ADHD Diagnosis and Treatment

Martin Docherty-Hughes Excerpts

Tuesday 15th May 2018 Westminster Hall

[Jo Platt]

I thank the hon. Gentleman for that intervention. I completely agree that we need to highlight the workforce, but before we do that we need the data to see how many people we need in all workforces. Again, I will come to that point later.

[Martin Docherty-Hughes (West Dunbartonshire) (SNP)]

I congratulate the hon. Lady on introducing today’s debate. Do they agree that one of the additional complexities in the workplace is the bureaucracy of the workplace assessment? If the Minister takes anything away from today regarding those living with ADHD in adulthood, it should be that that process urgently needs review in terms of its effectiveness and the impact on those with ADHD in the workplace.

[Jo Platt]

I completely agree. We have focused on young people in school settings, but that affects adults enormously.

I received a message from a constituent, Diane, who felt that she was different at school. Diane’s story speaks to the point, made by the hon. Member for West Dunbartonshire (Martin Docherty-Hughes), that adults are affected too. Diane went under the radar as she was high-functioning. She passed her GCSEs but failed at university as she felt that she could not concentrate. Diane developed mental health issues and has spent most of her life on anti-depressants, which she found did not work. She was unable to keep a job or a relationship, and in her 30s she tried to take her own life. It was only when her doctor advised her to be tested for ADHD and she was treated appropriately that her life turned around. That is not an uncommon story.

Since the debate was publicised on the House of Commons Facebook page last week, it has become clear that the scale of the diagnosis crisis is even greater than I could have imagined. The post was seen by 37,000 people and was engaged with by more than 1,000 people, shared right across the country. We saw stories of five-year waits and longer, of people forced to get a private diagnosis costing up to £1,000, and of children in school without the support they need. I urge the Minister to head to the Commons Facebook page and read some of the powerful stories.

After reading those stories, I could not help but wonder how in 2018 our healthcare provision can be so unresponsive to a condition that affects so much of the population. Earlier I quoted from a survey but did not state what the average waiting time is for a diagnosis across the country. That is because such information is not collected by the NHS or the Department of Health and Social Care. We have no idea what the average wait for diagnosis is, and therefore there are no target times.

From the unofficial data that is collected, it seems that we are likely encountering a vast postcode lottery that is unfairly dictating the speed of a diagnosis and the support available. Just take the comment of Sian on Facebook. Her son in Wigan has received excellent care, which she described as “life changing”. However, she teaches in a neighbouring constituency where children are waiting more than a year for diagnosis and encounter a far more confusing process. Without the diagnosis data, we have no way of either assessing the effectiveness of the current diagnosis process or identifying areas of good practice. That data must be collected before we can begin to assess our treatment strategies.

The third way we are letting people down is through the lack of an integrated support strategy for those with ADHD. By looking at each impact of ADHD in isolation—at just the medical impact, just the impact in educational settings, or just the behavioural impact and the social implications of the condition—we, as a society, are failing to offer the whole-system approach to ADHD, and to mental health more generally, that is needed. Tackling ADHD should be about transforming lives; not just responding to symptoms, but working to unlock the full potential of the incredibly creative minds that those with the condition possess.

The current approach to ADHD is not fit for purpose. Too many are falling through the net; too many are still waiting for a diagnosis after years on a waiting list; too many are without the right support; and too many are living undiagnosed with a condition that can have a severe impact on their daily life. I introduced today’s debate because of stories such as Becky’s, Sam’s, Hugh’s, Sarah’s, Claire’s, and the countless others who got in contact with me out of desperation, and who I know will be watching today.

What changes do we need? First, there needs to be more research. A recent Demos report highlighted that ADHD is under-researched, particularly its social and economic impacts. There also needs to be research into the difference made by early access to diagnosis and treatment to the long-term outcomes and costs of people with ADHD.

Secondly, the NHS and the Department of Health and Social Care need to collect data on waiting times. As we have seen, there is a vast postcode lottery across the country that determines the speed of diagnosis and the level of support. The system is grossly unfair and is reducing the life chances of people, based purely on where they live.

