This article was first published on www.WriteYou.co.uk
As she entered Number 10, Theresa May announced herself as a social reformer committed to tackling the inequalities and injustices that persist in Britain.
This was a welcome statement of intent, albeit one that will be overshadowed by the Brexit negotiations and economic instability that look set to dominate the early part of her premiership.
Keeping unfashionable social issues high on the political agenda will be tough, and the record of the previous Conservative governments hardly inspires confidence. But if she really hopes to secure a legacy as a bold reformer and a champion for those left on the margins of society, May must succeed where her predecessor fell short by showing the drive and ambition to act on her promising early rhetoric around mental health.
The challenge was succinctly put on the steps of Downing Street: “If you suffer from mental health problems, there’s not enough help to hand.”
Mental health has always been the ‘Cinderella service’ in the NHS, accounting for around 13% of NHS funding despite making up a quarter of the burden of illness. People with mental ill health do not enjoy the same rights of access to evidence-based treatment, close to home and on a timely basis, as those with physical conditions. All too often they are denied the treatment they need, or are shunted across the country in search of a hospital bed during a crisis.
The Liberal Democrats spearheaded a genuine momentum for change in the Coalition Government. One of my proudest moments as a minister was launching a new five-year blueprint for transforming mental health services for children and young people, backed by £1.25bn in funding.
We delivered a historic agreement on transforming mental health crisis care. And critically, we introduced the first ever access rights and maximum waiting time standards in mental health, guaranteeing fast access to effective treatment for people with common mental health conditions and psychosis.
The mission to achieve genuine equality for mental health was taking shape, and David Cameron’s majority Conservative Government had a solid platform to build on. But he depressingly failed to continue this progress – and indeed, the momentum has stalled more dramatically than most of us anticipated.
Promised investment in children’s mental health care failed to materialise in the scale promised. The scandal of sending people long distances from home to receive treatment is as widespread as ever. In February, the Mental Health Taskforce delivered a landmark strategy for ending the historic discrimination against people with mental health in the NHS; five months on, the Government has still not set out how it intends to ensure that this vision becomes reality.
Most outrageous of all, there is evidence of a failure to properly implement the flagship new access standards in mental health which came into force in April. In contrast, performance against key targets in the physical health system continues to be examined in forensic detail every week in the Department of Health.
Britain needs a Prime Minister who will place mental health at the heart of their agenda. For all his hollow rhetoric, mental health was never anything more than an afterthought for Cameron; and so my challenge to Theresa May is to seize the initiative and make this a key priority for her government.
We cannot afford to let mental health get drowned out by Brexit and the wider chaos that has engulfed our political system. If the moral case for action is not compelling enough, then the estimated £105bn annual economic cost of mental illness will surely be a test of the pragmatism so often celebrated by May’s colleagues.
Her maiden comments as PM hit the right note as she identified poor mental health care as a leading social malaise. While it remains to be seen whether she lives up to the weight of expectation that will now follow, some have already suggested that she will pursue her priorities with greater resolve than her predecessor – giving pride of place to policy rather than PR, substance over style. It’s the sort of gritty determination that the mental health community could welcome after a year of inertia from Whitehall.
May has a historic opportunity to be remembered as the Prime Minister who made a profound difference to the lives of the one in four people who will suffer from a mental illness. Let’s hope she doesn’t squander it.
Norman Lamb, the Liberal Democrat MP for North Norfolk has challenged the Government to guarantee the right of the 110,000 EU nationals working in the NHS and social care system to remain in the UK.
The Government has so far refused to guarantee the rights of EU citizens to remain in the UK following the decision to leave the European Union, with the Foreign Secretary Philip Hammond stating that any guarantee would have to be negotiated in Brexit talks as part of a deal for Britons living abroad.
Speaking at Health Questions in the House of Commons (5th July), Norman Lamb spoke out in support of EU migrants working in the health and care system, and attacked “the despicable suggestion that they should be used as a bargaining pawn in negotiations with the EU”.
The Lib Dem Health Spokesperson challenged the Health Secretary to work with the Government urgently to secure the right of EU citizens to remain in the UK. However, Jeremy Hunt fell short of any such commitment, and could only offer vague assurances that the Government “wants to find a way” of allowing them to stay in the UK for as long as they wish.
