Health and Social Care

Autism

Unfortunately I was unable to attend the both the Autism Awareness Session and the debate on Services for People with Autism due to prior commitments. I am very pleased to hear that the Health Select Committee will be undertaking an inquiry into Autism later this year. You can read the full text of the debate here.

Asthma and Prescription Charges

The issue of Asthma and Prescription Charges was raised with the Minister for Care on the 26th March 2019, you can find the Minister’s reply below.

Mary Glindon MP
What assessment he has made of the effect of prescription charges on the health and wellbeing of people with asthma.

The Minister for Care (Caroline Dinenage)
Extensive arrangements are already in place to help people afford NHS prescriptions. Those include a broad range of prescription charge exemptions, for which somebody with asthma may apply.

Mary Glindon
More than 90% of people on low incomes say they struggle to afford their prescriptions, and 71% told Asthma UK they skipped their asthma medication due to cost. Given the health inequalities in this country, will the Minister investigate that injustice?

Caroline Dinenage
People on low incomes who do not qualify for an exemption may be eligible for either full or partial help with prescription charges through the NHS low-income scheme. In addition, for those ​who do not qualify for that, the prescription pre-payment certificate is available, under which everybody can get all the prescriptions they need for only £2 a week.

Dr Philippa Whitford MP
Of the 300,000 who have missed out on their prescriptions, a quarter have had a flare-up of their asthma and 13% have ended up in hospital. Does the Minister not accept that prescription charges simply are not cost-effective and should be abolished, as they have been in Scotland?

Caroline Dinenage
Almost 90% of prescription items dispensed in the community in England are free of charge. That includes medicines for the treatment of asthma. The fact is that people who, like me, suffer from asthma and need those prescriptions have to decide, as taxpayers—as the people funding our NHS—whether we would rather contribute to those prescriptions or see the underfunding we have seen in Scotland, where GPs have been underfunded by almost £660 million over the last four years. It is a case of priorities.

Julie Cooper
I miss the former Minister, the hon. Member for Winchester (Steve Brine), but commend him for his principled stance.

The Minister is missing the point on prescription charges. It is now more than 50 years since the eligibility criteria for medical exemption charges were reviewed, and next week prescription charges will rise again, placing a financial burden on many who require regular medication for long-term conditions. Does she agree that it is high time the Government moved to address the very many anomalies in the system? How can it be fair that patients with some chronic illnesses get free prescriptions for all their ailments, while asthma sufferers pay for everything? When will she review this unfair system?

Caroline Dinenage
We all miss my hon. Friend the Member for Winchester (Steve Brine), so I thank the hon. Lady for her comments.

Since prescription charges were introduced, Governments of all colours have decided that some patients should pay prescription charges to contribute to the cost of running the NHS, but almost 90% of prescription items are dispensed in the community free of charge, which I think the hon. Lady will agree is an enormous amount.

HCPC Fees

Independent regulators like the HCPC do important work, helping to protect the public and ensure high levels of service and professionalism.

I understand that the proposals put forward by HCPC would increase renewal fees from £90 per year to £106 per year (on the basis that that payment is only taken once every two years). While this does represent an increase of 18 per cent, the fee remains the lowest among all regulators of health and care professionals overseen by the Professional Standards Authority.

The increase has been precipitated by a number of factors including; the need to reduce the likelihood of fitness to practice cases through earlier engagement; keeping pace with the cost of inflation; and offsetting the impact of the establishment of Social Workers England in 2019 and the subsequent decrease in subscribers. HCPC has also taken steps to reduce their internal costs in response to these changes.

Although I recognise that any increase in subscription can have an impact on the individuals required to pay for membership in order to work, the importance of an independent regulator in this sector cannot be underestimated, and helps to protect workers as well as the British public. These fees are tax deductible, and the fee rise will amount to just over £1 a month extra for most of HCPC’s registrants.

Diana Johnson’s Abortion Bill

Thank you for taking the time to write to me about Diana Johnson’s Abortion Bill. I appreciate your views on this matter but I believe that abortion is a matter for women and their doctors, not the criminal justice system. I fully support the decriminalisation of abortion.

I voted for this Bill which would change the law so that abortion would no longer be a criminal offence. One of the benefits would be that the current appalling situation in Northern Ireland would have to change. In that part of the United Kingdom, a woman or child has no choice but to continue a pregnancy even if she has been raped by a member of her family or has a foetal abnormality.

