Improving Healthcare: Isle of Wight
Bob Seely Excerpts(4 years, 7 months ago)
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Mr Bob Seely (Isle of Wight) (Con)
I beg to move,
That this House has considered improving healthcare on the Isle of Wight.
It is a pleasure to serve under your chairmanship, Mr Betts. It is good to see the Minister here; I thank her very much for attending. This is an important debate for the Island; I will demonstrate that to the Minister with an example from just yesterday, when, by coincidence, a friend of a friend went into St Mary’s A&E, on a doctor’s recommendation. They were seen and assessed quickly, within 15 minutes, which is great; but they then sat there for nearly 10 hours, with a cannula sticking out of their arm, and with “urgent” written on their paperwork. One o’clock, 2 o’clock, 3 o’clock and 4 o’clock came and went, and they left at 10 pm.
This is not a criticism of NHS staff—quite the opposite. I have friends and acquaintances who work at St Mary’s and in the NHS on the Isle of Wight; I know their dedication and professionalism, and I am very grateful to them for it. Nor is this criticism of the leadership at the trust under our new executive, Maggie Oldham; I am a big fan of her leadership and her team, who are doing good work. We need that leadership on the Island; frankly, we have lacked it in recent years. What I wish to discuss with the Minister is the NHS funding system and how that relates to the Isle of Wight as an island.
The broader context for this debate is my proposal for an island deal that recognises the additional costs––which are not massive; sometimes they are small—of providing on the Island good public services equivalent to those on the mainland. I have had several conversations with the Prime Minister about my proposal for an island deal, and I am delighted that he has agreed to it in principle; he most recently talked of it in the House on 25 September, when he spoke of
“the island deal that we are going to do—I can assure him that we are, do not worry.”—[Official Report, 25 September 2019; Vol. 664, c. 803.]
I am delighted with that.
This is not us asking for something that we think we deserve because we feel that our need is greater; this is an assessed case, based specifically on the fact that the Isle of Wight is an island and so suffers from issues to do with economies of scale and distortions in the market. The additional cost of providing public services on islands, with their limited markets and fewer possible economies of scale, has long been recognised. If the Minister wishes, I can send her an extensive list of academic research on the subject, the most recent piece of which was done for the Isle of Wight by the University of Portsmouth.
The Scottish islands have the special islands needs allowance, which gives additional funding of about £6 million per Scottish island to recognise the additional costs and challenges of providing public services to isolated island communities. We have no equivalent in England, and because of that, we have been structurally underfunded for generations, no matter whether Labour or the Conservatives have been in government; that is how the formula was designed. I wish to look briefly at three key aspects of this.
There are probably five or six elements to the settlement under the island deal that I am discussing with the Prime Minister, but today, I am looking specifically at healthcare costs. In July, the Secretary of State for Health and Social Care said that the Isle of Wight is
“unique in its health geography, and that there are places in this country—almost certainly including the Isle of Wight—where healthcare costs are higher”—[Official Report, 1 July 2019; Vol. 662, c. 943.]—
by dint of isolation and, in its case, of being an island.
The 2019 sustainability plan of the Island’s NHS trust estimates the following costs, which I will discuss in slightly greater detail and then put some questions to the Minister. I know that she will want a decent amount of time to reply, so I will not speak for more than another 10 or 15 minutes, so I can listen as well. The trust estimates that the additional cost of providing acute services on 24 hours-a-day, seven-days-a-week wards is £8.9 million. It assesses the additional cost of providing ambulance services, including a coastguard helicopter ambulance, as £1.5 million and the cost of patient travel by ferry as £500,000, although I suspect it is slightly more, as I will come on to.
Those figures come from the need to provide a baseline service by law for a smaller population than average for the size of a district general hospital. As the Island’s NHS trust states,
“the Island’s population is around half of that normally needed to sustain a traditional district general hospital.”
Because of that smaller population, we do not have the throughput of people, which means that we generate fewer tariffs. To explain it to a layman, we have fewer people going through our hospital, so we claim less money for those procedures, but we still need to keep the wards open and up to the decent baseline standard that people expect.
It stuns me that I still have to explain this. I was having a conversation about the Island this summer with a friend of mine, a Secretary of State and someone I hold in high regard, who turned to me and said, “You have to get to it by ferry, don’t you?” The Isle of Wight is not an island like the Isle of Sheppey or Anglesey in the sense of being connected to the mainland and an island only in a quaint medieval cultural way. We are an island in a practical way: we are separated from the mainland.
We lack a fixed link, which would cost between £2 billion and £3 billion. If the Government ever wish to discuss that, I would be delighted, but until such time, we are separated by water, so primarily, almost exclusively, people travel to the Island by ferry, which changes the dynamics of the hospital and our economy in many different ways. For example, we need to run an accident and emergency service 24 hours a day, seven days a week. It is the same with the maternity ward, because people cannot give birth on a ferry or in a helicopter, and the helicopters do not run in all weathers nor the ferries overnight.
We have a baseline legal requirement to have a hospital on the Isle of Wight, but we have half the usual population for a district general hospital, so everything costs more, because we do not have the tariff-per-head throughput. Our A&E runs seven days a week, but our income is based on a national tariff for a much larger population. We must have a four-cot special care baby unit as part of the maternity unit cover, but a lot of the time, I am delighted to say, it has no babies in it, because the births are healthy. That is wonderful, but we still need to run it, which costs quite a lot of money, even when it is empty, because we have half the population. The same applies to other wards, such as the dementia ward, and to intensive care.
For all those units and wards, we have to provide a baseline service with significantly less income from NHS England because we do not have the tariff, so it costs more to provide the same standard of service. Historically, therefore, we have been underfunded, which has had an impact on the quality of the service that we offer. For example, we are meant to have eight consultants in A&E, but we have four, which is why people wait for 10 hours rather than two—as happened yesterday.
