Obesity: Covid-19

Wera Hobhouse Excerpts

Tuesday 10th November 2020 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

It is a pleasure to take part in this debate with you in the Chair, Mr Davies, and I congratulate the hon. Member for Strangford (Jim Shannon) on introducing this important issue. It is also a pleasure to follow the hon. Members for Vale of Clwyd (Dr Davies) and for South West Bedfordshire (Andrew Selous). The hon. Member for Vale of Clwyd is a GP and the vice-chair of the all-party parliamentary group on obesity, so he speaks with great authority on this subject.

I believe that we have to focus on the social inequalities that are at the very bottom of this issue. Let us tackle it from that perspective. Obesity is, of course, a major problem and can greatly increase a person’s risk of other health conditions. It is absolutely right that supporting people towards a healthier weight is a Government priority, and I fully support it. Any strategy aimed at tackling obesity must recognise that it is a complex condition with many underlying causes, including factors tied to socioeconomic issues. Managing weight is often not simply a matter of just eating less and exercising more. Unless that is recognised, this strategy will not be effective in the long term.

I want to say something about my experience as a councillor. Before I became a Member of Parliament, I was a councillor in one of our most deprived councils, and 10 years ago we tried to ensure that children learned how to eat healthily. If people cook their own food at least they know what is in it, so we tried to ensure that people knew how to cook. We then recognised, going even deeper into that, that a lot of families did not even have the means to cook. Some of the children had never seen water boil.

Those are the issues we face if we are talking about how to teach children early how to eat healthily, cook their own meals and know what is in their own food. Some families are at that level of deprivation: children have not learned to cook and have not seen their parents cook. That is how deeply we need to get into the issue. We need to understand that, without stigmatising families who live like that and without using language that shames people who are overweight. We must understand that, additionally, there are mental health problems and other deeper underlying problems that go with this issue. I urge the Minister to go deeply into that subject and recognise the social inequalities that lie at the bottom of it.

I want to talk about one particular aspect of the strategy that concerns me—calorie labelling in restaurants. There is limited evidence to suggest that that measure has a meaningful impact on tackling obesity. Worse still, it could be harmful for those at risk of living with or recovering from an eating disorder; that is, of course, at the other end of this problem. There is an epidemic of people suffering from eating disorders such as anorexia and bulimia and being underweight. Approximately 1.25 million people suffer from an eating disorder in the UK. It is also true that many people living with an eating disorder also live with obesity. Treatment, therefore, is not as simple as consuming fewer calories. The eating disorder charity Beat is one of many voices sharing concerns about that aspect of the obesity strategy, and I ask the Minister to look carefully into that concern. Calorie counting is well recognised as an unhealthy behaviour: one sufferer described it as an “all-consuming obsession” that “took over my life”. Learning to disregard calorie counts is a large part of recovery from an eating disorder. Having the freedom to go to a restaurant with friends or family—something that many of us take for granted—can be a very big step.

I highlight a quote from one of Beat’s volunteers:

“One of the greatest joys of recovery is being able to go to a restaurant for a meal with friends, and I enjoy going out now with my friends and family, but I really struggle to eat in public once I have noticed the calories. Once I have seen the number, I can’t stop my brain telling me I can only have the food with the lowest amount of calories.”

Research shows that individuals with anorexia or bulimia are more likely to order significantly fewer calories when that information is provided.

Eating disorders and obesity can in many ways be part of our somewhat strange relationship with food. People can go from obesity into bulimia—these things are connected—and it is important that we recognise that. I was extremely grateful to the mental health Minister for meeting me and representatives from Beat a few weeks ago. I appreciate the time she spent listening to our concerns about this element of the strategy, and I know she is committed to supporting those with an eating disorder. As chair of the all-party parliamentary group on eating disorders, I would welcome the opportunity to have another meeting with her and representatives of Beat to talk about that particular, very concerning aspect of the obesity strategy.

Yes, we absolutely need to recognise that obesity is a massive public health issue. We need to tackle it, and I welcome the fact that the Government have made it a priority. But it is important that we make sure that the strategy does not hit people with an eating disorder, such as anorexia or bulimia, in an adverse way.

--- Later in debate ---

[Wera Hobhouse]

The hon. Lady is focusing on the number of takeaways in those communities. They are there because people cannot cook for themselves. It is important that the Government look at how many families have the ability to cook for themselves. I recognise the temptation to order a takeaway, but it is the result of the problem of people not being able to cook.

[Jo Gideon]

I thank the hon. Lady and absolutely agree. There are other factors as well, including income, housing, access to green space and exposure to junk food advertising.

On the extra factors, I discussed the issues around exercise with Stephanie Moran, the executive principal of the Esprit Multi Academy Trust, and visited the Grove Academy in Hanley to see first hand the challenges of organising outdoor exercise in a covid-safe way. This Victorian-built junior school, which was built for 100 people in a busy, dense residential area, has no green space and an inadequate playground area for what are now up to 480 pupils to exercise daily. We must include the right to exercise as a vital element of tackling obesity as well as looking at nutrition, and ensure that schools such as Grove Academy have access to green space.

Recently, I spoke to consultants at the Royal Stoke University Hospital, who shared their concerns about the increasing number of children with type 2 diabetes whom they had to refer as a consequence of poor diets and unhealthy lifestyles.

The Government started to address the challenge of poor diet in 2018 with the soft drinks industry levy, which has led to a significant reduction in the sugar content of drinks. This July, I wholeheartedly welcomed the Government’s Better Health campaign, which looked to address some of the issues through measures such as a ban on the TV and online advertising of fatty foods before 9 pm, and an end to all “buy one get one free” deals on unhealthy foods.

However, successive Governments have adopted different approaches to tackling obesity and, until now, they have neglected to address the structural inequalities that are so strongly linked to levels of obesity. The national food strategy and the Government’s obesity strategy are intended to be long-term approaches with comprehensive and holistic solutions.

I was delighted with the announcement from the Department for Work and Pensions earlier this week. It confirmed that, as of April next year, the Government will increase the amount of financial support made available to pregnant women or those with children under the age of four, to help them buy fruit and vegetables. The recommendation is to increase the rate of the Healthy Start payments from £3.10 to £4.25—just one of the core recommendations in part 1 of the national food strategy. It is a decisive step in the right direction, and I look forward to working with the Government, through my chairmanship of the all-party parliamentary group on the national food strategy, to see future recommendations implemented as part of their strategy for tackling obesity and malnutrition in the UK.

I say this to the Minister: although obesity is perceived as a health issue, for the reasons we have discussed today, it very much also goes to the heart of levelling up, so I believe that the solution can only be found in a cross-departmental way.

As we slowly but surely emerge from this pandemic, it is important we do everything in our power to capitalise on the momentum and shifting public perception within our attitudes towards tackling adult and childhood obesity. By addressing the structural, economic and social inequalities that exist in parts of the UK and by implementing the long-term and holistic solutions that will emerge from a national food strategy, we will be in the unique position to turn the tide on obesity once and for all, and ensure that everyone has access to healthy food and opportunities to exercise in every community across our country.

Covid-19

Wera Hobhouse Excerpts

Tuesday 12th May 2020 Commons Chamber

[Wera Hobhouse (Bath) (LD) [V]]

I wish to put on record my warmest thanks to all our doctors, nurses and care workers here in Bath, to the police and emergency services, key workers and council workers, and to everybody else who has helped us keep going during lockdown.

The covid pandemic has forced us all to change our lives in ways we would not have imagined only a few months ago. In all of the hardship and tragedy of this time, one of the brightest points has been the improvement in our air quality, because many fewer cars are on the road. As we have adjusted to lockdown, many people have commented that they have thought about the benefits of talking a walk or going for a bike ride, because it is much more relaxing and there is more time to reflect. Walking and cycling contribute greatly to our wellbeing. We have talked at length about social distancing measures and the space we need to give each other when we are socially distancing. In this country, safety has always been a barrier to cycling, but now, as our towns and cities are less congested, cycling has become a much safer option. Of course, we want to restart the economy as soon as it is safe to do so, but when we do we have a once-in-a-lifetime opportunity to look at our streets with fresh eyes. We need to think about what did and did not work before lockdown, and at what we want to achieve as we put in place the conditions for a new normal.

