Oral Answers to Questions

Barry Sheerman Excerpts

Tuesday 21st October 2014 Commons Chamber

[Dr Poulter]

My hon. Friend is right to highlight the fact that the annual cost of PFI left by the previous Administration is £1.79 billion, which will rise to £2.7 billion. It is right that we do all we can to support hospitals to reduce the costs of PFI that have been inflicted upon them, and we will continue to do that and work with the Treasury to make sure that that specialist advice is available for the NHS to reduce the cost.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I am worried that the members of the ministerial team are living in some sort of parallel universe. At the Calderdale and Huddersfield Trust we had a PFI. A hospital that has a long history of success is now struggling because it cannot get a management that works between the clinical commissioning groups and the trust. That is the truth—it is chaos.

[Dr Poulter]

There is nothing wrong with PFI schemes in principle; the point is the way in which they were put together by the previous Government. In 2011, the right hon. Member for Leigh (Andy Burnham) said:

“We made mistakes. I’m not defending every pen stroke of the PFI deals we signed”.

Those PFI contracts have damaged local hospitals and damaged local health care provision—

Foetal Alcohol Syndrome

Barry Sheerman Excerpts

Tuesday 14th October 2014 Westminster Hall

[Bill Esterson]

I thank my hon. Friend for mentioning the excellent work done by her constituents. I, too, praise them and many others who have done such good work to raise awareness of the condition, the risks and the need for action.

On greater awareness, the Education Committee is about to start an inquiry into personal, social and health education. What better subject for children at school to learn about than the dangers of drinking in pregnancy? I hope that my comment is taken on board by my fellow Committee members when we consider what to look at during that inquiry.

Al Aynsley-Green describes sitting in a class of seven–year-olds in Canada:

“‘What do you never drink when you have a baby in your tummy?’ asks the facilitator. ‘We never drink alcohol, Miss,’ chorus the children.”

That level of awareness at that age is in stark contrast to anything that happens here. He then mentions a conference in Toronto on prenatal alcohol exposure, attended by several hundred scientists, clinicians, lawyers, parliamentarians and lay people. Emily is 16 years old and has severe learning difficulties. She stood alongside her twin sister, courageously describing what it is like to be affected by the alcohol drunk by their Russian birth mother before they were adopted by their Canadian family. Emily described social isolation, bullying, fidgeting, impulsivity, distractibility, loud noise intolerance and poor concentration, which makes learning difficult.

Canadians take the impact of alcohol before birth seriously. Federal and provincial governments are convinced that prenatal alcohol causing foetal alcohol spectrum disorder is the most important preventable cause of severe brain damage in childhood. It affects affluent families and aboriginal people. Less badly affected children exhibit poor behaviour in their schools and communities and populate the prisons. Canadians express incredulity that the economic cost, let alone the human cost of the syndrome, has not been grasped by politicians in England.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

In that Canadian classroom, the children might well, if my Canadian experience is anything to go by, have also been shouting, “And no drugs and no smoking too.” That is important. I know that the debate is not about that, but it is linked, is it not?

[Bill Esterson]

Indeed it is. Awareness of the dangers, particularly of smoking during pregnancy, is much higher. Why, when we know what we know about smoking and the damage it causes to the unborn child, would we not ensure that the same awareness is in place for alcohol?

We have known about the dangers of alcohol to the foetus for a long time. Judges 13:7 says:

“Behold, thou shalt conceive, and bear a son; and now drink no wine or strong drink”.

Aristotle wrote about the effects of women drinking during pregnancy. Sir Francis Bacon advised women not to drink during pregnancy. The gin epidemic saw a rise in birth defects in Britain in the 1700s. The infant death rate was 20% higher for alcoholic women in prison in 1899 as compared with the rest of the population. Distinct facial characteristics were noted by French researcher Dr Paul Lemoine—I apologise for the pronunciation—who studied families where mothers drank a lot in pregnancy. The term “foetal alcohol syndrome” was first used by English researchers Jones and Smith in 1973.

There has been extensive preventive and clinical work in Canada, the United States and Australia. In 2007, Lord Mitchell’s private Members’ Bill called for it to be mandatory for alcohol sellers to display warning labels. That was seven years ago, and it has not happened yet. We saw recent success when legislation on smoking in cars with children present was passed. The Minister was heavily involved, and I commend her for her work on that. Perhaps we can persuade her to do the same on the labelling of alcohol.

At the severe end of the spectrum, there are some 7,000 live births of children with foetal alcohol syndrome each year in the UK, with three or four times as many babies born with the wider foetal alcohol spectrum disorder. There is, however, a suggestion of under-diagnosis, as symptoms are similar to those resulting from such conditions as attention deficit hyperactivity disorder or autistic spectrum disorder. The neglect of children who end up in care or being adopted can also produce behaviours that are similar to those seen with foetal alcohol spectrum disorder. The combined effects of neglect and FASD can make life difficult for children in care and those around them.

Diagnosis among some groups can be difficult. As the parent of two adopted children, I have no idea whether their birth mother drank during pregnancy. As a result, behaviours consistent with foetal alcohol spectrum disorder, which my children exhibit, could be due to neglect or alcohol consumption during pregnancy or both or neither. There is no way of knowing. The point is that we have to raise awareness, because we have to reduce risk. The education and development needs of this group of children are specialised. I refer the Minister to the research and ask her to look further at what is needed and just how demanding it is to enable children with foetal alcohol spectrum disorders to achieve their potential, given their difficulties in learning and in relating to others.