The Bill passed to the next stage but without Government time is unlikely to become law. On Wednesday, an amendment to the Northern Ireland Bill was successful. It merely requires the Secretary of State and her officials to monitor human rights in Northern Ireland but it marked a step forward to conveying the same rights on abortion and equal marriage for people in Northern Ireland as we have in Broxtowe. Please watch my speech in favour of the amendment here.

I should be clear that this Bill does not deregulate abortion provision, reduce the role of medical professionals in abortion provision or change the time limit for abortion. What it does do is ensure that consensual abortions up to 24 weeks would no longer be a crime in England, Wales, or Northern Ireland.

Members of Parliament like myself have as much of a duty to women in England and Wales as we do to those in Northern Ireland. I strongly believe that the near total ban on abortion in Northern Ireland must end.

ME

Thank you for contacting me about ME/Chronic Fatigue Syndrome (CFS). I know that this can be a painful and extremely debilitating condition, impacting on the quality of life of an individual.

I welcome ME Awareness Week, and I hope it helps more people understand this condition, which can be so frustrating and distressing for many. While I understand that there is currently no cure for ME/CFS, I am aware there are treatments that may help to ease symptoms, although no one form of treatment may suit every patient. Patients should be involved in decision-making throughout every stage of their care. Furthermore, patients should be offered information about local and national self-help groups and support groups for people with ME/CFS and their carers.

I believe that research into this area is vital. The Medical Research Council (MRC) and the National Institute for Health Research welcome high quality applications for research into all aspects of ME/CFS. ME/CFS research is a current MRC priority area and so far over £2 million has been invested into this research area.

The majority of services for people with ME/CFS are the responsibility of local clinical commissioning groups. To assist diagnosis, the National Institute for Health and Care Excellence (NICE) produced clinical guidance on the diagnosis, treatment care and support of children and adults with ME/CFS.

You may be interested to know that NICE is currently reviewing these guidelines. This process will require thorough and careful consideration, and I understand that NICE expect to publish new guidelines on ME/CFS in 2020. I have been assured by my ministerial colleagues that these new guidelines will take into account patients’ concerns about the PACE trials and the effectiveness of some existing recommendations. I believe, therefore, that it would not be appropriate for Ministers to interfere in its important work.

Cancer

Cancer survival rates in the UK have never been higher, however, I am aware that there is still more to be done. The Government is working with the NHS, charities and patient groups to deliver the new cancer strategy developed by the independent Cancer Taskforce. By 2020, everyone urgently referred with a suspicion of cancer will receive either a definitive diagnosis or the all-clear within four weeks.

The £1.2 billion Cancer Drugs Fund has helped over 95,000 people and I continue to support the Government’s commitment to increase NHS spending in England by a minimum of £8 billion in real terms over the next five years.

Bowel Cancer Screening

I appreciate your concerns as I know that bowel cancer is one of the most common types of cancer diagnosed in the UK. Over eight in ten cases of bowel cancer occur in the over 60s and I agree that early diagnosis is key.

Under the NHS Bowel Cancer Screening Programme in England, people aged 60-74 years old are sent a home testing kit every two years. Those aged above the eligible age limit are also able to self-refer for screening. As part of the Programme, a new test is being introduced which is easier to complete and it is hoped that 200,000 more people per year will take up the opportunity to be screened.  An additional one-off bowel scope screening test is also being introduced for those aged 55 years old. As of March 2015, roughly two-thirds of screening centres were offering this test to 55 year olds. This is an important test which can find and remove any small bowel growths, which could turn into cancer.

All hospital trusts are able to offer screening for patients if clinically appropriate. New cancer referral guidelines by the National Institute for Health and Clinical Excellence published in June 2015 state that GPs should refer patients for testing in hospital if they present with relevant symptoms at relevant ages.

Breast Cancer

It is important that every effort is made to continue raising awareness of breast cancer, and tackle this disease, which has taken so many lives over the years.

In 2015, Public Health England launched Be Clear on Cancer, a national scheme which, I am pleased to say, has significantly improved awareness of breast cancer in women over 70, who account for roughly 1 in 3 cases of breast cancer. Breast cancer survival rates have improved remarkably over the last40 years, and this is testament to the efforts made to raise awareness of, and boost funding into tackling this disease.

