Mental Health Treatment and Support
Debate between Lyn Brown and Maria Caulfield(10 months, 4 weeks ago)
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Maria Caulfield
Unfortunately, given the time I have left, I will not give way any more.
As for the challenges we face, we are seeing rising numbers, but we are seeing that in all parts of the country. The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), talked about not judging Labour on its track record on health in Wales, where Labour has produced smaller funding increases for its health service; its 7.8% increase compares with the 8.6% increase that we have given in England. Mind Cymru has said that hundreds of people across Wales are currently waiting more than a year to access psychological therapies. The target is supposed to be that 80% of people in Wales access therapies within six months, but that target has never been met. It gets worse, because since 2020 the number of people waiting longer than a year in Wales for mental health support has increased by 17%. Labour talks a good game, but its actions speak louder than its words. I urge shadow Ministers to acknowledge that these problems exist in all countries and that we all face these pressures. A grown-up conversation would be about sharing best practice and working together to make that happen.
Many Members talked about preventive and early intervention therapies. My hon. Friends the Members for Bosworth and for Devizes (Danny Kruger) talked about that and about moving away from the medicalisation of mental health. That is why we are investing in talking therapies. For anyone who has not been on the Every Mind Matters website, let me say that it provides practical support for people who are anxious, distressed or not sleeping. It also provides for self-referrals to talking therapies. Since we introduced that, more than 1.2 million patients have accessed NHS talking therapies in the last year, helping them to overcome anxiety and depression. More than 90% of those people have had their treatment completed within six weeks.
Many Members talked about schools, and we are introducing mental health support teams in schools. We have almost 400 now, covering more than 3 million children, and about 35% of schools and colleges. More than 10,000 schools and colleges have trained a senior mental health specialist, including more than six in 10 state schools. That work is happening already and it is making a difference right now. My hon. Friend the Member for Newcastle-under-Lyme (Aaron Bell) highlighted how we need to move that into universities, and I would be happy to talk to him about how we can do that further.
On in-patient services and the quality of care, we have recently conducted a rapid review of mental health in-patient settings. The Secretary of State will announce the results of that soon. We have also introduced a three-year quality transformation programme, which seeks to tackle the root cause of unsafe, poor-quality in-patient care, particularly for those with learning disabilities and autism.
On suicide prevention, our forthcoming strategy will target high-risk groups and locations of concern. We will also provide £10 million of funding for charities that do so much good work in this space. I say to my hon. Friend the Member for Penrith and The Border that I would be very happy to meet the 3 Dads Walking, Andy, Mike and Tim. I know that they have met the Prime Minister.
Maria Caulfield
I am just answering a question on suicide. I would be very happy to meet the 3 Dads Walking to learn the lessons for our suicide prevention strategy.
Maria Caulfield
I will not give way. I only have a few minutes left.
It is disappointing that Labour Members cannot understand the progress that has been made and are determined to make political points, damaging the work that our NHS staff up and down the country do day in, day out, backed by record levels of investment that have never been seen before in mental health services.
It is true that we have tabled an amendment this afternoon, in which the Prime Minister acknowledges how much work we have done in this space. With a rising number of people accessing mental health support, which is a good thing and not something to be criticised, we are investing in those services and in 27,000 extra staff.
Maria Caulfield
Madam Deputy Speaker, I will continue if I may.
Despite the disingenuous motion proposed by the Labour party, it is my privilege to hear about the valuable contributions being made up and down the country. It is so easy to talk down our services, but if Labour Members are serious about improving mental health services, perhaps they should talk to their Welsh counterparts. Action speaks louder than words. Mental health services in England are performing better than those in Wales. We all know that this is not really about improving mental health services; it is about using mental health as a political football, but we on the Government Benches will not play that game.
Question put (Standing Order No. 31(2)), That the original words stand part of the Question.
NHS Hysteroscopy Treatment
Debate between Lyn Brown and Maria Caulfield(1 year, 3 months ago)
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Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
It is a pleasure to serve under your chairmanship, Sir Mark. I congratulate the hon. Member for West Ham (Ms Brown) on securing this important debate. As Minister, I also responded to her debate on the subject last year and I recognise her campaigning on the issue.
