Community Pharmacies

Sharon Hodgson Excerpts

Wednesday 2nd October 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Sir David. I thank my hon. Friend the Member for Halifax (Holly Lynch) for securing the debate, and for her excellent opening speech. For their contributions early on this cold Wednesday morning, I also thank my hon. Friend the Member for Heywood and Middleton (Liz McInnes), my right hon. Friend the Member for Rother Valley (Sir Kevin Barron), the hon. Member for Strangford (Jim Shannon), my hon. Friend the Member for York Central (Rachael Maskell), the hon. Member for Westmorland and Lonsdale (Tim Farron), my hon. Friends the Members for Scunthorpe (Nic Dakin) and for Great Grimsby (Melanie Onn), and the hon. Member for Motherwell and Wishaw (Marion Fellows), who speaks for the Scottish National party.

It is clear that community pharmacies are valued across all our constituencies. On Friday I will be visiting Davy Pharmacy in Castletown in my constituency. I will hear once again at first hand how my constituents benefit from community pharmacies, and the impact that their services are having.

I welcome the new Minister to her role. I look forward to hearing from her today and to shadowing her in the months to come. I know that health is very important to her, and that it is one of the reasons why she stood to be a Member of Parliament. We previously worked together as officers of the all-party parliamentary group on breast cancer.

I will begin with one of the first things that springs to all our minds when we think about community pharmacies: prescriptions. As my hon. Friend the Member for Leicester South (Jonathan Ashworth), the shadow Secretary of State for Health, announced in Brighton last week, the next Labour Government will introduce free prescriptions for all. We believe that prescription charges are a tax on sickness. When as few as 5% of patients actually pay for their prescriptions and many of them struggle to pay, surely it is time that the charge was scrapped.

The £9 per item prescription charge results in some patients on low incomes reducing their medication or going without, which is dangerous and can impact on a patient’s long-term health. It can even be fatal, as in the heartbreaking case of 19-year-old Holly Warboys, who died of an asthma attack. Holly did not have a full inhaler because she could not afford one. Nobody should have to pay to breathe.

A large proportion of the 5% of people who pay for their prescriptions budget for them by taking advantage of prepayment certificates, to reduce what they have to pay to the equivalent of about one and a half prescriptions per month. When all the costs of administering the fines and prepayment certificates, and the whole kit and caboodle around charging, are taken into account, it seems eminently sensible, fair and cost-effective to extend free prescriptions to all.

Research backs that up. A study from the University of York has shown how beneficial free prescriptions can be as a means of prevention. When patients suffering with Parkinson’s disease, for example, were given free prescriptions, hospital admissions were reduced by 11.4%, patient day care was reduced by 20.4%, and accident and emergency attendances were down by 9%. I am sure that the Minister will see that the policy will improve patient outcomes and save precious NHS resources. I know that she is new to her post, so she might want to make a bold announcement today. Will she match Labour’s commitment to ending this tax on sickness? The subject was definitely on the radar of one of her predecessors on the health team, the hon. Member for Winchester (Steve Brine), as I had conversations with him about it.

As we have heard, filling prescriptions is only the tip of the iceberg of the services that our community pharmacies provide. There is the potential for the expansion and development of a whole range of services. For example, I would like to see an expansion of pharmacists being able to prescribe, especially basic medications, in order to relieve pressure on our GPs. I understand that that service is very successful where it currently happens. Community pharmacists are the most accessible healthcare professionals, and community pharmacies are a genuine hub for the delivery of a diverse range of health and wellbeing services. The Government’s television campaign advises people to ask their pharmacist, because it really is an easy thing to do. That is especially true for traditionally hard-to-reach people who benefit from the barrier-free access to healthcare that community pharmacists provide.

In some circumstances, if there is a high turnover of GPs in an area, the community pharmacist is the only one providing continuity of care, which builds invaluable trust and the capacity for important health interventions. It is therefore a natural and sensible progression to allow basic prescribing, especially if it is coupled with a sort of triage service that is linked to an ability to make appointments for people with more serious concerns directly with their GP.

As we have heard, community pharmacies have long provided a range of services in addition to the provision of medicines, including minor ailment schemes, smoking cessation services, blood pressure testing, support for asthmatics and diabetics, emergency hormonal contraception and monitored dosage systems. Despite that, community pharmacies are in many ways the NHS’s best kept secret. They are invaluable in a health service that is overwhelmed by increased demand.

There is so much untapped potential in community pharmacies, as well as some excellent examples of best practice across the country that could be rolled out nationwide. For example, when patients phone the Central Gateshead Medical Group with a minor illness such as earache or a sore throat, they may be offered a referral to one of 13 community pharmacists in the Gateshead area for a same-day booked consultation, which creates capacity for GP appointments for patients who need to be seen by a GP. The patient’s referral details are sent to the pharmacy using a secure NHS mail account. Patients are then sent a text message to confirm the details of the appointment with the community pharmacist. Community pharmacists are already doing some great work and they have a huge role to play at the heart of every primary care network. The Government are failing to recognise that if they do not try to roll that out.

I welcome the Government’s commitment to prevention, but they must put their words into action, for example by reversing the terrible cuts to local authority public health budgets and by recognising the importance of community pharmacists in particular and the role that they can play in prevention. As we have heard, thousands of people—millions, actually—visit their community pharmacy every day. Every one of those presents an opportunity for a positive health or wellbeing intervention. In the words of Simon Stevens, “Make every contact count”.

The profession and its representatives, the Pharmaceutical Services Negotiating Committee and the National Pharmacy Association, have offered to deliver more services. The recently negotiated new pharmacy contract begins to recognise what the NHS has been missing for so long. There are many welcome features, including the new community pharmacist consultation service, which will take patient referrals from NHS 111 and will be extended for referrals from other parts of the NHS, such as GPs and A&E. Similarly, the new Medicines reconciliation service will ensure that medicine prescribed in secondary care is appropriately implemented on discharge to the community, which will reduce the number of unnecessary hospital readmissions. Those changes will be not only convenient for patients, but enormously important in relieving pressure on GP surgeries and A&E departments, which is what we all want to do.

That is why we need a shift to service-based remuneration in the context of a five-year agreement. If community pharmacies, with their huge potential, are to remain viable, the remuneration must be adequate. Can the Minister tell us today what the new funding settlement will look like? I hope that, in her response, she will celebrate the work of community pharmacies—I am sure she will—and set out what the Government will do to utilise their potential.

Hernia Mesh in Men

Sharon Hodgson Excerpts

Thursday 5th September 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hanson. I thank the hon. Member for Strangford (Jim Shannon) for securing the debate and for his characteristically passionate, thought-provoking and knowledgeable speech. Although, for all the reasons he gave, the debate is not heavily subscribed, it is an extremely important debate about an issue we have not yet addressed in this place. I know that all the men and, indeed, women watching—be they wives, partners, family members or mesh sufferers themselves—will thank him for bringing this issue before the House too. I also thank the hon. Member for Linlithgow and East Falkirk (Martyn Day) for his remarks on behalf of the SNP.

I welcome the Minister to her new role. We were both elected in 2005—I remember seeing her at the induction on my first day—but I think this is the first time we have faced each other speaking from our respective Front Benches in this capacity. I look forward to shadowing her on some of her policy areas and to holding her Government to account on all things public health and patient safety, which tends to be the area I cover. I also look forward to her response to the debate, but first I have some questions of my own for her.

As the hon. Member for Strangford said, we have had a number of debates in this Chamber and the main Chamber about the impact of vaginal mesh on women—including, sadly, as I am sure Members have heard, my own mam. She is a sufferer of vaginal mesh, which I have spoken about at length in other debates. Although this debate is about hernia mesh in men, it is clear, as the hon. Gentleman said, that there are similarities between the two that need to be addressed. First, the devices are made of the same material—usually polypropylene plastic, which is also used for plastic bottles. It is hard to believe that it is being inserted inside people; obviously, we are now hearing about the damage that causes. The other similarities are a lack of data and a lack of information about the risks for patients, both of which cause harm to patients.

As we heard, the majority of hernia mesh operations are successful, and the Royal College of Surgeons states that the implants remain “the most effective way” to treat a hernia. However, that does not mean we should ignore the patients who tell us that the operation caused them extreme pain and discomfort. The surgery might be successful in the sense that it repairs the hernia, but if it causes extreme pain and life-changing symptoms for some patients, it cannot be right to call it successful.

As I have said in debates about vaginal mesh, if a car, a washing machine or a drier failed in such numbers, there would be a full recall and sales would cease immediately, no ifs or buts. Research shows that between 10% and 15% of people who have hernia mesh surgery suffer from chronic pain and complications after the surgery. That is just not acceptable. That is not a tiny number of people—it is not just the odd one—and it is devastating for the lives of every one of them.

According to NHS data, 10% of people who have hernia mesh fitted go back to their clinician at some point after their surgery. Some surgical experts claim that complications occur in as many as 30% of hernia mesh surgeries, and that those can be every bit as harmful as with vaginal mesh. Until today, hernia mesh patients have not had their voices heard, because the extent of the problem is just not measured. What assessment has the Minister made of the number of complications following hernia mesh surgery, and what consideration has she given to establishing a hernia mesh database to audit the number of surgeries and any associated complications?