It also costs more to attract permanent staff due to isolation, because of the island factor, so we tend to spend more on agencies and specialist services. Our use of agency and locum staff is frankly bad. We need to find solutions to it, and we are having to do so. To get a locum to come to the Island, we may have to offer to pay the ferry fare, because our ferries are probably the most expensive per mile on the planet. The use of locums and temporary staff also has a knock-on effect on training for our young doctors and nurses. The General Medical Council found issues with foundation training due to inconsistent supervision, up to and including earlier this year.
That is the first point, on acute services; I will speed up, because I want to get as much in as possible. Secondly, our ambulance service has suffered, too. Why? Because we cannot use an overlay of ambulance. When someone is taken ill and needs an ambulance and they are on the Hampshire-Sussex border, if there is not a Hampshire ambulance willing to take them, we can pretty much guarantee that there will be a Sussex ambulance coming along.
We cannot have that. We do not have that on the Island, because it would take an hour and a bit for a Hampshire ambulance to get on the ferry to come over. We cannot call on out-of-area ambulance services from Sussex, Hampshire, Dorset or Cornwall to support us. At busy times, when we are taking folks to the mainland, the additional overtime and manning costs stack up very quickly as soon as there is a slight pressure on our ambulance service. We estimate that cost to be £1.5 million, and I am very happy to discuss that, along with the £8.9 million and the £500,000 for patient travel. This is not based on people being poor and earning a bit less than the national average; they are specific costs associated with islands.
Finally, there is patient travel. In 2017-18, there were 31,314 episodes of planned care—sorry for the bureaucratic terminology—on the mainland relating to Isle of Wight patients, which translates to 44,608 related journeys from the Isle of Wight to the mainland. Through our plan to improve quality of care on Isle of Wight, with the use of telemedicine and better-integrated IT, we hope to reduce the amount of travel to the mainland, but I believe that NHS England should be funding some of that patient travel.
At the moment, the council funds £60,000-worth of chemotherapy visits; the ferries, to their credit, subsidise others, but I want the ferries to spend that subsidy money on other things and I want NHS England to pay for this. I look at the Scilly Isles as an example: the National Health Service (Travel Expenses and Remission of Charges) Regulations 2003 set out that any Scilly Isles resident not entitled to free NHS travel will pay a maximum of £5 for their travel costs. I ask for that £5 maximum return fare to be funded as part of this Isle of Wight settlement and for NHS England to take on the cost of patient travel to the mainland, such as for chemotherapy and other specialist services, which is estimated at £500,000 per annum, or maybe a little bit more, depending on how it is calculated. I would like NHS England to fund that cost. That would also act as a spur to improve IT integration and telemedicine, because the Island wants to become a model.
I am delighted that we got the £48 million from the Department of Health and Social Care recently—thank you very much indeed. It was a fantastic bid put in by Maggie and her team, which I was delighted to support and meet Ministers about. Some of that money is for improving A&E, but some of it is for telemedicine.
I have met some of the guys and girls doing the telemedicine work: we have 42 nursing homes on the Island, and in, I think, 18 we now have a little blue box so that residents in the nursing home can have their vital statistics checked on an almost daily basis, which saves money and time and means that their information is sent every morning to the GP or district nurse so that they can be checked up on. It is much more proactive. This is the future; it is really good and very exciting, and we want to be in the forefront of that. It would make not only ethical and medical, but economic sense for us to do that, because there would be fewer trips to the mainland, lower costs, fewer trips to St Mary’s and even fewer trips to GP surgeries.
Those are the three areas I am focusing on: the cost of acute services, £8.9 million; the cost of ambulance, £1.5 million, including coastguard and air ambulance; and the cost of patient travel. I stress that this is not related to wider problems. We have problems with deprivation on the Island, which sometimes surprise people. Areas of Newport and Ryde are among the 10% most deprived in England. Our disease prevalence is significantly higher than the national average for dementia, stroke, learning disabilities, arthritis and some cancers. I am not yet making a case for additional funding for those things, because the priority is for the Government to recognise the additional costs of providing healthcare on the Isle of Wight.
We are doing our own thing. I stress to the Minister that we are not covering up for a poor-quality NHS trust. It is in special measures, but we have new leadership, we are turning it around and we are going in the right direction. Again, I pay tribute to the leadership of the NHS team on the Island. We know that we need to do more to improve our productivity. We had 149 nurse vacancies earlier this year. By the new year, we expect that figure to be under 90—by getting Filipino nurses in, for sure, but also by training up Islanders and giving them jobs as nurses. We have new models of care, particularly in mental health and acute services, which in the past have been too—I think the word is paternalistic. We are significantly improving those fields, especially mental health, which is still seen to be inadequate and failing.
We are also sharing consultants more. This is the way ahead. We cannot afford specialists on the Island, given our size, but by working with Southampton or, more likely, Portsmouth, we can afford to share those specialists. We are about to sign a memorandum of understanding with Portsmouth, so that we make greater use of efficiencies, sharing consultants, specialisms and specialists, so that when they are not working in Portsmouth, they can jump on the ferry and come over to St Mary’s, or wherever they are needed on the Island, and support us.
As we know, there have been recent failings, which is why we are in special measures on the Island. Some recent episodes that concern me include patients leaving hospital without a discharge summary. That has been happening too often—it was raised in a coroner’s court recently—and it is not good practice.
I cannot make things in the past right, but I can do my utmost to make sure they do not happen in future. I am trying, in my role as Member of Parliament for the Island, to be a critical friend to Maggie and her team. When I hear complaints from my fellow Islanders about certain things, I will pass them on to her, in the hope that she can focus on them, while I understand the importance of supporting the new leadership team. What I ask in return from that team is honesty, to ensure that we are transparent about any past or current failings—not to lay blame or have a go at people, but to work collectively towards raising our standards and giving Islanders the quality of healthcare that, frankly, we deserve and that I want to see for the Island. Until that time, what we have will not be good enough, because the Government have never taken into account the additional costs of being an island.
