NHS Winter Crisis
Baroness Laing of Elderslie Excerpts(6 years, 10 months ago)
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Steve Brine
The sustainability and transformation partnerships have been established across England—I am sure that the hon. Gentleman will have engaged with the one in his area—and they take local decisions about how services are organised in local areas. I implore him to engage with his STP; indeed, I know that he is already doing so. If he wishes to talk to me about this, he can of course do so.
Let me respond to some more of our contributors. The hon. Member for Bristol South always speaks sensibly. She spoke about the public representation and involvement in STPs. I agree that we could do more in that area, and as the Minister responsible for STPs, I want to see that we do so. Her point was well made. The hon. Member for Crewe and Nantwich (Laura Smith) spoke about her constituent, Elle, who lost her battle with cystic fibrosis. She speaks up for her constituents well, and very emotionally, and if she continues to do that, she will do extremely well in this House.
The hon. Member for Stockton South (Dr Williams) is a new Member, and I already have a lot of respect for him. In his typically sensible contribution, he made some sensible suggestions for improvement in the NHS. He went on to talk about how we could do better on prevention, and he was absolutely spot on. We all agree that prevention is part of our one NHS. He said that this was not all about money, and I agree. Money is a key part of this, however, and that is why we spend 9.9% of our GDP on healthcare, which is above the EU average.
The hon. Member for Leicester West (Liz Kendall) said that this is not what happens every year, but the NHS is under great pressure at this time every year. A headline from The Guardian newspaper on 27 October 2001 stated “NHS faces another winter of crisis”. The NHS is often under pressure at this time of year, and the important thing is how we prepare for that. As I have said, we are better prepared than ever. It is a shame that the hon. Lady is not listening to my response. [Interruption.]
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I hesitate to interrupt the Minister, but I do not understand why there is so much noise on the Opposition Benches. I would not be surprised if Members were heckling the Minister, but they are simply making a noise, so the Minister cannot be heard. He is answering the questions that he has been asked this afternoon, and those who asked the questions ought to want to hear the answers.
Steve Brine
Thank you, Madam Deputy Speaker. The Members appear to be heckling themselves.
The hon. Member for Wirral West (Margaret Greenwood) said that the NHS was a political organisation. I totally disagree. The NHS is an organisation run by hard-working people who are public servants. They go to work every day to do a job for our constituents, and the NHS is not a political organisation. The Labour party is a political organisation, and it is politicising the NHS—
Jonathan Ashworth
On a point of order, Madam Deputy Speaker. Can you confirm that the effect of the Government refusing to defend their position in the Lobby this afternoon is that the motion that stands in the name of the Leader of the Opposition has been endorsed by the whole House and that we should therefore expect the Secretary of State to come to the House before the end of the month to make an oral statement to explain to our constituents when their cancelled operations will be rescheduled?
Madam Deputy Speaker (Mrs Eleanor Laing)
What I can confirm to the hon. Gentleman is that the House has just voted to carry the motion that was before us. The motion therefore stands. As to what the Secretary of State will say or do over the next few weeks, I am sure that he will be back at the Dispatch Box in the near future as he is a most assiduous attender of this Chamber, but we all appreciate that he has other work to do, and we look forward to seeing him doing that.
Autism Community: Mental Health and Suicide
Baroness Laing of Elderslie Excerpts(6 years, 11 months ago)
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Several hon. Members rose—
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. As the House knows, we have limited time this afternoon, so we have to start with a time limit of seven minutes for Back-Bench speeches.
Several hon. Members rose—
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I do not criticise the hon. Lady for having taken interventions—that is the stuff of debate, and a lot of people want to intervene—but it means we now have to go down to five minutes per person.
Thangam Debbonaire (Bristol West) (Lab)
I thank the Backbench Business Committee for bringing this debate before us and the hon. Member for East Kilbride etc. (Dr Cameron) for leading on it. I also wish to say a special thank you to Mr Speaker and Mrs Bercow, who have done so much to support autism awareness in the House and beyond, particularly through their support for the National Autistic Society.
I should make a declaration of personal interest: I have a young cousin on the autistic spectrum, and I am married to someone who runs a special educational school for people with autism. My constituency team has also prioritised making Bristol an autism-friendly city. We have made a start, but we have more to do. We have held a training event for employers on how to make reasonable adjustments in recruitment and employment practices, and have had training for my team and made some adjustments ourselves.
That matters because unemployment is unacceptably high among people with autism, which contributes to mental ill health. According to the National Autistic Society, only 16% of adults with autism are in full-time paid work, and only 32% are in some kind of paid work, compared with 47% of disabled people and 80% of non-disabled people, and we know that unemployment affects mental health and self-esteem. The Government have committed to halving this autism employment gap by the end of this Parliament. In the interests of the mental health of people on the autistic spectrum, I urge the Minister to urge her colleagues to do everything they can to meet that much-needed target.
I have heard from schools in my constituency that funding pressures are affecting their specialist provision for children with special educational needs and mental health problems. Some families have told me that they have experienced effective or partial exclusion from school because of a lack of understanding of autism or of specialist support. That in turn leads to further mental health problems and is exacerbated by a lack of autism-focused specialist mental healthcare and high demand for mental healthcare generally. They have also told me of brilliant support and help from some teachers and schools, but they have fears about staff changes and worries about funding.
I have talked to public venues about what they can do with the help of the National Autistic Society and others to make themselves more autism-friendly. It cannot be acceptable that, according to the Royal College of Psychiatrists’ briefing for this debate, autistic people are more than seven times more likely than non-autistic people to commit suicide and that so many young people on the spectrum have at least one anxiety disorder. None of us wants to accept this, and we do not have to, and there is much we can do.