The lack of data collection means patients cannot adequately be informed about the risks before surgery. I hope that changes as a result of the debate. Hon. Members may have heard of Dai Greene, a world-class hurdler who captained the Great Britain athletics team at the 2012 Olympic games and was subsequently treated with hernia mesh. He says he cannot remember being warned about any associated risks but was told he would be back training after a few weeks. That was not to be the case: Greene lost five years of his career due to complications after the surgery.

We all trust that surgery will be safe for patients and will improve their quality of life. Patients trust that they will be informed of any associated risks. With vaginal and hernia mesh, that has not been the case for thousands of patients. How will the Minister address these serious concerns? Patient safety and trust must not be compromised in favour of a cheap or quick procedure. My mam was told, “Oh, it’ll be 15 minutes that will change your life.” My word, it changed her life—but not for the better.

I understand that the independent medicines and medical devices safety review is due to report its findings soon. I attended one of its sessions in Newcastle with my mam. It was very well attended, as I believe they all were. Baroness Cumberlege was there, and she was very attentive and compassionate to all the women in attendance. I look forward to her report. Hernia mesh is not included in the review, but given the parallels between vaginal and hernia mesh, which have been highlighted not just today but consistently— the hon. Member for Strangford cited Victoria Derbyshire, who has also done great work on this issue—the Minister should consider the review’s findings in the light of this debate and treat hernia mesh with the same seriousness as vaginal mesh.

Will the Minister work with NICE and NHS England to ensure that patients are clearly informed in good time before surgery about the risks associated with their treatment so that they can make properly informed decisions, with updates on risks as research develops? This is about patient safety and confidence, which is paramount to our NHS.

In closing, I welcome again the Minister to her role. I appreciate that this week must have been a baptism of fire, trying to get on top of so many issues. I understand that she has had to respond to three debates—as the hon. Gentleman said, she has got a hat-trick. Nevertheless, I hope she will address these concerns today and take away any that she cannot. No doubt, we will revisit this issue for debate at a later date.

--- Later in debate ---

[Ms Dorries]

I thank my hon. Friend for his absolute honesty and openness in bringing forward his own case.

The bowel can come through the opening in the muscle wall, strangulate and develop into peritonitis, with dire consequences. The fact is that the alternative method of repair—just to stitch the muscle wall—is nowhere near as effective, and the same dangers can present. There can be a rupture, and the hernia will present again with the same complications.

[Mrs Hodgson]

The Minister, with her medical knowledge, can give the details on hernia repairs in men that otherwise would have been missing from the debate. The hon. Member for Burton (Andrew Griffiths) speaks from his experience. Although I do not want to be a harbinger of doom, for him it is very early days; often the pain that comes in 10% to 15% of cases appears a few years later, as the hon. Member for Strangford said in his speech. The Minister rightly points out that it is a good operation for what is a life-threatening condition in men, as opposed to stress incontinence in women, but still in 10% to 15% of cases we are talking about real pain. I would like her to elaborate on what we should do about that.

[Ms Dorries]

The hon. Lady is absolutely right. No one should suffer with chronic pain. There is a difference between acute and chronic pain, with acute pain happening immediately post operation and the chronic pain continuing afterwards. In inguinal mesh repair operations, the chronic pain is due to the mesh—like a small piece of net curtain—rubbing up against nerve endings and causing inflammation. For many men, the pain is quickly cured by an injection of local anaesthetic such as lignocaine with a steroid, which reduces the inflammation and takes away the pain completely. For many men who present back in out-patients, their pain is quickly sorted.

I do not want it to sound as though I am trivialising in any way the problems of those who continue to suffer pain. I believe that the Cumberlege report covers mesh as a wider issue, as well as issues related to the use of mesh, so we may gather more information from the report that will inform the debate on inguinal hernia mesh repair.

There are, however, other options. The best practice is shared decision making between the patient and the clinician, with the clinician fully explaining the operation to the patient, what is involved and what the options are. One option for patients who present with a hernia is for the clinician to reduce it in the clinic back in through the muscle wall. At that point, the patient may know how to handle it and manage it by not over-exercising and being careful when they cough. The patient will be registered as having had a hernia reduced and, if they want it operated on, they just ring up and go straight on to the operating list. That is a good option for many men if they think they can carefully and responsibly manage the hernia and come back to hospital only if it gets worse, if it pops again or if they need immediate attention. Whatever happens, they will be registered as having had an inguinal hernia and seen a clinician and therefore in need of treatment should it reoccur.

We are encouraging clinicians to have that conversation with patients. I do not know whether the clinicians treating my hon. Friend the Member for Burton (Andrew Griffiths) did, but clinicians should do so that patients can decide whether they want to go ahead with an operation.

--- Later in debate ---

[Ms Dorries]

I am delighted to hear that.

I am pleased to say that shared decision making is set out in the NHS long-term plan and I hope we will see more of it in other areas. As the hon. Member for Strangford mentioned, it has the full backing of the Royal College of Surgeons and the Royal College of Anaesthetists. I know from my own experiences in the health service that the role of patient voices is critical at every stage along the treatment pathway. Indeed, as we have said, the Government have asked Baroness Cumberlege to lead a review on the theme of patients’ voices. I will say more about that later.

All of us, including Ministers, regulators and clinicians, must listen to patients, such as the constituent mentioned by the hon. Member for Strangford who has had an ongoing problem, when they raise concerns. Only by listening to those patients’ voices and understanding the issues they have after hernia repair can we learn and develop what we need to do to ensure that it does not happen to people in the future. We must strike a fine balance as we steer through innovation, emerging science, clinical advice and the voices of a multitude of patients.

Hernias are relatively common. One in five men will get an inguinal hernia in their lifetime and it is worthwhile briefly outlining why men are mostly affected. Inguinal hernias are a type of groin hernia, which are the most common type of hernia. Some 98% of them are found in men, as the male anatomy is particularly vulnerable in this region. The main reason to operate on a hernia is to reduce the risk of bowel obstruction or necrosis, which is tissue death. Both of these conditions require major emergency surgery, where there is a risk of death.

Hernia surgery is therefore often a necessity. I have been advised by clinicians that when an individual’s condition indicates surgery, mesh repair is the standard operation for adults with inguinal hernias. It is safer than non-mesh repair in the first instance and is less likely to lead to pain post operation. It is also less likely to lead to hernia recurrence. To address the point made by the hon. Member for Strangford, I hope he understands not only that this treatment is the most effective but that the alternative is more likely to result in complications. Mesh is therefore used in approximately 97% of all surgical inguinal hernia repairs in England.

All the expert scientific advice that Ministers have received does not support a ban. It is important to emphasise that internationally no other country has banned the use of mesh to treat hernias. According to the National Institute for Health and Care Excellence, approximately 70,000 surgical inguinal hernia repairs are performed in England each year, at a cost to the NHS of £56 million a year. These mesh repairs are performed by either open surgery or laparoscopic surgery, as my hon. Friend the Member for Burton described.

NICE has developed guidance which recommends laparoscopic surgery as one of the treatment options for the repair of inguinal hernia. The guidance states that it should only be performed by appropriately trained surgeons who regularly carry out the procedure. This evidence was reviewed by NICE in February 2016 and the recommendations have remained in place since then. The Medicines and Healthcare Products Regulatory Agency and others will continue to review the situation as further evidence and analysis emerges, and will take any appropriate action on that basis. That is why this debate and the recounting of the experiences of constituents is important. They have ensured and will continue to ensure the safety of patients who need treatment.

Unfortunately, no type of surgery is without risk, both during and post surgery. The right balance between risks and benefits for individual patients must be achieved, which places patient autonomy and consent at its heart. I stress that I am deeply concerned to hear about instances where these conversations may not have happened, or have not been conducted in a manner that sufficiently informs the patient. Every patient should expect to receive safe and effective care, and to have an opportunity to raise concerns and feel confident that they will be listened to.

I will talk about the pain and suffering experienced by some men after mesh surgery. The vast majority of patients who undergo surgery using mesh to treat hernias go on to live normal, independent lives. While we do not know the exact number of complications, we believe it is low. However, I understand that those who experience the most adverse outcomes are those who suffer chronic pain or long-term discomfort.

I have been advised that 10% to 12% of men experience moderate to severe chronic pain post surgery. While that number is high, it is lower than for those who have non-mesh repair. I have been advised that acute pain is normal during healing, but chronic pain is not normal. As I said, one example of pain management is to treat chronic pain by injecting local anaesthetic and steroid. Long-term discomfort or pain is fortunately rare, but can still occur in one in 20 inguinal hernia repairs. While this number is still concerning, and, I believe, too high, the risk is dependent on the circumstances of each case. For example, there is an increased likelihood of it where patients have small hernias and where the predominant symptom before the operation is pain. Patients present at the clinic with pain and continue to have the pain after the operation. Both these adverse outcomes—the severity and the longevity of pain—remind us that regrettably complications can arise when any person undergoes surgery.

[Mrs Hodgson]

What we are establishing is that there are still many unknowns with regard to the numbers and when the pain occurs. That is what we need to drill down on. The hon. Member for Burton said that his surgery has been totally successful, however many months it is since it took place. However, the problem is not just post-surgery. Often, as we have heard, people are fine for two or three years and then suddenly, “Boom!”—they are hit with whole host of pain and autoimmune reactions. We need to drill down on that when we are looking at the problem. Will the Minister commit to trying to use the data to do that?