Overall, things are getting better. I am delighted about the £48 million, and I have discussed telemedicine and IT, so I will not go over them again. To sum up, we face special circumstances—severance by sea—hence the need for an island deal, which I have discussed with the Prime Minister. In this debate, I am looking at healthcare and additional costs in three specific areas: acute, at £8.9 million; ambulance, including coastguard helicopter, at £1.5 million; and patient travel, at half a million. Those are what we accurately and honestly assess to be the additional costs.
I am hugely grateful to the Minister for being here. I hope that she is not missing conference on my account—or perhaps she is very happy to be; I am not quite sure nowadays. My questions to her, finally, are these. Will NHS England accept our costings for the additional costs of providing services on the Isle of Wight that are due to the requirement for baseline services, yet with fewer people coming through and therefore less funding? Or will NHS England provide its own costings, and if so, on what basis? I would like to know whether NHS England disputes our figures and when we can expect official comment. I am not trying to bounce the Minister into a decision today, as well she knows. The most important thing is that we get a considered response and that the conversation now begins, so that I can deliver what I need to deliver for my people.
Can the Minister please outline for the public record, or write to me if need be, a route by which the Island and NHS England can work together to identify the additional costs of providing healthcare on the Island and look at the timeframe for decision making? Finally, where does she feel the additional healthcare pressures figure in the overall funding for the Island? I ask that because we have additional costs that are associated not only with being an island, but with being slightly more deprived in some areas. We have higher dementia, cancer and arthritis rates on the Island, so we are not only dealing with some acute and chronic diseases that have rates higher than the national average, but we are dealing with the island factor as well. I thank the Minister for her time.
NHS Long-Term Plan: Implementation
Bob Seely Excerpts(4 years, 10 months ago)
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Matt Hancock
Yes, and I suggest we meet also with the Secretary of State for Communities and Local Government. I have met the Northants MPs to progress this, and I have also meet the Communities Secretary about it. My hon. Friend is dead right. There is a serious problem, but there is also an opportunity for much more integrated health and social care. If Northants MPs, the Communities Secretary and I can find an opportunity to meet, perhaps we will be able to crack through this one.
Mr Bob Seely (Isle of Wight) (Con)
I thank the Secretary of State for his announcement. I have two questions. First, do he and his Department accept that there are additional costs in providing healthcare on an Island that is of an equal standard to that provided elsewhere? Secondly, will he and his officials agree to meet Island officials to discuss plans for a pilot scheme to help integrate healthcare, adult social care and other local government services to ensure maximum efficiency in the delivery of services, as my hon. Friend the Member for Kettering (Mr Hollobone) just talked about, and to ensure that as much money as possible goes to frontline services?
Matt Hancock
Yes, I shall be happy to ensure that that meeting happens. As for Island healthcare costs, my hon. Friend is right to say that the Isle of Wight is unique in its health geography, and that there are places in this country—almost certainly including the Isle of Wight—where healthcare costs are higher because of the geography. There is a programme for smaller hospitals that are necessarily smaller because of the local geography, as they need special attention.
As I have said, I shall be happy to ensure that the meeting goes ahead, and I shall continue to talk to my hon. Friend, who makes the case for the Isle of Wight better than any other.
Healthcare on English Islands
Bob Seely Excerpts(5 years, 10 months ago)
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Mr Bob Seely (Isle of Wight) (Con)
I beg to move,
That this House has considered the provision of healthcare on English islands.
It is a pleasure to serve under your chairmanship, Mr Hanson. I thank the Speaker’s Office for granting this debate and the Minister for coming to respond to it.
I will outline three arguments. First, I will explain why I believe Isle of Wight health services remain underfunded compared with the mainland. My trust believes that that underfunding ranges from £5 million to £8 million just for acute services. Secondly, I will ask why the Isle of Wight is the only UK island, separated by sea, without NHS-subsidised travel. I believe that is deeply unfair to my constituents. Thirdly, I will suggest ways in which we can help both the Department of Health and Social Care to deliver better health and social care on the Island through the creation of a single public services authority for local government and health, and the Island to become a national leader, as it has done in the past, in improving Government services by combining them.
By way of background, I start by paying tribute to the Island’s NHS staff, who do a wonderful job delivering NHS healthcare provision. We greatly value their professionalism and dedication. I also acknowledge the work of the Island’s NHS leadership in the clinical commissioning group and the trust, and the work of Maggie Oldham and Vaughan Thomas specifically. Along with their wider teams, they do a challenging job in difficult circumstances, and I am hugely grateful for their work and that of everybody in the health services, including medics and ambulance staff, and our public services.
I have called this debate both as Member for the Isle of Wight and as chairman of the all-party parliamentary group for UK islands. The purpose of the APPG is to promote the needs of island communities within Great Britain and Northern Ireland and to advocate for their economic and social wellbeing, the provision of high-quality, accessible public services, and affordable transport arrangements, which are particularly pertinent to the Island I have the privilege of representing. The issues I am raising today focus directly on those matters.
Today’s subject follows earlier debates that I or the APPG have called on the economies and public services of UK islands. Due to devolution, this debate is largely focused on English islands, meaning primarily the Isle of Wight, whose population is approximately 140,000, and the much smaller Isles of Scilly, which I believe have a population of about 1,500.
As I have previously raised, there are additional costs associated with providing public services in island communities. The University of Portsmouth has issued a peer-reviewed report showing that the extra costs of providing local government services on the Isle of Wight are some £6.4 million a year. Coincidentally, that is similar to the amount of money that Orkney, Shetland and the Western Isles get, despite having much smaller populations.
Those principles work for healthcare provision as well. I believe there are significant additional costs to providing services on the Isle of Wight. As I have said, we have a population of 143,000. That is half the size of a population that would usually have a district general hospital, so we are very grateful to have such a hospital and its great staff. However, because our helicopters do not fly 24 hours a day and sometimes the ferries do not go at night, the Island needs a maternity unit. Women cannot give birth in a helicopter. We need paediatrics and we need A&E. Our funding is naturally and obviously skewed by our environment, and because of that there is an argument that we are unable to properly fund some of the other services we need.