As I have said, my team has made autism a priority. In association with the fantastic Bristol Autism Support service and the local branch of the National Autistic Society, we recently held what we think was the country’s first MP constituency surgery specifically for adults with autism and parents of children on the autistic spectrum. I encourage all colleagues to do likewise, and I am happy to talk to them about how we did it. It meant that adults with autism and the parents of children with autism could come and tell us about challenges they faced with simple things such as transport and public spaces, as well as housing and employment, all of which affect mental health.
I am not going to repeat things that hon. Members have already said, particularly the hon. Member for East Kilbride, Strathaven and so on—I am so sorry, I cannot pronounce the last bit.
Thangam Debbonaire
Thank you, Madam Deputy Speaker.
The hon. Lady comprehensively listed recommendations that I urge the Minister to follow. I will finish by recommending two things. First, I suggest that hon. Members who care about autism and the 1% of our population who are on the autism spectrum consider, as I have done, asking a member of staff to champion that cause. I work closely with my member of staff, Councillor Mike Davies, who is our local autism lead on the council and within my own team. He has patiently taught me a great deal about how to make Bristol a truly autism-friendly city. We have a lot more to do, but I know that, with someone like Mike, I will be able to do much more than I would otherwise have done.
Secondly, I would like us to take a leap. In the House restoration and renewal programme, we could decide to work with the National Autistic Society to make this place autism-friendly. Doing so would help not just people on the autistic spectrum, including children and their parents, but all of us. It would make the place calmer, more welcoming and truly more accessible for everyone. It would be the mother of Parliaments leading by example to the rest of the country so that we can truly make the United Kingdom autism-friendly and address the chronic levels of mental ill health and suicide risk for people on the autism spectrum. I recommend that colleagues consider the suggestions that have been made by me and my team, and by others in this House.
Patricia Gibson
I absolutely agree with the hon. Lady’s excellent point. Should such a tragedy occur and a suicide take place, it is important that the family is supported through that as much as possible.
Some 70% of autistic people are reported to have mental health disorders, such as anxiety or depression. As we have heard, suicide is one of the leading causes of death in the autism community, and that alone tells us that this issue demands our attention. As the hon. Member for Blaydon (Liz Twist) pointed out, diagnosis is important because it should be the foundation on which effective support for autistic individuals and their families is built. Similarly, a delay in diagnosis can hinder effective support and prevent intervention strategies from being put in place.
The National Autistic Society Scotland reported in 2013 that 61% of those it had surveyed said they felt relieved when they received a diagnosis, because such a diagnosis can end years of feeling misunderstood and isolated. We have talked a lot about this as a UK issue, but as a Scottish MP, I want to mention the Scottish Government’s strategy for autism. The strategy, which is based on research, is working to improve waiting times for diagnosis and assessment to create consistent service standards across Scotland, and is providing training opportunities. The entire autism spectrum needs to be addressed, as well as the whole lifespan of people living with autism in Scotland. This is the logic behind this autism strategy, so it is a very positive step.
We have heard about initiatives such as autism hours in supermarkets and special autism-friendly cinematic screenings, and these are all very important and positive steps. There is a greater awareness and understanding of autism in this country but, as we have recognised today, we still have a long way to go. I will end by saying that we often think of those with autism as finding it difficult to see the world as we see it, but the truth is that we need to see the world as they see it, because if we do so we may then be able to start to make real progress.
Dr Cameron
This has been a wonderful debate. It has been truly cross-party and collegiate, and we must work together to improve the lives of people across the autistic spectrum and the services that we provide for them. This is about lifespan, so it involves a number of services for all aspects of the lifespan. It is also about streamlining the transfer from child to adult services. This is a multi-departmental matter, and I urge the Minister to speak to other Departments to ensure that the autism strategy is embedded in all their policies. As has been said, we need more early diagnosis, awareness and support in schools, and treatments that can be adapted. There is also vital research to be done, and we could be world leaders in that regard. That is a key aspiration that we should endeavour to meet. People with autism need support from school to the workplace, and carers and families also need support. We also desperately need to provide crisis services. Parliament must be inclusive, and I am keen to hear more about what we can do as individual MPs, both in our surgeries and through Parliament, to take these issues forward. We need to make our surgeries autism-friendly places, to ensure that we are role models in service development.
The Minister has many issues to take forward, and I am thankful for her response. I am glad that her door is open, because I might be coming through it on numerous occasions. I am also keen to visit the projects that she has described, which are going to pave the way for progress. It is vital that we take this forward and save lives. Let us work together and do this right across the United Kingdom. Finally, I would like to wish everyone a happy St Andrew’s day.
Madam Deputy Speaker (Mrs Eleanor Laing)
Happy St Andrew’s day.
Question put and agreed to.
Resolved,
That this House has considered the support available for autistic people experiencing mental health problems; calls on the Government to ensure that the NICE-recommended indicator for autism in GP registers is included in the Quality and Outcomes Framework; and further calls on the Government to ensure NHS England works closely with the autism community to develop effective and research-based mental health pathways.
Ian Blackford (Ross, Skye and Lochaber) (SNP)
On a point of order, Madam Deputy Speaker. I want to raise with you a conversation that I have had in the past few minutes, in which I have been informed that Royal Bank of Scotland is going to close three branches in my constituency, at Kyle of Lochalsh, Beauly and Mallaig. I am asking for your assistance, Madam Deputy Speaker. What do I need to do in order to ask one of the Treasury Ministers to come to the House to discuss this important matter? We understand that Royal Bank of Scotland is operationally independent, but none the less, we as the state are the majority owners of the bank. The bank in Kyle is one hour’s travelling distance to the nearest Royal Bank of Scotland branch in Portree. The one in Mallaig is an hour’s distance to Fort William. Those banks have thousands of customers. The branch in Beauly is the last remaining bank in that village. We need to have an urgent debate in the House about the responsibility that banks such as Royal Bank of Scotland have to their communities.
