Melanoma

Chris Skidmore Excerpts

Wednesday 18th January 2012 Westminster Hall

[Pauline Latham]

Yes, I would like that to happen. Looking tanned does not mean that someone is healthy. In fact, tanning increases the risk of malignant melanomas, which are rapid killers, and I would like councils to have the strength to say, “No.”

It may be expensive to prescribe the drug, but it is the first advance in treatment for a long time, and if used, may offer the opportunity of more trials to refine it, which could lead to its becoming even more effective. For young people with melanomas, it is a lifeline, even if they only survive for a relatively short time. Let us not forget the possibility that agencies, such as social services, and welfare benefits can cost the country huge sums if the remaining parent has to give up their career to look after a young family. Patients with this aggressive disease are expected to have a median overall survival time of six to nine months, but in trials, 46% of patients taking ipilimumab were still alive after a year, and in some cases, patients can live even longer.

At the stakeholder’s meeting on 8 November, we heard from a patient called Ian. He seemed well, spoke eloquently and raised many important points on access to treatment, which I urge hon. Members to read in the report that we submitted to NICE—I am happy to provide a copy. Sadly, before 21 December 2011, Ian became very unwell and was ultimately bedridden. The short time between Ian attending the meeting in November and his death a week ago demonstrates the aggressive nature of advanced melanomas.

Lack of access to the drug is still a major concern to all melanoma patients and, of course, to their families and friends. It is very distressing for them to know that there is a drug on the market that has been proven to prolong the lives of sufferers, if even for only a few months or years, yet they cannot access it through the normal channels. I acknowledge that ipilimumab is available in some parts of England through the cancer drugs fund, but it is not available in all areas, and the fund does not even exist in Wales—yet another example of inequality from the cancer drugs fund and another illustration of a postcode lottery.

[Chris Skidmore (Kingswood) (Con)]

On my hon. Friend’s point about a postcode lottery and regional variation, I think that she will be interested in figures that I recently obtained through a parliamentary question. They break down the number of registrations of newly diagnosed cases of melanoma—skin cancer—by local authority and region. I would happily give her a copy. In my region of Avon, Somerset and Wiltshire, there has been an explosion of newly diagnosed cases of skin cancer, from 254 in 1999 to 455 in 2008—an increase of 79%. The huge variation across the country shows that this is not just about the future, but that we have a problem now that we must urgently tackle.

[Pauline Latham]

Yes, I agree. I thank my hon. Friend for raising that point, because although we are talking about a big increase by 2030, he is right that melanomas are affecting more and more people, particularly the young, and they are usually a death sentence.

What will happen to those patients in areas covered by the cancer drugs fund who can access ipilimumab through the fund when funding ends in 2014? That further illustrates why it is imperative that NICE recommends ipilimumab, so that it is available across England and Wales to all patients who could benefit from it. The Minister knows that my concerns about access to treatments for other cancers—for example, Avastin as second-line treatment for bowel cancer via the cancer drugs fund—are well versed through parliamentary questions and speeches in the Chamber. I remain equally determined to ensure the availability to cancer patients of other life-prolonging drugs, such as ipilimumab.

Alongside Factor 50 and Skcin, I urge in the strongest possible terms that the Department of Health, the manufacturers and NICE work together, so that ipilimumab is available to appropriate patients across England and Wales. There are huge concerns that, without a positive decision on ipilimumab, patients will lose out on a lifeline to have those extra months or even years with their loved ones.

NHS (Private Sector)

Chris Skidmore Excerpts

Monday 16th January 2012 Commons Chamber

[Andy Burnham]

My argument would be that if those decisions are to be made, the people who make them should be accountable to the hon. Gentleman and the House, whereas the Bill that his right hon. Friend the Secretary of State is introducing proposes to push those things away. There will be an independent commissioning board that GPs and clinical commissioning groups will not be able to overturn; it will make the decisions. That is a completely unacceptable state of affairs.

Before the last election, we proposed a modest loosening of the private patient cap in response to pressure in another place when we were debating the Health Act 2009, but compared with our modest reforms, the Government’s plans are off the scale. Instead of private sector activity at the margins, the Health and Social Care Bill places market forces at the heart of the system. The private sector will not support the NHS, but will replace large chunks of the service in commissioning and provision.

[Chris Skidmore (Kingswood) (Con)]

I should be interested to learn—as I am sure would the whole House—the right hon. Gentleman’s definition of modest loosening. In the four years between 2006 and 2010, the amount of money going to the private sector rose from £2 billion to about £12.2 billion. Does the right hon. Gentleman simply oppose the 49% cap or will he pledge to reverse it if he returns to government? What exactly would the cap be? Would it be 30% or 12%? Please let us know.

[Andy Burnham]

May I refer the hon. Gentleman to the motion? Its request to the Government is not unreasonable; it asks them “to revise significantly downwards” the cap they have proposed.

--- Later in debate ---

[Mr David Anderson (Blaydon) (Lab)]

The NHS is rightly the most valued institution in this country. It has an impeccable track record of continuing improvement and innovation going back more than 60 years. The staff on the front line and those in the support services who are disparaged by Conservative Members as somehow irrelevant to the success of the service have never been frightened to face up to the challenges of change. They are, however, sick and tired of the constant demands of know-it-all politicians on all sides for endless reorganisations, restructuring and re-profiling. That is why they were so disappointed after the Prime Minister had told them that there would be no more top-down impositions from on high; they and the British public were, quite simply, misled.

The fears around privatisation are a reflection of yet another change to the structure of the NHS, and it is a very unwelcome one. The Secretary of State tried to rubbish the trade unions tonight. He did not mention all the other professional bodies in the NHS that are opposed to the changes. The only people who seem to be in favour of them are those in the Tory party, and their friends in the Liberal Democrats. None of the people who are delivering the services want the changes to happen. That includes the GPs that the hon. Member for Crawley (Henry Smith) was talking about. They might well be doing good work in Crawley, but the key is that they do not want to have to do it in that way. The general public are also worried about the changes.