Thirdly, we need a streamlined and integrated approach to the support process we offer to children and adults with ADHD. As I have mentioned, those living with the condition are no less able but are often not suited to traditional methods of learning. We must implement a strategy that diagnoses an individual with ADHD speedily and then, crucially, signposts and tracks that individual through a system that promotes educational or employment opportunities suited to their skill set. More broadly, that means that as a society we must be unafraid to promote the untraditional or unconventional routes to success, to promote the creative industries, and to destroy the social stigma that too often forces individuals down the academic route.

In my own borough of Wigan, we have seen the beginnings of such an approach. The local clinical commissioning group has implemented a new joint mental health strategy that is designed to facilitate the seamless interaction of healthcare professionals with support services and education providers. The early signs are promising. Already we have seen the average local wait down from 15 weeks to six weeks, which will help numerous local young people to thrive. However, there is still a long way to go. The strategy addresses ADHD only in children and its implementation is too recent to see the long-term local impact. The local nature of the strategy also highlights yet again the importance of a national framework to achieve equality of provision across the country.

--- Later in debate ---

[Jackie Doyle-Price]

My hon. Friend will be aware that we have addressed those issues in the Green Paper. We are investing in a whole new workforce in support of CAMHS, which will have a direct relationship with schools, where it will be possible for a lot of the wraparound help to take place.

I would like to make some progress on the specifics of ADHD and move on from CAMHS. The hon. Member for Leigh highlighted the massive variation in services across the country. I fully acknowledge that there are long delays for some to see a specialist and secure a diagnosis. That will clearly have a negative impact on those living with ADHD and their families, who can also find the experience confusing.

We are determined to see improvements in the patient journey. There are NICE guidelines. The earlier the diagnosis the better, and the better the chance of getting the right support and better outcomes for the individual. The NICE guidelines were published in 2016 and set out the process for managing ADHD for people aged three years and above. The guidelines aim to improve the diagnosis of ADHD, as well as the quality of care and support for people with an ADHD diagnosis.

An updated guideline was published in March this year, which particularly addresses under-diagnosis and misdiagnosis of ADHD in girls. People think it is just about behaviour, but in girls it does not play out in exactly that way; there is a lot to be done in education on exactly what this condition is. As the hon. Lady said, people think it is about bad parenting or bad behaviour when it is much more complex. The guidelines advise practitioners to be alert in such circumstances to the possibility of ADHD. We will be failing girls if we do not raise awareness of how that might be playing out.

The guidelines also recommend that people with ADHD would benefit from improved organisation of care and better integration of child health services, CAMHS and adult mental health services. Although NICE clinical guidelines are not mandatory, we expect health and care professionals and commissioners to take them into account fully as they design and put in place services to meet the needs of their local populations. NICE has published a range of tools to help local areas put the guidance into practice, but that is clearly not happening everywhere. I always find that sunlight is the best disinfectant, so the more we can do to ensure transparency, the better. That is why data is so important, as the hon. Member for Leigh said.

The NICE guidelines do not at this time recommend a waiting time for seeing a specialist for diagnosis, but they do recommend that parents of children whose behaviour is suggestive of ADHD should be offered a referral to group-based ADHD-focused support without waiting for a formal diagnosis. That will clearly be helpful, but we should also look at the waiting times.

An issue that I am particularly concerned about—I look forward to engaging with the APPG on this—is support for schools, which the hon. Lady mentioned. Getting the right support package for children with ADHD can be challenging for some institutions. I am concerned that anecdotal evidence suggests that people are being excluded disproportionately, so we really need to tackle that discrimination. Perhaps I can ask the APPG what we can do together to give schools extra support and better advice about how to support children with this condition, rather than simply marginalise them.

The Children and Families Act 2014 and the special needs code of practice set out ways in which care services should join up, and we need to hold them to account. We expect CCGs and local authorities to work together to support children with special educational needs or disabilities, including ADHD. That includes co-ordinating assessments of individual needs and, for those with the greatest needs, providing an individual education, health and care plan. I am interested in hearing evidence from the APPG about how many children are not receiving such plans.