Speaking afterwards, Norman Lamb said: “It’s important that we recognise and pay tribute to the dedicated staff from across the EU, and indeed the rest of the world, who play an essential role in our NHS and social care services.
“Our entire health and care system would be brought to the point of collapse if hardworking EU citizens were forced to return to their native countries – and it would be a travesty if they were made to feel so unwelcome in the UK that they decided to leave of their own accord.
“Britain is the home of everybody who was living and working here on June 23rd. It should be their fundamental right to stay in this country, and I’m horrified that the Conservative Government doesn’t seem to share this view. The Liberal Democrats will continue to speak out to defend the rights of EU migrants living in the UK, so that they can continue to enrich our society and carry on making an invaluable contribution to our public services.”
The full exchange in the House of Commons is below:
Norman Lamb MP: Very many of those 110,000 people are now acutely anxious about their future in this country, because of the despicable suggestion that they should be used as a bargaining pawn in negotiations with the EU. Will the Secretary of State ensure that the Government, as a matter of urgency, guarantee their future in this country doing their dedicated work in our NHS and care system?
Secretary of State for Health, Jeremy Hunt MP: I can reassure the right hon. Gentleman that we are incredibly aware of the brilliant work that EU nationals do, not just in the NHS but in the social care system, which he was responsible for, in care homes up and down the country. We recognise that, and I hope that he will be reassured by statements made by the Foreign Secretary and the Home Secretary yesterday that we want to find a way of allowing those people to stay in the UK for as long as they wish to. We recognise the incredibly valuable contribution that they make, and we are confident in the negotiations ahead that we will be able to secure the outcome that they and we all want.
By Brenner Munden
Norman Lamb, the MP for North Norfolk and Liberal Democrat spokesperson for Health, attended a charity event at Cromer Ambulance Station last Sunday (3rd July). Norman opened the day with the Mayor of Cromer, Cllr Timothy Adams, to celebrate the vital role of local emergency services and the hard work they provide to the local community.
Local organisations that had stalls at the event included Age UK, RNLI, and Norfolk Lowland Search and Rescue. The Norfolk Ambulance Service were also joined by Norfolk Fire and Rescue Service and Norfolk Police.
Throughout the afternoon, live music and refreshments were offered to all who visited, and proceeds will go to Nelson's Journey, a charity that supports bereaved children in Norfolk.
The afternoon was a huge success with many local people attending in support of the charities. Last year, the open day raised over £300 for Nelson's Journey.
Speaking after the event, Norman Lamb said: "I was really pleased to have the opportunity to open the event. It was fantastic to see all the local organisations getting support from everyone who came. Paramedics dedicate their lives to this job, working incredibly hard behind the scenes as well as on the front line. Thank you to all paramedics for their dedication, and to all who attended in support today."
Photo: Norman Lamb MP and paramedic Fraer Stevenson
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Norman Lamb, the Liberal Democrat spokesperson for Health, yesterday argued for a change in the law which would prohibit the use of Tasers in psychiatric wards and end the use of police cells to detain adults under Sections 135/136 of the Mental Health Act.
The proposals were part of a raft of amendments to the Policing and Crime Bill, tabled by the North Norfolk MP to protect the rights and wellbeing of people with mental illness.
In 2007, the United Nations Committee Against Torture has stated that Taser X26 weapons – the type used by trained police officers in the UK – provoke extreme pain and constitute a form of torture, and have even been known to cause death in certain cases. The Home Secretary was also quoted earlier this year saying: “I have been hearing stories, for example, of Tasers having been used in mental health wards and you think, ‘Hang on a minute, what is happening here?’”
Speaking in the House of Commons, Norman Lamb said that he wanted to begin a wider debate on whether it is appropriate to use electroshock weapons against mental health patients, after the charity Black Mental Health UK called for an end to the practice.
Mr. Lamb also praised the “inspiring leadership” of police officers and mental health services in places such as London and the West Midlands, where the use of police cells for people experiencing a mental health crisis has ended in all but the most extreme cases.
The Policing and Crime Bill prohibits any child aged under 18 from being removed to a police station as a place of safety under S135/136 of the Mental Health Act. Arguing for the ban to be extended to cover adults, which is supported by the mental health charity Mind, Mr. Lamb said: “If those areas of the country with impressive leadership can do it, we should challenge every part of the country to do so, and the Bill should lead the way.”
The amendments were not supported by the Conservative Government or the Labour Party, and will not become law.