First and foremost, I recognise the pain suffered by women during the hysteroscopy procedure. Many women have contacted me to share their stories and distress. The testimony of the shadow Minister, the hon. Member for Enfield North (Feryal Clark), was powerful in explaining the distress the procedure can cause.
We have seen some progress around the tariff issue, which I will touch on later in my remarks. Last year, the tariff system financially rewarded out-patient settings that undertook hysteroscopies, but that has changed. However, I take the point made by the hon. Member for West Ham about getting it right first time. I may be doing the same with a new initiative, so I will certainly commit to looking at that.
We heard about patients such as Julie, and about how, right from the very start, an appointment letter is sent out that does not provide information about what to expect or the choices that are available. We heard about the procedure itself, including what pain relief is given, and the need to give women informed consent—they can have a general anaesthetic or ask for the procedure to stop. Another 30 seconds is not the answer to “stop”, and that would be my first concern.
My hon. Friend the Member for Thurrock (Jackie Doyle-Price) made a valid point about why the procedures are being done in the first place, and the testimony of Martha lends itself to that. Bleeding after HRT is very common for the first three to six months, and it is usually only after six months, or if there has been bleeding after long periods of non-bleeding, that perhaps an investigation could be considered. My hon. Friend pointed out that sometimes we carry out the procedure where there is not necessarily a clinical case for it. Both the procedure itself and the reason for it need to be justified in those cases.
As the shadow Minister said, hysteroscopy is an essential investigative tool. We do not want to put women off coming forward for diagnosis of their conditions or for investigations into distressing problems—whether it be heavy periods, miscarriages or difficulty getting pregnant—but it is true that women’s experiences of pain, and sharing those experiences with friends and family, can put women off or prevent someone from coming back for treatment or further investigation. Many women experience little or no pain, but the percentage that do experience pain is of significant concern.
The hon. Member for York Central (Rachael Maskell) highlighted the experience of Jan and the sheer scale of her pain. That was very powerful, and I reiterate to Jan’s husband, Steve, that her voice has been heard very powerfully in the debate. I am keen that we make progress on the issue, because we, like the hon. Member for West Ham, who comes on an annual basis, have been talking about it for far too long. I am keen to meet with the Campaign Against Painful Hysteroscopy group, and hope to do so fairly soon, to discuss how we can take the issues forward. A general anaesthetic can be used in some circumstances, but there are also a range of other anaesthetics—it does not have to be general anaesthetic—to make the procedure less painful.
For most women, the first issue is choice, having information about what to expect up front and being able to make a decision based on that. That needs to be done in advance of the procedure and not, as my hon. Friend the Member for Thurrock described, when your legs are in the stirrups. That is why the guidance is so important. The Royal College of Obstetricians and Gynaecologists provides evidence-based guidance. It is old, and it is being updated. My understanding is that RCOG is producing a good-practice paper on pain relief and informed decision making for out-patient hysteroscopy that will be published imminently— I understand in days rather than weeks or months. I committed in the debate last year to wait for that, and I hope that it will be through fairly soon. If we can get those good-practice guidelines, it is essential that they are rolled out in practice.
Ms Lyn Brown
I do not really know how to phrase this, but part of the problem is that, as we have heard, gynaecologists are basically being utterly insensitive to the needs of the women they are treating. My anxiety is that we will be told, yet again, that it is all okay, and that they have changed this or tweaked that. But the stories that we have heard today are from this year, so there has not been change. I am not sure whether we will be able to manage change unless the Minister is quite firm about the actions that she wants to see.
Maria Caulfield
I very much take the hon. Lady’s point. The change to RCOG guidance is not the only way we will change this. The hon. Member for Strangford (Jim Shannon) highlighted his wife’s experience, which also shows why this is so important. The royal college is important because it can bring clinical change on the ground, but it is not enough just to assume that its updated guidance will be enough to change what happens in practice. Its current guidance already sets out that a leaflet should be provided with information about what a hysteroscopy is, what happens, and what the possible risks and alternatives are, but that does not always happen. Women can choose whether to have their hysteroscopy in an outpatient setting or have a general anaesthetic and come in as a day case. They do not always get that leaflet now, so just changing the guidance does not necessarily mean that we change the practice, and that is the key.
