NHS 70th Anniversary

John Howell Excerpts

Wednesday 16th May 2018 Westminster Hall

[John Howell (Henley) (Con)]

It is a great pleasure to serve under your chairmanship, Mr Hosie. Let me begin by reassuring the Minister that I am not going to give a list of all my medical complaints—I seem to have a tendency to do that at these debates. I will just say that they are very few in number. As one of the officers for the all-party parliamentary group for diabetes, I agree with what the hon. Member for Blaenau Gwent (Nick Smith) said about diabetes, and the way we need to tackle it by fighting obesity and waiting for the effects of that to come through.

If there were one birthday present that I would like to give the NHS, the Prime Minister has already given it: a long-term plan for the NHS and a multi-year funding settlement in support of it. That is very important for a number of reasons. We all know that the NHS has suffered its most challenging winter for many years. We also know, as Opposition Members have pointed out, that we are living in an ageing society. By 2020, there will be more 70-year-olds than there were five years earlier. I am not sure whether my hon. Friend the Member for Ayr, Carrick and Cumnock (Bill Grant) and I will be in that category—I have not done the maths yet—but we will go there jointly and with good humour, I am sure. The number of over-85s will nearly double by 2035. We have to focus our services on dealing with the requirements of that group of people, who are living in a modern age where the NHS has introduced many improvements over the past few years.

For the NHS to plan and manage budgets effectively in the long term we need to move away from annual top-ups of its budget, and towards a sustainable long-term plan. Whatever plan we introduce, it has to be sustainable. We have the five year forward view as a basis on which to work towards that. I was very pleased that the Prime Minister announced to the Liaison Committee that the Government would introduce a long-term plan for the NHS and, most importantly, do so in conjunction with the leaders of the NHS, clinicians and health experts. We cannot introduce that long-term plan simply as politicians. I look forward to that with a great deal of anticipation.

We all know that care is not properly integrated—we have seen that in our constituencies—and we all know that we need to integrate health and social care more quickly than we can really manage. I fully support that process. All those things came up at a public meeting in my constituency just a few days ago. Somebody asked why we still fund the NHS on an annual basis, and I was able to point out that we are moving away from that system.

I will finish with this point: putting public health at the heart of what we are doing with the NHS is crucial. We cannot stand here and speak about the future of the NHS unless we put public health at the centre of everything we do. I recommend that course of action to the Minister.

Education (Student Support)

John Howell Excerpts

Wednesday 9th May 2018 Commons Chamber

[Stephen Barclay]

I absolutely recognise that the apprenticeship route will take four years, but the Government have given a clear commitment to that and that is backed up by significant—[Interruption.] The UCAS figures are embargoed, so I do not have the latest figure. The point is that it is a four-year programme and it will take time to roll out, but it is backed by significant funding: the NHS is contributing £200 million to the apprenticeship levy. That is a signal of this Government’s commitment. The Minister for Apprenticeships and Skills is here, championing the apprenticeship route, as are other Members through the Select Committees. It is a shame that some Opposition Members are not reflecting on the benefits offered by apprenticeships as an alternative route into the nursing profession that will deliver more nurses. That should be welcomed.

[John Howell (Henley) (Con)]

I think my hon. Friend the Minister has forgotten that the Minister for Education, my right hon. Friend the Member for Bognor Regis and Littlehampton (Nick Gibb), is also here, which reinforces the point that the starting point for promoting nursing is at school. Does my hon. Friend agree?

[Stephen Barclay]

I do agree with my hon. Friend. Indeed we have three Ministers from the Department for Education here, which again shows the Government’s joined-up approach. The NHS, as the employer of 1.5 million people, is a standard setter that can provide leadership in the apprenticeships market and looks at doing so not just for nursing apprenticeships, but across a range of apprenticeship routes. The Minister for Apprenticeships and Skills, who is a former Minister in the Department of Health, understands that issue extremely well.

