Surrogacy

Andrew Gwynne Excerpts

Tuesday 14th October 2014 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Edward. I congratulate the hon. Member for Erewash (Jessica Lee) on choosing this interesting and important subject for a Westminster Hall debate. She put the case eloquently, sensitively and sensibly.

It is some decades since the main rules controlling surrogacy were put in place, and it is no exaggeration to say that they are a product of their time. Although there has been welcome progress on some aspects of surrogacy—for example, provision for adoption leave and pay for intended surrogate parents was included in the Children and Families Act 2014—a more fundamental examination of our position on surrogacy is needed, so the debate is extremely timely.

Of course, it is important to say at the outset that the health and well-being of any children born as a result of surrogacy arrangements must be at the heart of our concerns. As the hon. Member for Stevenage (Stephen McPartland) rightly said, that must sit firmly alongside the need to prevent exploitation of any of those involved in surrogacy, but the welfare of children must be paramount.

Aspects of the current situation can certainly be described as troubling. The growth of the internet continues to accelerate, and it takes only a few keystrokes to bring up a search engine web page with paid advertising for commercial surrogacy services abroad. The revelation that Britain may account for as many as 1,000 surrogate births in India every year is shocking enough, but when it is contrasted with the low numbers known to be taking place in Britain, it is clear that the situation requires serious review. There is a clear need for further research to establish the size of the international trade in surrogacy and to enable the development of a deeper understanding of how it functions.

It is not just the hon. Member for Watford (Richard Harrington) and my hon. Friend the Member for Bolton West (Julie Hilling) who have experienced tricky constituency casework on this issue. Earlier this year, she and I had almost identical cases, which we discussed. The legal issues got very tricky, and that was compounded by the passport fiasco. Thankfully, my case, like hers, has been satisfactorily resolved for the parents and the child. However, the cases were tricky, which highlights just how difficult some of these surrogacy arrangements can be. While that can be compounded by factors outside the control of those involved, the arrangements in India were incredibly tricky and caused the parents a lot of heartache and trauma, as well as a lot of unex—I am trying to think of the word. I have lost my train of thought.

[Sir Edward Leigh (in the Chair)]

Unexpected.

[Andrew Gwynne]

Thank you, Sir Edward—unexpected expense. That placed the family in severe difficulties while they were in India.

Although our legislative framework might restrict exploitation in connection with surrogacy in the UK, it might simply be shipping exploitation abroad, where there are undoubted commercial opportunities to make large amounts from the exploitation of poor women. In the past few days the case has been reported of an Australian couple who are said to have abandoned one of two surrogate twin babies born in India, taking only one of them back with them. That amply demonstrates the need for international action. I hope that today’s debate will highlight the need for consideration of an international convention on surrogacy, so that we can put an end to such unethical and immoral practices.

The international dimension is important, but inevitably the question arises of how we might alter the situation in the UK to enable aspiring parents to explore the option of surrogacy in a way that protects all parties and puts children’s interests first. I suggest that we consider three things. The first is an assessment of the scale of the need for surrogacy and whether we can reduce that need through action to reduce the incidence of infertility in women. The second is an assessment of the extent of the international trade in surrogacy; on international health questions, we are much more effective if we operate in concert with other countries. The World Health Organisation appears to take little interest at present in surrogate motherhood issues, and perhaps the United Kingdom, as a member of its executive board, should take a lead in raising the issue and ensuring that it is included in the WHO programme of work. I should be interested to hear how the Minister can take that matter forward. The third thing to consider is a review of UK legislation on surrogate motherhood. Difficult issues will inevitably need to be considered, particularly the potential involvement of commercial interests in arranging surrogacy. The hon. Member for Erewash set out a possible framework, and that should be considered carefully. I am interested to hear the Minister’s response to the important points she made.

The current position is clearly unsatisfactory and in need of attention. If the population is to continue to make use of surrogate motherhood to deal with the problem of infertility, it would surely be better for the processes to take place within an ordered, regulated system here, than in a system that is not ordered, halfway round the world. It would be better for the parents, the surrogate mother and the child. The comments and suggestions made by the hon. Member for Erewash were compelling. She is right to raise the question of how to strengthen our domestic law to protect all concerned. This is a sensitive area that needs to be considered carefully, but there is a need for change at home as well as internationally, and I look to the Minister to give direction, answer questions and consider the possible solutions that Members have suggested. Thank you, Sir Edward, for filling the gaps that were left in my speech when, sadly, my train of thought left my brain.

Community Hospitals

Andrew Gwynne Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is, as ever, a pleasure to serve under your chairmanship, Mr Owen. I congratulate the hon. Member for Dover (Charlie Elphicke) on the eloquent case that he made in opening the debate, and I warmly welcome the Minister, for whom I have a great deal of respect. He will be a huge asset to the Government.

Now that the hon. Member for Strangford (Jim Shannon) has been deserted by the hon. Member for Upper Bann (David Simpson), we are on an equal footing. I assure him that he can aspire to be the second party, because I hope very much that in eight months’ time my party will be back in its rightful place as the main one in the House. However, I am sure that that view will not garner full support in the Chamber today.

As many Members have testified, community hospitals play an important role in the communities they serve. They provide rehabilitation and follow-up care, and they can help to move care, diagnostics and minor injury and out-patient services, among others, from acute hospitals back to the community. They provide planned and unplanned acute care and diagnostic services for patients closer to home, and contribute to the local community by providing employment opportunities and support for community-based groups. It is fairly clear that people prefer the more common medical treatments, whether palliative care, minor injury services or maternity care, to be brought nearer to their homes. Those are exactly the services that community hospitals can help to deliver, as we have heard in the debate.

