Oral Answers to Questions

Baroness Ritchie of Downpatrick Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Hunt]

The attitude to which my hon. Friend refers is totally unacceptable. It is not specifically an NHS problem; we need to change the way of thinking across our society. In particular, I worry about people with dementia who are sometimes in hospital wards where they are not able to speak up for themselves. That is why we have introduced probably the toughest inspection regime of any hospital system anywhere in the world, and I hope it will make a real difference.

[Ms Margaret Ritchie (South Down) (SDLP)]

In view of the fact that there are currently 10 million people in the UK over 65, and the latest projections are for a further 5.5 million elderly people in 20 years’ time, what plans have the Government made to allocate and prioritise resources for the future care of older people with complex needs?

[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.

Organ Transplants

Baroness Ritchie of Downpatrick Excerpts

Tuesday 8th July 2014 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I am pleased to have the opportunity to speak on this subject. We debated the organ donation register only a few weeks ago, but it is appropriate to highlight the issue in national transplant week. I believe that everyone present is committed to ensuring that organ donation increases throughout the United Kingdom.

I pay special tribute to the hon. Member for Stretford and Urmston (Kate Green), because although I am introducing the debate, I must confess that she asked me to do so. We asked the Backbench Business Committee for an opportunity for this debate, and that opportunity has come this morning. I thank the hon. Lady for giving us all the opportunity to participate, and I hope that the debate will be useful to all involved. I also thank the Backbench Business Committee for giving us the opportunity to speak on this subject in national transplant week. I am passionate about organ donation not just because of the cold facts, but because I witnessed first hand how urgent and important organ transplantation is when my nephew Peter required a kidney transplant.

I was delighted to hear that the latest figures from the British Medical Association show that the number of people who have registered to be an organ donor in Northern Ireland has reached an all-time high of just over 582,000. I checked that figure last night and again this morning because I wanted to make sure that it was right, and it is correct: 582,000 people are registered. That is fantastic news. That all-time high has no doubt been aided by the marvellous work of our Health Minister in Northern Ireland, Edwin Poots, who since 2012 has been dedicated to increasing awareness of organ donation and achieving the desired figures.

That said, much more needs to be done. The UK has one of the lowest rates of organ donor registration in Europe, with 96% of the population supporting the principle of organ donation yet only 30% actually being registered. More than anything else, those low numbers are because the UK population is unaware of and often misinformed about organ donation, how to register, the process involved and how vital transplants are. Many campaigns are under way. I do not often read The Sun, but it is running a campaign on transplants. It pursues many issues, and today it is trying to encourage more people to sign up to the organ transplant list.

Currently, 7,000 people are waiting for an organ transplant, and three people die each week while waiting for organs. That is three people too many: three families left heartbroken by the loss of a loved one who could have been treated if more people were on the list to donate. Just one person can save up to nine lives, so the Government must encourage as many people as possible to sign the register. I know that the Minister is committed and that her response will be positive. With this debate, we want to encourage our nations, collectively, to get involved and sign up.

A third of families refuse to give consent for their loved one’s organs to be donated because they are unaware of their loved one’s wishes. That is just one reason why the Government must consider legislating on the introduction of a “soft” presumed consent system, wherein the families of the deceased can object to donation if the deceased dies without expressly electing whether or not to donate their organs. I strongly believe that people should be on the list as an organ donor unless they opt out. That is very much the soft option. Such a system would undoubtedly increase the number of organs available for transplantation and reduce the number of people dying while on waiting lists.

In 2013, the Public Health Agency in Northern Ireland carried out a survey in an attempt to gauge public opinion about organ donation and came up with some interesting figures. It found that 56% were in favour of presumed consent, just 18% were against it, 8% wanted more information and 18% did not know. A further 62% said that they would not opt out if a soft system was introduced. I believe that there is movement among the people of the United Kingdom of Great Britain and Northern Ireland towards the soft option, which we should consider.

The NHS “Taking Organ Transplantation to 2020” strategy seeks to increase donor rates by 80%, but it does not include or discuss the option of a soft opt-out system. Perhaps the Minister could share her thoughts on that in her response. The lack of mention of a soft opt-out is unfortunate, as the strategy refers positively to the evidence from countries such as Belgium, Croatia and Norway showing

“an increase in donation rates following a move to an opt-out system together with investment in infrastructure and raising public awareness of organ donation.”

