone we might think suffered from mental illness. I pick out those three to demonstrate my point. These are not weak individuals or failures in life, but confident individuals, and had they not told me, I would not have known, and neither would anyone else, apart from their immediate families.

I want to give another example. I was on Chester-le-Street in my constituency one Saturday morning. I was walking down the street and a lady, perhaps in her late 50s, early 60s, came up to me and said, “Mr Jones, can I thank you for what you said on mental illness?” I said, “Thanks very much.” She said, “I’m a recovering alcoholic who had 10 years of depression, but now, with the proper support, I am leading a good, constructive family life.” Normally, if I had walked past her in the street, I would not have thought that this well-dressed, middle-class lady had suffered from mental illness. That reinforced the point that unlike a broken leg, for example, we cannot see mental illness. Every day we pass people in the street or working with people—people we might know very well—who have suffered from mental illness or who has a family member who has suffered from it.

[Ian Austin]

What my hon. Friend is saying illustrates how important the speeches that he and the hon. Member for Broxbourne (Mr Walker) made were. The key point is that despite the number of sufferers who battle against these problems at some point in their lives, there is still a huge amount of stigma attached to them. That is why debates such as this are so important. On his point about health, it is quite right that the Government and public health organisations do so much on smoking, weight loss and reducing alcohol intake to improve health and well-being, but why does he think so little is said publicly, or by health organisations generally, to raise the problems of mental health?

[Mr Jones]

That is our great challenge, and not just for the present Government. We did a lot in the last Government to recognise the problem. I pay particular tribute to my right hon. Friend the Member for Leigh (Andy Burnham), who championed IAPT—improving access to psychological therapies—services, for example, but part of the problem is cultural. We do not talk about these issues in this country. I think that is changing—I will come to the stigma in a minute—but for anyone who has suffered from a mental illness or who has a family member who has, there is a sense of shame. There should not be, but there is a sense in which talking about it means that those people are failures, when I would argue the opposite. In many cases it is a sign of strength. With the right support, people can function normally, work perfectly normally and have a perfectly happy and productive family life.

[Yasmin Qureshi]

I congratulate my hon. Friend on being brave and speaking about his situation—as I congratulate the hon. Member for Broxbourne (Mr Walker) on speaking about his—and on highlighting the issue. There is a stigma attached to it, and we should discuss it more. My hon. Friend said that the lady who approached him said that she was able to recover after she was given support. Does he agree that some mental health treatments are often quite costly? There is a funding issue, so should we not also encourage the Government to ensure proper funding for services across the country for everyone who may have problems?

[Mr Jones]

We need to explode the myth that the problem is funding. I do not think it is; I think it is where the funding is spent—a point raised earlier. Indeed, funding that is properly spent on early interventions for people with mental health issues will save the NHS money in the long term, not cost it.

[Mrs Moon]

There is an issue with the interaction of mental health and alcohol. I repeatedly had texts from a dear friend of mine who is a minister in the Church. He had severe depression and was self-medicating with alcohol. His family and the police would repeatedly take him to mental health services, which would turn him away, because they said he had been drinking. He was drinking because he needed their services and could not access them. We have to ensure that mental health services cannot turn away people who have been drinking, but hold them until they are no longer under the influence of alcohol and then ensure that they access the services they need. The link between alcohol and mental health has to be explored and tackled.

[Madam Deputy Speaker (Dawn Primarolo)]

Before the hon. Member for North Durham (Mr Jones) continues, let me say that interventions are becoming speeches in their own right, when they are supposed to be brief and pertinent to the point that has just been made. If we could return to that, perhaps it would help the flow of the debate.

[Mr Jones]

It is a statement of fact that people with mental illness will self-medicate, and alcohol is the most easily available drug. I am surprised by what my hon. Friend describes. If services are taking that approach to people, that is wrong. Her point is also linked to the bigger debate about access to alcohol.

Let me return to the issue of stigma, which my hon. Friend the Member for Dudley North (Ian Austin) raised. He quite rightly said that we do not talk about it, but we are making some progress. I thank Mind, Time to Change, Rethink and the Royal College of Psychiatrists for doing a great job of raising the issue and tackling the stigma. We should remember that it is not just the individuals with mental illness who suffer, but family members too. Earlier my hon. Friend the Member for Ashfield (Gloria De Piero) mentioned her own family. A lot of families suffer in silence because they think there is no one to turn to. In many cases, they think they have failed in some way or wonder where they can get help. It is not uncommon—I have come across a lot of these cases—for carers to end up suffering from mental illness themselves because of the daily pressures on them.

The hon. Member for Broxbourne raised the issue of schizophrenia. I pay tribute to the Schizophrenia Commission, which reported towards the end of last year. It looked not only at services for schizophrenia, but at the stigma attached to. Again, the popular image in the media is that someone suffering from schizophrenia is potentially the mad axeman or woman next door who will come and kick the door in, when nothing could be further from the truth. When we describe people’s conditions, there is an onus on us all to describe them properly, because there are people suffering from schizophrenia who, with proper treatment and support, can function quite normally.

I also pay tribute to the hon. Member for Croydon Central (Gavin Barwell), who introduced the Mental Health (Discrimination) (No. 2) Act 2013—a good use of a private Member’s Bill. Like my friend the hon. Member for Broxbourne, I also pay tribute to Lord Stevenson, not only for championing the Bill through the other place, but for the work he does with his new charity. Did that legislation help in itself? Yes, it did, because it sent a clear signal that we were starting to take discrimination more seriously. Will it change things overnight? No, I do not think it will, but the more we talk about the stigma, the better people can address it.

I have been criticised—we see this occasionally in some newspapers—by people who say, “Well, it’s okay for famous film stars or even MPs to say they’ve suffered from mental illness,” as though it is somehow an easy thing to do, but I can tell Members now that it is not. I would like us to reach a position where people generally are talking about mental illness, so that if people are suffering in a workplace, they can open up to their colleagues. I should point out—not just to people in this Chamber, but to those in the wider audience—that most people who are suffering from a mental illness would be very surprised by the reaction if they told people. However, it is a big step, and I know personally that it is a very difficult one to take.

One of the best examples of that was from a Channel 4 programme that I appeared on after I spoke last year—I pay tribute to Channel 4 for its work to raise awareness of the stigma around mental illness. The programme had the great title of “Mad Confessions” and was presented by a very mad individual called Ruby Wax. By chance, it happened to include one of my constituents, Derek Muir, who suffered from depression. The programme started with him talking about his depression—he had been off work for a number of months and lives in Edmondsley in my constituency. At the end of the programme they got all his colleagues together in a room and he told them. It was the first they had known about it, but the reaction was very positive and supportive. That is the point we need to get to. Sometimes it is a big step for people suffering from mental illness or depression to admit what is seen as a frailty—although it is not. The strength is in opening up and asking for help.

One area that we need to do more work in is getting mental health policies in the workplace right. I pay tribute to BT and Dr Paul Litchfield for their policies, which have buy-in not just at the level of personnel managers, but from the board downwards. They are not only talking about getting people to talk to one another and open up about mental illness, but trying to be supportive of people with mental illness. When I was at a seminar with Paul last year, somebody asked him, “Why has BT done this? Is it just to tick the social responsibility box?” He said no. Indeed, the board was quite clear: the policy makes economic sense for BT. The message we need to get across to more and more employers is: “Why write off people who are valuable to your business, just because they happen to suffer from a mental illness?” BT is to be congratulated, and I certainly congratulate the board and Paul on their work in this area.

[John Glen]

The hon. Gentleman is making a typically brilliant speech on this subject. Will he also focus on what we could change in regard to education in our schools? For many, laying the foundations of understanding at an earlier stage, prior to the workplace, would be very effective in creating better outcomes and helping all those young people who have to witness mental health problems among adults.

[Mr Jones]

The hon. Gentleman makes a very good point: schools are important in this regard, and it is important to get young people to talk about the issue. I have a fantastic charity in my constituency called If U Care Share, run by Shirley Smith. It was created following the tragic circumstances in which Shirley’s 19-year-old son hanged himself. Her organisation goes into schools, youth groups and football clubs—Shirley is working with the Football Association and others—to get people talking about their emotions. We need to get more of that kind of work going.

The workplace is important. Although he is not in the Chair at the moment, I want to pay tribute to Mr Speaker, as well as to the House of Commons Commission. Following our last debate on this issue, they earmarked some funding for our own mental health in this place. Dr Ira Madan, the head of the unit across the road that MPs and staff can access, has told me that that was valuable in that it allowed her to assist Members with mental illness, and that there had been an uptake of the services since the money was made available. I would recommend that anyone who wants to go and have a chat with her should do so, as she is a very good and open individual. We must give credit to Mr Speaker and the Commission for that funding, because that was not an easy decision to make, especially as he was getting criticism from certain newspapers for giving special treatment to MPs. It is not special treatment; it is a vital service. Unfortunately, it is still not open to many MPs because of the stigma that surrounds mental illness.

[Norman Lamb]

I pay tribute to the hon. Gentleman for the incredible contribution that he has made to this subject over the past year or so. It was encouraging to hear what he said about Mr Speaker’s actions, and I want to alert him to the fact that I am trying to get every Government Department to sign up to Time to Change, so that they can all make the commitment to be an exemplar. If we are talking about what employers in the private sector should do, it seems to me that we should be taking the lead here.

[Mr Jones]

I have spoken at a few events with the Minister, and I want to thank him for his interest in, and understanding of, this subject. Getting Government Departments signed up to Time to Change would be a very good move, and he should please ask if he requires any assistance from me.

I want to talk about an issue that affects many of our constituents—namely, the work capability test and the ongoing issue with the company Atos. Is work good for people’s mental health? Yes, it is. Should people be in work if they can work? Yes, they should, with the right support. The problem with the work capability test, however, is that it is still not looking at people with mental illness with any sympathy or understanding.

I believe that individuals with long-term mental illnesses should be taken out of the current work stream, and that there should be a dedicated system for dealing with such people. I am not saying that we should write them all off and leave them at home without making any assessment, but we cannot continue with the present ludicrous system in which they are assessed by the same people who assess claimants with bad backs and other injuries. There are assessors with no expertise at all in mental illness. The assessment process is leading to some people’s conditions being made worse, and, in some cases, to people taking their own lives. One of my constituents has taken an overdose because of the trauma of being asked to attend an interview.

[Jeremy Corbyn]

My hon. Friend is making an excellent point. Does he think it would be better if, instead of calling people with mental health conditions in for an interview, Atos simply sought medical reports on them and then considered setting up an interview with a suitably qualified examiner? Would that not be better than the production line that Atos operates at the moment?

[Mr Jones]

My hon. Friend makes a good point. The starting point should be the medical history of those individuals. Someone at the Department for Work and Pensions has said that it is not possible to identify such individuals, but that is complete nonsense. The process my hon. Friend has just suggested should be the starting point.

Professor Harrington’s review of the process put forward the idea of mental function champions. The Government spun that idea out a bit, as though it was the big answer to the problem, and I actually fell for it at the beginning, thinking that those people would be the ones who would carry out the assessments. That was not the case, however; they are there to give advice to the Atos assessors. We still have assessors with no mental health qualifications.

Representatives of the charity Mental Health Matters, a good advocacy charity in the north-east, have just met Atos to ask about the champions, and a number of questions have been raised. Atos would not tell them how the champions were recruited, and there is no indication that they need any formal qualifications. I understand that they are given a two-day Atos in-service training course, but they do not interact with any of the royal colleges or other outside bodies. Remarkably, they are also not accountable to the DWP. I put it to the Minister that he needs to tell the DWP that this must be looked at again. The process is not only causing a lot of heartache and difficulty for many of our constituents; it is actually not a good use of public money. People are failing the tests and going to appeal. At least one of my constituents has been affected in that way. They sometimes go through the process and end up in a residential hospital for a month, which must cost more than the amount of benefit that might have been saved.

We also need tailor-made programmes for people with mental illness. We should consider a separate work stream that could include voluntary work, given that many people with mental illness find the transition back into work through voluntary work easier than being thrown straight back in. We also need a pool of employers who understand and are sympathetic towards people with mental illness. There is an idea that such people can just join the normal job market and that employers will just accept that they might not turn up for work for a day or a week because they are not feeling well, but that is not the case. Those people will not keep their jobs for very long.

[Nic Dakin (Scunthorpe) (Lab)]

I was at a recent meeting of the Mind support group in Scunthorpe, and I was concerned to hear people saying that they were anxious about taking on voluntary work because of the impact it could have on their benefits and their access to other services. Does my hon. Friend think that that issue needs to be looked at?

[Mr Jones]

Yes, it does. If there were a separate work stream for those individuals, of which the voluntary sector was a part, we could use the voluntary sector to get people back into the world of work. I agree with my hon. Friend, however, that they should not be penalised for doing so through loss of benefits.

I also want to talk about the old issue of the NHS reorganisation. It provides some great opportunities for doing things differently, and there should be an opportunity for local providers to bring in the third sector. I have one problem with that, however. I am president of the local Mind, which has just received a contract to provide certain services, and the process it has to go through is very difficult. I am not suggesting for a minute that such organisations should not be performance managed, because there are some large contracts involved, but we need an easier system for applying for the contracts. We also need to ensure that when bodies are competing for the contracts, people can access the services.

Another area of concern is the increased waiting lists for IAPT services. I know that the world has changed since 1 April, and people who lobby on behalf of mental health services are going to have to change their lobbying tactics. It is important to ensure that commissioning groups have an understanding of mental illness and of the importance of IAPT services.

If we look at the Royal College’s report, we find that people are going through the system saying they are quite happy when they get a diagnosis, but are then told they might have to wait up to a year for a talking therapy—that is just no good. What we need—again, this will save the NHS and the economy money—is a quick service such as the IAPT service. I know from people in my own constituency and others who have written to me that the wait is totally unacceptable. If we want to make this work, we have to make sure we have a joined-up service and that people who want a diagnosis get the support they need quickly. Otherwise, people will be stuck in this no man’s land between diagnosis and treatment.