It is important that women are in control when it comes to hysteroscopies, which we are talking about today, and many other issues that we have debated. That is the fundamental principle behind the women’s health strategy, which we introduced because women are very often not listened to in all aspects of their healthcare.
The hon. Member for Enfield North touched on the top priorities for the first year of the women’s health strategy. The reason that hysteroscopy did not make that list is that we want to wait for the guidance before we act, but it will be a high priority, and work is starting this year.
One of the key priorities is to provide better information to women and girls about their health. We are setting up a space on the NHS website for women’s health so that women who are going for a procedure have go-to information. If they are thinking, “I don’t know what a hysteroscopy is. I don’t know what sort of tests I need. I am going for an ultrasound, but what else might they suggest to me while I am there?” they can go to that site and get reliable information that will help them make that decision. If they are not sent a leaflet and the procedure is not discussed in the clinic, they will be able to know in advance what to expect. We want that to happen this year so that women have more power when making decisions about their healthcare needs.
Waiting times for gynae procedures have not come up much today, but we know that the covid pandemic has had an impact on them. Gynae procedures are part of the elective recovery plan, which is why we are investing in community diagnostic centres to get those waiting lists down as quickly as possible. It is hoped that by having specialist centres such as community diagnostic centres, which are specialists in doing diagnostic tests, we may be able to improve women’s experience.
One of the things that will make the greatest difference is the appointment of Professor Dame Lesley Regan as the first women’s health ambassador—my hon. Friend the Member for Thurrock mentioned her. She is a female gynaecologist, and she completely gets the issues facing women. We also now have the patient safety commissioner, Dr Henrietta Hughes, who was appointed last year. She is a female GP. Dame Lesley has been passionate about this issue for many years and has been working with women’s groups on it. I have asked her and Dr Hughes to discuss hysteroscopies. They are planning a roundtable on the issue to get stakeholders round the table to discuss how we can make things happen in practice. If guidance is issued, how do we make sure that is what is happening on the ground? The roundtable will be chaired by Dame Lesley, and the patient safety commissioner will be attending. I will update Members on their recommendations, which I will take extremely seriously, and I will want to implement them as quickly as possible.
NHS Hysteroscopy Treatment
Debate between Lyn Brown and Maria Caulfield(2 years, 3 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Maria Caulfield)
I congratulate the hon. Member for West Ham (Ms Brown) on securing this debate. I thank her for all her hard work. I am very sorry that she has been speaking about this issue for nine years and is still having to share some of the stories and experiences of women who have contacted her, whether that is Jane, who was unaware of the potential for pain when having such a procedure—women being investigated for endometriosis often wait eight to 10 years to get a diagnosis, so if there is an offer of a procedure to find the cause of their problems, of course they will grab it and not necessarily ask questions about what is involved; or Sandy, who got no information on pain relief at all, or Penny. Penny was warned by the nurse—often nurses are attuned to these things—and was worried about what the outcomes were, but went ahead with the procedure. These are shocking tales that should not be happening in this day and age. I appreciate everything that the hon. Lady says, and I offer that I will be happy to work with her on this issue.
As Members will be aware, hysteroscopy is an essential tool to get to the bottom of many complaints. Whether that is cancer, endometriosis, vaginal bleeding or pelvic pain, it is a necessary test. While other tests can be used, they do not necessarily get to the level of clinical detail that a hysteroscopy can provide for clinicians. It is therefore important that the test is available for women, but in a way that does not create the problems we have heard about this evening.
Many women can have the procedure as out-patients in 10 to 15 minutes and it can be relatively painless, but many women, as we have heard today, experience great pain, which puts them off from coming back if they need further procedures, as the hon. Lady has said. If they share that story with other women they know, it can put them off from coming forward, too.
Unfortunately the NHS does not collect data on the number of women who experience pain during a hysteroscopy or the women who fail to have the hysteroscopy and then need to have either a general anaesthetic or further anaesthetic later on. I am aware that the Campaign Against Painful Hysteroscopy estimates that between 5% and 25% of women are affected and have reported severe pain, and frankly that is not good enough. I welcome that NHS England will be meeting the campaign group on 4 February. I look forward to hearing the outcome of that meeting, and I will be following up any recommendations after that.