In 2009, the National Organisation for Foetal Alcohol Syndrome said:

“Teachers and teaching support staff will undoubtedly meet children with FASD in their classrooms. They need to know how to respond to their learning needs effectively, enable them to maximise their potential, improve their life chances and take their places alongside their mainstream peers as citizens…FASD now accounts for the largest, non-genetic group of children presenting with learning difficulties/disabilities. The difficulties that children face in the classroom epitomise that much-used phrase ‘complex needs’…Their unusual style of learning and their extreme challenging behaviour is out of the experience of many teachers”—

and support staff—

“and, as there is significant shortfall in guidance for teachers on how to educate children with FASD in the UK, teachers find themselves ‘pedagogically bereft’.”

We have to look at how we can reduce the number of children with FASD. Advice that says that someone may want to stop could and should be harder hitting. As my hon. Friend said, drinking while pregnant will harm the baby, just as smoking does. The private Member’s Bill introduced by Lord Mitchell in 2007 called for mandatory labelling. In 2005, the French Government made it a legal requirement for alcohol to display a warning for pregnant women on the container. The French research quoted the same dangers, research and risks as I have. Crucially, alcohol, according to the French research, can affect the brain at any stage of pregnancy. There is no safe level. The advice in France is that the safest option is no alcohol during pregnancy. That comes from the alcohol project manager at the National Institute for Prevention and Health Education. It faced a lawsuit in 2004, and later that year moved to change the law. In 2005, the law was changed. In France, it now says on bottles of alcohol that the consumption of alcoholic drinks during pregnancy, even in small amounts, may have serious consequences for the child’s health. There is also the symbol of a pregnant woman drinking in a red circle with a red line through the centre. Why do we not have that here?

The Under-Secretary of State for Health, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter) was on the Health Committee in 2012. At that time, he was quoted as saying that there should be better warnings on the dangers of alcohol. He and others in the medical profession have warned of those dangers for some time, including those posed by drinking during pregnancy. He called for greater publicising of the dangers to raise awareness. As a Minister—along with his colleagues, whom he can advise—he is in a better position to act than he was in 2012.

Last week, the British Pregnancy Advisory Service raised concerns about the impact on pregnant women of the recent publicity on this issue, of which there has been a significant amount in recent months. The BPAS said that women are considering abortions because they fear they may have harmed their unborn child before they realised they were pregnant. It stated that occasional binge drinking was unlikely to cause harm to the baby. From the research I have looked at and the evidence available to us, it is true that binge drinking may not harm a baby, if it happens on occasion, but the trouble with that advice is that there is no way of knowing which babies will be harmed. The concern raised by the BPAS should not be taken lightly. It says that media coverage has caused panic among some pregnant women. That is the last thing that anyone who takes an interest in this issue wants, but, equally, there is a danger that playing down the risks of damage from foetal alcohol spectrum disorders could lead to some women continuing to drink, thinking it is safe when it is not. The BPAS points out that half of pregnancies are unplanned, so many women do not know that they are pregnant, meaning that many women will be drinking alcohol while pregnant. I agree that women should not be alarmed as there is nothing that can be done about what has already happened. However, if greater awareness of the risks can reduce the number of women drinking while pregnant in future, which is the experience in other countries, that must be a step forward.

--- Later in debate ---

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

It is a pleasure to serve under your chairmanship, Mr Turner, as you used to serve under my chairmanship.

I have been interested in this subject for a long time. I am a trustee of the National Children’s Centre, which is based in my constituency, and part of the initiative to form a new children’s commission. Also, for quite a long time, I was Chair of the Select Committee on Children, Schools and Families.

I have to say one slightly party political thing: I still deplore the smaller emphasis placed by the coalition Government on children’s issues. We have a junior Minister, but we should have a Secretary of State and a whole Department. I thought that the Department for Children, Schools and Families was a breakthrough Ministry, and I am sorry that it is much diminished, although I have a lot of respect for some of the ministerial team, as colleagues know. Today, however, there is relative neglect of children’s issues.

I have some practical experience of children: three daughters, one son and nine grandchildren under the age of 10. We are quite a tribe when we are all together. When my wife and I had children, we were aware that we should not drink too much—she said that she should not drink too much—but my generation thought that a little bit of alcohol was all right. That was wrong, but luckily we survived and had healthy children. My daughters, however, never drank during pregnancy.

My hon. Friend the Member for Sefton Central (Bill Esterson) made a brilliant speech, but the speech by the hon. Member for Chatham and Aylesford (Tracey Crouch) was also thoughtful. She mentioned the growing consumption of alcohol by women. Only the other day, I chaired a session—one of those irritating breakfast meetings—by the Parliamentary Advisory Council for Transport Safety, or PACTS, on women and alcohol, and it was explained to us that the likelihood of a man being caught for drink- driving has plateaued for some years, but the figures for women are going up fast.

A senior policewoman from one of the home counties, or perhaps Hampshire, stood up at that breakfast meeting to say, “We have done a study of all the pubs by going in and asking for a small glass of wine, and they all said, ‘No, we only do medium and large.’” Three large glasses of wine in a pub is a bottle of wine. Many of the women pulled over by the police, according to that policewoman, would say, “I have only had two glasses”, but that means that they have had two thirds of a bottle of wine. With the drinks industry trying to increase sales, many more women are drinking high levels of alcohol. Is that binge drinking? Most of the people whom we describe as binge drinkers would not think that they were binge drinkers. Yes, they have a couple of large glasses of wine, but they have learned to feel that that is relatively normal.