Speaking after the debate in the House of Commons, Norman Lamb said:
“I was pleased to put forward these important amendments to improve the rights of people with mental ill health, who are too often let down by the system.
“Tasers present an enormous ethical dilemma. Whilst I appreciate the arguments put forward by some police officers for the use of Tasers as a last resort, there is a powerful case to be made for ending their use in mental health wards altogether.
“In some U.S. states including New York, Pennsylvania, and Ohio, Tasers are not permitted in state psychiatric wards. Police officers are required to store their weapons in a secure area or lock box before entering a patient area.”
“I hope that my amendments will help to kick-start a full and frank debate on the circumstances, if any, in which it can be necessary or justified to use a Taser in a mental health ward.
“I will also continue to argue against the use of police cells for adults detained under the Mental Health Act. Although I welcome the Government’s commitment to end the use of police stations for children, it seems arbitrary that adults in some parts of the country will still have to suffer this indignity due to a lack of health-based alternatives. People with mental illness should not be treated like criminals.”
During the debate, Norman Lamb also argued for his other amendments to the Policing and Crime Bill which would:
Prevent a person from being taken back to their own home and detained there if they are sectioned under section 136 of the Mental Health Act. For some people experiencing a mental health crisis, being detained by a stranger in their own home can cause long-lasting damage for the way they feel about their home. In the Commons, Norman Lamb argued: “The fear is that that will become the default position in some localities because of the lack of resources available… In circumstances where section 136 is used, surely the person should be taken to a health-based place of safety.”
Place a duty on the police or local authority to ensure that children who are believed to be the victims of sexual abuse or exploitation are referred to an appropriate mental health service for assessment and appropriate support. This seeks to implement one of the recommendations in the ‘Future in Mind’ report on children’s mental health services published by Norman Lamb in the Coalition Government, which states that sexually abused and exploited children should receive “a comprehensive specialist initial assessment, and referral to appropriate services providing evidence-based interventions according to their need.”
Extend the right to an independent mental health advocate to people detained under sections 135/136. An appropriate adult can help a person understand their rights and the reasons why certain decisions have been made, speak on their behalf, and stand up for their interests if they have been badly treated. Anyone detained under the Mental Health Act currently has a right to an advocate, apart from people who are detained under certain short term sections (4, 5, 135 and 136).
Ensure that the permitted 24-hour ‘period of detention’ for people detained under sections 135/136 would start at the point a person was detained, rather than the time they arrived at a place of safety. This would address concerns that people might be travelling for a long time before arriving at their place of safety, deprived of their liberty, without this being counted in the permitted period of detention.
Norman Lamb, MP for North Norfolk, is showing his support for unpaid carers across the country by backing this week's annual awareness campaign, Carers Week.
Carers Week 2016 (6th-12th June) aims to raise awareness of the vital contribution made by the 6.5 million people in the UK who care unpaid for a disabled, older or ill family member or friend, and the pressures and challenges they face.
Stress, anxiety and depression are all too common among carers in the UK, who often struggle to combine their caring responsibilities with work, education, and personal relationships. New research launched for Cares Week 2016 shows that 3 in 4 carers don’t feel that their caring role is understood or valued by their community. The survey found that:
- 51% of carers have let a health problem go untreated and 50% said their mental health has got worse, while 4 in 10 haven’t received any training or information about how to stay well.
- A third of carers (33%) say their employer doesn’t have policies in place to support them. Of these, 72% had to give up work or reduced their hours, and more than half have suffered higher stress levels (57%) or struggled financially (55%).
- Nearly half (46%) of carers say there are no policies in place to support them at their school, college or university. 48% of these were unable to progress their education and were forced to give up their studies.
That is why the focus for this year’s Carers Week is on ‘Building Carer Friendly Communities’ – communities which support carers to look after their loved ones, while also recognising that they are individuals with needs of their own.
In a Carer Friendly Community, for example, a GP service might offer appointments at times that fit around a person’s caring responsibilities; employers might offer flexible working hours; and a college or university could offer young carers flexible timetables and coursework extensions to allow students to continue their education and work towards a bright future.
Norman Lamb MP, Liberal Democrat Health Spokesperson and former Minister of State for Care and Support (2012-15), said:
“It is extremely important that we recognise the dedicated and inspiring care given by millions of unpaid carers every single day. Whether it’s by providing emotional support, personal care like getting someone dressed and helping them to the bathroom, or helping with daily routines like shopping, cleaning and cooking, carers make an invaluable contribution to society which too often goes unnoticed.