I know that ministers are making great efforts to improve cancer services, and ensure that the NHS provides some of the world’s best cancer care. The NHS has launched the National Cancer Programme which is committed to offering uniquely tailored cancer treatment to all patients with breast cancer by 2020 It is working closely with Health Education England and Macmillan Cancer Support to understand the best ways developing and implementing cancer services by the same date.

You may be interested to know that the National Institute for Health and Care Excellence (NICE) is updating its guidelines on the diagnosis and management of breast cancer. These guidelines will cover the use of adjuvant bisphosphonates and other cancer drugs, and will be published in July 2018.

I appreciate your concern regarding the age at which mandatory mammograms are offered by the NHS. Mandatory mammograms play a key part in the early diagnosis of breast cancer, which is central to the Government’s ambition of achieving world-class cancer outcomes. The breast cancer screening programme is currently offered to all women between the ages of 50 and 70. You may be encouraged to hear that the NHS is trialling expanding compulsory screening to women aged between 47 and 73. This trial began in 2009 and is expected to run until the mid-2020s, until the NHS has sufficient information to understand its effectiveness. Figures from Cancer Research UK show a significant increase in the incidence of breast cancer in women in their mid-40s, and very low rates of occurrence in those under the age of 30. I believe it is appropriate that the NHS is looking at expanding the screening process, whilst ensuring resources are allocated wisely, and directed towards those women most likely to be at risk of contracting breast cancer.

I believe these developments will significantly improve patient experience and quality of care. The NHS is implementing the independent Cancer Taskforce’s recommendation that all breast cancer patients shall receive access to a Clinical Nurse Specialist, or other key workers. This will enable greater detection of any recurrence or secondary breast cancer, and enable a quick and effective return to care.

Secondary Breast Cancer 

I am glad that the Breast Cancer Care campaign, ‘Secondary. Not Second Rate’, is raising awareness of secondary breast cancer, which is estimated to affect 36,000 people in the UK. First launched in 2017, the campaign seeks to ensure that every person living with secondary breast cancer receives the appropriate care and support they require.

Ovarian Cancer

I fully support the objective of improved awareness for all cancer symptoms, including ovarian cancer where early diagnosis makes a huge difference in survival. I know this is a priority for the Government which is why Public Health England (PHE) is working with cancer charities to pilot and assess the feasibility of an ovarian cancer audit over the next two years.

In October, the Prime Minister announced that NHS England is introducing Rapid Diagnostic and Assessment Centres which will operate as one-stop shops to reduce time-to diagnosis and time-to-first treatment. This is a real step change in the way people with unclear symptoms are identified, diagnosed and treated.

Young Cancer Patient Travel Fund

I appreciate how distressing it must be for young people, and their families, if they are diagnosed with cancer and it is vital that young people affected by this terrible disease get the care and support they need. Cancer can affect all areas of a person’s life, including finances.

The Healthcare Travel Costs Scheme allows for patients (and in some circumstances their carers) to receive reimbursement for travel if they are receive certain benefits or are on a low income, and if they have been referred to hospital or other NHS premises for specialist NHS treatment.

NHS England has stated that work is underway to review the service specifications for children and young people with cancer services. I understand this will provide an opportunity to consider how some aspects of the patient pathway may be provided more locally to reduce the travel burden for patients and their families. I look forward to seeing the outcomes of the review in due course.

Unfortunately I am unable to attend the ‘Cancer – A Costly Diagnosis? Stories of the Financial Impact of Cancer’ event on Tuesday 9 July due to prior commitments.

Mental Health

I agree that tackling poor mental health in the UK must be a priority and Ministers have legislated to ensure it is treated with the same importance as physical health. Progress is being made with more Government investment in mental health than ever before and an estimated 1,400 more people accessing mental health services every day compared to 2010 – up 40 per cent, as well as around 750,000 more people accessing talking therapies since 2009/10.

In February 2016, an independent Mental Health Taskforce published a new national strategy, setting out an ambitious vision for mental health services.

To make these recommendations a reality, the Government will spend an additional £1 billion on mental health by 2020-21 to improve access to services so that people receive the right care in the right place when they need it most. This includes increasing the number of people completing talking therapies by 600,000 per year (an increase of two thirds), and helping 20,000 more people to find or stay in work through individual placement support and talking therapies.