Community hospitals usually have good relationships with their local communities, and many of the speeches this morning attest to that. They are often supported by local fundraising and, indeed, many were opened prior to the creation of the NHS, by public subscription, as the hon. Member for Congleton (Fiona Bruce) outlined.

We have heard from a number of right hon. and hon. Members today about the great work being done by friends groups. The right hon. Member for North West Hampshire (Sir George Young) and the hon. Members for Stroud (Neil Carmichael) and for Totnes (Dr Wollaston) mentioned those in their areas. I pay tribute to those groups and to the staff and volunteers who work to make things happen in those hospitals. Staff in community hospitals can also build personal relationships with patients and carers as they deliver continuous care from outside the hospital environment, as the hon. Member for Strangford, among others, pointed out. That is an important point that should not be overlooked.

Community hospitals continue to play an important part in health care provision. Their role is valued, and we are right to support it. For the record, Labour continues to be committed to community hospitals when they represent the best solutions for local communities. My constituency is urban and it is served by several large district general hospitals, with not one community hospital, but I acknowledge that other parts of the country have a very different geographical make-up, and that community hospitals are the right way forward for the provision of health care in those communities.

However, the NHS Healthier Together consultation is under way in my area; that is a proposed radical upheaval of hospital care, with fewer and larger specialist hospitals, which will leave some of the smaller district general hospitals to become, effectively, large urban cottage hospitals. It remains to be seen whether that approach will work, but it is at least an option that keeps some hospital care in the community in urban areas. Often full-scale hospital reorganisations do not do that, so perhaps what is happening is a new venture.

Community hospitals can provide a vital step between social care and acute care, and Labour would seek to develop that further. The case made by the right hon. Member for North Somerset (Dr Fox) about, particularly, the invaluable role that community hospitals could play in providing extra respite care beds, is one we should take seriously, especially given the new obligations under the Care Act 2014.

Perhaps community hospitals could move into that role more, along with the provision of more GP and dentistry services. There could be much more provision from within the existing bricks and mortar—services could be nearer to where people live, and there could also be support provision, which is particularly relevant for community hospitals that may at present be only marginally viable. That possibility should be explored.

Some concerns remain, however, and I hope that the Minister will be able to offer the House some reassurance today. He will, I hope, be aware of our ongoing concerns about the Government’s structural reforms. I know that the hon. Member for Stroud has come to a different conclusion, but I think that evidence is mounting that some of the reforms have made the co-ordination and delivery of integrated services far more difficult. I suspect the Government now agree with that view, and that they are permitting the emerging integrated care organisations to be exempted from parts of the regulations on competition under section 75 of the Health and Social Care Act 2012 for precisely that reason. We believe totally that the future requires the integration of care and health services. Yet I fear that some of the Government’s policies are driving us more towards fragmentation. Let us not be in any doubt: community hospitals have a vital role to play. However, as we have discussed, the approach may not be the right one everywhere.

The Labour party remains committed to community hospitals. The last Labour Government introduced a fund specifically to help them, and I suspect that the Vale community hospital in the constituency of the hon. Member for Stroud, which opened in 2011, was paid for partly from that fund. The fund was not automatically taken up by primary care trusts throughout the country and in some areas there was a different view of the role of community hospitals, but where it was taken up, it has clearly made a huge difference to those communities.

I looked at the Care Quality Commission’s website, and the Vale community hospital has an outstanding reputation. The Labour party made a commitment to community hospitals where they are the right choice for the local community, and that commitment continues. I hope that the hon. Member for Maldon (Mr Whittingdale) secures a future for his community hospital because it sounds as though it is really needed in his community.

We are just over a year into the changes introduced by the Health and Social Care Act 2012. I hope that the Minister will take stock of some of those changes and some of the service reconfigurations that are now being proposed in different parts of the country, and reassure us that community hospitals are not being unfairly penalised in the new internal market.

Responsibility for commissioning health care services has moved into the hands of clinical commissioning groups from the former primary care trusts, and there was a worry during deliberation of the Bill that the role of community hospitals might be overlooked. Has the Department assessed whether those fears have come to anything anywhere in the country? The hon. Member for Totnes hit the nail on the head when she referred to the complexity of tendering rounds for funding at the expense of local services. I would be interested to hear the Minister’s view on that.

One obvious consequence of the 2012 Act has been the introduction and rapid expansion of “any qualified provider”, which made it easier for commissioning groups—indeed, it often became necessary—to look outside the NHS to the private sector to provide even more services than ever before.

I am still worried that when trusts are faced with the financial pressures that we have heard about, which arise for a variety of reasons, they often look at the need to remodel clinical services and centralisation, as the hon. Member for Dover said. That takes services away from the community and sometimes from district general hospitals. Sometimes there are sound clinical and financial arguments for that, but it is often financially driven. That will almost certainly have an effect on any extension to the provision of those services in community hospitals.

The concept of whole-person care necessitates patient-centred care closer to where people live, and there may be a huge opportunity for cottage hospitals and other smaller localised health facilities to adapt and to fit comfortably into this model. Clinical commissioning groups and integrated care organisations should look seriously at the possibilities that such facilities provide for the future delivery of joined-up health and social care in a community setting.

