(1 day, 23 hours ago)
Commons ChamberThe NHS online hospital will connect patients with clinicians anywhere in England through the NHS app. It will deliver up to 8.5 million appointments in its first three years—four times more than the average NHS trust—finally bringing the NHS into the digital age. We are cutting waiting times and providing patients with more choice and convenience.
The wellbeing of our nation’s young people remains in crisis, with one in five having a probable mental health condition and the number being referred to emergency mental health care continuing to rise. In communities like mine in Croydon East, where young people are waiting months and sometimes even years for help, families are desperate for support. How will NHS online help young people access the mental health support they need, and what impact will it have on reducing the waiting times for children and adolescent mental health services?
I thank my hon. Friend for bringing this crucial issue to light. Early access to high-quality support is critical for young people struggling with their mental health. That is backed by us with an extra £688 million this year. We are hiring more staff, expanding support teams in schools and boosting support in new Young Futures hubs so that children can get the best possible start in life. Although initially not focused on CAMHS, the scope of the NHS online hospital is a personal priority for the Prime Minister and has the capacity to grow, and we will consider incorporating it when safely able to alongside other services.
Whatever the impact of these new online services, the Opposition Front-Bench team have drawn attention to the fact that waiting lists in England have risen for the last three months. I can inform the House this morning that waiting lists in Scotland are coming down. Would the Minister like to explain why that is the case?
I am so glad the hon. Gentleman took the time to ask that question, because while we invest in digital services, Scotland and Scottish patients are still waiting for the most basic digital infrastructure. While we invest record amounts in Scotland’s budget, the SNP’s excuses keep rising. What he needs to answer is why Scottish patients are living in a digital desert, while patients here in England are getting more and more sophisticated NHS digital services.
We have already made excellent progress, turning commitments in the women’s health strategy into tangible action. We are delivering 5.2 million extra appointments, which includes tackling gynaecology waiting lists. We know, though, that more needs to be done for women experiencing the menopause and on improving awareness and access to treatment. Menopause Mandate has long campaigned, alongside many Members in this House, for the menopause to be included in the NHS health check. I hope to be able to say more soon, but rest assured that we have heard those calls.
Earlier this year, a constituent came to speak to me about shortages of the one hormone replacement therapy drug that was working for her after years of misdiagnoses and ineffective treatment. She told me that GPs have very low awareness of menopause and often recommend alternatives that cause adverse reactions, leaving her and many other women paying for private advice and treatment and taking time off work. Will the Minister update the House on what the Department is doing to address HRT shortages and to improve training for GPs so that millions of women get the support that they need?
I thank my hon. Friend for highlighting this crucial issue. The majority of the more than 70 HRT products are in good supply, but we are aware of shortages affecting certain estradiol patches, and we are engaging with suppliers to expedite deliveries wherever we can. We have issued guidance to healthcare professionals under the serious shortage protocols methodology to enable community pharmacists to supply alternatives where appropriate. Furthermore, we are committed to funding research into women’s health, and we have invested approximately £5 million through the National Institute for Health and Care Research scheme into menopause research, including studies for new treatments to improve outcomes for women experiencing the menopause.
It is being reported in the press this week that women are being exploited by a menopause “gold rush”, enabled by tech giants such as Instagram. What steps can be taken to ensure that women have access to the very best of information and that misinformation on the internet is brought under control?
I thank the hon. Lady for highlighting this issue. The best way to do that is to beef up NHS digital services, as we are doing to the NHS digital app, so that women and all patients can have confidence in the advice that they receive.
Alton and Petersfield hospitals give excellent step-up, step-down and end-of-life care. The trust is introducing more home-based care, which is good, but it also proposes closing a ward in one of the community hospitals. Will the Minister ensure that there remain sufficient beds and sufficient capacity in our local community hospitals for those patients who need them?
In September, Hampshire Hospitals NHS foundation trust reported step-down immediate care capacity as the primary reason for discharge, and at Portsmouth Hospitals University NHS trust, the discharge figure was 13% lower than the average. As important as immediate care is, we know from the evidence that getting home is better; we are putting record amounts of money into the better care fund to make that possible.
I draw Ministers’ attention to the Prostate Cancer Research report published last week. It busts the myth that a screening programme for prostate cancer would cost the NHS too much money. It would focus on the people most at risk—in other words, black men over the age of 45, and those who, like me, have a history of it in their family. Will the Secretary of State join me in commending this report to the UK National Screening Committee?