[Ms Dorries]

I am hopeful that the Cumberlege report will touch on that area to some degree. I will study the report in some detail, as will officials in the Department, and we will decide where we go from it, but I emphasise that the alternative of not having the mesh repair is more dangerous and has more complications, as we know from the data, than having it.

Body Image and Mental Health

Sharon Hodgson Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

I think we can all agree that this has been an eye-opening and interesting debate, and I start by thanking all the hon. Members present for making such excellent, personal and candid speeches. I also want to continue the theme of hoping that the Minister will still be in her position at the end of the day, because, as everyone has said, she really takes on board the cross-party consensus on many such issues, doing so with regard to the matter rather than the politics. On these things, there is always more we agree on than disagree on. Having reinforced her embarrassment, I will now move on.

Today we have heard about the impact that negative body image can have on people’s mental health, and I will particularly address the mental health of children and young people. It is clear that more needs to be done to promote healthy body image, which should start as early as possible.

I pay tribute to the Mental Health Foundation for its comprehensive research and campaigning on this topic. It has found that even children under the age of six have reportedly felt dissatisfied with their bodies, so promoting a healthy body image from an early age is therefore a crucial step. It is obvious from what we have heard today that more needs to be done to ensure that happens.

It is heartbreaking to hear that more than half of children and young people have been bullied because of their appearance, and that one third of teenagers say they have felt shame because of their body image. The Children’s Society has found that children’s happiness with how they look has not improved since the mid-1990s, and young people themselves say that body image is their third biggest area of concern in life, after their education and employment prospects. Why, then, are we failing to address poor body image when it is such a crucial issue?

It is clear that educating young people about their bodies is an important step in improving their body confidence, so do the Government have plans to ensure that schools cover body image concerns as part of the introduction of compulsory relationships and sex education in 2020? More needs to be done to promote healthy body image and good mental health among our young people.

Classroom-based teaching should not only extend to teaching children about their bodies; more needs to be done to ensure that children understand how to use social media safely, understand how to improve their self-esteem and understand their emotions. Can the Minister outline how the Department for Education is tackling these issues in schools? I know the Minister is here representing the Department of Health and Social Care, but the Under-Secretary of State for Education, the hon. Member for Stratford-on-Avon (Nadhim Zahawi), the Children’s Minister, was here a moment ago, and they should be in close contact on this.

Children who are concerned about their body are less likely to take part in physical activity. We can all remember our school days, and I am sure we were all concerned about that. This is concerning when we know the health benefits of physical activity, so promoting positive body image can have benefits for physical health, as well as for mental health.

The mental health consequences of poor body image can be severe. Although having body image concerns is not a mental health problem in itself, having such concerns can be a risk factor for mental health problems. Mental health support should start where children need it, which is in school. Can the Minister tell the House what interim funding has been offered to schools to provide mental health support, given that the Green Paper’s proposed support package will not be rolled out nationally until 2023? Schools really cannot wait another four years for this support because, as we know, they are already struggling with their current budgets.

Where mental health problems develop, early intervention and support from mental health services is crucial. Too many young people who are not able to access the mental health support they need from child and adolescent mental health services are left waiting for treatment on waiting lists for far too long or are turned down for help because their condition is deemed to be not bad enough. The best way to stop our young people developing eating disorders is to make sure they do not have to wait until they have an eating disorder and until they are bad enough to get that help. For children and young people who need support from CAMHS, there needs to be specific support to help them with body image concerns. What are the Government doing to ensure that support is in place?

According to a survey of family doctors, nearly all GPs worry that young people with mental health problems will come to harm because of difficulties in accessing treatment on the NHS, which should absolutely not be the case, and I know the Minister agrees. As was said at Health questions earlier, it is time to ring-fence funding for children’s mental health budgets to ensure that mental health services for children are properly funded.

I have spoken mostly about the impact on children and young people, because it is vital that the causes of poor body image are addressed early to ensure that children and young people think positively about their bodies and therefore go on to think positively about their bodies as adults. People with long-term conditions, such as cancer, and new mums can also have particular body image pressures and concerns, so it is important that as well as mental health services, other health services are there to support people when that is required. In some other cases, the issue is not due to mental health but can become a mental health issue if the matter is not addressed earlier.

According to the Mental Health Foundation, cognitive behavioural therapy—CBT—and other talking therapies can help people who are struggling with body image concerns, but we know that access to talking therapies can be a bit of a postcode lottery. Will the Minister explain how the Government plan to try to end that postcode lottery?

It is worrying to hear about body image concerns among lesbian, gay and bisexual people. One third of adults who identify as lesbian, gay or bisexual have reported experiencing suicidal feelings in relation to their body image. It is therefore important that lesbian, gay and bisexual people have access to support that is tailored to them. Has the Minister taken steps to ensure that lesbian, gay and bisexual people have access to appropriate mental health support?

As we know, trans body image is often linked to a specific condition called body dysmorphia, which means it is not included in the statistics I just mentioned. Trans people face specific challenges in accessing mental health support, so it is vital that the Government ensure that mental health support tailored to trans people is available throughout the country. Will the Minister explain what steps the Government are taking to provide mental health services for trans people in this regard?

We have heard today about the profound impact that social media, celebrity culture and advertising can have on young people and adults and their views of their bodies. Too often, the content shared on social media is having a negative impact on mental health. That is why it is vital that more is done to protect children and young people and vulnerable people online, including from harmful images that can affect their body image. Far too often, social media companies turn a blind eye to harmful content. More really does need to be done to stop such content appearing online. I commend my right hon. Friend the Member for North Durham (Mr Jones) for mentioning Facebook, as well as a former Member of this place and what he might be able to do in that regard.

I am reminded of all those pro-ana websites. I never even used to know what pro-ana meant—I did not realise it was even a thing—but when I see some of those websites and some of those YouTube stars, and the sort of body image that they present as being obtainable and the norm, I think more really should be done to take those images down. I also include in all that the fact that the movie world, Hollywood, TV and Netflix have a responsibility to promote a healthy body image when they cast their shows and movies. I will not name any particular show, movie or artist, but I have in mind a particular example of casting that really does, in my opinion, promote a very wrong body image. That does cause harm. The harms caused online need to be seen and treated as public health concerns, which, as shadow public health Minister, I am passionate about.

Labour is calling for a regulator with teeth that can take serious action against social media companies and for an enforceable duty of care to deal with the harms, hate and fake images that many online companies allow to flourish on their platforms.

The Government heeded Labour’s call and announced a regulator in the online harms White Paper, which is great, so it is now imperative for a regulator to be put in place as soon as possible. Will the Minister let the House know when that regulator might be expected? The process might take many months, and meanwhile children, young people and vulnerable adults are left at risk of severe online harms. The Government need to move faster and to go further, and perhaps we might see that under the new Administration—who knows—but it is clear from this debate that more needs to be done to tackle harmful content and body stigma, and to provide appropriate mental health support for everyone who needs it. Following this debate, as we have all said, I hope that the Minister will still be in her job and able to tackle this.

Decriminalisation of Abortion

Sharon Hodgson Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

My hon. Friend reminds us that this is not always an easy process for women to go through. As with any medical procedure, full consent must be given, based on full information. As long as pills can be accessed via the internet rather than via medical professionals, it is clearly more likely that women will not be informed of the risks of taking the pills. Any medication can have risks and consequences, and women need to be fully advised so that they can manage what they are going through.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Thank you, Mr Speaker, for granting this urgent question. I thank my hon. Friend the Member for Kingston upon Hull North (Diana Johnson) for and congratulate her on securing this urgent question, and thank her for her tireless campaigning on this issue. I share her disappointment that no Home Office Minister was available to respond to this urgent question; waiting for a call is obviously more important. I thank the British Pregnancy Advisory Service for its excellent work on this issue, and for its new campaign, launched today, called #PunishedForPills.

Following the passage yesterday of the Northern Ireland (Executive Formation) Bill, we find ourselves with a discrepancy across the UK when it comes to abortion. As we have heard, sections 58 and 59 of the Offences Against the Person Act 1861 no longer apply in Northern Ireland, but still apply in England and Wales, which means that if a woman does not seek the permission of two doctors before having an abortion, she could face up to life imprisonment in Britain, but not in Northern Ireland. The same goes for women who access abortion pills online. There are a whole host of reasons why women may do that, including not being able to get an appointment at a clinic, which now happens more and more often; not having childcare; living in a rural area; or being in an abusive relationship. Although women in Northern Ireland will no longer be persecuted for accessing abortion pills, the same cannot be said for women in Britain. I know this issue does not fall under the Minister’s brief, but will she ensure that abortion will be decriminalised, but not deregulated, throughout the UK? That would increase access to and the safety of abortions for women throughout the UK.

No one takes abortion lightly—this is a very sensitive issue—but I am sure that we in the House can all agree that women deserve access to safe and legal health procedures, and that includes abortion. A woman’s right to choose is a human rights matter. We need to seize on the momentum of the great result in the Republic of Ireland and deliver equality of rights for women throughout the UK and equality of resources across the whole NHS. The Government need to make this a landmark year in which women’s reproductive rights are fully respected and realised. That is why I call on the Government to repeal sections 58 and 59 today, to make abortion rights equal throughout the UK.