There is one point I will take issue with. Why not scare people? When we campaigned for seat belts, against drink-driving and on the dangers of smoking, there had to be a bit of fear. We have to change the culture. If someone went into a pub now and said, “I’m only going to have a couple of pints, and then I’m driving home—I’m a better driver when I’ve had a couple,” they would be excluded from the pub and their local community, because that is not acceptable. We have to have a little element of fear to get over the message that people who drink while pregnant are damaging their unborn child. The message has to be very strong; it has to be from the Department of Health and all the other Departments, and it has to be loud and clear.

Let us not pussyfoot about on this—you and I do not pussyfoot about, Mr Turner. Let us be honest: people from more disadvantaged backgrounds—poorer people—drink more than other people during pregnancy. That is the truth, and we have to accept it; otherwise we cannot get the message across. Of course, a lot of middle-class women drink, but more middle-class women tend to give up drinking when they are pregnant. However, a lot of people who have copied middle-class role models over the years and who are drinking are not seeing the danger signs during pregnancy.

[Bill Esterson]

The point about women from disadvantaged backgrounds is right, but is my hon. Friend aware of some of the research from the United States? In some studies, mentoring of women in at-risk groups has led to something like a 50% reduction in drinking during pregnancy in cities across America. Does he agree that that is the kind of bold action we need here?

[Mr Sheerman]

My hon. Friend is absolutely right. I love that sort of idea, because it is holistic. We have to go right across the piece—mentors, health visitors and GPs. GPs should wake up. For goodness’ sake, what are they doing if they are not telling pregnant women, “Do not drink when you are pregnant.”? I despair when I see the level and quality of advice from some GPs, who should be telling women in very firm terms about the damage they could do to a little child.

[Mr Robin Walker (Worcester) (Con)]

I apologise for missing the opening comments in this important debate. The hon. Gentleman mentioned GPs. Does he agree that it is important that there should be clinical leads on FASD in each part of the country? I met the clinical lead on FASD in Worcester, along with Richard Procter of the FASD Trust, to talk about the issue. We should build up clinical leads, so that they can make sure that best practice is shared among GPs and other health groups. That is one way we can make sure that there is a better approach to this issue.

[Mr Sheerman]

The hon. Gentleman is right, but he tempts me to make the political point that getting a message to local health people now is very complex. I used to be able to pick up the phone to one person—the trust’s chief executive—and have a conversation about health in Huddersfield. Now, I have to make about seven phone calls to get any sense of a holistic approach to anything. I admit that that is a bit of a snide reply, but we must make things as holistic as possible.

We must get the drinks industry involved. Why do we not have the sign that my hon. Friend the Member for Sefton Central mentioned—the red slash across the pregnant woman with the glass of wine? Why can we not, as we did with the tobacco industry, get industry, the pubs and the restaurants on our side? Why can we not get the schools on our side? Where are the schools in all this? We must tackle this issue across the piece, and we must have one consistent message: do not consume alcohol, drugs or tobacco when pregnant.

Ebola

Barry Sheerman Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

My right hon. Friend makes an important point. I discussed this with United States Secretary Burwell today. The US is piloting a programme in Liberia, and we are doing the same thing in Sierra Leone. We are both providing the same response, which is to tackle the disease at source. We know that, if we can get 70% of the people who develop Ebola symptoms into treatment and care, we will contain the disease. At the moment, the disease is replicating at a rate of 1.7, which means that every 10 people infected are going on to infect another 17 people. That is why the virus is spreading so fast, and we can halt it only if we get people into treatment very rapidly. Community treatment centres are therefore an important part of the Department for International Development’s strategy to help to contain the virus, and that is why we are supporting the development of 700 beds in Sierra Leone.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

May I beg the Secretary of State to work across Europe and all the countries that can help? I have a daughter who has just returned from west Africa and she has reported to me and the family that the situation is critical—it is desperate. There is a lack of any kind of facility to control this disease. Parents are dying, leaving children with nobody to care for them. The situation is very grave, so will he redouble his efforts to persuade Europe, the World Health Organisation, the UN—all of us—to do something more significant and to do it now?

[Mr Hunt]

The hon. Gentleman speaks movingly and well about the incredible gravity of the situation, and he rightly says that we need full international support on it. In such a situation there are a number of things we are much better tackling as part of an international effort; we are very proud of our 659 NHS volunteers, but volunteers from the whole of Europe could go out and play a part. They need reassurance that they will be safe if they end up contracting the virus, because the truth is that there is no 100% guarantee of safety, even for people who follow the correct procedures—that is why these people are so brave. The hon. Gentleman is absolutely right in what he says, and I reassure him that that is exactly the conversation I have been having with international colleagues: we do need a co-ordinated effort.

Care Home Top-up Fees

Barry Sheerman Excerpts

Tuesday 22nd July 2014 Westminster Hall

[Paul Burstow (Sutton and Cheam) (LD)]

It is a pleasure to have the opportunity under your chairmanship, Mr Sanders, to debate an issue that is of growing importance and will increasingly find its way into the mailbags of hon. Members on both sides of the House. The issue is how much people pay for care in the 10,000 or more care homes up and down England and, in particular, whether the top-up payments that some residents and their relatives make to secure care home accommodation are fair and transparent. With the Department currently consulting on draft guidance for the Care Act 2014, this is a good time to turn the spotlight on these issues.

