Performance-enhancing Drugs and Body Image

Debate between Margaret Ferrier and Stuart C McDonald

Tuesday 21st February 2023 Westminster Hall

[Margaret Ferrier]

The hon. Member mentions aggression. A common side effect of steroids is roid rage, which means that it is not just those who choose to use steroids who are impacted, but everyone around them, too, and that can lead to serious life-ruining consequences all around. Does the hon. Member agree that greater understanding of side effects is an imperative part of tackling the abuse of these drugs?

[Stuart C. McDonald]

The hon. Member makes a valid point. One report I read suggested that when engaging with people who are already using steroids, sometimes the most persuasive factor in getting them to reconsider and move away from this conduct comes from speaking to them about the consequences for their mental health rather than the physical consequences. That appears to have more influence when it comes to behaviour. The hon. Member makes an interesting point.

Alone, most steroids are taken in pill form. If needle sharing is involved, there are other risks in terms of HIV and hep C. Use of counterfeits also further complicates risk. Of course, another consequence if they are used in sport is that unfairness is created and sporting integrity is undermined. As has been set out, the drugs are regulated under the Medicines Act 1968 and classified as class C under the Misuse of Drugs Act 1971.

The question rightly posed to us today is: what more can we do? I speak from a position of weakness, but I agree that first and foremost, we all need to improve our knowledge of the issue. Evidence has to be at the heart of the approach, as the hon. Member for Bosworth has said, so how better can we understand the scale, incidence and causation of the problems that have been highlighted and thereby better craft a response?

As the hon. Member highlighted, last August the Health and Social Care Committee reported on the impact of body image on mental and physical health and recommended a national review of the growing use of anabolic steroids as it relates to body image. That seems to me to be an essential first step. That research will then shape our response, which will have to use a public health approach and education to tackle demand and to try to close off access as best we can. That, of course, will involve a cross-departmental approach, which was another important point made by the hon. Member.

On education and campaigning, there are two sides to the coin. First, we need to look at the material and propaganda influencing and driving people to a place where they feel it is necessary or desirable to access IPEDs. That includes media and social media, as hon. Members have said, with the all-prevalent perfect body images in the press, on TV and increasingly on social media and in online advertising. If anyone shows a remote interest in trying to keep fit or even just losing a few pounds, they suddenly find themselves bombarded on Instagram or Facebook or whatever else with relentless images of what has been referred to in the past as the “Love Island” look, which to me seems pretty much unachievable for anyone who cannot spend every waking hour in the gym or unless they use IPEDs.

The Health and Social Care Committee dealt with that point in its report, calling on the Government to work with advertisers to feature a wider variety of body aesthetics and with industry and the Advertising Standards Authority to encourage advertisers and influencers not to doctor their images. The Committee said that

“the Government should introduce legislation that ensures commercial images are labelled with a logo where any part of the body, including its proportions and skin tone, are digitally altered.”

Those seem to be valuable suggestions that are certainly worth considering. The hon. Member for Bosworth pointed out that there has been some progress, but there is further to go.

As well as tackling the images and messages that promote the use of IPEDs, Government also need to raise awareness of the risks and how to minimise harm. Again, various Committee recommendations seem sensible, advocating for a campaign co-ordinated

“through existing steroid user support groups and targeted at areas of highest risk, such as gyms with a high proportion of body builders.”

We need to tackle head on the idea that these things are some sort of equivalent to supplements. They are in a different category altogether. The Committee also heard evidence stressing the importance of education about body image for young people, in terms of both critical thinking and appraising images, as well as self-worth. Again, the Government should strengthen those areas in education settings.

A report by the Scottish Drugs Forum noted the significance of close friends as a source of IPEDs. It suggested that peer education programmes could be an important way of overcoming that, with community members cascading positive health messages. And this is not just about education; mental health strategies need to be revisited as well, and we need to think about how we can support people struggling with self-esteem amid a bombardment of images.

Finally, we also need to consider appropriately targeted harm reduction advice and drugs services. There are many examples of good work out there. Yorkshire and the Humber has a regional steroid and IPED reference group and a workers forum of more than 30 people and with every district represented. In Glasgow, an image and performance enhancing drugs clinic provides testing, needle exchange services, consultation and advice on harm reduction and alternatives. Edinburgh, too, has a steroid clinic based in the harm reduction team of NHS Lothian. It provides advice services, equipment and testing, psychological services, and support to stop with mental and physical assistance. There is good work happening in the different parts of the United Kingdom. We should learn from that, and seek to ensure that more people around the various countries can benefit from it. Those are just a few ideas.

I will close by thanking the hon. Member for Bosworth again for bringing forward this debate. None of us have all the answers; I certainly do not—far from it. He had lots of ideas. He highlighted that there are pros and cons to some of them. Some of them are quite bold or controversial, but they are definitely worth discussing. His central point was that we need to have evidence to make the discussion as fully informed as possible. We should revisit this topic, and ensure that we continue to drive forward as we seek to address what is a growing public health issue.