For decades we have been overdependent on cars, and that must change. I have also spoken before about the need to tackle emissions from surface transport. We have been having these discussions in my city of Bath, which has suffered from severe air pollution, for many months now. As we slowly emerge from lockdown, we need to look at ways to avoid a dramatic resurgence in car use, particularly as many people may be nervous about using public transport. Other countries are already looking at ways to rebalance the priority given to cars over cyclists and pedestrians in urban areas, through segregated cycle lanes, speed reduction zones or new and widened pavements. I welcome the Transport Secretary’s new guidance to local authorities. Early action will be crucial, in order to embed changes in behaviour This is a great moment for change, and we must ensure that our economic recovery is focused on the need to get to net zero.

[Madam Deputy Speaker (Dame Rosie Winterton)]

I now call the shadow Secretary of State to wind up for the Opposition and ask that he speaks for no more than eight minutes.

Women’s Mental Health

Wera Hobhouse Excerpts

Thursday 3rd October 2019 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

I beg to move,

That this House notes with concern the rise in mental ill health among women, with one in five now experiencing common mental disorders and young women the most at-risk group; recognises that women’s mental health problems are often rooted in experiences of violence and abuse; believes that mental health services often fail to respond to women’s specific needs, including their experiences of trauma; calls on the Government to ensure that the gender- and trauma-informed principles of the Women’s Mental Health Taskforce are adopted by mental health services and that women’s mental health needs, including their experience of violence and abuse, are prioritised and taken seriously in all mental health policy, strategy and delivery.

Constituents often come to us at their lowest point, and we see them going through anxiety, depression and trauma. Poor mental health affects not only the individual, but everybody around them. Women are far more likely to experience serious mental health issues. Young women are at the greatest risk, with one in five having self-harmed and 13% having been diagnosed with post-traumatic stress disorder.

Over the course of this Parliament, there has been a great deal of talk in this House about mental health, which is progress, but the opportunity to discuss women’s specific needs when it comes to mental health services has been limited. Ten months after the publication of the final report of the Women’s Mental Health Taskforce, little has changed. There is a long way to go before our mental health services work for women. There is an obligation on Government to step in and respond to the growing crisis in women’s mental health with a substantive policy.

[Jeff Smith (Manchester, Withington) (Lab)]

I very much welcome the work of the Women’s Mental Health Taskforce, its report, and the principles laid out in it. Does the hon. Lady share my concern that those principles will not be effectively implemented unless there are clear targets and concrete commitments from the Government, and that the next stage needs to be a full strategy on women’s mental health, with those targets and commitments in it?

[Wera Hobhouse]

I could not agree more. We need a strategy. More than half of women who experience mental ill health have a history of abuse, meaning that their conditions are rooted in experiences of gender-based violence. In yesterday’s moving debate, we heard many harrowing examples of that. We have a long way to go if we are to change the whole culture around domestic violence and treat its consequences. When it comes to treatment, we must ensure that frontline mental health services for women are trauma-informed. There is a legal framework that we could use; it is called the Istanbul convention. We signed up to it back in 2012, but so far we have failed to bring it into domestic law.

One consequence is that we do not have enough rape crisis centres across the country. Earlier this year, Fern Champion, a survivor of sexual violence, came forward after being turned away by her local rape crisis centre. She launched a petition asking the Government to ratify the Istanbul convention, which has so far received 171,000 signatures. It is hard to suggest that we can do the groundwork to support women and their mental health challenges effectively when there are fewer than 100 rape crisis centres across England and Wales. This is simply not good enough if we are to support women effectively and prevent them from developing serious mental health problems after suffering abuse. Ratifying the Istanbul convention would mean that the UK was upholding international standards on survivors’ rights.

Earlier this year, I tabled a Bill that would guarantee mothers a health check-up six weeks after giving birth. Depression before, during and after birth is a serious condition that is unrecognised and untreated for nearly half of new mothers who suffer from depression. Statistics suggest that mothers are afraid to speak up, and 47% of new mothers get less than three minutes to discuss their mental health with a healthcare professional. Conversations about the reality of motherhood and perinatal depression are still few and far between. This is a huge problem—and not just for the mother; undiagnosed mental health problems in mothers have serious consequences for the newborn child and their development.

I have been campaigning for better treatment of eating disorders. Eating disorders disproportionately affect women, although they do not discriminate. Women in the LGBTQ community are particularly susceptible.

[Tim Loughton (East Worthing and Shoreham) (Con)]

I am absolutely in accord with the hon. Lady. Before she gets off the subject of perinatal illness, she will agree, I am sure, that it is a shocking statistic that in the UK, suicide is the leading cause of direct maternal deaths occurring within a year of the end of pregnancy. Perinatal mental illness can actually lead to a loss of life among mothers. We need to do so much better for them in those early mental health checks.

[Wera Hobhouse]

Absolutely. Post-natal depression is hidden, and the NCT’s “Hidden Half” campaign addresses that. Anyone who has been a parent knows that parenthood is not easy. Probably all mothers go through some form of depression, or feel really down after birth. I keep saying that if anybody had asked me how I felt, I would probably have said, “Oh God, I am not feeling particularly well.” The problem is in not addressing that early on, because these things can develop into something much more serious. That is why it is very important that there be a check-up six weeks after birth for women, not just for the newborn child.

[Jeff Smith]

I thank the hon. Lady for giving way again; she is being very generous. A number of my constituents have been in touch about perinatal check-ups. My constituent Catherine told me of her experience:

“I asked for a 6 week check with a GP—this was, at best, brief. Physical symptoms were looked at, but nothing was checked with regards to my mental health. There needs to be a standard physical and mental health check for ALL new mothers.”

Does the hon. Lady agree that we need to do better?

[Wera Hobhouse]

Yes indeed. I talk to campaigners, who are now looking at the new general practitioner contracts that are going out. That is definitely a way forward, but we also need to ensure adequate training, because people have to ask the right questions. The issue is sort of stigmatised; everybody thinks, “You’re a new mum—you should be on top of the world.” Nobody really wants to admit that motherhood can be very difficult, and that one does not always feel great. We need training, so that when new mums come in, they are asked the right questions.

Going back to eating disorders, they have the highest mortality rate of all mental health conditions. There are about a million sufferers from eating disorders. That is an epidemic of illness that is going undiagnosed and untreated. We must do much better. Our NHS is not well equipped to spot the problem early and treat it. Waiting times for adults have been shooting up over the last few years. Outdated methods, such as the body mass index measurement, are still being used to diagnosis the condition, but that fails to recognise that at the core of an eating disorder is a mental health, not a physical health, problem. Despite increasing public and professional awareness of eating disorders, medical students receive only two hours of training in the condition and its treatment during their entire time in medical school.

Those are just a few examples of where our NHS does not work for women’s mental health. We need a strategy. The Women’s Mental Health Taskforce did some extremely important work, but its recommendations have been left on the shelf. A Government strategy would help individual trusts to make the changes required to implement the recommendations. The Liberal Democrats have championed the fight for better mental health care for many years, and we believe that mental and physical health should be supported equally by our services. I have highlighted a few areas where women’s mental health provision could be improved, and I am looking forward to the debate and to the Minister’s response.

[Sir David Amess (Southend West) (Con)]

As a man, I make no apology for contributing to this debate, Madam Deputy Speaker, because I come from a household in which four of my five children are women. My late mother had a big role in my life and, of course, I do have a wife. I am prepared to say that I think women are the fairer sex but, by and large, they do have the tougher deal in life. I certainly would never fancy giving birth to a baby, and there are so many other things that women face that men do not.

I congratulate the hon. Member for Bath (Wera Hobhouse) on allowing us to debate this subject. I agree with all her points, and I just want to pick out a few other subjects that colleagues may not talk about later in the debate. With World Mental Health Day just one week away, I am pleased that the hon. Lady has secured this debate because, as she said, reports indicate that one in six people has experienced a common mental health problem in the past week—truly shocking. With a population of roughly 65 million in the UK, almost 11 million people need to access publicly funded support. The prevalence of mental health issues is similar for men and women in the UK but, as I have said already, women have to deal with different challenges. The House of Commons Library’s superb briefing on this topic makes it clear that the greater caring responsibilities and a high risk of domestic violence are contributing factors to the challenges that we are discussing today.

