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Mental Health: Pharmacists

Volume 630: debated on Wednesday 25 October 2017

Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)

I wish to use tonight’s Adjournment debate to raise the sad case of my constituent Alison Stamps, a 33-year-old pharmacist who sadly took her own life on 25 May 2015. I will outline the circumstances of the case, but will also raise wider concerns that I and her family have around the operation of Boots UK and how it dealt with her death, as well as my broader concerns concerning pharmacists and mental health issues.

Alison was clearly an exceptionally bright and talented individual. After finishing at Pelton Roseberry comprehensive school in my constituency in 2000, she went on to study—

Motion lapsed (Standing Order No. 9(3)).

Motion made, and Question proposed, That this House do now adjourn.—(Rebecca Harris.)

Alison went on to study biology at Durham University and graduated in 2003. She then began work as an audit and accounting technician at Sunderland city hospital before choosing to return to university—the University of Sunderland—to study for a four-year masters degree in pharmacy. While she was at Sunderland, Alison was awarded the prize for the best overall student in the first year, before going on to be awarded the Royal Pharmaceutical Society’s award for the best student on a masters degree programme in 2012. Her achievements were remarkable, and clearly she was dedicated to public health and the pharmacy profession.

Alison began work at Boots’ Tindale store in Bishop Auckland in August 2013. Her parents tell me that she enjoyed the work but increasingly complained about the long hours and demands it placed upon her. By mid-December 2014 she was clearly overwhelmed by what she was having to do. Her store manager noticed that she was losing weight and looking unwell. Following a conversation with the store manager, Alison expressed how down she felt. The store manager provided her with a phone number for an independent counselling service and encouraged her to speak to her GP and her family. Like many people in Alison’s position, she felt she could not speak to her family or strangers about her situation. Still concerned, her manager arranged an appointment with a GP for Alison and even attended the appointment with her. I understand that the GP indicated that she should take antidepressants, but Alison did not wish to do that. The GP gave her a crisis number to ring and also suggested some other coping mechanisms.

At this point, I would like to commend the actions of the store manager, who I think genuinely tried to help Alison. I understand that she reported her concerns about Alison to her area manager, and I have had it confirmed by the director of human resources at Boots that this case was referred and flagged up with the firm’s central HR department. It appears that all that happened, however, is that the store manager was advised about what counselling was available, but no alarm bells rang in Boots’ central HR department that one of its pharmacists was in a crisis situation and no action seems to have been taken. Instead, it was left to the store manager to do her best to assist Alison in her time of crisis.

This raises serious concerns about how Boots as a company handled the case. Having been made aware of Alison’s situation, no attempt seems to have been made centrally or high up in the organisation to intervene directly. This was a young woman not only holding down a responsible job dispensing medicines but who was clearly in a severe mental health crisis. Throughout this time, the store manager was also aware that Alison was self-harming—she had confided in her that she had cut her legs. For six months, Boots was aware of Alison’s situation but simply left it to the store manager to deal with it, although I put it on the record again that she did a great job in trying to help, and she did it to the best of her ability.

Sadly, on 25 May 2015, Alison took her own life in a room at the Hardwick Hall hotel, having taken an overdose of prescription medication. At the coroner’s inquest, it was determined that Alison had taken her own life while suffering from depression. Her parents, Mr and Mrs Stamps, attended the inquest. So did representatives from Boots, who made no attempt whatsoever to offer sympathy or speak to the family. The coroner invited those present to introduce themselves, but because it was a public hearing, the Boots representatives chose not to do so. Mr and Mrs Stamps felt, I think understandably, that their attitude was very legalistic—that they were concerned with their fears about the possibility of a legal case as a result of Alison’s death, rather than with having a compassionate understanding of how her death had occurred.

I congratulate the hon. Gentleman on raising an issue in which he takes a great interest, as is clear from other occasions when he has spoken in the House. I believe that this very sad case highlights for all of us the need to ensure that those in the workplace are given adequate training to offer support to workers with depression or other mental health issues. Does the hon. Gentleman agree that the Government must initiate, or make available, courses for all small and medium-sized enterprises, which would be free of charge and which would provide tools for employers that would enable them to help such staff members?

As I have said on other occasions, I think that mental health in the workplace is one of the big issues that we do not talk about. I think the hon. Gentleman’s suggestion should be considered, but what struck me about this case was that it involved not a small employer but a huge multinational company, which should have had the capacity within its organisation to provide assistance.