The Secretary of State said that we should not look back, but if we do not learn the mistakes of history, we will repeat them. We need to look at the situation that prevailed a long time ago. The working people in this country in the first half of the last century were desperate for a health care system. People came back from the devastation of world war one to a worldwide influenza epidemic. They were living in desperate conditions and working in massively unsafe workplaces. They were bringing up families whose lives were blighted and shortened by the diseases of poverty: tuberculosis, rickets, malnutrition and pneumonia. Their conditions of life at home and at work had changed little since the days of Dickens, yet we saw yet another world war where money that could not be found to build a decent society in peacetime was miraculously produced to kill millions in wartime.

At the end of that war, the men and women of this country were determined not to continue with that and were not going to put their faith in a Government and a private sector-driven economy that had failed them so badly. They turned instead to a Government who, despite the biggest debt crisis ever, determined that the health and well-being of this country’s people was paramount. That is why Labour built millions of homes for people, why swathes of industries that had been disgracefully run down by the private sector owners were nationalised, and why we, the Labour party, built the NHS to ensure that never again would the quality of a person’s health care depend on the depth of their wallets.

People quite rightly felt bitter about the way they had been treated for decades. That was perhaps best summed up by Nye Bevan, who set up the NHS, when on 4 July 1948, two days before the NHS came into being, he said:

“no amount of cajolery and no attempts at ethical or social seduction can eradicate from my heart a deep burning hatred for the Tory party that inflicted those bitter experiences on me.”

As expected, the Opposition did not like that, and Mr Churchill labelled Mr Bevan “the Minister for Disease”. Equally as expected, Nye Bevan was having none of it. Speaking from the platform of the Durham miners’ gala, he reminded people of the reality of life under Tory rule when he said—

[Chris Skidmore]

Will the hon. Gentleman give way?

[Mr Anderson]

Go on, then.

[Chris Skidmore]

The hon. Gentleman is quoting history, so I wonder whether he would agree that Nye Bevan could be seen as the pioneer of private sector involvement within the NHS, given that he accepted that more than 4,000 pay beds should be part of the NHS in order to ensure bags of investment in facilities?

[Mr Anderson]

Of course, the reality is as envisaged by my right hon. Friend the shadow Secretary of State, who has accepted that there is a role for the private sector within the health service, but the debate is about how big it should be and how much control there should be of the health sector. [Interruption.] May I carry on?

As I was saying, Nye Bevan responded to Churchill’s criticism by saying:

“Who should be called the Minister for Disease? I am keeping mothers and children alive when he half starved them to death.”

That is the legacy with which the Conservative party is lumbered. It is the burden round the neck of Conservative Members when the people of this country get worried about private involvement in health care. I have no doubt that Conservative Members will not agree with me, but it was right and proper when my right hon. Friend the Member for Leigh (Andy Burnham) drew an analogy between this privatisation and that of the utilities. We should look at the results of those privatisations: unfettered and uncontrolled expansion, with our energy supplies now controlled by foreign companies; huge, uncontrolled price increases; millions of people in fuel poverty; no control over the security of supply; a national grid not fit for purpose; and an incoherent strategy to face up to the challenge of climate change. Those are all the result of giving away our vital services to the highest bidder. People are quite right to say, “Why would it be any different in health?”

The people of this country do not want the NHS to become a copycat version of the American model—a model that costs twice as much as ours to run, yet leaves 20% of the population out in the cold when they are ill. Our NHS has a tremendous track record, dealing with millions of people every week. Our life expectancy levels have risen rapidly, especially over the period when the previous Government reversed the years of underfunding that were the trademark of the last Tory Government. Public satisfaction rates were at record levels when we left office 18 months ago.

This present Government have broken their promise to the British people. They have lied to the staff who work magnificently to deliver our NHS. They are intent on breaking up the NHS and replacing it with a system based once again on a programme that puts profits before patients. If Conservative Members really believe in privatisation, they should ask the people what they want. The people have woken up to the reality of the Conservative party; they realise that once again the NHS is not safe in Tory hands—even though they are wearing the yellow gloves provided by the Liberal Democrats. Patients, as the figures clearly show, want no further privatisation of our NHS.

Oral Answers to Questions

Chris Skidmore Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Lansley]

The hon. Gentleman will know that the Department of Health continues to support the voluntary sector considerably through section 64 funding and related support. If he wishes to write to me about the specific circumstances of the Brittle Bone Society, I will be glad to reply to him.

[Chris Skidmore (Kingswood) (Con)]

I recently made a freedom of information request to all 170 acute trusts asking for the estimated total cost of missed out-patient and surgery appointments. So far, 61 have come back to me, and the cost is already over £1 billion. Will the Secretary of State seriously consider what we can do to tackle the enormous cost of missed appointments in the NHS?

[Mr Lansley]

Yes. My hon. Friend makes an important point, and it is something the NHS must focus on. There are considerable opportunities through new technologies substantially to reduce the extent of missed appointments, including through things such as text messaging. What is frustrating is that, sometimes, appointments are missed because patients have not been adequately contacted by hospitals. As for people who abuse the NHS, I hope we will give them no excuses for not meeting their obligation to attend appointments.

National Health Service

Chris Skidmore Excerpts

Wednesday 26th October 2011 Commons Chamber

[Andy Burnham]

My hon. Friend makes a very important point. That was precisely why I said it was irresponsible for the Conservatives to promise increases to the NHS in the way that they did, on a much-reduced public spending envelope. That has led to precisely the consequences that she describes. Indeed, that hidden cut to adult social care has been quantified at £2 billion.