I was not in the Chamber yesterday for the Second Reading of the Domestic Abuse Bill—I was in my House of Commons office—but I was dumbfounded by the speeches. The hon. Member for Dewsbury (Paula Sherriff) may sit on the Opposition Benches, but she is a thoroughly wonderful colleague in every respect. She has had some terrible issues to deal with over the past few months and beyond, and I think of her struggle and hope that colleagues are rallying round to support her. We then heard the speech from the hon. Member for Canterbury (Rosie Duffield) the likes of which I have never heard before. It was so brave and truly shocking, but she was prepared to share that with colleagues. The hon. Member for Bradford West (Naz Shah) then told us about her life and I just could not believe it. It must have taken enormous guts and courage to speak publicly about it, knowing that all sorts of people on social media are going to pick up on the issue while not necessarily being sympathetic. It was a wonderful debate, and I absolutely agree with Mr Speaker that the tone used yesterday and today is far better than that used in recent months.

Women are more likely than men to experience anxiety, depression, post-traumatic stress disorder and eating disorders, as the hon. Member for Bath said. We need to recalibrate entirely how the media put ideas into young women’s minds about how they should look and how they live their lives. There is so much pressure on them to have the perfect figure or the perfect look, which is unreasonable and definitely adds to mental health issues. The suicide rate for young women has more than doubled in the past 10 years, which is shocking. Such facts are easy to speak about, but it is for the House of Commons to try to come together to think of some solutions.

I have two former Ministers behind me—my hon. Friends the Members for Thurrock (Jackie Doyle-Price) and for East Worthing and Shoreham (Tim Loughton)— who have more expertise in this subject than me and who did great work. I really am glad that this subject has at long last reached the top of the political agenda. I sat on the Select Committee on Health for 10 years and although we held inquiries into abuse in institutions in which people with mental health issues were detained, we never really tackled what lay behind those issues, so I am glad that we are highlighting them today. Since 2010, Back Benchers have come together to put pressure on Governments of different persuasions to set up the Women’s Mental Health Taskforce, which was a clear indication of the Conservative party’s commitment to understand and address problems with current women’s mental health support. It was also announced at the party conference in Manchester that funding will be made available for 1,000 extra staff in community mental health services.

I congratulate the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Mid Bedfordshire (Ms Dorries), on her appointment, and I wish her well. However, my hon. Friend and parliamentary neighbour, the hon. Member for Thurrock, spent two days at the Dispatch Box just before we—how can I put it delicately?—formed a new Government responding to points about mental health issues. She was a first-class Minister, and I thank her very much for her work highlighting the mental health challenges that women face. I am glad to see her here today, and I shall enjoy listening to her speech.

My hon. Friend used to be the Parliamentary Under-Secretary of State for Mental Health, Inequalities and Suicide Prevention and was kind enough to meet me together with my constituent Kelly Swain and her team at N.O.W Is The Time For Change. Kelly works tirelessly to provide alternative therapies and wellbeing classes to people of all ages. Before my hon. Friend left office, she seemed to have a magic wand, because I find that Kelly Swain is now pushing at open doors in trying to spread her message throughout Essex, so I thank my hon. Friend for that. The all-women leadership team led by Kelly Swain works so well together, and I am glad that local organisations, along with the clinical commissioning groups, are now considering how they can integrate and support the ideas that Kelly has promoted.

Another trailblazing constituent is Carla Cressy. I look to the hon. Member for Dewsbury at this point, because she was present at a meeting with Carla and my hon. Friend the Member for Thurrock. Again, it may seem strange to have a chap as the chairman of the all-party parliamentary group on endometriosis, but it was decided that I should chair it, and I am very proud of that. I now understand the damaging effect that the condition can have on women’s mental health, and I salute my constituents. Carla’s charity is called Women with Endometriosis, which seeks to provide comprehensive mental health support to any woman facing that uphill battle, and I will continue to support her work in any way that I can.

Something that both those charities have in common, other than the brilliance of the two founders, is a commitment to pulling down barriers and removing any stigma around mental health. As the hon. Member for Bath so rightly said, it is difficult to talk about these topics, and people can be branded very unfairly. We must do something to change people’s perception of women who have mental health issues, and there are still more barriers to be brought down. I have been in this place for 36 years—some people might say that that is too long, but I still have a bit more that I want to do—and there are still issues to tackle, and my two constituents have brought the challenges home for me in very different ways. Both their organisations provide tailored support to individuals, and they are always ready to listen without judgment. That is a basic requirement for mental healthcare at any level, and it would be a great asset to our nation if we could provide that service to every person who required it.

As the hon. Member for Bath rightly pointed out, mental health issues are probably the most difficult healthcare issues to deal with. When I first became a Member of Parliament, I did not see many people with mental health issues at my surgeries, but now that is a regular occurrence. Of course, people with mental health issues need our time, but Members of Parliament are not necessarily equipped with the expertise to give advice and support; we try to signpost people in the right direction. I am sure all Members would say that, although they are very grateful for their local mental health services, we could all do better. That is where the real investment needs to be made.

[Wera Hobhouse]

I go to many schools. Mental health problems often start early, when people are teenagers, so does the hon. Gentleman agree that it is important that mental health services are also provided through schools? That is where we are falling very short.

--- Later in debate ---

[Tim Loughton (East Worthing and Shoreham) (Con)]

I concur with every word of your comments, Madam Deputy Speaker, and the response to this debate, and the one we held yesterday on domestic abuse, has shown this Chamber in a much better light than that of a week or so ago. These are things we can agree on and that are of acute, everyday importance to our constituents.

As I have said previously, I have been in this House for 22 years and we never used to debate subjects such as this, and rarely held debates on children’s issues or many social issues. It is absolutely right that we hold such debates much more regularly these days, and they are enhanced by the personal, often emotional, harrowing and brave testimonies of hon. Members who bring such experience and richness to the debate. They show that we do have some understanding of the complex, complicated and challenging issues that face so many of our constituents every day.

I had not intended to speak in this debate, but I was moved by the contributions from my hon. Friend the Member for Southend West (Sir David Amess) and the hon. Member for Lewisham West and Penge (Ellie Reeves). I have a long-standing interest in this issue, and I declare an interest as chair of the all-party group for conception to age two—first 1001 days. That issue has growing traction and importance, and it should be mainstreamed. I also chair the charity Parent Infant Partnership, PIP UK, and co-chair the all-party group on mindfulness. If any hon. Members present have not attended a mindfulness course, I reiterate that they are available on Tuesday afternoons, usually at 5 o’clock in Committee Room 7. Given the stress of recent weeks, attendance has been noticeably higher and perhaps of more benefit than usual.

I am slightly daunted by speaking in this debate. Yesterday I said that I was daunted by speaking in the fantastic debate on domestic abuse, on the basis, first, that I am a man, and, secondly, that I am not from Wales. Today I am daunted, first because I am not a woman, and secondly because I am not from Essex, which seems to have a dominant geographical impact on the contributions that we have heard and will hear.

Next week we will celebrate Mental Health Awareness Week, and we will also relaunch the charity PIP UK. I have just written a letter to the Minister, and I very much welcome her and the huge amount of experience that she brings to her role from her health background. I am glad that perinatal mental health featured in the remarks of the hon. Members for Bath (Wera Hobhouse) and for Lewisham West and Penge, because that is where I think we can have the biggest impact on the mental health of future generations.

A few years ago, the Maternal Mental Health Alliance produced a valuable piece of work that estimated that perinatal mental health issues affect at least one in six women. Too often that happens in silence, which is why it is so important that the hon. Member for Lewisham West and Penge recounted how it happened to her—why would it not happen to somebody just because they happen to be an MP? The cost to the nation of perinatal mental health issues was estimated at £8.1 billion every year, which is probably an underestimate. We can add to that the cost of child neglect in this country, which is estimated at £15 billion and is often born out of problems with attachment in those early years, even before the child is born, and particularly if a woman is facing huge stresses and challenges, or domestic violence and so on. The statistic that I gave yesterday, which I still find hard to believe, is that a third of domestic violence cases start during pregnancy. The cost of getting this issue wrong is more than £23 billion a year. That is so much more than the more modest investment we could make to get this issue right and prevent those problems and the huge issues they create, financially but also socially—problems that are often lifelong for future generations.