The hon. Member for Dover and other hon. Members, including the hon. Member for Totnes, raised the prospect of community hospitals becoming social enterprises. To me, as a member of the Co-operative party, that is an interesting concept. However, in response to an intervention, the hon. Gentleman referred to the NHS “leviathan”. There are pressures on centralisation, as we have heard, but I am worried that under the 2012 Act cottage hospitals will also have to compete with the leviathan of large corporate private providers. I am worried that “any qualified provider” means that private sector organisations will cherry-pick services and leave cottage hospitals vulnerable to the pressures of centralisation and of losing key local services; such organisations are often better at going through the bidding process, as the hon. Member for Totnes said.

This Government and the next should do all they can to ensure that patients can make real choices about receiving the health care they need close to their homes. We must make the vision of whole-person care a reality. Community hospitals are valued and must have a real role in developing and delivering a more integrated and people-centred health care system. I hope that we all support that, and I look forward to the Minister’s reply.

[Albert Owen (in the Chair)]

Before calling the Minister, I add my congratulations to him and welcome him to his new position.

Hospital Car Parking Charges

Andrew Gwynne Excerpts

Monday 1st September 2014 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to follow the hon. Member for Hexham (Guy Opperman). I also thank the hon. Member for Thurrock (Jackie Doyle-Price) for opening the debate in a very thorough and meaningful way. There has been a large degree of consensus across the Chamber on this important issue.

The Opposition welcome any move that could help to ease the financial burden on those suffering from illness. As said, when people go to hospital, the last thing they want to worry about is keeping the car parking ticket up to date. For some patients and their families, the costs can really rack up, and we have seen big increases in charges in recent years, adding to the cost of living crisis facing people up and down the country. In the past four years, more than a quarter of hospital trusts have increased their charges, some of them substantially, as we have heard today, and it cannot be right either if some people do not get visitors because they cannot afford the parking fees. We know that having friends and families around helps patients to get better quicker, which can save the public purse—the NHS—money down the line, as several hon. Members have pointed out.

As we have also heard, the problem extends to staff, too. In my role as a shadow Minister, I get to visit hospitals around the country. A nurse working in Liverpool told me fairly recently how unfair it was that she had to pay for parking, even when her shift ended past 10 pm. She said she often felt vulnerable when using public transport at night, yet she had to pay extra for the privilege of using her own method of transport. Even when public transport is still running, it is not unreasonable to expect better treatment when working late hours.

It is right that we debate this issue today, and I pay tribute to the Members who secured this debate and to the Backbench Business Committee for finding the time to have it in the main Chamber. I also pay tribute to Members on both sides of the House, particularly the hon. Member for Harlow (Robert Halfon), who has pushed this subject on to the Minister’s desk. Despite the consensual nature of Backbench Business Committee debates, it would be wrong of me not to point out that this issue was on Ministers’ desks back in May 2010, when the previous Labour Government left fully costed plans to phase out charges for in-patients—to be fair, the hon. Member for Peterborough (Mr Jackson) mentioned that. Our plans would have seen patients given a permit to cover the length of their stay that visitors could also use to park for free.

The hon. Gentleman also touched on the important issue of information. I do not wish to enter into a game of hospital top trumps with the hon. Member for Hexham, but in 2010 I also spent an awful lot of time in my local hospital through illness. Three weeks into an eight-week stay—my first of two long stays in hospital—my wife was told that she could apply for a parking permit. It was not advertised; somebody mentioned it in passing when she was visiting me in the high-dependency unit. Frankly, that is not on. If there are permit schemes, it should be advertised to all patients and their visitors.

We were also consulting on extending free parking to out-patients, and I want briefly to pay tribute to Macmillan Cancer Support for its campaign on this, but for whatever reasons, Health Ministers shelved our plans soon after the election. At the time, they said there were better uses of public money. I am pleased that there has been an apparent change of heart. Members can imagine my delight in the summer recess when, reading the news, I learned that Ministers had changed their minds. “Victory over parking cowboys” and “End of the hospital parking rip off”, the headlines read. I think we know it is probably not quite as simple as that. Perhaps the Minister will admit that, despite their good intentions, the Government have no power to force hospitals to follow these laudable principles and that trusts are under no such obligation. Is it not the case that all the Secretary of State has done is effectively to amend existing guidelines to suggest that some people should not have to pay to park?

One of the few changes to the guidelines is the addition of pay-on-exit schemes, which is something that we have discussed tonight and which I fully support. As we have heard, appointments often take longer than planned. However, these schemes come with their own additional costs, which was why I was interested in the suggestion from the hon. Member for Harlow of a special fund. Is the Department of Health considering that and will it be contributing towards the purchase and installation of the new equipment and software, not to mention the lost revenue from people paying less across the board?

More broadly, will the Minister confirm that there is no new money attached to the implementation of any of these guidelines? When money is tight, is there not a huge danger that some trusts will be left with the choice of either implementing the principles, which we all support, or threatening to cut back on services? That point started to come out in the arguments put by Members. Indeed, that is exactly what one hospital has already warned about. A governor at Dorset county hospital said:

“When the government makes announcements like this, it has an effect right the way along the line. The money has to come from somewhere.”

That was why I was interested in the special fund idea suggested by the hon. Member for Harlow. It needs proper consideration by the Treasury and the Government.

