Covid-19 Regulations: Assisted Deaths Abroad

Baroness Stuart of Edgbaston Excerpts

Tuesday 10th November 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the debate has not been scheduled, but evidence that would be of interest includes evidence from clinicians themselves, many of whom have seen some movement in their attitudes on this subject. There is also an enormous amount of values-based and faith-based evidence from those who have a particular view on this subject. There is also the evidence of the personal choices of those approaching death themselves. There are extremely moving testimonies by individuals faced with very daunting and challenging circumstances. All of these views have relevance and value, and they should all be part of this important and delicate debate.

[Baroness Stuart of Edgbaston (Non-Afl)]

My Lords, in response to the noble Baroness, Lady Grey-Thompson, the Minister stressed that this was travel advice, but surely it goes further than just travel advice. At a time of Covid, when many people in care homes would seek the companionship of members of their families but forgo it in the wider community interest, is it really the right decision to create a presumption that people at the end of life only have the option to travel abroad and to facilitate that? Surely more palliative care and more focus on helping people to a good death are more important during this Covid crisis than facilitating people to travel abroad.

[Lord Bethell (Con)]

I entirely agree with the noble Baroness that the contribution of hospices and the role of those involved in palliative care has been an incredibly important part of the Covid crisis, and it has given huge succour, compassion and care for those at the end of their life. We have sought to help with the financing of the hospice community with a substantial £150 million payment in the first wave, and there are currently talks in place on funding for hospice care through the second wave. Hospices’ work is enormously valued, and anything in this debate does nothing to underplay the value of the role that they play at the end of people’s lives.

Covid-19: Charitably Funded Hospices

Baroness Stuart of Edgbaston Excerpts

Wednesday 28th October 2020 Lords Chamber

[Lord Bethell (Con)]

The noble Lord is entirely right to cite the challenge being faced by Sue Ryder and other hospice charities that depend on retail income. They face a most difficult and challenging problem; it is one that we acknowledge and recognise. The question of misdiagnosis leading to a bump in arrivals in hospices is not one that I have been conscious or aware of, but I am grateful to the noble Lord for flagging it up for me. I will take that back to the department and, if it is something that we should be focused on, I will write to him accordingly.

[Baroness Stuart of Edgbaston (Non-Afl)]

My Lords, the manner of our going is as important to the human condition as the good life lived. Hospices have played an important role, in particular those hospices that care for children. The provision for children’s hospices is very patchy across the country, as is their need. At the meeting on 4 November, will the Minister pay particular attention to hospices caring for children and providing the necessary outreach work to families?

[Lord Bethell (Con)]

The issue raised by the noble Baroness is one that I am aware of. Who can think of a more moving cause than hospices for children? This will be definitely be on the agenda for 4 November and I will raise the issue with my honourable friend the Minister for Social Care.

William Mead: 111 Helpline

Baroness Stuart of Edgbaston Excerpts

Tuesday 26th January 2016 Commons Chamber

[Mr Hunt]

All 111 services have clinicians present at call centres, so it is about not the availability of clinicians, but the speed with which they are involved in cases where they can make a difference. It is also about the training of those clinicians so that they can recognise horrible infections such as sepsis quickly. It is a combination of things. The important thing here is that if we are to give the public confidence in a simpler system where they have a single point of contact—albeit a phone line or a website—they need to be confident that if they are not immediately speaking to someone who is clinically trained they will be put through to such a person if it is necessary. We have not earned that confidence yet, which is why it is so important that we learn lessons from what happened in this tragic case.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

I was the Minister who set up NHS Direct, and one of the first cases that caused us to review the algorithms was a meningitis case. May I therefore say to the Secretary of State that just looking at the algorithms used by call-handlers will not be sufficient? It is clinically exceptionally difficult, and his review is too limited to address the problem.

[Mr Hunt]

I understand what the right hon. Lady is saying, and of course I would listen to her because of her experience, but I reassure her that that is not the only thing that we are doing; we are doing lots of other things. The report makes many recommendations, one of which is to look at the algorithms that the call-handlers use to make sure that they are more sensitive to some of the red-flag signs of sepsis, meningitis and other conditions. There are lots of other recommendations. They include earlier access to clinicians where appropriate, and recommendations on the training of clinicians in the out-of-hours service, the training of GPs and the training of people in hospitals. So we will be undertaking a much bigger body of work as a result of this review.