As the chair of the all-party parliamentary group on dyslexia—an issue on which I have campaigned for many years—I remain alarmed at the high number of dyslexic people who still need to use mental health services. Will the Minister meet me to discuss how we can better serve dyslexic people in Broxtowe and across the UK, and will he consider measures to prevent more dyslexic people from needing mental health services?
I am very grateful to my hon. Friend for sharing her personal experiences, and I would be delighted to meet her.
I welcome the approval of plans for a new dental school at the University of East Anglia. What arrangements and incentives will the Minister put in place to keep dental graduates in the most poorly served areas, such as my constituency of Waveney Valley?
Children in Runnymede and Weybridge are waiting on average two years to get a diagnosis of autism or attention deficit hyperactivity disorder from Surrey and Borders Partnership NHS foundation trust. The trust is deviating from national guidance on new developmental pathways, and waiting times are even greater if children need medication. Does the Secretary of State share my concerns, and will he investigate the trust and make sure that children and families get the support that they need?
The hon. Gentleman has considerable expertise in this field, and I am grateful to him for bringing this matter to light, but he was part of the previous Government, who let waiting lists get out of control. He will appreciate that I am unable to directly interfere in ICB decisions, but I am very happy to write to the board to ask for an update, and to update him when it replies.
My constituents’ baby, Bran Tunnicliffe, sadly died last year. His parents shared their experience with me, and described the wait for a coroner’s report as a lottery that depends on which hospital, pathologist and coroner is involved. I know that there is a shortage of pathologists in the UK. Will the Secretary of State meet me to discuss my constituents’ experience?
(1 week ago)
Written StatementsToday I am pleased to announce an ambitious programme of applied health, public health and social care research through 10 National Institute for Health and Care Research applied research collaborations—ARCs. This will help power transformations in the health and social care systems that we have identified in our plan for change, for the benefit of the health and wealth of our nation.
ARCs will receive funding to both develop and deliver research, and support the implementation of research in practice, responding directly to the needs of the health and social care systems. Research is vital to supporting the required change to keep people healthier for longer through prevention, fixing the NHS and supporting the sustainability of the social care sector. There will be strong patient and public involvement to ensure what matters to our population is at the heart of everything they do. The new ARCs have a strengthened remit to respond nationally to tackle the biggest challenges in the system, as set out in our 10-year plan for health.
An NIHR ARC network will also be commissioned to provide strategic and operational co-ordination to optimise synergies, increase alignment and facilitate national working with key partners, including other NIHR infrastructure. Fast-track research and collaboration will be further supported over the lifetime of the programme, to respond to Department of Health and Social Care priorities.
ARCs will also work with industry to embed new treatments into care pathways, making it easy for the NHS workforce to deliver seamlessly in their busy working days. Enhanced health economic expertise will ensure the economic impact of evidence is better understood to support decisions on efficiency, productivity and growth. The plans we set out for growth and for health provide the solutions people want to see to the difficulties of their daily lives. Research is a vital part of ensuring we deliver on these. This investment supports the scale of transformation that is needed to have a health and care system fit for the future and there for everyone when they need it.
[HCWS968]
(1 month, 1 week ago)
Commons ChamberIt is an honour to respond on behalf of my hon. Friend the Mental Health Minister and the Government on this uniquely emotive topic that impacts every community. I thank my hon. Friend the Member for Doncaster East and the Isle of Axholme (Lee Pitcher) for giving us the opportunity to have this debate the day after World Suicide Prevention Day. I know that the whole House will join me in thanking him for channelling a deep amount of personal pain and sorrow into such a constructive debate. His family and constituents should be rightly proud.
I also want to commend all hon. Friends and hon. Members for their contributions, many of which have also come from a position of personal pain and experience. Often in our society it is the doctors and nurses who are perceived to be the lifesaver, but I am confident that every hon. Member who has taken part in the debate is a lifesaver, and their constituents should be rightly proud of all of them.
The hon. Member for Winchester (Dr Chambers) spoke about the mental health fund, and I would be delighted to set up a meeting with him and my colleague the Mental Health Minister to talk further about that. My hon. Friend the Member for Burton and Uttoxeter (Jacob Collier) asked for a meeting with his constituent Helena’s parents, and I would also be delighted to arrange that. The hon. Member for Hinckley and Bosworth (Dr Evans), in his usual forensic manner, asked a number of questions that I hope I will address in my speech, but I am sure he will be forthcoming if there are any shortcomings in my answers.