Learning Disabilities Mortality Review

John Howell Excerpts

Tuesday 8th May 2018 Commons Chamber

[Caroline Dinenage]

It is not about that. This is about inquiring into the deaths of people who have died in our care. Despite all the really difficult decisions we have had to make to deal with the financial challenges this country faced, which the hon. Lady’s party will be well aware of, we have made progress on this issue in terms of transforming care and the healthcare checks on people with learning disabilities, and this very report on the learning from deaths programme proves how absolutely committed we are to ensuring that not one single one of those deaths goes unrecognised or uninvestigated.

[John Howell (Henley) (Con)]

Surely the quicker integration of the NHS with social care across the board will help to solve some of these problems. Does the Minister agree with that?

[Caroline Dinenage]

Yes, my hon. Friend is absolutely right. The integration of health and social care services is absolutely vital, and that is why we are so delighted that we have renamed the Department as the Department of Health and Social Care. That has to be more than just a title; it has to be a statement of intent.

HPV Vaccination for Boys

John Howell Excerpts

Wednesday 2nd May 2018 Westminster Hall

[Sir Roger Gale]

My hon. Friend the Minister indicates that he knows the problem only too well. My hon. Friend the Member for Finchley and Golders Green has done a significant amount of work in achieving the provision of human papillomavirus vaccine for gay men—a small but significant step in the direction in which I hope we may travel further this morning.

Until a relatively few weeks ago, I knew very little about this issue. I concede that entirely. Unlike one of my colleagues who was here in this Chamber yesterday morning while I was in the Chair listening to the debate, who had a relative who had died of bowel cancer, I have no personal experience. However, when I met Professor Nutting and Peter Baker, I was astonished at the speed with which they convinced me of the argument—and I am not a pushover when it comes to spending taxpayers’ money. I think it is a no-brainer, and I hope to persuade my hon. Friend the Minister, and others, on this cause.

The human papillomavirus causes, among other things, cervical cancer, throat cancer, anal and penile cancers, and cancer of the back of the tongue. The virus is carried by about 80% of the population, which means somebody in this room is a carrier; it is not uncommon. I would like everybody to take that on board. Go on the tube in the morning and there will be dozens of people carrying the virus—most of it dormant, and a lot of it non-malignant. It is contracted in sexually active youth and, for men, usually in their teens or 20s.

The point is that it is a slow-burn issue. Its effects are not experienced overnight. A condition contracted as a teenager or at university may not rear its head for 30 years. We are talking about men now in their 50s and 60s, who some of the eminent people sitting behind me in the Public Gallery are treating, waiting that length of time without realising that they have anything wrong with them at all, because there is no screening process for men, unlike the screening process for cervical cancer.

I spoke yesterday to two people, Jamie Rae and Stephen Bergman—both sufferers, and both in their mid-50s—who described their experiences to me. I will not go into too much of the gory detail. I heard again this morning of another experience: somebody’s colleague, himself an eminent surgeon, who had throat cancer and suffered many months out of work, which was a loss to the health service, damage to his family and, of course, the treatment. The treatment involves chemotherapy and radiotherapy; it may involve a tracheostomy; and it inevitably damages the saliva glands in the mouth, leaving the patient who survives with permanent dryness, considerable pain and ongoing discomfort. As I have indicated, there is also the social damage. Both Jamie Rae and Stephen Bergman described to me in graphic detail the processes they have been through and the discomfort—I use that word very modestly indeed—they have experienced. They described themselves as the lucky ones, because both those gentlemen have come through it relatively unharmed, but of course there are many others who do not.

The HPV vaccine has been available to adolescent girls since 2008. A pubescent girl of 12 or 13 is offered the opportunity to be vaccinated in school. The parents, quite properly, have a right to refuse that vaccine. Just in case anybody has any doubt, I am aware that there are a small number of cases where parents believe that things have gone wrong and that children have suffered as a result of the vaccination. That is medically unproven, but we have to recognise that the parents believe it. Parental choice is vital, and in the case of pubescent girls there is parental choice.