An additional problem is that if the trust has a full-time consultant on its books and pays them for their expertise while, in effect, using them only three days a week, or if the maternity consultant is not being used to his full capacity because, although we do need a maternity unit, ours is not as active as that of the average district general hospital, those consultants are not getting the required hours on their ticket, to put it in layman’s terms. That causes diseconomies of scale. One solution is to work much more closely with Southampton and Portsmouth. That is critical to our future, and it is going to happen.
Our costs are also exacerbated by the demographic profile of Isle of Wight residents. We have a lot of young people, as the Isle of Wight festival proved, but it is also the case that 24% of our population are aged over 65, and that percentage will increase. As the Minister and I discussed before the debate, there is an argument that NHS funding for those over 80 is not generous enough, because of the more focused health requirements of people of those advanced ages. Given that a fair chunk of our population are over 80, we have significant pressures. More than 2,700 residents are living with dementia, which is double the national average per constituency.
We are experiencing a growing financial challenge. Our CCG is £19 million above its target funding. The Island overall receives £233 million to fund its healthcare services. The CCG and the trust are seeking to make £19.1 million savings this year, which will still leave cost pressures. The rise in our funding has been marginal compared with that in trusts and CCGs elsewhere in the UK. Those very small rises in funding are now having a very negative effect, and I would appreciate the Minister looking closely at that.
Financial modelling undertaken as part of the acute services redesign shows that even if services are reconfigured to the maximum extent, there will still be a gap between the costs of funding services for the Island population and the amount of money its NHS receives. Our trust believes that the cost, even under our most ambitious plans, is between £5.3 million and £8 million. That is just for the delivery of acute services, if I understand correctly.
My first suggestion to the Minister is that he accept that there are additional costs associated with providing those services on the Island. This is not a case of special pleading; it is merely an acceptance that the Island’s healthcare structure has exceptional circumstances by dint of being separated from the mainland. The Minister could build us a fixed link, at a cost of about £3 billion, or we can argue about the extra millions needed to properly fund the NHS.
I strongly welcome the Secretary of State’s recent announcement of a new long-term funding plan for the NHS, which is a clear sign of our party’s commitment to ensuring that the NHS continues its world-class provision—but I want to ensure that some of that funding comes my way. I would be grateful if the Minister would continue that conversation and meet our Island NHS leadership, so that he and his officials can understand the extra costs in detail.
I also want to propose a way that we on the Island can work more effectively with the integration of public services. I hope that idea will be attractive to the Minister and his officials. As I have said, we are not looking for special treatment, but we are looking for fairer funding. I place emphasis on both provision and access because we want to provide as many services as possible on the Island, but we also need access to the mainland for when some of our Islanders need to go to Southampton or Portsmouth for specialist services such as radiotherapy. There will be a small decrease in the number of visits to the mainland, but a small rise in the number of more specialised healthcare appointments there.
As the Minister may know, the NHS trust has laid out a series of options for the future of healthcare on the Isle of Wight. I seek Government support for its more ambitious aim of taking back more bread-and-butter acute services to the Island, thereby requiring fewer trips to the mainland, rather than the current option of slightly fewer services on the Island and slightly more on the mainland. We will discuss that at length.
The local care finance system has undertaken a detailed assessment of how to strike the appropriate balance between providing services within the shores of the Island and enabling access. However, there are increased patient safety risks associated with any shift of more services to the mainland, particularly for patients who may be frail and in need of swift access to services.
My constituents have made it clear, through a range of public engagement exercises, that they wish to see the maximum retention of services on the Island, and they join me in asking the Government to ensure that that is recognised in any future funding. As recently as two weeks ago, the Isle of Wight County Press and Isle of Wight Radio hosted a question time event with representatives of the Isle of Wight NHS at which the Island-mainland split in services was debated. My constituents’ views were clear: where possible, the retention of services on the Island should be a priority. I therefore urge the Minister to carefully examine the funding arrangements in place for healthcare, to ensure that those needs are met.
I also ask that we examine the issue of patient travel and how visits to the mainland from the Island are funded. As I have said, the Isle of Wight is the only UK island with no subsidised ferry travel to support local residents in accessing specialised services on the mainland. I will not dwell on arrangements for Scottish islands, because they are part of a wider mechanism and their arrangements are devolved.
The National Health Service (Travel Expenses and Remission of Charges) Regulations 2003 set out that any resident of the Isles of Scilly not entitled to payment in full of NHS travel expenses in accordance with low-income criteria will pay a maximum of £5 for their travel costs. A document from the Cornish CCG, NHS Kernow, also sets out that residents of the Isles of Scilly have to pay only £5 towards the cost of NHS-funded patient transport to the mainland. Furthermore, if it is deemed necessary that the patient needs an escort, a further maximum payment of £5 will be applicable.
I have talked about the matter with my hon. Friend the Member for St Ives (Derek Thomas), who represents the Isles of Scilly. I am delighted that residents of the Isles of Scilly benefit from such an arrangement, but why is it not available to my constituents as well? Although some on the Isle of Wight meet the narrow definition of being on a low income and would benefit from having such costs met, many other residents have to regularly access healthcare treatment on the mainland—such as those with prostate cancer, who may need 40 trips —and face difficulty in affording the associated and oft repeated costs. I believe it is inequitable and unfair for one set of English islands to enjoy such a benefit when others do not. It is yet another example of the Isle of Wight’s not being treated fairly.
The arrangements for Isle of Wight residents travelling to the mainland for operations and medical appointments are much less generous, and exist only due to the co-operation of our three cross-Solent operators. Red Funnel offers a special return ferry fare; Wightlink offers a discount for both vehicle and foot passengers plus a patient escort; and Hovertravel offers a 20% discount on day returns. I am grateful to those operators for putting those arrangements in place, and to the NHS on the Isle of Wight for negotiating them, but the reality is that even with such discounts, the cost of trips to access healthcare on the mainland can place a great financial burden on patients, which is at odds with the NHS’s founding principle of being free at the point of delivery.