It is clear that other nations have made the move and seen the benefits; it is time that our nation moved in the same direction.

The 2013 survey also found that 84% of respondents in Northern Ireland supported the idea of transplantation, but only 32% were on the register. Worryingly, more than a third of respondents were not aware that the organ donor register existed, with that lack of awareness being lowest among 16 to 29-year-olds and people over the age of 65. Perhaps we need to do more to encourage people in those two age categories.

[Ms Margaret Ritchie (South Down) (SDLP)]

The hon. Gentleman is making a compelling argument about the need for organ transplants and has addressed the opt-out system that has only recently been introduced in Northern Ireland. Does he have any suggestions as to the possible reasons why many people do not offer to give their organs for donation?

[Jim Shannon]

I thank the hon. Lady for that intervention. I will come on to address that issue later in my speech, but we can do a number of things. In Northern Ireland, when people apply for a driving licence they must decide whether they want to be on the organ donation list. There is no dispute: they have to answer yes or no. If they answer yes, they are on it; if they answer no, they are not. It is as simple as that. I think that that is one reason why 582,000 people are on the donation list in Northern Ireland. Perhaps the Government here on the mainland can take that approach as well.

I want to highlight a couple of other important points about the 2013 survey. Many of the respondents were wrongly informed on the subject of organ donation—for example, one in five wrongly thought that it was possible for a brain-dead person to recover from their injuries and that only the organs of young people were good for transplants. That shows the need for better understanding of the system, and we should look at how we can educate people through campaigns in schools, TV adverts and in GP surgeries. Maybe we MPs can post on our Facebook pages or websites—not maybe; yes we can. We must encourage people to sign up to the organ donation list.

In Northern Ireland, 78% of people surveyed said that they would accept an organ if they needed one. Some 96% of families claim that if they knew their loved one’s wishes, they would agree to the donation. That shows how important it is for families and friends to discuss organ donation. It should be a subject for consideration. Perhaps a media campaign could be organised and the issue written into the storylines of some of the soaps. That might make it an essential subject matter for discussion around the dinner table.

Several charities have backed this debate, and I would like to mention a few shocking statistics that they have kindly supplied me with. I want to focus on cystic fibrosis; I know that other Members will focus on other things. The chief executive of the Cystic Fibrosis Trust, Ed Owen, said:

“We are delighted to lend our support for National Transplant Week. For many with the life-shortening condition of cystic fibrosis, a lung transplant is the only way to prolong life. Yet it is a tragedy that one in three on the transplant list will die waiting for new organs.

It is vital that more lungs are made available for transplantation. So we strongly support measures to encourage more people to donate their organs in the event of their death—and we continue to support a change in the law to a system of presumed consent to help ensure more people have that vital discussion with their loved ones about their wishes.

Alongside this, more effective action is taken to ensure that a greater number of donated organs are used for transplant with a new national lung allocation scheme and greater use of extended criteria lungs. Our report, ‘Hope for More’, published earlier this year, set out a series of recommendations”.

I want some of those recommendations to be looked at.

Last Saturday, I was judging horses. I do not know very much about horses, but I was lucky; they said to me, “Pick the one that looks the best to you,” which was dead easy. It may not have been the horse the experts thought was the right one, but it was the one that I thought was the right one. At that event, I met a constituent, a gentleman with cystic fibrosis. I remembered him as a healthy, active person, but when I met him on Saturday, he told me that his condition had worsened. I am ever conscious of him and of many other constituents affected by this issue.

In March 2014, the Cystic Fibrosis Trust published the report “Hope for More”, which contained 12 recommendations for increasing the number of successful transplants. Key among them was a call for a national lung allocation system similar to the UK urgent heart system. We have a system in place that works; why can we not extend it to lungs? Regular audits have been key to the success of the urgent heart system. Surely a similar system could be introduced in relation to lung transplants.

In Germany and America, the introduction of a lung allocation system has led to a significant increase in lung transplants and huge decreases in waiting lists. I presume that we could do the same here; there is no reason why we cannot. The current system certainly seems flawed. If a patient in the south of England needs a lung transplant, they must wait for one to become available in their area rather than receiving a lung from the midlands or the north of England. We need some kind of scoring system so that those who are most desperate for a transplant receive one first, and people are ordered from those most at risk to those least at risk.