Does my hon. Friend agree that all employers could benefit from having policies to support staff when they are at work, and when, sadly, an employee dies by suicide? Should not employers be encouraged to take up programmes such as those developed by the Samaritans, Business in the Community and Public Health England for the benefit of staff?

I agree with my hon. Friend. I know that she is involved with the Samaritans, and I congratulate her on the work that she does. Yes, there are a lot of tools out there for companies to use, but they must take them seriously rather than treating them as a tick-box exercise. Policies of this kind must actually be used in the workplace, and people must be trained so that if they encounter a case like Alison’s, they do take it seriously. That is what I would have expected from a large company such as Boots.

Anyone who has looked at the details of this case cannot but be moved by its tragic nature, and by the failure of Boots to exercise its duty of care at a national level. Mr and Mrs Stamps are certain that the long hours and the workload that Alison faced were a contributory factor in her death. I have spoken to representatives of the pharmacists’ trade union, the Pharmacy Defence Association. They made it clear that there are increasing demands on pharmacists, not only in terms of workload but as a result of staff cuts. Last year an article in The Guardian highlighted the situation at Boots, including many emails from Boots’ pharmacists claiming that profit was being put in the place of pharmacists’ health, and that they were increasingly being asked to hit targets for medicines use reviews—the company is paid £28 per review by the NHS—rather than concentrating on dispensing and the care of patients.

Those pressures are putting an increasing strain on pharmacists who work for companies such as Boots, but, like Alison, many choose not to complain, because they fear that if they do so they will lose their jobs or their professional qualifications will be withdrawn. That is a particular issue in the context of mental health, and in professions such as pharmacy. People remain silent for fear of the consequences of speaking up. I think that pharmacists need a system like the one that has been introduced for GPs. Many GPs also do not want to talk about their mental health problems because they fear that they will be disciplined. I think that that was Alison’s fear: she feared that if she raised issues relating to her mental health, she would be taken down the disciplinary route and lose her job.

I suggest to the Minister that that needs to be looked at. Pharmacists should have a system similar to that for GPs. I have done some work on this with GPs. The NHS has the GP health service, which is a confidential service for both GPs and trainees. I have met some of its staff, and it works very well in allowing GPs to self-refer confidentially. The GP health service can help doctors with anything to do with mental health, including stress and depression. The effort that has been made to ensure that there is GP support needs to be replicated for pharmacists, because I can say from a personal point of view that, with the best will in the world, giving someone with depression a helpline to ring is not the answer. People do not ring them; I can say from personal experience that I would not have done so when I suffered from depression. The work done for GPs offers a way forward that I ask the Minister to explore.

I also have to raise questions with the Minister about the role of the General Pharmaceutical Council. Following Alison’s death and Mr and Mrs Stamps coming to see me, I wrote to the GPC asking for its opinion of the case. It wrote back saying that its role was to protect patients by

“setting and upholding standards for individual pharmacists and pharmacy technicians.”

I understand that the GPC has been aware of complaints concerning Boots’ working practices for pharmacists, but has taken no action against that company or—so far as I can see—any other company about how pharmacists were being employed. That raises the question of what this regulator is actually doing.

It is also disappointing that the regulator sees itself as a peripheral player on the issue of workplace pressure and stress, and the pressures put on pharmacists. This stance by the regulator allows employers such as Boots to preside over poor working conditions without any threat of sanction. It says that its job is to protect patients, but if a pharmacist has a severe mental health problem that is being created by workplace pressures and stress, that must be putting patients at risk. The potential danger of mistakes being made will be heightened if pharmacists are under such pressure.

In response to Alison’s death it seems as though Boots was most concerned about its own reputation. At the time, its main concern appeared to be whether any controlled drugs were missing from the pharmacy where she worked. It would appear that the drugs that Alison took to end her life came from the unused drugs that were returned to the pharmacy by patients. Although there is a register of these drugs, I wonder whether there should be tighter regulation because it is up to individual pharmacies whether the drugs are recorded. There should be a process of monitoring how the drugs are collected, registered and ultimately destroyed.

While doing the research for this debate I tried to find statistics on mental health problems and suicide among pharmacists. I am not aware of any statistics being held centrally that show this information. We might look into collating such figures to inform this debate, which is clearly ongoing.