Madam Deputy Speaker (Mrs Eleanor Laing)
I thank the right hon. Gentleman for his point, but he knows that it is not a point of order for the Chair and I cannot give an answer on the substantive issue that he has raised. He seeks my advice, however, on how to bring a Minister to the Dispatch Box, and I can advise him that there are various methods that he can use to do that. He might like to consult the Table Office on the best way forward. I am sure that he will also consider other ways, such as approaching the Backbench Business Committee in order to arrange a debate, if he is so inclined. If he is certain that this is a matter that ought to be discussed on the Floor of the House, I am sure that his ingenuity will ensure that that happens.
Social Care
Baroness Laing of Elderslie Excerpts(7 years ago)
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Barbara Keeley
On a point of order, Madam Deputy Speaker. Again we see the Government refusing to vote on a motion—[Interruption.]
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I cannot hear what the hon. Lady at the Dispatch Box is saying, and she is speaking to me.
Barbara Keeley
Thank you, Madam Deputy Speaker. Again, we see the Government abstaining—refusing to vote on a motion tabled by the Opposition. This time, we have been debating vital issues: the funding crisis in social care and whether the Government will confirm their intention not to proceed with the policy for funding social care that they put forward, frightening people, during the general election.
My hon. Friend the Member for Denton and Reddish (Andrew Gwynne) has just described this Government as the “weakest and most divided” for many years. May I ask you, Madam Deputy Speaker, whether it is in order for this weak and divided Government to pick and choose when they will vote on matters that are raised in this House?
Madam Deputy Speaker
The hon. Lady has taken this opportunity to make the points that she wishes to make, and the House has heard them. She knows, and the House knows, that the Government’s decision on what they answer, what Ministers say at the Dispatch Box and how individual Members of this House choose to vote—or not—are not matters for the Chair. We will have no more points of order on that; it is not a point of order.
Tobacco Control Plan
Baroness Laing of Elderslie Excerpts(7 years, 1 month ago)
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Several hon. Members rose—
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. Before I call the next person to speak, may I say that we have plenty of time for this debate and I hope that we will manage without a formal time limit? I much prefer to rely on the reasonableness and honour of hon. Members to have regard for others as well as themselves. If every speaker takes approximately eight minutes or so, then everybody who has indicated their wish to speak will have an equal chance to do so. If that does not happen, I will impose a time limit.
NHS Pay
Baroness Laing of Elderslie Excerpts(7 years, 2 months ago)
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Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I appreciate that the hon. Member for Lincoln (Ms Lee) is new to the House, but Members do not make interventions while they are sitting down. If you wish to intervene, you must stand up to do it. I have noticed this happening quite a lot. This is not a general discussion, but a debate.
Dr Whitford
It is very important that people recognise the role that everyone plays, but for nurses in particular this is not just a matter of pay. Last year, we spent a lot of time debating changes to working tax credits, which can leave a lone parent nurse very much worse off. We also spent a lot of time debating the imposition of tuition fees and the removal of the nursing bursary. The nursing bursary still exists in Scotland. It is a non-means tested bursary of £6,500, potentially with a caring supplement of £3,500. We know that the average age to take up nursing study is at the end of the 20s, which means that people often have family commitments. Such people will receive approximately £10,000 a year so that, at the end, they will not face what future nurses in England will face, which is a debt of more than £50,000. The repayment on that kicks in immediately, because graduate nurses start at around £22,000, which is over the limit. At the lower end of band 5, that is another £400 a year off. By the time a nurse gets to the top of band 5, it is another £1,000 a year off. They will never manage to pay off that £50,000 to £60,000, which means that their salary will be reduced by that amount throughout their careers.
Dr Wollaston
I welcome that and I look forward to working with the right hon. Gentleman over the coming months to try to encourage colleagues on both sides of the House, including the Front Benches, to agree to the idea. Next year is the 70th anniversary of the NHS, and I cannot think of anything more constructive we could do than to work across political parties in order to deliver sustainable long-term funding for health and social care.
I will bring my remarks to a close because I know that many hon. Members wish to speak. I look forward to hearing suggestions from colleagues in the House and outside this place about the points they would like the Health Committee’s inquiry into the nursing workforce to cover.
Madam Deputy Speaker (Mrs Eleanor Laing)
It will be obvious to the House that a great many people wish to speak this afternoon. We have a limited time for this debate, which will probably finish at around 4.30 pm. Therefore, after the next speaker, I will impose an initial time limit of five minutes, which might be reduced further depending on how many people still wish to speak. There will, however, be no time limit on the next speaker as I call Mr Stephen Morgan to make his maiden speech.
Southend Hospital
Baroness Laing of Elderslie Excerpts(7 years, 4 months ago)
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Vicky Ford (Chelmsford) (Con)
I would like to introduce Broomfield hospital in Chelmsford into the discussion as one of the hospitals in the mid-Essex area along with the three in Southend and those in Basildon. I congratulate my hon. Friend the Member for Southend West (Sir David Amess) on bringing so much experience to this debate. Broomfield is deeply loved. It serves our newest city. We too need our 24-hour consultant-led A&E. NHS England made it clear to me on Monday that it is not only 24-hour, but consultant-led. Can the Minister confirm that? Can he also confirm that any decisions made will put patient safety first? The future of our NHS relies on first-class training and innovation in Chelmsford. As part of the mid-Essex area, we have the country’s first new medical centre. Will the Minister confirm that he supports that medical centre?
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. The hon. Lady’s question is slightly tangential to the subject of the debate, but I appreciate that she has made a connection. The Minister might be able to make the connection between the subject of the debate and her question, but I know that he will concentrate on the subject of the debate introduced by the hon. Member for Southend West (Sir David Amess).