The Government stood on a manifesto commitment to tackle the biggest killers, and suicide remains the leading cause of death for young people in this country. Every life lost to suicide is one too many. That is why our men’s health strategy, our plan for change and our 10-year health plan have given a renewed focus on prevention. Our aim is to get the NHS, Government Departments, academia and the private sector to intertwine like never before in a call to action.
Let me briefly set out the different strands of the work. First, we will target high-risk groups, including children and young people, middle-aged men and people known to have a history of self-harm. Secondly, we will expand the offer of our mental health emergency departments as part of our 10-year plan. Thirdly, we will imbibe a greater sense of responsibility and responsiveness in the digital and media sectors.
Too often people in crisis find themselves terrified and vulnerable in places that are least equipped to help them—for example, traditional A&E departments, facing long waits and often inadequate support. That is why we are committed to expanding mental health emergency departments. We are investing up to £120 million to bring the number of mental health emergency departments up to 85, while piloting an innovative model of mental health care for people with serious mental health needs. That will mean that people in their darkest moments can access immediate specialist care in safe and dignified spaces.
Given that only one third of people who die by suicide are in contact with mental health services, we are also working to make support easier to find and easier to navigate. Our shift from hospital to neighbourhood care in the 10-year plan is a big part of that, as is NHS England’s recently published “Staying Safe from Suicide” guidance, which is for all mental health practitioners to follow. It removes any uncertainty about the approach that they should take, moves them away from tick-box checklists and puts each patient and their individual circumstances at the centre of their care. Today, I can update the House that NHS England is launching an e-learning module as a practical resource to support the implementation of the guidance.
The whole country was horrified by the excellent portrayal of the issues currently affecting young men in the television show “Adolescence”. It is a work of fiction, but it shone a searing light on many of the struggles that young people face, including social isolation—ironically, in an age of social media and connectivity. That is why this Government are taking action by equipping a generation of young people with the tools to manage their mental health. By the end of this Parliament, every school in England will have access to a mental health support team.
But as we safeguard our children in schools, we cannot remain blind to the poisonous environment that children are exposed to online. As a father, I know that this is something that keeps every parent up at night. That is why we are promoting online safety and ensuring responsible media representations of issues relating to suicide and self-harm. Under the Government’s Online Safety Act, all in-scope services are now required to protect their users from illegal content, including illegal suicide and self-harm content. Beyond that, the strongest protections in the Act are for children who are now also protected from legal but harmful suicide and self-harm content.
We have seen too many tragic stories of children being bombarded with that content, often with fatal consequences. The onus is now on tech firms to recognise that that material has no place on their platforms or in our society. Ofcom is continuing to implement this regime, and it has recently published proposals regarding additional steps that should be taken to ensure that such content is not promoted in an algorithmic fashion, but we know that legislation is not enough.
I will now turn to the point made by my hon. Friend the Member for Doncaster East and the Isle of Axholme about first responder training. First responders play an important part in preventing suicides, as they are often the first port of call for someone in distress and experiencing suicidal ideation. We will work closely with first responders, including the police and ambulance staff, to support suicide prevention efforts. Sometimes the first response to someone experiencing distress is provided by Government frontline services. That is why the suicide prevention strategy includes the training of frontline staff in some Departments. The Ministry of Justice is rolling out mandatory suicide awareness training to prison staff, and Department for Work and Pensions frontline staff are receiving mandatory training. The NHS is committed to ensuring that all healthcare professionals receive the necessary mental health training to meet the need of patients.
I will now turn to the question of neighbourhood mental health services. The international evidence base is robust, and we are currently testing the extent of the benefits of the model here. There will be an external evaluation of these pilots to determine their impact, particularly in terms of patient experience, access, reductions in pressure on existing services, and economic impact. We will follow the evidence and make an assessment for future roll-out.
I will now turn to the research into gender differences in suicide. We agree that research is hugely beneficial for making good-quality policy. That is why the ambitions outlined in the suicide prevention strategy for England cover five years and includes research on national trends and suicide rates in specific groups. We will continue to look for ways to improve our national real-time suspected suicide surveillance system so that we can pick up on these trends and act on them faster. We will draw on experts from our advisory groups and listen to people with lived experience to help us understand why we see some of these patterns and what can be done to address them.