The legal framework setting out what local authorities need to do when a resident who qualifies for means-tested support enters a care home has been fairly clear for a long time. The “Charging for Residential Accommodation Guide” and the 2004 choice of accommodation directions are straightforward, at least in so far as they clarify that, if local authority-supported residents would like to move into more expensive accommodation—for example, they might want to secure a place in a home nearer their family—they can, provided that a third party, normally a relative, can pay a top-up payment, make that choice. The rules are also clear that if, for whatever reason, no care home places can be provided at the rate that the local authority would normally pay, it is the responsibility of the council, not the resident or their relatives, to pay more to secure reasonable care home accommodation.

The rules are clear. The trouble is that evidence is mounting that they are being broken. Local authorities are confused about how to apply the rules consistently, so that families can be informed about the rules on choice and choose more expensive accommodation, knowing that that will involve additional costs, while at the same time being protected from paying a top-up payment for essential care that it is the council’s responsibility to pay for and meet.

An estimated 54,000 local authority-funded adults are part-paying their care home fees. That is 28% paying top-up fees. Just over one in 10 of all care home placements involve someone paying a top-up fee.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I congratulate the right hon. Gentleman on securing the debate, because up and down the country and certainly in my constituency of Huddersfield, there is real concern about this issue. Does he agree with the finding of a recent survey that many councils do not know what is going on? It is not that it is malign; they just do not know what is going on.

[Paul Burstow]

That is really the thrust of this debate. Whether it is malign or not, it is ignorance, and when it comes to a local authority, that ignorance is not acceptable.

The problem is that the people I am talking about are often out of sight and out of mind. We do not know how many of the 54,000 people who pay a top-up know that a top-up is intended to allow relatives to pay a little extra for a care home place that is above and beyond the “standard” level available from the council. We do not know how many of the 54,000 people know that their council or care home should not be requesting a top-up for any care; it should request it only for a higher standard of accommodation.

Based on the evidence that I have seen, I believe that we need to examine whether the rules governing choice and charging for residential accommodation are working as intended and that we need to look again at what we can do to clarify local authorities’ responsibilities now that the legal framework is being strengthened by the Care Act. We need to get this right because top-ups look set to grow in number, not least with 35,000 more care home residents qualifying for some level of means-tested support when the upper capital threshold is increased to £118,000 from 2016. It is in councils’ interests to get it right because, again thanks to the Care Act, there will be a new appeals process for each local authority. Unless the often grey area of top-ups is sorted out, it is likely that a growing number of residents will be challenging the decisions that councils have made about care home fees. Councils can take steps to minimise the risk of legal challenges, but they need the Government to provide clear and practical guidance on what they are required to do and, crucially, what they cannot do.

[Mr Sheerman]

Will the right hon. Gentleman give way, just on that point?

[Paul Burstow]

I cannot because—

[Mr Sheerman]

May I intervene very quickly just on that point, because it is very important?

[Mr Adrian Sanders (in the Chair)]

Order. It is for the Member who secured the debate to give way.

[Paul Burstow]

I will give way, but I need to stress to the hon. Gentleman that this is a half-hour debate and I need to make quite a few points myself.

[Mr Sheerman]

I was trying to intervene on this point only because it means so much to some of my constituents. Some of them have said that the trade association for care homes, which is a very powerful one, should have a charter of rights. As someone goes into a home, it should be there and should show the clear responsibilities and clear duties of care.

[Paul Burstow]

That is a very good point and one that I am sure Care England and other organisations representing care homes would want to take on board.

It is important to understand the scale of the problem. Research carried out last year by the charity Independent Age highlighted the fact that 72% of local authorities—there was a very high response rate to this freedom of information request—were unable to demonstrate that they met their legal obligations with an overview of top-up payments in their area. In other words, they were not routinely monitoring and reviewing whether third parties remained “able and willing” to make top-up payments. That is a core requirement of the existing guidance. The onus is on councils to check that families are not unwittingly making top-up payments for care that should be paid for and met by the council as part of its duties to meet assessed, eligible needs. Those payments can range anywhere from £31 a week to perhaps £131 a week. In some cases, it is probably even higher than that.

The research also found that just under 30% of councils said that they did not hold or collect information about top-up fees in their area. This was a typical quote from a council:

“As a Council we’ve never had any involvement in top-up care home fees...The Council does not know how many top-ups are in place, in any financial year”.

Perhaps most disturbing was that so few councils knew what was taking place in terms of top-up fees arranged between care homes and families in their area. Almost 80% of councils did not routinely check up on the health of top-up payments as part of their annual reviews, and 75% of councils did not signpost families of care home residents to independent advice before entering into third party top-up agreements.

--- Later in debate ---

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

I congratulate my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) on securing the debate. It would be wrong for the debate to be an exclusively Liberal Democrat affair, so I am delighted to see the hon. Member for Huddersfield (Mr Sheerman) in his place. This debate is, in some ways, a unique event.

My right hon. Friend raises an important issue. He provided two case studies, which almost smack of exploitation of vulnerable older people. The ratcheting up by a care home of the top-up fee for someone in the latter stages of their life who suffers from dementia is completely unacceptable exploitation of that individual, and it should be condemned.

Equally, the idea that it is suitable or appropriate to shove someone into a home far away from London but a long way from where she wants to be goes against the central principle of the Care Act 2014: the individual’s well-being. I know that my right hon. Friend is committed to upholding that principle. The issue that he raises is of real importance, and the findings of the local government ombudsman’s report from last year, to which he referred, are of real concern.

People should have a choice over the establishment in which they receive care and support. That establishment will, after all, become their home. Where the local authority is involved, it has a responsibility to ensure that the establishment meets the person’s needs without costing more than it needs to. However, another important principle, which we must respect, is that people or their loved ones should have the choice to use their own resources as they see fit. If by doing so they can improve their surroundings by having a bigger room or a better view, they should have that choice. I emphasise that that must be a positive choice on the individual’s part—something that they understand the costs and consequences of, never something that they feel pushed into.