Steve Brine
I will, Madam Deputy Speaker. I could feel you bristling at the length of the intervention. I can assure my hon. Friend that none of the options being considered includes the closure of any of the three A&Es, and all will continue to provide emergency care 24 hours a day, seven days a week.
I was mentioning the work of the Mid and South Essex STP, which was published in November 2016 as part of the work to ensure that there are sustainable services in mid and south Essex. There is now a major workstream looking at service configuration across the three hospital sites. Work led by clinicians in 2016 arrived at five possible future configurations for consolidated specialist services across the three hospitals. As well as providing the majority of routine hospital care for its local population, each hospital site would provide some centralised specialist services.
Let me briefly outline the current thinking as it has been set out to me. Southend hospital will continue, as I have said, to provide substantial emergency services 24 hours a day, seven days a week. In addition, it will be a centre of excellence, as my hon. Friend the Member for Southend West rightly said, for planned care, alongside its already well-established cancer centre and radiotherapy services. Basildon hospital will provide enhanced specialist emergency care—for example, specialising in the total management of major life-threatening illness. Broomfield Hospital in Chelmsford will provide a combination of specialist emergency and planned care, with the potential to provide a specialist centre for children. I have to emphasise that these ideas are being further developed by the clinical groups as we speak. No single preferred option for consultation has been arrived at.
Let me now turn to the proposals for emergency care. It is important to note, and I wish to reiterate, that in all potential options for hospital reconfiguration currently being discussed, Southend hospital would continue to provide emergency services 24/7. An options appraisal process was held earlier this year involving clinicians, stakeholders and local people. The higher-scoring options listed one hospital as the provider of specialist emergency care. Basildon was identified as the better location for that. Southend and Chelmsford would continue to provide emergency services, but they would be less specialised than Basildon. Southend would instead specialise in planned care, cancer and radiotherapy, building on the excellent work already being done at the hospital. There would be separate units specially designed to give fast access to assessment and care for older and frail people, children and people who may need emergency surgery. In some cases, that could include an overnight stay, if necessary. Those units would involve both health and social care so that patients could return home as quickly as possible with any continuing support and treatment that they may need.
The potential services in the A&E and assessment units at Southend would be able to respond to a range of emergency needs, some of which could be initiated by a 999 call and may involve an ambulance. The possibility of Basildon hospital being the provider of specialist and complex emergency care has benefits for local patients. It would have several teams of specialists ready to provide immediate access to state-of-the art scans and treatments around the clock, which is not always possible in the current three general hospital A&Es.
I also understand that the practice of taking patients by ambulance from Southend to a specialist centre is already established. For example, people who suffer an acute heart attack in Southend are currently taken by ambulance to the Essex cardiothoracic centre—that was easy for me to say—in Basildon. I have been advised that that arrangement has been in place for many years. Separating some of the major emergency work in that way releases capacity and resources for planned surgery and other treatments.
For the local NHS, new centres of excellence across the hospital group in both planned and emergency care have the potential to compete with the best in the country to attract high-calibre staff and bring the best of modern and world healthcare to mid and south Essex. I emphasise that in all options currently under discussion, about 95% of hospital visits would remain local at each hospital.
As I have stated previously, the programme is currently under discussion and I am advised that the aim is to launch a full public consultation at the end of the year at the earliest, centring on a single preferred option. The public consultation will explore in detail the benefits and implications of the proposals and will inform plans for implementation. Engagement with staff and local people will continue to influence and refine plans at every stage. That is a key principle, as I have said, in local reconfiguration of services, and it has to be right that the process is guided by those who know and understand the local area best.
In conclusion, as a constituency MP I completely appreciate the concerns of my hon. Friend the Member for Southend West, whom I again commend for his work.
Health Service Medical Supplies (Costs) Bill
Baroness Laing of Elderslie Excerpts(7 years, 7 months ago)
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The Minister of State, Department of Health (Mr Philip Dunne)
I beg to move, That this House disagrees with Lords amendment 3B.
Madam Deputy Speaker (Mrs Eleanor Laing)
With this it will be convenient to discuss Government amendments (a) and (b) in lieu.
Mr Dunne
When we last debated the Bill, I reminded the House of its importance. I do not intend to go over all that ground again, save to note the three primary purposes of the Bill: first, to give powers to align broadly our statutory scheme for the control of prices of branded medicines with our voluntary scheme, by introducing the possibility of a payment percentage for the statutory scheme, which could deliver £90 million of funding for the NHS every year; secondly, to give us stronger powers to set prices of unbranded generic medicines where companies charge unjustifiably high prices in the absence of competition; and, thirdly, to give us stronger powers to require companies in the supply chain for medicines, medical supplies and other related products to provide us with information. We intend to use that information to operate our pricing schemes, to reimburse community pharmacies for the products they dispense and to assure ourselves that the supply chain or specific products provide good value for money for the NHS and the taxpayer.
We agreed with 23 amendments made by their lordships during the passage of the Bill through the other place. Those, we accept, have made this a better Bill. We rejected just a single amendment. Despite the strength of our arguments, the other place has now made amendment 3B, which to all intents and purposes has the same effect as the original Lords amendment 3. It would introduce a duty on the Government, in exercising their functions to control costs, to take into account the need to promote and support a growing life sciences sector and to ensure that patients have access to new medicines. As I explained previously to this House, the amendment, which is no different in its effect from previously, would undermine one of the core purposes of this Bill: to enable the Government to put effective cost controls in place.