I remember well Conservative party claims before the election about death taxes, but what about the dementia taxes that the Conservatives have loaded on to vulnerable older people up and down this country, who are now paying more out of their own pockets to pay for the care that they desperately need? That is the effect of cutting adult social care and cutting council budgets in that way.

We today the nail the position once and for all. The real position is worse than the one I described because of spiralling inflation, which in effect means even deeper real-terms cuts for the NHS this year and in all the years that follow.

[Chris Skidmore (Kingswood) (Con)]

The right hon. Gentleman mentions that the £2 billion transfer from the NHS social care budget is not ring-fenced, but I am sure he is aware that ring-fencing can have the perverse effect of ensuring that local authorities do not spend existing budgets. Will he clarify his position? Is ring-fencing a good idea or not?

[Andy Burnham]

I disagree with the hon. Gentleman. I said that it was irresponsible to pledge the money for the health service in the way that the then Opposition did in the run-up to the election precisely because I realised that more would be needed for adult social care. However, if the NHS is to transfer money to local government for adult social care, we must be certain that it will pay for that and not for weekly bin collections or for whatever else he thinks is more important than supporting older, vulnerable people with the costs of care. He makes my point that that money should have been ring-fenced, so that adult social care could have been protected.

[Chris Skidmore]

indicated assent.

[Andy Burnham]

The hon. Gentleman nods, but I am afraid that that was not the Secretary of State’s policy.

--- Later in debate ---

[Andy Burnham]

I shall give way in a moment.

If we thought that the Conservative party’s promises on funding were bad enough, the sheer audacity of its claims on hospital closures is breathtaking. Before the last election, the right hon. Gentleman toured the country promising the earth to every Conservative candidate he met. I recall seeing his commitments—I have them here—pile up in the Ashcroft-funded glossy leaflets that landed on my desk in the Department of Health. He said that he would reopen the accident and emergency department in Burnley; he said that he would save and A and E in Hartlepool, but, scandalously, only if the town elected a Conservative MP; and I well remember the day he visited his hon. Friend—although, after this week, I doubt that the Government Front Bench team still consider him a friend—the hon. Member for Bury North (Mr Nuttall) and promised the people of Bury in the leaflets I have here:

“Vote Conservative and if there is a Conservative government the maternity department will be kept open.”

It could not be clearer. However, the maternity department at Fairfield hospital is scheduled to close next March. It is disgraceful. However, the Prime Minister’s most shameful politicking came in north London. I lost count of the number of times he promised to save the A and E department at Chase Farm hospital.

[Chris Skidmore]

On a point of order, Mr Speaker. Is it in order for the right hon. Gentleman to name my hon. Friend the Member for Bury North (Mr Nuttall) without telling him?

[Mr Speaker]

Yes, it is.

--- Later in debate ---

[Chris Skidmore (Kingswood) (Con)]

It is remarkable that we are having this debate today. As the Secretary of State has said, the Opposition’s motion is a remarkable own goal, especially as it has been confirmed that the Government will be increasing funds in real terms by 0.4% over the course of this Parliament. The shadow Secretary of State is shaking his head, but that will mean an extra £12.5 billion, which he has opposed today. It also remarkable that we have had confirmation from him of his comments in The Guardian on 16 June 2010, when he stated:

“It is irresponsible to increase NHS spending in real terms within the overall financial envelope”.

He agreed with that and I am delighted that he has put that on the record now that he has a second bite of the cherry, as the shadow Secretary of State for Health. He had an opportunity to make amends, and I thought he would, but unfortunately he has not. He also stated in the New Statesman on 22 July 2010:

“They’re not ring-fencing it. They’re increasing it.”

He was talking about the NHS budget and the fact that the Government were increasing it.

We have heard from the Secretary of State today that if there is an underspend, it has come entirely from the central departmental budgets. What is wrong with that? Does the shadow Secretary of State disagree that we might have cut down on costs such as the £115,759 he spent on a personal chauffeur during his time as Secretary of State? Does he oppose an underspend, given that during his time at the Department it spent £3.65 million on almost 26,000 first-class rail tickets? We have slashed that cost by more than 70%. Does he deny that he and the Department spent £1.7 million on luxury hotels during his time there? What is wrong with cutting such spending? What is wrong with the fact that Ministers are no longer using hotels such as the Hotel President Wilson in Geneva as they did in 2008 when the bill was £548.87 a night? If we are making those cuts to the central budget, I quite welcome our doing so.

[Barbara Keeley]

I wonder that the hon. Gentleman is not more worried about issues such as those I raised earlier. The real cuts being experienced in my constituency are in NHS walk-in centres and in the active management of long-term conditions. That is a real downgrading of patient care. I am surprised that he is bringing up these expenses; I think he should focus on what is happening in the NHS.

[Chris Skidmore]

I entirely agree that we need to integrate better social care in the NHS, and part of the reason why we have £2 billion going into social care is to tackle that problem. It is interesting that the hon. Lady does not deny that those spends have happened and that she does not apologise for the fact that the previous Government made those spends. Personally, I think they are a disgrace. Obviously, Opposition Members do not have a problem with spending £600 on a hotel in Switzerland, but I do. I say to the shadow Secretary of State, “Don’t build a greenhouse and then throw stones out of it.” Let us remember that it was the Labour party that gave us an NHS IT system at a cost of £12.7 billion—450% more than the original cost. It was the Labour party that gave us private finance initiative deals that were so badly drafted that they were worth £11.4 billion but cost £65 billion to pay off. What did the shadow Secretary of State say when he was the Secretary of State?