The process ties in directly with the Department of Health and Social Care’s cancer strategy, which of course is about prevention. The Department has done significant work on preventing or seeking to prevent other prominent cancers. Lung cancer is the obvious one, and the anti-smoking campaign is highly relevant in this context. Melanoma is another; something that people of a certain age, such as myself, probably did not bother with at all has suddenly become prominent as the realisation of the damage that the sun’s rays can do to the skin and the cancers that can arise from that has dawned on the population. Any responsible parent or grandparent now takes the trouble to ensure that their children have appropriate sunscreens at all times when enjoying the sun. HPV vaccine falls directly into that category. It is usable for prevention and, used properly, it works. That is proven. As I said, this has been available to adolescent girls since 2008.

We now come to the hard bit of the argument, because up until now I think everybody would probably agree that we are on a winner in using HPV vaccine, but of course there is the question of cost and efficacy. The argument has been deployed that herd immunity, to use the colloquial phrase, will mean it is not necessary to vaccinate boys, because if we eliminate the infection in girls, boys will not catch it from the girls. That is nice in theory, but wrong in practice.

I am told by those who know better than I do that the average young male has at least 10 sexual partners. The Minister might find that surprising; I did myself, but it is so. It depends whom we believe, but in the United Kingdom the vaccine has an uptake of between 70% and 83%, although in some parts of the country it is as low as 50%. A young man embarking on an exciting night out with his girlfriend therefore has a very high risk of contracting HPV from a girl who has not been vaccinated, and that is just in the UK. We overlay on that the foreign travel that many young people are now happily able to enjoy. Sometimes, with sun, sea and sand goes sex, and the risk of exposure to HPV in those circumstances can be even greater. Therefore, the idea that herd immunity will in time address the problem is fallacious, and this is where I have to accuse those who are responsible for taking the decisions—that is not the Minister—of short-termism.

I can see the attraction of the argument that extending vaccination would not be cost-effective and that herd immunity is coming downstream. Yes, the cases coming through now are historical, in the sense that the disease was contracted 20 or 30 years ago, so well before any immunisation. If we want to save money and damage health at the same time, that is quite a good way of going about it. I am seeking to persuade the Minister of the real value of having the courage—he is not lacking in courage—to take a long-term decision now.

The cost of immunising every adolescent boy within the relevant range in the UK is estimated to be, at the top end—this includes the purchase of the vaccine, which of course has to be negotiated by the health service, and its application—about £22 million a year. That is a lot of money, but in health service terms it is almost a bagatelle. Set against that, I am told by those with real experience, some of whom are sitting behind me in the Public Gallery, that there are about 2,000 patients a year—men in their 50s and 60s—who have developed throat, penile or anal cancers. The cost of treating those is about £21 million a year. Of course, that takes no account of the social costs and the other damage that can be done. In the case described to me this morning, of a surgeon who was taken out of play for a considerable time, the cost of treatment—of a replacement jaw, as well as the chemotherapy, radiotherapy, hospitalisation and everything else that goes with it—is looking like being somewhere between £50,000 and £100,000, and that is just one case.

[John Howell (Henley) (Con)]

My hon. Friend mentions the 2,000 people. Does he have an estimate of the total number of people who might be spared the effects of the virus if the actions that he proposes are taken?

[Sir Roger Gale]

I am afraid that I do not. The figure that I have is 2,000 people a year, so one has to assume that it is that—but it is growing.

The reason the condition is becoming more prominent, not less, is the change in sexual attitudes from the 1960s onwards, when practices that were previously unacceptable became acceptable. Oral sex, for example, became relatively commonplace. We can therefore expect, certainly within the next 10, 15 or 20 years, a significant rise in the number of cases. The discussion has to be about what happens after that and whether the herd immunity actually works. I am arguing that it will not, for the reasons I have given.