We need better attached children, and attachment dysfunction has gone under the radar for so long. It is therefore essential—I am glad that the hon. Members for Bath and for Lewisham West and Penge mentioned this—that the vital six-week checks on new babies should also include the physical and mental health of new mums, particularly first-time mums. I make no apology for repeating that health visitors have been an important component in helping with those checks, and one great achievement of the coalition Government—I was also part of the shadow health team when we worked on this—was the substantial increase in health visitors. That was based on the Kraamzorg programme in Holland, which we went to see. It showed that if we work intensively with new parents in those early stages, we can prevent many problems from happening later on. Health visitors are such a good investment to ensure happy, healthy, stable new parents who are able to interact in a sensible, robust, proper and healthy way with their children, and that is in the best interests of kids and their parents.

[Wera Hobhouse]

The health visitors in the early weeks when I was first a mother, and subsequently, were wonderful and a real lifeline. We do need to continue with that, but the problem is that it is not systematic enough. Making sure that a mandatory six-week health check is done by a GP and a health professional is the way forward. Currently, the system is too haphazard and we need to have a much more watertight system to get help to every woman who needs it.

[Tim Loughton]

We need both. The health checks are NICE-recommended, but alas not mandatorily funded or instituted across the country. Frankly, all GPs need better training on mental health and mental illness prevention generally, and especially on perinatal mental health.

It was a huge success of the coalition Government that we recruited almost the 4,200 target for health visitors that was set back in 2010. We have lost as many as 30% of those now, since the responsibility for health visitors went from the NHS to local authorities. I am not saying whether that was the right move or not, but, given the cash constraints on local authorities, health visitors have turned out to be a soft target. That is a hugely false economy and certainly needs to be revisited as a priority by the health team.

The lifelong importance of early attachment should not be underestimated. It has been judged that for a 15 or 16-year-old suffering from depression—an all too common problem among teenage children in schools—there is around a 99% likelihood that his or her mother was suffering from depression or some other form of mental illness during or soon after pregnancy. The correlation is as close as that. Not getting it right during the conception to age two period will have an impact on many children for their childhood years and, for too many, continuing into their adult years too. Maternal mental health is very important, not just for the mother herself but for her children and the surrounding family.

Let us not underestimate the impact this has on fathers as well. I will be ruled out of order if I go too much into the subject of male mental health—although I hope we have a debate on male mental health too—but the impact of poor attachment between a mother and baby has significant impacts on fathers. It is important that they are also given every help and support to have that attachment to their children. Too often, children’s centres and other support mechanisms are mum-centric and we overlook the role of the father. The father has an important role to play in the life of the child and an important support role to play in the physical and mental health of his partner, the mother.

The Government have done an awful lot in recent years to raise the profile of the importance of mental health and flag up how we need to do much more. Importantly, they are also investing much more in mental health. We talk about the parity of esteem between mental health and physical health, and we all agree that that is necessary. Much has been done to reduce the stigma that was attached to mental illness just 20 years ago. It is good that so much more money is going into the area. We have a shortage of mental health practitioners and we need to make sure that we prioritise recruiting, training and getting them in service as soon as possible.

The criticism I have is that last year’s Green Paper on mental health included a lot about school-age children, which is important, but virtually nothing on pre-school-age children and perinatal mental health. Shifting the age profile forward and making it more about prevention and early detection—rather than dealing with the symptoms of a child who may already be damaged because their mother was damaged in their early years—is the way we have to go. We have to do much more in schools, but we need to do so much more before children get to school, by working with their mothers and fathers at an early stage.

--- Later in debate ---

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

I congratulate the hon. Member for Bath (Wera Hobhouse) on introducing the debate and welcome the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries), to her new position.

I welcome this debate because it is another opportunity to talk about mental health. As was said earlier, at one time it would not have been spoken about, but our debates, which have in large part been cross-party and consensual, have changed people’s attitudes. That is the real difference that we have made. The hon. Members for Southend West (Sir David Amess) and for East Worthing and Shoreham (Tim Loughton) were right that this is the House at its best—disagreeing politely, but ensuring that issues that frankly are not very popular are debated consensually. I welcome that. These debates have made a real difference in changing people’s attitudes to mental health. I pay tribute to the charities that have recently been involved in various campaigns, because eradicating stigma is a big issue that we still need to work on in our discussions about mental health.

The hon. Member for Bath pointed out in her introduction to the debate that one in five women can at some stage experience a common mental health issue, whether depression or anxiety. Often, they are the ones at greatest risk, especially young women. Although all the evidence suggests that men are more likely to take their own lives, there is an increasing danger among young women of taking their own lives. The statistics have not really budged since 2012, and I think the same is true for the suicide rate among women generally, which at the moment I think is 5.4 per 100,000 of the population. Those rates have remained static for the past 10 years. Some great work has been done on suicide prevention, which led to a slight drop—although I notice that the figures recently went up again—but we need to put more effort into looking in detail at the underlying reason why the suicide rate among women remains static.

The other issue is that women are more likely to suffer from mental illness because of trauma, such as domestic violence and sexual abuse, and issues around body image, which the hon. Member for East Worthing and Shoreham spoke about and which I will come on to.

I welcome the work of the women’s mental health taskforce, which reported in 2018. Let me put on record my thanks to the hon. Member for Thurrock (Jackie Doyle-Price) for the work she did. She was a great champion not only for women’s mental health but for the entire mental health agenda. Not only was she always available to speak to Members, but I know from speaking to charities and others working in the field that her door was always opened. She listened; she made sure she got change; and she can be proud of the work she did.

The taskforce’s report touched on something that is quite self-evident, but which we sometimes forget—namely, the clear link between poverty and socioeconomic conditions and women’s mental health. It found that 29% of women in poverty experience poor mental health. Another issue touched on, which was raised by the hon. Member for Southend West, was prisons. The report highlighted the depressing statistics for women self-harming in prison, which are obviously linked to other issues such as poverty, which has already been mentioned, and substance abuse.

I agree totally with the report’s conclusion that we need to link those issues up and take an holistic approach, but I would go one step further. I have spoken about this before, but we also need to hard-wire mental health and wellbeing into all public policy, whether nationally or locally. We need a system whereby any policy being developed should be tested against a matrix of mental health indicators before implementation, and I would include spending decisions in that. The hon. Member for East Worthing and Shoreham talked about spending cuts, and although we might disagree about their effects on Sure Start centres for instance, making what the Treasury might see as easy cuts leads not only to problems locally but to more expense for the taxpayer in the long term. We should certainly look at that when we are spending money, because while the call is often for more money—which we do need in mental health—we also need to ensure that it is spent correctly and joined up. We could achieve a lot more if we took a joined-up approach.

Let me give two examples of where not having that prerequisite for testing is leading to problems and costing the taxpayer and society more. One is the Department for Work and Pensions and its employment and support allowance assessment. I am clear that people should be encouraged to work, and we all—let us be honest—know that the right type of work is good for people’s mental health. However, we should not have a system that is very blunt in terms of assessment and that takes little account of those living in our communities with long-term mental health problems.

A constituent in her late 50s came to see me a few months ago, having lived with long-term mental health issues in the community. She went for her ESA assessment and got no points. She was then virtually suicidal. I intervened, although, frankly, it should not have taken me to intervene. She then had a mandatory reconsideration, and her payment was reinstated. If we look at that woman’s history, it is clear that she is not going to work, but the process did not take that into account. If that person had then been sectioned, had gone into hospital or had—let us be blunt—taken her life, that would have been a huge cost to society.

[Wera Hobhouse]

I have been an MP for a relatively short time, and I find increasingly that trying to access services or get universal credit throws perfectly healthy people into mental health problems, because it creates anxieties and delays. I am not surprised that a lot of people are being thrown into mental health problems, because our public services are increasingly not responding in a humane way to people’s needs.

[Mr Jones]

I agree, and I will come on to the other example I have in a minute. Those problems then result in a cost to the taxpayer. If we had road-tested the ESA policy in terms of mental wellbeing and assessment when we were developing it, that would have helped the situation.

The other example, which the hon. Lady has just referred to, is universal credit, which is creating huge problems for many of my constituents. They are going up to six weeks without any money. That is having a huge effect on women’s mental health, because the main carers in most of these households are women, who have to juggle budgets. Again, we should have thought beforehand about the cost to society and the taxpayer of the added mental health problems generated through this policy.