I am not going to stand here and pretend that everything is perfect, because I know perfectly well that it is not, but we have the opportunity to highlight good practice, help local authorities and CCGs to learn from it, and highlight when people are being failed.

[Martin Docherty-Hughes]

On best practice, I asked the hon. Member for Leigh (Jo Platt) about the Department for Work and Pensions’ workplace assessments. Will the Minister speak to her colleagues in the DWP about how effective they are for adults with ADHD in the workplace?

[Jackie Doyle-Price]

I will be happy to look into that in response to the hon. Gentleman’s question. The Government are trying to encourage as many people into work as possible, and we want to get an additional 1 million people with disabilities into work. Employers should treat people sensitively, and people with ADHD can be valuable members of the workforce. I will be happy to have a conversation with my colleagues in the DWP to encourage that. Those people have a skill set that can be extremely productive for enlightened employers who are prepared to make concessions and work with them effectively.

I acknowledge that data is an issue. Without robust and comparable data about waiting times, we do not have the tools with which to challenge local areas, but hon. Members can raise anecdotal evidence in advance of our being able to put together a suitable dataset. I have asked my officials to explore with NHS Digital what data can be made accessible via the mental health dataset. We also need to work alongside the Department for Education, because people with ADHD start manifesting issues in school.

A number of hon. Members said that it is important for employers to improve outcomes for people with ADHD. Unless we get people with ADHD into meaningful employment, there is a risk that they will fall into the criminal justice system, quite unnecessarily. Work is not just about earning a living; it contributes to people’s psychological wellbeing and gives them a sense of belonging, purpose, confidence and self-esteem. As I have said many, many times before, work is good for people’s health, so we need to ensure that nobody is excluded.

People with ADHD can be well skilled, highly qualified and employable individuals, with exceptional and unique talents, who can bring real benefits to businesses. I am more than happy to bang the drum to encourage more employers to be sensitive to people with ADHD, as they should for people with autism, who also have big skill sets that they can offer to employers.

I do not have much time left. I thank hon. Members for their contributions. This group of people has been poorly served for a very long time. I therefore welcome the establishment of the all-party group and I look forward to having ongoing dialogue with all its members. I hope that, before long, we can achieve some material differences and improved outcomes for all those people.

Question put and agreed to.

HPV Vaccination for Boys

Martin Docherty-Hughes Excerpts

Wednesday 2nd May 2018 Westminster Hall

[Martin Docherty-Hughes (West Dunbartonshire) (SNP)]

It is a pleasure to serve under your chairmanship, Sir Henry. I am grateful to the hon. Member for North Thanet (Sir Roger Gale) for bringing this debate today. I participated in the debate in June 2016, which the hon. Member for Finchley and Golders Green (Mike Freer) brought to the Floor of the House. I am delighted to be here for this debate. I also congratulate the hon. Members for Worthing West (Sir Peter Bottomley) and for Henley (John Howell) on participating. I am slightly disappointed that more hon. Members are not here, because this is an important debate. It is especially important for hon. Members who happen to be men to understand the issue of HPV and their role in prevention.

Across the UK, the Governments of the various nations are progressing towards what I see as a progressive policy on HPV vaccination. As a Scottish constituency MP, I am delighted that the Government in Scotland are progressing that way and that this debate is taking place in the UK Government. In all good conscience, however, as a constituency MP I also have a role to highlight the issue around HPV and the need for men to be more aware of their role in sexual health, predominantly because this is a public health issue. A great amount of work is being done all over the world, which has impacted on people’s lives.

We heard about issues relating to penile cancer. It would be interesting to know how many hon. Members know that men can get penile cancer. When I was the secretary of Cahonas Scotland, a male cancer charity in Scotland, we did a piece of work with a broad range of men from different socioeconomic backgrounds. The very idea of issues such as penile cancer was an absolute shocker to them. We showed them pictures of men wearing adult nappies. The lived experience of other men dealing with the impact of cancer related to HPV was profound and they did not know anything about it.