Alison Stamps’ death is a tragedy, not only for her family but for us all as citizens, as we have lost a bright, conscientious young lady with much to offer. Her life was, sadly, cut short by circumstances she thought she could not face. It is quite clear that lessons need to be learned and that changes need to be made, not just in the way we regulate pharmacists but in the way we employ them and treat them in the workplace. Alison’s employer, Boots, should take stock not only of how it is dealing with her case but of how it employs other people within its organisation. It would be right to finish with something that Mr and Mrs Stamps said in a letter to me when they first raised the case with me. They said:

“It is clear that Alison was a victim of corporate greed and collateral damage by an uncaring company intent only on its own agenda.”

I thank the hon. Member for North Durham (Mr Jones) for bringing this debate before the House tonight. I am especially gratified to see so many hon. Members in attendance. This illustrates the very real concern that we have for suicide as an issue, and I welcome their participation here. I know that the hon. Gentleman has been deeply concerned by this incident, and my thoughts also go out to Alison’s family, friends and colleagues. This must be an extremely difficult episode for them. He has described a young woman of great talent and potential, and with timely support she could still have been with us today. I am truly sorry that we have had to hold this debate at all, but in doing so we must learn the appropriate lessons from this case.

Every death by suicide is a tragedy. As the Minister responsible for mental health, I hear from families bereaved by suicide about the devastating impact it has on them. That is why I am determined to drive forward the action we are taking at national level and within local communities to reduce suicides. I am encouraged that suicide numbers have fallen in recent years but they still remain too high. I am aware that the north-east of England has the highest suicide rate in England, and that Durham has one of the highest suicide rates in the region. Really, however, this debate is about Alison Stamps. I am aware that she was a pharmacist, and the hon. Gentleman has raised the issue of suicide risk among pharmacists. He has also put on record his concerns about Boots as an employer. Alison clearly had support in the workplace, but her colleagues did not know how best to help her, and that is not satisfactory.

The hon. Gentleman might be aware that the Office for National Statistics has published research on the suicide risk in occupational groups. While the research did not find a high risk in pharmacists specifically, there is a heightened risk of suicide among health professionals generally. I understand that Alison’s family raised concerns with the coroner about the awareness of mental health issues in the workplace and the ability of employers to support people who experience problems. This is an important concern and one that the Government are addressing.

First, we are looking at the issue of mental health first aid. In Alison’s case, this could have helped. Although general awareness has been raised, we recognise that there is further to go. That is why we have recently announced that we are investing £15 million to deliver an ambitious national mental health campaign to ensure that at least 1 million people receive mental health awareness training. That will be starting next year. Through innovative national programmes to engage the public and continuing to raise the importance of mental health in the same way that we do with physical health, we will increase awareness and knowledge, as well as challenging stigma.

The real concern that the hon. Gentleman has raised about the support—or rather, lack of it—provided to Alison by her employer is firmly at the top of the list in terms of what the Government are doing to address this issue. We recently commissioned Lord Dennis Stevenson and Paul Farmer to conduct a review of how people are supported in the workplace in relation to their mental health and wellbeing. I can advise the House that the outcome will be published shortly, and we will expect employers to step up to the plate as a result of what is in the review.

Pharmacists carry out important and precise work in dispensing medication, and the hon. Gentleman is right to point out that they are exposed to the very tools that can be used to take their own lives if they are minded to do so. I am aware that organisations such as the Pharmacist Support charity, which was set up by the Royal Pharmaceutical Society, do a tremendous amount to support pharmacists on a wide range of issues. That organisation also publishes information and resources about mental health support.

The hon. Gentleman has asked what more can be done, but from the Government’s perspective, the buck stops with the employers. It is they who must ensure that there is sufficient mental health support for their workers. There is much happening in this space, but change will not happen overnight. I am acutely aware that this has come too late for Alison Stamps and her family and is of little consolation, but I hope that improving mental health awareness and creating more mentally friendly and healthy workplaces will increase the likelihood that people will feel able to talk about their mental health problems at work and be assured they will get the understanding and support they need.