The Cystic Fibrosis Trust has come up with more ways in which the number of organ donors and therefore transplants could be increased. Although time does not permit me to go into great detail—I am conscious that other Members want to contribute—I believe that those suggestions warrant a committee to consider and delve into the issue. I hope that the Minister will indicate in her response whether she feels that a committee would be helpful in moving the campaign and this debate further on.

Existing lung donor criteria were originally drawn up over 30 years ago. Although they were reviewed in 2001, they have changed little. The criteria place limits on donors according to age, previous health complications and a number of other clinical measures. Although it is important to ensure that only viable lungs are transplanted, those limiting rules mean that lungs from fewer than 25% of brain-dead donors are used in clinical lung transplantation. There are clinically viable lungs among the remaining 75%, and we need to maximise their use. I suggest that we look into that.

On lung resizing, data on organs exported overseas suggest that many lungs from larger donors are not used due to size mismatch. The technology exists to resize organs, and it must be made more widely available. People with cystic fibrosis have smaller than average bodies due to difficulties absorbing nutrients from food.

Extracorporeal membrane oxygenation techniques, which artificially preserve critically ill lung transplant patients and allow them extended time to receive donor lungs, have been developed to prevent death. ECMO is available at eight designated centres in the UK, but guidance is lacking on its appropriate use in lung transplants, where it has been shown to work as a bridge between respiratory failure and transplantation. It is feared that without clear guidance, ECMO will not be used appropriately in such circumstances, leading to adverse outcomes for patients.

The NHS Blood and Transplant 2020 strategy commits to providing

“guidance on levels of acceptable risk in relation to offered organs, particularly from extended criteria donors”.

It notes:

“Clinicians…will use their judgment, based on the current national and international evidence, to draw up criteria for non-acceptance”

and that

“there is variation in acceptance practices throughout the UK.”

Further, the strategy lays out actions

“to improve certainty about organ function”,

including investment in research to identify better biomarkers associated with good or poor function.

The Cystic Fibrosis Trust believes that it is the responsibility of NHSBT to publish guidance that brings together current national and international evidence to provide an up-to-date framework to support and guide clinicians’ judgment. It is a weakness of the NHSBT 2020 strategy that there is no commitment to providing clinicians with such a resource. Since the introduction of a German surgeon, André Simon, as head of transplant at Harefield, transplants have increased by 50%, while outcomes have remained every bit as good. It is ascribed to the culture difference in Germany. André Simon, having transferred that willingness to use extended criteria lungs at Harefield, has had an impact on the transplant programme there.

The 2020 strategy mentions the need for NHS hospitals and staff to be better supported to meet demands. That is welcome, but no mention is made of lung downsizing, and very little is made of extended criteria organs. Elsewhere in Europe, donor lung resizing is commonplace and outcomes are equitable with those of lungs that are not resized. Only three doctors in the UK can resize lungs, so it is a lottery as to whether they may happen to be around when needed. That is not disrespectful to anybody; it is a fact of life. Methods such as those, which involve controlled and safe innovation, are key to improving the likelihood of a lung transplant and go hand in hand with the NHSBT’s aim to

“ensure that transplant centres have the capacity and surgical expertise and other clinical skills to meet the demands for transplantation”.

Innovation has not been addressed in detail in the strategy, but it has been identified as an area on which commissioners must focus in order to make it a reality. Although the NHSBT strategy expresses a desire for a 5% increase in the number of hearts and lungs transplanted from donors after brain death, it is unclear how that will be achieved. We believe that there must be a renewed focus on understanding which lungs are suitable for transplant. There is strong evidence indicating that a new approach is increasing the rates of successful lung transplant elsewhere in the world.

Recent scientific guidance suggests that extended criteria lungs are key to progress in increasing lung transplant rates. Research published over the past 10 years by a range of international centres such as the university of Toronto, Hannover medical school, University Hospital Zurich and the Royal Brompton and Harefield Trust suggests that the use of selected extended criteria lungs may safely expand the donor pool without adverse consequences for lung transplantation. Many lungs designated as marginal by the International Society for Heart and Lung Transplantation criteria are now perceived by experts to be as clinically effective as standard criteria lungs.

Things are changing. Scientific evidence and research shows that more lungs are suitable, and we should be using them. Although the medical evidence is continually evolving, public perceptions are falling behind. We must address the issue of education and perception in the general public. We as MPs, this Government and the House can collectively ensure that that happens.