The hon. Lady is right that for many procedures a man would undertake, anaesthetic is probably routinely provided or offered. We need to ensure that the same applies to those procedures that women have to go through.
There are guidelines in place, and I spoke only last week to the president of the Royal College of Obstetricians and Gynaecologists, because I knew this debate was coming up. Those guidelines were published back in 2011, and they need updating. The guidelines focus on minimising pain and optimising the woman’s experience, as well as making specific recommendations on how to reduce pain, but as the hon. Lady said, we do not have the information to know who is and is not following those guidelines. We are therefore not in a position to say whether, if those guidelines were followed, many women would not experience pain, and that is the difficulty we have. The data is therefore crucial.
In the last debate that the hon. Lady secured on this issue, which I think was in September 2020, my predecessor, the right hon. Member for Mid Bedfordshire (Ms Dorries), informed the House that to ensure the recommendations were robust and up to date, the royal college would be producing a second edition, in which it will assess whether the current guidelines are effective and are being used. The second edition is being jointly developed with the British Society for Gynaecological Endoscopy, and I am assured that patients’ voices will be at the heart of its development. The royal college has informed me that good progress is being made, and that it will have the updated guidelines by next year.
Maria Caulfield
I said to the president that I would follow up after the debate, so I can certainly make that request.
The royal college has also said that it is producing a good practice paper specifically on pain relief and how informed decisions should be made, particularly in out-patient hysteroscopy procedures. It is going through the peer review process next month and will be published shortly afterwards. Once it is published, I would be very keen to hear from campaign representatives about whether they feel that those guidelines would make a difference to them in a practical session.
It is crucial that women who are offered a hysteroscopy are given the information they need to make an informed decision, given that they have sometimes waited a long time for the appointment and that serious clinical conditions can be diagnosed from it. That should include information about potential pain, options for pain management and alternative procedures that could be used.
The Department and NHS England recommend that, as part of good practice, the royal college’s patient information leaflet, which was published in 2018, should be provided to patients to aid decision making. I think that should be provided in advance of the appointment, because it is often hard for someone to take in all that information in the midst of a consultation. Again, I would be interested to hear from the campaign whether that is happening in practice.
The House will also be interested to learn that the British Society for Gynaecological Endoscopy recently published a statement to clarify that from the outset women should be offered
“the choice of having the procedure performed as a day case…under general or regional anaesthetic”.
It further asserts that the procedure should be stopped immediately if a woman experiences pain.
I encourage any woman offered a hysteroscopy to read those valuable resources along with any additional resources provided by their clinician. I agree with the hon. Lady that women often do not understand what a hysteroscopy is or what is involved, and debates such as this highlight how important the procedure is, the options around pain relief and the different anaesthetics available.
The hon. Lady touched on the tariff. Previously, there was a different rate of payment for hysteroscopies carried out in an out-patient setting compared with in-patient procedures. I recognise that that is a concern for many hon. Members on both sides of the House because of how it affects patient choice and the choices that are offered to them. In the last debate on the topic, my predecessor announced a statutory consultation. I am pleased to say that as of 1 April, hysteroscopy out-patient procedures will no longer attract a higher tariff than elective procedures as an in-patient day case. That will hopefully make a difference to the choices offered to women.
Ms Brown
That is absolutely true and we are delighted about that; I welcomed it in my speech. The problem that we now have is that if a hospital offers an anaesthetic, it does not get compensated for the resource that it has used. We need to go one step further to ensure that there are no incentives for not offering women proper anaesthetic.
Maria Caulfield
I completely agree with the hon. Lady. She made a point about having the data to see how many hysteroscopies fail and whether that money could be better spent on offering an anaesthetic up front to many women. I do not have an answer to that, but it would be interesting to look at that information.
Alongside clinical guidelines and access to high-quality patient information, I stress the importance of the voices of patients, which are critical at every stage of the treatment pathway. Decisions should always be discussed and shared between clinician and patient. The Government are committed to ensuring that the voices of women in particular are more central in the healthcare system.