I am pleased to say that the profile of suicide prevention has never been so high, which is testament to the progress we are collectively making in tackling the stigma surrounding suicide and mental health problems more widely. I pay tribute to the hon. Gentleman for that. He has done much to raise awareness in this place of the impact of mental ill health. The Prime Minister has spoken about her commitment to tackling the burning injustices of people who experience mental ill health, and many well-known figures have helped to bring this vital issue into the national conversation. I am grateful to the hon. Member for Blaydon (Liz Twist) for mentioning the fantastic work of the Samaritans—what would we do without them? I am pleased to say that I met Ruth Sutherland just this week. The Samaritans is a key partner as we tackle the whole issue of suicide prevention.

Turning to Government action and the suicide prevention strategy, we are making a big step forward and responding to the calls of stakeholders. We need to ensure that locally managed suicide prevention plans are targeted, and we will provide support where plans are insufficient. We have done that because a previous suicide attempt is the strongest indicator of future risk of suicide, so local areas need to keep that intelligence and act upon it. We welcomed last year’s Health Committee inquiry into suicide prevention, which made a wide range of recommendations to reduce suicides. The Government published their response in July to set out how we are progressing many of those recommendations. We also welcomed the recommendation in the five year forward view for mental health to reduce suicides by 10% by 2020-21. The commitment is supported by an additional £25 million between 2018-19 and 2020-21, and we are working with NHS England and other stakeholders to identify the priorities for this funding in local areas.

Local areas are where real change will be delivered, and I am pleased to report that 98% of local areas have a suicide prevention plan in place or in development. I am also pleased that Durham County Council, which serves the constituency of the hon. Member for North Durham, is part of that 98%. Our aim is to reach 100% by the end of the year, but we need a qualitative assessment of the quality of the plans. We do not want this to be a box-ticking exercise, so we will work with local areas to ensure that their plans are high quality and to identify areas for improvement.

We remain committed to delivering the five year forward view for mental health and the Prime Minister’s mental health reforms. That work is supported by an additional £1 billion of funding up to 2020-21 to ensure that an additional 1 million people can access mental health services. We certainly do not want people like Alison Stamps to feel that they have nowhere to go. Much of that investment will directly impact suicide prevention, such as the £400 million we have invested in developing mental health crisis services in the community and the £250 million to implement liaison mental health teams in emergency departments to support people who present at general hospitals with mental health problems.

I am grateful to the Minister for giving way. In Northern Ireland, where health is devolved, we have not had an Assembly for 10 months and we do not have a Health Minister. May I urge the Minister to ensure that there is a suicide prevention strategy? She says that there is a national strategy. I love the word “national” because Northern Ireland is part of the United Kingdom, so will the Minister ensure that the permanent secretary for the Health Department in Northern Ireland is aware of the progress being made in the rest of the United Kingdom? I am encouraged by what she has said this evening.

The hon. Lady makes a fair point, and I will ensure that that is taken up with officials in Northern Ireland, because it is important that the situation is tackled locally.

Members may also be aware that we launched the “Beyond Places of Safety” programme this month to provide £15 million of support for local community-based projects to ensure that there are more appropriate places of safety for people experiencing a mental health crisis and to avoid police custody or unnecessary hospital admissions. That builds on the £15 million we invested in the first phase of the programme.

The forthcoming children and young people Green Paper will set out a range of measures to improve access to services and support for young people. We will provide mental health first aid training to all state secondary schools by 2019, and we will expand that training to state primary schools. I hope hon. Members will agree that the Government’s continued investment and drive to improve mental health services will bring real change for people.

The death of Alison Stamps has been particularly tragic. Her case is a clear lesson that employers need to be alive to the mental health needs of their staff, and I make it clear that that is what we expect. There is political consensus that we must address issues such as suicide prevention, so now is the time for us all to take action to make change a reality for people and communities. We must be ambassadors in ensuring that employers step up to the plate.

As I have set out, this Government are committed to tackling the burning injustices experienced by people with mental health problems so that more people will feel able to speak out about their problems and feel confident that they will get support from those around them, including their employer. I was struck when the hon. Member for North Durham said that people are scared to speak out in case they end up being taken down a disciplinary process or losing their job. That is not acceptable, and employers need to ensure that employees realise that support will be forthcoming.

We have made huge strides on delivering parity of esteem between mental health and physical health, and on ensuring that more people have timely access to services when they need them, but there is still much more to do. We must not be complacent in pursuing those goals. We will be tireless in that pursuit, and I can tell from their interest that other hon. Members will be tireless, too. We must ensure that other families do not have to experience the grief and pain that Alison’s family are feeling now.

Question put and agreed to.

House adjourned.