The charity Anthony Nolan seeks to help people with blood cancer or rare blood disorders who require blood stem cell or bone marrow transplants. The charity has said that despite the fact that there are more than 553,000 donors on the register, there are still not matches for every patient in need of life-saving transplants. Once again, more donors from black and minority ethnic communities are needed, as the only chances of finding a match are among those of similar ethnicity.

The average number of donors per constituency is 796, which is encouraging, but more are desperately needed. In my constituency of Strangford, we have a lot to do, with just 381 donors. I intend to use my opportunities as an MP through Facebook, my website, this debate and the local press to encourage more people to sign up and show the importance of organ donation and transplantation back home, but we must encourage Government to consider new ways of campaigning and raising awareness and new approaches, such as a soft opt-out system and a national lung allocation system.

I have had other correspondence from other bodies relating to organ transplants and blood safety. There are certain risks to organ donors, but they can be monitored in such a way as to reduce safety concerns. Maybe we need to raise the level of awareness and education, so that donors know they are in safe hands. We need to ensure that blood donors and organ transplant patients receiving blood transfusions are as well educated and informed on blood safety issues as they can be.

I am very aware that other Members want to speak and I will give them that opportunity; I also want to give the shadow Minister, the hon. Member for Liverpool, Wavertree (Luciana Berger), and the Minister the opportunity to conclude the debate. I will just give a few figures to put matters into perspective. Since 1 April, 309 people have donated organs; an additional 563 people have donated corneas; 824 people have received the gift of sight; and 804 people have received transplants. However, there are still 6,966 people waiting for the gift of a long and healthy life. Ultimately, choosing whether or not to donate organs will always remain the individual’s right, which is good and proper, but we in this place have a responsibility to ensure that the individual is well-versed in the matter and that the choice they make is an informed one. In organ transplant week, we need to focus on the legislative change that can and will put more people on the organ donor list, so that we can save even more lives. The first stage of that campaign is today in Westminster Hall, and we ask the Minister to respond appropriately.

Meningitis B Vaccinations

Baroness Ritchie of Downpatrick Excerpts

Monday 7th July 2014 Commons Chamber

[Geoffrey Clifton-Brown]

I am grateful to the hon. Gentleman for his intervention. As I shall discuss later, this is obviously a big and costly undertaking for the NHS. As I am sure the Minister will mention later, there are delicate negotiations to be had, but if we start with babies—preferably babies under the age of 12 months—and then roll it out to students, the whole population will eventually have been vaccinated. Perhaps that will take too long, and once we have vaccinated those cohorts of the population, we might be able to find the money later to vaccinate other cohorts, but let us start, for goodness’ sake. In particular, vaccinating young babies would be an important start.

In my view, and in the view of many others, the Bexsero vaccine should have been rolled out immediately. Doing so could have prevented around 600 cases of meningitis B, and the associated 200 deaths between January 2013 and now. Although there have been delays in rolling out this vaccine on a national scale in the UK, it has been available privately since December 2013 for parents able to pay the high price, and it has been used across several university campuses in the United States. I am sure the House would agree that it is unsatisfactory that where a vaccine has been licensed and is available for use, only those who can afford to pay can get it.

[Ms Margaret Ritchie (South Down) (SDLP)]

I congratulate the hon. Member for The Cotswolds (Geoffrey Clifton-Brown) on achieving this debate on an extremely important subject that impacts on many of our constituents. I have been tabling questions to the Minister about this. Does the hon. Gentleman agree that the most important issue is the time scale for the roll-out of this vaccine? I agree that the important age cohort is infants, and that vaccination should be rolled out to other age groups later.

[Geoffrey Clifton-Brown]

I thank the hon. Lady for her intervention. The key thing that we want to hear from the Minister tonight is an honest assessment of when the roll-out of the vaccine is likely to happen. That information will be particularly important to parents of young babies.

Within the announcement that there would be vaccine as part of childhood immunisation, the Department for Health stated that the Bexsero vaccine would be made available—I quote from a letter dated 25 April 2014 to me from the Minister—

“subject to it being made available by the manufacturer at a cost-effective price”.

That is the crunch point, as that will be a very large cost to the national health service, and the Minister needs to negotiate a good low price so that immunisation does not become prohibitively expensive. If anyone would like to see a copy of that letter, they should email me at [e-mail] and I will willingly send them a copy. I am told that I am not allowed to deposit it in the Library, otherwise I would do so.