Is there anything to prevent trusts from no longer offering parking as part of their hospital provision and selling off any car parks they might have developed—particularly multi-storey car parks—with capital costs to a private operator? If we are not careful, that could be one of these unforeseen consequences. Forgive my scepticism, Mr Deputy Speaker, but the problem is that the Government are trying to use the carrot-and-stick approach without either a carrot or a stick. It reminds me of when a public health Minister told a crowd that the Health and Social Care Act 2012 had pretty much given away the Government’s control of the NHS. That is the real reason why I fear those headlines possibly will not match the reality, because the Government have given away so much day-to-day control that I fear they are powerless to do anything about ever-increasing car parking charges, particularly if no funding follows that. The former Health Secretary would be more than entitled to ask the current Health Secretary, “Whatever happened to operational independence?” The guidelines are not mandatory on hospitals, so what confidence can we have that trusts will pay even a blind bit of notice to the new regulations?

Members are right to raise this issue and to push the Government further on it. The aims are laudable, and anything that helps people with the squeeze on living standards, especially at a time of need, when somebody is in hospital, has to be welcome. The challenge for the Government now is actually making it happen.

Mitochondrial Replacement (Public Safety)

Andrew Gwynne Excerpts

Monday 1st September 2014 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

May I first place on the record my thanks to the hon. Member for Congleton (Fiona Bruce) and the other sponsors of this debate for securing the time from the Backbench Business Committee to ensure that the House can discuss such an important issue? I also hope that my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) will get well soon: she should have been closing this debate on behalf of the Opposition, but unfortunately she is not well today. Some people have greatness thrust upon them and I have had to do two Back-Bench business debates this afternoon.

I also thank all hon. and right hon. Members for their contributions throughout the 90 minutes that we have had to discuss this very important issue. We have had no fewer than 19 Back-Bench contributions, which have all been of incredible quality. The impassioned and thoughtful considerations we have heard are a testament to what a sensitive and complex matter this is. As my hon. Friend the Member for Stoke-on-Trent South (Robert Flello) said, it is important that we have this debate, wherever one comes from and wherever one arrives at, and that the House of Commons discusses these issues.

On the one hand, we have celebrated the triumph of science that these new techniques represent. As my hon. Friend the Member for Newcastle upon Tyne Central (Chi Onwurah), the hon. Member for Hexham (Guy Opperman) and the right hon. Member for Havant (Mr Willetts) have said, it is thanks to years of pioneering research at the university of Newcastle into how we can prevent the transmission of genetic mutations that we are finally reaching the point at which we can consider using these transformative techniques in humans. We have within our reach the possibility of eradicating mitochondrial disease from families who have been blighted by it for generations—families who have endured a disease for which there is no cure, who have suffered daily battles with painfully debilitating symptoms and who have lost their children prematurely.

[Glyn Davies (Montgomeryshire) (Con)]

Does the hon. Gentleman accept that those of us who remain uncertain about the proposals share the exact same concern as those who support them about those who suffer from mitochondrial disease? That should never be forgotten: the concern of those of us who are uncertain about the proposals is every bit as great.

[Andrew Gwynne]

I absolutely agree. I have to say that I do not often agree with the hon. Member for Cambridge (Dr Huppert), but he made the very important point—one of many in his speech—that whether people are coming from a scientific perspective or a religious one, their views are equally important in this debate. I am very glad that both sides of this debate have been able to air their views.

Of course, families have had to face up to the risk—perhaps the certainty—that to be a parent will come at the expense of a difficult and, in too many cases, painful life for their children. On the other hand, we have grappled with the undoubted ethical and moral questions raised by the proposed introduction of such techniques. Some hon. Members have shared their anxiety about the uncharted territory we are now in, but that has been good for the public debate. Indeed, the proposed regulations would make Britain the first country to legalise mitochondrial transfer, and scientists have acknowledged that there will always have to be a leap of faith when the technique is first used.

It is important that all these arguments are debated at length and given full and proper consideration, but it is also critical for the integrity of the eventual decision that the debate should be based on the facts. When debating such matters, we will naturally hear a number of contradictory assertions. I hope that the Minister can reassure the House about some of those issues we have discussed.

The first concern raised is that the process has been rushed through. Anybody involved in the development of the techniques would disagree that this has moved quickly. Indeed, my right hon. Friend the Member for Holborn and St Pancras (Frank Dobson) pointed out that the consultation on the process began in 2003. It was more than six years ago—back in 2008—that the Human Fertilisation and Embryology Act 1990 was amended to introduce powers to allow regulations to be brought forward to enable mitochondria replacement to take place. It was back in 2010 that researchers at the university of Newcastle developed the techniques to avoid diseased mitochondria being passed from a mother to her children, and it was not until after another three years of consultation and review processes that the Government announced in July that they would introduce regulations to enable mitochondrial donation techniques to be used. As we have heard, expert scientific review panels in April 2011, March 2013 and June 2014 found no evidence to suggest that the techniques are unsafe for clinical use.

If Parliament passes the regulations, specialist clinicians will have to obtain a licence from the HFEA to use the techniques. A licence will be granted only once the HFEA, operating case by case, is satisfied that any risk of using the techniques is low. I hope that the Minister will provide the House with more detail on the robust process that has been followed for us to reach this point. I ask her to set out the further safeguards built into the regulations to guarantee that the decision to use these techniques cannot be taken lightly.

We have heard concerns that allowing mitochondrial donation is a dangerous road to start down, and might lead to designer babies and parents being able to select the physical characteristics of their children, which I would find absolutely abhorrent. However, we have also heard that those fears do not take into account that the regulations are very specific and cover only mitochondrial DNA, not the nuclear DNA that determines our physical characteristics, as was so eloquently outlined by the right hon. Member for Havant. We are talking about the use of these techniques only in the clearly defined situation of incurable mitochondrial disorders.