I therefore ask the Minister to amend the 2003 regulations to extend that statutory requirement to the Isle of Wight, as well as the Isles of Scilly. That would be a significant step forward and would have a transformational effect on the lives of many of my constituents who go to the mainland for treatment. Around 32,000 return visits are undertaken a year. Under option 3, that would be about 30,000, while under option 4 it would be about 27,000 or 28,000. We are talking about numbers in the low tens of thousands, and funding those visits would require relatively small amounts of money.
However, as those visits are in the tens of thousands, and because our CCG is struggling for money, I ask that any such arrangements do not have a budgetary impact, either on Cornwall’s or the Isle of Wight’s CCGs, and that the cost of funding the discount comes directly out of the NHS budget. That would be recognition that English islands should be treated similarly to Scottish islands, and of the cost of going to the mainland from the Isles of Scilly or the Isle of Wight. Under this plan, patients and their escorts would pay no more than £5 to travel to the mainland for treatment. I believe that to be a fair and reasonable gesture for the Government to make, and I ask for that change to be brought forward, along with the changes to the 2003 regulations to allow the Isle of Wight to benefit from statutory obligations.
There is also the issue of travel for families. Staying overnight in a mainland hospital brings about financial pressures for my constituents. I appreciate that the 2003 regulations do not provide for support in these cases, but if the Minister was generous enough to consider those changes, and to find the small amount of money to fund directly the £5 fare for people seeking treatment, my hon. Friend the Member for St Ives and I could go back to the ferry companies serving our respective islands and see if they would be generous enough to make similar provision for patients’ visitors. Someone from Ventnor, Cowes or Ryde who was going to hospital in Southampton on the mainland would pay £5 to get to the hospital, but their families often pay full whack on the ferries. That is not cheap. If we changed those arrangements, we could talk to the ferry companies about providing properly recognised and organised support to families visiting their loved ones in hospital. That would be a generous gesture to the Isles of Scilly and the Isle of Wight.
I am grateful to the Minister for listening, and I will raise one other issue. To recap, the Isle of Wight is not properly funded, and my folks—my constituents—are hard done by when traveling to the mainland. Do not get me wrong: we love being an island, but we seek fair funding to mitigate the effect of the Solent, which is often overlooked by the Government. However, I am here not just to ask, but to offer. We on the Island are already committed to integrating health and social care as much as possible, and I believe that Islanders would be delighted, with Government support, to lead the way in delivering best practice in the integration of council, health and adult social care services.
For example, we have the “My Life a Full Life” programme, which is a collaboration between the Isle of Wight CCG, the NHS trust and the Isle of Wight Council. The programme works in partnership with local people, voluntary organisations and the private sector to deliver a more co-ordinated approach to the delivery of health and social care for older people and people with long-term conditions on the Island.
My aim is to keep as many young people on the Island as possible, to build an economy for them, and to get a university and improve our education system. However, at the same time, it is critical that we become a leader in ensuring quality of life in later life. We are naturally drawn towards integrating our services, because we are a small island, so we have the potential to be a national leader in this. “My Life a Full Life” is a great idea, but it arguably has not reached the point that it should, because we still have siloed organisations. There are bureaucratic hurdles to overcome in combining the leadership of those organisations, but ensuring their full integration could save a considerable amount of money on appointments, which could then be put back into frontline services.
I would like to acknowledge the work of all those involved on the Island in delivering some really good programmes that we have for integration, but particularly Councillors David Stewart and Clare Mosdell, along with professional officers such as Dr Carol Tozer, the director of adult social care. They have established a local care board, and it is already bringing the services together as part of our One Public Service vision for the Island, but it is still not combined structurally and in terms of leadership and governance.
At the moment, the Government provide one pot of money to local government on the Island, another to fund the Isle of Wight NHS, and another to the CCG. Does it have to be that rigid? Can we aspire to a situation in which one combined funding pot is made available for public service provision on the Island, thereby increasing the requirement for deeper and more meaningful integration? Such circumstances may require combining the governance and leadership of public services. It is important to explore that, and there are questions about the role of experts, certainly in healthcare and adult social care provision.
I ask the Minister to explore, with his ministerial colleagues, whether there is an appetite for creating a unique public authority on the Isle of Wight that combines traditional local government functions with those of NHS trusts, the CCG, adult social care, mental health services and so on. If such a fully combined and integrated approach can work anywhere, it should work on the Island. Such a step would be a natural progression from the integrated way in which we are trying to work; we are trying to overcome those siloed, bureaucratic, financial hurdles. Clearly, if we achieved that, we would ensure that the input of healthcare professionals was still very much at the forefront of decision making. I urge the Minister to work with us as closely as possible on that, because that could be a valuable exercise that could be repeated elsewhere, perhaps in more isolated communities, and in places where the combination of healthcare and public service could achieve real public good and address public need.
I will not talk for much longer; I will just make a couple of other points briefly. I am grateful to you, Mr Hanson, for allowing me to speak at length.
I want to talk about digital solutions. Again, we are not the only part of Britain that is isolated, but clearly the Solent is a boundary and border for us. I find the situation slightly ridiculous. Yes, if people need to go to Southampton for an operation, that is great, but do they need to go there for every pre-op appointment? Do they need to go to Southampton or Portsmouth for every post-op appointment? We were talking about this earlier. We need to find the greatest centres of expertise in Britain and be able to buy in those services. Perhaps people can have their appointment in Southampton, Reading, London or Portsmouth, but can have their pre-op using digital technology—telemedicine. We need to be much more efficient in how we use that.