There are three things that I would like to ask the Minister to do. First, what does her Department consider to be a “cost-effective price” for something that will save many lives in the future? Surely it is impossible to put a monetary value on young lives. I urge her not to base her decision solely on how much the vaccine will cost, but to look at the hugely positive effects that implementing a vaccine will have, especially when one considers the trauma that parents have to go through and the devastating pain of losing a young child suddenly within 24 hours. Indeed, there are large costs associated with not vaccinating, as it is estimated that every case of MenB which leads to a severe disability will cost the Government £2 million to £3 million during the life of that child.

Secondly, the announcement made in March confirmed that the vaccine would be introduced only for infants at two months old, with a limited catch-up period for babies up to four months. Given that, as I said earlier, cases peak at around five or six months and the illness remains most common in babies under one year, I urge the Minister to consider implementing the vaccine for all infants under one year old at the time of introduction, to ensure that we protect as many babies as possible. In her response tonight could the Minister inform me of the difference in cost between providing the vaccine for all two-month-old babies, with a catch-up for all four-month-old babies at the time of introducing the vaccine, and the cost of providing it for all 12-month-old infants? I appreciate that she might not have those figures this evening. If she does not know the figures, I would be grateful if she would undertake a cost-benefit analysis of vaccinating all 12-month-old babies and let me have the figures. That would be helpful.

Thirdly, as I said earlier, there is another peak of individuals contracting meningitis B during late adolescence, as my constituent’s granddaughter sadly did. At university, people’s lifestyle is totally different; they mix and get different germs, and unfortunately that seems to mean that they are more susceptible to this dreadful meningitis B. There is therefore a strong case for a roll-out of Bexsero to university students to prevent the spread among that age group. As I have said, some campuses in the US have already administered the vaccine to stop outbreaks of meningitis across the student body. When evaluating the costings, will the Minister please embark on a cost-benefit analysis of providing the vaccine to all 18-year-olds in full-time education?

The Joint Committee on Vaccination and Immunisation has recommended a study to inform its decision on whether to recommend a vaccine for adolescents as the second most at-risk group of people. In her letter to me of 25 April, the Minister told me that the Department is

“considering how best to proceed with this”.

I urge her to instigate the study as soon as possible to prevent any further delays. Once it has been decided how to develop the study, people must be recruited to it as soon as possible, and once the results are available, they should be presented to the JCVI without delay, so that a recommendation can be made quickly. Only with speedy action and decisions can we prevent any more unnecessary deaths and suffering as a result of meningitis B in this group.

I would like to end where I started. Thousands of families suffer from the devastating effects of meningitis B, but we now have a preventive vaccine, which is fantastic news. The vaccine has been licensed for 18 months without being rolled out by the NHS. That delay has had a devastating effect on families of individuals who have contracted the infection and died or become seriously disabled. Now that the JCVI has given a positive recommendation for roll-out of the vaccine, that should happen swiftly. I urge the Minister to conclude rapid negotiations with Novartis. I ask the drug company to enter those negotiations with the Government in a spirit of good will, so that we can get this vaccine rolled out as quickly as possible. I also urge the Minister to consider expanding the current proposal of vaccination to include children up to one year old and adolescents, so that we cover all high-risk groups.

It is now possible to prevent further tragedies similar to that of Emily and thousands of others. We have experienced too many delays already. Let us end those delays, make quick progress, and find ourselves in a situation in which parents are confident that their child will be safe from the devastating effects of this dreadful infection. Every day’s delay is a potential life lost. Please will the Minister act as quickly as she can?

Oral Answers to Questions

Baroness Ritchie of Downpatrick Excerpts

Tuesday 10th June 2014 Commons Chamber

[Jane Ellison]

We all appreciate the wonderful work done by cancer charities such as Macmillan Cancer Support and Cancer Research UK, and the Department works closely with those charities. We want outcomes for cancer patients in England to be among the best in Europe. As I said, we know we are not there yet, but a great deal of effort and money is going into getting there. The NHS is treating more cancer patients than ever. Since 2009, we have seen numbers rise by 15%—that is 1,000 more patients with suspected cancer referred to a specialist every day. That is the success of some of the early diagnosis and awareness raising activity. Of course we want any local dips in performance to be addressed, but let us give credit where it is due to clinicians who are diagnosing more cancers and catching them earlier, because that is the key to treating cancer successfully.