[Jackie Doyle-Price]

I thank the hon. Lady for the characteristically constructive spirit in which she has engaged with this issue. The nub of the point she makes is that decriminalisation must not be met with deregulation. Whatever we do, we must make sure that in repealing those sections of the 1861 Act—if that is what Parliament chooses to do—the regime that replaces it must not only guarantee the rights of women to take decisions for themselves but protect them and keep them safe. That is my priority in addressing this issue.

Oral Answers to Questions

Sharon Hodgson Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Seema Kennedy]

As I said to the hon. Gentleman and other hon. Members in the Westminster Hall debate on the drug, a deal is the preferred option. However, the attitude taken by Vertex, which has been called an outlier in this situation, means that my right hon. Friend the Health Secretary has instructed NHS England to look at other options.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Over the past three years, all of us in this House have heard the numerous calls for Orkambi to be made available to cystic fibrosis patients. The Minister could go down in history if she takes the all-important step this week, while still in her job—I hope she will still be in the job tomorrow—of announcing an alternative route to access cystic fibrosis drugs, such as a Crown use licence or clinical trials. Today, before we break for recess, will she commit to that so that families can have Orkambi now?

[Seema Kennedy]

The National Institute for Health and Care Excellence process is important, because it is an independent expert review and the way in which we allocate resources sensibly. The Crown use licence is not a quick or easy solution, and it is open to legal challenge, which might delay things even more. Vertex has been offered the biggest settlement in NHS history, and I urge the company to accept it. However—I have said this on numerous occasions from this Dispatch Box and in Westminster Hall—the Secretary of State has urged and asked NHS England to look at other options, such as the ones to which the shadow Minister has referred.

Batten Disease

Sharon Hodgson Excerpts

Monday 22nd July 2019 Commons Chamber

[Seema Kennedy]

I thank my hon. Friend for his questions. I will attempt to answer all of them.

In terms of governance, no, NICE is not above accountability. Ministers set the framework for NICE, which is a non-departmental body. The reason it was established was to have fairness—so that there was no postcode lottery on access to various drugs. It is important that medical experts and scientists make these decisions rather than politicians. Regular governance meetings are held between the Department and NICE. There is a framework agreement. Where the Secretary of State considers that NICE is failing, or has failed, to discharge its functions or to do so properly, he can direct NICE to discharge functions. If NICE were to fail to comply with the Secretary of State’s direction in those circumstances, he could discharge such functions himself. There is therefore a strong and robust governance system with regard to NICE.

It is not always very helpful to use other jurisdictions as a comparison because we do not know the exact price that has been agreed. In addition, different systems have different healthcare populations and do not necessarily have the equivalent of our national health service.

Turning to access to Brineura, I pay tribute to my hon. Friend and to Max’s family. I know from the very moving testimony by him and by other hon. Members such as the hon. Member for Newcastle upon Tyne North (Catherine McKinnell) and from speaking to my constituent Melanie on numerous occasions that this is an absolutely dreadful disease. That is why we want the NICE process to be able to bring drugs to market as quickly as possible. Drug companies find this drug difficult to develop—that it is very expensive. It is not necessarily a drug that will be paid for by having millions of sufferers globally, and therefore a different system needs to be in place. That is why the bar for QALY is so much higher.

My hon. Friend’s suggestion on arbitration is very interesting, and I will take it away. On NHS England and the negative procedure, yes, in theory we could do that, but it is unlikely if NICE does not recommend a process. Overall, where a drugs company and NICE are unable to come to an agreement—we see this with other medication as well—Ministers urge the company to carry on negotiating to have a fair price, because every pound spent on one drug is a pound that we cannot spend on a drug for another sick person.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

Thank you, Mr Speaker, for granting this urgent question. I thank and congratulate the hon. Member for North East Somerset (Mr Rees-Mogg) for securing it following his Adjournment debate last week. I do not doubt that he would have preferred the Minister to have come before the House voluntarily, rather than being forced to come here today for his urgent question.

Time and again, we come to this place to talk about a drug and its benefits to patients, only to be told that no matter how good it is, people cannot access it on the NHS. Among all the politics, there are people, including children like Max, who are suffering. No parent wants to hear a critical diagnosis for their child who has not yet really experienced childhood, let alone reached adulthood.

As we have heard, Brineura, a drug made available by BioMarin, could stop the progression of Batten disease. An assessment by NICE has found that Brineura could provide 30 extra years of good-quality life to patients. But, as has become expected when we discuss drugs for rare diseases in this place, Brineura is not available for patients on the NHS. NICE confirmed earlier this year that it was unable to recommend the use of Brineura on the NHS because of cost-effectiveness. The drug costs over £500,000 per person for each year’s treatment. BioMarin has another drug for rare diseases—Kuvan, for patients with phenylketonuria, or PKU. PKU patients do not have access to Kuvan, because it is also deemed not to be cost-effective. Does the Minister agree that the NICE appraisal process is just not fit for purpose when it comes to assessing the suitability of drugs and treatments for rare diseases?

Access to Brineura would help to give patients and families their child back, and it would allow them to enjoy time with their child and treasure special moments with them. As time ticks on without access to the drug, parents will witness their child’s condition deteriorate. No parent wants to see that, so we really need an appraisal process that captures rare diseases effectively.

Will the Minister step in and personally urge BioMarin, NHS England and NICE to meet and come to an agreement? Families do not want just warm words from the Minister; they want and need access to medicines now. I hope that this urgent question will result in real change in how we address rare diseases.

[Seema Kennedy]

In answer to my hon. Friend the Member for North East Somerset (Mr Rees-Mogg), I urged BioMarin to get back around the table with NHSE and NICE and come to a fair and reasonable price. NICE has already approved drugs for 75% of rare diseases through its technology appraisal programme, including drugs for idiopathic pulmonary fibrosis and neuroblastoma. NICE’s process and review methods are constantly reviewed, and they are internationally respected. NICE knows that it has to keep up to date with developments in science, medicine and healthcare. There is a periodic review going on at the moment, and that includes extensive engagement with stakeholders.

NHS Workforce: England

Sharon Hodgson Excerpts

Wednesday 17th July 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Moon. I thank my hon. Friend the Member for Wolverhampton South West (Eleanor Smith) for securing this important debate, and for her excellent and knowledgeable speech. I also thank all other hon. Members who made excellent speeches. They are all very knowledgeable, and some have had long careers in the health service, which really adds to the quality of the debate.

I pay tribute to the approximately 1.4 million members of the dedicated and hard-working NHS workforce, who are responsible for making our health service one of the best in the world. This debate is absolutely not about criticising them or the NHS, as others have said; it is about criticising the Government, who have continued to undervalue the NHS workforce. NHS staff too often find themselves working under unacceptable levels of pressure following nearly a decade of mismanagement and underfunding. They are consistently asked to do more with less. That pressure has led to abhorrent working conditions. Staff shortages in the NHS have spiked consecutively over the past few years. Recent estimates suggest a shortfall of about 100,000 staff, including 40,000 nurses and 10,000 doctors. If the trend continues, it is estimated that the shortfall will more than double by 2030.

We know that staff shortfalls put patients at risk. They prevent treatment and lead to a poorer quality of care. A 2017 study concluded that lower staffing levels can lead to necessary care being missed, patients being more likely to die following common surgery, and lower patient satisfaction, yet hospitals frequently have gaps in rotas and lack medical cover, which prompts significant concern about safety. Does the Minister believe that is appropriate care for patients and their families? If those substantial staff shortages continue, we will face even longer waiting lists and a deteriorating quality of care, and money ring-fenced for NHS frontline staff and services will go unspent due to lack of staff.

The effect of staff shortages is already evident. We have already seen care homes shut, an increase in agency hires, and chemotherapy treatments postponed because of a lack of staff at hospitals across the country. The effect that staffing shortfalls have on patients must not be underestimated, but we must also remember the effect on the staff themselves. NHS staff are consistently asked to take on additional responsibilities, to work harder, to do more intense shifts and to take on an excessive number of patients. Working in an already high-pressure environment without adequate resources or support not only puts patients at risk but damages the mental health of staff, leading to lower morale, poor wellbeing and a poor working life.

Working life is becoming intolerable for some of our NHS staff. It is no wonder that 20,000 nurses have left the NHS since 2010, and that the NHS has seen a 55% increase in voluntary resignations, with staff citing a poor work-life balance as their primary reason for leaving. The number of voluntary resignations due to health problems and stress has increased threefold in the past 10 years. The recent interim NHS people plan states that people are “overstretched” and admits that people no longer want to work in the NHS. What steps will the Minister take to ensure that NHS staff are retained once they are trained and experienced?

The standards of protection and safety that are rightly expected by staff and enshrined in the NHS constitution are being abandoned. On top of the cuts to staff wellbeing services that have consistently been made across England since the introduction of the Health and Social Care Act 2012, the number of understaffed shifts and overworked practitioners is forcing staff to take time off work and has led to increased requests for employed staff to take on extra shifts. That risks their health and can lead to increased locum use to cover staff rota gaps and vacancies. Staff shortages can have a significant impact on patient and professional safety.

It is welcome news that NHS Improvement will monitor trusts’ use of safe staffing guidelines. However, five years after the Francis report, the action taken on safe staffing simply is not good enough. The exodus of dedicated staff over the past 10 years, staff shortages, long waits for treatment, and frequent cancellations of operations demonstrate that the National Institute for Health and Care Excellence’s suspension of work on setting evidence-based staffing rules in 2015 was a mistake.