On women in prison, it saddens me a little that the Government have now taken up the “lock them up and throw the key away” agenda in the criminal system. We need to reduce the number of people who are actually in prison, and especially women. If we look at the evidence and at the reason why women are in prison, we see that it is linked to domestic violence, mental health problems and substance abuse.

In County Durham, I pay tribute to Durham police and the crime commissioner Ron Hogg, who introduced Checkpoint in 2011. He did that because he was sick and tired of putting women shoplifters through the criminal justice system when what they really needed was help. If we look at the statistics and at the changes that the programme has made, we see that it is cutting reoffending rates. It is addressing the real issue, which, in most cases, is domestic abuse and mental health issues.

In addition, we need clear pathways. The report says we need joined-up local services. That is not just about the acute sector and GPs; it is about the voluntary sector as well, and we need to ensure that it is part of that joined-up local system. Certainly, in my experience, it is delivering local services and good value for money very effectively for local communities. In my constituency, I have a fantastic project called Just for Women, which deals with women who have faced domestic violence and mental health problems and who have been in probation. The project staff do one simple thing: they allow time, and they talk to people. They use crafts and other things to get women’s confidence back. If we sit and talk to the women in that project, we find that most of them have been through every programme possible—they have gone through systems and systems. We need to ensure that we put in place a system that works.

Finally, I want to touch on body image. I welcome this year’s report by the Mental Health Foundation, which focused on the link between body image and the nation’s mental health. In the report, one in five UK adults said they felt ashamed of their body image and 43% of women had low self-esteem when it came to their body image. That does lead to psychological effects.

I agreed with the hon. Member for East Worthing and Shoreham when he talked about the internet companies. They have a huge responsibility in ensuring that the messages they put out do not perpetuate the myth of the perfect body image. That is leading not only to psychological problems but to people having unnecessary cosmetic surgery and interventions, which are harmful to them.

I have challenged Facebook, for example, to ask why it continues to carry adverts for Botox, which is a prescription drug. Just try to take one down; my constituent Dawn Knight, who has been campaigning on this, tried to take one down, but it cannot be done. These companies should take a proactive approach to blocking these adverts, because they are not only perpetuating the image of the perfect body, but are, in some cases, I think, actually breaking the law. If social media companies such as Facebook will not change, there needs to be legislation.

In conclusion, I welcome the debate, because we are talking again about mental health. Is this about money? Yes, it is. We do need investment in mental health services. However, we also need to ensure that we have that joined-up approach to not only services but methods and processes. That can reduce people’s mental illness and ensure not only that we have a society that is content with itself but that, when people do get into crisis, there is a service and support there for them.

--- Later in debate ---

[Wera Hobhouse]

I thank the Backbench Business Committee for granting this debate, everybody who has made vital contributions this afternoon and the Minister for her responses. If I could take one thing out of this afternoon it would be for the Government to take seriously my request for the Women’s Mental Health Taskforce recommendations to be put into a full strategy in order to bring everything together.

Question put and agreed to.

Resolved,

That this House notes with concern the rise in mental ill health among women, with one in five now experiencing common mental disorders and young women the most at-risk group; recognises that women’s mental health problems are often rooted in experiences of violence and abuse; believes that mental health services often fail to respond to women’s specific needs, including their experiences of trauma; calls on the Government to ensure that the gender- and trauma-informed principles of the Women’s Mental Health Taskforce are adopted by mental health services and that women’s mental health needs, including their experience of violence and abuse, are prioritised and taken seriously in all mental health policy, strategy and delivery.

Body Image and Mental Health

Wera Hobhouse Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

It is a real honour to speak in this debate, and I regret that not many people are here to participate in it, but as we know, today is today. Even though I have only recently become a Member of Parliament, I echo the comments about what a pleasure it has been to work with the Under-Secretary of State for Health and Social Care, the hon. Member for Thurrock (Jackie Doyle-Price), and I hope that she will continue in her post.

We have talked about many issues, and I want to pick up on what has been said about the cynicism with which advertising exploits vulnerable people. I will be speaking mostly on eating disorders, and many victims of eating disorders already have a massive problem, even before they go online. If they then order slimming pills online, for example, they will be bombarded by adverts persuading them to buy even more, which they then do. That is nothing short of exploitation, and we need to be alert to that.

We are all ultimately affected by our body image. People might say to me, “Well, you look all right”, but we all think, “Well, this could be better and that could be better.” We all want to please the people around us and ourselves when it comes to what we look like, and that is nothing new. It is only unusual or harmful when it so negatively affects us that it is the only thing that guides our lives. There is a certain intolerance surrounding having to have a particular look, and that is where the real danger lies. People feel they have to look a particular way rather than feeling that it would be fun to look this way or that way and to be playful with what they look like. Instead, they are being shoehorned into a particular image, and anyone who does not fit that image can be badly affected and develop serious mental health problems, including eating disorders. I have been campaigning on the particular issue of eating disorders and mental health.

This debate is important for millions of people across the country, and I hope that we can set an example today by honestly exploring the issues. In fact, I think we already have. In a culture that is obsessed with image, we must talk more openly about the impact that body image scrutiny has on our mental health. It has been said before that we are focusing too much on how we look, rather than on who we actually are as people and what we can bring to the table, whether we are short or tall, male or female. That is one of the obsessions of our society: we are always thinking about what we look like, rather than about who we actually are.

For the past year, I have been campaigning for better treatment for eating disorders. Speaking openly about such conditions is more important than ever, because early identification and intervention are key. Mental health conditions thrive in the shadows and are protected by our ideas about what is and is not appropriate to talk about. Eating disorders have a reputation, and sufferers who do not fit cultural stereotypes are often afraid to speak out or, worse still, are refused help.

[Mr Kevan Jones]

The popular image of eating disorders is that they mainly affect young women, but does the hon. Lady agree that young men and people of all ages are increasingly likely to be affected?

[Wera Hobhouse]

The right hon. Gentleman is absolutely right, and that has been explored in several debates on eating disorders. We are somewhat hemmed in by stereotypes, and I wonder whether our age is particularly prone to that. We think eating disorders are a particular thing, so for a long time they have been a problem for young girls, but they affect people of all ages, and men increasingly. As we have explored today, body image and mental health are not gender-specific, but men suffer in silence more, because they are much less likely to talk about things, and subsequently they seek help a lot later, which can be dangerous. In fact, it is well known that the highest number of suicides is among men between the ages of 18 and 25, because men—this is a cultural stereotype that we can hopefully overcome—just do not talk about their body image, anxieties and mental health as much as women.

Research by the Mental Health Foundation published last March shows how common it is to have body image concerns, and we have heard many other statistics today. One in five UK adults have felt anxious or depressed about their bodies in the past year, and that anxiety can turn into long-term mental health problems, such as eating disorders. Across the country, eating disorders affect 1.25 million people, which is probably a conservative estimate. My work in this area supports that suggestion, and the sufferers I have met come from a range of different backgrounds, but they are united by their dissatisfaction with, and need to control, their body image. The hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) has already talked powerfully about that.

Of course, eating disorders are far more complex than stress over body image. They are serious conditions that ruin, define and, all too often, end lives. However, the seeds of emergent eating disorders can often be spotted in stress or anxiety about body image. For the more than 1 million people who were identified as having an eating disorder, the outlook is not good. On average, it takes 85 weeks between someone realising they have an eating disorder and that individual receiving treatment. That lost time can be the difference between full recovery and living with a permanent disability or disorder. The Government targets introduced to limit child waiting times for eating disorder treatments were a positive step, but thousands of adults across the UK need the same measures. We need to consider the waiting times for adult sufferers of eating disorders, and I know that the Minister has already looked into that.

Understanding eating disorders better is key to improving treatment. Many sufferers still report being turned away and refused referral, because doctors have told them that they are not thin enough to be treated for an eating disorder—I know that the Minister has talked to Hope Virgo, who has been running the “Dump the Scales” campaign—but an eating disorder is not just about someone’s body mass index. By talking about eating disorders, especially in the context of body image, we can start to grasp how damaging that can be. We must educate everyone, from sufferers’ families to doctors, about the many different forms that such conditions can take and how best to treat them. Eating disorders have the highest mortality rate of any mental health condition, and our mental health policy must reflect that. This is a crisis, but we are not treating it as such.