This is not just a sexual health issue, but a public health one. Knowledge is power. Knowing more about the issue and being able to make an informed choice to have the vaccination with parental approval is critical in ensuring that young men are protected for the future. Nevertheless, clarity is required—it is a challenge for me to say this to Governments across the UK—on why we are articulating a message about the numbers game, in which it is just about cost. If we relate that to the lived experience of men living with the consequences of not having the vaccination—I believe there may be some in the Gallery today—the clinical evidence needs to inform the economic choice. The clinical evidence is that the vaccination for young men will save lives. That is about understanding the consequences of the failure to give the HPV vaccination to young men. Governments across the UK should no longer be timid. We are being progressive at the moment, but timidity does not save lives.

There is also a difficulty at the core of this debate. In public policy debates on public health, it seems that those of us in the public policy arena—men, predominantly—are abdicating responsibility by saying, usually through the herding immunisation argument, that the public health and sexual health of young men are down to young women. I do not find that acceptable. I can no longer stand as a Member of Parliament and look young women in my constituency in the eye and say that, from a policy perspective, abdicating sexual and public health to them is acceptable. It is the responsibility of policy makers to articulate a view that young men and young women have the right to this vaccination. In allowing that public policy narrative to continue, we as men are abdicating our responsibility to those young women. That is no longer sustainable.

Historically, it is now 100 years since women over 30 got the vote. How does that relate to this issue? It is about gender being at the heart of a public health debate. We are saying to young women that they are responsible for young men’s sexual health, with negative consequences for young men. In the 21st century, that is no longer tenable. It has profound consequences for young men in the future, in relation to cancers, and it is the same stuff that we said to young women in the 19th century: “We’ll just leave it to you when it comes to sexual health.”

The hon. Member for North Thanet said that instances of oral sex were a new thing since the 1960s, but I have to admit, that is news to me. When I look at the historical narrative of sexual—[Interruption.] I sometimes feel as though I might have been born then. The historical narrative of sexual health has traditionally been an abdication of responsibility from men to women. One need only look at the friezes in Pompeii where oral sex is de rigueur. It was no different in the 18th century, when women had to tolerate the sexual norms of men who would have sex with other men and with sex workers, and when the attitude was that women just had to deal with sexual health issues.

In 2018, I make no apology for saying: not in my name. The young men of the UK deserve better, and the young women in my constituency should expect no less from me as their Member of Parliament than for me to say to Ministers—not just here in London, but in Holyrood, Belfast and Cardiff—that we need to take collective responsibility and stop genderising the public health debate. Only then will we create a more equal, fairer and far healthier society, in which young men have the opportunity to participate and acknowledge their role in sexual health and, in future, to live healthy sexual lives without fear of talking about sex or HPV—and, frankly, without having to tell parliamentarians stories of their sexual activity to bring a debate to the Floor of the House. That is no longer tenable and we need to rise to the challenge.

We need to say to young men and older men who are suffering from HPV that we will do everything in our power as politicians to meet the challenge they have placed before us. We need to say to young women that we no longer accept that they are responsible for the sexual health of young men.

Leaving the EU: NHS

Martin Docherty-Hughes Excerpts

Thursday 22nd March 2018 Westminster Hall

[Martin Docherty-Hughes (West Dunbartonshire) (SNP)]

It is nice to see you in the Chair, Mr Davies.

I congratulate the right hon. Member for Exeter (Mr Bradshaw) on bringing this debate to Westminster Hall today. It is a very important debate, which is part of a much bigger debate going on in households and workplaces, such as the Vale of Leven Hospital and the Golden Jubilee National Hospital in my constituency.

Let me also associate myself with the words many have said about the loss of PC Keith Palmer last year. Due to their sacrifice, we are able to be here to debate today.

