Children and Families Bill
Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak
I am proud to be a patron of Devon Rape Crisis, which, like all of us in this House, is deeply concerned about sexual violence against women and girls. All of us in this House are particularly concerned about the extent to which young people are accessing their information about sex from violent pornography. The influence of violent pornography is to normalise distorted relationships. It teaches some young men that it is normal for women to enjoy violent sex, and to have a total lack of understanding about what constitutes consent. Disturbingly, many young women are being pressured into accepting deeply abnormal and often very violent relationships.
I completely accept that many parents wish to take on the role of delivering sensitive teaching on relationships in a home environment, but let us be absolutely clear that that is not happening for many young girls. The recent outrages in Oxford and in too many of our towns show that young women are being predated on by violent and often much older men. Young women have had no training in how to say no, or an understanding that it is okay to say no. Too often, there is no one for them to confide in. I put it to the House, therefore, that we need to have sex and relationship education in our curriculum: if it is not there, it will not happen. Too often when we teach sex in schools, it is about plumbing and prevention.
Fiona Mactaggart (Slough, Labour)
The hon. Lady's words echo those of Ofsted, which pointed out that the secondary sex and relationship curriculum is not only too focused on plumbing but does not build on the skills that young people need to decide whether they want to enter a relationship—the skills to say no.
Sarah Wollaston (Totnes, Conservative)
It is about teaching girls to say no, and teaching young men to understand that no is no. That needs to be delivered in an age-appropriate way. It is not about frightening young people or taking it out of the hands of parents. In fact, many parents feel relieved that other people are delivering it.
There are very competent peer educators out there, ready to deliver these programmes in schools, but I am afraid that if it cannot be counted, it often does not count. It is important, then, to establish the principle that these programmes should be happening; then, of course, we would need to discuss the matter further, because it would need to be delivered in an evidence-based way. I get the message from teachers that they often do not feel they have the skills to deliver these programmes. Let us make sure that this is delivered in an age-appropriate way and by the right professionals, then, but first let us make sure that it happens, because this is about reducing violence against women. We can send out the message that this is important and deliver it well.
Tobacco Packaging
Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak
Does the Minister agree that there is nothing plain about plain packaging? It just shows the reality of gangrene of the foot with graphic images, which is not very attractive to hand round at a party.
Anna Soubry (Broxtowe, Conservative)
Yes.
GCHQ
Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak
Is the Foreign Secretary absolutely confident that, if a member of staff working at GCHQ had real concerns about wrongdoing among colleagues, the channels exist for that member of staff to have their concerns heard without needing to go to the media?
William Hague (Secretary of State, Foreign and Commonwealth Affairs; Richmond (Yorks), Conservative)
Yes, absolutely. In such a case, concerns can be raised through the management structure. There is also the Investigatory Powers Tribunal, to which members of the intelligence services can take complaints or concerns without having to do so in public
Pollinators and Pesticides
Sarah Wollaston (Totnes, Conservative)
In medical research, there is a huge issue with drug companies not publishing inconvenient data. Does the hon. Lady feel that that is a serious problem with neonicotinoids?
Joan Walley (Stoke-on-Trent North, Labour)
I am grateful to the hon. Lady for raising that point about commercial confidentiality and the lack of transparency. We hear a lot at the moment about lobbying and related issues, but if the agri-chemical industry wishes to make claims about the value of its products, it must open up the evidence to full scrutiny. There is no case for hiding behind so-called "commercial confidentiality". That prevents the open, transparent and informed policy making that is so badly needed. I agree with the hon. Lady and her point relates to one of the recommendations in our report.
When the weight of peer-reviewed evidence rendered untenable DEFRA's position on the need for unequivocal evidence, it claimed that it would commission the Food and Environment Research Agency to conduct a realistic field study to resolve the matter. That study was not peer reviewed and it was, as one witness to our inquiry presciently pointed out, clearly too small to provide conclusive results. It was undermined by fundamental errors in its execution, such as placing the various hives that were used in the experiments outside on different days of the year.