Early intervention is key. Schools, doctors and support workers must be equipped with the tools to identify when body image concerns are becoming dangerous. Furthermore, we must change the cultural conversation around body image, which can be done on many levels. As we have already heard today, social media companies have a responsibility to police the content on their websites, ensuring that anything that actively incites self-harm is taken down. Eating disorders are on the rise, and many adult sufferers are failing to receive the early intervention they so desperately need. We must do better for those suffering in silence and start having a conversation about body image, mental health and the awful reality of life with an eating disorder.

Services for People with Autism

Wera Hobhouse Excerpts

Thursday 21st March 2019 Commons Chamber

[Huw Merriman]

The hon. Gentleman has put it beautifully. As he probably knows, a recent survey showed that 50% of autistic individuals and families were scared to go out, and did not go out, because they were worried about how they would be judged. That isolation is a huge challenge for us.

[Wera Hobhouse (Bath) (LD)]

rose—

[Dr David Drew (Stroud) (Lab/Co-op)]

rose—

[Huw Merriman]

I will take two more brief interventions, and then I will make some progress.

[Wera Hobhouse]

I am pleased that the debate is taking place in the main Chamber. We had a very moving debate some months ago in Westminster Hall, but this is such an important issue that it needed to be raised here. Unfortunately I shall have to leave soon. The debate was meant to start about an hour ago, according to my diary. I am so sorry not to be able to stay, but I am so pleased that the hon. Gentleman is raising the issue now.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order. I do not know who told the hon. Lady that the debate would start at that time. Someone must have misled her, because there was no set time for it to start.

[Wera Hobhouse]

In that case, Mr Deputy Speaker, I apologise.

My local authorities have some excellent care providers and support services, including Parent Carers Voice. Does the hon. Gentleman agree that services for children with autism should be financed through council budgets rather than the responsibility being pushed on to struggling families?

[Huw Merriman]

I think that we all face a real challenge. At a time when local authorities are themselves having to watch their budgets, it is the altruistic services—the support services—that tend to go. The challenge I face is that as authorities look just at their statutory obligations, they may end up spending more money to deliver those than they spent on some of the support services beforehand. I have every sympathy with the point that the hon. Lady has made.

Eating Disorders Awareness Week

Wera Hobhouse Excerpts

Wednesday 27th February 2019 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

I thank the hon. Member for Angus (Kirstene Hair) for securing this important debate. It has already been said that this debate has cross-party support, and we have come a long way in recognising and understanding eating disorders. I find it depressing that although we have made this progress, increasing numbers of people are suffering from eating disorders. We must get away from just talking and start getting some change. I hope that Eating Disorders Awareness Week will bring about that change, so that we do not stand here next year without having made significant progress.

I will limit my remarks to the research that Beat has done that shows that eating disorders do not discriminate, and the importance of early intervention and prevention. Over the past five months, I have been campaigning to raise awareness. I have spoken before in this place about the need to recognise eating disorders early. Stories such as Hope’s highlight how ludicrous it is for people seeking help to be told that they are not thin enough.

At the heart of any improvement to eating disorders treatment lies education—of our medical staff, of the whole of society, of schools and of families. I have personal experience of a family member with an eating disorder, so I know very much how families and friends suffer around a sufferer. It is not just the sufferer who is affected, but those around them.

Eating disorders are too often trivialised and seen as an illness that exclusively affects one type of person. That is reinforced by research released this week by Beat, which found that discrimination was ingrained in how we view eating disorders. Beat’s research found that four in 10 people believed that eating disorders were more common among white people, and nearly 30% thought that eating disorders were most likely to affect people from higher socioeconomic backgrounds. The reality is that eating disorders do not discriminate.

The tragedy of eating disorders is that they are preventable. By focusing on early intervention, the numbers of those suffering can be greatly reduced, but the stereotypes around eating disorders mean that certain people are far less likely to recognise the condition and seek or be referred to treatment. For example, ethnic minorities are substantially less likely to be referred to eating disorder services than white patients, but once referred, ethnic minorities receive the same treatment as white patients. A central problem is what doctors and the public understand about the population of people who suffer from eating disorders. The network of family and friends who surround those with eating disorders make a great deal of difference to their recognising the condition and receiving the correct help.

Research on specialist out-patient family intervention for children shows that it is highly effective and reduces the need for in-patient care, which eases pressure on the NHS. New ways of looking much more holistically at the treatment of eating disorders are highly effective, and we should look at them. The research identifies the importance of a truly joined-up approach to recovery, ensuring that the community around an individual with an eating disorder is supportive and supported by the medical team. Those types of programmes are being run in select areas across the country, and they must be extended, given their positive outcomes.

Treatment for eating disorders is a postcode lottery. We need to look at that. We must set standards and deliver training that will help doctors and medical staff to identify people who need treatment, regardless of any preconceived stereotypes. Additionally, it is vital that we continue to listen to the stories of real people who have suffered from eating disorders, and hear what they have to say about their experiences of the system.

The last thing I want to mention is the Local Government Association’s “Bright Futures” campaign. It highlights to councils across the country the importance of increasing funding, and ensuring that all the promised £1.7 billion for children’s mental health is spent in children’s mental health, not elsewhere. Prevention and early intervention, as we have heard several times today, are absolutely key to saving many lives from being destroyed, including those of friends and families of sufferers. Together, we can make a real difference, but let us make it happen, rather than just talking about it.

--- Later in debate ---

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

I thank all hon. Members who have contributed to this very constructive debate. They all showed massive care and compassion, with a recognition that we have come a long way but need to go a lot further. I am grateful for their constructive contributions.

I congratulate my hon. Friend the Member for Angus (Kirstene Hair) on securing this debate in Eating Disorders Awareness Week. I thank her for her very frank exposition of eating disorders, and of the helplessness felt not only by those who are suffering, but by those around them. It is essential that we ensure that people have access to the right mental health support in the right place and at the right time, because time is of the essence. Improving those services is a key priority for this Government, as part of our wider agenda to improve mental health services.

As several hon. Members have said, eating disorders are serious: they have some of the highest mortality rates of any mental health disorder. We need to ensure, more than ever, that people get access to support as early as possible, because eating disorders quite often begin when people are young. Representations have been made today about why our targets are for children, rather than adults. Those targets recognise the fact that early intervention is best and that issues often surface when people are younger, but that does not in any way diminish the challenge of ensuring that adults also have access to services.

That brings me to a point that several hon. Members have made: the perception that eating disorders affect only young white women. They do affect adults. I have heard of a case of an elderly lady in a care home being diagnosed with an eating disorder that she had obviously been suffering from for decades. One of the tests that I will set myself is for that never to happen again, because we need to ensure that people get early diagnosis.

As the hon. Member for Islwyn (Chris Evans) very frankly reminded us, eating disorders affect men and boys too. If there is a perception otherwise, it may partly be because men and boys are much less likely to seek help than women and girls. We need to make it clear that the issue can affect absolutely anyone, as the hon. Gentleman showed very courageously by sharing his own experience; I am very grateful for his comments.

It is important to continue to raise awareness. We need to reduce the stigma associated with eating disorders so that people are more likely to talk about them. Like all hon. Members, I pay tribute to the campaigners who do so much to raise awareness, particularly the charity Beat, which does absolutely excellent work. I also pay tribute to Hope Virgo for her campaign and look forward to meeting her very soon.

We cannot emphasise strongly enough that this is not about weight; it is about the mind. Some of the stories that were shared in this debate were quite horrific. If there is such lack of understanding among medical professionals—if the people we trust to look after us end up doing harm because they see eating disorders as a weight issue—we have a serious problem to tackle. Of course training has its part to play, but I should add that we expect a lot of our GPs. One of the real challenges is to continue to roll out multidisciplinary GP service teams to ensure that there is much greater expertise in each medical practice, rather than relying on one individual to be the expert on everything. Frankly, they are only human beings—they are not God.

[Wera Hobhouse]

I thank the Minister for giving way; I know that her time is very limited. When services let people go too early, the danger of relapse is much higher. We could prevent relapses by not letting sufferers go too early, when they are half better but not fully better.

[Jackie Doyle-Price]

The hon. Lady makes a good point that I will address further if I have time. We need to look carefully at the care pathway and at the whole practice of referrals and the journey that people take, so that we can ensure that they are in a position to manage their disorder. The truth is that no one is ever cured of these things; it is a matter of managing their wellbeing to tackle them.