[Stephen Pound (Ealing North) (Lab)]

I am grateful to the hon. Gentleman for giving way and I hope that my intervention allows him to cool his jets a little. One cannot make a case about this by arguing about minutiae. Will he accept that for many of us the reality of the NHS is what we see at Central Middlesex hospital, where somebody turns up on a Monday to be told that the accident and emergency department closed on the previous Friday and has now been rebranded without there having been any democratic input? If one has any complaints about that, however, one should not even bother trying to find a person to speak to. That is the reality. The NHS is over-commercialised and is losing touch with its roots.

[Chris Skidmore]

The hon. Gentleman will regret his comments. We have to pay back £65 billion on PFI deals that were originally signed for £11 billion—that ain’t minutiae. Many constituents are concerned about the waste that took place under the previous Government.

In 1997, there were 23,400 managers. That has gone up to 42,500. We are making a genuine attempt to tackle the problem. I could go on, but I will put the party politics aside.

[Grahame M. Morris]

Would the hon. Gentleman care to comment on the National Audit Office report in relation to savings that could be made from NHS procurement? Does he think that fragmenting the NHS will assist that or hinder it?

[Chris Skidmore]

We are spending £1 billion more than we should on procurement because of the lack of consistency across the NHS, delivered principally by the previous Government. That is one area in which we could make vital savings. The NHS needs to change. Your boss, the Leader of the Opposition, said:

“To protect the NHS is to change it”

and we need to do so. The reforms that we are bringing in are essential if we are to deliver savings and also to ensure that the NHS survives when our ageing population means there will be twice as many 85-year-olds by 2030.

We need to reform the NHS and we do so in the spirit of what Tony Blair and new Labour put forward. Julian Le Grand, Tony Blair’s key adviser, said that the reforms were

“evolutionary, not revolutionary: a logical, sensible extension of those put in place by Tony Blair”.

When I asked him in the Health Committee whether this is what Blair would have done, he said: “Absolutely. Blair ‘would have tried’ to get these reforms through, but I imagine the left of his party may have prevented him from doing so.”

[Joan Ruddock]

How does the hon. Gentleman square his enthusiasm for all these reforms with the Prime Minister’s statement that there would be no top-down reforms of the NHS?

[Chris Skidmore]

We are introducing these reforms principally so that we put power back in the hands of GPs and, above all, patients. We are making these reforms because we have to. The status quo cannot remain—[Interruption.] If the right hon. Lady wants the NHS to continue as it is, fine. If the NHS is to be free at the point of delivery, it needs clinician-led commissioning. That is what we are going to achieve.

[Sarah Newton]

I agree with much of what my hon. Friend says. Does he agree that on such an important subject as the NHS, the people we represent and who sent us here would expect us to be thinking about how we can improve the NHS for patients and for the people who work in it, rather than engaging in this ridiculous tit-for-tat party political scrap that we are seeing this afternoon?

[Chris Skidmore]

I entirely agree. A constituent, a lady who sadly lost her foot through a rare cancer, came to my surgery recently. She is allowed only one type of plastic foot from the NHS and the PCT. She wants what is called an Echelon foot which will allow her to walk up a hill—she is a hill walker—but under the current model she cannot get that alternative foot. By bringing in any qualified provider, we will allow patients and clinicians the freedom to choose for the first time—a choice that was denied under the “any preferred provider” model that the shadow Secretary of State still clings to vainly. We need to ensure that our NHS operates for the 21st century and I hope the reforms will deliver that.

To sum up, I will oppose the motion. It is juvenile—the text could have been written by Adrian Mole. This is about getting away from the politics of debate in the Chamber and giving the NHS back to the professionals and the patients. It is not our NHS; it is their NHS, and we need to ensure that we achieve that aim.

Oral Answers to Questions

Chris Skidmore Excerpts

Tuesday 18th October 2011 Commons Chamber

[Mr Lansley]

I am grateful to the hon. Lady. All the representations that we have received in the debates in this House are ample evidence of the high regard and support that Members have for their children’s heart surgery services. None of this is about saving money or resources. It is entirely about what delivers the best quality surgical services for children with cardiac problems. To that extent, the intention is that those services—once the decision has been made—are fully funded.

[Chris Skidmore (Kingswood) (Con)]

9. What progress he has made on reducing the number of foreign nationals using NHS services without payment.

[The Minister of State, Department of Health (Mr Simon Burns)]

We have updated and simplified regulations and guidance on identifying and charging visitors who must pay. Immigration rules now before Parliament will allow the UK Borders Agency to refuse entry to visitors with an unpaid debt to the NHS, and we are now reviewing this area more fundamentally to identify further improvements.

[Chris Skidmore]

I thank the Minister for that answer. On 19 July, I spoke in the House about foreign nationals using the NHS without payment and, having entered a freedom of information request to each foundation trust and PCT, I now have a more accurate picture of the sums involved. It suggests that some £15 million has been completely written off. Will the Minister meet me to discuss the findings and what possible solutions might be found to tackle this important issue?

[Mr Burns]

I share my hon. Friend’s concerns about this important issue and challenge for the NHS. I would be more than happy to see the results of his FOI request, and I or a colleague would also be happy to meet him to discuss the matter further.

--- Later in debate ---

[The Minister of State, Department of Health (Mr Simon Burns)]

The hon. Gentleman seems to be somewhat confused. This is not about privatisation in a derogatory sense, as he is trying to suggest. For many years, including the 13 years of the Labour Government, hospital cleaning services in NHS hospitals were put out to tender, and many private companies provided the service. That is simply continuing.

[Chris Skidmore (Kingswood) (Con)]

T9. I am a long-standing supporter of independent sector treatment centres and of the need for commissioners to be able to bring in private and voluntary sector providers, as well as alternative NHS provision where existing services fail to improve—[Interruption.] I see that some Labour Members, including the hon. Member for Leicester West (Liz Kendall), disagree, but does at least the Secretary of State agree—

[Mr Speaker]

We are grateful.