The fact that the techniques apply only to the mitochondrial DNA and not to nuclear DNA should provide further reassurance to hon. Members who are concerned that the process will result in three-parent babies, as my right hon. Friend the Member for Holborn and St Pancras said. As we have heard, mitochondrial DNA controls only mitochondrial function and energy production; it is important to point out, as many hon. Members have done, that nuclear DNA, which makes us who we are and determines appearance and personality, is not altered by the proposed techniques. The Nuffield Council on Bioethics conducted an ethical review, which concluded that by “societal norms”, mitochondrial DNA

“does not confer genetic identity.”

Again, it would be helpful if the Minister put it on the record that children who are born from mitochondrial donation will have two biological parents and one mitochondria donor.

Finally, I come to the issue of safety. There have been questions about the safety of the techniques. Again, we must be sure that we base our arguments on facts. Comparisons have been made with the cytoplasmic transfer techniques that were used by a private fertility clinic in the United States in 2002 and the current investigation into the health of the children born from that process. However, this is a fundamentally different technique, as the hon. Member for Mole Valley (Sir Paul Beresford) suggested.

There are other safety concerns that apply directly to mitochondrial donation techniques, and those must be examined in detail. As we have heard, the technique has received unprecedented scrutiny by the HFEA’s specially convened expert scientific review panel. The question for us is whether the benefits of preventing the transmission of mitochondrial disease and the likelihood that children will continue to be born who will die in infancy outweigh the risks of the techniques. The scientific community and the families experiencing mitochondrial disease say that they do. It is now up to Parliament to decide whether it agrees.

We are approaching the final stage in what has been a long and considered process, and we cannot delay it any further. Time is precious for the parents who are at risk of passing on mitochondrial inherited disease to their children. The research has been done, the reviews have been carried out, and the experts and the public have been consulted. The arguments have been made and the families are waiting. It is time for us to make a decision.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Hunt]

The hon. Lady is absolutely right. The figure always in my mind is that by the end of the next Parliament we will have more than 1 million additional over-70s. We need to totally change the way we look after those people, through the single point of contact and a different attitude to continuity of care. One of the things that matters most to those people is the feeling that there is someone in the NHS who knows about their particular needs, their family and their carers. That is the big challenge for the NHS in the next few years.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The Health Secretary does not seem to realise that continuity of care is actually getting worse under him. The GP patient survey shows that the proportion of people who cannot regularly see their preferred GP has risen from 34% in 2012 to 39% in 2014, an increase equivalent to 1.2 million people. Experts say that that is one of the reasons why A and E is under so much pressure. Will he confirm that on Friday it will be precisely one year since hospital A and E departments last met his Government’s own A and E target?

[Mr Hunt]

What I will confirm is that the worst possible thing for continuity of care was Labour’s scrapping of named GPs in 2004. The single thing that makes the biggest difference is to have, for every frail and elderly person in our NHS, someone who is responsible. That is what we are bringing back.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 10th June 2014 Commons Chamber

[Dr Poulter]

My hon. Friend makes a very good point, and we know that rural practices have unique challenges. The point is that because the money from the minimum practice income guarantee is going to be reinvested in a global sum payment, and because the global sum payment per practice is increasing, one of the key determinants of that payment is, in fact, rurality, so that should be of benefit to many rural practices.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The situation is far more urgent than the Minister’s complacent answer suggests. One practice in a deprived part of London has said that it is weeks away from laying off staff and just months away from closure. The Royal College of General Practitioners says that 1,700 practices could be affected, with over 12 million patients potentially facing even longer waits for appointments. Is it not the case that until we have a Labour Government, GP services are going to be marginalised and patients are going to face ever-longer waits?

[Dr Poulter]

I am afraid that the distance between the real world out there for patients and the Labour Government’s record is very clear. Under the Labour Government’s record on general practice, 20% of patients were routinely unable to get a GP appointment within 48 hours, and a quarter of patients who wanted to book an appointment more than 48 hours in advance could not get one. That was what happened under Labour; that is Labour’s commitment to general practice and GP patients. Under this Government, we are making sure that there is equality of finance per patient according to patient need, and that is how health care decisions should be made.

Health

Andrew Gwynne Excerpts

Monday 9th June 2014 Commons Chamber

[David T. C. Davies]

It is not a mixed picture at all and we should be very clear about that. People wait longer for treatment in Wales than they do in England. People wait longer to be diagnosed in Wales than they do in England. People wait longer for an ambulance in Wales than they do in England. Money for the NHS is being cut in Wales and it is being ring-fenced in England, because the NHS will be a priority.

The real disgrace is that Labour Members have always prided themselves on being the party of the NHS and have gone out of their way to do so. Because they have that reputation, they know that in Wales, and possibly in England too if they ever end up running things, they can get away with making cuts and with cosying up to the unions because they feel that people will trust them.

I say to anyone independent and impartial who wants to know what it would be like for NHS patients if Labour Members ever get into government, they should look at what is happening in Wales right now.

[Andrew Gwynne]

rose—

[David T. C. Davies]

I will give way to the hon. Gentleman even though he did not extend that courtesy to me or to anyone else from Wales.

[Andrew Gwynne]

Of course, people only needed to see the NHS at its highest satisfaction levels in 2010 to know what Labour in Westminster would do. I will correct the record on cancer waits, because of course Wales has a better record on cancer waits than England does: 92% of people in Wales are seen within 62 days, as opposed to 86% of people on this side of Offa’s Dyke.