I thank the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron) for her acknowledgment that we have come a long way. She is right that we need to ensure that we have proper specialist services to do this work, because of the risk of harm. She is also right to mention obesity, which we could do an awful more to address. I watch a lot of rubbish TV—we work long hours here, so that is my relaxation—and I am horrified by some of the channels, which basically run a succession of programmes about weight that are almost freak shows. That is not how we should be talking about the issue if we want to encourage people to access help. We need to tackle the stigma around obesity as much as the stigma around any other disorder.

The hon. Member for Westmorland and Lonsdale (Tim Farron) and I have already discussed his concerns about his area. I know that there are challenges and we need to ensure that provision is sufficient. He spoke very frankly about the guilt and terror that people around those who suffer from eating disorders feel, because they genuinely do not know how to help their friend or loved one. Reducing stigma and raising awareness is partly about helping people to understand what they can do. Everybody wants to help, because nobody wants to see people suffer so much.

Social media has been mentioned a lot. I absolutely recognise that it can be a force as much for good as for bad, but I must say that we are seeing content that encourages harmful behaviour. It is about the whole psychology of people joining communities. When people use social media regularly, they can become isolated from the physical world and join an online world in which everyone is like them. It becomes normalising, and it can worsen their experience.

Equally, social media can be a community of self-help. I agree completely with the hon. Member for Islwyn that we have to be careful: of course we must challenge companies to be responsible, but it is not black and white, and we need to handle the issue sensitively. I am pleased to say that some companies are very responsive, but not all, so we will continue to challenge them. The hon. Gentleman raised an issue that particularly concerns me. It is one thing to regulate public platforms, but encrypted direct contact is having a growing impact. We need to look at Snapchat, WhatsApp and so on, because the fact is the Government are always three steps—probably more—behind technology.

The hon. Member for East Kilbride, Strathaven and Lesmahagow emphasised peer support. I could not agree more: peer support is important for mental health generally. If I could make one challenge to NHS commissioners, it would be to recognise that providing support to people who suffer mental ill health is not just about clinicians; it is about the voluntary sector and peer support workers. If we are to really step up to that challenge, I hope to see much more imagination in how services are commissioned.

I have so much more to say, but I am running out of time. With hon. Members’ indulgence, I will write to them—not least the hon. Member for Newcastle-under-Lyme (Paul Farrelly)—to outline our response to the points that they raised. We have a lot of figures and have shown that we are meeting targets, but I think all hon. Members would be more confident if there were more granularity—not least because of the cases raised today in which people have not received the treatment that they deserve.

Motion lapsed (Standing Order No. 10(6)).

Healthcare (International Arrangements) Bill

Wera Hobhouse Excerpts

Wednesday 14th November 2018 Commons Chamber

[Wera Hobhouse (Bath) (LD)]

We have heard many comforting words from the Government today, but there is nothing comforting in the proposals in the Bill. If we Brexit, UK citizens here and abroad will lose their rights to automatic healthcare in other EU countries. The automatic right to healthcare in Europe has been one of the visible successes of the single market—a peaceful continent and EU countries working together. If we Brexit, new healthcare arrangements will need to be negotiated with the EU or EU countries individually, and the Bill is intended to make it possible for the Government to negotiate those new arrangements.

The Government intend to do this by using Henry VIII powers. Today could be the last time this Parliament discusses how 70 million UK citizens can go abroad and receive, or not receive, healthcare while there, not to mention the non-UK EU citizens who live in or travel to the UK. We have been through this debate before. Henry VIII powers are the preferred route for a Government who want to bypass parliament and get Brexit through at any price, including the price of democracy. This debate comes at a time when the Government are proposing a deal with the EU. There were only ever three possible outcomes for the UK in this negotiation: no deal, Brexit in name only, or staying in the EU. It looks like the Prime Minister has gone for Brexit in name only, although of course she will not call it that.

Brexit in name only means staying in the customs union and the single market, and it could mean retaining healthcare within the EU. That would be good news. The bad news is that no UK Minister or bureaucrat will be around the table with the EU27. We will be receiving our instructions, and that is it. When the EU decides changes, we will be notified and have to implement the changes. Henry VIII powers will be a way to hide our national humiliation.

The political question is why anybody would vote for Brexit in name only. It is not just a fudge; it is the worst of all possible worlds. It will, perversely, do the opposite of taking back control; it will keep us in complete dependency but without any say. Many parliamentarians have woken up to the fact, or have known for a long time, that our only secure economic future and the only way to guarantee all the rights we have negotiated, including free healthcare, lies in being a member of the EU. As we have heard today, rather than getting a Brexit dividend from the NHS, the new arrangement might end up being extremely costly for this country.

Why do we not dare to say it loud and clear? Not saying it loud and clear is dishonest; Brexit in name only is dishonest. To do something dishonest and call it the will of the people is a travesty. Only the people themselves should decide what is done in the name of the people. Let us ask the people. Let us give the people a say on whether they really had all this in mind when they voted in 2016. Let us give people a chance to decide that when all is said and done they want to stay in the EU. And of course that would make the Bill completely unnecessary.

Prevention of Ill Health: Government Vision

Wera Hobhouse Excerpts

Monday 5th November 2018 Commons Chamber

[Matt Hancock]

My hon. Friend is absolutely right; I strongly agree. Reformulation is critical. However, it is crucial to look not just at sugar, but at calorie count. Replacing sugars with higher calorie products is not necessarily the right way forward.

[Wera Hobhouse (Bath) (LD)]

Current average waiting times for eating disorders are 27 weeks, during which time the condition can become much worse. Will the prevention strategy look into concrete proposals to reduce waiting times, with, specifically, targets for waiting times for adult sufferers from eating disorders?

Autism and Learning Disability Training: Healthcare Professionals

Wera Hobhouse Excerpts

Monday 22nd October 2018 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

It is a real honour to follow the hon. Member for Sheffield, Hallam (Jared O'Mara), who defeated a colleague of mine at the last election. It is very powerful to hear from somebody who is directly affected. However, it is also a reminder to us all how difficult it is for an institution such as Parliament to be truly inclusive and to make sure that everybody who lives in this country has their voice heard.

I pay tribute to Oliver’s family, and I echo the cross-party agreement on this issue. I am the MP for their neighbouring constituency of Bath, and since Oliver was a member of Team Bath, I feel that he is very much part of the Bath family. I say to his family: your campaign will become my campaign.

There are often shocking misunderstandings or misconceptions about people who suffer from autistic spectrum disorder—ASD—or mental ill health, and I find that the two are mixed up in an alarming way. ASD is a learning disability, not mental ill health, and it is important that we separate the two. Mental ill health might be an additional diagnosis, and many people with ASD also suffer mental ill health, but they are not the same. Mental ill health is often a consequence of misunderstanding and isolation, and can be avoided if a person with autism is diagnosed early and treated accordingly. Early diagnosis is therefore crucial to addressing not only the issue itself but the mental ill health that might be a consequence of it. All too often, even once people have an ASD diagnosis, mental illness can be overlooked. The National Autistic Society estimates that mental illness is far more common in people with autism than in the general population.

The debate is focused on training for health professionals to diagnose and understand autism better. So far, the Government have done very little on that. The petition was created by Paula, who is here today, and we have heard powerful testimony about her son, Oliver. I do not need to go over all the details of that, but I understand entirely how the inquest’s outcome must have been devastating the family. Clearly, something went awry. Our laws and regulations are not fully clear about the proper training that should be given, but Paula is in the petition. Her son could possibly still have been here with us. All of us here are truly sorry, and we need to do something about it.

[Darren Jones (Bristol North West) (Lab)]

I rise as the Member of Parliament for Bristol North West, which contains Southmead Hospital: it was part of Oliver’s story, from which lessons need to be learned. Does the hon. Lady agree that the important point here is that we evidently have strong cross-party consensus; that we must now focus our efforts not just on debate and consultation but on achieving real change in the health service and our public services generally and right across our country; and that today’s debate gives us the impetus to do that?

[Wera Hobhouse]

I thank the hon. Gentleman for his intervention. I have said at another occasion today that the word “Parliament” comes from the French word “parler”, which means to talk, but we are also here to take action, so we must stop talking and take action. The issue of mandatory training is something that we can fix or determine here, and I very much hope that the Government will take that on board.