Health and Social Care Bill (Programme) (No. 3)

Chris Skidmore Excerpts

Tuesday 6th September 2011 Commons Chamber

[Liz Kendall]

The Minister groans. If he thinks that the body representing doctors in this country is worthy of that response, that is a disgrace. The BMA says that the Bill is still

“an unacceptably high risk to the NHS, threatening its ability to operate effectively and equitably now and in the future”.

It calls for the Bill’s withdrawal

“or at the very least further, significant amendment”.

[Chris Skidmore (Kingswood) (Con)]

Is the BMA not the same organisation that opposed the creation of the NHS in 1948?

Health and Social Care (Re-committed) Bill

Chris Skidmore Excerpts

Tuesday 6th September 2011 Commons Chamber

[Chris Skidmore (Kingswood) (Con)]

Is the hon. Lady placing on the record her party’s opposition to any form of competition in the NHS?

[Debbie Abrahams]

As we have shown, we are not opposed to private sector involvement in the UK’s health system. What is important is that it should add value and capacity. The Government’s proposals are a completely different ball game.

--- Later in debate ---

[Frank Dobson]

I entirely agree. Nobody could possibly claim that redundancy payments constitute money being spent on improving services for our constituents. That is just money down the drain as far as patient care is concerned.

The fundamental problem behind the proposals is that the Government are, in effect, proposing a further major fragmentation of the national health service. In the past, up to the point at which the previous Tory Government introduced an internal market, the spending on administration in the NHS amounted to 4% of the total. That was largely because great big slugs of money were transferred round the system, and I am prepared to accept that there might be some disadvantages in that arrangement. Since then, however, under that Government and the Labour Government, the system has changed to one in which the money follows the patient. That has led to the creation of all sorts of exceptionally expensive systems to bring about individualised transactions, which has resulted in the cost of administering the national health service rising to 12% of the total—an increase of 8%. The NHS is spending about £100 billion a year at the moment, so an extra £8 billion that should have been spent on patient services is now being spent on the administration of the semi-fragmented system. What is now being proposed will involve yet further fragmentation, and I shall explain why I believe we will end up spending yet more money, but not on patients.

[Chris Skidmore]

The right hon. Gentleman has mentioned the £8 billion being spent on administration in the NHS. I assume that he therefore welcomes the coalition Government’s decision to cut the administration budget by £5 billion by 2015. In his speech so far, however, he seems to be suggesting that the status quo is acceptable. I believe that it is unacceptable. Does he welcome the fact that we will be putting an extra £12.5 billion into the NHS?

[Frank Dobson]

If the hon. Gentleman—and, for that matter, the Secretary of State and the Chair of the Health Select Committee—had ever listened to what I say, they would know that I think that we need change. We need organic change, however, rather than structural change, because structural change generally costs more than it provides. If the hon. Gentleman thinks that introducing a system in which virtually every transaction will be a legally binding document, with herds of lawyers grasping their share of proceedings, will reduce the amount spent on administration, he obviously believes in Father Christmas and various other mythical figures.

Frenchay Hospital

Chris Skidmore Excerpts

Wednesday 14th July 2010 Westminster Hall

[Chris Skidmore (Kingswood) (Con)]

Thank you, Mr Hood, for allowing me to initiate this important debate on the future of Frenchay hospital. My constituency is currently served by Frenchay hospital’s acute hospital facilities, so its downgrading is one of my constituents’ most important concerns. The decision to downgrade the hospital and establish a new super-hospital at Southmead in Bristol was taken as part of the Bristol health services plan in March 2005. Meanwhile, Frenchay is to become a community hospital, the development of which will take place in 2014.

Five years might seem a long time ago, but over those years the future of the hospital has remained an ongoing point of concern and debate. The decision to downgrade is deeply unpopular and has been challenged by South Gloucestershire council and tens of thousands of local residents, nearly 50,000 of whom petitioned the then Secretary of State for Health, Patricia Hewitt, to allow for the decision to be referred to an independent reconfiguration panel. In my view, those are 50,000 reasons why the hospital should be saved, but the petition was rejected, as was a request by South Gloucestershire council’s health scrutiny sub-committee that the matter be referred to the same panel. Instead, the then Health Minister, Lord Warner, said that he saw

“no reason to ask the Bristol health services plan to reconsider…There is no need to refer the decision to the independent reconfiguration panel.”

The current Health Secretary also supported at the time the move for a referral to the independent reconfiguration panel. In a letter dated 27 July 2005, he wrote to Ms Hewitt, stating:

“Plans to change radically hospital provision on the scale proposed in Bristol and South Gloucestershire clearly need to have the confidence and support of the community served by these hospitals. It seems clear that currently the proposal to downgrade Frenchay does not have the support of tens of thousands of local people…my reason for supporting referral is that I believe the people of South Gloucestershire have the right to expect the decision to deprive them of Frenchay Hospital, as they know it, to be independently scrutinised”.

I agree with that letter; he was right that the decision to downgrade the hospital should have been independently scrutinised, as clearly the decision did not, and still does not, have the support of the local community across south Gloucestershire.

In October 2007, there was further hope that the then Secretary of State for Heath, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), might reconsider the case for the decision to downgrade the hospital to be referred to the independent reconfiguration panel. However, he replied to the request by the council’s health select committee simply by stating:

“The previous Secretary of State, Patricia Hewitt, dealt with the referral on this issue ... it is not intended to revisit that decision”.

The leader of the council, John Calway, commented at the time:

“This decision will come as a body blow to everyone who is continuing to desperately search for a lifeline for Frenchay…I believe the anger at this decision has been compounded by the fact that the Government has consistently refused local people’s wish for an independent inquiry into the decision.”