On some of the other Members who have spoken, I am sure it will come as no surprise to the hon. Member for Hammersmith (Andy Slaughter), who had to leave early, my hon. Friend the Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), the hon. Member for Stockton South (Dr Williams), the right hon. Member for Carshalton and Wallington (Tom Brake) and my hon. Friend the Member for Motherwell and Wishaw (Marion Fellows)—for Hansard, what I say sounds like “Wishy” but it is spelt “Wishaw”—that I agree probably with everything they have said. As for the hon. Member for Bosworth (David Tredinnick), I am sure that they will appreciate I slightly disagree that inviting the People’s Republic of China into the NHS structure is the best way forward and a good argument for Brexit. We have already sacrificed the nuclear energy industry to that, and it is not going well.

Many people are quietly and rightly concerned about the impact of Brexit on our national health services—I say to Hansard that that is in the plural because there is more than one NHS structure in the United Kingdom of Great Britain and Northern Ireland—and their social care partnerships. Members have touched on that this afternoon, on the high numbers of EU nationals who are employed across those sectors and on the valuable contribution that those workers provide in areas across our communities.

In Scotland, EU nationals in the workforce are employed across all sectors. They play a critical role in our communities and in the NHS. Communities across these islands and the NHS health and social care systems have benefited greatly from the contribution made by staff and, yes, volunteers in those sectors from across the European Union. Citizens volunteer to gain experience, and a lot of EU citizens who engage with NHS structures across the UK have used volunteering to provide a service free of charge, so we must ensure their long-term futures are confirmed and not left in limbo.

To illustrate a point, I have been contacted by constituents who work in the NHS and its social care partners who are extremely worried by the manner in which the Government have approached the situation. They feel they are being used as political pawns in a game of chess where all the pieces have yet to be put out on the board. They have seen a lack of preparation in the Government’s approach to leaving the European Union. We should use this debate to celebrate the selfless individuals providing services within our NHS and social care partnerships. Instead, here we are having to protect them. If that is how EU nationals are being treated, as many Members have intimated today, what message does it send to people around the world, whether they are from Australia, India, Brazil, New Zealand or even the United States, who are considering bringing their skills, talents and enthusiasm to the NHS structures across the UK?

As a Scottish constituency MP, I hope that Scotland will at least strive to be a welcoming nation—I am sure the rest of the UK would as well—as we aim to attract the best talent to our universities and our health and social care workforce. From my perspective, the effects of Brexit will have a profoundly detrimental impact on that goal of being an inclusive society.

Since the creation of the NHS system, the world of medicine has moved on, and with growing patient needs, particularly from an ageing population, as well as the complex needs and conditions that are associated with that, we must ensure that our NHS structures and the interdependent health and social care partnerships have the ability to move with the times.

Some years ago, the Scottish Government, through the Scottish Parliament, passed legislation to integrate—quite early in the UK—the health and social care sectors to ensure a higher standard of care to meet the challenges of dealing with more complex population needs. That has been extremely beneficial for those delivering services, such as the NHS, local authorities, the third sector, which has yet to be mentioned, staff, and volunteers. More importantly, it is critical for those who rely upon the public service being delivered.

However, with the number of EU nationals moving to the UK declining and those already here anxious about their future, everyone in these islands could receive a double hit with the loss of talent of those who are qualified to work in both the health and social care sectors. There is also the issue of cross-border activity in health sector situations. That is not the border between the EU and the English channel or the North sea, but the one that everyone keeps forgetting: the land border of over 300 miles between the UK and the 500 million citizens of the European Union in the isle of Ireland. It shocks me that we have yet to hear about that in this debate.

We only need to go back to 2016 after the European Union referendum when Derry City and Strabane District Council, in conjunction with Donegal County Council, published the report on the impact of Brexit on Derry/Londonderry north-west city region, which was damning about the impact of Brexit on shared services, practical healthcare services, GP-led services and surgery services between County Donegal and the Strabane District Council region of Northern Ireland. It is shocking that that has yet to come up in the debate.