The urgent need for better training on autism and learning disability and the complications of the condition could not be shown more starkly than by the failings in Oliver’s case. In February, the charity Mencap launched the “Treat me well” campaign, which is aimed at transforming how the NHS treats people with a learning disability in hospital. In particular, women with a learning disability suffer disproportionately from health inequalities. We have heard the statistics today; they die on average 29 years before women in the general population, and men with a learning disability die on average 23 years before those in the general male population. That cannot be overlooked. We have also heard these figures today, but that does not matter—it will do no harm to repeat them: a YouGov survey conducted in 2017 found that nearly one quarter of the health professionals surveyed had never attended any training on learning disability, and two thirds wanted to have more training, so what are we waiting for?

Any illness or disorder that is either misdiagnosed or diagnosed late leads to far greater problems down the line. Early intervention depends on early diagnosis, and early diagnosis on training of those who come into contact with the sufferers. We are calling today for better training of healthcare professionals, which is an obvious start, but why not go even further? Let us look at the settings to which young people are exposed from an early age—namely, nurseries and schools. Given that ASD is so widespread, nursery nurses and teachers should receive at least some basic training to recognise the early warning signs. Far too little is being done. In my constituency of Bath, we have an autism board, but it rarely meets and has not even set up a work plan yet. Clearly, none of this is good enough.

ASD and learning disabilities can be successfully treated to give sufferers a full life. The earlier we diagnose the problem, the better the outcome. Many people with ASD also suffer from mental health problems, often as a consequence of not being diagnosed early enough. Let us end this tragedy. I fully support the recommendations that have been made, and I hope that we have the cross-party consensus to really do something quickly.

[Dame Cheryl Gillan (in the Chair)]

We now move to the Front-Bench spokesmen, and it gives me great pleasure to call Hannah Bardell.

Perinatal Mental Illness

Wera Hobhouse Excerpts

Thursday 19th July 2018 Westminster Hall

[Wera Hobhouse (Bath) (LD)]

It is a real pleasure to serve under your chairship, Mr Davies. I congratulate the hon. Member for Stockton South (Dr Williams) on securing this excellent debate, which perfectly brings together my personal and political lives. I am a mother of four and, like the hon. Member for Canterbury (Rosie Duffield), I had them 20 years ago so I know what it feels like to have children completely outgrow me.

This issue does not go away. When I speak to mothers in my constituency, I know that the issue of perinatal health is as alive as when I was a young mum. Some things are getting better, but others are getting worse, particularly because of the time that health professionals can give to people who come to a surgery or the time that a health visitor can give to someone in their home.

I am here because I serve on the all-party group for the prevention of adverse childhood experiences. ACEs are well known in the United States, and the APPG is doing excellent work with the WAVE—Worldwide Alternatives to Violence—Trust. I also pay tribute to the #HiddenHalf campaign group, which came to the APPG the other day and specifically campaigned on the additional six-week check-up for mothers after childbirth.

Pregnancy, childbirth and the first year of a baby’s life is one of the most life-changing experiences in a woman’s life and her partner’s life. It is meant to be amazing, exciting and wonderful. All the folklore and our societal expectations are around how wonderful all that is. Actually, it is a time of profound change. In my experience, it is not only physical change, but mental change. Most women who have experienced pregnancy and childbirth will testify that a big mental change happens, too. All women are at a vulnerable point at that time in their lives. Apart from the physical exhaustion, there is the pressure to prepare and provide for another person’s life. All parents ask themselves how they will cope, how it will all work out, and whether they will love this new being.

While medical attention is focused on the physical health of the mother, the unborn child and, later, the born child, little medical attention is given to mental health during pregnancy and after birth. We are missing out on a vital aspect of health, with enormous consequences for the mother and the child. The APPG is concentrating on this particular issue: adverse childhood experiences and what affects a child’s health from the start.

We know how vital the first 12 months are for a new baby. An enormous amount of development is happening not only physically, but mentally and emotionally. If a mother is mentally unwell—for example, if she is depressed or suffering from anxiety—she will not bond properly with her newborn baby. She cannot give the baby the attention it needs, and the child will suffer. We know that a lack of attention during the first 12 months puts a child at a severe disadvantage for the rest of their life. To address that, they will require a lot more intervention later on, with a lot of extra resources. It therefore makes utter sense to focus our attention on a mother’s mental health before, during and after pregnancy. No woman can be expected to be in perfect mental health during those profound changes in her life. Even mild mental health problems can lead to much bigger problems, with severe consequences for mother and child.

I fully support the call for a six-week check-up in addition to that which already exists and which focuses mainly on the baby. The additional check-up should focus on the mother and her mental health. In my experience, I was never asked how I felt; I was expected to get on. If anybody had asked me, I would probably have cracked up and cried—and why not? It would have brought out that I felt utterly exhausted, inadequate and isolated. I felt that I was letting people around me down. I would probably have been reassured that that was normal, and people would have kept an eye on me.

We still do not know enough about mental health, but as with physical health, early detection and intervention are key. Sometimes symptoms go away on their own, but unlike with physical health, many people will not go back to their doctors if mental health problems do not go away. Those problems can fester and grow bigger. With a six-week check-up, we have a chance of early detection and early intervention. To conclude, let us ensure that all new parents receive the full support they need and deserve. It will be of great advantage to us all.

--- Later in debate ---

[Jackie Doyle-Price]

I thank my hon. Friend for being my conscience—we absolutely must not forget dad or partner, or for that matter the wider family. Members have expressed concern about the declining number of health visitors, and the beauty of having a health visitor is exactly the fact that they develop a relationship with the family and can talk to dad as well. Quite often, dad feels excluded from the process.

[Wera Hobhouse]

Valuable and important as that exchange is, the point about the #HiddenHalf campaign is that often attention is diverted away, because the baby and the dad are there. #HiddenHalf is looking for quality time for the mother in particular. I want that space to be preserved, however much is done by the GP. It is important that a woman who has gone through the trauma that the Minister described is able to feel, “Someone is just looking after me.” It is important to recognise that.

[Jackie Doyle-Price]

I agree and do not think the two points are in conflict. We need both—we need the wider package of support.

The theme we have been considering—of women not always being asked about themselves, and its being all about the baby—is not confined to the issue of perinatal mental health. Women face that across the board with respect to their health. The hon. Member for Worsley and Eccles South (Barbara Keeley) spoke about a women’s health strategy and women’s mental health. I co-chair a women’s mental health taskforce with the chair of Agenda, and in the coming weeks we will present our report on a year-long piece of work. It will have information about tools to enable the health service in general better to support women’s mental health. I am also doing more to raise the whole issue of women’s mental health, because I feel strongly that women are often disempowered in health settings. We need to give them the tools to take control of their own care and to feel empowered to engage in good conversations with medical professionals, to benefit their health.

We have heard anecdotal accounts of women’s experiences, and what has come across is the arrogant behaviour of some medical professionals. They see a large number of patients and they are not always sensitive to how best to communicate with certain individuals. We need that practitioner-patient relationship to work a lot better, particularly in the case of women. I am open to representations from everybody about what tool we can use.

The hon. Member for West Ham (Lyn Brown) is no longer in her place, but I have been impressed by her work on hysteroscopies with women. We are developing tools on that. I reassure all Members that women’s health and the way in which the national health service can better serve women are high on my agenda. I am not going to stand here and say that the world is perfect, but we have made perinatal mental health a priority in the five year forward view. We are midway through that review, so I should give Members an account of how far we have got and what more needs to be done.

To go back to 2010, the situation was really quite poor. Only 15% of localities had fully fledged specialist services in the community, and 40% of communities provided absolutely no service at all. People talked about a postcode lottery; clearly, we could not allow that to continue. We need to work towards universal provision. We are implementing the recommendations of the five year forward view for mental health taskforce, which reported in 2016. From 2015 to 2021, we are investing £365 million into perinatal mental health services. NHS England is leading a transformation programme to ensure that, by 2021, at least 30,000 more women each year are able to access specialist mental healthcare during the perinatal period. In May, NHS England confirmed that, by April next year, new and expectant mums will be able to access specialist perinatal mental health community services in every part of the country. We are making progress. The key to that is community provision.