Councillor Calway then stated:

“While we are denied an independent inquiry we will never know whether the decision to downgrade Frenchay was made in the best interests of our residents...Sadly for us in South Gloucestershire, the Government has made it very clear that it is supporting the downgrading of Frenchay a has no intention of intervening to even allow this to be questioned or scrutinised.”

That is a view I continue to share.

Ultimately, the previous Government’s decision not to refer the decision to downgrade Frenchay hospital to an independent reconfiguration panel has resulted in the current situation. Five years after the original proposals for the Bristol health services plan were formulated, the contracts for the new super-hospital at Southmead were finally signed in February 2010. The result, I am informed, is that that has ultimately dealt a death blow to any chance of the hospital retaining its acute hospital facilities. I am also informed that, the contracts having already been signed under the previous Government, reversing that decision seems impossible as it would come at massive cost to the NHS and the Government because of the legal implications.

I would be grateful to the Minister for any comments he might have on that matter. Has the previous Government’s refusal to allow local people to have their say on where their local hospital and acute facilities should be located meant that it is too late to intervene?

I understand that on 20 May 2010 the Secretary of State wrote to all NHS chief executives, advising them that their current and proposed reconfigurations must meet four criteria: they must have the support of GP commissioners; they must have strengthened arrangements to ensure that local people’s views are not ignored; they must be supported by clear clinical evidence; and they must support and develop patient choice.

I am very interested to hear from the Minister whether there has been any response to that letter from North Bristol NHS Trust, as many local people would not agree that those four criteria have been met. I hope that that is not the case but, if it is, does the Minister agree with me that the downgrading of Frenchay hospital was Labour’s downgrading? If Frenchay must lose its acute facilities in 2014, that was not the decision of the current Government, but of the previous one. The downgrading of Frenchay hospital, if it is to take place, is a testament to Labour’s NHS record in Kingswood and south Gloucestershire. That is, in my mind, both a tragedy and a national disgrace.

For my Kingswood constituents, the decision, taken under the previous Government, to downgrade Frenchay hospital will be nothing short of disastrous. In this, the second decade of the 21st century, local services should be becoming more, not less, convenient and local. Many constituents are extremely worried about the consequences of the move to Southmead. They are concerned about how, in times of greatest need and when their lives might depend on it, they will be able to reach a hospital over the other side of Bristol. If Frenchay is to become a community hospital under the previous Government’s downgrading, we need to look forward, to ensure that the maximum possible numbers of facilities remain there.

I do not propose to go into detail about the hospital’s reconfiguration, as I understand that the Frenchay project board has yet to finalise details of its scheme. There is, however, concern over exactly what will remain at Frenchay when it becomes a community hospital. Concern has been voiced over the future of its world-class facilities—for instance, the head injury therapy unit, which deals with brain injury rehabilitation services for the community. There is also the Headway organisation, which is based in the hospital grounds and offers vital support to those who have suffered a brain injury and would like to remain at Frenchay. The organisation stated last year:

“we have been unable to get any answers yet as to our future location.”

Then there are the excellent paediatric burns and neurological units, which will possibly move from Frenchay ahead of its becoming a community hospital, though decisions have yet to be finalised.

As the local MP for an area that depends heavily on Frenchay, I do not want to see the hospital, if it has indeed lost its accident and emergency facilities, to be run down to the ground and stripped of its world-class facilities. I raise these issues today because I would like to see the maximum possible number of facilities remain at Frenchay hospital. It is still an excellent world-class treatment centre, and I would like to pay tribute to all the fantastic staff, who have worked so hard to make it what it is today. Frenchay is, quite simply, too valuable to lose.

People with Learning Disabilities (NHS Treatment)

Chris Skidmore Excerpts

Wednesday 14th July 2010 Westminster Hall

[Chris Skidmore (Kingswood) (Con)]

As the secretary of the all-party group on disability and a member of the Select Committee on Health, I have a dual interest in this debate. I am also a member of the all-party group on learning disability. I am sorry that I could not attend yesterday’s AGM; it sounds as if it was a fascinating event.

I thank the right hon. Member for Coatbridge, Chryston and Bellshill (Mr Clarke) for calling the debate, which is clearly necessary. If I repeat any of the points that he made so eloquently, it will be only because they need to be driven home. The debate highlights some current failings in the NHS with respect to people with learning difficulties. As the right hon. Gentleman said, there have been several reports on the issue in recent years. The Disability Rights Commission’s report, “Equal Treatment: Closing the Gap”, published in 2006, showed that although people with learning difficulties were more likely to develop conditions such as obesity and respiratory diseases, they were less likely to receive adequate care, treatment and health checks.

In the following year, as the right hon. Gentleman also mentioned, came Mencap’s report “Death by indifference”. That seminal study highlighted some of the failings of the past several years and showed that six people with learning difficulties had died prematurely owing to discriminatory care. Yet after those reports were published, and despite moves towards dealing with the situation, the most recent survey by Mencap, which was released in June—again, the right hon. Gentleman referred to it—showed that half of doctors and a third of nurses had witnessed a patient with learning disabilities being treated with neglect or a lack of dignity, or receiving poor quality care. Those statistics are clearly unacceptable.

What can be done? The right hon. Gentleman has already referred to the issues that we need to address. I shall probably repeat some of what he said, and I hope that he does not mind. To my mind, the first issue is training for professionals in the NHS. There is clearly an institutional failure to make adequate provision for people with learning difficulties in the NHS, despite the fact that they receive £1.7 billion of NHS money. The Mencap survey highlighted the training issue; it found that 53% of doctors and 68% of nurses felt that they needed specific guidelines on how to care for people with learning difficulties, and how treatment should be addressed to them, to meet their needs. There is clearly a gap that we need to examine in closer detail.