The people who work and volunteer in the NHS and those who rely on the NHS need assurances that services will not be harmed. I hope the Minister will be able to discuss some of that in their response and that patient care will not be downgraded. They need more than a simple slogan on the side of a bus.

Many of the challenges that the NHS structures and social care partnerships across the UK face, including those in Scotland, are not exclusive to the mainland of the UK. They also impact on Northern Ireland. The Government must take responsibility and action to fully assess the potentially damaging impact of Brexit on the delivery of health and social care. I look forward to the Minister summing up how the Government will answer many of the questions posed by me and other Members today.

--- Later in debate ---

[Stephen Barclay]

My point is that we will have control of our trade deal. The Prime Minister has made it clear that there will be no change in the protections afforded to the NHS. The subject of the debate is Brexit, and we are talking about the difference between being inside and outside the EU. The regulatory controls as they would have been under TTIP will be no different in the new landscape.

I remind the hon. Gentleman, who was very critical of Brexit, that more than 61% of people in Stockton voted to leave the EU. He might think that his voters are misguided and wrong, and that they made a huge error in how they voted, but I hope he agrees that it is right that the Government respect that democratic decision and deliver control over our trade policy.

[Martin Docherty-Hughes]

The Minister will appreciate that Northern Ireland voted to remain in the European Union. He seemed to hop, skip and jump over the issue of the border. Will he clarify today, or in writing to Members who are participating in this debate, that the common travel area will extend to a member of NHS staff working in Northern Ireland who happens to be a Romanian or French citizen but lives in the Republic of Ireland, and that they will not be forced to become a citizen of the Republic of Ireland or the United Kingdom after Brexit?

[Stephen Barclay]

I am very happy to write to the hon. Gentleman about that. The question of the border is for deep negotiation with our European partners. There is a desire on both sides for us to get it right, particularly given the sensitivities in Northern Ireland.

HPV Vaccinations for MSM

Martin Docherty-Hughes Excerpts

Tuesday 7th June 2016 Westminster Hall

[Martin Docherty-Hughes (West Dunbartonshire) (SNP)]

It is always a pleasure to see you in the Chair, Mr Hollobone. I congratulate the hon. Member for Finchley and Golders Green (Mike Freer) on securing this important debate. I will concentrate on four points that I believe are fundamental: stigma, the recommendations of the Joint Committee on Vaccination and Immunisation, implementation and lessons to be learned. I have no doubt that living with HPV can be similar to living with HIV/AIDS. Nobody wants to talk about it, even today, and that cultural silence embeds the stigmatisation of those living with HPV, while limiting our ability to improve access to services and to reduce the indices of, in this case, men who have sex with men who are infected with HPV.

As my hon. Friend the Member for East Dunbartonshire (John Nicolson) said, HPV is one of the most prevalent infections. Statistically, most of us in this room will have been infected by at least one of the differing strains at some point in our lives. Although the majority of us deal with that infection naturally, which has already been mentioned, challenges in removing the infection remain for those, critically, who smoke, and those with compromised immune systems—for example, people living with HIV/AIDS.

As for stigma, let us be frank. Discussing anal warts can be a conversation stopper. For men, in particular, addressing and discussing health-related issues is problematic in general. With that in mind, I encourage Members to reflect on research undertaken several years ago in Scotland on male cancers for Cahonas Scotland by John Docherty-Hughes of Queen Margaret University, Edinburgh. I must declare an interest: he happens to be my husband. Entitled, “Men, Masculinities and Male Cancer Awareness: a preliminary study”, it found that men felt uneasy when being open about their fears in relation to their own health, specifically in relation to cancer for that research, but also health in general. I recommend Members avail themselves of that research as it challenges those who seek to improve services for men, whether cancer or HPV specifically. It is critical that we reduce stigma in relation to male health and wellbeing.

Let us return to the recommendations of the JCVI. As a Scottish constituency MP, I am delighted that the Scottish Government earlier this year announced that they will make men who have sex with men eligible to receive the HPV vaccine without recourse to a pilot. They are working to ensure that the vaccine can be introduced for men who have sex with men as soon as possible, in contrast to the pilot programme being proposed by the UK Government in England. On implementation, the roll-out of the HPV vaccine has so far been a resounding success, with HPV immunisation uptake exceeding 80% in Scotland.