Another area on which the new organisation needs to focus is local government. Local government now has an important role in health care through health education and protection. The Royal College of Psychiatrists is working with councils on a project to have champions at the local level. It is important for local councils to have councillors or chief officers who can champion the need for mental health services locally.

I welcome the debate. It is important to talk about these subjects, and the more we do, the better. To adopt an old BT phrase, “We need to talk”. If we talk about it—whether it be in schools, the workplace or here—we will erase the stigma of mental illness. That has to be the goal: mental illness being treated just like any other long-term condition. People should not be afraid of admitting to it and should not feel that they cannot be helped. We also need to recognise that in many cases—including, I have to say, my own—it can be strength rather than a weakness.

--- Later in debate ---

[Jeremy Corbyn (Islington North) (Lab)]

Like all the other Members who have spoken, I welcome the debate. It is important for us to have it, and I hope that it will become an annual event. It is a way of reducing the stigma that is attached to mental illness, increasing understanding of it, and also, quite correctly, holding the Government to account on how their policies develop.

There is still an enormous amount of discrimination against people who have suffered from some kind of mental illness or breakdown, or have spent time in a long-stay institution. Like all discrimination, it is incredibly wasteful of resources, because it means that those people cannot contribute to society in the way that we want, and as a result we all lose out.

I want to raise two points. The first relates to local experiences, and the second to national policies. My borough has an image as being relatively wealthy and high-achieving, and there are certainly some wealthy and high-achieving people in it. Islington council, however, undertook an interesting exercise: it set up a fairness commission to examine the quality of the delivery of public services to everyone in the borough, with the aim of ensuring that the purpose of the council’s policies, including health policies, was to reduce inequality.

According to a briefing that the council gave me before the debate, it is estimated that in my borough

“30,000 adults experience depression or anxiety disorders in any one week…. Mental ill health among 5 to 17 year olds is estimated to be 36% higher…than the national average”.

The briefing states that more than one in eight children are

“experiencing mental health problems at any one time.”

It also states:

“The suicide rate is… 8 per 100,000…second highest in London”,

and broadly

“similar to the national average”.

Physical ill health is often related to mental health problems. According to the briefing,

“Poor mental health was found in 43% of all Islington patients who died of cardiovascular disease before the age of 75. As people live longer, there are an increasing number of people with dementia, although Islington has a relatively smaller number of older people”—

only 9% of the population. Islington has a 70%—higher than average—rate of diagnosis of dementia. Increasingly, as others have pointed out, people who care for adults with mental health problems are much older people who find it extremely difficult to cope. Those carers need more support, so that they are better able to look after people who are becoming more and more dependent.

Both my local council, in its study, and the Mental Health Trust draw attention to the enormous over-representation of people from black and minority ethnic communities in the context of diagnosis and, in particular, the context of long-stay institutions. We should ask whether there is, in fact, a higher level of prevalence, or whether there is a perception that it is somehow OK to put black and minority ethnic people into long-stay institutions, whereas it would not be OK in the case of other people.

Indeed, I urge Members to visit long-stay institutions and talk to people resident in them. I get the impression some of them have had very difficult lives and very little support, and that they have led very isolated existences. I also get the impression that many of them have very few friends and very little representation, and whereas those who come from a fairly stable family background with a series of understanding relatives are able to get representation and often win their cases where there has been a section order, others do not get the same quality of representation and consequently do not win any tribunal cases.

In an earlier speech, I made an intervention about the role of the voluntary sector in dealing with mental health conditions. As I have pointed out, my borough has considerable problems in dealing with mental health, but we have a number of very good local organisations that often deal with mental health issues in an innovative and supportive way, and are often very successful. Nafsiyat, an intercultural therapy centre based in Finsbury Park which was founded by the late Jafar Kareem, was groundbreaking in its ideas of looking at the cultural background and ensuring culturally appropriate treatment of people with mental illness, for example by making sure there are people who speak the necessary languages and understand something of the specific cultural background. The Maya Centre, which particularly relates to women, does much of the same work, as does ICAP or Immigrant Counselling and Psychotherapy, a counselling and psychotherapy centre originally founded by people in the Irish community that now deals with a much wider community.

We also have a considerable refugee population. A very good group called Room to Heal deals with people who have achieved asylum status in this country. They have often been through the most dreadful experiences of torture, which are frequently dealt with in a community way. People meet regularly and do things together, such as gardening and taking trips. Many of them improve a great deal and get through the terrible traumas they have suffered. I find it very interesting talking to people from different countries all around the world who have all experienced torture in one form or another and who have benefited from these activities. We also have the Refugee Therapy Centre and the Women’s Therapy Centre, which also provide therapy on a culturally sensitive basis. Finally, we have the Holloway Neighbourhood Group stress project.

These are all valuable groups, and they all depend on contracts obtained either from the local health authority or neighbouring health authorities. All of them spend a great deal of time filling in forms in order to gain what are often relatively small sums of money for relatively short-term contracts. Health authorities must value these organisations and look to use them. We should give out the message that we recognise that the voluntary sector has a very important complementary role to play in supporting statutory services in the treatment of mental illness. I do not see them as competitors or rivals; I see them as complementary.

[Mr Kevan Jones]

I agree with what my hon. Friend says about the smaller contracts these organisations get and the bureaucracy they have to deal with. Does he agree that some of them could bid for larger contracts to provide services as well, but the bureaucracy and financial hurdles involved in bids for such contracts make it very difficult for them to do so?

[Jeremy Corbyn]

I agree. The bureaucracy involved and the skewing of the contract culture frequently means voluntary organisations that have a tradition of the voluntary provision of services—often in an effective and innovative way, as I have described—are debarred by the contracting process. Instead, very large private sector medical companies come in to privatise those services and run them in a profit-related way, rather than the voluntary sector, which is motivated not by profit, but by the care of the individuals. I urge Ministers to look very carefully at how services are contracted out to the private sector, which is motivated by profit, as opposed to voluntary sector organisations, which often have a very good record in looking after people who need help and support.

We must also recognise that if we are to deal with mental illness problems in any community, there must be a level of understanding that goes wider than just what GPs, hospital doctors and the statutory services do. There is the question of signposting. I pay tribute to local organisations—voluntary groups, churches, mosques —that understand the situation and help signpost people into getting help and support, because many people in our society with some degree of mental illness get no support whatever. This debate may well help us to understand that that is needed.

We must also recognise that there is a cost involved. The cost to health budgets of dealing with mental health is very high. Unfortunately, the policy of community care for the mentally ill has often resulted in lack of care, and in deep isolation and serious problems for the individuals concerned.

I recall a debate in the House in 1986. The Select Committee on Health was looking in an interesting and critical way at the closing down of large asylums and long-stay institutions, such as Friern Barnet and Napsbury, that existed all around London, and, indeed, all around the country. The Committee warned that community care should not be seen as a cheap option, saying it should instead be seen as an opportunity, but as one requiring comprehensive support, support workers and care.

I am sure all MPs have talked at their surgeries with neighbours of those with mental health problems who have come to complain about noise and inappropriate behaviour. Many of them say to me they are sympathetic to the plight of the individual, and recognise there is a lack of support. We should not see community care as the cheap option. It is an option that can be followed, but a great deal of support is also required to carry it through.

[Mr Kevan Jones]

Does my hon. Friend also agree that under the new NHS structure, local councils will have to do a lot more in terms of understanding the needs of people with mental health conditions?

--- Later in debate ---

[John Pugh (Southport) (LD)]

I apologise to the House for not having been here at the start of the debate. I was in the Finance Bill Committee, and unfortunately I cannot be in two places at the same time. I also apologise for missing the introductory speech by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow). I pay tribute to everything he has done to put mental health on Parliament’s agenda.

It is unquestionably the case that Parliament has got its act into gear on this. I refer to Parliament rather than the Government or the Opposition because this is genuinely an all-party matter. Last night I went to a very encouraging event, which other hon. Members attended, run by the Alzheimer’s Society. The Minister was there, as was the shadow Secretary of State, a Conservative Minister, and my right hon. Friend the Member for Sutton and Cheam, and they spoke with their customary eloquence. In fact, to be fair, there were not very many Members there. I think that other people were detained with matters that had something to do with Europe. However, all of us who were there would have to acknowledge that no matter how eloquently the Minister or the shadow Minister spoke, the most impressive speech was by a very feisty medical lady who had Alzheimer’s and discussed the importance of talking about her condition and people talking to her about it.

That emphasises the fact that there is a blurred division between people who have mental problems, allegedly, and those who appear not to have them. There genuinely is not a clear distinction, other than at the extremes. If we were asked who here has perfect mental health, we would not necessarily all volunteer with alacrity, any more than we would if someone asked who has perfect physical health. It is rather like the Bible saying that the person who is without sin has to step forward. We would not say that because we acknowledge that we all have our own peculiarities and weaknesses and are not as mentally robust as we would always wish to be.

I was made aware of that the other day when I went to an event organised by Liverpool Personal Service Society, which is a well-established charity. The event was a memory day for elderly people in which it invited me to participate. The old ladies and old men were passing round objects that came from their youth, and music was being played in the background that also came from their youth. The environment was made to look almost like a 1950s drawing room. I was very struck by what it did for them. It was like the events organised by football clubs such as Everton and my own local football club in Southport, which bring old men together to talk about teams long since vanished and the glories of the past.

I picked up on two important features of that occasion. First, it was undoubtedly beneficial to the people concerned, who have dementia. Secondly, it is not in any way onerous for anybody else to participate in it. It is incredible fun. It is really enjoyable to hear these people talking about things that are now obsolete, like cigarette cases, nylons of the kind that people had in the war, or EPs—things that we no longer have and that our children do not even understand. That brings it home to us that memory is very relative. There is no magic cut-off point between a memory lapse that may afflict us at any time—

[Mr Kevan Jones]

Nick Clegg knows all about that.

[John Pugh]

We are presumably talking about unintentional memory lapses—senior moments that may afflict any of us.

There is no absolute cut-off point between mildly obsessive behaviour and obsessive compulsive disorder, between mood swings and genuine bipolar conditions, or even between irrational fears of which everybody is sometimes a victim and some of the conditions we would call paranoia. There is a continuum; it is, to some extent, a matter of degree. It is even possible, apparently, to have hallucinations without having schizophrenia. Delusions are not unique to asylums; there are many victims in this place. There is nothing especially rational about clever, civilised people gathering here every Wednesday at 12 o’clock just to shout at one another.

There are two aspects to addressing the stigma of mental health. One of those is to persuade people that this can happen to anyone, including MPs. That is very important. The other job is to persuade the public that mental health is not an either/or, black/white distinction. I recognise that there are conditions such as serious neurological malfunctions, deterioration of the brain, and so on. Affective disorders can be evident in people classified as being well and also in people classified as being unwell with mental health issues. What determines the classification is not only the severity of the condition—the extent to which the person is down one continuum or another—but the capacity of society to deal with the condition and the ability of the person to cope within society with the condition. The cultural comparison made by the hon. Member for Bolton South East (Yasmin Qureshi) is useful in this context. The mental health of a society and the mental health of individuals are intertwined, and one is the index of the other. I wonder whether, when we talk in this place about producing a prosperous society or economic growth, or doing something about social mobility or social inequality, we ask ourselves sufficiently whether we are doing enough to make society a happy place for us all to live in.

Let me add one other point with which I think you, Madam Deputy Speaker, will be au fait. Community treatment orders were a bone of contention throughout the passage of the Mental Capacity Act 2005, when I served on the Bill Committee. We have to review that issue, and the Minister needs to make a response. I think that we made the right decision, but that depends on whether the Act is understood and implemented properly. There is a genuine case, particularly given some of the variations, for trying to see whether we have got it right.

--- Later in debate ---

[Norman Lamb]

I am grateful to the hon. Gentleman for his intervention. I was going to mention his contribution, even though I was not present to hear it, for which I apologise. As a Member of Parliament, concerns have been raised with me about the suitability of those tests for people with mental health problems, and I was going to suggest that I should talk to the appropriate Minister at the DWP. I am of course happy to do that. Someone else made the point that this is not a question of not addressing the need to help people get back into work. Work is particularly important in relation to people suffering from mental ill health, and the idea that we should simply leave them undisturbed and out of work for the rest of their lives is totally wrong. The way in which we handle this is incredibly important, however, and if we have more to learn in that regard, we should be prepared to learn the lessons.

[Mr Kevan Jones]

I made the point in my speech that work was good for people with mental illness. The problem is that the present system is inefficient and costly, and that it is creating absolute agony for many people. I know that the Minister has a great understanding of, and a deep passion for, the subject of mental health, and I urge him to put pressure on the DWP to change the system. We are not asking that people should be excluded completely from work capability tests; we are just asking for the system to be changed.

[Norman Lamb]

I am grateful to the hon. Gentleman for reminding me that he, too, had made that point. I knew that someone else had talked about it, but I could not remember who it was. I take his point; I have heard it.

My hon. Friend the Member for Southport (John Pugh) made a thoughtful speech in which he talked about reminiscences. Oh! He has gone! Even though it pains me, as a Norwich City supporter, to talk about Everton, it appears that Everton and even Southport have done some very good work in these areas. My hon. Friend talked about a continuum of mental health. That was a good point, well made. He also mentioned community treatment orders and the need to look at how they are working. I will certainly reflect on that.

My hon. Friend the Member for Battersea (Jane Ellison) made a powerful contribution about the mental health aspects of female genital mutilation, a most horrific experience suffered by so many young girls. I really pay tribute to her for the work that she has done on that issue. The fact that there are 66,000 females in this country who have suffered this assault was an extremely striking point.

The hon. Member for Finchley and Golders Green (Mike Freer) talked about waiting times for access to treatment. He asked if he could gently challenge the Minister—I appreciated that approach. On the mandate for the NHS Commissioning Board, NHS England has been very clear that we expect it to assess the scale of the problem of access, including for IAPT. Other Members have raised the question of whether we are meeting the IAPT programme’s four-week target. We want the NHS Commissioning Board to assess the scale of the problem with a view to setting access standards.