One way of ensuring the system has the number of staff it needs would be for England to follow the approach that is taken in Wales and is planned in Scotland, which is to legislate for safe staffing levels, yet the Government have continuously refused to bring forward legislation on safe staffing levels. Will the Minister reconsider that?

It remains unclear who is responsible for interventions in the workforce supply, as the Government certainly seem to be abdicating responsibility. The Government must consider seriously the legal proposals put forward by NHS England and NHS Improvement to amend the Health and Social Care Act to ensure that the workforce crisis is meaningfully and explicitly addressed. Can the Minister explain what impact workforce accountability requirements would have on the current legal framework? Surely the fact that Scotland and Wales have explicit accountability for the provision of the workforce across health and social care but England does not will lead to unequal progress and quality of care across the country and, inevitably, to a postcode lottery for patients.

We cannot tackle this problem if the pool of talented medical professionals in Britain continues to shrink. Safe staffing is not just a numerical issue; it is about having enough staff with the right skills, experience and knowledge. The UK trains only 27 nursing graduates per 100,000 of population, compared with the average of 50 across other OECD countries. The Government have continually undermined incentives to join the NHS workforce, which is demonstrated by their treatment of junior doctors, their introduction of salary caps, their cuts to bursaries and funding opportunities for students, and their hostile approach to those who travel from overseas to join the NHS. Does the Minister recognise that restrictive migration policies act only as a further barrier to tackling the NHS workforce crisis?

Does the Minister also recognise that the Health Education England budget has been cut by 17% in real terms since 2013-14? Applications to nursing training have fallen by 30%, particularly since the nursing bursary was removed. The NHS long-term plan set out some ambitious targets, such as diagnosing 75% of cancers at an early stage by 2028, expanding emergency service care and increasing the availability of mental health services. However, without a long-term, fully funded staffing plan for the NHS, those targets are impossible to reach.

The Government’s warm words and commitments to increase the number of NHS staff working and in training “as soon as possible” are appreciated. However, legislative action must be taken to ensure that patients and staff are not exposed to unsafe staffing levels, which can have dire consequences for patient outcomes and workforce retention. I look forward to the Minister’s response.

--- Later in debate ---

[Mrs Hodgson]

The Minister says that accountability is already in place. Staffing levels may be required and desirable, but what happens when they cannot be met because the staff are not there? Where is the accountability?

[Stephen Hammond]

The hon. Lady will know that the CQC regime puts directives in place if staffing levels are not there. The local providers are then forced to address those issues. The accountability is there.

Beyond this issue, several hon. Members talked about exactly what we are doing now. There was recognition that the Government have put in place the long-term plan and the people plan. Any reading of those will see that our overarching plan for the health service looking forward recognises explicitly that getting the workforce supply right is key. That is therefore an important part of the long-term plan, which sets out the vital strategic framework to ensure that in the next 10 years the NHS will have the staff it needs. Nurses and doctors will have the time they need to care, work in a supportive culture and allow them to provide the expert, compassionate care to which they are committed.

Hon. Members rightly said that that will not be for this Government; it may well be for the Government beyond. However, the long-term plan rightly recognises by its very nature that what we need to put in place today must continue through the next 10 years to ensure that we have the staffing levels we need.

[Stephen Hammond]

I will come to the number of nurses in training and related issues in a moment, to address the hon. Lady’s comments.

Associated with the long-term plan is the people plan, which clearly recognises, to reference what I said about Health Education England, the significant role of that organisation in securing the NHS workforce for the future. That is why my right hon. Friend the Secretary of State for Health and Social Care commissioned Baroness Harding, the chair of NHS Improvement, to work alongside and closely with Sir David Behan, the chair of HEE, to develop the workforce implementation plan. The interim people plan published in June set out the actions needed to change positively the culture and leadership of the NHS, making it the best place to work, which addresses the issues rightly raised about recruitment and retention.

The people plan commits to developing a new operating model for the workforce that ensures that activities happen at the optimal level, whether in individual organisations, local healthcare systems, regionally or nationally, with roles and responsibilities being clear.

On NHS workforce supply, hon. Members talked about demand for nursing and midwifery courses. The latest available evidence shows that we are starting to see a substantial rise. Data published only last week showed a 4.5% increase in applicants compared to 2018, with that being the second increase in as many years. To build on that, to ensure that we increase the pipeline of nurses coming into the profession, the Department has worked with NHS England to ensure that funding is available for up to 5,000 additional clinical placements for nursing degrees in England. The chief nursing officer for England has led work to identify and accelerate the availability of such clinical placements. It is vital that universities ensure that they take up offers and provide placements to ensure that places are filled at the end of this year’s recruitment cycle. That can happen.

[Mrs Hodgson]

I acknowledge the 4% increase—it is a small increase—but figures show that the numbers are still down 29% from 51,830 in 2016, when the bursary that covered training was removed. Even with that small increase, we are still 15,000 short of the figure when the bursary was axed.

[Stephen Hammond]

The figures show an increase in applicants this year. The hon. Lady will know that there are 1.4 applications for each place, and she will have heard me say that we are creating additional clinical placements to ensure that more nursing places are available. I recognise that there has been a drop, but I hope that she applauds the 4.5% increase in applicants this year. That is key.

A number of Members rightly talked about additional nursing roles and support. Health Education England is leading a national nursing associates programme with a commitment for 7,500 nursing associate apprentices to enter training this year. That builds on a programme that has already seen thousands start training in 2017 and 2018.

The RCN is leading work focused on the legislative framework for all professional groups. I should set out that work on the people plan also included examining options for growing the medical and allied health work- force, including the possibility of further medical school expansion, increasing part-time study, expanding the number of accelerated degree programmes and greater contestability in allocating the 7,500 medical training places each year to drive improvements in the curriculum.

For allied health professionals, the long-term plan sets out a commitment to completing a programme of actions to develop further the national strategy, focusing on implementation of the plan. There will be a workforce group to support that work and make recommendations, including on professions in short supply, which would address the podiatry point made by my hon. Friend the Member for St Ives. That is essential.

I do not think that anyone should be in any way complacent, and the Government are clearly not complacent. Many hon. Members will have heard me say that, as well as training the workforce for the future, it is important that we support and retain the current workforce. The interim people plan is committed to reviewing how to make increases in a number of factors. One such factor is national and local investment in professional development and workforce development.

There are examples of good practice in this area across the NHS, and I was particularly pleased when I visited Leeds Teaching Hospitals NHS Trust to see how a group of band 6 nurses had created their own in-house training programme, boosting management skills and leading to greater collaborative ways of working. That example of best practice makes the case for national investment in such programmes and for national funding for continuing professional development.

Everyone recognises the need to recruit more staff, but it is also fair to put on the record the fact that the number of staff working in the NHS today is at an all-time high—it is the highest it has been in the NHS’s 70-year history. Since 2010 there has been a significant growth in qualified staff. [Interruption.] I hear a sigh from Opposition Members, but it is worth making the point that there are now 51,900 more professionally qualified staff, including 17,000 more nurses working on wards. That is a simple fact; it is a piece of data, and we cannot get away from it. I do not suggest that one should be complacent in any way, but we should recognise that there are more nurses and doctors, and the Government are committed to delivering on our promise to ensure that the NHS has the right staff with the right skills in the right place at the right time to deliver the hugely valuable, excellent care that patients deserve.

Question put and agreed to.

Resolved,

That this House has considered the legal duties of the Secretary of State for Health and Social Care for NHS workforce planning and supply.

Child and Adolescent Mental Health Services: North-east

Sharon Hodgson Excerpts

Wednesday 10th July 2019 Commons Chamber

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

As hon. Members know, it is very difficult sometimes to secure an Adjournment debate—the last one took me over a year to obtain—so I was very pleased when this one was granted, especially as it is on such an important matter, as I will outline in some detail tonight. It is especially welcome that business has fallen early tonight, so I do not need to rush or curtail my remarks to leave time for the Minister. This is such an important matter and I know we will both have plenty of time to deal with this issue.

I would first like to thank my constituents for bringing their case to me, and for waiving their anonymity in the hope that their story can help other families and ensure that something like this does not happen again, as it could so easily have had a tragic ending. Going public like this is a very brave thing to do and I sincerely hope that their story, and today’s debate, will spark a change.

In March this year my constituent, Mr Thomas, wrote to me about his daughter Jane, and the

“deplorable treatment when attempting to access CAMHs support”.

Jane, aged 16 at the time—she is now 17—tragically lost her mother as a result of alcohol abuse. Everyone will appreciate the grief that this will have caused Jane and her family, and the lasting impact of that grief after years of watching a parent decline due to alcohol abuse. Many hon Members, such as my hon. Friend the Member for Leicester South (Jonathan Ashworth), my right hon. Friend the Member for Don Valley (Caroline Flint) and my hon. Friend the Member for Birmingham, Hodge Hill (Liam Byrne), have spoken growing up with similar experiences. I pay tribute to them, and to Jane, today.