Our view on the study, which was that we should not accept it, was confirmed by the European Food Safety Authority on Tuesday, when it identified the same weaknesses as we did.
Augmentative and Alternative Communication Services
Sarah Wollaston (Totnes, Conservative)
Does my hon. Friend agree with me and my constituents with children using these important assisted technologies that what matters is not just providing the equipment, but the cost of providing training and support, without which children and adults cannot benefit fully from these important technologies?
Paul Maynard (Blackpool North and Cleveleys, Conservative)
I thank my hon. Friend for that perceptive contribution. The concern is that NHS England's budget for AAC will not be sufficient for training. The only way that the hub-and-spoke model can work effectively is if the hub can train up more people in the spokes to deliver the more complex tools. Complexity is at the heart of the problem in the structure. AAC is one of five areas for which complex disability equipment is to be commissioned nationally—incidentally, another is artificial eyes, the national centre for which is based in my constituency. It would be remiss of me not to congratulate that centre during an Adjournment debate on a parallel issue. As I was saying, though, complexity is the key: it determines whether a patient is treated at the hub or at the spoke........
Accident and Emergency Waiting Times
Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak
This is an enormously complex issue and we must not look at A and E in isolation. We also have to be very careful about the way we use data. I recommend that all Members look at the King's Fund blog on this to see how the way in which the codings were changed and the data recorded to include walk-in centres and minor injuries units between 2003-04 gives a different perspective to the debate.
Given that complexity, we need to look at the solutions, which need to come by ensuring that people can see the right professional at the right time in the right place. That is key to this. But as my right hon. Friend Mr Dorrell said, we must also recognise that the key driver for demand in this is our ageing population. If we look at the impact within general practice, we see a 75% increase in the number of consultations during a 13-year period. This is not just within general practice. The patients who are arriving are much sicker and have much greater complexity, and that is the root of the problem. It is a cause for celebration that we are all living longer, but dealing with that needs detailed planning.
David Lammy (Tottenham, Labour)
I am grateful to the hon. Lady for giving way, given her expertise in these areas. Does she recognise the work of Sir George Alberti a few years ago and the establishment of emergency care collaboratives that were very engaged with social care and local councils, and that the further cuts expected in local authorities will make this worse for elderly communities throughout the country?
Sarah Wollaston (Totnes, Conservative)
The reality that we face is that there is a limited amount of public funding. We can spend that pot of public money only once, so we must spend it in the right place, and that often means that we need to spend more of it within social care. That is why I welcome the fact that some of the health budget has been shifted to social care, and that is very important. I also commend Torbay. My constituency covers Brixham and Paignton, and Torbay has been nationally and internationally recognised for its work on integrating health and social care. It is no coincidence that it does so well on A and E waiting times, and we should be looking at what it has achieved.
But how will we keep people out of our A and E centres? In the Health Committee, we heard evidence about the effect that paramedic crews have. If the paramedic crew in an ambulance are highly skilled, the person they treat is less likely to need to go to casualty in the first place because the expertise is there to keep them at home. There needs to be better access to records. We need to consider how we can improve IT so that the patient owns their record and every part of the system can safely access their drug and medical history—with their consent, of course.
Ben Bradshaw (Exeter, Labour)
Given the hon. Lady's previous distinguished career as a Devon GP, does she, like me, deplore the comments made today by a Government Minister, who sought to blame the current crisis in the NHS on the growth in the number of women doctors?
Sarah Wollaston (Totnes, Conservative)
I commented on that on Twitter. The remark was unfortunate; I think women GPs contribute enormously, but there we are. I would say that, wouldn't I?
Health and Wellbeing Boards
Today I chaired an event on the opportunities for Health and Wellbeing Boards to improve health in local communities. The challenges facing rural communities were set out by Cllr Andrea Davis who chairs Devon's HWB.