In our view, the amendment could encourage companies to bring legal challenges where the cost controls have not in themselves promoted growth in the life sciences industry. That could significantly hinder the Government’s ability to exercise their powers effectively to control costs. That would have a particularly detrimental effect if the Government were to take action to control the price of an unbranded generic medicine where it was clear that the company was exploiting the NHS—a point on which there was cross-party agreement when we debated the matter. That is because the Government might be challenged, not on the basis that the action was inappropriate, but on the basis that it did not promote the life sciences sector. Nevertheless, as I am sure all Members would agree, such action could be the right thing to do for the NHS, patients and taxpayers. The powers in the Bill that enable such action have received universal, cross-party support in both Houses.
Through debate on the issue in the other place, we have clarified that their lordships did not intend to undermine the core purposes of the Bill. Rather, the intent was to ensure a mechanism, laid out on the face of the Bill, to ensure that the Government pause to reflect on the impact of any proposed price control scheme on the life sciences industry and access to cost-effective medicines. With this clarity, the Government are now proposing amendments in lieu of Lords amendment 3B that will achieve that intent without undermining the core purpose of the Bill.
Consultation requirements prior to the implementation of any new statutory price control scheme for medicines are already set out in section 263 of the National Health Service Act 2006. Our amendment (b) in lieu would amend the 2006 Act to include particular factors that must be consulted on before proceeding with a new statutory scheme. They are:
“(a) the economic consequences for the life sciences industry in the United Kingdom;
(b) the consequences for the economy of the United Kingdom;
(c) the consequences for patients to whom any health service medicines are to be supplied and for other health service patients.”
The requirements are framed in that way to allow us not only to consider the economic consequences for the life sciences industry and for patients who may benefit from new medicines, but to balance those factors against wider considerations. I am sure the whole House can agree that while a thriving life sciences industry and access to new medicines are highly desirable, they must not come at any cost. It is the Government’s responsibility to achieve the right balance, and, indeed, to be held to account for it.
Several hon. Members rose—
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I thank the hon. Gentleman for his extremely kind words, and for his courtesy, which he always shows at the Dispatch Box and in the Chamber.
Dr Philippa Whitford (Central Ayrshire) (SNP)
Like the hon. Member for Ellesmere Port and Neston (Justin Madders), this will be my last time speaking in the Chamber before Dissolution, and as a newbie I also want to pay tribute to the staff of the House, who made coming here much easier than we had expected it to be. I am also glad that my final speech before Dissolution is on a Bill that, despite some of our disagreements, we have worked on on a cross-party basis to produce a piece of work that we all agreed needed to be done.
I, too, welcome Government amendment (b), although I would have laid out the three paragraphs the other way around, because the whole point of the NHS, and the whole reason we are discussing this, is patient access: that is the No. 1 concern. I would have put patients first, not third. The fear of not getting access to drugs is a great issue for patients. As the hon. Gentleman mentioned, we have a significant delay that is measurable in comparison with other countries. For certain types of cancer, our performance in relation to patients with early disease is as good as anywhere, but we fall down in dealing with people with difficult or advanced disease. That is because of the delay.
I want briefly to mention the interaction of the budget impact assessment with our no longer being part of the European Medicines Agency. I am not talking about the United Kingdom losing the agency itself; I am talking about our no longer being part of the scheme. We know that there is a danger that drugs are presented for licensing in the United Kingdom at a later date than in the United States and the European Union, which are major markets. It is likely that we could also be behind Japan. I am not suggesting that we should simply hand over any amount of money, but if we were also seen as a hostile market in which there was an expected delay of three years for expensive drugs, there would be a danger that international pharma would simply say, “You know what? We’ll license everywhere else, then we’ll come back to the UK in a few years.” That could result in significant delayed access for our patients.
We need to think about how all this feeds into trials and research, and into the life sciences system. If we are not using what is considered to be the gold standard drug at the time of a new international trial, we will not be able to take part in the comparison of the gold standard with the new drug. The UK has led the EU research network, which is the biggest research network in the world. We have been a major player in that, and it is important to realise how building in this delay from NHS England could undermine that. Surely this should be part of the NICE process. It should be clear to pharma, when it comes with a drug at a price, what process it will have to go through, what evidence it will have to bring forward and how it will have to negotiate a price. I fear that there will be delays in drugs being licensed.
This will affect us in Scotland even though NICE decisions do not apply to us. If a drug were simply not licensed here, it would be irrelevant that the Scottish Medicines Consortium chose to fund it—as it did the other week with Kadcyla—because it would still be an unlicensed medicine. We need to look at how the loss of the European Medicines Agency will work in this regard. There should not be a separate procedure after NICE that could suddenly hit pharma with another barrier to jump over. This will hit new cancer drugs, because they are expensive. It will particularly hit drugs for rare diseases, which the EMA has led on, because they are bespoke and therefore inevitably expensive. The £20 million limit would mean that if someone came up with a fabulous cure for dementia, for example, a budget impact assessment would be triggered.
Contaminated Blood
Baroness Laing of Elderslie Excerpts(7 years, 7 months ago)
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Andy Burnham
I will not be here, but I make a plea to the hon. Gentleman, if he is returned—do not rule out Labour in Scotland, it is on the way back. I make a plea to everybody here in the Chamber today and to the candidates who may be coming here that they must act on this information. They cannot leave this where it is. Their conscience must tell them that they have to do something about it.
When the Government ruled out an inquiry into Orgreave, despite the existence of clear evidence of serious wrongdoing by the police, they did so on the basis that “nobody died”. I am afraid that that threadbare defence will not hold here. People have died—2,000 in all—and they have been the victims of both negligence and a cover-up. In its heart of hearts, this Parliament knows that to be true, and so the question is: what are we going to do about it?
I will end with a quote from an email I received from another victim, Roger Kirman, who became infected with Hepatitis C in 1978 but only found out by accident when having a hip replacement operation in 1994—this despite having raised his family in between. His brother George died from AIDS in 1991. He wrote:
“I have been fortunate to make it as far as I have but I have a real sense of anger against successive governments for their indifference to the plight of so many. Politicians should not be surprised at the loss of confidence in Parliament when candour is not forthcoming and they are seen as interested only in preserving their own position and the status quo.”