I have talked about the slow burn, the 20 or 30-year wait, and the costs to the health service, on which the view seems to be, “Okay, fine. Let’s kick that into the long grass. It’s not our problem.” There will be 15 Ministers between the present one, sadly, and the time when people are developing diseases. However, the condition of genital warts, which is also caused by HPV, takes only three, four or five years to incubate, and the cost of that annually is £50 million, so do the maths. The economics of this are unassailable, and on those grounds I defy anyone to challenge my argument. The argument comes down to herd immunity. Will vaccinating girls do the job or not? I have made it clear that I believe it will not, and I think that the time has come for the Department to take a further long, hard look at the issue.

Up to now, the Joint Committee on Vaccination and Immunisation has indubitably taken a short-term approach to this: “Does it work? Well, yes, the vaccine works. Is it worth it? Well, not if we are vaccinating girls. Let’s see what happens—kick it down the line and save £20 million a year today,” even if that means that in 10, 15 or 20 years’ time we will be spending not £20 million but £200 million a year, which will be in addition to all the social costs. I understand that the JCVI will meet in the first week of June. We were promised that a decision on extending vaccination would be taken in 2015. That was deferred until 2017 and has now been deferred without a date being set for the final result.

Before I conclude with a request to the Minister, I want to say this. Chris Curtis, chairman of The Swallows head and neck cancer charity, sent me a video this morning. It was compelling, because he has been a sufferer himself and he described his own circumstances. I want to say something to the JCVI, to each and every member of that august body, who are of course medically qualified in a way that I am not. What I want to say on behalf of all the people who have been treated and have approached me is what Chris Curtis said at the end of his video. Friends, when you are thinking of kicking this into the long grass because it is not going to affect many people for a very long time and we do not have to concern ourselves with tomorrow, remember what Chris Curtis said, very starkly: “Tomorrow comes very quickly.”

I will not ask the Minister to second-guess the JCVI—that would not be right. I do not believe that this is his decision to make, in the sense that I suspect he is little more medically qualified than I am. Neither of us has the expertise to make this judgment. Will he please convey that sense of urgency about tomorrow to the JCVI, with the firm and genuine request that he wants them to take a long-term view, and to make the decision on the balance of long-term cost, not savings tomorrow?

--- Later in debate ---

[John Howell (Henley) (Con)]

It is a pleasure to serve under your chairmanship, Sir Henry. There is not much more that I can add to the presentations that have been made by my colleagues, but I want to make a couple of points. First, this is not simply about the sexual relationships of gay people. It affects all of us. My colleagues made that point firmly, but we need to make it again. Secondly, this virus is horrible. It is a disgraceful virus—to anthropomorphise a virus. We have heard the descriptions of the cancers that are induced by it.

I want to concentrate on the preventive powers of this vaccination for genital warts. There is a strong case for that. They may appear to be insignificant, but I do not believe that they are; they are much more widely distributed among the population than the cancers induced by the virus. My hon. Friends the Members for North Thanet (Sir Roger Gale) and for Worthing West (Sir Peter Bottomley) have made a compelling case for the immunisation of boys, which I fully support.

Autism

John Howell Excerpts

Thursday 29th March 2018 Commons Chamber

[Robert Halfon (Harlow) (Con)]

I am hugely grateful for the opportunity to speak in this important debate, and I again congratulate my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan) on her work in this area. I particularly want to pay tribute to the work of organisations that support autistic people, such as PACT for Autism in my constituency of Harlow. It started off as a small charity, but has now become a national one, and it has done so much to educate me about autism and to support families with autistic children across my constituency and elsewhere.

Ensuring that all children are able to access supportive, high-quality education and post-16 opportunities is essential for their life chances and for enabling them to climb the education ladder of opportunity. Our Education Committee is currently holding an inquiry into alternative provision, and we are likely to do an inquiry in the future into the role of special needs in education.