Having experienced such loss on top of what she would have seen her mum go through over the years, Jane was understandably struggling with her mental health. Mr Thomas therefore felt that Jane needed professional intervention. Having consulted Jane’s GP, Jane was referred to North Durham child and adolescent mental health services at Tees, Esk and Wear Valleys Foundation NHS Trust. This is where Mr Thomas’s frustration begins.

Jane waited weeks for a CAMHS appointment following the referral, but it was not forthcoming. Mr Thomas went back and forth with the GP to ensure that the referral had been made, and was assured that it had. He was even shown the email confirming that. He then contacted the CAMHS team directly over the phone. As you can imagine, he was surprised to hear that they had no record of any referral regarding Jane. Mr Thomas says that this

“set the pattern of misinformation and incompetence that Jane and I were to encounter.”

Mr Thomas contacted CAMHS again to enquire whether an appointment would be made for Jane, and was told that Jane would not be seen as her need had already been assessed and her case was closed. That exasperated him further, as it referred to an earlier episode and a case from several years earlier, not the most recent case following the death of Jane’s mother. Therefore, it did nothing to inspire confidence.

Jane finally saw a CAMHS practitioner at the end of last year and was making positive progress, but her last appointment was on 4 January 2019. It is now July, and Jane has not had another appointment on the national health service in the past seven months. The initial reason for the delay was that Jane’s counsellor had left to start her maternity leave—something that, of course, she is absolutely entitled to do—but the trust will have been well aware for some time that the counsellor’s maternity leave would need to be covered. There also should have been a period of handover so that the service could continue its work smoothly. That did not happen.

Maternity cover was found after a gap of more than two months. However, just days after starting, that person resigned their position, leaving the trust unexpectedly without any cover. I am told that that was for personal reasons. It was at that point that the trust wrote to Jane Thomas, on 8 March, apologising for the delay in her treatment and suggesting that, if she had any inquiries, she should contact the team at North End House or, if she was in crisis, she could call the CAMHS crisis team. It was then three months since her last treatment.

It was upon receiving that letter that Mr Thomas contacted me to bring all this to my attention. There was nothing in the letter to Jane—I have seen a copy of it—to suggest that she should contact the trust to arrange an appointment or alternative provision; it just said to call if she was in crisis. I therefore wrote to the trust on 18 March, asking them to examine this matter further and advise Jane and Mr Thomas.

On 29 March, I received a reply that said that the trust had

“looked at interim solutions, such as part time staff working additional hours.”

It did not say whether that was actually happening, or whether that would include an offer of support to Jane, only that they were looking at it. That was just one of the many opportunities that the trust had to take another look at Jane’s case, to see what interim solutions were in place for her and to make contact with her directly, perhaps by calling her, as they did yesterday—I will come to that in a moment. But that did not happen.

Yesterday, I spoke to Mr Levi Buckley, director of operations at the trust, in advance of this debate. We had been trying to arrange a call for some time and could not get the dates to match, but obviously that changed once I secured this debate. I was told yesterday that alternative arrangements had been put in place for the majority of patients. He told me that when Jane’s counsellor went on maternity leave in January, all those patients should have had their cases reviewed and reassigned to another counsellor or another support network. However, for whatever reason, that did not happen for Jane, although I am told that it did for all the others. Jane had obviously, and shamefully, just slipped through the net. The trust realised that, no doubt prompted by Mr Thomas, and in March, when the new counsellor started and then left after two days, they contacted Jane to apologise with the letter dated 8 March that I mentioned earlier.

There was no concerted effort at any point by the trust to re-establish contact with Jane, who for all they knew was getting no support at all with her mental health. There was just that one letter. Even after I contacted the trust on 18 March to begin this dialogue, they still made no further contact with Jane until yesterday, when she was called within two hours of my conversation with Mr Buckley, prior to this debate. I understand that Jane spoke to the head of the CAMHS service, who apologised and offered her transitional provision to move her into adult services, as she is 18 later this month. It is, of course, entirely up to Jane what she decides to do.

Having spoken to the trust, they agree that they could have done more to make contact with Jane, who obviously was easily contactable, as they spoke to her without delay yesterday. There have been many opportunities available, since March when I first contacted the trust on behalf of Mr Thomas and Jane, to make that direct contact and arrange counselling provision for Jane, but that did not happen. That means that a vulnerable young person had fallen through the gaps because of incompetence, and even when it had been brought to their attention in March, nothing was done to rectify the situation until yesterday.

It does not need me to point out that this could have been fatal, had Mr Thomas not sought and paid privately for mental health provision for Jane. I understand from my call with Mr Buckley yesterday that the situation at the trust was made more difficult because, after advertising the job twice and getting no applicants, they had to lower the grade of the position—meaning that the person would require more supervision—in order to attract someone they could employ. This person is due to start in September—nine months after the counsellor on maternity leave left. Mr Thomas emailed me earlier today to say that the

“analogy of too many Generals and no Soldiers would suggest itself”.

I agree.

In April, when I met Mr Thomas in my constituency surgery, he was very clear that this was about incompetence and bad management within the trust that had allowed his daughter to slip through the cracks. What has most frustrated him about this ordeal is the lack of accountability for what he calls the

“appalling management of the service”.

He went on:

“This CAMHS organisation is poorly led, poorly administered and managed with incompetence.”

Can the Minister please inform the House who should be accountable for these failures?

A freedom of information request made in 2018 to the Care Quality Commission by a concerned parent inquiring into numbers of complaints made against CAMHS went unanswered, with the CQC stating that it did not have full oversight of this organisation and therefore could not provide the requested information. Who does oversee CAMHS? Who should be taking responsibility for the vacancy gap and the real problems that the trust has had in filling the vacancy, and for the impact it has had on vulnerable young people who need access to support? What advice can the Minister give to my constituent, who just wants to help his daughter get the professional treatment she needs, when she needs it, on the NHS? Does the Minister think that trusts should not be able to mark their own homework on such cases? They must surely be held accountable when there are failures and recognise the need for change. I hope that this debate brings about some change.

[Hugh Gaffney (Coatbridge, Chryston and Bellshill) (Lab)]

I thank my hon. Friend for bringing this debate to the Chamber, and for explaining the importance of mental health services in the north-east. In Scotland in the last five years, there has been a 50% increase in the number of suicides among 15 to 24-year-olds. We need to do something about this national crisis.

[Mrs Hodgson]

I thank my hon. Friend for his intervention. I would encourage him to apply for a debate with the same title, only with “Scotland” at the end instead of “North-east” so that he can explore that 50% increase in greater detail. If he is lucky, he might get a nice long session like me, but I know the Minister will have heard his comments.

Throughout all this incompetence it is Jane who has suffered. If this is an issue of recruitment and retention, which it seems to be, what will the Minister do to ensure that CAMHS staff are both recruited and retained nationally, and specifically in the north-east? Nationally, the number of consultant child and adolescent psychiatrists fell by 4.5% between October 2013 and October 2018, which might account for why it was so hard for the trust to recruit someone, while the Government are on track to miss their mental health workforce target by 15,000 staff. Labour research in January found that the total number of mental health nurses had fallen in every month the previous year. I should be grateful if, in her remarks, the Minister would address the issues that led to this decline in the number of mental health nurses and evaluate the impact that it is having on young people such as Jane.

If an A&E just closed its doors because of a lack of staff and stopped treating people, there would be an outcry—we would not stand for it—so why do we allow it to happen when it comes to mental health? The Prime Minister said she wanted mental health to be a priority, but the Government are nowhere near achieving that goal. Mental health awareness is one thing, but it must be matched by mental health support and treatment services, and that is where the Government are failing, especially with regard to staffing.

According to research carried out by the Children’s Society, more than 110,000 children a year are unable to access mental health support from a CAMHS service, despite being referred for support. Three out of four children with a diagnosable mental health condition do not receive the support that they need, according to similar research conducted by YoungMinds. This is therefore not a problem exclusive to the north-east—or even Scotland, as we have just heard from my hon. Friend the Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney)—which is why the Government must take action.

I wrote to Tees, Esk and Wear Valleys NHS Foundation Trust, which informed me that it did not operate a waiting list in County Durham and Darlington CAMHS. However, Jane and other young people, across the north-east and the whole country, are still waiting. It beggars belief that the trust could say that, but it is in the letter that it sent to me.

As I have said, Mr Thomas was left with no choice but to engage a private practitioner. That came at a huge cost to him and his family, but as a loving parent he felt that he had no other option. No parent should be put in that position, and not all parents have the means to step in when the services let them down so badly, as was the case for Jane.

According to the Royal College of Psychiatrists, mental health trusts have less money to spend on patient care in real terms than they had in 2012. Of course, lack of funding means that trusts are strained and unable to provide vital services. Is that what led to the staffing problems in this trust? Was its inability to fill the vacancies down to the salaries being offered, or was the workload that was being demanded of staff too high? Why did that new person leave after only two days? Will the Minister support Labour’s calls for the ring-fencing of NHS mental health budgets and an increase in the proportion of those budgets that is spent on support for children and young people? Increased funding will relax some of the pressure on services, and will ensure that they can be sufficiently staffed and resourced to improve patient experiences.

As I said at the beginning of my speech, Mr Thomas and Jane were very brave to allow me to share their story with the House in so much detail today. However, it should not have come to this. Jane, having mental health problems, should have been referred to CAMHS, been assessed and then been given therapy appointments as necessary to support her recovery—unbroken, with no seven-month gaps in provision. Instead, she and Mr Thomas have been back and forth and have had to fight, and even pay, for the support that she needs and to which she is entitled.