[Ms Margaret Ritchie (South Down) (SDLP)]

5. If he will meet the chair of the College of Emergency Medicine to discuss A and E units.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I met the chair of the College of Emergency Medicine four times in the last six months and I will meet him again next week.

[Ms Ritchie]

I thank the Secretary of State for his answer. Will he tell the House what progress has been made by Health Education England, along with the College of Emergency Medicine, to recruit trainee doctors from India in an attempt to address the serious staffing shortages in emergency medicines departments? Will he work with Ministers from other devolved regions to address the serious shortage in A and E doctors, which is having an impact on waiting lists in hospitals the length and breadth of the UK?

[Mr Hunt]

The hon. Lady is right that operational pressures on A and E are happening throughout the United Kingdom. We have made good progress in recruiting 50 A and E doctors to help relieve pressure this year in A and E departments, but that is a short-term measure. The long-term issue is to get more doctors going into A and E from training, and we are looking at contract structures and at what we can do with training schedules to make that more attractive. We will certainly work with colleagues in devolved Administrations and tell them what we have learned.

Oral Answers to Questions

Baroness Ritchie of Downpatrick Excerpts

Tuesday 25th February 2014 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. I encourage those on the Opposition Front Bench in particular to talk to a few people in A and E and ask whether they think they have been supportive, in a very difficult winter, by whipping up all these scare stories when, in fact, because of their hard work, we are seeing 2,000 more people every single day in less than four hours than when the shadow Secretary of State was Health Secretary. A and E is performing better than ever.

[Ms Margaret Ritchie (South Down) (SDLP)]

T5. There are nearly 500 UK-trained medical practitioners now working in Australia, of whom 6% never return owing to the better conditions available there. What steps will the Secretary of State and his ministerial team take to ensure that we retain those qualifying in emergency medicine this year, to keep local A and E departments open in Britain and Northern Ireland?

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

I would like to point out to the hon. Lady that it is not unusual for doctors in training to work overseas to improve their medical experience. Many of my contemporaries did that, and every one I know has returned to work in the NHS in the UK. It is a common phenomenon that benefits doctors’ experience. What we have done, unlike the previous Government, is ensure that we now have a 100% fill rate for people entering A and E common stem training.

NHS

Baroness Ritchie of Downpatrick Excerpts

Wednesday 5th February 2014 Commons Chamber

[Mr Hunt]

Let us be absolutely clear. Why has Labour decided to remove the word “crisis” from the motion it submitted to the House this afternoon? It does not mention the word “crisis” at all, because the winter crisis that the right hon. Gentleman has been predicting for over six months now has simply not materialised.

Let us look—this is important—at how the right hon. Gentleman has been manipulating the statistics. He knows perfectly well that there is no A and E target for single categories of A and E; rather, the target applies to all A and Es. He gets his numbers by singling out the biggest A and E departments, type 1s, which are extremely important. How did type 1s—the most important and biggest A and Es—perform during the winter when he was Health Secretary? Let me tell the House: they missed their target every single week up until this point in the year. There are indeed pressures on A and E departments, but why does he think the country will listen to him, when by his own yardstick he failed to deliver every single week up until this point in the year?

The right hon. Gentleman has been predicting a winter crisis for months, and we are still waiting. For him, these debates are not about the reality on the ground; they are about hyperbole and spin. As someone who has been Health Secretary, he must know—this is a serious point—the effect that lurid headlines based on dubious statistics have on morale for staff and those using the NHS, but still we get the same cracked record, because for him, politics always matters more than patients.

It is not just A and E performance; under this Government—[Interruption.] It might not be comfortable for the Opposition, but let us look at the figures. Under this Government, MRSA rates have virtually halved, mixed-sex wards have nearly been eliminated and when it comes to elective care, more than 35,000 fewer people are waiting more than 18 weeks. That is thanks to the efforts of hard-working front-line staff. Our NHS is doing 800,000 more operations year in, year out than it did under Labour—something we can be immensely proud of.

[Ms Margaret Ritchie (South Down) (SDLP)]

My right hon. Friend the Member for Leigh (Andy Burnham), the shadow Secretary of State, has referred to comments by Dr Cliff Mann about the shortage of A and E doctors and the fact that the issue was flagged up some two years ago. What will the Government do to address the 50% shortage in A and E doctors, not only in England but throughout the UK?