One of the big problems relating to what I regard as the institutional bias against mental health is that on one side of the equation we have the 18-week maximum waiting time for physical health, which is a very powerful political driver of where the money goes, yet we have nothing equivalent for mental health on the other side. That, to me, is a lack of parity of esteem. For people with mental health problems, early access is particularly important to ensure that their condition can be halted, if possible, and the deterioration stopped. The hon. Member for Finchley and Golders Green made a good point there, and he also rightly talked about the importance of consistency and continuity of care.

I want to mention four of the most important things that this Government are doing to create the environment and incentives for improving mental health across the system as a whole. The first is the Health and Social Care Act 2012, which creates a “parity of esteem” so that mental and physical health share the same importance, as we have discussed this afternoon. Changing the law is just the start, but it sends a clear signal—that mental health is important, and that the health and care system can and must play a leading role in changing attitudes across society as a whole.

Secondly, there is the mandate the Secretary of State has issued to NHS England. It shows the importance we have ascribed to mental health and makes it clear where improvements are needed. The mandate makes clear our overarching goal—that mental health must have equal priority with physical health across all aspects of NHS work. In particular, we have highlighted the need to close the gap in outcomes between people with mental illness and the population as a whole, as well as the absolute imperative to ensure that people can access the services they need when they need them. Neither of these facets of good mental health treatment is entirely up to scratch at the moment. I think we all recognise that.

Immigrants (NHS Treatment)

Kevan Jones Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

Yes it is. We are always likely to pay out more than we receive under that scheme because we have a number of pensioners who decide to retire to slightly sunnier climes and there is a cost to the UK under EU treaty law with those decisions. My hon. Friend is right to point out that just as inadequate as our failure to charge people from outside the EU when we should is our failure to collect money from inside the EU when we are able to, and we must also look at that.

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

The Secretary of State has clarified the Prime Minister’s figure of £20 million, but he used inflammatory language to my hon. Friend the Member for Bolsover (Mr Skinner) about health tourists clogging up A and Es. He claims that £200 million could be the tip of the iceberg, but if he does not know the figure is that not the worst example of dog-whistle politics?

[Mr Hunt]

If we do not know the figure, is not the right thing to do to find it out and sort out the problem, unlike what the hon. Gentleman’s party did during 13 years in office?

Suicide Prevention

Kevan Jones Excerpts

Wednesday 6th February 2013 Commons Chamber

[Mr Nigel Dodds (Belfast North) (DUP)]

I am pleased to follow the hon. Member for Pudsey (Stuart Andrew), who spoke about the impact that suicide can have. He mentioned a memory of his school days. In preparing for this debate, I, too, reflected on my first acquaintance with suicide. At school one day, we discovered that a chap in my class in the third year had died by suicide. I experienced feelings of absolute bewilderment and shock that someone who had been with us only the previous day—playing a normal role in school and taking part in normal activities—was gone from us. I remember racking my brains and feeling totally bewildered. What had caused it? Were we missing something? That vivid memory, which will never leave me, had an enormous impact on me.

Just today, a friend of mine related to me the sad news of the death by suicide overnight of a mutual acquaintance, and again those feelings of shock and bewilderment came back. I am sure that every hon. Member can relate to this issue in some shape or form. I know that some have experienced personal loss through death by suicide. It is very painful, but it is right that we talk about it, so I am glad of this opportunity to say a few words. Only by highlighting this issue of suicide and talking about its causes and what prompts people to take their own lives can we in some way help others not to go down this path. We need to talk about what we can do in government and society and through working with voluntary community groups to help these vulnerable people.

I want to talk from my perspective as the Member for Belfast North, which has been mentioned a number of times. It has one of the highest suicide rates of any part of the United Kingdom, with 25.2 deaths per 100,000 in the period 2006 to 2011. In the last five-year period for which we have figures, from 2007, that figure crept up to 25.9 per 100,000. As has been said, only the constituency of Belfast West has a higher rate. Those rates are high for Northern Ireland, which has high rates compared with the rest of the United Kingdom. I therefore know about this issue from my constituency surgeries, as well as from meetings with the Minister of Health in Northern Ireland, Edwin Poots, from delegations that I have led of families bereaved by suicide and from my work with groups such as PIPS, which my hon. Friend the Member for South Antrim (Dr McCrea) mentioned—I commend him on his excellent speech in introducing this debate—and others that do such tremendous work in Belfast North. They include Lighthouse, FASA—the Forum for Action on Substance Abuse—and many other charities and Churches.

Those working in such organisations do enormously dedicated work in difficult circumstances, often volunteering and bearing a great emotional burden every day, as they cope with young people, middle-aged people and older people who are going through difficult times, as well as counselling and helping in a practical way families who have been bereaved. This work takes a great toll on the volunteers and others working in such organisations. I commend them publicly for the work they do on behalf of us all.

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

I have similar organisations in my constituency doing the kind of work the right hon. Gentleman describes. One of the questions they are asked by many relatives is: “What did we do wrong?”, which is a very difficult issue to deal with.

[Mr Dodds]

The hon. Gentleman is absolutely right. When I speak to people working in those organisations, I am told that this issue comes up time and time again. It is very difficult to give answers to families who are struggling to cope with the nature of the passing of their loved one. Often it is hard to find any answer that can satisfy—it is just not possible to do that—but in the long run, the work these organisations do provides enormous consolation, help and support. The work of the Samaritans has been mentioned. The right hon. Member for Bermondsey and Old Southwark (Simon Hughes) mentioned Papyrus, and there are many, many others. It is right to put on record our tremendous debt to such organisations and the people who do such tremendous work.

The new suicide prevention strategy, which was launched in September 2012 here in England and Wales, is excellent. The chair of the advisory group, Professor Appleby, who has been mentioned, has said:

“Suicide does not have one cause—many factors combine to produce an individual tragedy.”

Therefore,

“Prevention too must be broad—communities, families and front-line services all have a vital role.”

That is absolutely right, and that is why our motion today talks about government, community and society—all of us—working together to try to prevent suicide. The Samaritans chief executive, Catherine Johnstone, has made an important point—I suppose this sums up what we are trying to get at today—which is that

“suicide can be prevented by making sure people get support when they need it, how they need it and where they need it.”

We know that that is very difficult and complicated to put into practice, because as has been said—the hon. Member for Bridgend (Mrs Moon) mentioned this and the Minister reiterated it—75% of those who die by suicide were not known by, or in contact with, social services. This is not just a simple matter of saying that it is about people who are having mental health problems and who are known to the various agencies; that is often not the case at all.

As I have said, we have a particular problem in Northern Ireland, where death by suicide has gone up by 100% in less than 15 years. Some 300 people each year are dying by suicide in the Province, with men three times more likely to die in that way than females. I shall discuss some of the reasons for men being more prone to taking their lives and for their reticence in coming forward.

The hon. Member for North Down (Lady Hermon) asked the Minister a question about the amount of money that was being spent. I am glad to say that the Department of Health, Social Services and Public Safety in Northern Ireland has spent £32 million over the past six years on suicide prevention under the Protect Life strategy. That money has been extremely helpful, and it has been well spent on helping some of the groups that I have mentioned.

Of course, money can do only so much, because of the broad range of reasons that lie behind suicide. I will not go over all the issues that have been mentioned, but I will deal with one or two of them. As well as social isolation, there is the problem of drug misuse, which my hon. Friend the Member for East Antrim (Sammy Wilson) mentioned. In Rathcool and elsewhere in my constituency, good work is being done to try to reach young people with drug problems and to counter those problems. We are finding that a lot of young men—again, it is particularly young men—who get themselves into that situation end up attempting to commit suicide or actually dying by suicide. Problems with alcohol abuse are also a factor.

I also want to draw attention to a piece of research recently carried out by Mike Tomlinson of the school of sociology at Queen’s university. The key finding of his study entitled “War, peace and suicide: the case of Northern Ireland” was that

“the cohort of children and young people who grew up in the worst years of violence…have the highest and most rapidly increasing suicide rates”.

Those generations were the most acculturated to division and conflict, and to externalised expressions of aggression. The report continues:

“The transition to peace means that externalized aggression is no longer socially approved. It becomes internalized instead.”

My constituency of Belfast North probably suffered more than any other constituency in Northern Ireland—that could be true of Belfast West as well, but I can speak only for my constituency—during the period euphemistically known as the troubles. That was a heinous, horrible period of our history, with its violence, blood-letting, murder and mayhem. Today in Belfast North, and in Belfast West, we are still paying the price for that period of violence and bloodshed. Young men and women are still dying, as are middle-aged men and women, as a result of the troubles in Northern Ireland. Nowadays, they are dying not as a result of murders committed by paramilitaries, but as a direct result of the troubles because, having been brought up in a culture of violence, they cannot cope in this period of relative peace.

--- Later in debate ---

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

I congratulate the Democratic Unionist party on securing this debate. It is a privilege to follow a very moving speech by the hon. Member for Foyle (Mark Durkan).

The right hon. Member for Belfast North (Mr Dodds) is right to say that the reasons for suicide are complex. The question that most families usually ask is: why? My constituency has a great organisation called If U Care Share, which was set up by Shirley Smith, whose 19-year-old son, Daniel, hanged himself a few years ago, having not showed any of the signs referred to by the right hon. Gentleman. He was, the family thought, a perfectly happy, contented teenager. The family then wondered what they could do. They set up If U Care Share, and Shirley, her husband, Dean, and their children, Ben and Matthew, go into schools to talk to young people about suicide and people’s feelings. People should not be ashamed to open up and talk about their feelings. They also work with youth clubs and the Football Association to get their message across.

The hon. Member for Pudsey (Stuart Andrew) noted how the highest number of suicides seem to be among men, and the hon. Member for Upper Bann (David Simpson) mentioned the figure of 6,000. I have just looked up the figure and it is about 4,500 who are actually men. As the hon. Member for Pudsey has said, mental health is not an issue that we talk about. I might sound like a broken record, but we need to keep talking about mental health.

Today’s debate is good because, as the hon. Member for Foyle has said, we are talking about one of the great last taboos. The more we talk about mental health and the effect of suicide—not just on the individual and the lost opportunities for them and their family, but on society—the better we can draw up the systems to help.

There is nothing wrong about talking about mental health, or about people admitting that they need help. As the right hon. Member for Belfast North has said, that is the big step that needs to be taken in most cases. We need to get the message across, not only to young people, but to everyone, that if they are in distress they need to ask for help. In my area, the statistics show that an older generation of men in their 30s and 40s are committing suicide. A reason for that might be the issue of the economic role of men in society, which has been mentioned. Unless we talk about it and put it on the national agenda, we will continue to come up against these issues.

I have just one point to make. We need to join up the services, because the roles of the voluntary sector and the NHS are vital. GP commissioning could have great benefits, but it also brings great risks. I fear that when GPs commission services, mental health services might again be seen as the poor relation. We need a joined-up approach if we are to prevent the tragic losses that are now at a level which most people would say is unacceptable.

I will finish by saying—again, I will sound like a broken record—that the more we speak about these issues, the better it is, because it will help young people and others who are in distress to take the major step of getting the help that is there if they only ask for it.

[Mr Deputy Speaker (Mr Nigel Evans)]

To resume his seat no later than 5.45, I call Mr Jim Shannon.

Mental Health

Kevan Jones Excerpts

Thursday 14th June 2012 Commons Chamber

[Nicky Morgan (Loughborough) (Con)]

I beg to move,

That this House has considered the matter of mental health.

I am particularly grateful to all members, old and new, of the Backbench Business Committee for allocating time for this debate in the Chamber. The effort to secure the debate has been done jointly with my hon. Friend the Member for Broxbourne (Mr Walker), the chairman of the all-party group on mental health, which he has led so well, and with my hon. Friends the Members for Worthing West (Sir Peter Bottomley), for New Forest East (Dr Lewis) and for Halesowen and Rowley Regis (James Morris)—I hope I have pronounced that one correctly—and the hon. Members for Dagenham and Rainham (Jon Cruddas) and for Foyle (Mark Durkan).

We were quite clear when we put in our bid that we wanted a full debate on the Floor of the House. Why? It is at least four years, and probably slightly longer, since the general topic of mental health was debated in the Chamber. That is a long time, given that 25% of the population—one in four people—will experience a mental health problem at some point in their lives. Just imagine if this were a physical health condition and it had not been talked about by Members in the House of Commons other than in very specific ways such as Adjournment debates for a very long time.

Mental health comes at an economic and social cost to the UK economy of £105 billion a year, yet mental health has been a Cinderella service—poorly funded compared with other conditions and not spoken about nearly enough either inside or outside this House. It is the largest single cause of disability, with 23% of the disease burden of the NHS, yet the NHS spends only l1% of its budget on mental health problems.

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

Does the hon. Lady agree that it is not only a matter of the effects on individual mental health because mental health issues can lead to physical disabilities, leading to extra costs to the NHS on top?

[Nicky Morgan]

I entirely agree with the hon. Gentleman. The Centre for Mental Health has shown that for a person who has a physical and a mental health condition, the costs of treatment are increased by 45%. Those are additional costs around mental health problems, which are often untreated initially and then have to be treated at a later stage, so the hon. Gentleman is absolutely right.

According to the Centre for Mental Health, only a quarter of people with mental health conditions—children as well as adults—receive any treatment. I have no reason to doubt that statistic, and I find it shocking that three quarters of people with mental health conditions are not being treated. We should ask ourselves why that is.

Recent figures have shown that depression alone is costing the economy £10 billion a year. As we all know, we do not have a lot of money to spend, so we should be working as hard as we can on preventive measures. One in every eight pounds spent on dealing with long-term conditions is linked to poor mental health, which equates to between £8 billion and £13 billion of NHS spending each year.