I welcome the plans in the White Paper that has just been published to end the top-down managerial approach and the current centralised funding of education and training, because previously the multi-professional education and training levy was not accountable in relation to the amount of training and continuing professional development that it provided. The White Paper sets out welcome plans to give employers greater autonomy and, above all, accountability. Accountability is what we need, because training has been available but there is no way of showing that it works. We need to get back to a local level, which is what the White Paper sets out to achieve, so that there will be greater professional ownership of the quality of training. I welcome that accountability and recognise that accountability at local NHS organisational level must also ensure that people with learning difficulties are treated adequately.

The second issue that I want to mention is the broader one of communication. That is at the heart of treatment for people with learning difficulties. The question is how to cross the communication barrier between professionals—doctors and nurses—and people with learning difficulties, who often cannot express their needs, which may be very individual. One of my constituents was recently rushed to the Bristol Royal infirmary on a weekend. He had a procedure on his heart and a doctor explained his condition to him as if he were communicating with a normal member of the public. That approach was clearly inadequate for someone with learning difficulties. The nurse then presented him with some complicated leaflets, which he could not understand. There was no co-ordination with his carer at NHS level—or certainly not at the acute hospital level—and that led to a man who was already very sick being further distressed and scared.

It is in that context, to which the right hon. Member for Coatbridge, Chryston and Bellshill referred, that the role of learning disability liaison nurses is crucial, for the support of patients, families and those who support people with learning difficulties. It is not yet clear how many such posts exist. In my area of Bristol, which has the Frenchay and Southmead hospitals, there are only two. However, I was surprised to discover that that is pretty good by national standards.

I understand that interesting new moves are under way towards developing the role of liaison nurses, and in particular that St. George’s healthcare trust in south London has gone further, by appointing a nurse consultant in learning difficulties. The success of that probably says something about the need to examine the NHS staffing structure in relation to people with learning difficulties. The holder of that nurse consultant post remarked:

“This job would not have had the impact it has had if it was not at consultant level.”

That shows an interesting divide, by which those with learning disabilities are often dealt with at a nursing level, when to get the impact that is needed it is necessary to go higher up the chain. Clearly, there is a need to explore the greater use of liaison nurses, the employment of a number of such nurses, and what happens at local level.

The White Paper gives us much encouragement about the personalisation of services, and, above all, the determination to put patients at the heart of the NHS. I note with interest that one of its principal aims is to ensure that shared decision making will become the norm. To use the familiar maxim that we use in the all-party group on disability, “No decision about me without me.” Sadly, we know that for some with learning difficulties that will be impossible.

We already know about the difficult ethical issues, which have been reported in the national media, in respect of those with learning difficulties having treatment forced on them. For instance, a lady with cancer was forced to undergo an operation. I do not want to touch on the ethical issues today, but such cases clearly raise questions about the relationship between patients and professionals. Given the White Paper, the greater personalisation of services and putting patients at the heart of the NHS, we must ensure that patients with learning difficulties are not left behind.

Personalised care that reflects individual health care needs is just as relevant for those with learning difficulties, if not more so. If we want to realise the promise of the White Paper—I note that it is also committed to promoting equality—we must understand the importance of health outcomes for those with learning difficulties. Moving from targets towards outcomes will benefit those with learning difficulties, as some of their problems need to be considered over a greater period, and hospitals cannot always deal with them in a single session. However, those outcomes are not being met, and that reflects on society.

Above all, it is important to ensure that the most vulnerable, particularly those with learning disabilities, receive the greatest care. In that regard, the introduction last year of incentive payments for GPs to carry out annual health care checks for those with learning difficulties was welcome. However, there is clearly a problem. Take-up has risen by about 60% between 2008-09 and 2009-10, yet still only half the money allocated for such checks by doctors is being used.

The White Paper and Government statements show that giving GPs greater control over their budgets will circumvent some of the centralised mechanisms. GPs will thus know exactly what tailored care is necessary for their patients, including those with learning difficulties. I hope that GPs will take the opportunity to expand the use of health checks within their allocated budgets. That will ensure that prevention is at the heart of treatment.

Above all, the issue is about prevention. As the right hon. Gentleman said, those with learning difficulties and disabilities are often at greater risk of illnesses that could have been prevented; they could avoid reaching the acute hospital stage, which can often be confusing and stressful, early in their treatment. Personalised care will ensure that GPs monitor patients more carefully. I hope that having annual health care checks in place will ultimately prevent people with learning difficulties from reaching the stage in the NHS that they find so disturbing—the stress of late diagnosis.

Finally, I echo the right hon. Gentleman’s comments about the national health service. We are not here to criticise the institution. We share a common cause; we wish to make it better and more effective for those with learning difficulties.

[Mr Gregory Campbell (East Londonderry) (DUP)]

I thank the hon. Gentleman for giving way. He touched on the excellence of the national health service. Does he agree that we must try to ensure best practice throughout the United Kingdom, particularly in devolved regions, and that we should not have patients in one part of the UK demanding of the health service a level of service that they see elsewhere? We should aim for equality and best practice across the UK.

[Chris Skidmore]

I agree with the hon. Gentleman. We are learning that health inequalities throughout our nation are extremely profound. Only by dealing with health inequalities can we raise the standard of public health in the nation as a whole—something that applies to many of our public services. Having a greater drive towards the localisation of services and the personalisation of care will get us to the stage where prevention is at the heart of NHS treatment. Through prevention, we will achieve greater equality; it will iron out some of the inequalities that we see in our most deprived communities.

The principles on which the NHS was founded are still relevant today, and we agree that that must remain so. However, although free health care at the point of access should be available to all, based on need, we must look harder at how to ensure that the needs of the most vulnerable are met. That includes those with learning difficulties. More clearly needs to be done, but I hope that we will be able to achieve it.