[Mr Sheerman]

Will the Minister give way?

[Norman Lamb]

Very briefly.

[Mr Sheerman]

The right hon. Member for Sutton and Cheam (Paul Burstow) put his finger on it when he talked about secrecy. There are many excellent people in this field doing a fantastic job—my mother-in-law is in a care situation—but a certain percentage of people do not know what is going on. They need to know, and it should be in the public domain.

[Norman Lamb]

I agree with the hon. Gentleman. He will find that the Care Act has a much greater focus on transparency, and it strengthens the legal obligation by providing that personal budgets must reflect the cost to the local authority of meeting the adult’s needs. That is a legal requirement in the Care Act, whereas previously it had been guidance.

Oral Answers to Questions

Barry Sheerman Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for her work to promote good health care in her area. I very much enjoyed meeting her local GPs. I was disappointed that it was only for about five minutes. I very much hope to go back and have a proper discussion. They were very enthusiastic about the Prime Minister’s challenge fund, and are making some very innovative changes.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

May I push the Secretary of State on this matter? What my constituents want is to be able to get to see a GP when they really need one; they do not want to turn up in A and E just because they cannot get an appointment for a week. Is not poor management of GP surgeries—poor management from top to bottom—at the heart of this problem?

[Mr Hunt]

Actually, I agree with the hon. Gentleman. I think that we do have a problem. We have some fantastically good GP surgeries and some brilliant GPs, but we have not in the past had structures in place to make sure that we deal quickly with underperforming GP surgeries and, indeed, underperforming GPs. We need to have much more transparency of data so that we can see where the problems are. We have introduced a rigorous new inspection regime, with a new chief inspector of general practice, and I hope that that will go some way to addressing the issues he raises.

Health

Barry Sheerman Excerpts

Monday 9th June 2014 Commons Chamber

[Andy Burnham]

I am quite clear in what I said. I said that the finding of the Francis report was that it was a local failure, but of course there were lessons to be learned. That is why I brought in Robert Francis in the first place to begin inquiries at Stafford. The claim that we just brushed everything under the carpet could not be more wrong. The Secretary of State needs to drop it and start dealing responsibly with these issues.

The right hon. Gentleman wanted to distract the House from what I was saying—that a Bill should have been brought forward in this Gracious Speech to modernise professional regulation in the NHS. I quoted strong sentiments from Niall Dickson and Jackie Smith. There was no room for such a Bill, but it is hard to find measures in the rest of the Gracious Speech that may be considered more important than that Bill. The Speech found space, for instance, for measures on pubs and plastic bags, but not on patient safety. There was a time when the Prime Minister used to say that his priorities could be summed up in three letters—NHS. Not any more. Those letters did not appear in the Gracious Speech and received only a cursory mention when the Prime Minister addressed this House.

So what explains the relegation of health down the Government’s list of priorities? One commentator writing last Thursday offered an explanation. He said that

“there was no mention of the health service in the Queen’s Speech. Indeed, the Tories have had little to say on the subject at all recently.

I’m told that there is a precise reason for this: Lynton Crosby has ordered them not to.”

I do not know whether that is true, but it does not look good, does it? It creates the clear impression that the shape of the Gracious Speech had more to do with the political interests of the Conservative party than the public interest of the country.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Is not another explanation for the absence of any mention of the NHS in the Queen’s Speech that the Government do not want it? They are quietly privatising the NHS by the back door, so they do not need legislation.

[Andy Burnham]

I think that that is exactly the reason. They introduced a reorganisation that nobody wanted, that nobody voted for, that put the wrong values at the heart of the NHS and that has dragged the NHS down, and all the while they are softening it up for accelerating privatisation. That is the record on which they will have to stand before the country in less than 12 months’ time. If the Secretary of State can justify that record and breaking the coalition agreement to his constituents, I would be very surprised indeed.

--- Later in debate ---

[Alun Cairns]

rose—

[Mr Sheerman]

rose—

[Andy Burnham]

I give way to my hon. Friend.

[Mr Sheerman]

Does my right hon. Friend agree that this destabilisation has reached such an extent that very good hospitals, such as those in Huddersfield and Halifax, have a cloud over them because they might lose their A and E departments? What does that do for morale and culture, which have been so good in those two hospitals? Up and down the country, morale has been shaken to the roots.

[Andy Burnham]

What I find surprising is that all over the country plans are being developed to close A and E departments. How can that make sense when we are in the middle of an A and E crisis? In west London my hon. Friend the Member for Hammersmith (Mr Slaughter) has done much work to raise concerns about the changes to hospitals there.

Care Homes

Barry Sheerman Excerpts

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

Thank you, Mr Speaker, for your gentle guidance. I will do my best.

The hon. Gentleman makes an incredibly important point. One cannot change the culture of an organisation overnight. The Care Quality Commission was a dysfunctional organisation, but it now has really good leadership in the form of David Behan and its chairman, David Prior. They understand the importance of changing the culture and ensuring that they are always the champion of the patient.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I say to the Minister and all colleagues in the House that this is not good enough. It is disgraceful. We had it before and we had similar answers. We have to stop this. There are wonderful carers out there—most carers are wonderful—but they need support, good skills training and to be paid properly. Surely we ought to have a charter in every home that says, “These are your rights. Don’t let them be infringed. They are clear.” Every good hotel and business has such a charter hanging up where everyone can see it. Can we not have that tomorrow?