I welcome the Health and Social Care Act 2012. I hope that today’s debate will be conducted on pretty non-partisan terms, but I realise that that may strike Opposition Members as a controversial comment. I welcome the opportunities that the Act offers for the commissioning of mental health services. I spoke in the Third Reading debate, and I especially welcomed the Government’s acceptance of an amendment tabled in the other place to ensure parity between physical and mental health. Although those are only words in a Bill, they are very important words, and they send a very clear signal not only to sufferers from mental health conditions and their families, but to those working in the NHS. I hope that, in his annual mandate to the national commissioning board, the Secretary of State will insist that the board prioritise mental health.

How are we to achieve parity between physical and mental health conditions? The question is about money, certainly, but it is also about awareness. Confessing to having a mental health condition carries far too much stigma. That is part of the reason for our wish to hold a debate on the Floor of the House. If we do not start to talk about mental health in this place, and encourage others to talk about it, how can we expect to de-stigmatise mental health conditions and enable people to confront their problems?

I find it interesting that, when I was preparing for the debate, a few people who had initially said to me “Yes, go ahead, mention my name” came back after thinking about it for a couple of days and said “Actually, I would rather you didn’t, because I have not told my employer,” or “I have not told all my friends and my family.” It is clear that mental health conditions still carry a considerable stigma. Admitting to having been sectioned is traumatic, especially when the information appears on Criminal Records Bureau checks connected with job applications.

I welcome the work of Time to Change, which has been funded partly by the Department of Health as well as by Comic Relief. I also welcome the Sunday Express campaign on mental health. However, the de-stigmatisation of mental health conditions is down to all of us, and it is especially important for those of us who are employers not to discriminate against people who may be working for us and who tell us that they have a mental health condition. I hope that today’s debate will constitute another firm step on the path to ensuring that mental health conditions are de-stigmatised, because I think that without that de-stigmatisation, successful treatment will be very hard for a person to achieve.

We asked for today’s debate to be kept deliberately general, so that Members in all parts of the House could raise many different issues on behalf of their constituents and, perhaps, themselves or their families as well as looking at the mental health policy landscape. Mental ill health is no respecter of age or background. It can strike anyone, often very unexpectedly. That includes people in senior positions such as Members of Parliament, company directors and school governors. I am sure that my hon. Friend the Member for Croydon Central (Gavin Barwell) will refer to the private Member’s Bill that he will be presenting, which would end discrimination against people in such positions who have mental health conditions.

I expect that during today’s debate we shall hear about new mums with post-natal depression. For them, a time of life that should be one of the happiest is often one of the most difficult. I welcome the recent Government announcement that health visitors will be properly trained to recognise signs of post-natal depression, which I think was long overdue. I expect that we shall also hear about veterans from our armed forces who suffer from mental health conditions, and about older people who suffer from dementia. Particular issues affect our black and ethnic minority communities, as well as those who find themselves in the criminal justice system. I am sure that we shall hear from the Minister abut the Government’s widely welcomed framework document “No health without mental health”, which was published last year. We now await the detailed implementation plan on which the Department of Health is working alongside leading mental health charities.

I want to talk, very briefly—I have noted Mr Speaker’s strictures about time limits—about three specific matters: listening to patients, integrated care, and the wider mental health well-being landscape. We made it clear during the passage of the Health and Social Care Act that one of the developments that we wanted to see, as a Government, was “No decision about me without me.” That means patients having a voice in their care. It seems to me from my discussions with those in the mental health system who have been sufferers that once the initial crisis has been dealt with, they tend to want choice and involvement in their treatment. They are facing a lifetime condition. They will have to self-medicate, look after themselves and identify the point at which they may be deteriorating or potentially reaching crisis point for years and years to come. They want a voice. They want to be heard by the health care professionals, and I think that it is up to us as a Government to help them to achieve that.

--- Later in debate ---

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

I congratulate the hon. Member for Loughborough (Nicky Morgan) and the Backbench Business Committee on securing this debate, and I pay tribute to her very well-informed contribution. She is obviously a great champion for people who in many cases do not have a voice in the health system. Let us hope that by securing this debate we can give those people the voice they need, and not only, as she says, in the health service; we also need to get the message across to employers and others that mental health issues are not an inhibitor to a good and successful career and a fulfilled life. I shall discuss that in a moment.

I declare an interest as the president of my local Chester-le-Street Mind group. I have had an interest in mental health for a number of years. The hon. Lady mentioned the role of the voluntary sector. It plays a fantastic role, not only in promoting the issue of mental health but in delivering services. In some cases, these organisations are better vehicles for delivering this localised help than some of the larger companies referred to by my hon. Friend the Member for Islington North (Jeremy Corbyn), or even the NHS itself.

The hon. Lady said that one in four people could suffer from mental health problems in their lifetime. The hon. Member for Southport (John Pugh), speaking from the Lib Dem Front Bench, is both right and wrong in what he said. Some people do have mental health issues because of events in their life—crises happen and people can get over them in a short time—whereas others have long-term conditions that have to be lived with throughout their life, by way of drug treatment and other effective therapies, as the hon. Lady said. There is a big difference between those two situations. Anyone in this Chamber or any of their family members could suffer from short periods of mental health illness or be long-term sufferers. That is the important thing to get out of today’s debate.

We also need to address the cost, which the hon. Lady mentioned. I am thinking not only about the cost to the NHS, and the personal cost to individuals and their families, but about the cost to UK plc. I reiterate that mental health issues can affect anyone. I know general practitioners who have gone through periods of severe depression. I know one who works as a consultant cardiologist and is brilliant in his field but who lives with mental health issues, and has for many years. He has a very understanding employer and is very open about it. Let us not say that there are any boundaries in mental health, because there are not; these issues can affect anyone in society.

I wish to discuss two issues, one of which is the effect of funding on mental health. The other relates to the welfare reform changes, to which my hon. Friend the Member for Bolton West (Julie Hilling) referred. They are having a disproportionate impact on people with mental health issues. I accept the view of the hon. Member for Loughborough that we do not want to get into a party political debate, but there is unjoined-up thinking in some parts of the coalition’s policy. I must say that I saw exactly the same thing when I was a Minister, when one Department does something that has an effect on others, and it is sometimes difficult to get round those circles. However, local authorities in the north-east are clearly having to cut back on funding for this. Mind has said in the briefing note it sent to us for today that about 22% of its funding at the local level has been cut. That is a shame because, as I said, those organisations are sometimes the best at not only being advocates for local mental health services, but at providing care. In regions such as my own in the north-east, funding is vital for those organisations. When I talk to local mental health professionals and charities, I find that it is unfortunately a fact of life that economic conditions at the moment mean that the demand for services is increasing.

The hon. Member for Loughborough referred to the Health and Social Care Act 2012, and I agree with her that it does present some opportunities, if things are done properly. Chester-le-Street Mind, under the great leadership of Helen McCaughey and her husband, Charles, delivers a local therapy service, commissioned by the primary care trust, and it is great. It is carried out in the community, and that is the model that I like to see. The only concern I have, from talking to GPs over the years, is that although some of them are passionate about mental health and understand it, others do not. The challenge for the new commissioners is to take a bold step and say that some of these services can be delivered in the community by groups such as Chester-le-Street Mind and others. The Government might have to be aware of that nationally. As my hon. Friend the Member for Islington North said, this does not have to involve just large companies, because the approach I have described would be effective. That is my only concern: that although I know some very good GPs, including my own, who have a clear understanding of mental health issues, others are not very good at giving this appropriate priority—I am sure that the hon. Lady is aware of some of those. We are thus presented with both an opportunity and a risk.

[The Minister of State, Department of Health (Mr Simon Burns)]

I am extremely grateful to the hon. Gentleman because he is making an extremely good point, but does he agree that, under the reforms and the new NHS, a crucial role will be played by the health and wellbeing boards, which are there to monitor and ensure that the local health needs of local communities are provided for?

[Mr Jones]

Yes, that is one of the key roles of those boards. Again, however, it will be important to ensure that we get the right people on those boards—for example, counsellors who really understand mental health. As the hon. Member for Loughborough said, people have empathy in respect of cancer, but do not quite understand mental health. I agree with the Minister that it is important that the boards are the counterweight to ensure that that happens, but I think that central Government also have to play a role in ensuring that it happens. As I say, we have some great opportunities here and the commissioned work that Chester-le-Street Mind delivers is excellent. In addition, it is cheap compared with some of the major contracts in terms of delivery, because it is delivered by well-trained professionals and by very committed and hard-working individuals in the community.

A lot of mental health charities also rely on charity funding from organisations. In the north-east this funding comes from, for example, institutions such as the Northern Rock Foundation, which has now been taken over by Virgin Money. There is real concern that as those sums contract, the money going into mental health services from those groups will also contract. We need to keep an eye on the situation to ensure that, be it through the lottery or through organisations such as the Northern Rock Foundation or the County Durham Community Foundation, where funds are limited because of the economic crisis, mental health gets its fair share of the funding available. I mean no disrespect when I say that people give happily to Guide Dogs for the Blind or to cancer charities, but it is very much more difficult to get a lot of people to recognise and give money to mental health charities, unless they have been through or had a family member who has been involved in mental health issues. We need to be wary of that, too.

I now wish to discuss the welfare benefit changes, which my hon. Friend the Member for Bolton West mentioned. I commend Mental Health North East, a very good group in the north-east that has interacted with the Department of Health. It is an umbrella group of mental health charities that not only campaigns for and raises awareness about mental health but delivers services to mental health charities and individuals. The organisation is run by a very dynamic chief executive, Lyn Boyd, and is made up of paid individuals and a large number of volunteers, many of whom have personal experience of mental health issues. They are very good advocates, not only ensuring that mental health is kept high on the political agenda but interacting very successfully with the Department of Health in consultations and so on.

One piece of work that that organisation has considered is on a matter that I have increasingly seen in my constituency surgeries. There are people with mental health issues who were on the old incapacity benefit and are now on the new employment and support allowance and who are, frankly, being treated appallingly. The way that is being done is costing the Government more money in the long term. I know that it is not the direct responsibility of the Department of Health, but some thought needs to go into how we deal with the work test for people with mental health illnesses. I am one of the first to recognise that, as most of the professionals say, working is good for people’s mental health; it is important to say that. However, we must recognise that certain people will have difficulties with that. If we are to get people with mental health problems into work, we must ensure that the pathway is a little more sympathetic than the one we have at the moment.

Another massive problem is the work needed with employers. If employers are going to take on people with mental health issues, they will have to be very understanding to cope with those individuals.

[Jeremy Corbyn]

Many of those who are taken for work-related interviews by Atos are declared fit for work, only to win an appeal to show that they are not. On many occasions, the levels of stress they have been through in going for the interview, failing it and winning an appeal are very detrimental to their health. Does my hon. Friend agree that the Department must be far more sensitive about that and think a lot more before it starts to call people in for these interviews?

[Mr Jones]

I totally agree and I shall give some examples of that in a minute.

We must try to get a system in which employers, even in these tight economic circumstances, understand the mental health issues and can make adaptations. Whether we support employers who take people with mental health issues on for a certain period or whether we do other things, we need to think it out a bit more than it is at the moment.

[Nicky Morgan]

One statistic that I did not use in my speech was that only 1% of the access to work funding, which employers can use to help to smooth someone’s path back into employment, is used for mental health facilities. It could be used for counselling or support workers, but only 1% is spent on such provision in the context of the prevalence of mental health issues in the general population.

[Mr Jones]

The hon. Lady makes an important point that should be considered. That is where we need to join up the two relevant Departments.

Mental Health North East has carried out a survey and I thank that organisation and Derwentside citizen’s advice bureau for the examples I am going to use. Like the hon. Member for Loughborough, I asked whether I could use names. One person said that I could, but late last night she rang me to say no. I am sure that people will understand why I use letters to refer to these individuals rather than their names.

The first case is that of Mr A, a 50-year-old man who lives alone and received ESA. He suffers from depression, anxiety, agoraphobia and anger issues. Despite the support he is getting and the drugs that he is taking, he was called by Atos to a work-related interview. He got no points at all even though he finds it very strange to go outside the house, let alone to interact with people. He decided to appeal and attended the appeal. There is a huge backlog in the appeals system that is adding to people’s anxiety as they are having to wait a long time, and the pressure on citizen’s advice bureaux and local welfare rights organisations to support those appeals is creating a crisis in some of them. When I give some of these examples, Mr Speaker, you will see that they should never have gone to appeal in the first place.

This case was very interesting. Mr A turned up at the appeal, which, as my hon. Friend the Member for Islington North mentioned earlier, caused him huge stress as he thought he was going to lose. He turned up in the afternoon, and his appeal had been heard that morning without his being present and his award had been granted on the basis of the medical evidence. If the appeal hearing could do that, why could Atos not do so? The reason is that Atos is not taking medical evidence into account at all.

The second individual is from Stanley in my constituency and I have known this young lady since she was in her early 20s.

[Sir Peter Bottomley (Worthing West) (Con)]

In the hon. Gentleman’s example, was Atos setting its own procedures or was it following the instructions under the contract?

[Mr Jones]

Having seen the form, I think it was according to the contract, and this is where things need tweaking. We need a special form for people with mental health issues, rather than using the generic form for people with other disabilities, too. That is the important point that needs to change.

Miss B, as I will call her, is 36 and a single parent who lives in Stanley in my constituency. She has a very supportive family and receives huge support from her local Sure Start and her local community mental health team. She has been unemployed, suffers from bipolar depression and is on a cocktail of medication. Although everyone has been told not to contact her directly but to contact her mother, Atos contacted her directly. She lives independently just down the street from her mother, which is good, but everyone has been told to contact the mother because she does not quite understand. When Atos contacted her with a telephone request for interview, according to her mother it sent her into an absolute panic. If her neighbour had not been there to help her, it would have caused huge problems.

Miss B went to the interview and failed it, getting no points. She is now having panic attacks, she has had episodes where she has felt suicidal, and without support her child would have been taken into care. She was nearly hospitalised because of the stress. She has now had to wait upwards of eight months for her appeal to be heard, but in the meantime, and not just because of the ESA, her housing benefit has been stopped so she is in debt. It is one thing after another, which is not what someone with severe mental health illness needs and that is why we must refine the system. That woman has been waiting for an appeal for eight months now and, knowing the case as I do, I have no doubt that she will win.