Junior Doctors Contract

Baroness Stuart of Edgbaston Excerpts

Monday 30th November 2015 Commons Chamber

[Mr Speaker]

Order. The Secretary of State is seeking to provide comprehensive and informative replies and that is appreciated. However, progress so far—and it is not entirely down to the Secretary of State, but to the length of questions—has been a bit slow. I am keen to get through everybody if possible, but I remind the House that the next debate is very heavily subscribed, so brief questions and brief answers are the order of the day. We will be led, as usual, in this matter by Gisela Stuart.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

When the Secretary of State chaired his three contingency meetings, did he take account of the fact that last year we had about 43,900 excess winter deaths, which were avoidable and largely caused by almost toxic overcrowding of emergency departments? What provisions has he made to avoid the excess deaths that we had last year and to make sure that that is not made even worse by the present situation?

[Mr Hunt]

The hon. Lady is right to be concerned by the much higher than normal excess winter deaths that we had, but I would not characterise the reason for those excess deaths as she did. We think they were largely caused by the ineffectiveness of the flu vaccine that was recommended by the World Health Organisation last year but proved not to be as effective as it normally is. The early signs are that this year’s flu vaccine will be more effective. Those excess deaths are deaths at home and throughout the system, not just in hospitals, but of course we are doing everything this winter, as we did last winter, to make sure that we minimise the possibility of excess deaths.

Junior Doctors’ Contracts

Baroness Stuart of Edgbaston Excerpts

Wednesday 28th October 2015 Commons Chamber

[Heidi Alexander]

If the hon. Gentleman reads the motion, he will see that it talks about a return to the negotiating table, but the BMA and the junior doctors need to know that the Health Secretary is genuinely willing to compromise, and his performance over the past few months suggests otherwise.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

My constituency has one of the highest proportions of doctors of any in the country. My junior doctors are worried that they are being asked to work in conditions that are becoming unsafe. They also point out that they have choices, and many do not think that their future lies in this country. They will make a different choice because the damage has already been done.

[Heidi Alexander]

My right hon. Friend is completely right, and I will come to some of those challenges later in my speech.

When the NHS is facing unprecedented challenges, it cannot be right to pick a fight with the very people who keep our hospitals running. I come here today to ask the Secretary of State to do three things: to show that he is willing to compromise by withdrawing the threat of contract imposition; to guarantee that no junior doctor will be paid less to do the same, or more, than they are currently doing; and to ensure financial penalties for any hospital that forces doctors to work excessive and exhausting hours.

--- Later in debate ---

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

I beg to move an amendment, to leave out from “House” to the end of the Question and add:

“welcomes the Government’s commitment to delivering seven-day hospital services and saving lives by combating the weekend effect; notes the British Medical Association’s (BMA) decision to walk away from negotiations to reform a contract which all sides acknowledge is not fit for purpose; further notes the Government’s proposed introduction of new contractual limits which protect staff from working unsafe hours and the commitment that average junior doctors’ pay will not fall; and calls on the BMA to put patient care first, to choose talks over strikes, and to return to negotiations.”.

I warmly welcome the hon. Member for Lewisham East (Heidi Alexander) to her post at her first Opposition day debate.

One Saturday in April 2006 a 20-year-old man called John Moore-Robinson was out mountain biking with his friends in Cannock Chase when he fell off his bike and the handlebars hit his stomach. His friends dialled 999 and he was rushed to hospital. Although the paramedic who took him to hospital thought he had life-threatening internal bleeding, instead of being treated he was left for 50 minutes, apart from a brief examination. Then he was told he had bruised ribs and sent home. In fact, he had a ruptured spleen and tragically died later that Saturday night.

Tragedies happen in any healthcare system, and despite such stories I am fiercely proud of our NHS and the brilliant care given by our doctors and nurses seven days a week. The hon. Lady was right to thank each and every one of them. Anyone who uses such stories to denigrate the NHS should remember that last year the Commonwealth fund rated us the best healthcare system of 11 major countries—better than France, Germany, Australia or the US—and rated our A and E departments —[Interruption.] It was the Opposition who called this debate, so they might want to listen to some of the arguments. This is a very important issue about the lives of NHS patients, and I am saying that the tragedies and the problems we have should not be used to denigrate the NHS or our A and E departments.

Part of being the best in the world is being honest about where we need to improve, and the fact remains that in our hospitals today we have around three times less medical cover at weekends. In our manifesto in May this Government committed to a truly seven-day NHS so that we prevent a repeat of the tragedy that happened to John Moore-Robinson.

[Ms Gisela Stuart]

The Secretary of State is absolutely right that we need to address the fact that there seems to be less cover at the weekends. He is trying to circle that square without expanding the number of doctors and the services. He is thinning the service on Monday to Friday to bring more cover to the weekends. That does not solve the problem.