Again, we are not the only isolated part of Britain. However, I am offering the Island to NHS England as a pioneer in not only integrated services, but how we use advances in telemedicine and all those other wonderful things. Also relevant is data collection. The NHS does not use data terribly well, if I understand correctly. In relation to data for preventive medicine, we are small enough to be manageable. Social scientists love us because we are geographically isolated; we are clearly, in a very geographically obvious way, measurable. And for relatively small amounts of money, a great deal of learning could be done on the use of data in relation to preventive medicine, telemedicine and integration—the combining of health and adult social care.
As well as saying, “Please look at our funding”, because we have funding problems on the Island, we have special needs that have never, ever been recognised. I find the situation shocking, frankly. The Government, with the best will in the world, try to be fair. They fund the Scottish islands via the Scottish Government; they give them extra money. Anglesey has a bridge; the Scilly Isles have a small population anyway. However, the Government permanently function without taking into account my constituency. I know that they do not mean to do that, but our circumstances are unique, in that we are isolated by water, and that has never been recognised. When isolation factors are looked at, we never seem to qualify.
We are not properly funded, but we would like to be, and I would like the Government to look seriously at the struggle that some Islanders face in paying for the travel to the mainland when they go for treatment. I am offering the Government suggestions of ways in which the Island could be used as a test case, as a national leader, to integrate services better, to use data better and to combine all these functions, using telemedicine, to create a world-class service on the Island. That could be used not only to deliver great healthcare to my residents, but as a national role model for others.
The Minister for Health (Stephen Barclay)
It is a pleasure to serve under your chairmanship, Mr Hanson. I pay tribute to my hon. Friend the Member for Isle of Wight (Mr Seely) for raising the issue in the way that he has. He has used Westminster Hall exactly as it should be used—to bring the concerns of his constituents front and centre before the House. He set out not only the challenges faced, but the ways forward and a number of solutions for different issues. In short, he raised issues of funding that relate to population and geography, travel, the potential for further integration, and also a way forward involving digital and data. I will address each of those in turn.
This is also a timely debate, as the shadow Minister mentioned, following the Prime Minister’s announcement at the Royal Free Hospital last week of a significant funding boost to the NHS. Alongside that, NHS leaders are drafting a long-term, 10-year plan on services, which will look at many of the issues he cited in his speech. As we start that journey with NHS leaders, bringing the issues of the Isle of Wight front and centre is timely and helpful.
I would segment the funding formula issue into two: the challenges that the Island has in common with other parts of the country, such as those posed by the over-80s and by the significant number of constituents with dementia, and those that are unique to it. Indeed, few hon. Members feel that their constituents’ circumstances do not merit being higher up the funding formula than they currently sit. It is valid to raise those issues, and NHS England will look at them on the advice of the Advisory Committee on Resource Allocation, which advises on the funding formula. Those decisions are common to other areas, but they need to be made in respect of the Island. If my hon. Friend wishes, I am happy to facilitate a meeting with NHS England so the funding pressures pertaining to the demography of the Island can be raised. He will recognise that the setting of the funding formula is an independent process.
There are specific issues about the geography that my hon. Friend raised very well, not least about maternity services and paediatrics. The Island needs to supply those services and that will have an impact on its funding. I am happy to look at those issues. Integration is one way that headroom will be facilitated to meet those challenges. As he said, the Island was a vanguard site that has received £8.4 million of extra funding since 2015 to facilitate the transformation of services. That funding recognised some of the Island’s specific geographical challenges.
Although geography can be, and is in certain areas, a disadvantage and a driver of cost, it is also a driver of opportunity, as my hon. Friend set out. The Island has a strong sense of place and identity, and there are strong personal links between key decision makers and stakeholders. As the shadow Minister rightly said, the move towards greater integration between health and social care—as is reflected in the name of the Department—is also an opportunity to drive integration between the council and health services. My hon. Friend alluded to the bureaucratic obstacles to that, and I am happy to work with him to overcome them. As patients present with multiple conditions and as we move away from silos of care to a more holistic approach to patients and their wellbeing, the Island offers a huge opportunity for greater integration.
On my hon. Friend’s point about data, I had an interesting meeting yesterday with the chief executive of the Christie in Manchester, which is one of our outstanding trusts. I was struck by the fact that 19% of its patients take part in medical research programmes. The chief executive set out how that is hugely beneficial to the trust and to the patients, who get access to cutting-edge drugs and the latest thinking. He has also been able to attract some of the world-leading figures in research because he has a population that researchers can work for, which is very attractive to them. That is a real win-win, and the demographics of the Island offer an opportunity in that regard.
Mr Seely
One point that I did not make was that when it comes to looking at dementia, the Island would be very open to becoming a national leader or a place where academics and researchers could investigate how we can live better with dementia in this country. We have double the national average of people with dementia, so it would be a natural fit for us.
Stephen Barclay
I am keen to work with my hon. Friend on that, because the Government have prioritised their research and development budget, as I know from my time at the Treasury. A significant investment has also been made in health R&D. The NHS has an opportunity to combine its patient data with our world-leading universities and R&D to attract researchers, drive forward the most innovative approach on healthcare and translate that cutting-edge research into day-to-day care. That can be a frustration for our constituents; it is fine to have the research, but we need to roll it out to scale in a way that is meaningful for patients. The challenge of the Island’s geography is also a huge advantage to it. I do not know what percentage of its patients are taking part in research, but that may be an area for him to explore and for the Department to work with him on.
My hon. Friend also raised the potential of digital. He will be aware that the Secretary of State has asked Dr Eric Topol, one of the world leaders on the use of digital in healthcare, to undertake a report for the Department. My hon. Friend is right that rather than a patient having to be physically present in all instances, as was traditionally the case, there is scope to use digital much more for them to see a consultant online and for information to be sent digitally. I recognise that if the clinical commissioning group is in deficit, finding the headroom to invest in that technology becomes a trade-off and a challenge, but that is one of the opportunities that will be opened up by the Prime Minister’s investment in the NHS and it is an area that the 10-year forward view will specifically examine.