The Government has also introduced the first-ever mental health access and waiting time standards to ensure that 75 per cent of people referred for talking therapies to treat common mental health problems such as depression and anxiety start their treatment within 6 weeks, and 95 per cent within 18 weeks. These targets have been met and the latest data shows that in May 2016, 84 per cent of people waited less than 6 weeks and 97 per cent of people waited less than 18 weeks.

New Mothers 

As you suggest, it is vitally important that women have access to the right care during pregnancy and in the first postnatal year. I have helped ensure that Ministers are aware of the National Childbirth Trust’s ‘Hidden Half’ campaign on this important issue.

Improving perinatal mental health services during pregnancy and in the first postnatal year should be prioritised. I am told that the Department for Health is investing £365 million over five years in perinatal mental health services. NHS England is leading a transformation programme to ensure that, by 2020-21, at least 30,000 more women each year are able to access evidence-based specialist mental health care during the perinatal period. Where possible, the transformation programme aims to improve prevention of perinatal mental illness, including through earlier diagnosis and intervention, support for recovery and reducing avoidable harm.

Investment by NHS England in multidisciplinary perinatal mental health clinical networks, which include GPs, will also help drive change. I hope that by working together through these networks, health practitioners can ensure women at risk of perinatal mental health problems are identified at an earlier stage and can receive better, more coordinated care.

Mental Health in Schools

The mental health and wellbeing of our children is fundamental to ensuring that they are able reap the full benefits of their education and can enjoy their childhood to the fullest. Half of all mental health problems in the UK start by the age of 14. At such a young age, mental health issues can have a lifelong impact and can potentially affect school performance. It is therefore incredibly important that children and young people are provided with the help and support they need to grow up feeling confident about themselves and their future.

Tackling mental health, especially amongst the young, was a particular priority for me during my time working as Minister for Health. I was very proud of my work together with many of my colleagues, funding the “Time to Change” campaign which raised in the region of £16 million between 2011 and 2015. This programme worked to support and empower people to discuss their mental health problems and to tackle the discrimination that many of them faced. Within this programme was a tailored sub-programme specifically designed to help children and young people deal with mental health problems.

I am encouraged that the Prime Minister is seeking to fully address the issue and has announced a comprehensive package of measures to transform support in schools, workplaces and communities. These proposals include an additional £1.4 billion on mental health support for young people by 2020-21.

I know how important counselling services are in schools. The Future in Mind report is being implemented to expand access to counselling in schools. This will see all areas in England draw up plans for the greater integration between mental health specialists, GPs and schools. Recent data suggest that 62 per cent of schools offer counselling services; I am encouraged to say that this figure continues to increase over time, and more pupils are able to gain access to effective mental support. I also welcome that every secondary school in the country is to be offered free Mental Health First Aid training. This will enable staff to better spot the signs of mental health problems that young people may face. By 2020 it is expected that every secondary school will have one Mental Health First Aid trained member of staff.

Mental Health Children and Young People 

I am encouraged by the continued commitment of £2 million a year to the NSPCC to assist with the running of Childline. Those growing up in Britain today experience a range of ongoing pressures and risks in a changing World, and Childline provides them with a safe, supportive and confidential space that empowers them to improve their wellbeing. Over the years, more than 4.5 million children and young people have sought Childline’s help and last year more than 295,000 counselling sessions were provided to children and young people.

I believe it is incredibly important to protect the health of children and young people in our society. In recent years we have made huge progress in understanding mental health issues, and I support the Government’s efforts to transform children and young people’s mental health for the better in coming years.

Approximately 10 per cent of 5 to 16 year olds have a clinically diagnosable mental health problem. Between 2015 and 2020, an additional £1.4 billion is being invested to transform children and young people’s mental health; this money will support clinical commissioning groups and various national programmes, including improving crisis support and expanding the workforce.

The Children and Young People’s Mental Health Green Paper is a joint enterprise by the departments for health and education, which sets out ambitious proposals to improve mental health services for children and young people, together with over £300 million of funding. This will incentivise and support schools and colleges to train designated leaders for their pupils’ mental health, and introduce new mental health teams, both of which will ease pressure on NHS mental health services.

I received a number of complaints from constituents directed towards CAMHS in Nottinghamshire. I have been working with the CQC to improve children’s mental health services locally and am happy to see improvements are being made. A multi-million pound new facility with over 30 beds will be completed this year but there is still more that can be done to ensure that children and young people with poor mental health receive the treatment and the support that they need.