“Yet without the right support and understanding from the community, the pressure of being a carer can take its toll. Nobody should be expected to care for someone else without support for their own personal, physical and emotional wellbeing, and that is why I’m pledging my support for the campaign to build Carer Friendly Communities.
“By doing things a little differently, we can make a really positive difference to the lives of carers by helping them to pursue an education, stay in work, and find the time to look after their own health. I hope this year’s Carers Week will be a catalyst to provide carers with the help and support they need.”
About Carers Week 2016
Carers Week takes place from 6–12 June 2016, across the UK.
Carers Week is an annual awareness campaign which takes place to celebrate and recognise the vital contribution made by the UK’s 6.5 million carers. It is also a time of intensive local activity with thousands of events planned for carers across the UK.
Carers Week is made possible by Carers UK joining forces with Age UK, Carers Trust, Independent Age, Macmillan Cancer Support, Motor Neurone Disease Association and MS Society. Carers Week is supported by Sainsbury’s, Nutricia and the Lockwood Charitable Foundation.
Facts about carers
- 6.5 million people in the UK are carers; that’s 1 in 8 adults
- By 2037, it is estimated that the number of carers in the UK will rise to 9 million
- Every day another 6,000 people take on a caring responsibility – that equals over 2 million people every year
- 58% of carers are women and 42% are men
- Carers save the economy £132 billion per year, an average of £19,336 per carer
- Over 3 million people juggle care with work, however the significant demands of caring mean that 1 in 5 carers are forced to give up work altogether
Norman Lamb, Liberal Democrat MP for North Norfolk, today challenged the Government to ensure that social care services in Norfolk do not miss out on vital resources from the Better Care Fund, after Norfolk County Council was informed that local CCGs and NHS England plan to remove additional funding that was provided to protect social care last year.
The Better Care Fund, which pools resources from the NHS and local government to strengthen the integration of health and social care services in a locality, has been beset by concerns that the Fund is mainly being used to ease pressures in the NHS, rather than provide much-needed support to social care services which are under severe strain.
In a letter sent on behalf of West Norfolk, Norwich, South Norfolk, Great Yarmouth and Waveney, and North Norfolk CCGs, seen by Norman Lamb MP, Norfolk County Council was informed that none of the CCGs are able to support spending plans to protect social care in the 2016/17 round of the Better Care Fund, due to pressures on CCG finances.
The CCGs admit that the decision, which is endorsed by NHS England, will leave Norfolk County Council “with a significant challenge in bridging the [financial] position during 2016/17”.
In Parliamentary Questions to the Secretary of State for Communities and Local Government, Norman Lamb referred to the latest developments in Norfolk as an example of the failure of the Better Care Fund to properly support social care. He said that there was a “very real risk” that elderly people and people with disabilities would miss out, and asked how the Department for Communities and Local Government will work together with the Department for Health to address the situation.
Commenting after speaking in the House of Commons, Norman Lamb said:
“We have a deeply worrying situation in Norfolk. The whole point of the Better Care Fund, which I helped establish, was to invest more in joined up care which prevents people becoming more unwell and ending up in hospital.
“The decision by the Clinical Commissioning Groups to remove funding for the protection of social care is, in one sense, understandable, because they face an impossible financial challenge. But it is disastrous for vital support services for frail elderly people and disabled people.
“The ridiculous thing is that it will end up with more people being admitted to hospital with all the disruption to people's lives that that involves and it will cost more to the NHS.
“The bottom line is that the NHS and social care need more resources. That's why I will keep repeating my call for a cross party commission to develop a long term settlement for the NHS and care.”
Norman Lamb’s full question in the House of Commons was as follows:
“In my county of Norfolk, the clinical commissioning groups have told the County Council that they are withdrawing the money from the Better Care Fund that was available for the protection of social care last year, leaving at least a £7.5 million gap. What is he doing in his discussions with the Secretary of State for Health to ensure that social care is protected? The risk of elderly, frail people and disabled people losing out more is very real.”