[Norman Lamb]

Many care homes are signing up to exactly those standards. The more that happens, the more we should applaud and encourage it. The hon. Gentleman is right that we should all be completely intolerant of such abuse and neglect. It is a challenge for the whole of society. Whichever Government are in power need to hold the line of being absolutely intolerant of any failures of care and must demonstrate that when they happen, there are real consequences that will hold people to account.

Oral Answers to Questions

Barry Sheerman Excerpts

Tuesday 1st April 2014 Commons Chamber

[Dr Poulter]

That is a good point. On screening, we have to listen to the advice of the national screening committee, as I am sure hon. Members on both sides of the House would agree, but on the enriched culture medium test, I have had further meetings with Group B Strep Support and with the former editor of the obstetricians and gynaecologists journal, the BJOG. On the back of that meeting I have written to the Royal College of Obstetricians and Gynaecologists to ask it to look at the clinical evidence on that test, and it will take the matter forward.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I thought that answers to questions were improving after 12 noon, but the last answer on post-natal depression was not as good as I expected. We have a campaign on post-natal depression, which is the biggest killer of healthy young women through suicide. The Minister is being complacent. Early diagnosis and good GPs are essential. What is he really doing about that?

[Dr Poulter]

The hon. Gentleman is absolutely right. I thought it was disgraceful, when we came to power and inherited the legacy of the previous Government on post-natal depression, that only 50% of maternity units had perinatal mental health support. That was not good enough, and that is why I have ensured that in the mandate to Health Education England, and working with NHS commissioners, all maternity units will have specialist perinatal support by 2017. There is more training going in for the work of the Royal College of General Practitioners on mental health support for GPs in helping women, and we are now increasing the number of health visitors by almost 2,000, and health visitors do a fantastic job in providing perinatal mental health support to so many women.

Atrial Fibrillation

Barry Sheerman Excerpts

Wednesday 12th March 2014 Westminster Hall

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I hope that colleagues from Yorkshire who have been listening to the debate on trans-Pennine rail would like to stay for this important debate on atrial fibrillation, but in truth I know that many would ask what on earth atrial fibrillation is. Part of the purpose of the debate, therefore, is to open up our understanding and knowledge of the condition. I am sure that some colleagues at least will know that atrial fibrillation is a disease of the heart—[Interruption.] Excuse me, Mr Turner; I thought that that was the Division bell. Atrial fibrillation is a disease that causes an irregular heartbeat. It can often lead to a stroke and therefore to either a disabling long-term disability or death.

I called for this debate because 750,000 people in this country have atrial fibrillation. We know that because they have been tested for it. They may or may not be receiving treatment, but we know about them. It is estimated that another 750,000 suffer from atrial fibrillation but are undiagnosed, so we do not know where they are, although we have an idea because we can do the stats. If we know the average number of AF sufferers in a given area, we can extrapolate the numbers across the country. Where we see very low diagnosis numbers, we know that the local GPs and health service are not getting to grips with discovering who has AF, checking them out and treating them.

I would like to tell a little fairy story. There is a fantasy world in which a dreadful heart condition affects more than a million people in our country. A great deal of research is carried out, because no one really knows how to tackle it, and then there is an enormous breakthrough: we discover a new class of drugs that can not only help people to avoid having a stroke in the first place, but allow them to live a good, full and healthy life. However, the wicked godmother arrives and says, “Thou shalt not have any of these wonderful drugs, even though the National Institute for Health and Care Excellence says that they are good and should be available.”

I remind Members that the NHS constitution states that patients have a right to

“treatments that have been recommended by NICE”

when they are deemed “clinically appropriate”. That is the right of your constituents, Mr Turner, and mine. However, the fact is that most people with AF in this country are not getting the opportunity to receive such drugs. There is a real problem: we have a new generation of drugs that are recommended by NICE, but they are not available. What is the barrier? The barrier is the clinical commissioning groups and GPs.

If someone is a sufferer of AF—my wife is, which is why I know something about the condition—they are traditionally treated with warfarin, which is a very popular drug in this country. You will not be surprised to hear, Mr Turner, that even on the Isle of Wight GPs know—because they are highly skilled and knowledgeable —that warfarin is very cheap indeed. It is one of the cheapest drugs that can be prescribed.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing such an important matter to the attention of Westminster Hall and of the Minister. Warfarin can be used to treat hyperthyroidism, as well as many other conditions. The issue that comes to my attention is that of GPs and their training, and their ability to administer to atrial fibrillation as required. Does the hon. Gentleman feel that GPs can do more in their own surgeries?

[Mr Sheerman]

The hon. Gentleman is absolutely right. I was going to come on to that issue and I am grateful to him for making that point. The fact of the matter is that a very high percentage of people who are diagnosed with atrial fibrillation are currently either not treated with anti-coagulants, or they are given aspirin. Everyone knows that aspirin is very cheap but not effective as an anti-coagulant.

People with AF may also be given warfarin, which is a good treatment. I can say that from the heart. I have watched a close member of my family—it does not get any closer than one’s wife—undergo treatment that must be evaluated day in, day out. It is quite complicated to ensure that the dosage is right. If someone does not have a home testing kit, they will have to go regularly to the hospital for their blood to be tested and their dosage evaluated. If they have a full-time job or family responsibilities, that is an onerous requirement. As a result, many of the people who are taking warfarin are not taking it in the right dosage and so are not getting the proper, balanced treatment.