[David T. C. Davies]

That is a fairly minor difference—[Interruption.] Oh yes. However, what the hon. Gentleman has forgotten to say, of course, is that those people in Wales will have waited far longer for the diagnosis of cancer than people in England. That is why he is not being entirely straight in putting his facts across. When he is winding up, I challenge him to say whether he thinks what is going on in Wales at the moment is good and something that Labour Members would like to aim for. Is what is going on in Wales what they aspire to?

I urge anyone in the Opposition to look at The Guardian, which recently did an exposé of the NHS systems around the UK and showed that people in Wales have the longest waiting times of anyone in the United Kingdom, and that is the vision for the NHS that Labour Members want to impose on the people of England. I advise people in England to look at the figures before they decide to vote for Labour Members.

I ask the hon. Member for Denton and Reddish (Andrew Gwynne) if he would be prepared to allow patients in Wales to be treated in England, and patients in England to be treated in Wales if they wish to do so. I doubt very much whether he would support such a thing.

[Andrew Gwynne]

I am grateful to the hon. Gentleman for giving way again. He is obviously not aware that the number of English patients being treated in Welsh hospitals has increased by 10% since 2010.

[David T. C. Davies]

I am well aware of that, but the hon. Gentleman might not be aware that those patients have no choice. [Interruption.] He is laughing, but he does not understand how the system works. There are many patients on the English side of the border who are treated in Wales, but they have no choice about that. They have set up a pressure group, Action for our Health—he can look it up on one of his smart phones—because they are so disgusted with the service that they are getting in Wales that they want to be treated in England. The point is that they do not have a choice, and I believe that they should. Those English patients are very angry about the fact that they are treated in Wales and not given the choice.

When the Secretary of State was talking about some of the things that have gone wrong in the NHS, I heard an Opposition Member shout, “He hates the NHS.” My right hon. Friend does not hate the NHS, but he does believe in putting patient choice and patient voice first. He believes in standing up for patients against vested interests, wherever they may be. I fully support him in that and commend him for what he has done. My only criticism of Ministers in this Government is that they have improved services in England so much that I have an enormous mailbag of letters from people who want to access the services that they have put on offer. If anyone wants to find out what would happen if Labour ran the NHS in England, they should look at the facts and figures for Wales.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 1st April 2014 Commons Chamber

[Jane Ellison]

I know of my hon. Friend’s extraordinary work as a first responder, and we all greatly admire it. He makes another great point about how we tackle this long-term challenge of the sustainability of our acute services. I am happy to draw his comments to the attention of NHS England. I am sure that it is one part of all the things it is looking at as it addresses this issue.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The complacency of this Minister knows no bounds. In 2011, the Prime Minister said:

“I refuse to go back to the days when people had to wait for hours on end to be seen in A and E.”

In 2013-14, the first year after the Government’s reorganisation, we saw the worst year in A and E for a decade, with almost 1 million people waiting longer than four hours to be seen in accident and emergency. As A and E is the barometer of the whole health and care system, is this not the clearest sign that the NHS is getting worse on their watch?

[Jane Ellison]

So desperate are the Opposition, I think the shadow Minister actually used the same opening line that he used at the last Health orals. It really is time to change the script. The NHS has seen more people in A and E than ever before. Waiting times have halved since the last Government left office. If he wants to come to the Dispatch Box and highlight problems in A and E, why does he not try the 86.6% of people being seen in Wales, which is a truly shocking performance statistic.

Stillbirths and Infant Mortality

Andrew Gwynne Excerpts

Wednesday 26th March 2014 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I pay tribute to the hon. Member for Chatham and Aylesford (Tracey Crouch) for securing this important and sensitive debate. There are few more pressing issues than protecting the health of small babies and reducing the deaths of babies under one.

I want to put on record my appreciation of the Rainbow clinic at St Mary’s hospital in Manchester. Mancunians—I am proud to be one—are incredibly proud of the work not only of the Rainbow clinic, but of St Mary’s in general. It is a centre of excellence for Greater Manchester and the north-west, and I am not just saying that because I was born there as a premature baby almost 40 years ago. It genuinely is a superb facility not only for babies, but for mums, and I commend its work, just as the hon. Lady has done.

Members on both sides of the House will know from their experiences and as constituency MPs the heartbreak and pain that the death of an infant can cause a family. I was particularly touched by the powerful speech by the hon. Member for East Worthing and Shoreham (Tim Loughton) about stillbirth. From a recent tragic occurrence in my family where stillborn twins were induced, I sadly know just how painful such an experience can be not only for parents, but for family members and how upsetting losing a child before birth can be. I know how unfair the law is; those children are not legally recognised by the state. The hon. Gentleman is absolutely right that it is important that the law be changed to reflect the realities, so that parents and grandparents can get closure, support and relief during such dreadful occasions.

We have seen some significant advances over the decades. It is easy to forget where we have come from, but we should recognise the work of health professionals and scientists to reduce the infant mortality rate in England and Wales to its lowest levels. In 1981, there were 11.1 infant deaths per 1,000 live births. In 2011, that had dropped to 4.2 per 1,000, equating to a 62% decrease over 30 years. It is worth reminding ourselves that, in 1911, before the introduction of the social security system and the NHS, the rate was 130 deaths per 1,000 live births.