Dementia Care

Thank you for contacting me about dementia care.

I can assure you that dementia is a priority for the Government. In 2015, the Challenge on Dementia 2020 was launched and I know that the Government remains committed to delivering this. This sets out the vision for dementia care, support, awareness, and research to be transformed by 2020. I fully support the ambition to ensure England offers the world’s best dementia care.

Progress in the care, support and treatment of people with dementia has been made, with more people receiving a diagnosis of dementia than ever before. Over 660,000 NHS staff have received dementia training with further training opportunities rolled out to all NHS staff by the end of 2018. Over 100,000 social care workers have received some form of dementia awareness training. Since 2015, new care staff have been trained to receive the Care Certificate, which equips them with the knowledge and skills to provide safe and compassionate care, including for those with dementia.

I believe it is important to increase public awareness of dementia and I am encouraged that there are over 1.7 million Dementia Friends and 175 Dementia Friendly Communities in England.

Research is crucial to understanding and tackling dementia and the Government has doubled research spending on dementia. This will be maintained to total over £300 million by 2020, with the UK’s first ever Dementia Research Institute receiving £150 million.

The Government is integrating and improving health and social care to protect people at every stage of their lives, increasing NHS spending by a minimum of £8 billion in real terms over the next five years. Furthermore, the Government is committed to publishing a Green Paper this year, which will outline a new social care policy, which is financially sustainable, accessible, and properly integrated with the NHS. To this end, I am encouraged by the establishment of the Department of Health and Social Care this year, which will oversee the intelligent integration of health and social care, which I believe will be vitally important with Alzheimer’s, on which so much important research is undertaken in the NHS.

I’m afraid I am unable to attend the event on the 9th July due to prior commitments, please accept my sincere apologies.

Arthritis

Treatment and Diagnosis

To help clinicians to identify the symptoms of rheumatoid arthritis (RA) and make prompt referrals to specialists, the National Institute for Health and Care Excellence (NICE) published guidelines in 2009. This best practice guideline sets out the signs and symptoms of the disease and emphasises the need for early diagnosis, with urgent referral to a specialist rheumatologist on suspicion of RA. The commissioning of arthritis services, including the establishment of arthritis clinics, is the responsibility of local areas, taking account of the needs of the local population.

The national clinical audit of rheumatoid and early inflammatory arthritis published its latest report in July 2016 and assesses the quality of care by specialist rheumatology services. The report showed significant improvements in patient experience and the time taken to receive treatment, although there are areas where further improvement needs to be made. The report makes a range of recommendations, including improving the training and awareness and amongst GPs, and it encourages all participating organisations to reflect on their own performance and consider what more could be done.

NICE has published best practice clinical guidelines for the treatment of arthritis which highlight the importance of self-management, and lifestyle advice to help patients manage their condition, and live as independently as possible.

Support

I agree with you that work is really important for ensuring that people with arthritis are able to lead fulfilling lives. I can assure you that as part of the Green Paper on work, health and disability, Ministers have explored ways to improve support for people with conditions such as arthritis to find and remain in work. Musculoskeletal conditions are one of the two key areas, along with mental health, which the Green Paper placed specific focus on.

The Government response to the paper recognised the important role of musculoskeletal care services, including physiotherapy, and launched new trials to help support people move back into work. It is also important to work more closely with employers to raise awareness of issues around disabilities and health conditions, and to share best practice. The Disability Confident campaign has done great work in this area in recent years, and a new Disability Confident Business Leaders Group was announced in the Green Paper to work alongside ministers and officials to increase employer engagement around disabled employment.

The Access to Work scheme is also being expanded to help more disabled people start or remain in work. Access to Work is receiving a real-terms increase in resources, enabling increased marketing of the scheme to raise awareness among those who could benefit from it. The new Personal Support Package announced in the Green Paper will also mean that people with health conditions such as arthritis will be able to receive employment support which is more tailored to their specific individual needs.

The Work and Health Unit has been established to lead the drive for improving work and health outcomes for people with health conditions, like arthritis, as well as improving prevention and support for people absent from work through ill health and those at risk of leaving the workforce. The Unit will seek to do this by improving integration across healthcare and employment services as well as supporting employers to recruit and retain more people with long term health conditions.

I’m afraid I’m unable to attend the reception on the 2nd July due to prior commitments.