I suspect that Roger speaks for every single family affected by this scandal.
It has been an enormous privilege to serve my constituents in the House, and it is with real sadness that I prepare to leave, but in my 16 years here I have also had my eyes opened to its shortcomings. The simple fact that since Hillsborough I have been approached by so many justice campaigns—many of them from the 1970s and 1980s—tells me that this place has not been doing its job properly. Westminster will only begin to solve the political crisis we are living through when, in the face of evidence, it learns to act fearlessly and swiftly in pursuit of the truth and gives a voice to those of our fellow citizens who through no fault of their own have been left in the wilderness.
Collectively, we have failed the victims of contaminated blood. I do not exempt myself from this, and I wish to apologise to all those affected for coming so late to this issue in my speech tonight. I also apologise to you, Madam Deputy Speaker, for the length of my comments—but in a way I do not actually: the House should be delayed tonight on this matter. Truth and justice have been delayed for people, so the House should be delayed tonight, as it hears directly what they have been through. I hope that we have given a flavour of that tonight. I say to Members here and those who might follow: it is never too late to do the right thing. [Interruption.]
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I do not want any clapping; “Hear, hear” will be fine.
As the right hon. Gentleman concludes his valedictory speech in the House, I am sure that the whole House will join me in wishing him well.
Several hon. Members rose—
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. We have an unusual procedural situation here. Of course there is plenty of time for our Adjournment debate, given that it started as early as this, and we are discussing a very serious matter, but Members who are now rising to speak gave no indication before the Minister spoke that they wished to do so. That does not mean that they will not be permitted to speak, but just because this happens to be the end of a Parliament, and there is time available to discuss this important issue, does not mean that I will ignore the—[Interruption.] Order. Mr Durkan! I am addressing the House. This does not mean that I will ignore the normal courtesies of this Chamber. Two people have indicated that they wish to speak. They must know that they ought to have done so before the Minister spoke. It was quite obvious when I was going to call the Minister. In these unusual circumstances, I will allow those two Members to speak very briefly now, and I do not expect further interventions.
Rationing of Surgery
Baroness Laing of Elderslie Excerpts(7 years, 8 months ago)
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Rachael Maskell (York Central) (Lab/Co-op)
I am grateful for the opportunity to debate the rationing of surgery. The reason this is such an urgent issue is threefold: first, it is causing detriment to the health of the people of York; secondly, it is discriminatory; and, thirdly, the policy now reaches beyond York.
I am sure the Minister will set out how, under the Health and Social Care Act 2012, matters of clinical decision making were devolved to clinical commissioning groups to make decisions about local need, but this matter is so serious that I urge him to take action, as the Secretary of State said he would. I have exhausted all routes to getting the policy reviewed, so I am now appealing, through this debate, for a complete review. NHS England has previously been clear that even time-limited bans on particular groups of patients receiving treatment is inconsistent with the NHS constitution. In the light of that, I trust it will commit to withdrawing its support for rationing now that evidence of its detriment is coming through.
The Vale of York CCG determined to delay surgery to patients who smoked or had a body mass index of more than 30. The policy came into force on 1 February 2017. It was first proposed in September last year, but then withdrawn and reintroduced in November. The reason: to delay immediate spend on surgery. However, it is a totally false economy, and although it may delay CCG spend now, in order to meet imposed spending restrictions, the Royal College of Surgeons says that it may actually increase NHS costs if patients develop complications while waiting for surgery. The college has been clear that rationing policies, such as those implemented by the Vale of York CCG, are unacceptable.
The York CCG’s ability to make rationing decisions comes direct from the 2012 Act. The duty on the Secretary of State for Health to “provide or secure” the health service was removed from section 1 of the National Health Service Act 2006, thereby removing his responsibility, and replaced by a duty to make provision for the health service. The list of services that the NHS had to provide—a principle that had been embedded in the NHS since its inception—was also removed, meaning there no longer had to be a universal list of service provision, and that each CCG could determine its own. In other words, it became a complete postcode lottery: where someone lives determines the healthcare they can access.
Nevertheless, I was encouraged by the Secretary of State’s response to a question on rationing from the Health Committee on 18 October 2016. He said:
“When we hear evidence of rationing happening, we do something about it…we are absolutely determined to give people the clinical care that they need.”
In response to the Chair of the Committee, he said:
“When we hear of occasions when we think the wrong choices have been made, when an efficiency saving is proposed that we think would negatively impact on patient care, we step in, because, challenging though it is, our responsibility to the public is to make sure that we continue to make the NHS safer and higher quality and that it offers a higher standard of care”.
Minister, it is time to step in.
Early on, the Vale of York CCG hit the headlines and became unstuck when it rationed interventions such as in vitro fertilisation treatments—a decision that was reversed—so this CCG has form. As we saw from yesterday’s health and social care debate, the NHS financial model has failed. Not only does the funding formula fall short of real need, but the NHS now has the wrong financial drivers in place, resulting in a demand- led approach to health provision and uncontrollable spend.
I could talk more on that, but the Vale of York CCG introduced a delay on surgery as a direct result of its failure to contain its spend within budget; it now has special measures bearing down on it. The CCG receives around £1,150 per patient, when demand seriously exceeds that. CCGs just down the road are receiving 50%-plus more. York has an ageing population demographic and areas of serious deprivation. I urge the Minister to look again at NHS funding, because it simply is not working and our CCG is being penalised for that.