[Mr Hunt]

I am happy to deal with that. We went into the election in May saying that on the back of a strong economy we were prepared to commit £10 billion extra to the NHS in real terms over the course of this Parliament. That was £5.5 billion more than the hon. Lady’s party was prepared to commit. In the last Parliament, when the increase in NHS spend was half that amount, we increased the number of doctors by 9,000, so we are increasing the number of doctors, but as we do so we need to ensure that we give the right care to patients.

I want to give a word of caution to the shadow Secretary of State. The tragedy of John Moore-Robinson, the gentleman I have mentioned, happened not only on a Saturday, but at Mid Staffs. The last time the House discussed the difference between excess and avoidable deaths was under a Labour Government, when they tried to brush the problems at Mid Staffs under the carpet, saying that we should not take the figures on excess deaths too seriously because they were a statistical construct and different from avoidable deaths. I would have hoped that the Labour party learned the lessons of Mid Staffs and would not make the same mistakes again. [Interruption.]

NHS: Financial Performance

Baroness Stuart of Edgbaston Excerpts

Monday 12th October 2015 Commons Chamber

[Ben Gummer]

My hon. Friend is entirely right. Every penny that we can save in bureaucracy and administration is a penny that we can spend on patient care, which is why the Secretary of State commissioned Lord Carter to look at the administration and bureaucracy that surrounds hospitals especially. Lord Carter has identified many billions of savings that can be made, and I anticipate that there will be more to come.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

The university hospitals trust in Birmingham, Edgbaston is balancing its books, but the neighbouring hospital, Heartlands, ran up a deficit of £5.6 million last year. In the first five months of this year, the deficit has reached £29.4 million. GPs in Worcestershire recommend that their patients are not referred to Worcestershire hospitals but to University Hospitals Birmingham NHS Foundation Trust. What action has the Minister taken to prevent those few hospitals that are balancing their books from being pushed over the edge?

[Ben Gummer]

The right hon. Lady makes the important point that exceptional hospitals such as her own not only balance their books, but have a management culture that allows them to deliver some of the best care in the country. She is right that there is a continuing challenge for all trusts, whether they are well managed or poorly managed. The measures that we have brought in, especially those on agency nurses, are designed to enable the chief executive of her trust to continue with that exceptional management in the years to come.

A&E Services

Baroness Stuart of Edgbaston Excerpts

Wednesday 24th June 2015 Commons Chamber

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Thank you, Madam Deputy Speaker; it is an exceptional pleasure to speak while you are in the Chair. I hope that I will be forgiven for returning to the motion, which seems to have slipped Members’ minds over the past hour or so. It specifically states:

“That this House notes that hospital A&E departments have now missed the four-hour A&E target for 100 weeks in a row; further notes that trusts are predicting record deficits this year”.

The Government were asked to respond to that. As the Minister singularly failed to do so at the start of the debate, I hope that he will return to it in closing.

I have in my patch the University Hospitals Birmingham NHS Foundation Trust, where I first met a heart surgeon call Sir Bruce Keogh—I am not entirely sure what happened to him. I therefore have either the highest or the second highest proportion of constituents who are either doctors or who work in the health service, so the NHS and everything associated with it is something that I cannot escape. I thought that it would be useful to have an NHS tracker survey, which records over a period of time how the health service is seen not just by those who use it, but by those who work in it. I want briefly to share the results of the surveys with the House, because they show that the people who use the NHS and who work in it are becoming increasingly concerned about the conditions in which they are treated or in which they work.

I received about 400 responses to the last survey. Some 74% of respondents said that they were very concerned about the future of the NHS. One respondent commented:

“I work in a large university hospital Emergency Department”.

We have a number of large trusts in the west midlands conurbation, so people might be living in my constituency but working in a different trust.

“The hospital bed occupancy consistently exceeds 99%, with hundreds of well patients in beds unable to be discharged due to inadequate social care. Consequently, the A&E is overwhelmed with patients lying on trolleys while I scrabble around trying to get something done.”

Another respondent said:

“My work load leaves me worrying about my own health in the future.”

Another referred to

“staff shortage on wards leading to the use of more agency staff, wasting money on unnecessary management… staff are stressed due to doing more shifts to make ends meet.”

Another said:

“All parties want better 24-hour access but there are not enough trained doctors—especially GPs—coming through the system, and too much money is spent on bank staff and locums.

That is not political scaremongering; that is what people who work in the health service have said.

We have face up to that. It is no good sitting here and pretending that we have no control over it. Decisions on the NHS are political decisions, because we decide annually how much money to spend on it. That means that there has to be some element of control. University Hospitals Birmingham has said:

“Emergency Department activity has continued to rise with the Trust passing the 102,000 ED attendances a year… equating to a 4.9% increase”.