Mr Buckley, from the trust, informed me that North Durham CAMHS had seen an 18% rise in referrals over the last year. It follows that as the number of referrals rises, the funding must also increase to meet that need. The Government must increase the proportion of mental health budgets spent on support for children and young people: they must make mental health a priority, with actions and not just warm words.

While the staffing crisis and mismanagement at Tees, Esk and Wear Valleys NHS Foundation Trust rages on, Jane still has no access to treatment and support on the NHS, although I have been told that she received a call yesterday suggesting that the problem might be resolved shortly. I therefore ask the Minister what she will do for Jane, and young people like her, to ensure that situations like this do not occur in future.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

I thank the hon. Member for Washington and Sunderland West (Mrs Hodgson) for the sensitive way in which she has outlined the case of her constituent Jane. We often debate NHS issues in this place, and it is often a case of trading statistics and numbers, but the hon. Lady has reminded us all that there are vulnerable people needing help who are potentially at risk of more harm when the NHS fails them. I will write to her in more detail answering some of the questions that she has posed to me today, but for the moment I will address some of the issues with which I am able to deal.

We have articulated clear ambitions for improving children’s mental health services, but, as the hon. Lady outlined extremely well, this follows decades of under- investment in those services, and there is a way to go from where we are now to where we need to be. The waiting times that Jane has experienced, which the hon. Lady outlined, really are not acceptable.

We will be very clear about our ambitions, but the hon. Lady is also right to highlight that we are very dependent on the performance of individual trusts in terms of delivering that. She set out the challenge as regards the Tees, Esk and Wear Valleys NHS Foundation Trust very well. The Care Quality Commission is giving quite a lot of attention to that trust for one reason or another, and the trust will be made much more accountable. I always say that sunlight is the best disinfectant, and one of the issues that we collectively face is that because mental health has for so long been something we have not talked about enough and has been stigmatised, mental health services have been a bit out of sight, out of mind, and have not had the scrutiny that they should have had.

The comparison the hon. Lady draws with an A&E, saying if it was turning away patients like this there would be an absolute scandal, is right, and part and parcel of achieving parity of esteem is that we must expect the same high performance and standards of our mental health services as we do of our physical health services. I know that the hon. Lady will not let me get away with not taking that as seriously as I possibly can.

We have made some progress, but, as the hon. Lady has heard me say before, I am in no way complacent about where we are. It is not just that we need overall improvement; there is great disparity between various regions and areas across the country, and the hon. Lady represents an area that is particularly challenged. She made some points about waiting time standards, and I am getting quite an inconsistent picture as regards the performance of that trust, which suggests to me that there is something wrong with the data and how things are being measured. Again, we need to hold everyone to account so we can be sure that our waiting list and waiting time data are accurate.

[Mrs Hodgson]

When I spoke to Mr Buckley about the sentence in the letter that said a waiting list was not operated, he explained that that probably was not very accurate, because when everyone is seen and triaged, if they need an appointment to see a therapist they are given one in, say, six weeks, eight weeks or 12 weeks. He said that the fact that they are given an appointment explains why there is no waiting list. So as the Minister rightly pointed out, we will have to drill down on that, because I do not think we are measuring the same thing across all trusts if they are all using different forms of words.

[Jackie Doyle-Price]

There might be something we can do on standardising the approach, but that brings us to another challenge. We apply these targets to try to achieve a standardised service and to ensure that people get treated when they need it, but that encourages some perverse behaviours, and the hon. Lady has just outlined one of them. The challenge for us is how we apply standards of behaviour and targets without driving perverse outcomes and bad outcomes for patients. I still think we have a lot to do on that, and probably a lot of learning. We need to identify those areas that really are doing it well so that we can spread good practice throughout the system.

But there is obviously a good reason why we must make sure we get child and adolescent mental health services much better: because we know that people who suffer from mental health issues tend to develop those conditions when they are children—when they are young. We all know that early intervention is the best way, not least for the individual concerned, because they will suffer less harm, but it is also good for the taxpayer because it costs less money to help people sooner. So we must make sure that we continue to give children’s mental health much more priority than it has had hitherto, and central to that will be greater provision of services in the community.

I am really concerned about the story the hon. Lady has just told. The process that Jane has been taken through appears to have completely failed, and the communication with her and her father appears to be extremely poor. Again, I think we can go away and look at how we communicate with patients and their families, and particularly at the tone that is used. We are dealing with people who are in a very vulnerable position, and to put it bluntly, it should not be “take what you’re given”, should it? Ultimately, our NHS is there to serve all of us, and it needs to do so with sensitivity and tact.

The hon. Lady rightly challenged me about money and the need to ensure that it delivers extra appointments. We are ambitious to see many more children, through the investment we are making, but unfortunately I do not have a magic wand and I cannot roll it all out overnight. As she points out, we need to ensure that we are investing in the appropriate workforce to deliver these services.

I would like to make another point about NHS commissioners. While we are delivering this real step change in mental health provision for children, there are other things that can be done by local health commissioners—and by local authorities, for that matter—while people are waiting for referrals and appointments. There is still additional support that can be given by organisations doing good voluntary work to give wraparound support and take some of the pain out of the experience. I often say that good mental health care is not all about clinical interventions; it is about the wider support that can be given in the community as well.

Our reforms to mental health in schools have that kind of support very much in mind. We are rolling out a new workforce, which is going be based on people who are trained in psychology and therapies, but the ethos will be very much that they are working with voluntary sector organisations that will be able to provide that additional support to people who are going through periods of mental ill health. We want to ensure that many more children who are going through mental ill health are seen, not least because we are seeing increased prevalence and it will take substantial extra effort to ensure that we are providing that service.

I turn specifically to waiting times. We have introduced new standards for mental health services, and in particular, we have introduced targets with regard to eating disorders and to a first episode of psychosis. We are making good progress on those, but as the hon. Lady says, Jane had clearly gone through significant trauma and it would not be unanticipated that that would impact on her mental wellbeing. Our targets for psychosis and eating disorders would perhaps not capture someone with that level of need, but it is still important that she has access to that support. Sunderland clearly has longer waiting times than many other areas of the country. I understand that the trust has been successful in bidding for additional NHS England funding as part of a national waiting list initiative, and I sincerely hope that that will improve access for the hon. Lady’s constituents.

When we hear of cases such as that of Jane, I can understand why people feel that our commitments on transformation ring a bit hollow. I know the hon. Lady will understand that we see this as a long-term process of rolling out improved services. That is the only way we are going to embed the change in culture that we really need in how we prioritise mental health, but we need to redouble that progress, as she says. We are determined that NHS funding for children and young people’s mental health services will continue to rise.

The hon. Lady asked me about making sure there is a proper ring fence. We have demanded that CCGs increase mental health spending on children’s services by more than their budget rises, but I think we will be taking a more interventionist approach. I know that NHS England is having robust discussions to ensure that all commissioners do exactly what is expected of them. We expect to have been able to treat an additional 345,000 children by 2024 through the additional funding, and we are already seeing some benefits.

I understand that in Sunderland, local commissioners have commissioned Mind to work with young people aged 11 to 25 and give direct support in that way. In addition, there is the new Lifecycle service, which includes access to adult therapies—one of the issues the hon. Lady raised. I am told that in Tyneside 90% of young people are seen within five days for triage into the service, but on the basis of what the hon. Lady has told me, I would like to do a bit more digging to make sure that the figure is robust.

We know that the mental health sector is showing imagination and innovation in filling the skills gaps in mental health nursing and psychiatry, but it is worth noting that one of the upsides of us talking about this subject and giving so much more attention to mental health is that it is raising the profile of the sector as somewhere to work. The really nice thing is that people do care about it. Applications for psychiatry are increasing, in part, I guess, because would-be psychiatrists can see that there will be plenty of demand for their services. Although we are making the sector more attractive, providing the workforce will be a big challenge, so we need to encourage more imagination about how that is delivered.

New roles are emerging, such as peer support workers, making use of lived experience. It strikes me that people going through mental health issues often find it intimidating to talk about it and to respond to treatment. Getting support from someone who has been through a similar experience can be enormously important to their recovery, and we want to encourage much more of that. We have the new nursing associates, and we want to encourage more mature workers—perhaps women re-entering the labour market—to explore careers in mental health. We will need much more imagination in the coming years if we are to continue to deliver the workforce we need.

[Mrs Hodgson]

I am sure the Minister can guess what I am about to say. Previously, the nursing bursary was so important for older people going back into the workforce or making a career change, and especially the group of people who now do not even apply for those opportunities. Is there any influence she can exert on the Government, any hope that at some point in this Parliament they will bring back that bursary?

[Jackie Doyle-Price]

I walked right into that one, didn’t I? The hon. Lady is right in the sense that we need to enable people to learn and earn. That is the key. I have conversations with Health Education England about how we can meet our ambitious workforce targets, and I am sure that it will have noticed what she just said and my reply. Applications are increasing despite the removal of the bursary, but I believe we could do more to encourage people who are considering entering the sector, perhaps later in life, when they have a family and they need to earn.

The NHS long-term plan, which contains some very ambitious commitments on mental health, is a huge opportunity for commissioners to think much more creatively about how they deliver their local services, because we are going to have to deliver a step change in the provision of services available in the community.