Mental Health
Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak
It is a pleasure to follow Jeremy Corbyn, who made some powerful points. Perhaps I might add to what he said about the appalling difference in respect of the use of compulsory detention under the Mental Health Act 1983 for those from black and ethnic minorities. We heard in evidence that the fear of this among some communities is acting as a deterrent to seeking early help. We must address that, making sure that people do have that access and that that fear is removed from communities in order to improve health for everybody.
I wish to begin by stating for the record that I am married to a consultant NHS psychiatrist who is also chair of the Westminster liaison committee for the Royal College of Psychiatrists, which provides impartial advice to all political parties on psychiatry. He is also now a clinical director of NHS England's mental health and dementia network in the south-west.
The corresponding debate last year focused importantly on the issue of stigma in mental health, and I congratulate the ongoing work of Time to Change in reducing stigma. The other issue that was raised, which many Members have focused on today, was parity of esteem. It is wonderful that that important principle is established within the Health and Social Care Act 2012, but we now need to ensure that that translates into action and practice on the ground. As we have heard, 23% of the overall disease burden lies in mental health, but we all recognise from stories that we hear in our constituency surgeries, and from clear evidence, that that does not translate into either funding or our constituents' experiences of services. How are we going to see that translated into action? We need to look at the evidence of what works and to focus on the outcomes.
We know that 30% to 65% of hospital in-patients have a mental health condition and that mental health and physical health are inextricably linked. Not only is someone more likely to suffer from a mental illness if they have a chronic long-term condition, but someone who has a mental illness will find that there is an impact on their physical health. We have heard again about the scandal that the life expectancy of people with a serious mental illness will be shortened by between 20 and 25 years.
Anna Soubry (Broxtowe, Conservative)
My hon. Friend is picking up on the point made by the hon. Member for Islington North about there being a real link between public health issues such as smoking and alcohol, and mental health issues. Does my hon. Friend agree that we can do great work in this area at a local level, especially under the new arrangements whereby public health is devolved back down to local authorities, where it used to be and always should have been?
Sarah Wollaston (Totnes, Conservative)
I am grateful to the Minister for that intervention. There has been a consistent tendency to ignore physical health problems in those who have severe mental health illness. She is right to say that putting in primary prevention work locally is important, but the Government could perhaps do more on primary prevention, through having a relentless focus. I am grateful to her for the personal support she has given to addressing issues such as alcohol pricing and the availability of ultra-cheap alcohol. Such issues are very important, and the Government need to deal with them to support the work that is being done. Minimum pricing is, of course, not a magic bullet, but unless we address the issue of ultra-cheap alcohol all the other measures that public health directors wish to take within local communities risk being undermined.
Anna Soubry (Broxtowe, Conservative)
Does my hon. Friend agree that we can do great work on the minimum pricing of alcohol at local level? I urge her to examine the work being done in Newcastle and, in particular, in Ipswich, where all the agencies are coming together. We have seen supermarkets and many off licences agreeing not to sell cheap beer and lager. Does she agree that such an approach has the potential to be a better way—I think it is one—of dealing with this issue than minimum unit pricing?
Sarah Wollaston (Totnes, Conservative)
Although I absolutely agree that those projects in Newcastle and Ipswich are impressive, there will, unfortunately, always be ways in which they can be undermined. In my area we can find an example of maximum alcohol pricing, whereby white cider is being sold at a maximum price of 23p a unit, and that is destroying areas. There will always be a way for people to get around a minimum pricing level and, although we can see real benefits from these projects, particularly for street drinkers in isolated pockets, I feel overall that minimum pricing would be a good way of addressing this issue on a wider level. But I will not focus on that today.