My final example is Mr J, a 52-year-old who suffers from mental health illness, partly as a result of his separation from his partner a few years ago. He suffers from very severe depression and is on antidepressants. He has tried to help himself by going to cognitive behavioural therapy sessions. In January 2012, the Department for Work and Pensions wrote to ask him to attend an Atos interview, which caused him to withdraw from his treatment programme. That was not good for him. Very insensitively, Atos then rang him on Christmas eve to organise the appointment. Again, despite the fact that a lot of medical evidence was presented, Atos did not take any of it into account.

There is another thing that Atos is getting completely wrong, or at least has an inconsistent approach to. Mr J took his son, who is one of his key supporters, along with him and asked whether he could make representations on his behalf. He was told no. In other cases, people have taken their community psychiatric nurses with them only for them to be told to sit outside the interview while the individual goes in. Atos is being inconsistent in its approach and is clearly not taking on board any of the medical evidence that is put forward. Mr J appealed and, as in the first case I cited, the appeal went through on the basis that the medical evidence presented was good enough. What is Atos doing? What concerns me about these cases is the cost not just to the individual but to the health service and the local NHS.

Let me highlight the findings of the survey I mentioned and read some quotes from it. In response to a question about whether medical evidence was taken into account, someone said that it was “not even looked at.” Another response was:

“Not at all and there was a great deal including an advocate (myself) attending the Medical. Nothing that I said”

seemed to make a difference. Yet another:

“Generally, clients feel that mental health is not taken into consideration”

and is not being focused in the way that physical disabilities are.

“Most clients believed that their own medical evidence had been completely disregarded”

at the interviews they attended. Another issue that was commonly raised was how little time it took—less than 15 minutes in most cases.

Question 6 asked about the impact on individuals. Let me quote some of the answers directly:

“Despair. Resignment to the cruelty dished out”

by the system.

“Very distressed, anxious, scared”.

“Very stressed, confused, angry and frightened as you can imagine, these people are already existing below the poverty line”

and this increases stress levels.

Judging by those examples, the system needs to be changed. It is inefficient, it is causing huge problems for individuals, and is also costing the system more. What we need to do, possibly through the Department for Work and Pensions and the Department of Health, is come up with a specific work test for people with mental health issues, and recognise that individuals have to be supported.

Now I am going to throw my notes away—I thought long and hard last night about whether to do this—and talk about my own mental health problems. 1n 1996, I suffered quite a deep depression related to work and other things going on in my life. This is the first time I have spoken about this. Indeed, some people in my family do not know about what I am going to talk about today. Like a lot of men, I tried to deal with it myself—you do not talk to people. I hope you realise, Mr Speaker, that what I am saying is very difficult for me.

I have thought very long and hard about this and did not actually decide to do this until I just put my notes down. It is hard, because you do not always recognise the symptoms. It creeps up very slowly. Also, we in politics tend to think that if we admit to fault or failure we will be looked on disparagingly by the electorate and our peers. Whether my having made this admission will mean that the possibility of any future ministerial career is blighted for ever for me, I do not know. I was a Minister in the previous Government and I think that most people on both sides of the House thought I did a reasonable job.

We have to talk about mental health issues in this place, including people in the House who have personal experience of it. As I have said, I thought long and hard last night about doing this and I did not come to a decision until I put my notes down just now. Whether it affects how people view me, I do not know; and frankly I do not care because if it helps other people who have depression or who have suffered from it in the past, then, good.

Politics is a rough old game, and I have no problem with that. Indeed, I am, perhaps, one of the roughest at times, but having to admit that you need help sometimes is not a sign of weakness. I also want to say to you, Mr Speaker, that we need to do more here to support Members with mental health issues. In terms of occupational health, we have an excellent individual in Dr Madan, who understands mental health issues very well. I know of only one other Member who has suffered from mental health problems because a colleague on the Labour Benches has spoken to me about her mental health issues and depression, but it is important to get the message across to individuals that if they are having problems they can go and see Dr Madan and her team.

May I also highlight to you, Mr Speaker, the problems that Dr Madan has with getting funding for treatment afterwards? The hon. Member for Loughborough mentioned drugs, and they are part of the answer, but they were not the solution for me. Things like cognitive behavioural therapy can be far more effective. As I learned over many years, it is about how you think. Dr Madan raised an issue with me regarding an individual for whom she was trying to get funding, but the House authorities were not prepared to do it. If she comes to you, Mr Speaker, regarding any Member who wishes to have mental health support you have to say yes because it is not easy for Members of Parliament to go to their own GP or local community to talk about these issues. Sometimes, it is perhaps better for them to have treatment and find solutions here rather than in their constituency. That is a plea to you, Mr Speaker, and I would be grateful if you took that on board.

As I have said, I do not know whether I have done the right thing. Perhaps I will go home tonight and think I have not, but I think I have. I hope that it does not change anyone’s view of me. Most people might think, “Christ, if it can happen to him, it might happen to anybody.” On that note, let me put on record my thanks for the opportunity to debate this issue. Let us go out and champion this issue.

Finally, let me say to every hon. Member present and to those who are not present that although being an MP is a great privilege—I have always thought that; it is a great thing that I love—it also has its stresses. Unless someone has done it, they do not know what those stresses can be personally, in terms of family, and in terms of what is expected of us in the modern technological age. A little more understanding from some parts of the media and some constituents about the pressures on the modern-day MP would be very valuable.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

I am privileged to be in the Chamber to hear some of the speeches that have been made, including those by the hon. Members for Broxbourne (Mr Walker) and for North Durham (Mr Jones). It is a great privilege to hear what they said. I congratulate the hon. Member for Loughborough (Nicky Morgan) on raising the matter in the Chamber. She said that everyone has mental health issues; I suppose it is a matter of how they deal with that and control it. We all have a breaking point. I hope that I never reach that breaking point, and that others do not do so either.

As an elected representative, in my interaction with constituents in my office, I see very clearly how people deal with depression. As the hon. Member for Strangford, I wish to express views on behalf of my constituents, ever mindful of the fact that health in Northern Ireland is a devolved matter. However, the debate is on mental health generally, so the issues in Northern Ireland are every bit as relevant as those in Broxbourne, North Durham, Loughborough and anywhere else in the United Kingdom. Every day I deal with those issues, whether through employment and support allowance appeals or disability living allowance appeals, or by interacting with people and the way in which they deal with their benefits.

An issue that has been highlighted in the Chamber is the difficulties that can arise. That was an issue before the economic downturn, but it is a bigger issue today, because people find it harder to deal with the economic and financial realities that face them, which compounds their problems. In all honesty, over the past year or 18 months, I have seen greater need in people who suffer from depression, as they have had to deal with issues with which they have never had to deal before. We have debated many great issues in the Chamber in the two years in which I have been an MP, but this issue is certainly one of the most important.

I want to deal with two issues. I want to talk about mental health from the perspective of Northern Ireland, and I also want to touch on an issue the hon. Member for Loughborough mentioned when she talked about the armed forces. There are problems for our soldiers and service personnel returning from the battlefield, whether Afghanistan or Iraq, because their memories of those conflicts do not finish when they get off the plane or boat after returning home; they are still with them many years after the conflict. I feel strongly about that for those who returned from both Iraq and Afghanistan.

Good mental health should be a priority for us all, as every Member who has spoken so far has indicated. In Northern Ireland we have also made it a priority. However, Northern Ireland—I say this with respect—has been underfunded for many years, owing to direct Government reasons and others. The figures show that mental health is a greater issue in Northern Ireland than it is in other parts of the United Kingdom. People would say that that is perhaps because of the 30 years of the troubles, which I think is probably true. When someone is under pressure or stress and worried about whether they will live or die, they turn to drink, drugs or other things, and that affects their lifestyle. Ultimately, a great many people in Northern Ireland suffer from depression and mental health issues because of our country’s past. I am glad to say that we have moved on. We now have a partnership Government and we are working together to ensure that there is a future for everyone, and that in the future there is a lessened threat of terrorism.

The British Medical Association in Northern Ireland has done significant research on mental health there. When the hon. Member for Loughborough introduced the debate she mentioned a number of the points that are also in the BMA’s report, so I could not help but wonder whether she had perhaps seen the same report. It contained a number of points that she referred to and commented on. I think that the reason those points are so similar to what she said is that the same issues are just as relevant in Northern Ireland as they are in Loughborough and the rest of the United Kingdom.

I would like to touch on how we can improve the situation. I know that the Minister will have a detailed and helpful response to the debate. To start with, it is a taboo subject. I think that the Government and policy makers must strive to ensure that the stigma, which Members have talked about, and the clear discrimination and fear that surround mental health are eliminated or addressed by focusing on promotion, education, prevention and early intervention. Those are the four headlines the BMA puts forward in its suggestions. There is clearly a work force planning problem that, in some occasions, occurs simply because of reductions in staffing levels. There are a number of things we need to do, and perhaps the Minister, when he responds, can tell us how the issue of mental health will work within the staffing restrictions and assure us that that concern will be taken on board.

The Northern Ireland Executive’s programme for government made a commitment to work for a healthier people and identified mental health as a priority. It also set out targets to try to address the issues. The person who suffers from mental health problems is only part of the problem. When a constituent with mental health problems comes to my office, as they do to the offices of other Members, there is not just one person sitting in a chair in front of me, because they are usually accompanied by someone else; there is a family circle, children, mums and dads and everyone involved. While one person might suffer from mental health problems, half a dozen people could be affected by the ripples.

I am also concerned about teenagers who suffer from depression. Between 10% and 20% of our teenagers will suffer from depression at some point in that short period of their life. I believe that there has to be recognition of mental illnesses, notably depression, and it means that we need to look beyond good mental health and at preventing mental health problems and ensuring early intervention. Many personal issues affect mental health, including drink, drugs, working conditions, homelessness, poverty, unemployment and risk-taking behaviour, whether smoking or unsafe sex, and those issues affect many of the people who come to my office with these problems.

Let us address these problems first by strengthening individuals, by addressing emotional resilience and by promoting self-esteem, life skills, coping skills and communication skills. We also have to strengthen communities. Those are the issues I feel are important. That means addressing the issue of social inclusion, improving neighbourhood environments, which make a difference. In relation to teenagers, we also have to try to address the anti-bullying strategies in schools. Those are important because bullying is one of the things that lead to young people having these depression issues.

We also have to reduce the structural barriers to mental health, which means access to education and meaningful employment. I know that that everyone will agree with that, but at the end of the day we need to have a strategy in place to address mental health issues, and that is what we are seeking to do through this debate. We all agree that there is absolutely no doubt that we all support the issue and the vulnerable people affected, people who we meet every day and who need real help.

Suicide in the community is a great worry for us all as elected representatives. Every one of us will have dealt with families, with people whom we know personally or with people from families that we know personally who have lost loved ones—who took their own lives because they felt that there was no way forward. They were coming off the back of terrible depression or terrible pressure, and did not know where they could go next.

[Mr Kevan Jones]

We have been talking about the voluntary sector, and in my constituency there is a very good organisation, which also came about as a result of a personal tragedy for the individual—a woman called Shirley Smith, who runs If U Care Share. Her 19-year-old son died, and it is about young people and talking about those issues. She goes into schools, youth groups and football clubs to do so. Does the hon. Gentleman think we should have a national strategy on that to ensure that it is part of the curriculum as well?

[Jim Shannon]

Yes, I do. When a constituent of mine died in a car accident on a Sunday night, I went to her house on the Monday night, and her father just wanted to speak and to talk about his daughter. That is the issue. On many occasions, it is just a matter of having someone to talk to, someone who can lend a sympathetic ear when it is needed most, so I wholeheartedly agree with the hon. Gentleman on that matter.

Back in 2005, the then Secretary of State for Northern Ireland, who had some responsibility for health, the right hon. Member for St Helens South and Whiston (Mr Woodward), set up a task force to develop a suicide prevention strategy for Northern Ireland. It is paying some dividends in relation to a decrease in the number of suicides, but the number is still at a very high level.

Other Members have touched on dementia and Alzheimer’s, and after wearing my hat as a councillor for 26 years and as an Assembly Member for 12 years, before being privileged to enter this House, I must note that the number of people with Alzheimer’s and dementia is greater today than ever before. I do not know the reasons why, but they are real, the statistics prove it and we have an issue there as well.

On employment support allowance appeals, the hon. Gentleman made an interesting point about those who have mental health issues, because when they go to an ESA appeal the issue is clearly not a physical one, because physically they can walk about, move their hands, brush their hair—if they have any, unlike me—or put a hat on their head. They are asked whether they can do those things, but those are not the questions that a person with mental illness needs to answer. They need to answer the questions, “Are you moody?”, “Do you fall out with people?”, “Are you aggressive?”, “How do you cope with difficult situations?”, “Do you start a task that you cannot finish?” Those are the questions for a person who is depressed, and I agree with the hon. Gentleman, because the appeals panel—the chair and those who deal with such tribunals—need to understand those issues better, so that an appeal can be presented in a way that people understand.

It has been stated that everyone has mental health issues. No one is immune, and although stress is greater among the poor and the unemployed it applies throughout society. Good mental health is crucial to the overall well-being of an individual, of societies and of countries.

In Northern Ireland there are about 150 suicides each year: 41% are single males, and 22% are males between 25 and 34-years old. Some 50% of suicides in the UK involve psychiatric patients, and one reason is a loss of contact; in that context I want to talk about soldiers, about a loss of contact by the health service and about treatment non-compliance, whereby people do not take the medication that doctors give them.

Figures for the United Kingdom as a whole indicate that depression accounts for about 60% of the country’s main health problems, alcoholism about 10%, Alzheimer’s about 8% and severe stress about 6%. That leads me on to that second issue, which is to do with our soldiers.

The week before last I had the opportunity to go to Cyprus with the armed forces parliamentary scheme. Some MPs in the Chamber will be members of that great scheme, some will be aware of it and some will have been members in the past. We have an opportunity to meet soldiers and to hear about strategic issues so that we can present them to the House in an informed and knowledgeable way.