Supporting Carers

Chris Skidmore Excerpts

Thursday 1st July 2010 Westminster Hall

[Chris Skidmore (Kingswood) (Con)]

As a member of the Select Committee on Health and secretary of the all-party group on disability, I take a keen interest in this important matter, and I am very grateful to the Government for arranging the debate.

The figures mentioned in the debate are clear. As a nation, we rely on a silent army of carers—some 6 million people or 10% of our population—to look after and support the most vulnerable in society. Those people dedicate and sacrifice their own time and lives for the sake of those whom they love. Family members depend upon such people—as we all do—to ensure that those in the greatest need live the best possible lives, as they deserve.

We should not have this debate today without admitting the enormous emotional and, at times, physical cost that the role of a carer can bring. Some 1.9 million people care for more than 20 hours a week and around 1.25 million people care for more than 50 hours a week, although I suspect that the hidden figures—those that no Department is able to calculate—are probably far greater. Often the people who have to care for a relative, husband or wife—with whom they have spent their entire lives—who is incapacitated by dementia or physical frailty are themselves elderly. It is estimated that over-65s account for around a third of all carers who provide more than 50 hours of care a week. As a result, it is sadly of little surprise that carers are twice as likely to suffer from ill health, because they are providing such substantial care.

As the Minister said, caring comes to dominate the lives of such people, and as the recent figures released by Carers UK reveal, 76% of carers have no time left at all in their lives to do anything other than care for the relative concerned. We know that carers, through their selfless dedication, make an enormous contribution to society—estimated at some £87 billion a year—yet we must realise that carers do not do what they do for money or see their role in terms of the economic benefits. Carers looking after a relative or a member of their close family—a son or daughter, their father or mother—do so because of love.

I suspect that each of us in this Chamber has in some way cared for a relative—either in the final days of their life or through some period of illness or accident—and at times have been the single person responsible for that person’s well-being. That is an awesome burden to bear on one’s shoulders, yet we must consider that it is carried by some people every day, with tireless devotion. However, with that devotion, comes the sheer exhaustion of wanting to do one’s best to ensure that a loved one is best looked after. There may also be frustrations caused by the fact that such love is not reciprocated by the person being cared for and that, for whatever reason, they are unable to say thank you.

If a relative has a degenerative condition, a carer will also have anxiety about what the future might hold. At the same time, for a carer, considering having a few hours break or a temporary escape seems a betrayal of the love that is so clearly there. Too often, it is easy for politicians and policy makers to revert to statistics and jargon that is in many ways all too familiar to us in such debates. We must not forget that every carer has a personal story that cannot always be easily told—one that we can never put a price upon. However, we must accept that caring will take an ever greater role in the structure of our society.

As a result of improvements in the quality of treatment and medical technology, more children and young people are surviving with complex health conditions. It is estimated that 1.7 million more people will need care and support by 2026, because they are living longer, and they will need that care and support for a longer period. More people are living longer, with the number of people expected to live beyond 90 soaring. However, one in four of those people will probably suffer from some form of dementia. We must therefore recognise that, in this decade, more people than ever before will become carers.

The new Government are determined to do all that they can not just to recognise, but to improve the lives of carers across the nation—we must do so at every level—and I welcome the fact that the Secretary of State for Work and Pensions has said that the Government want to

“enhance and support that role”—

of carers—

“ensuring that carers are valued throughout what we do”.—[Official Report, 14 June 2010; Vol. 511, c. 600.]

There is a need to ensure that the benefits system is easier for carers to access. Carers UK has said that:

“carers want to see the benefits system simplified since its complexity often prevents people from finding out about their entitlements”.

The welfare system that was inherited from the previous Government is hugely complicated, and simplifying the system should encourage fairness and responsibility. It is encouraging that the Government have stated that they

“will consider carefully the needs of carers as we develop our thinking on welfare reform.”—[Official Report, 7 June 2010; Vol. 511, c. 5W.]

I, for one, thank them for that.

There is an urgent need to balance the needs of carers who work—something that has been touched upon already in the debate. It is estimated that as many as one in five carers have left or turned down a job because of their caring responsibilities or because they feel social care support is insufficient. As the Minister has outlined, there is a strong case for increased flexible working. Currently, flexible working is available to employed parents of children aged under 17, disabled children under 18 and carers of certain adults. Therefore, approximately 10.5 million employees benefit under the current legislation, including 8 million parents and 2.65 million carers of adults, yet Carers UK points out that up to 79,000 carers do not request flexible working

“because of the way that the complex definition of carer has been put together.”

That must change.

Extending the right to request flexible working to all employees should help those carers. The coalition agreement contains the commitment to

“extend the right to request flexible working to all employees, consulting with business on how best to do so”.

Following on from that, the Government have maintained that extending the right to request flexible working to all will ensure that individuals within the wider caring structure—for example, grandparents and neighbours—can also take a more active role in caring and managing their work and family lives effectively. That extension will also remove the stigma attached to flexible working requests, as the Minister has mentioned. Both those developments are welcome.

I welcome what the new Government are setting out to achieve in improving the lives of carers and in granting them greater independence, so that they can live their lives as best they possibly can. As the Prime Minister has said,

“carers are the unsung heroes of our society…the work they do to help disabled people is simply invaluable. Just imagine what would happen if all the carers in this country suddenly packed their bags and left. It’s not just that the financial cost of looking after so many disabled people would be a massive burden on the state. It’s the sheer emotional effect on all the people who depend, day in, day out, on their love and care.”

Carers across the country do so much for so little. We must do even more to ensure that they are supported and looked after, which I know the new Government will do their best to achieve.