[Mr Hunt]

The hon. Lady is right to highlight the fact that there has been a long-standing issue with recruitment into A and E. We have made some good progress. We have 350 more consultants in post than at the time of the election, but we need to do even better, so we are looking at the training process for A and E consultants. We are also looking at the contractual terms for A and E consultants, particularly as they relate to things such as shift work, to try to make it a more attractive profession. I am confident that these issues are now being addressed—in fact, I have had some encouraging feedback from the College of Emergency Medicine saying that it, too, is confident about that.

Oral Answers to Questions

Baroness Ritchie of Downpatrick Excerpts

Tuesday 14th January 2014 Commons Chamber

[Jane Ellison]

I can confirm that the Department of Health is investing an additional £250 million over the next two years in A and E, with NHS England also allocating an additional £150 million for the current year. Milton Keynes has been allocated £2.8 million to support local initiatives to relieve pressures on A and E, and I know that, as a great champion for his local hospital, my hon. Friend will welcome that additional support.

[Ms Margaret Ritchie (South Down) (SDLP)]

Given the ongoing crisis in A and E units in the UK, particularly in the area I represent in Northern Ireland, will the Minister confirm whether the Health Minister in Northern Ireland has had discussions about possible solutions to finding and recruiting extra doctors?

[Dr Poulter]

I am not aware of any direct conversations with Ministers here, but as the hon. Lady will be aware, the Minister responsible for A and E services is my right hon. and noble Friend Earl Howe. I will write to her about the discussions that have been had with the noble Lord and Health Education England.

Accident and Emergency

Baroness Ritchie of Downpatrick Excerpts

Wednesday 18th December 2013 Commons Chamber

[Andy Burnham]

That is the central point of my speech: the removal of the guarantee that patients could get an appointment within two working days. The Government removed it in June 2010 and, as a result, we all hear stories, do we not, of people saying that they are getting up and ringing the surgery at 8 or 9 o’clock in the morning and are being told that there is nothing available for days. That is a result of the Government’s decision to remove the two-day guarantee. That is why people are facing that frustration. I shall explain that in more detail—[Interruption.] Government Members say that the guarantee did not work, but in 2005 nine out of 10 people said that they could get an appointment within two days. Have those Members checked the figures recently? There is falling satisfaction with GP services and it is happening on their watch.

I asked the Secretary of State whether he had spoken to the Work and Pensions Secretary, and he needs to do so urgently. The truth is that pressure has been growing all year on A and E and he has been ignoring the warnings, sticking to his usual line of blaming everyone else. His original line was to blame the 2004 GP contract, but that was undermined by the Chair of the Select Committee on Health and the inconvenient fact that there was no winter crisis in 2005, 2006, 2007, 2008 or, indeed, 2009.

Having seen his original spin dismissed, the Secretary of State changed tack. In a message to NHS staff on 6 December he said:

“Our ageing society has meant 1.2 million more people in A&E every year compared to 3 years ago”.

Finally we have an admission that the pressure has built on his watch, but as ever, it is nothing to do with the Government. It is nothing to do with the break-up of NHS Direct and its replacement with the disastrous NHS 111, nothing to do with the closure of a quarter of NHS walk-in centres, nothing to do with the severe cuts to social care and the removal of home care from vulnerable people, nothing to do with the loss of 6,000 nursing jobs and nothing to do with the reorganisation that no one wanted and no one voted for that threw the entire NHS into chaos just when it needed stability and that has led to precious NHS money being spent on redundancy payments only for those people to be re-employed by new NHS bodies. No, it is now all the fault of the ageing society. You could not make it up, Madam Deputy Speaker.

[Ms Margaret Ritchie (South Down) (SDLP)]

My right hon. Friend is making a compelling case about the problems in accident and emergency. Is he aware that they extend to Northern Ireland? Although devolved arrangements are responsible, we are told that the problems are down to the shortage of doctors, which emanates from Whitehall and the Department of Health. It is no longer a compulsory part of GP training for doctors to do a component in A and E and that is causing a problem.

[Andy Burnham]

I mentioned the reorganisation, through which we saw the complete disruption of training arrangements in the NHS. The Government’s eye was taken completely off the ball of the growing problem of recruitment, not just of GPs but of A and E doctors. That is a real problem around the country. We now have fewer GPs per 1,000 of population than we had a few years ago, so my hon. Friend is absolutely right to raise that issue.