The Vale of York CCG took the decision to ration surgery for up to a year for those overweight and up to six months for smokers. Having worked in the NHS as a clinician—I was a senior physiotherapist—I am all too aware of the risk factors created by people smoking and being overweight, not least when it comes to surgery, and I do not need the Minister, as a non-clinician, to spell them out to me today. I would see patients pre-operatively to provide advice, and would also treat them post-operatively to address the risks through respiratory therapy and mobilisation. All clinicians understand the risk factors, which is why it is so important that money is invested in public health services—something that the Government have failed to do.
A child receives, on average, 12 minutes a year of school nursing, which includes child protection work. That means that they get only a few minutes a year of advice on diet, exercise, smoking and sex education. Clearly, that is not enough, especially as PE has also been cut. Yesterday, I met local school nurses who set out how their service was being cut, and how school nurses are being downgraded and de-professionalised to make savings in York.
When the Government switched public health back to local authorities, which have had their grants slashed, public health services also suffered. The irony is that York’s council completely cut funding for smoking cessation services and for NHS health checks. It also cut the health walks programme, which was a service to help people exercise more and lose weight. Therefore, public health measures to address smoking and weight were cut first, and then patients were denied surgery because they smoked or were overweight—you could not make it up. It again shows how fragmentation creates health detriment.
GPs are now actively writing to patients to ask them whether they smoke—not that they have a smoking cessation service to refer them to. They say that it is just “for their records”. Patients who are seen by their GP and who are considered to be in need of an assessment by a specialist for surgery fill out a form. They have to declare their smoking and weight status. One would think that the surgeon would receive a letter, highlighting the risk, and then would make a clinical assessment of that risk—but no. The referral is diverted, and the patient is sent a standard letter and a leaflet, which does not reflect on their own personal circumstances, but tells them that they smoke or are overweight and therefore need to change their ways. As a penalty, they are denied surgery. The specialist never gets the opportunity to assess the patient and make clinical judgments accordingly.
I am sure that the Minister will recall the narrative, which enticed some in this House to support the Health and Social Care Act 2012. We heard that doctors will be at the heart of the NHS and that they, not bureaucrats, will be the ones making the decisions. Then there was, “No decision about me without me.” Here we have a system where clinicians are being undermined by diktats from bureaucrats; patients and clinicians have no say; and clinical evidence is left wanting.
Before I progress, let me turn to this letter that patients are sent. First, it is generic and has no personal advice about the patient’s own clinical circumstances. By the time a patient reaches the third paragraph, they are told how obesity is costing the CCG £46 million and smoking £7.2 million a year, as if that is an issue for the patient who needs surgery. The penalties are then set out. Those who are obese have to lose 10% of their weight or reduce their BMI to under 30, or wait 12 months. Those who smoke have to stop smoking for eight weeks, or wait six months. Enclosed with the letter is a leaflet entitled “Stop before your op” and a web address so that people can find out how to get support. I went through this and the convoluted website. Any public health practitioner would tell you how inappropriate and ineffective this whole system is. There is no real help available.
The Royal College of Surgeons states that denying or significantly delaying access to NHS treatment does not help patients to lose weight or stop smoking. Now those being denied surgery are paying a heavy price. I have spent much time talking to GPs and surgeons about this matter, as well as to patients. I have also talked to the CCG, which knows that the system is totally wrong, but because it is in a financial hole and NHS England has waved it through, it is just complicit. It is not standing up for patients in York.
One more point on the process: in York, patients who were referred for surgery, ahead of this policy being introduced, had their referrals sat on. The first thing that they received was their refusal letter. It is shocking that those patients’ surgery was delayed by the CCG even though their referral was made before the policy came into effect. So what is the impact on patients? Well, it is devastating. We already know that waiting times for surgery are going up, and delay in itself creates detriment. It is true that some patients are exempt—I am talking about those needing urgent care, the removal of a tumour, or trauma surgery. However, if someone requires a joint replacement because they have not mobilised well for some time due to osteoarthritis, is in pain, and, as a result of not mobilising, have put on weight, things are very different. With a new joint, they will be back on their feet. A 12-month delay in being referred will exacerbate their problems. A year of degeneration, pain and not being able to mobilise, an initial clinical assessment and then the wait for surgery will result in a surgeon presented with a more complex operation, and a physiotherapist with a patient who is less mobile and weaker, needing more input and possibly longer in rehab. Bang!—there go all the savings from rationing and more, all at a cost to the patient and a risk that the long-term clinical outcomes will be worse.
The British Orthopaedic Association said:
“There is no clinical, or value for money, justification…Good outcomes can be achieved for patients regardless of whether they smoke or are obese”.
If someone were 20 stone, they would have to drop to 18 stone before having surgery, but if they were 18 stone, they would have to drop to 16 stone 2 lbs. One person asked why surgery is safe at 18 stone in one case, but not the other. I ask the same. A patient has presented to me who was prescribed medication that had a side effect of weight gain. They were on drugs that risked weight gain, required surgery and were denied by the same GPs who gave them the drugs.
I have had a patient who is active and works full time, but is over the weight threshold. She needs surgery to enable her to conceive. She is not young. Surgery is needed now, as recommended by her GP. However, it was denied and could result in her never having a family. A patient with hypothyroidism, a chronic condition that leads to weight gain, needs surgery for gastrointestinal abnormalities but, despite their condition, will be restricted. One patient was a very fit body builder, but was refused surgery because of their high BMI. The case for delay has not been evidenced.
From talking to epidemiologists and reading academic papers on the issue, we know that there is a strong correlation between smoking and obesity, and social and economic deprivation. As the British Medical Association said, this could also be seen as rationing on the basis of poverty. Those with mental health challenges have a higher propensity to smoke, and those with chronic conditions are more likely also to have elements of depression and possible weight gain. Many people find it difficult to lose weight or give up smoking. Minister, you know the figures. This policy is totally discriminatory.
Madam Deputy Speaker (Mrs Eleanor Laing)
I am quite sure that the hon. Lady did not mean to address the Chair, but means to ask the Minister whether he knows the figures.