I want to draw attention to the evidence on providing integrated services. Mental health and physical health services should be much better integrated. Is the Minister aware of the recent report by the Centre for Mental Health and the London School of Economics, which evaluated the use in Birmingham city hospital of the RAID service—the rapid assessment interface and discharge psychiatric liaison service? Is the Minister aware of the role that liaison psychiatry plays? Such services are greatly appreciated by patients and provide an excellent way for them to receive services; moreover, they are incredibly cost-effective. By providing rapid access to a professional service, not only for in-patients but for people who attend accident and emergency services and those who are seen by the poisons unit, it reduces re-admission rates, provides better care and far better outcomes, and saves money. The pressure on A and E services has been much in the news in recent weeks. Liaison psychiatry reduces re-attendance at minor injury units and A and E departments, so such services are vital. It would be really helpful to know whether the Minister is aware of the evidence base and will be promoting liaison psychiatry services.
I want to talk about social exclusion and the role of mental health services in social exclusion. If a person is homeless, they are far more likely to suffer from mental health problems. Equally, if a person has mental health problems, they are very much more likely to end up homeless and on the streets. In my area of Totnes, we tragically have suffered some deaths among our homeless population. We know from those who provide help to the homeless in south Devon the level of dual diagnosis—the number of people who have both mental illness and, for example, addiction problems. I would very much like to hear from the Minister in her summing-up what work will be done to improve access to dual diagnosis. I pay tribute to Mark Hatch and the work that he has been doing, alongside very many dedicated volunteers, with the Revival Life Ministries and with Shekinah, providing an outstanding service to our local community.
I want to raise a point about access to GP services for the socially excluded and homeless. In coming months, there will be much focus on how we reduce health tourism. If, in reducing health tourism, we require people to bring a passport to their GP in order to be registered, very many people who are socially excluded will not be registered because they simply do not have access to identification. I ask the Minister, in addressing an important problem of great concern, to be particularly careful to avoid making it even harder for the socially excluded to obtain help with their problems. That would be a real avoidable tragedy.
Prior to the debate, a constituent wrote to me most movingly about the Cinderella service around autism, and lack of access to mental health services for those who suffer from autism, which has a knock-on effect on their carers. Listening to accounts from parents, who have been struggling for so long to obtain the help that their children need, and their description of what happens as their children move into adult services, it becomes clear that that is an area where services genuinely need to be improved. I look forward to hearing from the Minister what more can be done.
Finally, I return to the Health Committee's review of the Mental Health Act. Would the Minister look at the evidence on the variation in the use of community treatment orders around the country, and tackle that variation? It cannot be right that in some parts of the country they are not used at all, while in others they are heavily used. The evidence base on their effectiveness is very poor. Should the Government lead on that, or should the royal colleges take a lead, so that we have a system that is transparent and used equally around the country?
Burma Human Rights
Sarah Wollaston (Totnes, Conservative)
Does my hon. Friend agree that we should not see an amnesty for those who perpetrate sexual violence as a weapon of war and ethnic cleansing?
Debate on the Queen's Speech
Sarah Wollaston (Totnes, Conservative) Click here to watch Sarah speak
It is a pleasure to follow Bill Esterson and my hon. Friend the Member for Lichfield (Michael Fabricant). I agree with my hon. Friend's reservations about High Speed 2, and if just a fraction—even the tiniest fraction—of the investment in HS2 were invested in cycling infrastructure, it could transform the lives of millions of people across the UK. I am a south-west MP and in that region we feel that we could have benefited from a small percentage of that investment in HS2 being invested in electrification of the line down to the south-west, preventing it from being completely cut off every time that it rains heavily.
Michael Fabricant (Lichfield, Conservative)
Which is most days
Sarah Wollaston (Totnes, Conservative)
Yes, indeed. They say in the south-west that if one can see across the valley, it is about to rain, and if one cannot see across the valley, it is raining already.