The women’s health strategy has been touched on several times. We have also taken key learnings from reports such as the Cumberlege review, where women were talking for a long time about the issues that they faced before anyone truly listened. We need to improve that so we are not learning from such incidents after nine years of raising them on the Floor of the House. The women’s health strategy will include gynae issues such as endometriosis and polycystic ovary disease, which are conditions that do need a hysteroscopy, so I am pretty confident that we will cover that in the strategy. We will also have a women’s health ambassador—they will be appointed in the coming weeks; applications are almost closed—with whom I will meet. I want them to lead on these issues, where they can be a real voice for patients, do a deep dive into what is happening at the coalface and speak up for women if it is not working. We have guidelines, but we do not know whether they are being used in clinical practice. From what the hon. Lady says, it sounds like there are clearly issues that need to be addressed.
I reassure the hon. Lady that I am happy to work with her on this issue. Improving the tariffs is one thing, but there are still women who are not getting the information that they need to make informed decisions about pain relief and anaesthetic that could be available. I welcome the new information from the Royal College of Obstetricians and Gynaecologists on pain relief specifically for this procedure, which will be out next month, and I will feed back to it on updating the guidelines to ensure that patients are involved in the process.
I thank the hon. Lady for raising this important matter. I hope that we have raised its profile and that women are more aware of their options. When they go to that clinic appointment, they can ask for pain relief, they can have it as an in-patient, and they do not need to have it right there, right then. I look forward to continuing to work with her and all Members across the House to ensure that women are offered a hysteroscopy and can access the information they need and the care they deserve.
Prisons (Interference with Wireless Telegraphy) Bill
Debate between Lyn Brown and Maria CaulfieldFriday 6th July 2018
(5 years, 9 months ago)
Commons ChamberRead Full debate Prisons (Interference with Wireless Telegraphy) Act 2018 View all Prisons (Interference with Wireless Telegraphy) Act 2018 Debates Read Hansard Text Read Debate Ministerial Extracts
Maria Caulfield (Lewes) (Con)
I beg to move, That the Bill be now read the Third time.
It is an honour to follow the hon. Member for Croydon North (Mr Reed), who has done great work on his private Member’s Bill.
I am grateful to Members from across the House for giving clear cross-party support to this Bill, which is small but nevertheless important. There are a number of people I would like to thank. I particularly want to thank the Clerks of the Public Bill Office, who have helped me through every stage of the process to get the Bill to Third Reading. As we know, it can be difficult to get a private Member’s Bill to this stage, and their support has been so helpful. I would also like to thank the Ministry of Justice team for all their support and information, and all Members of the House, particularly those from the Opposition, who have supported the Bill and who recognise the important difference that this will make in prisons up and down the country. In particular, the Bill will make a great difference for prison officers, who do such sterling work under very difficult circumstances.
Members may know that I inherited this Bill, so I want to put on record my thanks to my right hon. Friend the Member for Tatton (Ms McVey) for her previous work in championing the Bill and for trusting me with the responsibility of ensuring its safe passage. I hope I have repaid her confidence. I also want to acknowledge the groundbreaking work of my hon. Friend the Member for Mole Valley (Sir Paul Beresford) in steering the original Prisons (Interference with Wireless Telegraphy) Act 2012 through Parliament. It could be argued that because we are revisiting the 2012 Act only six years later, it was in some way deficient, but nothing could be further from the truth. The 2012 Act was an important and far-sighted contribution to the fight against the scourge of illicit mobile phones in prisons. The reason it has proved necessary to legislate again so soon is the sheer speed of technological change and the sheer scale of the problem posed by illicit mobile phones in our prisons.
Figures provide a stark illustration of the scale of the problem. In 2011, just a year before the 2012 Act was introduced, about 7,000 illicit mobile phones and SIM cards were found in prisons in England and Wales. By 2016, that figure was nearly 20,000. Last year, it had risen to 23,656 mobile phones and SIM cards.
Lyn Brown (West Ham) (Lab)
I congratulate the hon. Lady on how far the Bill has progressed so far. Last night I was talking to some mums whose young people had been caught up in crime, and they were horrified to tell me that people are using mobile phones to continue criminal activities in jail, and to continue to hold in their thrall the young people they have groomed. Does the hon. Lady share my concern that that is allowed to continue?