It is a scandal that 8.5% of atrial fibrillation patients are not receiving treatment, 35% are receiving aspirin, and only 56.9% are receiving oral anti-coagulation treatment. What is more, we now have three drugs that could be prescribed. We should be saying, “Isn’t it wonderful? We’ve had a breakthrough!” I hope that I can pronounce them properly—they are dabigatran, rivaroxaban and apixaban. However, compared to the 3p that it costs for a dose of warfarin, they are more expensive—I have seen an estimate that treatment would cost around £800 a year.

That might be considered an excessive cost compared to the tiny amount that warfarin costs, but strokes cost this country £2.5 billion a year. If we really want to wreck the national health service, we should not treat people with AF properly. They will have a stroke and end up in long-term care, making great use of hospital beds and highly qualified medical staff. Such a burden on the health service could be avoided.

I have been a member of the all-party group on atrial fibrillation for some time now, and I know that its chair, the hon. Member for Montgomeryshire (Glyn Davies), is going to speak after me. We served together on the Education and Skills Committee, Mr Turner—do you remember when we had a very good Clerk working for us? I think he is sitting on your left-hand side. When we were on that Select Committee, you will have heard me articulate many times the watchwords, “I like evidence-based policy.” The atrial fibrillation campaign is the one, against all others, for which the evidence shows that if we have a drug that can sort out the condition, it should be used.

NICE says that we should use it, and it is clear that it is the right of patients to have it. The people getting in the way are GPs—not because they are malign, but because the cost means that they are leant on by their practices about prescribing it. Also, a very substantial population of GPs do not understand the treatments and their effectiveness—which treatments work and which do not. It is a scandal that people suffering from AF are prescribed either nothing or aspirin by their doctors. That is a very serious problem for the profession, and we have been taking it up with the Royal College of General Practitioners.

There is a second barrier, which is that even with the cheapest of the drugs—warfarin—the sophistication of the treatment and the monitoring are very difficult for very large numbers of our population to deal with. My constituents and your constituents, Mr Turner, find it very difficult to get the right dosage and to maintain the quality of treatment.

The third barrier is the clinical commissioning groups. There is no doubt that the clinical commissioning groups are a barrier to this spending. These are relatively new drugs. They were approved by NICE about 18 months ago—I am looking at the chair of the all-party group in case that is not correct—and NICE said that by now it would expect about 20% of AF sufferers to be on the new anti-coagulants, but only 3.4% of sufferers are on them. Even NICE, projecting forward, thought that the figure would already be 20%.

I do not want to talk for too long, because other hon. Members want to speak, but it is a national scandal that people are dying today, are dying every day and are having incapacitating strokes, and that that is costing the national health service an enormous amount of money and requiring the use of an enormous amount of expertise. It is a burden on the national health service that should not be there.

There is an easy resolution. It is based on science, based on research, based on evidence. It is about time that the ministerial team took the lead on this matter, that GPs woke up, and that clinical commissioning groups heard the hard words that we will not allow our constituents unnecessarily to die or suffer long-term disability just because of the inactivity of the system. We are seeing this short-term saving, this mean-minded pettiness of saving a bit of money on the balance sheet of a CCG today, when the real cost to the health service is a generic one right across our country.

This is the beginning of a campaign. We have been campaigning for a long time, but it is at a new level. We are not going to let this issue go away. This is not party political. We will chase the Minister, chase the Secretary of State and chase the Prime Minister, because this issue is important and we cannot allow this injustice to continue any longer.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship for the second time, Mr Turner. It is also a pleasure to congratulate the hon. Member for Huddersfield (Mr Sheerman) on securing the debate, and to thank my hon. Friend the Member for Montgomeryshire (Glyn Davies) for his important contribution about his own experiences of atrial fibrillation and its consequences. Although he spoke about the cardioversion treatment he received for sudden onset AF, much of the debate today has been about those who have chronic AF, which is often undiagnosed. The debate provides a good opportunity to raise such issues and ensure that those who are listening—in particular, bodies such as the Royal College of General Practitioners —take away messages about what more they can do to support GPs in earlier detection and diagnosis, where that is possible, and to make sure that the right treatment pathways and proper medications are provided to patients.

It may be useful if I talk briefly about the condition. The heart is not my area of medical expertise, but as a junior doctor I looked after several patients with AF, some of whom came through the front door of the hospital in a similar condition to that described by my hon. Friend the Member for Montgomeryshire, so I have seen it at first hand. AF is the most common sustained heart rhythm disturbance, and it occurs as a result of rapid, disorganised electrical activity in the heart’s upper chambers—known as the atria, hence atrial fibrillation—which results in an irregular heart rhythm. As we have heard, AF is a major predisposing factor for stroke and it accounts for approximately 14% of all strokes.

[Mr Sheerman]

On that point, would it not be a fine idea for the Minister or one of his colleagues to write to every Member of Parliament with the statistics? In the Calderdale and Huddersfield NHS Foundation Trust in my constituency, liaison between hospitals and GPs is not as good as it should be. When someone such as the hon. Member for Montgomeryshire (Glyn Davies) comes out of hospital after having an episode, there is no linkage of treatment between the hospital and the GP. Would it not be a fine idea to send a letter to every Member of Parliament giving them the statistics and urging them to talk to their clinical commissioning groups and GPs about the matter?

[Dr Poulter]

The hon. Gentleman is absolutely right about the importance of raising awareness of AF. He is also right to point out that co-ordination between primary and secondary care is not always as strong as it could be, not only in this area but throughout the NHS. Part of the reason the Government are investing in the £3.8 billion integrated health fund is to ensure that health and social care are better joined up, to achieve a more co-ordinated and holistic approach that is about individuals’ needs.