One result of the major improvements in public health over the 20th century, such as slum clearances, the provision of fresh water, mass inoculation, health screening and the NHS, has been a huge reduction in the tragedy of infant mortality. I am proud that the previous Labour Government reduced infant mortality by 27% between 1997 and 2010, which equates to more than a 1,000 fewer baby deaths a year. As we have heard today, however, there is no room for complacency. Hundreds of babies still die each year from perinatal respiratory problems, bowel failure or infection. Such deaths are not evenly distributed across our society, which raises critical questions as to how we tackle health inequalities. In his groundbreaking report on these matters, Sir Michael Marmot said that

“one quarter of all deaths under the age of one would potentially be avoided if all births had the same level of risk as those to women with the lowest level of deprivation”.

Things are getting better, however. We achieved our ambition to narrow the gap of infant mortality by at least 10% between routine and manual socio-economic groups and the England average, but there is still far more work to do.

Office for National Statistics infant mortality statistics for 2011 show that infant mortality rates were highest for babies with fathers employed in semi-routine occupations, such as shop assistants or care assistants. One of the Minister’s predecessors as Minister responsible for public health, the hon. Member for Guildford (Anne Milton), has said that disadvantaged groups and areas have higher infant mortality rates and that poor health outcomes such as that are often linked to social factors, including education, work, income and the environment. I welcome the Government’s recognition of the link between poverty, housing, diet, neighbourhood and health, a point which was made powerfully by the hon. Members for East Worthing and Shoreham and for Chatham and Aylesford. We must continue to tackle the conditions that cause health inequalities and the unfair distribution of infant mortality across society. There is no good reason why, in the seventh richest country on this planet, the likelihood of a family’s baby surviving its first year of life should depend on their socio-economic background. Will the Minister address directly the inequalities around infant mortality and still birth?

We should also note that women over 40 are at greater risk of having a baby who dies before it is one year old. Women under 20 are at greater risk, too. Will the Minister’s speech address how health services can be specifically targeted to support pregnant women over 40 and under 20?

There is a growing understanding that early intervention is the key to preventing infant mortality. The Royal College of Paediatrics and Child Health states:

“The evidence quite clearly states that early intervention is the best form of prevention. Early intervention will not only lead to significant financial savings in the medium to long term, it is underpinned by sound science.”

A healthy pregnancy begins before conception. Action on health issues before pregnancy can prevent many problems for the mother and baby.

The hon. Member for East Worthing and Shoreham made a powerful point about understanding risk factors such as exposure to smoke and prenatal drug or alcohol use by mothers, but there are also positive steps that pregnant women can take to improve their and their unborn baby’s health, such as maintaining a healthy diet and weight, getting the right vitamins, taking folic acid and regularly being physically active. Women need proper advice, information and support to help them to understand the risk factors and make informed, healthy choices. What is the Department of Health doing to promote early intervention, and what resources is the Minister making available for that?

Of course, appropriate information continues to be important during pregnancy and after the child is born. Midwives and health visitors are our most crucial resource in ensuring that women have the information they need at every stage, and in supporting the development of confident, effective parenting. Forming trusting relationships with the women they care for is a critical part of the process, but many women do not have one midwife or health visitor whom they see regularly and with whom they can build a relationship. I hope that the Minister will explain what steps the Government are taking to deal with the problem and improve the consistency of care that women receive in pregnancy and after the birth of their child.

Two hundred babies a year die of sudden infant death syndrome and I welcome the work of the Lullaby Trust and the charity Bliss, which do an important job in advising and supporting parents in that connection. Tragically, five babies a week die without any explanation. Thanks to the “Back to Sleep” campaign, which advised parents to encourage their children to sleep on their backs, the figure is down from five babies a day in the mid-1980s; but five babies a week is still five too many, and I should like to know what the Minister and the Department are doing to try to reduce the figure further.

We have come a long way, but we still have some way to go. Advances in medical science must be matched by provision of NHS services and other social services in every part of the country. No one should be significantly disadvantaged by where they live. For pregnant women and young mothers to take responsibility for their health and that of their babies, they need the warm embrace of a strong system of health care, advice and support. If we want the coming decades to be characterised by further falls in infant mortality, and if we want many fewer families to suffer the terrible tragedy of a baby’s death, we need a continued, concerted and co-ordinated effort throughout Government.

I congratulate the hon. Member for Chatham and Aylesford on securing the debate, because it is important to discuss the matters in question. It was perhaps remiss of me not to convey the apologies of my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger), the shadow Minister who leads on these issues. Sadly, just before the debate, she dislocated her shoulder and hopefully she is now receiving excellent NHS treatment at accident and emergency. I know she would want to pass on her thanks and appreciation to the hon. Member for Chatham and Aylesford for securing the debate and raising an important matter.

Francis Report

Andrew Gwynne Excerpts

Wednesday 5th March 2014 Commons Chamber

[Jonathan Reynolds (Stalybridge and Hyde) (Lab/Co-op)]

I will focus on the impact of the Francis report on my local hospital in Tameside.

Tameside hospital has been a major issue for me, as the MP for Stalybridge and Hyde, and it featured prominently in my election literature in 2010. At the general election, I pledged to work with my hon. Friends the Members for Denton and Reddish (Andrew Gwynne) and for Ashton-under-Lyne (David Heyes), to resolve what we believed to be the serious problems at Tameside hospital by building on their work and statements in the previous Parliament. Securing improvements at the hospital has been a priority for all of us and it will continue to be so. The stance that we have taken, combined with the work of Sir Bruce Keogh, has allowed genuine improvements to take place at Tameside and I am proud of that work.