I want to end by thanking my hon. Friend the Member for Doncaster East and the Isle of Axholme for bringing forward this debate. I also thank all other colleagues who have contributed to it, but I want particularly to thank my hon. Friend the Member for Blaydon and Consett (Liz Twist) for her tireless campaigning since she was elected to this place eight years ago. In her maiden speech, she stood on the Opposition Benches and spoke very movingly about her husband. She then gave this House a call to arms, saying:
“I do not ask for sympathy; I ask for your support”.—[Official Report, 19 July 2017; Vol. 627, c. 907.]
She may not remember, but the Secretary of State for Health and Social Care, my right hon. Friend the Member for Ilford North (Wes Streeting), was sitting behind her on that day. He is delighted, as I am, that we are now in a position to be able to answer that call.
(9 months, 2 weeks ago)
Public Bill CommitteesI am an officer of the responsible vaping all-party parliamentary group.
I declare an interest as an NHS transplant and vascular surgeon. My wife is a lung cancer doctor.
I declare an interest as a public health consultant and a member of the British Medical Association.
Q
Professor Sir Chris Whitty: Our view is that the benefits of preventing people who are not currently vaping, particularly children, from vaping through what is proposed in this Bill significantly exceed that risk. However, that risk exists; we all accept that. To go back to a previous point I made, that is why having these powers gives us the advantage that if, as a result of where we get to—remembering that this change will come after consultation and there will be secondary legislation going through Parliament—it looks as though we have gone too far, it will be possible to ease back. Our view, though, is that at this point in time, and subject to what the consultation shows, the net benefit in public health terms is positive for the prevention of children starting smoking, over any risk for adults.
The area of greatest uncertainty is on flavours. There is some genuine debate around that, with a range of different views from people who are quite seriously trying to wrestle with this problem—rather than doing marketing masquerading as wrestling with this problem—but in all other areas, most people think that the benefit outweighs the risk.
Q
Professor Sir Chris Whitty: I will give a view, and I think Sir Gregor will want to add to it. It will make a very substantial difference. The thing to understand is that not only does cigarette smoking cause individual diseases, but many people as they go through life have multiple diseases from smoking. They will start off with heart disease, for example, as a result of smoking, and will go on to have a variety of possible cancers, and they might have chronic obstructive airway disease, and they will end up potentially with dementia. All of these would have not happened at all or would have been substantially delayed had they not smoked. Of course, this is heavily weighted towards areas of deprivation, people living with mental health conditions, and other areas where I think most people would consider it really unjust in society. All of us, and anybody who has looked at this in public health terms, would say that if you could remove smoking from the equation, the chronic disease burden would go down very substantially, and be delayed, and the inequalities of that burden of disease would also be eroded. The arguments for this are really clear.
To give some indication of the numbers involved, we have thousands of people every year—millions over time—going into hospitals and general practices only because they are smoking. Had they not smoked, they would not have to use the NHS, and they would not have the chronic disease burden that disbenefits themselves, disbenefits their families and, of course, because of the impact on wider society, disbenefits everyone else as well. Undoubtedly this Bill—if it is passed by Parliament—will reduce that burden and have an enormous impact.
Professor Sir Gregor Ian Smith: Thank you for raising this as a question, because it is a very important point to understand. I will speak to the experience in Scotland. The Scottish burden of disease study published by Public Health Scotland suggests that from now to 2043 we are going to see a rise of 21% in overall burden of disease across our society in Scotland. That burden of disease is very much weighted towards a number of conditions such as cancer, dementia including vascular dementia, cardiovascular disease, and others. There is no doubt in my mind that smoking contributes to those.
Chris’s point about the multimorbidity that people experience is really important in this context. There are more people in Scotland who experience multimorbidity under the age of 50 than those who do over the age of 50, and much of that is related to smoking. Anything that we can do to reduce that burden of disease on people will not only make their own lives so much better, but make them more productive—they will be able to spend more time with their families, they will be economically active for longer, and they will also use health services less. So there is both a compelling health argument and an economic argument here on the preventive nature of stopping smoking and stopping people from beginning to smoke, which is really important to understand in the context of that projected increase in the burden of disease.
The last thing to remember is that our experience of disease can sometimes be cumulative. As Sir Chris alluded to, people who have developed diabetes for other reasons but who smoke as well, will have accelerated disease as a consequence. Removing as much as we can, step by step, the risks that are associated with the development of that accelerated disease—you will have seen it very clearly in your role as a vascular surgeon—has to be a step that we take to maintain both the health and the economic prosperity of our nation.