When we were in Cyprus two weeks ago, we noted its importance from an Army and a strategic point of view, but we had not realised that it is halfway to Camp Bastion in Afghanistan. There is a new scheme in Cyprus whereby soldiers returning home from Afghanistan come through a so-called decompression centre in Akrotiri; last year 30,000 did so. They call it decompression because it helps them to unwind after what they have experienced in Afghanistan over the previous few months. The sun is usually shining, which makes a big difference. They have a chance to shower, to have their kit completely dry-cleaned, and to have a good meal. They have access to mobile phones, and they are able to speak to their doctor, padre or commanding officer. They have a chance to get back into normal life—to step down and get themselves ready to go back home to their family. The work done for our soldiers in the Akrotiri centre, which cost £4.5 million to build, gets them ready for life back home.

Those soldiers have seen in Afghanistan the most horrific things that we cannot begin to visualise. They have seen friends and colleagues killed or injured, some with life-changing injuries. We know of those people because we have met some of them, and we are humbled when we do so. The bullets and the bombs are intermingled with the stress, the trauma, the bad memories and the nightmares—those are all part of the things they have to face long after they leave the Army. While the Army, the Royal Navy and the Royal Air Force look after their personnel, the forces associations do likewise. We recognised from our time in Akrotiri, as we have in our constituencies, that once soldiers are out of the Army they are often distanced from those associations too. The Royal British Legion might not always be at hand for them. They might have no friends or their marriage might have split up. They might turn to drink and drugs, but that will give only temporary relief and they are still on their own. I am mindful that defence is not the Minister’s portfolio, but I hope that when he replies he will consider the welfare of our soldiers who have returned from Afghanistan, who are not in the forces any more because they have left or retired, and are now apart from the ritual and discipline that they were once very much part of.

Every one of us will be aware of constituents who have lost control because of the memories and nightmares of what they have seen. Whenever the memories flood back and the flashbacks reappear, they relive what they have come through, and then they face their demons alone. We need to face up to this issue confronting those who have served, and are serving, in the Army, the Navy and the Air Force. The health service needs to address it UK-wide, in England, Wales, Scotland and Northern Ireland. The plight of our soldiers should be a priority for this Government, as I know that it will be. I commend the motion to the House and hope that Members will support it.

[The Minister of State, Department of Health (Paul Burstow)]

There is no health without mental health. In that simple statement I sum up the coalition Government’s approach to mental health.

In contributing to this important debate, I start by congratulating my hon. Friends the Members for Loughborough (Nicky Morgan) and for Broxbourne (Mr Walker), among others, on tirelessly pursuing the case for having this debate on the Floor of the House. It is one of the rare debates that we have on this subject, and it clearly airs the issues that are so important to so many of our fellow citizens.

The hon. Member for North Durham (Mr Jones) said that it was a privilege to have the job—the vocation—of being a Member of Parliament, and I could not agree with him more. Sometimes, that privilege involves the surprise that we can still experience in the Chamber when debates are genuinely authentic and when people speak from the heart. I thank him for his candour and honesty; we need more of that. The chair of the all-party parliamentary group on mental health, my hon. Friend the Member for Broxbourne, talked, with humour and much else besides, about his experience with obsessive compulsive disorder. Anyone living and struggling with such conditions, who has not perhaps reached the point of wanting to talk about it, will feel huge respect for both Members for bringing the attention of the House to these matters. They have made us all wake up to something that we ought to know, but that we too often forget. That is that mental health is not a “them and us” game; it is about us—all of us. It touches us all in one way or another.

I am probably not going to be able to do justice to every contribution in the debate, not least those that I have not yet heard, but I assure hon. Members that I will continue to listen throughout the remainder of the debate, and that if any issues arise that I have not covered in this speech, I will write to the Members concerned to address those points.

The hon. Member for Strangford (Jim Shannon) made some important points about the support for our veterans, and for our armed forces more generally. This Government have done a lot in that regard—not least the commissioning by the Prime Minister of my hon. Friend the Member for South West Wiltshire (Dr Murrison) to produce his report, “Fighting Fit: a mental health plan for servicemen and veterans”. The report deals with many of these issues, and the Government take them, and the action that they require, very seriously.

[Mr Kevan Jones]

I congratulate the hon. Member for South West Wiltshire (Dr Murrison) on the report, but would the Minister acknowledge that it built on a lot of the work done by the previous Government, which I was responsible for?

[Paul Burstow]

I hope that there will be cross-party consensus on these issues today, and I shall take the hon. Gentleman’s question in that spirit. He makes a fair point. This is about building on what is working, and ensuring that it can work even better. The work done by my hon. Friend the Member for South West Wiltshire has certainly accelerated the pace.

When the Deputy Prime Minister and I launched the mental health strategy last year, we recognised the need to tackle the root causes of mental illness as well as ensuring that community and acute services provide timely treatment and care. We placed a strong emphasis on recovery from a human, rather than just a medical, perspective. We also made it clear that delivering significant improvements in people’s health and well-being requires parity of esteem between physical and mental health.

I know that some hon. Members are concerned that not enough emphasis has been placed on acute and in-patient care. Let me be clear. Our plans to provide a safe, modern, effective mental health service give equal emphasis to the full range of services, from public mental health and prevention through to forensic mental health services. This is about people receiving high quality, appropriate care when they need it. If services can intervene early—the case for that has already been powerfully made—so that mental health problems can be managed in the community before more serious problems develop, that should result in acute in-patient care being made available more quickly for those who need it.

My hon. Friend the Member for Loughborough mentioned the concerns raised by the Association of Chief Police Officers about places of safety. In partnership with the Home Office and the police, we are examining how to ensure that health services are properly commissioned in custodial situations. I would be only too happy to meet her and the ACPO mental health lead to discuss those issues further.

--- Later in debate ---

[John Pugh (Southport) (LD)]

Let me begin by commending those who have spoken about their own problems today. I assure them that they have done their prospects no harm whatsoever. They have risen appreciably in the esteem of the House, although whether that is the key to promotion I do not know.

[Mr Kevan Jones]

I am grateful to the hon. Gentleman, but the use of language is very important when it comes to mental health. I do not consider it to be a problem. My own experience has made me stronger. I think we should be careful about how we use language: we should not describe mental health as a problem, because it is not.

[John Pugh]

I think that the expression used nowadays is “issue”.

--- Later in debate ---

[Chris Ruane (Vale of Clwyd) (Lab)]

Most of the contributions we have heard so far today have concentrated on mental ill health, but I also wish to address mental health and well-being, and not just for those who have experienced mental health problems, but for the whole population in general.

Over £400 billion worth of illegal drugs are traded around the world ever year, which is the same amount that is spent on energy, or 8% of the world’s wealth. When that is combined with the amount spent on alcohol, cigarettes, legal drugs to help us over depression, over-eating and the amount spent trying to fix all those problems, we are probably talking about 20% of the world’s wealth being spent on, essentially, escaping from reality. That is a modern reality that has many causes. We need to look at the debate in the round and consider all the factors, including nutrition, advertising, the farming industry and work practices, because they all have an impact on what certain Members have so eloquently described today. We should look not just at the pinnacle of the problem, but what is behind it.

Statistics show that 29% of US school children have mental health problems. At what point will American society say, “Enough is enough”? Is it when 39%, 49% or 59% of their children are mentally ill? The UK is not far behind. We follow the Anglo-American pattern, because 22% of our children experience mental health problems, and they are the lucky ones, because 74% of children in care homes experience mental health problems, as do 46% of those who are fostered. Some 90% of prisoners have mental health problems. Obesity is also a problem. At age five 10% of UK children are obese, but by age 10 the figure is 20%. What is happening in that five-year period to make those kids consume the sugars, fats and salts that will react with their bodies? Those fats will react with the fats in their brain and their myelin sheaths and neural pathways. It is an epidemic that is growing out of control, and we will be picking up the costs, including the financial costs and health costs for the individual and their families, for decades to come.

I recently received an answer to a parliamentary question. It showed that in 1991 almost 9 million prescriptions for antidepressant drugs were dispensed in the UK, but by 2011 the figure had increased to over 46.5 million, a 500% increase. When I asked the Minister for his assessment of why that was so, he replied:

“We are unable to provide a conclusive account for the increase in the number of prescription items dispensed.”—[Official Report, 30 April 2012; Vol. 543, c. 1286W.]

We do not know what is making the kids obese and we do not know what is turning our population into legal addicts. Those statistics are just for antidepressants and do not take into account the other drugs taken to help us sleep, keep us awake, keep us happy or manage our sex lives, although I never use them. There are other ways, because drugs are just one way of handling it. One-to-one counselling is another way, but it is very expensive. There is a third way: self-help. One of the best ways of self-help is mindfulness.

Mindfulness has been around for 2,500 years. To give a definition, mindfulness means paying attention in a particular way; on purpose, in the present moment and non-judgmentally. In other words, it means someone just focusing—not being chased by their past or worried by their future, but experiencing what they are experiencing there in the moment.

Mindfulness has been taught very effectively in America over a 30-year period and more recently in this country over a 10 to 12-year period. It involves an eight-week course, two-and-a-half hours’ taught lessons a week and 45 minutes’ meditation at home for six days a week, and it is taught in groups of eight to 20, so the costs are minimal and the benefits are unbelievable. It is out there, but it has not been taken up—even when NICE recommended it as a more effective means of treating repeat-episode depression. In 2004, it recommended the programme as being better than pills, but it has not been taken up. GPs and, dare I say it, Ministers do not know about it. I have quizzed Irish and British Ministers, and they do not know about it.

[Mr Kevan Jones]

I am listening carefully to my hon. Friend, but my experience is that, although group therapy might work for certain individuals, for many it does not. One thing that my right hon. Friend the Member for Leigh (Andy Burnham) did in the previous Government, and which has made a real difference, was to open up cognitive behaviour therapy treatments, as they have been a substitute for drugs. So no one treatment is a silver bullet for mental illness.

Coeliac Disease

Kevan Jones Excerpts

Wednesday 7th September 2011 Westminster Hall

[Gordon Banks]

My hon. Friend is right. The range has improved, as indeed has the quality of food. In some ways, perhaps I was fortunate to be diagnosed in the past 10, 12 or 13 years. I am glad that I was not diagnosed 25 years ago, because I did not have to eat the rubbish that one had to eat 20 or 25 years ago to try to survive on a gluten-free diet. There is more choice. That is another issue about which we have concerns following the introduction of new regulations. We are worried about how supermarkets will react, because everything that they do is driven by the desire and the need to make profit at the end of the day.

I want to talk about my own experiences without being too graphic. In the early 1990s, feeling unwell I went to my GP, who eventually referred me to a specialist. After having cameras inserted everywhere, I was diagnosed with duodenal ulcers and put on medication. Unsurprisingly, that did not help much. I was then diagnosed with the catch-all complaint of irritable bowel syndrome. I endured a number of years where my routine comprised of largely being locked in the toilet until about 11 o’clock in the morning, and I had a rash on my face that looked like I had exfoliated with 80-grit sandpaper. I returned to my GP after a number of years and he referred me to another specialist who, simply on reading my notes, said, “I think I know what’s wrong with you. I think you have coeliac disease,” and he was right. If my memory serves me right, his name was Dr Wright and he turned out to be a bit of a wizard in the diagnosis of coeliac disease in the Forth valley and Scotland. I and others will be eternally grateful to him for that.

Hon. Members might be wondering why there has been a personal lesson from me and whether it is designed to foster sympathy. No, it is not. It is designed to highlight the fact that, as I have said, the average time for diagnosis in the UK is 13 years. That is sometimes 13 years of not being able to work; 13 years of worry about dying; 13 years of someone worrying that their wife thinks they are dying; and 13 years when the only people who are happy are the manufacturers of toilet roll. Part of the purpose of today’s debate is simply to stress that that is not good enough. Much more needs to be done to recognise coeliac disease and the array of symptoms in people presenting to a GP. They should not be told what my GP said to me when I returned to him after being diagnosed: “Oh coeliac disease. I never think of that. That’s two I have missed this month.” That is not good enough.

Why is it important to improve diagnosis times? It saves being given expensive drugs for other complaints that are totally unnecessary and, as I said, it saves a sufferer from not being able to lead anything like a normal life in all areas of work, rest and play. Early diagnosis reduces the risk of intestinal cancer, bowel cancer and osteoporosis among other things. In effect, early diagnosis saves not only lives, but money.

There is no cure for coeliac disease, which leaves the NHS with the task of managing sufferers’ condition. For me, diagnosis happened in my early 40s. However, that is not good enough and there remains a lack of guidance in the area. In 2009, the National Institute for Health and Clinical Excellence published guideline 86 on the recognition and assessment of coeliac disease. That short clinical guideline offers best-practice advice on the recognition and assessment of coeliac disease and the care of those undergoing diagnosis. Although that guideline was a great result for people with coeliac disease, it is not mandatory to follow it and more needs to be done.

Coeliac UK—the national charity for people with coeliac disease—has worked with NICE on that guideline, forming part of the guideline development group. It is anxious to take the matter further for very good reasons. Gastrointestinal disorders account for about 10% of NHS clinical work, and there is evidence that they are not always well managed in general practice. Few quality criteria are available to guide the management of such disorders. The treatment of coeliac disease requires support, with a gluten-free diet, the monitoring and management of symptoms and the screening and management of complications and other associated conditions for the rest of the patient’s life. There has been huge oversight on the part of the Department of Health, as GPs are struggling to meet targets for diagnosing conditions on the quality and outcomes framework and, with no points for gastroenterological conditions, there is an enormous gap.

The QOF is a key way to ensure that GPs are incentivised and is a means by which we could start to see an improved and accelerated rate of diagnosis and find the 500,000 people who are living with the condition but who do not know it. Sadly, a number of applications to QOF have been unsuccessful, which is not good news for people with coeliac disease.