The full response of the Secretary of State for Communities and Local Government, Greg Clark MP, was as follows:
“The Gentleman knows from his experience at the Department of Health how important it is to make sure that the social care system and the health care system are joined up. Part of the integration of health and social care is to make sure that these people – whether they are patients of the NHS, or whether they are cared for by local authorities – can have the best care available delivered in the most efficient way.”
Shocking new figures on the length of time patients wait in ambulances outside A&E departments have been uncovered by Norman Lamb, Liberal Democrat MP for North Norfolk.
The number of people waiting longer than 2 hours to be handed over to hospital staff quadrupled over the last 3 years, according to figures obtained from England's ten ambulance trusts following Freedom of Information requests.
A total of 10,418 people waited more than 2 hours in 2015/16 - a dramatic increase from just 2,215 in 2013/14. The figures were unveiled on ITV's Good Morning Britain.
Patients in London and the West Midlands were forced to endure waits of more than 9 hours before being admitted to A&E. The audit also showed that the number of people waiting more than an hour almost trebled from 26,462 to 70,504 over the same period.
The national target for handing patients over from ambulance crews to hospital staff is 15 minutes. However, figures show that a total of 397,308 hours were wasted due to handover delays exceeding this 15-minutes target - which is equivalent to a staggering 16,554 days.
In the North West, the number of people waiting for more than an hour increased four-fold and the number waiting more than 2 hours increased ten-fold. In the East of England, seven times as many people were waiting over 2 hours, while the total number of hours lost due to handover delays more than doubled from 25,000 to almost 55,000.
Commenting on the findings, Norman Lamb said:
“It is hard to imagine just how distressing it must be for a patient, having been rushed to A&E in urgent need of treatment, to then be left waiting hours for the care they need. The strain this puts on NHS staff and finances is also unsustainable.
“The Government cannot ignore the desperate state acute hospitals are now in, as they struggle to cope with the demand for services and limited resource. And it is quite clear that this problem is getting rapidly worse, not better.
“If the Health Secretary wants to show he is serious about protecting patients, and safeguarding our health and care services for future generations, he must bring together a commission of independent and cross-party experts to look at how to deliver health and care more sustainably and to secure a new long term financial settlement for the NHS and social care. These figures are yet more evidence of how seriously such a Commission is needed. At present the Government is sleep-walking towards a severe crash in the NHS which will have dreadful consequences for patients.”
Norman Lamb has also written a blog for Liberal Democrat Voice.
Norman Lamb, MP for North Norfolk, has called on the Government to extend the Public Interest Disclosure Act 1998, which provides legal protection for whistleblowers, to cover foster carers.
The call has been made during Foster Care Fortnight 2016 (16th-29th May), the UK’s biggest annual campaign to showcase the commitment, passion and dedication of foster carers and to highlight the need for more than 9,000 new foster families in the next 12 months.
The Public Interest Disclosure Act 1998 (PIDA) protects workers from detrimental treatment or victimisation from their employer if, in the public interest, they speak out against wrongdoing or malpractice.
However, the Act does not currently apply to foster carers – meaning that foster carers are in an extremely vulnerable position if they choose to disclose information about alleged wrongdoing such as criminal offences, illegal activity, or threats to the health and safety of a child. Foster carers are therefore less likely to have the confidence to blow the whistle, potentially placing children at continued risk.
In 2013, the Whistleblowing Commission chaired by the Rt. Hon. Sir Anthony Hooper recommended that PIDA is extended to cover foster carers to address this. Norman Lamb has now tabled a parliamentary motion calling on the Government to act on this recommendation by bringing forward proposals to extend the scope of the Act.
He has also written to the Chief Executive of the Fostering Network, which is the UK’s leading fostering charity, inviting them to support the motion.
Norman Lamb said: “I am very happy to raise this important issue in Parliament during Foster Care Fortnight. Too often foster carers are left marginalised and voiceless. The Queen’s Speech last week promised new legislation to improve the adoption system, but it was conspicuously silent on the invaluable role of foster carers who give a loving home to thousands of children in need.
“The wellbeing and safety of children will continue to be under threat if the Government does not address this legal anomaly and lack of rights for foster carers with regard to whistleblowing. Foster carers must be afforded the same protections that other carers enjoy. That was the clear recommendation of the Whistleblowing Commission, and I hope that the Government takes steps to implement this sooner rather than later.”