In terms of timing, the Island has a chance to look at how it can become a leader, what has been done with digital enablers and early adopters in the NHS, and in which areas it can lead on in technology. I will come on to the challenges of travel, but reducing the need for journeys is a more sustainable solution than seeking to subsidise them. Our starting point should be how we can use technology to reduce the need for as many journeys, rather than how we can subsidise more journeys. That offers significant scope.
On travel, I heard my hon. Friend’s remarks about the cost and its wider impact on families. There is a correlation with a separate debate we have had about car parking charges. Clearly, there are specific challenges related to travel, but as he also set out, it is quite complex, because there are already arrangements with the ferry companies and national schemes for subsidies and assistance that can be given to people who are financially challenged. It is a question of looking at how we can fit in with the existing schemes and what agreements can be reached with the companies concerned. I am happy to meet him to pick up on that specific point to better understand our current approach and what can be done, given the challenges. Again, the challenge of distance is not unique to the Island, but as he mentioned, there are certain features of travel to the Isle of Wight and the Scilly Isles that pose challenges.
As my hon. Friend will be aware, the NHS healthcare travel cost scheme provides financial help for travel costs for patients on low incomes who are referred. The scheme is part of the NHS’s low-income scheme, under which people are also entitled to free prescriptions and glasses. Under the scheme, the full cost of transport can be reimbursed by the NHS to eligible patients. Schemes are in place, but I hear the wider points that he has raised and I am happy to discuss them with him.
In short, my hon. Friend has set out that the Isle of Wight is ideally placed to be at the vanguard of the NHS’s approach as we move forward with the 10-year forward view, in embracing digital and integration and in looking at how to deliver place-based commissioning most effectively. There are some specific challenges with regard to its population and its geography in terms of travel. The interplay of those two things is another challenge in terms of efficiencies of scale and the services that are considered essential on the Island, which may be dealt with at a larger-population level elsewhere.
In the NHS more widely, as we move to a hub-and-spoke model and to more flexible population sizes, and as we look at place-based commissioning, the Isle of Wight has huge potential to be at the forefront, as my hon. Friend has set out. I am very happy to follow up this debate by meeting my hon. Friend, and to facilitate a discussion between him and NHS England, to ensure that we deliver what he has campaigned passionately for—the best healthcare for residents of the Island—and that the significant investment set out by the Prime Minister is maximised for his constituents.
The shadow Minister quite reasonably asked whether we were open to changes to the legislation. As he will be aware, the Prime Minister said to the NHS leadership in her remarks at the Royal Free Hospital that we are open to such suggestions if NHS leaders feel that changes are necessary. As part of the workings of the long-term plan, those leaders will need to look at what they need, and whether much of the integration—I know that the Mayor of Manchester supports the integration that is taking place in Manchester—can be done under existing legislation, or whether changes are needed, and if so, what those are. That will be part of the discussions with Simon Stevens and others in the weeks and months ahead.
Surgical Mesh
Bob Seely Excerpts(6 years ago)
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Emma Hardy
I absolutely agree, and I hope that will be included in future.
Analysis conducted by Carl Heneghan, professor of evidence-based medicine at the University of Oxford and clinical adviser to the APPG on surgical mesh implants, reveals that the 100,516 women who have undergone mesh surgery in England since 2008 have required follow-up treatment in 993,035 out-patient appointments. He has calculated the total cost to the NHS for all incontinence and out-patient appointments to be £245 million. His analysis of the trend in out-patient appointments also shows that more are required by women as each year passes after their surgery, which is completely the opposite of what you would expect after a successful surgery.
The data shows that the number of operations using mesh has halved over the last decade, which shows that doctors and patients are voting with their feet and telling the world that they do not want to use mesh.
Emma Hardy
I will have to continue.
In February came the welcome announcement of the Cumberlege review of how the NHS addresses concerns about vaginal mesh devices and how patients have been treated when raising those concerns. However, I remain deeply concerned that mesh has not yet been completely suspended and that it remains possible for doctors to use it, especially in the case of stress urinary incontinence. There is also still no universally available physiotherapy as standard for all new mothers, as there is in France, to stop these problems before they even arise.
I still believe that it is an absolute scandal that these devices were aggressively marketed to doctors and then used in patients for whom they were unsuited. We need to ensure that lessons are learned and that more steps are taken to make the medical products industry more transparent. Campaigners have even called for legislation, such as they have in America, to require doctors to declare any grants, inducements or scholarships that they receive from the industry.
Some patients think they are having the mesh completely removed, only to find out later that it has been only partially removed. They feel that they are suddenly better and that they are recovering only to go through the horror of having the symptoms come back later. It is important that, where possible, mesh should be removed in full.
Despite the fact that 100 different types of mesh are available in the UK and that we do not know whether just one type is causing the problem or 100 types; despite the fact that Carl Heneghan has raised concerns about the small amount of evidence that mesh manufacturers are required to provide before their products are approved; and despite the fact that Dr Wael Agur from the University of Glasgow, a one-time advocate of mesh surgery, is now arguing that the Medicines and Healthcare Products Regulatory Agency has only a fraction of the knowledge of the adverse effects associated with mesh, NICE is still not going to bring its guidelines for stress urinary incontinence forward from 2019 to 2018, and the Government seem more focused on process than on the actual product.
Suzy Elneil, consultant urologist at University College London and one of the few qualified surgeons who is able to remove mesh, tells me that she sees 15 women a week who are suffering after mesh surgery. Even if NICE releases its guidance on 1 January 2019, Suzy alone will see another 525 patients before that date— 525 more patients living in unbearable pain. I am sorry, but that is 525 people too many. The Government must press NICE to bring forward the guidelines and pay attention to the product as well as the process.
Emma Hardy
I am sorry, but I have to continue.