Professor Sir Chris Whitty: The numbers that I was looking for—
I am sorry, Sir Chris. Just for the purposes of timekeeping, which is my job, we have about 20 minutes left and five people wish to ask questions, so can we keep the questions as tight as possible, and within reason the answers as well?
Professor Sir Chris Whitty: I wanted to give the exact numbers, which I just found in my notes. Some 75,000 GP appointments a month are caused by smoking—just think of that when you phone up the GP—and 448,000 admissions to the NHS: again, think of that when you look at these areas. So the impact of this is really very substantial.
(9 months, 2 weeks ago)
Public Bill CommitteesQ
Professor Linda Bauld: It is very ambitious on tobacco. We will be the first in the world—after unfortunate events in New Zealand, from my personal perspective—to introduce the smoke-free generation policy, and the world is looking at us. That is good. In terms of protecting people from vaping, the Bill has a proportionate set of measures, but if I come back to the answer that I gave to the shadow Minister, we really need to keep our eye on the regulations and—going back to the Minister’s questions—make sure that we are striking a balance. Given the evidence that we have for much stronger regulations on vaping, I think this strikes the right balance, but we need to make sure that we do that in a proportionate way. Finally, to go back to the comments from the previous set of witnesses, we also need to make sure that local areas have the flexibility around some of the measures to adapt them for their local circumstances.
Q
Professor Linda Bauld: Dr Ahmed, you know—as Sir Gregor Smith said earlier—that smoking rates in our most deprived communities in Scotland are about 26%, compared with 6% in the least deprived. That is a very big number, and we see that pattern across the UK.
The Bill will make a difference in several respects. First, on preventing smoking uptake by gradually raising the age of sale, the evidence that we have from studies done by my colleagues at University College London and elsewhere is that previous rises in the age of sale have not exacerbated inequalities but have had a benefit in terms of preventing uptake. We know from the evidence that we have that those measures should be useful and helpful, and should not exacerbate that. The other thing is that, to go back to my earlier answer to the shadow Minister, by preventing smoking uptake in the groups that are likely to be future parents who are already likely to smoke, which are highly concentrated in our most deprived communities, we are going to have an impact there.
I do not see any signs in the Bill, when I look across the measures, that we will be exacerbating inequalities with it. I think that we will probably have the biggest impact in the areas where we have the most smokers which, unfortunately, are our most deprived communities.
Q
Dr Laura Squire: There are not, which is why that is the way we would prefer to do it. Again, if we licensed these consumer products as a medicine, there are very strict requirements on labelling and on what needs to be given to the patient to explain what the product is and its risks. That is not there with these consumer cigarettes. It is going to get stricter under the new rules, but my preference would be that we give people more information.
Q
Dr Laura Squire: It depends on what happens with the actual regulations. At the moment, we do not have powers to test consumer e-cigarettes—that power sits with trading standards. Again, if we license something as a medicine, we go into absolute detail about what is in it. At the moment, it depends on what is in the regulations that come round. We do not do testing at the moment, and it would be important to think about the point at which any testing is done. If it is done at the point where something goes on to the register, that is fine and it tells you that the sample we saw at that point was compliant. But what happens later down the track? I think the role that trading standards has in doing that testing is really important, because it can do it post-market at any point. The question really is about the role of the MHRA—a medicines and healthcare products agency. Is it getting deeper into these consumer products where the risk is not outweighed by the benefits? That is an uncomfortable position for a medicines regulator.
Q
Andrew Gwynne: The short answer to both those questions is yes. We have committed to an investment across HMRC, trading standards and Border Force of £100 billion over the next five years to enforce these measures—sorry, it is £100 million. The Treasury will be having a fit; I am getting my billions and millions wrong. I wish it was £100 billion.
As far as public health campaigns are concerned, just this week we committed £70 million for smoking cessation. For this new year, I have signed off a concerted public health campaign for smoking cessation on social and broadcast media. As this Bill progresses and becomes law, there will be a huge public health publicity campaign so that everybody is aware of our Smokefree 2030 target ambitions.
Q
Secondly, could you make a wider comment on the historical context of the Bill? In 2006, it was a Scottish Labour Government in the Scottish Parliament who set in train some of the processes that we are trying to finish today. Over those 14 to 15 years, we have seen many positive short-term and long-term public health outcomes. What do you think will be history’s judgment on this portion of that journey?