If someone has been diagnosed in hospital, it is important that they are given the right support in general practice and in the community. There is a lot of good practice out there, and there are a lot of good and well informed GPs. NICE is producing new guidelines and new draft recommendations on treatment—it has been looking at issues such as the use of anti-coagulants—and it is important that that information is disseminated quickly and effectively. My commitment to the hon. Member for Huddersfield is that I am happy to write to NHS England, which oversees CCGs, to raise the matter and ask it to disseminate NICE guidelines to CCGs and ensure that they are mindful of them.

[Mr Sheerman]

That is excellent news, but as someone with medical training, is the Minister not shocked that 36% of those with AF are being prescribed nothing or aspirin? Was he shocked to find out that rather than the 20% that NICE expected, only 3.4% of sufferers were on the new anti-coagulants?

[Dr Poulter]

The statistics that I am aware of are slightly less positive than those that the hon. Gentleman has cited. It is not for us in this place to micromanage medical professionals or to do their jobs for them. However, it is our job to raise legitimate concerns about care for AF or any other health conditions. We must do our best, as stewards of the health system, to push for good local commissioning that is mindful of best practice. I have undertaken to write to NHS England about that, and I will be happy to share the reply that I receive with the hon. Member for Huddersfield and other hon. Members and hon. Friends.

The exact causes of AF are unclear, but it is important to get the diagnosis right and to diagnose the condition as quickly as possible. We believe that some 18% of cases of AF are undetected, so there is more work to be done. NHS England has recognised that, and has suggested that CCGs should work with local practices to target people who are at risk from AF. The issue is already on NHS England’s radar, but I will write to obtain further assurances that it is being taken as seriously as it should be; I am sure that that is the case.

Research is under way into the condition. The National Institute for Health Research is funding a study into automatic diagnosis of AF in primary care using a hand-held device, which may help identify more patients who have AF and reduce the number of related strokes. If someone does not know that they have the condition, they do not know that they need to see a GP to get help. We must do as much as we can to support people to recognise that they have a medical condition and that help and treatment are available. I hope that the research into that technology provides better early detection of AF, and that that comes forward in a rapid and timely manner.

[Dr Poulter]

My hon. Friend is absolutely right to highlight that work. When NICE draws up guidelines, it consults best practice and tries to engage with key stakeholders. In addition, the Royal College of Physicians has developed some national clinical guidelines for stroke with the objective of encouraging higher levels of anti-coagulation. That is directly linked to some of the things we have debated today.

It is a testament to the work of groups such as the Atrial Fibrillation Association that we are helping to raise the profile of the condition and to get early support and help for people. There is clearly more to do, and NICE must continue to develop strong guidelines to support understanding of the best care and pathways for people who have AF. NICE is updating guidelines at the moment and developing a quality standard on AF, which will set out what a high-quality AF service should look like and drive improvement locally by helping local commissioners and CCGs understand what good looks like in AF care.

[Mr Sheerman]

Before the Minister, who is uniquely qualified to have an opinion, sits down, does he agree that more people should be on the new generation of drugs that will keep them alive and prevent them from having strokes?

[Dr Poulter]

It is not my medical specialty, but if new medication is developed, we need to evaluate it. The priority must be to give treatment according to clinical need. I, as a doctor, the Government and hon. Members on both sides of the House believe that it is right to treat patients according to clinical need and clinical priority. It is for CCGs to work with national guidelines, and we look forward to seeing the NICE quality standard on AF, which I hope will put CCGs in a much better position. I have already committed to writing to NHS England to ensure that it puts the matter high on its priority list, and that it supports and encourages all clinical commissioning groups to take AF seriously and make it a priority across the country.

Points of Order

Barry Sheerman Excerpts

Monday 3rd March 2014 Commons Chamber

[Mr Speaker]

I am extremely grateful to the Minister for what she said. It does seem to constitute a most full apology to and an explanation for the benefit of the House. We will leave the matter there. [Interruption.] We will not have a “further to” I am afraid. This matter has been fully addressed. If Members have totally unrelated points of order on completely different subjects, we will hear from them—in other words, for the avoidance of doubt, on matters not appertaining to that which has just been said. The hon. Member for Huddersfield (Mr Sheerman) intends to embark on entirely new terrain.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

On a point of order, Mr Speaker. As you know, I have been in this House a reasonable length of time, but something happened to me last Thursday that I do not recall having experienced before. I tabled a question, which in the preliminary agenda was signified as being question No. 7 for the next day. It was a question about my calling for the setting up of a royal commission on the link between climate change and flooding. By the time I got here on Thursday, the full agenda for the day—the Order Paper—had eliminated that question, and transferred it elsewhere. It was clearly a question to a climate change Minister. Why did it disappear and who allowed it to disappear?

[Mr Speaker]

What I would say to the hon. Gentleman, who has indeed been in the House for a goodly number of years—it will be 35, to be precise, on 4 May this year—is as follows, and I hope that he will take it in the appropriate spirit. It is entirely a matter for Ministers as to whether they make transfers. The transfer that took place, though immensely disagreeable to the hon. Gentleman, was entirely orderly, and I conclude by saying in the friendliest possible way to him that there are Members who do have something about which to complain but are disinclined to do so and there are Members who sometimes have very little about which to complain but make a very considerable meal out of doing so. It is my firm conviction that the hon. Gentleman has precious little about which to complain, and he is doing his best to make a very large mountain out of an extremely small molehill. [Interruption.] The hon. Gentleman is chuntering from a sedentary position about what I did when I was a Back Bencher, but that was then and this is now.