As to lessons learned—I do not want to detain the House for long—the hon. Member for Finchley and Golders Green has, by securing this debate, given us the opportunity to inform and educate not only the policy makers sitting behind the Minister, but colleagues and those watching the debate in the Public Gallery and on television. The key to improving the health and wellbeing of men, from my perspective and in much of the research I have read, is education based on their lived experience culturally, socially and economically. That is whether they have sex with other men—frankly, one can identify as being heterosexual and have sex with other men—are homeless, are black or from a minority ethnic community, identify as heterosexual, homosexual or bisexual, or are transgender, because even men in transition must deal with the consequences of male health.

The key question is this: are the UK Government and healthcare practitioners in the NHS and the charitable sector able to meet the challenge and listen to the lived experience of men who have sex with men living with HPV and those who support them? Will they begin the full implementation of the recommendations of the JCVI and start the full roll-out of that vaccination across England?

Mental Health (Armed Forces Veterans)

Martin Docherty-Hughes Excerpts

Wednesday 14th October 2015 Commons Chamber

[Alistair Burt]

My hon. and gallant Friend from the Ministry of Defence says that there is money available in a bidding programme and he will write to the hon. Gentleman and see what more can be done in relation to that.

I want to say two things as we run towards a conclusion. Many of the servicemen affected will of course be treated by the NHS in the course of ordinary medical treatment. The so-called talking therapies from the IAPT programme have been particularly successful. It is important to ensure that the particular needs of veterans are catered for in this programme. Work has been under way to ensure that that is done. The IAPT programme has been very successful. For the first time, we have standard waiting times and access targets. That will help veterans too.

[Martin John Docherty (West Dunbartonshire) (SNP)]

Will the Minister give way?

[Alistair Burt]

I only have a couple of minutes left, but if the hon. Gentleman must intervene, I will give way.

[Martin John Docherty]

I am very conscious of the time, and I am grateful to the Minister for giving way. We have heard much talk about service personnel, and I completely agree with it, but there seems to be little discussion about the impact of service personnel’s mental health issues on children. Given that the strategic defence and security review is coming up, will there be some commitment to investigations and discussions with the children’s commissioners of the United Kingdom of Great Britain, Northern Ireland, Scotland and Wales to see how they can inform that debate?

[Alistair Burt]

I note the hon. Gentleman’s remarks. I cannot say anything about the review, but I take his point. It is recognised that anything that affects the mental health of an individual can impact on the family. I hope that the veterans’ work involves that.

May I just say a little more as I have something specifically to say about that? Additional services include: a 24-hour veterans’ mental health helpline that receives more than 800 calls per month; an online peer support, well-being and counselling service called the Big White Wall, which provides support and services to armed forces, their families and veterans 24 hours a day all year round; Combat Stress, of which people are aware; and Help for Heroes’ “hidden wounds”, which is a psychological well-being service offering support to veterans and their families. It is important that these veterans’ services are both sustainable and fully embedded in the mainstream of the NHS so that veterans can move to other mental health services if necessary and at the right time.

In view of what colleagues have said, let me conclude by returning to my original point. There are services in place. They have clearly improved. We have recognised the good work of my hon. Friend the Member for South West Wiltshire some time ago and the demand that has come back, but it is plain from what colleagues are saying that they want us to do more. I do not think that there is a finite limit that we can go beyond in recognition of what has been done for us. I am absolutely certain that the commitment that the Prime Minister made this afternoon in his answer to the hon. Member for East Kilbride, Strathaven and Lesmahagow in which he demonstrated his own deep awareness of the situation is one that we can all rely on. We will continue to meet the commitments of the armed forces covenant and to work closely with all those relevant organisations in the best interest of veterans and their mental health. That is the best way in which we can say thank you.

Question put and agreed to.