It seems that our campaign must continue. We must ask again for renewed commitments from the Government to address these problems. Again, I ask the Government to commit to three things. First, we need a full and unequivocal suspension of mesh implant operations. Secondly, I ask them to bring forward the NICE guidelines for stress-related urinary incontinence from 2019 to 2018. Thirdly—this is a new one—will they please offer pelvic floor physiotherapy to all new mums as standard on the NHS, as happens in France, to help to restore the core after birth?
I end my speech with exactly the same words I used to conclude my remarks in Westminster Hall. Mesh implants have affected thousands of people all over the country. For some, the consequences of their operation will be life-changing and devastating. A Government commitment to taking these actions will not undo the suffering and pain that these women have endured, but would go a long way to making sure that nothing like this happens again.
This is the second time that I have spoken these words. Let us hope that justice is done before I have to speak them a third time.
Dr Sarah Wollaston (Totnes) (Con)
I pay tribute to the many women, including those in my constituency, who have come forward to discuss deeply personal and painful accounts of serious complications following mesh surgery, sometimes with life-changing and lifelong consequences for them and their families. I also thank the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) who, as always, has set out the background to the issue so eloquently. She has been such a campaigner on behalf of victims, and I really thank her for what she is doing. I will not repeat much of the background that she set out, but I will highlight a few points to which I hope the Minister will respond in her closing remarks.
As we have heard, NHS Digital has published a review of patients who have undergone urogynaecological procedures for prolapse or stress urinary incontinence, including those where mesh, tape or equivalents were used. However, as the hon. Lady pointed out, the review does not cover all procedures, nor does it include the men who have been affected. We know that 100,516 women underwent these procedures between 2008 and 2016, of which 27,016 cases involved mesh for prolapse. Although the numbers are falling, I am afraid that this is just a snapshot.
Mr Seely
I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on calling this important debate. Are the figures accurate? I have been told that some of the figures do not include people who are treated abroad and come here having developed complications, or people who have been to private clinics. The numbers that we have may therefore not be accurate, perhaps underestimating the true total.
Dr Wollaston
I was about to come to that very point. Crucially, many of the women I have met have been treated in the private sector. In this House, we should be concerned about all our constituents, not only those who are treated in the NHS. Of course, it is the NHS that often then bears the burden of managing complications, but we must have a much more accurate picture.
I support the call from the Royal College of Obstetricians and Gynaecologists and from the British Society of Urogynaecology for mandatory prospective data collection, using the BSU’s database. That is a well-established method of collecting outcome data. Retrospective snapshots are no substitute for collecting data as we go forward or, most importantly, for being able to track it in the long term. Although the majority of complications that happen after 30 days happen in the first year, many of the women I have met developed complications far later than that. I particularly want to emphasise to the Minister how important it is that we have access to shared databases not just here in the UK, but across Europe. Will the Minister tell us whether the Government will be seeking for us to remain part of the European Database on Medical Devices—EUDAMED—so that we not only get an accurate picture of what is happening here in the UK, where our population is smaller, but can compare our data with the whole European Union?
That brings me to the wider point about Brexit that is highlighted in the report of the Select Committee on Health on the implications of Brexit for medicines, devices and substances of human origin: the issue of access to clinical trials. It is encouraging that the Government have stated that they wish to remain a part of the European Medicines Agency or to have associate membership, but there are all sorts of aspects to forward clinical research on which it is essential that the Government campaign. They must campaign not just to maintain regulatory alignment and harmonisation, but to ensure that we can remain part of all research mechanisms and mechanisms for ensuring that we have the earliest possible awareness of any complications—not just from drugs but, as this situation has shown, from medical devices. I hope that the Minister will further outline the Government’s intention in that regard.
Contaminated Blood
Bob Seely Excerpts(6 years, 9 months ago)
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Mr Bob Seely (Isle of Wight) (Con)
I thank the Government very much for the announcement. I am new to the issue, and I pay tribute to hon. Members who have done much work in previous years, including the hon. Member for Kingston upon Hull North (Diana Johnson), my hon. Friends the Members for Worthing West (Sir Peter Bottomley) and for Stratford-on-Avon (Nadhim Zahawi), and others who had the wisdom to champion this cause when it was not fashionable to do so.
Islanders who have been affected will be relieved that all the truth behind the scandal will come out. I suspect that some of it will make for very difficult listening indeed. I did not know whether I should speak in this debate, but I decided to do so after listening to the moving experiences of some of my residents, who asked me to come to the Chamber and listen to the debate. I am glad that I have done so, and I thank them for that suggestion.
I represent residents, as we all do, who have lived with this for decades, including people who contracted illnesses linked to contaminated blood, some of whom were infected when only nine years old. One resident, Janet Sheppesson from Freshwater in the west of my constituency, worries not only for herself but for members of her family. She told me that her life had been turned upside down by the contaminated blood:
“My infection has caused me to suffer from a disabling and debilitating autoimmune disease. You may be amazed, as I am, to know that, despite all this, I was refused funding for the new generation, direct-acting antiviral treatment for Hepatitis C by NHS England and was obliged to buy it myself earlier this year.”
Not only do the residents I represent suffer but they feel that the NHS, which let them down in the first place along with others, has not provided the support that it should have done, which concerns me.
The light of investigation, whether by the Government, media or interested parties, is critical to making progress in our society, to upholding justice and to lessen suffering. Those inquiries are often difficult, as we have seen from Hillsborough and may well see from Grenfell Tower and others. Such inquiries ask questions of those in authority and test the system. The outcome should be justice and, as other hon. Members have said, trust in the system and in people here, who are doing the right thing and battling for their constituents.
Islanders want to know the answers to a series of questions, some of which have been asked. I will not repeat those, but there are two or three outstanding questions. Will the Government at some point explain the difference between a statutory and a Hillsborough-like inquiry, especially for my constituents who are interested in participating in it? How will the widows and families of the 2,400 people who have already died be treated as participants, and how will their financial and other claims be handled? The potential criminal elements have to be investigated to their ultimate conclusion. Will the Minister reassure us that the inquiry will be time-limited, while being as comprehensive as possible?