I have talked a bit about the mental health support teams going into schools, and it is pleasing to see that they are being rolled out. I do not believe we currently have a trailblazer that serves the hon. Lady’s constituency, but clearly if the local trust could work with local schools on delivery, it would make a huge difference to delivering services for children and young people. I believe teams are now covering Newcastle Gateshead, Northumberland and south Tyneside, and they will be testing the four-week waiting time, which she will believe is important, particularly when viewed through the prism of Jane’s experience. Later this week, we will be delivering the next wave of those sites, so let us watch this space—hopefully we will be able to get more provision.

The hon. Member for Coatbridge, Chryston and Bellshill (Hugh Gaffney) mentioned the issue of suicide and self-harm, which is clearly a considerable priority for me. We have been fortunate in seeing declining rates of suicide for a number of years, but we are beginning to see it on the rise again among children and young people. We could all speculate as to the reasons for that. They will be complex, because every suicide has its own story, and it is usually an escalation of factors that leads to someone taking their own life. We need to take a good look at exactly what pressures our young people are facing. Clearly, Jane had had adverse childhood experiences. We know they contribute to mental ill health, but other things are involved, too. If we can identify people who are at risk early—clearly, adverse childhood experiences are a good indicator—we can make sure we give that support sooner and then we will genuinely be able to tackle suicide prevention. We are on it, but we have a lot more learning to do on that.

I am really grateful for the sensitivity with which the hon. Member for Washington and Sunderland West has outlined Jane’s case, and I will take that away and respond in detail to the issues she has raised. As a pathway of experience, that clearly is not good enough, but I suspect it is all too common. Sometimes it is useful to use a particular case study to see exactly what is going wrong and what we can learn from. I would, however, say that I am proud of the progress we are making on improving services. We need to do much more. I wish I could do it quicker, but I will do the best I can.

Question put and agreed to.

Genetic Haemochromatosis

Sharon Hodgson Excerpts

Wednesday 3rd July 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is an honour to serve under your chairmanship, Mr Sharma. I thank the hon. Member for Rugby (Mark Pawsey) for securing this important debate, and for his excellent and detailed speech, which set the scene. I congratulate him on establishing the all-party parliamentary group on genetic haemochromatosis earlier this year. I have set up a number of all-party parliamentary groups and am a big believer in them. I know how important they are in getting things one, cross-party, in this House. I am pleased that he was able to bring the condition to the House’s attention.

I thank all hon. Members who have spoken in the debate—in particular my hon. Friend the Member for Heywood and Middleton (Liz McInnes) and the hon. Members for West Dunbartonshire (Martin Docherty-Hughes), for Ceredigion (Ben Lake), and for Paisley and Renfrewshire North (Gavin Newlands)—as well as my hon. Friends who made helpful interventions.

As we have heard, GH is a genetic disorder that causes the body to absorb excessive amounts of iron from the diet. Iron overload occurs in one in every 200 people and is now recognised as the most common genetic disorder. Although GH cannot be prevented, its symptoms and health implications can. When untreated, GH can cause serious health problems, including fatigue, weight loss, irregular periods, type 2 diabetes, early menopause and depression.

GH was previously thought to be a low-level health risk, but a study by the University of Exeter found that the genetic condition usually quadruples the risk of liver disease and doubles the risk of arthritis and frailty in older age groups. As hon. Members have already said, treatment of those conditions comes at a huge cost to the NHS, so it is important to ensure that symptoms are prevented by diagnosing GH early and advising on how to avoid iron overload.

[Sir George Howarth (Knowsley) (Lab)]

My hon. Friend must have extra-sensory perception because I was going to ask if she agreed with everybody else who stressed the importance of early diagnosis, and she just did.

[Mrs Hodgson]

Excellent. If something is worth saying, it is worth saying more than once.

With early diagnosis in mind, I have a number of questions for the Minister; I will rattle through them quickly. What assessment has she made of the diagnosis pathway for patients suspected of having GH? How early are patients diagnosed after presenting with symptoms, and which diagnosis route is the most successful and least painful and invasive for patients? Is that diagnosis route available across NHS trusts and clinical commissioning groups? When someone is diagnosed, is it routine for their family to be tested and treated?

GH can be aggravated by environmental and lifestyle factors, so can the Minister assure the House that patients with GH are clearly advised on how to care for themselves if they have the disorder? Are patients given direct advice on their diet and on alcohol and tobacco consumption? As we have heard, that can make the condition easier to manage, if the advice is taken on board, of course—often people do not want to hear what is good for them, myself included. Where necessary, is support available to help patients reduce their alcohol consumption and to quit smoking?

As we know, diet, alcohol and tobacco consumption have huge health implications for all society and cost the NHS millions in treatment. It is therefore crucial that public health services are available to everyone to allow them to live heathier lives, especially patients with GH, who are more susceptible to health problems relating to the heart and liver.

I never miss an opportunity to call on the Minister once again—if she can; it might be above her pay grade—to reverse the public health budget cuts that have decimated our vital public health services. I also urge her to ensure that when the prevention Green Paper is published—I have heard rumours that it could be as early as Monday—patients with any existing conditions are also taken into consideration for prevention, so that their symptoms can be controlled, too. I look forward to her response.

Electromagnetic Fields: Health Effects

Sharon Hodgson Excerpts

Tuesday 25th June 2019 Westminster Hall

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Hollobone.

I start by thanking my hon. Friend the Member for Gower (Tonia Antoniazzi) for securing this debate and for her excellent speech, which set the scene and informed us all about this issue. Earlier this year, I met her to discuss it, so I am pleased that she was able to secure the debate on it.

I also thank my hon. Friend the Member for Stroud (Dr Drew) and the hon. Member for Linlithgow and East Falkirk (Martyn Day), who spoke for the Scottish National party, for their thoughtful contributions to this debate. There were also excellent interventions by my hon. Friend the Member for Swansea West (Geraint Davies); I am pleased that he is still with us in Westminster Hall, as he had said that he had to leave early.

As we have heard, the World Health Organisation has concluded that current evidence does not confirm the existence of any health consequences from exposure to low-level electromagnetic fields. I know that the Government have followed a similar line, with the independent Advisory Group on Non-Ionising Radiation concluding that although a substantial amount of research has been conducted in this area, there is no convincing evidence that electromagnetic field exposures below guideline levels cause health effects in either adults or children. However, as we have heard, concerns exist about the long-term impact of electromagnetic fields, and although my hon. Friends did not go into great detail about individual cases, I have read of such cases and I am sure that all hon. Members have also read some of the details about them. As we become ever more reliant upon modern technology, such concerns will only increase.

On a more light-hearted note, those people who have Netflix might have seen the impact of electromagnetic fields being played out, albeit in a fictional sense, in a programme called “Better Call Saul”, in which the brother of the main character is terribly affected—indeed, he is housebound—by EMF. It is often said with these types of issues that Hollywood leads the way in bringing them to the public’s attention, and this example is definitely a case in point.

International studies, such as the cohort study of mobile phone use and health, or COSMOS, and national studies, such as the study of cognition, adolescents and mobile phones, or SCAMP, exist to continue research into any possible impacts. It is important that such studies continue, so that the public can be aware of all the current advice about electromagnetic fields. As we have heard, as technology develops there will be concerns—new and old—about the impact that it could have on our health. What assessment has the Minister made of all those studies, specifically those that conclude that radio waves are carcinogenic? As we have heard, Cyprus and Austria advise children and teenagers how to limit their exposure to radio waves. Will the UK Government consider doing that, too?

Some of my constituents have written to me with concerns about the new 5G network, as also reported by other hon. Members, and I am grateful for the Minister’s response on that. I know that my hon. Friend the Member for Gower has had conversations with her constituents, who are concerned about the new technology being rolled out across the country. As she said, she would like white zones to be considered and protected. White zones give people who are sensitive to electromagnetic fields, or are concerned about their impact, somewhere to live without interference from radio waves, and that is why it is important that the matter is looked at cross-departmentally.

[Geraint Davies]

Is my hon. Friend aware of the concern that 5G cannot penetrate trees and that, as a result, we are looking at the destruction of thousands and thousands of trees? That destruction has already started around Swindon. How can we possibly be serious about our ambitions for zero carbon if we are destroying the trees and have this huge carbon footprint? It does not add up and is clearly environmentally ridiculous.

[Mrs Hodgson]

I was not aware of that, but my hon. Friend has put it out there on the record. I had heard, though, that 5G can go through us, where other things go around us, so it cannot go through trees but it can go through humans. There is a lot more we need to know about the technology.

As I was saying, anything that looks at this must be cross-departmental because of the impact on health, business, digital and the environment. Each of the Departments responsible for those areas should consider the health implications of electromagnetic fields, whether it is for a small minority of the population or the majority. Is that something the Minister has considered?

As we roll out digital technology, particularly in rural areas, the protection of white zones should be considered. We can be world leaders in digital, but that must not be at the expense of health and wellbeing. I therefore urge the Minister to ensure that all the information about the health and wellbeing impacts of electromagnetic fields is made available to the public, and kept under constant review as we find out more. I also urge her to work with her colleagues, across several Departments, to ensure that health and wellbeing is prioritised throughout the digital roll-out.