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

There is also some evidence that the condition is hereditary, so testing family members of a diagnosed coeliac is an obvious way to identify such individuals. If doctors diagnose somebody as coeliac, would my hon. Friend suggest that other family members should also be tested?

[Gordon Banks]

I do and I will. I shall come on to that later. My hon. Friend is perfectly right.

Moving back to the QOF, approaches for groupings of gastroenterological conditions are being made. Those are important because coeliac disease is four times more prevalent among patients with clinical presentation of IBS, as in my case, than among the non-IBS population. There is also a NICE guideline that recommends the screening of patients with type 1 diabetes, but we do not know whether that screening is taking place. Without more stringent ways to incentivise and measure, we will not know.

As my hon. Friend says, screening family members when coeliac disease is present in the family is also a key concern. He might be interested to know that prevalence rates increase from one in 100 to one in 10 when a first degree relative has the condition. GPs should be screening, but we know that that is not happening routinely. I know full well is has not happened in my family, but it should. Coeliac disease is also more prevalent in people with other auto-immune conditions such as type 1 diabetes, as I have mentioned, and auto-immune thyroid disease. Hence, antibody testing for family members where coeliac disease has been diagnosed and for patients with autoimmune conditions is recommended by the NICE coeliac recognition and assessment guideline.

The Minister will be glad to hear that improving diagnosis is only one part of the answer; we also need improvement in the management of the condition after diagnosis. There are established clinical guidelines from, among others, the British Society of Gastroenterology, the British Society of Paediatric Gastroenterology, Hepatology and Nutrition and the Primary Care Society for Gastroenterology, which recommend an annual review for patients with coeliac disease and, indeed, dermatitis herpetiformis. Although that has traditionally been undertaken in specialist clinics in secondary care—or, indeed, not undertaken at all—it is an activity increasingly seen as suitable for primary care. We know of locally enhanced services where practices provide a structured annual review, but there are not enough of them. We would like annual reviews to be put more firmly into place to ensure that patients are complying with the gluten-free diets and safeguarding against potential associated conditions.

The improving management in gastroenterology—IMAGE—project provides a model for the development of quality markers for chronic disease management including coeliac disease. The project has developed patient-centred quality criteria based on current guidelines and has already been a source of a range of published papers, but health inequality is also a key concern in this area. Research has shown that coeliac disease is twice as likely to be diagnosed for the least deprived quintile of socio-economic groups than for the most deprived; it is usually the other way around. There is more work to be done to understand those results, but the working hypothesis is that the disease is under-recognised in the most deprived socio-economic groupings as a result of the wide-ranging nature of symptoms and, indeed, access to health care.

Where do we go from here? The NICE guidelines on recognition and assessment of coeliac disease showed that the “no diagnosis” strategy is the least effective strategy because of the low quality of life of patients and the costs resulting from undiagnosed coeliac disease. In applying accepted NICE thresholds, any testing strategy was shown to be more cost-effective than no testing strategy, despite the costs of the tests. Work also indicates that serological testing for coeliac disease in patients with symptoms such as irritable bowel syndrome, as I mentioned earlier, is, indeed, cost-effective.

The new NHS reforms may provide some opportunities for people with coeliac disease and provide different ways for them to be catered for within the new framework. Perhaps the Minister can say whether coeliac will be considered for one of the 150 quality standards soon to be rolled out, so that we can see diagnosis rates start to improve.

As I have said, once diagnosed, the only way forward is to manage the condition through a gluten-free diet. Many people do that through relying on prescriptions as the foundation of their condition management. On prescriptions, as the NHS looks to drive costs down during the past 12 months, a number of PCTs have placed strict limits on what can be prescribed for patients with coeliac disease. Those cuts, which include a blanket removal of almost 200 products prescribed to patients in Surrey, East Sussex and Kent, appear to be a knee-jerk reaction to costs linked to gluten-free foods on prescription. At the same time, they potentially threaten the long-term health of people with coeliac disease.

Hon. Members may have seen that, in July, a story broke in the national press that gluten-free bread on prescription was costing the NHS in Wales £35 a loaf. The story came from misinterpreted data following a question posed in the Welsh Assembly. Similar anecdotal figures had been used earlier in the year by medicine management teams linked to the south-east strategic health authority. Although the figures given in the national media were incorrect, sadly the story missed the real point about some high administrative charges added to a very small number of products, which appear to be unjustified.

--- Later in debate ---

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

I congratulate my hon. Friend the Member for Ochil and South Perthshire (Gordon Banks) on securing the debate. I also thank Coeliac UK for its work in campaigning and research, and the information that it gives to many thousands of individuals who are diagnosed with coeliac disease.

I have two interests to declare. I am the chair of the all-party coeliac disease group and, as my hon. Friend the Member for Ochil and South Perthshire said, I was diagnosed with coeliac disease nearly 10 years ago. I want to reiterate a point that my hon. Friend made, which is that what we are discussing is not the latest fashionable diet, or a lifestyle choice: it is a medical condition. Sometimes it seems from media coverage, and media understanding of the gluten-free diet, that people have a choice whether to eat foodstuffs containing gluten. We do not have that choice, because of the serious health conditions that my hon. Friend has already mentioned. It is important to ensure awareness and wider understanding, including among GPs.

It is worth reflecting on how people are diagnosed. I was diagnosed 10 years ago, at the age of 37. Did I know I was intolerant to gluten? No, I did not. It was only following a serious stomach operation that the consultant who treated me did tests and biopsies, and said, “You do realise that you are suffering from coeliac disease.” Had I heard of coeliac disease? No, I had not. As with all such things, people learn quickly. I have heard stories from talking to many members of Coeliac UK regional groups—and I thank the volunteers who run local groups for providing information. More often than not, the people I have talked to received mistaken diagnoses. Awareness among consultants, as well as GPs, is an issue.

One may ask what the average age of a coeliac is, but there is not one. I have met parents whose children became ill soon after they began eating food, by two and three years old. My 71-year-old mother was diagnosed only last year, and that was only because I asked her to insist that her doctor tested her for it. Interestingly, many of the complaints and health issues that she has had over many years were explained by coeliac disease, and the diagnosis has changed the way she feels. Awareness is important, therefore, not just in the wider population, but among GPs, to ensure that they ask the questions to find out whether a patient’s symptoms are down to coeliac disease—and the symptoms can be quite varied, as my hon. Friend the Member for Ochil and South Perthshire said.

I do not think that matters have been helped in the past few months by press coverage of prescription charges. Some of the debate is ill-informed. Earlier in the year a headline in The Sun ran: “NHS pays £32.27 for a loaf of bread”. As my hon. Friend has mentioned, if the story had been looked into, it would have been found that the sum was paid not for one loaf of bread, but for a number of products. However, there are underlying issues, which can be remedied by some of my hon. Friend’s suggestions. Nevertheless, the entire tenor of the article was that people are somehow getting free food on the NHS—not just loaves of bread but biscuits, cakes and things like that, which is not the case. Gluten-free products are a very expensive part of the household budget, certainly for families with more than one person affected. I do not get products on prescription, but purchase them. My hon. Friend the Member for Aberdeen South (Dame Anne Begg) is right; the range of products available now is far wider than when I was diagnosed. As for the idea that people are getting foods free, as has been said, they are not: if they receive them on prescription they will pay for that anyway. Many people do not choose to take anything in that way.

The reaction to the publicity, and the pressure on NHS budgets to secure value for money, which we would all support, has been a knee-jerk reaction to go the other way and reduce the number of products that people can get. That is not acceptable for low-income families and those who rely on gluten-free products on prescription. My hon. Friend the Member for Ochil and South Perthshire talked about a cost of about £400 a year, but in some cases it could be more, depending on how many affected people there are in a family. It has been recognised that the condition is not a fad or lifestyle choice, but a disease that needs treatment; and proper management can save the NHS money. People will not present at GPs’ surgeries with undiagnosed conditions. They can live perfectly well with the condition if it is properly managed; and my hon. Friend might agree that in some cases that improves health, because the diet is quite healthy—including, in my case, not being able to drink beer.

There has been a knee-jerk reaction from some PCTs. Is it acceptable that arrangements with suppliers are costing the NHS money? No—and I think that the Cumbrian and Northamptonshire examples are a way forward. If we encourage PCTs to adopt the approach of having prescriptions managed by the pharmacist, not only will the NHS save a lot of money, but that will be better for people who suffer from coeliac disease than going to the doctor for a prescription. I have talked to my GP about it, and doctors do not really review what is on the prescription. They just keep signing it. At least if the process happens in the pharmacy, the pharmacist, who knows the people involved, may review the quantity or type of products that the individual wants. I think that it would reduce the possibility of people getting the same prescription repeatedly, whether they need it or not. The pharmacist would be able to manage things. If someone has a prescription for eight loaves, but does not need them, why keep paying for them?

The examples and pilots in Cumbria and Northamptonshire show that not only can costs be driven down, but the service to the patient can be improved. There is an easy win there, and Coeliac UK and pharmacists are quite keen on the idea, and so are GPs, because it would cut the person hours taken up in writing the prescriptions. The pilots provide good instances of how GPs’ time is freed up. I urge the Government to look seriously at that, and consider how such best practice can be moved across. Quite rightly, when there are lurid headlines about people paying £32 for gluten-free bread, on top of the actual costs, that is not acceptable. If we can do something to reduce that problem, it would be good. We need to see more positive and constructive articles. To be fair, the Daily Mail in its health section has carried quite a few good articles about coeliac disease, explaining its symptoms, and promoting the suitable food that is available.

Some quick wins are available for the Government and the NHS, if they are allowed to take them on board. As chair of the all-party group, I would like the Minister to attend a meeting if that could be fitted into his diary commitments, and to meet the members of the group and others from around the country.

[The Minister of State, Department of Health (Mr Simon Burns)]

I am grateful to the hon. Gentleman, and it would be extremely useful to attend such a meeting. However, he may wish to invite the Minister of State, Department of Health, my hon. Friend the Member for Sutton and Cheam (Paul Burstow), who is the lead Minister on this medical condition.

[Mr Jones]

I am disappointed about that, because I was looking forward to the right hon. Gentleman’s attendance. He is a good friend, but I will obviously leave it to the Department to decide who is the best person to come, and we will certainly issue that invitation in the next few days.

I want to pick up some of the issues that my hon. Friend the Member for Ochil and South Perthshire raised, including the products that are available. My hon. Friend the Member for Aberdeen South was right when she said that products have changed remarkably in the last 10 years from bread like cardboard that was hardly edible without a pint of water to some very good products on the market now. It is interesting that on the commercial side, large bread manufacturers such as Warburtons are producing gluten-free bread, so it obviously sees a market. I have tried its bread, and it is very good. Likewise, the invention of products such as Genius bread has completely changed the type of bread that is available, and the technology for producing it.

The supermarkets have also changed. Asda, Tesco and Sainsbury’s in particular have done two things. First, they have shelving dedicated to gluten-free products, which is important. Secondly, labelling has changed, which is important for people who suffer from coeliac disease, because it is amazing how many products contain gluten. Some flavours of crisps contain gluten, but others from the same producer do not. Correct labelling is important for all products so that people may buy with confidence, and see that the products that they are buying are gluten-free. It is important that the supermarkets recognise that there is a large and growing market for such products, so anything we can do to encourage better labelling of food content is important.

My hon. Friend referred to eating out, which can be difficult, although some restaurants recognise the problem of gluten in certain foods. However, the bane of my life is organisations that provide food on airlines and National Express, on which I sometimes travel. The people serving the food have no understanding of what a gluten-free diet is, and offer everything from sandwiches to sausages. When asked whether those foods contain gluten, they look blank.

The other reaction, which one gets from British Airways and which is amazing, is that whenever one asks for a gluten-free meal it thinks that that means vegetarian. I am not sure why, but it seems to think that one can eat what everyone else eats, but without the sauce. It seems to think that coeliacs are vegetarians, and my usual response is to ask whether I look like a vegetarian. There should be a campaign to persuade airlines and train companies that provide meals to ensure that their staff know what a gluten-free diet is. They could also be more imaginative about what they provide, because it is often inedible.

[Dame Anne Begg]

My hon. Friend may agree that if one tells an organisation that is providing a sandwich lunch that one wants a gluten-free sandwich, it always seems to provide the worst possible gluten-free bread, without the same filling as everyone else. One is given processed cheese or a bit of cold ham, and looks lovingly at the filling in everyone else’s sandwiches. Not only does one get the worst bread in the world, one gets the worst filling in the world, when it would have been easier to take out the original filling and put it on a plate to make quite a good salad.

[Dr William McCrea (in the Chair)]

Order. Time is passing, and the Opposition Front Bench spokesman and the Minister must make their winding-up speeches, so perhaps the hon. Gentleman will draw his comments to a close.

[Mr Jones]

I agree with my hon. Friend. When I was a Minister, it took at least six months to convince those in my private office at the Ministry of Defence that I did not want a salad whenever I went anywhere.

I congratulate the House authorities on the steps that they have taken in the House of Commons to provide gluten-free products, including meals, and to put the crossed grain logo on menus and so on to inform people. I hope that the House of Lords will eventually follow the same principle. That shows that it is possible for catering establishments to provide for people who need a gluten-free diet, and the House of Commons should be congratulated. There are some important issues to consider, and I hope that today’s debate has raised awareness about people who suffer coeliac disease, and provided some practical suggestions, which I hope the Minister will consider.

Health and Social Care (Re-committed) Bill

Kevan Jones Excerpts

Tuesday 6th September 2011 Commons Chamber

[Grahame M. Morris]

I do not find this at all funny. I would find it really worrying if this report is an indication of what is in store. It is rather ironic that the Secretary of State quoted from the Labour party manifesto. Perhaps it might be instructive if I were to quote from the Conservative party manifesto. It said that the Conservatives would

“defend the NHS from Labour’s cuts and reorganisations”.

If this Bill is not the biggest reorganisation that we have ever seen—[Interruption.] Well, it is, even though the Conservatives said that they would not proceed with any such huge reorganisation.