The new spin is that the Secretary of State admits that A and E has got worse on the Government’s watch, but it is not his fault and it is not a crisis. That is the public line, at least. In private, it is a different story. This is the Secretary of State who has taken up ringing hospital chief executives who are not meeting their A and E targets. I have heard from two senior sources that the Secretary of State has discussed within government whether Cobra should be convened to discuss the A and E crisis. Can he confirm or deny whether that is the case? I have no way of knowing, but he needs to give a straight answer.

The longer we see the Secretary of State in this job, the more familiar we become with his style: spin before substance. That is the real danger when someone holds a job as important as his. If they use spin to distract people from the real causes of the problems, they end up neglecting those problems and precious time is lost.

Rare Diseases

Baroness Ritchie of Downpatrick Excerpts

Tuesday 17th December 2013 Westminster Hall

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Bayley. I thank the shadow Minister, the hon. Member for Copeland (Mr Reed) for his generous offer of support, and I am sure that we will be able to deliver his preconditions for that support. I congratulate the hon. Member for Strangford (Jim Shannon) on securing the debate. He is, as the shadow Minister has said, one of the most assiduous attendees at health debates and a consistent contributor on a whole range of different issues. We all welcome his contributions. He always makes the case for better co-ordination and collaboration between the different nations of the United Kingdom, and I completely share that aspiration. There is great value in a bit of diversity in the development of our health systems, because we can often learn things from the innovation and experimentation taking place in other parts of the United Kingdom. In opposition, I visited Northern Ireland because I was fascinated by the way in which Northern Ireland commissions and provides health and social care together. I wanted to learn more about the experiences in Northern Ireland, good and bad. Such diversity is to be valued and we should not have a one-size-fits-all approach, but I agree with the hon. Gentleman about the importance of collaboration. The Government’s strategy is an example of where that can be really strong and effective.

[Ms Margaret Ritchie (South Down) (SDLP)]

On the Minister’s point about collaboration, is he aware that a drug to deal with atypical haemolytic uraemic syndrome has been approved in England but the same approval has not been given in the devolved institutions, particularly in Northern Ireland?

[Norman Lamb]

I was not aware of that, but I am interested to hear it, and the hon. Lady makes her case powerfully. Before I respond fully to the points made by the hon. Member for Strangford, I want to deal with some of the other issues that have arisen during the debate. Several hon. Members, including the shadow Minister, asked whether the new architecture of the NHS had damaged the co-ordination of work on rare diseases. In many respects, I can reassure hon. Members. There is a danger that if one was coming into this place from afar and hearing the debate, one might think that we were moving from an idealised, perfect scenario into something more troubling. We all know, however, that that is absolutely not the case. The treatment of rare diseases historically has been far from optimal, and the greater involvement of clinicians in the commissioning of care can have real benefits for patients. Until 31 March 2013, far from being a simple matter, specialised commissioning was fragmented across a range of NHS organisations including regional specialised commissioning groups, a national specialised commissioning team and local primary care trusts, which remained ultimately responsible for the specialised health care of their populations. From 1 April 2013, under the terms of the Health and Social Care Act 2012, NHS England became the sole direct commissioner of specialised services, which provides a greater simplicity in the commissioning of services.

Tobacco Products (Plain Packaging)

Baroness Ritchie of Downpatrick Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Bob Blackman]

As I shall describe later, the evidence indicates the reverse; I will come to that in a few minutes.

I am pleased that the borough of Harrow, which I have the honour to represent, has a lower than average smoking rate. The latest data still estimate that 500 11 to 15-year-olds in Harrow currently smoke, which is 500 too many. I am sure that other hon. Members here have much higher smoking rates in their constituencies. Clearly, the Government’s duty to local authorities to promote public health means that they will have to take action against smoking.

[Ms Margaret Ritchie (South Down) (SDLP)]

Does the hon. Gentleman agree that some research suggests that when young people and children start smoking ordinary cigarettes, they can then move on to harder drugs, destroying not only their health but their families and their future career and health prospects?

[Bob Blackman]

Clearly, the younger someone starts smoking, the more likely they are to increase their smoking in later life, and the greater harm they will do their health. Evidence indicates that the earlier someone starts, the more heavily they are likely to smoke later in life, increasing their dependency and lowering their chances of quitting. They therefore have a higher chance of premature death from smoking-related disease. The appalling truth is that half of all lifetime smokers will die from illness caused by their addiction.