Having expressed those reservations about HS2, I welcome almost everything else within the Gracious Speech. My principal point is about the draft care and support Bill. To see that Bill finally being introduced in this Session of Parliament is very welcome. I remember well the shock and horror of many of my former patients when they realised that if they had assets above the threshold of £23,250, they would receive absolutely no support with their care needs. We know that one in 10 families face losing more than £100,000 of their income just to care for a relative, and that very many people end up having to sell their homes to pay for their care needs. So, such a massive increase in the asset threshold and a cap on lifetime costs is very welcome, particularly because those measures will encourage people to come forward at an earlier stage to seek the help that they need. In turn, that will help to reduce unnecessary admissions as well as helping people to remain as independent as possible for as long as possible.
Of course, the Bill will introduce support and proper assessments for carers, not only for adult and elderly carers but for child carers, who suffer and are robbed of so much of their youth as a result of their caring responsibilities. I am looking forward to seeing the detail in the Bill, and I very much enjoyed being part of the Joint Committee on the draft Bill that made recommendations to the Government; I hope that many of those recommendations will be included in the Bill when it is placed before Parliament.
I also particularly welcome the fact that there will be compensation for the victims of mesothelioma who cannot trace an employer and for those whose employer has gone out of business, or who do not have any insurance. It is particularly cruel that they receive no access to any compensation, despite mesothelioma being almost entirely attributable to asbestos exposure. But, and this is a big but, how ironic that while providing fairness and support for one type of lung cancer we are failing in this Queen's Speech to address preventing a far more common type of lung cancer—failing to address how we are going to stop the next generation of smokers coming on stream. We should bear in mind that every year 200,000 children take up smoking. Those children will be at risk of going on to face a lifetime of problems. We know that 100,000 people a year at least are dying as a result of smoking-related problems. The failure to take forward plain packaging is a huge missed opportunity.
I want to clarify one thing: there is nothing plain about so-called plain packaging. I would encourage everyone to google what plain packaging looks like. Plain packaging sets out very clearly what is involved. It sets out the disease and suffering that people will face if they do not address their smoking. My experience as a doctor was not so much that people feared the thought of death, but that they most feared the process of dying. The process of dying from many smoking-related illnesses is hideous. We are not just talking about lung cancer. We are talking about, for many people, the years spent in a kind of living death, tied to an oxygen cylinder, suffering from end-stage chronic obstructive pulmonary disease and many other conditions; or the suffering that comes from needlessly losing a leg from arterial disease. Smoking is a leading cause of blindness. There are many effects of smoking—all entirely preventable. So-called plain packs spell that out graphically, and to anyone who hands around such a pack, it is quite beyond a simple public health message. It is a very graphic message.
Bill Esterson (Sefton Central, Labour)
I welcome what the hon. Lady says about plain packaging. In the Committee stage of the Children and Families Bill, I and a number of Members tabled an amendment about banning smoking in cars with children present. I wonder whether she would agree that we hope that the Government will bring back their own version of that amendment in good time.
Sarah Wollaston (Totnes, Conservative)
I thank the hon. Gentleman for his intervention. Indeed, this is about protecting children, and that is what we should focus on. It is not about introducing a nanny state. The so-called plain packs would not necessarily change the habits of a committed lifetime smoker, but they are aimed predominantly at deterring the next generation. I feel this is a missed opportunity, and I very much hope that as further evidence emerges from Australia, the Government will reconsider their position and send a very sensible public health message.
Many Members have commented that the Gracious Speech is not just about setting out what legislation will be introduced; it is about sending a message on the direction of travel. My very clear view is that Government's core business does include public health. Members know that I feel strongly about minimum pricing for alcohol. I am not trying to be the nation's supernanny here— I enjoy a drink myself. This is about trying to get rid of ultra-cheap alcohol.