Immigration Fees for Healthcare Workers

Debate between Margaret Ferrier and Stuart C McDonald

Monday 30th January 2023 Westminster Hall

[Stuart C. McDonald (Cumbernauld, Kilsyth and Kirkintilloch East) (SNP)]

It is good to see you in the Chair, Mr Sharma, and it is a pleasure to take part in this debate. I thank the hon. Member for Gower (Tonia Antoniazzi) for introducing the subject so comprehensively and eloquently, and I also thank her and her colleagues on the Petitions Committee for bringing it before us for debate in Westminster Hall. The Committee also did a great job in carrying out the survey that has helped inform some of the contributions that have already been made, and which I will come to shortly. I thank colleagues for those contributions, which have all been very powerful.

As colleagues have said, the starting point of this debate must be praising the international NHS staff. We have heard about the extraordinary contribution of those overseas nationals who come to join with UK nationals in order to keep our national health services “brilliant”—to use the word that the petitioners have used—and we have heard facts and figures about how significant the contribution of those overseas nationals is. Around one in six NHS staff members in England is non-British, and if I have understood the figures correctly, it is pushing on one in three doctors and one in four nurses. Overall, there are over 200,000 overseas NHS staff, coming from over 200 countries. GP practices are no different: we had a very constructive debate in Westminster Hall a couple of months back about some of the problems with keeping international medical graduates here as GPs, and the Minister took some points away from that debate. It will be interesting to see whether there has been any progress in the work being done to encourage more of those graduates to stay, because there is a gap in how the visa process works in relation to people wanting to stay on as GPs.

In particular, we should all recognise the extraordinary role that overseas workers in our NHS played during the pandemic, and indeed the sacrifices they made in protecting us from covid and treating those who suffered from it. I think I am right in saying that overseas nationals were disproportionately represented in the number of health workers who lost their lives during the pandemic.

The next part of the equation is, of course, that the NHS continues to face unparalleled challenges, particularly in terms of vacancies. Despite the huge contribution of the overseas workforce, figures also show that massive vacancy rates remain. As of September, NHS England had a growing vacancy rate of just shy of 12% for registered nursing staff: full-time equivalent staff vacancies in NHS trusts in England increased from about 133,100 in June to 133,400 in the quarter to September 2022, which I think is a five-year high. Overall, the vacancy rate in the quarter to September 2022 was 9.7%—again, a five-year high.

The important point, putting aside all the numbers, is what those vacancy rates mean in practice. Last year, a RCN survey found that only a quarter of nursing shifts have the planned number of registered staff on duty, which means that three quarters of shifts are going ahead with a shortage of nurses. In the ideal world, even if some nursing staff had to call in sick, we would have enough nursing staff to cover for them, but even with the full complement on, we are still short-staffed—we spend £3 billion every year on agency staff.

It is absolutely valid to say that the answer has to be partly about improving training and recruitment locally and ensuring that we can rely on the domestic workforce much more in the longer term. However, as the Health and Social Care Committee recently pointed out, overseas workers are essential to the health and social care system in the short term and in medium to long term: any move to shift to more domestic supply is likely to take time. We will have to continue to rely on overseas nationals filling those jobs in the years ahead.

[Margaret Ferrier]

Although health policy is devolved, visa and immigration policy is not, which means that the decisions of Ministers here in Westminster are having a direct impact on the devolved Administrations’ ability to build resilience in healthcare staffing and to resolve the crisis. Does my hon. Friend know how Ministers have sought to engage with the Scottish Government on this issue?

[Stuart C. McDonald]

I do not, but I would be interested to hear from the Minister about that. I will come shortly to how visas will impact on the Prime Minister’s and the UK Health Secretary’s own plans for turning the NHS around, but to put it succinctly: we can have all the action plans in the world, but they will be made significantly more difficult to implement if the recruitment shortages are allowed to continue.

The argument made a few times in Government responses during similar Westminster Hall debates is that the Home Office does not make a profit on ILR visas. That seems to defy the normal understanding of the word “profit”. The fact that the Home Office reinvests into other border and immigration functions is utterly irrelevant. The Home Office charge for that type of leave is several times the cost of processing the ILR application: it is a profit. Those profits have been increasing exponentially in recent years. Research by the Migration Observatory at the University of Oxford shows that since the £155 fee was introduced in 2003, it had risen to £840 by 2010 and now stands at £2,404. At one point during the debate, the question of why that is was asked: I will be brave enough to hazard a guess. To my mind, the reason is quite simply that the Home Office is one of the unprotected Departments sat right in the eye of the storm of austerity. Baroness Williams, a former Minister of State, pretty much said that in an answer to a written question:

“Application fees have increased in recent years as the Home Office aims to reduce the overall level of funding that comes from general taxation.”

The long and short of it is that the Home Office is struggling for money and has therefore been ramping up fees in an extraordinary manner over the past 10 to 15 years. As we have heard from various hon. Members today, that profit margin is having hugely negative impacts, including the uncertainty that it causes staff on the front line and the effect it has on their health and wellbeing, particularly during this cost of living crisis. We even heard about the dangers of debt and exploitation as a result. Ultimately, all that impacts on patient care. How can we look after patients properly when we are struggling to recruit staff while making it more difficult to retain the excellent staff we have already managed to recruit?

The Doctors’ Association UK has pointed out that the fee is more than many health professionals will make in a month and that it is pushing skilled staff to consider careers outside the United Kingdom instead. I turn to the survey of the Petitions Committee, which showed that 71% of foreign healthcare workers did not intend to apply for ILR because of the cost, with a further 28% saying, as has been pointed out, that they had delayed their application due to the costs involved.