Rachael Maskell
Indeed that is the case.
This policy is totally discriminatory and is having further detriment for those with co-morbidities. It is creating problems, not solving them. All surgery carries a risk, and it is for clinicians to assess that risk. As the Royal College of Surgeons says,
“It risks preventing a patient from seeing a consultant who can advise them on the best form of treatment, which may not be surgery. Surgery may be needed to help someone lose weight.”
That point was also made by a patient who was able to mobilise after a joint replacement. This is why clinical decision making is needed. Patients have to be part of this too.
Public health programmes need restoring so that patients can properly engage with people to help to optimise their health. The passive approach of the CCG is setting patients up to fail. David Haslam, chair of the National Institute for Health and Care Excellence, said that rationing of surgery concerned him. He says that the NICE osteoarthritis guidelines make absolutely clear that decisions should be based on discussions between patients, clinicians and surgeons, and that issues such as smoking, obesity and so on should not be barriers to referral. These are the experts.
The Vale of York CCG has gone down this route, and others are now following, with 34% of CCGs looking to ration on the basis of obesity or smoking. Harrogate and Rural District CCG and East Riding of Yorkshire CCG target smokers and those who are overweight with a six-month delay. Wyre Forest, Redditch and Bromsgrove, and South Worcestershire CCGs ration on the basis of pain impact. South Cheshire CCG requires a BMI of less than 35—not 30—as does Coventry and Rugby CCG. The policy is spreading. Although York is the worse example of rationing, every clinician knows that it is wrong and contravenes their professional duty of care.
I am blowing the whistle on this today because the policy is directly discriminatory, clinically contraindicated and financially perverse. I would be the first in this House to advocate health optimisation programmes supporting smoking cessation or providing help to improve diet, exercise, wellbeing and lifestyles, but to leave someone in pain or without a child brings our NHS into disrepute.
This evening, I have made a clear case for why the rationing of surgery must end. As the Secretary of State said to the Health Committee, it is time to step in.
Health and Social Care
Baroness Laing of Elderslie Excerpts(7 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Dr Wollaston
My hon. Friend is absolutely right. It is important that the evidence is available not just to us, but to the local communities. There should also be a sense that consultations are a genuine process. As I have said, it is about the co-design of new services. Time and again, we have reports from the NHS that demonstrate that co-producing new services results in a much better service in the long run, so I thank her for her point.
We are talking about the cuts not only to the trusts, but to the clinical commissioning groups. What we are seeing now is that CCGs are being asked to hold back £800 million of their budgets to offset deficits in trusts. Again, this is about patient care that is being cut back. Alongside that, we have seen cuts to Public Health England and to Health Education England. The idea that we have an NHS that is on a sustainable footing is, I am afraid, simply not the case. I ask Ministers to be realistic about the current position, and I ask our Chancellor, in his forthcoming Budget, to address this matter by urgently giving a lifeline to social care, because that will benefit not just social care, but the NHS. In addition to announcing that lifeline, which I hope he can do by bringing forward the better care fund with new money rather than a transfer from the NHS, I hope that he will promise a genuine review of sustainable future funding covering both health and social care. I call on Members from across the House to agree that, rather than our having the usual confrontational debates, we should see this as a generational challenge that will face whichever party is in power over the coming years. We should all work together, for the benefit of our constituents, to produce a sustainable future for the NHS and social care.
Madam Deputy Speaker (Mrs Eleanor Laing)
I call the Chair of the Public Accounts Committee, Meg Hillier.
Several hon. Members rose—
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. It will be obvious to the House that a great many people wish to speak this evening. Of course, we have plenty of time, but it is limited. If hon. Members take a self-denying ordinance and speak for no more than nine minutes, everyone who has indicated that they would like to speak will have an opportunity to do so. I hope not to have to apply a formal time limit, because nine minutes is actually a very long time: if you cannot say it in nine minutes, you have to go away and practise. I know that no practice is needed by Anne Marie Morris.
Mr Betts
I just want us to have a process that gets us to a similar position. Even if local authorities remain part of the funding solution, we cannot assume that the increase in business rates and council tax will keep pace with the level of demand.
I know that you have encouraged us to keep to a time limit, Madam Deputy Speaker.
Madam Deputy Speaker (Mrs Eleanor Laing)
Order. I ought to say that, as the hon. Gentleman is the Chairman of a Select Committee, I do not apply the time limit as strictly to him.
Mr Betts
I have gone two minutes over time, so I had better not stray too far. Of course, health and social care need to work closely together. It is going to be very interesting to see how Manchester develops. It is not, however, a panacea; it is not going to solve all the problems.
I agree with the Chair of the Health Committee: the sustainability and transformation plans are an interesting way forward, but unfortunately they are seen as a way of making cuts. They will need some pump-priming to make them effective. They have not been done properly, with full co-operation, in every local authority area. If they are done properly and consider how we can better plan and pull together health and social care for the future, I think they will make an important contribution. Ultimately, however, we have to acknowledge that the process is going to take time and that it will need up-front funding to make it work.
We also have to acknowledge that there are big differences between health and social care. There are not many differences in culture, but the funding arrangements are different. Health is provided free at the point of use, whereas social care is not and probably will not after any changes are made. There is also a fundamental difference between the two on accountability: social care is accountable to directly elected local councillors, whereas health is ultimately accountable to the Secretary of State. If Members want to see the problems that creates, they should read the evidence that the former Health Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), gave to the Communities and Local Government Committee about his understanding of accountability in the Manchester system. It shows that the Government have not worked it out in such a way that they could flick a switch tomorrow and get it all operating smoothly. We have a lot of work to do. The Select Committee will consider all the evidence we have received and will produce reports on a range of issues.