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

Would not the Secretary of State be able to clear that up tonight by giving a categorical assurance that no hospital will be transferred to or run by a foreign entity?

[Grahame M. Morris]

I am happy to give way to the Minister, if he wishes to give that assurance from the Dispatch Box. It would reassure staff and members of the public. Perhaps we can read something into the Minister’s reluctance to give such an assurance.

The Government, despite the spin, are delivering one of the most radical reorganisations ever and in the view of many Opposition Members it will undermine the basic principles of the NHS. When the Health Secretary was shadow spokesman for the then Opposition, at no point did he explain his plan to apply 1980s-style privatisation mechanisms to the NHS. I am an avid follower of health policy and the idea of creating an economic regulator—as we have discovered through a series of parliamentary questions, the costs of Monitor could be £500 million in a single Parliament—is again ironic when we hear the Government talk about waste and bureaucracy.

As for exposing the NHS to competition law, I accept the point made by the hon. Member for Southport (John Pugh), which was also made by my own Front Benchers, that it is not the provisions on the face of the Bill but the changes to the architecture of the NHS that will expose the NHS to European competition law—the same law, as we have heard, as applies to the utility companies. Health would be considered a commodity and £60 billion of the NHS budget would be handed over to private bodies, by which I mean those bodies that were the GP commissioning consortia, now renamed clinical commissioning groups. Despite the assurances about openness, transparency and accountability, those would be private-sector companies and my understanding is that they would not be open to FOI requests. That must be of huge concern to people who champion civil liberties, freedom and transparency. Over the past six years or so, we had no indication from the Secretary of State that he was planning such a radical change.

On the subject of the new failure regime, as set out in the amendments, having sat through the Public Bill Committee on the initial Bill as well as that on the re-committed Bill and having listened intently to the arguments, I cannot decide even now whether this is a U-turn or a side-step. I have read this huge document—the weighty tome that makes up the Bill, with all its various chapters and parts—as well as the impact study and the whole justification behind the Ministers’ arguments was that the NHS needed a market and a failure regime to boost productivity. Has that whole idea been left by the wayside?

Congenital Cardiac Services for Children

Kevan Jones Excerpts

Thursday 23rd June 2011 Commons Chamber

[Mr Nicholas Brown (Newcastle upon Tyne East) (Lab)]

It is a pleasure to follow the right hon. Member for Charnwood (Mr Dorrell) in debate, something that I have not done for 15 years in this place, and as ever I agree with the broad thrust of what he has said. I welcome the opportunity to take part in this debate about the Safe and Sustainable review. I want to make two points about the case for the review itself and the case for children’s cardiac care at the Freeman hospital in my constituency.

The review of paediatric cardiac services in England and Wales was instigated in 2008 under the previous Government. It was instigated not by them, not by the civil service but by the health care professionals themselves. There were two previous reviews, in 2000 and 2003, recommending the establishment of fewer, larger cardiac surgical centres; in 2006, a national workshop of experts concluded that the current configuration was unsustainable; in 2007, the Royal College of Surgeons called for the concentration of surgical expertise in fewer, larger surgical centres.

The 2008 exercise has been carried out on behalf of the 10 specialised commissioning groups in England and their primary care trusts. The clinical case for the exercise is pretty formidable: clinical outcomes are better at high-volume centres; it is undesirable that surgical expertise is spread too thinly, because apart from anything else it mitigates against the provision of 24-hour surgical cover; the increasing complexity of what can be achieved argues for fewer specialist centres; it is easier for fewer units with larger case loads to retain surgeons and to develop expertise; and strong leadership from surgical centres underpins non-surgical cardiology care in local hospitals.

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

Will my right hon. Friend give way?

[Mr Nicholas Brown]

If my hon. Friend will forgive me, I will not.

There is strong clinical support for the review. The relevant royal colleges have all endorsed it; the available research evidence underpins it; and all 10 specialised commissioning groups and their local primary care trusts committed themselves to it at the outset. That seems to be a pretty formidable case.

I am the constituency Member for the Freeman hospital in Newcastle upon Tyne, and on 10 June I visited its paediatric surgery unit. I never cease to be impressed by the care, kindness and surgical skill that the national health service provides. It is very moving to see very young children whose lives are literally being saved, and to meet youngsters who, 20 years ago, would not have had a chance of life. The unit at the Freeman is one of two children’s heart transplant units in England, the other being Great Ormond Street in London, and of course the unit benefits enormously from its link with the internationally renowned adult cardiac services on the same site.

The expertise at the Freeman has been built up over decades. The first successful child heart transplant in the UK was carried out there 20 years ago, and I am happy to tell the House that the young lady is alive and well, living and working on Tyneside.

Clinical outcomes at the children’s heart unit at the Freeman are excellent. On my visit, I saw artificial ventricular device systems, known as Berlin hearts, attached to very young patients, but, if the unit closed, that pioneering work would move, probably to Birmingham, leaving the whole of the north without provision. There are similar issues with the extra corporeal membrane oxygenation services currently provided at the hospital. The children’s heart unit really is a national resource, with an international reputation.

No one can doubt the commitment of the senior management and of the trust board to the pioneering children’s cardiac work at the Freeman. The trust has invested in services and, pending the outcome of the review, has a further investment programme ready to go. The review team, in its assessment, has weighted quality, sustainability and deliverability more heavily than access and travel, and that seems to me to be the right prioritisation.

I want to make two final points. Although this is an England and Wales review, the people of Scotland could also be affected by the outcome, certainly as far as nationally commissioned services are concerned. As well as with Scotland, the Freeman hospital has well established connections with Northern Ireland and with the Republic of Ireland, and although I recognise that this was not formally part of the review team’s remit, I welcome its decision to invite observers from Scotland and Northern Ireland to its deliberations.

My final point echoes the point that the right hon. Member for Charnwood, the Health Committee Chair made. I welcome the effort made by the review team and its sponsors to meet MPs yesterday in the House. They made an impressive case for the review itself, and for the thorough and detailed way they have gone about it. We are constituency representatives, each trying to do our best for the communities we represent. Having said that, I believe we should think very carefully before trying to impose our political judgments—based on support for the constituencies that we represent—over the judgments of the health care professionals who have studied the issues in detail and spoken so clearly about the clinical priorities involved for the whole country.

--- Later in debate ---

[Greg Mulholland (Leeds North West) (LD)]

It is a pleasure to follow my Leeds colleagues, and it is a pleasure to work with all the Leeds and Yorkshire and Humber Members of Parliament throughout the House in support of the inspiring campaign to save the Leeds unit. I too was proud to be there to help present that remarkable petition. Nearly half a million people in the region have spoken out in an attempt to save the unit. When I visited it, I had the same experience as other Members have had when visiting their local units. I found it incredibly moving to meet those babies and children and their families, while also being conscious that I was walking into a centre of excellence. It benefits from a genuine co-location of services, which is the gold standard that has been set, and 370 operations are already being performed there—very close to the 400 figure.

[Mr Kevan Jones]

I note the size of the petition, but as a former Defence Minister responsible for defence medical services I faced similar petitions when the Ministry of Defence was concentrating military health care at University Hospital Birmingham NHS Foundation Trust, which is now a centre of excellence not just in this country but internationally. Although petitions are valuable, clinical outcomes must be at the forefront of any decision, and the MOD’s decision to concentrate defence medical services at Birmingham was the right one.

[Greg Mulholland]

It would be very worrying if the extraordinarily overwhelming views expressed by people were ignored, but of course the clinical view is vital, and, as I have said, many clinicians have a problem with the flaws—clinical flaws—in the review.

--- Later in debate ---

[Mr Kevan Jones]

Does my hon. Friend agree that in County Durham, the concentration of adult cardiac surgery and emergency care at the Freeman hospital and the James Cook university hospital, which was controversial when it happened, has improved not only care but the survival rates of individuals from County Durham? Even though there are hospitals in the county closer to some people, survival rates have gone up because of that concentration.

[Pat Glass]

Absolutely, and we need to appreciate why such moves are necessary. None of us wants another Bristol baby tragedy, and I think there is general agreement that we need changes in the organisation of services to drive up the quality of treatment and bring together specialist surgeons to work in larger teams.

Health and Social Care Bill (Programme) (No. 2)

Kevan Jones Excerpts

Tuesday 21st June 2011 Commons Chamber

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

On a point of order, Mr Deputy Speaker. I thought we were debating a programme motion, but the speech we are hearing seems to be a rehearsal of the Bill.

[Mr Burns]

rose—

--- Later in debate ---

[Chris Bryant]

If the Deputy Leader of the House had allowed more than an hour for debate today, I would give way to him, but I am not going to give way now. We have already heard from a Minister for 15 minutes.

It is a bizarre selection of clauses that the Committee will be allowed to discuss. For instance, it will not be allowed to discuss clause 239 on NICE’s charter, nor clause 240 on its functions, but it will be allowed to consider clause 242, on the failure of NICE to discharge its functions. There is absolutely no logic to what is being presented to us.

In addition, the programme motion does not allow enough time. The Prime Minister is profoundly confused about all this, because he said many times this morning that 10 days would be allowed. Indeed, he said:

“Ten days… I don’t want to sort of misquote the Monty Python sketch but when we were in opposition we used to dream of tens days to debate a government bill”.

Well, yes, we are dreaming of 10 days now. We would love to have 10 days, but there will not be 10 days; there will be 10 sittings.

[Mr Kevan Jones]

The Prime Minister is not very good on detail, because the Criminal Justice Bill to which he referred, and whose Committee he sat on, actually had 38 sittings over eight weeks.

[Chris Bryant]

My hon. Friend is absolutely right, but surely the key point is that we need to do this scrutiny properly. The Government may think that they are doing themselves a favour by trying to get the Bill out of this House by the summer recess, but all it means is that those in another place will have to do a proper job of scrutiny, and I bet that they will not get it out of the second Chamber before next year.

Finally, the motion states that we have to commit the Bill to the same set of people. Now, some splendid people sat on the Government Benches in that Committee, including the hon. Member for Preseli Pembrokeshire (Stephen Crabb). He is a splendid Member of Parliament whose integrity I do not want to be questioned, but he will now have to force all the people whom he forced previously to vote for one set of proposals in the Bill to vote for exactly the opposite. I therefore beg Government Members, if they value the hon. Gentleman’s career, to vote against the motion.

I say that because, theoretically, the Committee Chairman could rule that some amendments cannot be taken or selected because we have already presented them and the same Committee is re-sitting. We will find, however, that many Government Members have to stand on their heads and vote for the exact opposite of what they voted for earlier.

I understand that one of the great passions in life of the hon. Member for Southport (John Pugh), who speaks for the Liberal Democrats, is weight-lifting. Well, he did no heavy lifting of any kind on the previous Committee, and if there are changes to the Bill they are the work of Opposition Members, not the hon. Gentleman. He said that it was a wonderful Committee and could not have been better. Well, why was the hon. Member for Totnes (Dr Wollaston)—somebody who knows about general practice—not put on it? Of course, we know the reason: she did not agree with the Government.

I do not believe that the new Committee should include the same set of people, in particular because the hon. Member for Stafford (Jeremy Lefroy), on the final day in Committee, asked the Minister one of his great insightful questions: “What is the point of clause 249?” He is clearly a man of insight. In addition, he later said:

“I am still a member of the Committee, I think.”––[Official Report, Health and Social Care Public Bill Committee, 31 March 2011; c. 1268.]

We should have a new set of Committee members. There is no point in every Member who sat on the previous Committee, including those with direct financial interests in the Bill, being on the Committee in future, so I say, “Vote against this ludicrous, shameful and disgraceful programme motion.”

--- Later in debate ---

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

I rise to oppose the programme motion. I remember sitting and listening to some eloquent speeches against programme motions by Conservative Members when we were in government. What we uniquely have tonight, as has been highlighted by my hon. Friend the Member for Rhondda (Chris Bryant), is a double programme motion, because this debate is being limited to one hour, and then we will have a programme motion that rushes the Bill through by 14 July. Another unique aspect is that this is the first time since the coalition Government came into being that a Conservative Member has opened the debate following a major U-turn or embarrassment, when a Liberal Democrat is usually put up as a human shield. On this occasion, the Minister has obviously fallen for the trick.

It is important that this Bill gets proper scrutiny, but that will be difficult. The Minister has already said that the Government are going to table 160 amendments, and that is before any others have been proposed. He said that some would be technical, and I accept that, but we do not know what they will be about or how many there will be.

[Helen Jones (Warrington North) (Lab)]

Does my hon. Friend agree that it is disgraceful that we are not even seeing those amendments until two days before the Bill goes into Committee, giving outside organisations and members of the Committee no time to scrutinise them? Does that not show that the Government are running scared of proper scrutiny?

[Mr Jones]

My hon. Friend makes a good point. One innovation is the introduction of pre-legislative scrutiny of Bills by a Committee. In 2001, I served on one of the very first such Committees, which considered the Civil Contingencies Bill. That was an extremely good process during which the then Government accepted well over 100 recommendations and amendments. With a timetable of 10 sittings—not 10 days, as the Prime Minister said today—there will be very little time for outside bodies to scrutinise and have professional input into the Government’s amendments.

The hon. Member for Southport (John Pugh), who speaks for the Liberal Democrats, says that we cannot prolong the agony or uncertainty faced by the health service. I remind him that we are in this position because his party is supporting the back-of-a-fag packet proposals dreamed up by the Secretary of State for Health. If he really wants to be able to say that he has made a difference, he should have voted with the Opposition when he had the opportunity. It is interesting that he is again the sole Liberal Democrat on the Government Benches, even though we are being told that it is the Liberal Democrats who have made major changes to the Bill.

If the Bill is to get proper scrutiny, if we in this place are to get the respect of electors in thinking that we are doing a proper job of scrutiny and, more importantly, if we are going to get the health service that this country deserves, this is not the way to do it. I predict that we will get to 14 July, when most of the amendments will not have been debated, and once again let the other place dismember the legislation. We can see the job it is doing up there at the moment, and that is because ill-thought-out and ill-prepared Bills are being brought forward by this coalition Government.