In my part of the country, we have shops that sell white cider with a maximum price. They are not allowed to sell it for over 23p a unit. I am afraid that is causing carnage. We have recently seen deaths of rough sleepers in my community, and rough sleeping is very closely associated with dependency. We know that as people start to lose control of their drinking, they start to target cheaper and cheaper alcohol. We know that the heaviest drinkers spend 40% less per unit on their alcohol. Just as with the smoking issue, this is not necessarily about saying that it is always possible to save everyone who has become a dependent drinker. We know that 40% of dependent drinkers will, whatever happens, be unable to control their drinking and will lose their life as a result of their dependency. It is about trying to help those who are starting to lose control of their drinking.
It is about helping those who are right at the beginning of the journey, who may have developed a harmful pattern of binge-drinking.
The argument goes beyond the public health message and towards what alcohol dependency is doing to our communities. We know, for example, that there are 705,000 children in this country living with a dependent drinker—not just a hazardous drinker or a harmful drinker, but somebody who is dependent on alcohol. We also know that in 40% of child protection cases, alcohol is a key part of the problem. We know that nearly half of all violent crime is partly attributable to alcohol, as I know from my experience of seeing victims of crime and domestic violence. We know that a huge number of those who are victims of domestic violence report that alcohol directly caused or significantly worsened that violence.
We know that about a third of people feel that their town centres have become no-go areas to them at the weekend, and we know that all of us are paying for that. It costs us a staggering amount—about £21 billion a year just within our health service. I welcome the suggestion from the Secretary of State for Health that members of the Front-Bench team should spend time on work experience, and I suggest that suitable work experience for all members of the Front-Bench team would be a Friday night in casualty. If they really want to see what is causing delays in casualty departments at the weekend, they need look no further. Perhaps they would like to go out with the special constables in my area, who tell me that all their time at the weekend is spent dealing with alcohol-related crime and violence.
The final point that I would like to make about the subject is that it is an important cause of health inequality. To all those who say that minimum pricing penalises the poor, I would say that it is the poor who are suffering the most as a result of ultra-cheap alcohol. There are many reasons why we need to address the problem. If alcohol harmed only the individual who was drinking, that would be purely a matter of personal choice, but the wider harm is caused by the ripples that spread out from the individual who is losing control of their drinking, affecting those closest to them, their wider family and their community. So there are good reasons for saying that this is fundamental and core Government business.
I feel very disappointed that such a well-evidenced measure has been dropped from the agenda. It is not good enough to say, "We have not made a decision." Continually kicking a ball down the road can, in effect, be the same thing as dropping it altogether. I hope that alcohol-related measures come back as "any other business" within the legislative programme.
I call on the Government particularly to look at the emerging evidence from Canada. Apart from the myth from the alcohol industry that such measures would make alcohol unaffordable, which is not the case, other myths are perpetuated. We need to challenge those. What we have seen clearly from states in Canada that have introduced a floor price is that following a 10% rise in the floor price there is a 32% reduction in deaths directly caused by alcohol. That is important evidence. There has also been a decrease in alcohol-related hospital admissions. Let us look at the evidence and have evidence-based policy, rather than listening to the power of lobbyists. It is vital that we look at the power of the alcohol lobby and the way that that operates at the heart of Government. I would like to see a register of lobbyists. I would like to see transparency about who is calling the shots when it comes to forming policy.
I sometimes get a little flack for using social media—surely not, Members might think—but if we look at the Chamber now, which of course is where Members of Parliament should be, we might consider that Twitter can reach parts that other tools cannot. In particular, if we look at the tools that others use, and at the power of the lobbying industry, we will see that MPs need to use every tool at their disposal to fight for the causes they believe in. Public health is fundamental to why I applied to be in this place in the first place, and it is fundamentally Government business. We should look at the evidence.
Public Whip
If you would like to view my voting record it can be seen on the Public Whip's website, but you need to see how this information is compiled as it can sometimes be misleading.
What is on in Parliament
If you would like to see full details of what's on in Parliament this week, you can do so via the Parliament website.
Hansard
This will take you to all of my spoken material by date