Those are enormous numbers—102,000 emergency admissions in one hospital—and they are going up year on year.

That brings me to the targets. I know that they are difficult, but I remember that when we introduced them they were about the only way we could get good consultants to change their way of doing things. They kept saying, “This is the only way of doing it,” so we said, “Let’s try with targets.” If we look at the most recent statistics on waiting times of four hours or less in the west midlands, we see that Walsall Healthcare NHS Trust has achieved 95%; University Hospitals Birmingham has achieved 95%; but University Hospitals Coventry and Warwickshire NHS Trust achieved 79%; Worcestershire Acute Hospitals NHS Trust achieved 81%; and the University Hospital of North Staffordshire NHS Trust achieved 87%. That tells us that something is going on that is not quite right. I think that we ought to start debates such as this one by saying, “Both sides agree that something is going on that is not quite right.” These figures are not just inventions. They tell us the trend, so how do we address it?

The Government got rid of NHS Direct, and 111 did not replace it—[Interruption.] It is no good the Minister shaking his head. I set up NHS Direct, and the big thing was that there were trained nurses, not call handlers. They managed to deal with demand because the person on the other end of the phone could make a clinical decision, not just pass it on. We have had those knock-on effects. I hope that at least at some stage over the next two hours the motion on the Order Paper will be addressed. The trend is in the wrong direction and we need to think about what to do about it. People are waiting longer and the hospital deficits will be horrendous. This will be a problem for us all.

Oral Answers to Questions

Baroness Stuart of Edgbaston Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Ben Gummer]

I thank my hon. Friend for bringing that to my attention. I was not aware of it and it is certainly something I shall consider. There are several specialties in the NHS where this is a problem and I shall be addressing that as I review the workforce in the years to come.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Of course the Minister knows that his problem is not just recruitment; it is also retention. In that context, is he planning to make greater use of physicians’ assistants?

[Ben Gummer]

Yes.

Child and Adolescent Mental Health Services

Baroness Stuart of Edgbaston Excerpts

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

My hon. Friend makes an important point, and there are many excellent mental health services, as the hon. Member for somewhere in Birmingham—[Interruption.]—for Halesowen and Rowley Regis (James Morris), said earlier. If some areas can do things well with the available resources, then other areas can too. It is also true that some areas have chosen to cut funding for children’s mental health, in my view inappropriately.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

Birmingham is one of the fastest growing younger cities in Europe—40% of its population is under 25, and 30% under 15. Combined with local authority cuts of £281 per head in the next financial year, and a totally dysfunctional commissioning system, does the Minister seriously think that even the good intentions of the children and young person’s taskforce will address the problems we already have, as well as those that we can see coming but have no means of remedying?

[Norman Lamb]

Again, I gently make the point that we all, on both sides of the House, have to recognise the need over the next five years to make better use of the resources available. The hon. Lady’s own party does not propose ring-fencing local authority funding for the provision of mental health services at the lower tier level. We all have to work on making more effective use of the money, and I genuinely think that the taskforce is an opportunity to modernise how we organise services, particularly commissioning—having four different commissioners does not create the best chance of co-ordinating services.

NHS Major Incidents

Baroness Stuart of Edgbaston Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

I totally agree with the right hon. Gentleman. I am sure, too, that he will agree with me that the best way to give the NHS certainty over funding in the future and the increase in funding that it needs to implement the five-year forward view is a strong economy, and it is only this Government who are able to deliver that.

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

According to some statistics, I have more medics per square mile in my constituency than any other MP. I also have the University Hospitals Birmingham NHS Foundation Trust on my patch and a lot of people who work across the west midlands and in Birmingham. The Secretary of State’s operational guidance, as he has interpreted it, is not perceived in the way that he thinks it is. A and E consultants tell me that they are not just overworked and overstretched, but unsafe. If he thinks the guidance is purely operational without any political interference, will he follow the call of the shadow Secretary of State and say that he will issue a new set of guidance that makes that clear, because it is not how it is seen on the ground?

[Mr Hunt]

I have great respect for the hon. Lady, so I hope she will understand this: when people are worried about political influence over operational guidance, I do not then issue some political guidance. The only thing that I, as Health Secretary, say in respect of instructions going out is that patient safety must always be the priority, and that is what I have said time after time. But then the actual decision about whether to declare a major incident must be taken by people locally. Julie Moore, the chief executive of UHB, is fantastic and absolutely able to make those decisions, and those decisions should not be second-guessed by politicians.