The motion has been welcomed by the Norfolk Foster Care Association. Ray Bewry, from the NFCA, said: “We are highly encouraged by Mr Lamb’s initiative coming in this Foster Care Fortnight. The success of Mr Lamb’s motion will, we believe, give Foster Carers the courage to blow the whistle, giving them the same protection afforded by PIDA to all other members of the Care Team.”
Full text of the Parliamentary Motion:
EDM 53: FOSTER CARERS AND THE PUBLIC INTEREST DISCLOSURE ACT
That this House notes that the Public Interest Disclosure Act 1998 (PIDA) does not cover foster carers; further notes that such carers are therefore in a vulnerable position if they choose to speak out about alleged wrongdoing or poor practice; expresses concern that this may act as a disincentive to foster carers exposing wrongdoing or poor practice, thereby potentially putting vulnerable children at continued risk; notes that the Whistleblowing Commission chaired by the right hon. Sir Anthony Hooper recommended that the Government uses the powers set out in section 20 of the Enterprise Regulatory Reform Act 2013 to extend PIDA to cover foster carers; and therefore calls on the Government to bring forward proposals to extend the scope of that Act accordingly.
Norman Lamb, MP for North Norfolk, has tabled a parliamentary motion calling for urgent action to ensure that women are properly informed of the risks of a drug which can cause severe harm to an unborn child.
Valproate is used for treating epilepsy and bipolar disorder – but has long been known to carry an increased risk of birth defects and developmental disorders in babies when taken by pregnant women. These can include spina bifida, malformations of the face, skull, limbs and organs, lower intelligence, poor speech and language skills, and memory problems.
Following a Europe-wide review, which came about following pressure from Norman Lamb and campaigners during his time as Health Minister, the Medicines and Healthcare Products Regulatory Agency (MHRA) has developed a Toolkit to ensure that women who are being prescribed valproate medicines are better informed about the risks of the drug during pregnancy. The Toolkit includes clearer warning labels on valproate packaging, information booklets for women, and a checklist to ensure that the risks have been properly discussed with the prescribing clinician.
Although the Government says that the Toolkit should have been issued by the MHRA and the manufacturer in February 2016, there have been reports that many clinicians and pharmacies have not received these essential resources – meaning that women across the country remain at risk of taking the medicine without being fully aware of its dangers.
The motion tabled by Norman Lamb calls on the MHRA, UK Government, and NHS England to intervene urgently to ensure that the Valproate Toolkit is received and properly utilised by clinicians and pharmacists nationwide.
Norman Lamb said: “It’s incredibly worrying that this crucial information Toolkit isn’t getting through to women as it should. Valproate can cause severe harm to an unborn child, and the decision to use the medicine should only be made when a woman is fully informed of its risks.
“These risks have been known by regulators for decades. Now that this Toolkit has finally been developed, the Government, MHRA and NHS England must waste absolutely no time in getting to the root of this problem. There has to be accountability.”
Janet Williams and Emma Murphy from IN-FACT (The Independent Fetal Anti Convulsant Trust), which has campaigned for better communication of the risks of using valproate in pregnancy, said:
“IN-FACT worked closely with the MHRA to agree and disseminate the Valproate Toolkit. But because the MHRA has only sent the toolkit to pharmacies and surgeries that subscribe to its alerts system, it seems that its distribution has been left largely in the hands of the drugs company.
“This has caused system failure with this vital information not reaching women of child-bearing age, and therefore around 30,000 women prescribed valproate unable to make that all-important informed choice.”
EDM 83: VALPROATE TOOLKIT
That this House notes with concern that the medicine valproate, which is used for the treatment of epilepsy and bipolar disorder, can seriously harm an unborn child when taken during pregnancy, including increased risk of malformations and developmental disorders; welcomes the development of a valproate toolkit to aid communication of the risks of valproate in pregnancy, including a warning on package labelling, a checklist for discussion between prescribers and patients, a reminder card and information booklet for women, and a booklet for healthcare professionals; further notes that the toolkit was disseminated by the Medicines and Healthcare products Regulatory Agency (MHRA) and the valproate manufacturer, Sanofi, in February 2016; expresses concern at reports that many pharmacists and clinicians have not received the toolkit, potentially leaving many women ill-informed of the severe risks of the medicine; and urgently calls on the Government, the MHRA and NHS England to work together to ensure that the toolkit is effectively disseminated and utilised across the country so that all women being prescribed valproate are fully informed of the risks to an unborn child.