I regret the journey that there has been in this Parliament towards making Francis a more partisan issue. The Prime Minister’s initial statement on the matter was quite admirable and the work of Sir Bruch Keogh offered a way forward for problem hospitals such as mine. We all stand to lose that if we try to game it for partisan advantage. There is a feeling that the Government have tried to obscure the unpopularity of the NHS reorganisation by doing so. Surely we can all agree that the two matters should not be conflated.

I love the NHS, but I love my constituents even more. If any institution is letting them down, I will not hesitate to call it out. I believe that that is true of all my Opposition colleagues.

The recommendations of the Francis report were, without doubt, an important contribution to improving the quality of health care in England. The circumstances that led to the creation of the Francis inquiry threatened to undermine public faith in the NHS, and a serious and independent investigation into those factors was crucial to maintain people’s trust in the NHS. That investigation was begun by my right hon. Friend the Member for Leigh (Andy Burnham), in whom I have tremendous faith.

The stories of poor care at Mid Staffordshire and other NHS trusts were indefensible and often heartbreaking. I hope that we never see such instances again in the NHS. However, it is important that we also take this opportunity to commend the thousands of doctors and nurses who work tirelessly to provide people in this country with the very best of care. The people who work for the NHS, including those from overseas who choose to come and work in the NHS, do an incredible job and they must always know that we appreciate them greatly.

Following the publication of the Francis report, my local trust, Tameside Hospital NHS Foundation Trust, was one of five trusts that were investigated by Sir Bruce Keogh. It was not the work or recommendations of the Francis inquiry that were of the most immediate significance to my area, but the fact that the publication of the report sparked a chain of events that had a significant impact on the delivery of care at the local hospital in Tameside.

At the time of publication, Tameside had the second worst record for hospital deaths. Data from the summary hospital-level mortality indicator showed that 18% more patients than expected died at Tameside in the 12 months leading up to June 2012. The standards of care at the hospital had been of concern to the public for some time. I should perhaps mention that the information on Tameside hospital was complicated by the legacy of the crimes of Harold Shipman in my constituency. That had a huge impact on how people thought about care at the end of their life and on where they went for that care. That was always a plausible excuse for the mortality scores, but there was a need to push past the excuse and discover the real causes.

In the light of those problems, I cited my concerns about aspects of care at Tameside hospital on the record on several occasions, acting in conjunction with my hon. Friends the Members for Denton and Reddish and for Ashton-under-Lyne. We had already called for the resignation of the trust’s chief executive so that the hospital could improve.

The problems at Tameside were indicative of the broader issues that Francis and Keogh were attempting to address. The confidence of the local community in members of the senior management team had all but disappeared. That led to problems often not being adequately addressed or even acknowledged. The hospital became defensive and saw the issue as one of public relations management, rather than service improvement.

There is a fundamental point that we must grasp if we are properly to understand what factors contribute to the level of public trust. People understand that mistakes are sometimes made. That is the case in all professions and walks of life. However, people cannot understand it—and nor should they—when mistakes happen but no serious attempt is made to address the concerns of patients or clinicians in an open and transparent way to resolve the issues.

Sadly, that is exactly what happened for too long at Tameside hospital. In the worst cases, the hospital management actively tried to downplay the problems raised by patients, family members, elected representatives and even, in some cases, each other. That behaviour is not acceptable and a failure to address it undermines public faith in the NHS.

Putting the spotlight on these hospitals has had some success in breaking through this culture, and Tameside now has a clear set of objectives on which to develop a strategy for improvement. Without the Francis report and the subsequent work of Sir Bruce Keogh, that long overdue process of improvement at Tameside hospital might not have happened. We as local MPs would still be calling for those changes to happen, but we would not have had the expert analysis that the process provided to back up what we were saying.

[Andrew Gwynne (Denton and Reddish) (Lab)]

I am grateful to my hon. Friend for setting out the case. Does he share my confidence that the hospital has indeed turned a corner? Part of that is down to the buddying arrangements with the University Hospital of South Manchester in Wythenshawe and the excellent interim leadership of Karen James.

[Jonathan Reynolds]

I endorse those comments entirely and thank my hon. Friend for his contribution. The negative attention that the hospital received as part of the Keogh investigation was undoubtedly the catalyst for the departure of the former chief executive in 2013, and the first step on the road to improvement.

It is important, however, for us to note the limits of Government’s capacity to push this agenda. Of course, Government have to be the ones who set the framework for improvement in the NHS, but cultural changes can properly come only from the front line. What Tameside hospital now has is a set of recommendations to be implemented, a framework for the delivery of those changes, and new leadership which, ultimately, will deliver the improvements that patients in our area need. I still visit the hospital regularly; indeed, I was there on Friday last week, and I am pleased to say that in my view it is certainly turning a corner. I hope the Government maintain their commitment to all the Francis recommendations, and ensure that the high expectations are hardwired into the NHS’s leaders.

Just before Christmas, I was walking my dogs in Stalybridge as usual, and a friend of mine whom I had not seen for quite a long time shouted over to me. He explained that he had been receiving treatment for more than a year at Tameside hospital. Over that time he had been able to witness, in his words, visible improvements to his care and to how the hospital was run and how it functioned, due to the changes facilitated by the Francis report, the Keogh inquiry and, I believe, the work of myself and my hon. Friends. We will not stop that work or feel self-satisfied because of it, but I am pleased that we have been able to make that difference. That, ultimately, is what we should all be trying to bring about by discussing the anniversary of the Francis report.