Children in alternative provision are the most vulnerable children. Compared to their peers, they are seven times more likely to have a special educational need, 10 times more likely to have a recognised mental health problem and, as I said to my right hon. Friend earlier, four times more likely to be permanently excluded from school than any other child. We have a real problem with the number of exclusions in our country. We are excluding a classroom-plus—35 children—from school every day.

[John Howell (Henley) (Con)]

Is my right hon. Friend aware that schools deliberately exclude children with autism when they know that an Ofsted inspection is coming?

[Robert Halfon]

We have heard all sorts of stories about exclusions in schools, and I think there is a wild west of exclusions out there. This is why our Committee is looking into it and undertaking an inquiry, and we have heard what my hon. Friend has said.

--- Later in debate ---

[John Howell (Henley) (Con)]

It is a great pleasure to follow the hon. Member for Bristol West (Thangam Debbonaire) and all my other colleagues who have spoken on this matter. I congratulate my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan). I am very pleased to support World Autism Awareness Week.

I have a constituency interest and a personal interest in this issue. The constituency has a large number of centres that provide support to those with autism. We also have a spectacular charity, Music for Autism. I was interested to hear the comments on the link between music and those with autism, which has been enormously helpful. I hope to come on to my personal interest in due course.

Young people and adults with autism are some of the most loyal and hardworking people I have ever come across. All they need is a chance, and that chance comes through early diagnosis. The more I have looked at this issue, the more I have become attached to the idea of one-stop shops for parents or guardians. Provision varies depending on where one is in the UK. I refer Members to the Department for Education report that covers that, by our former colleague Lee Scott.

On school exclusions, what has shocked me the most is that young people with autism face more exclusions than any other group. That is a frightening thing to take on board. It is perhaps not surprising when we have heard that some schools are excluding people when they know that Ofsted is coming—a disgraceful use of the system.

My personal interest is as an ambassador for a scheme that goes by the names of the Glyn Hopkin Foundation, the Sycamore Trust, and Space—Supporting People with Autism into Continued Employment. The charity does a lot of the work that hon. Members have been talking about the Government providing. It not only provides people who are fully ready for work; it provides advice to employers on how they should go about changing their own operations to make them autism friendly. What I have taken away from its work is a reminder that minor, easy adjustments to recruitment and the workplace can make a huge difference. I am currently trying to take a young person with autism into my office here in the House of Commons to work alongside me, initially for a few weeks on my first attempt. It is a great privilege to be involved in this area.

I will finish a little earlier for similar reasons to those given by the hon. Member for Bristol West, but I will say that the Department for Education has done great work over many years. This is not a question of funding, but attitude. It is a question of getting the attitude right in the Department to face this opportunity to make the most out of those with autism, so that they can better contribute to our society.

Teaching has been mentioned. I am very appreciative of all that has been said about the provision of training for teachers, but actually I would not blame the teachers at all on this issue. I blame a number of local education authorities. It is currently very hit and miss as to whether a local education authority is autism friendly, and can cope and provide all the support services. There are many good examples, but I will not name them now.

[Dame Cheryl Gillan]

Does my hon. Friend agree that not only is it important that schools do not exclude a pupil with autism when the Ofsted inspectors are coming into the school, but that those Ofsted inspectors should be fully trained to understand autism? They could then inspect a real class in a real situation and see how the school handled it.

[John Howell]

My right hon. Friend makes a very good point. I expect Ofsted inspectors to be trained to ask the question, “Who has been excluded who has an autistic condition?” That should be fundamental to what an Ofsted inspector asks before beginning an examination. My criticism of local education authorities includes the fact that many do not pass on all the funding given to them by central Government. There is a great need for ring-fencing such funds so that LEAs can carry out what we are asking them to do.

GP Recruitment and Retention

John Howell Excerpts

Wednesday 28th March 2018 Westminster Hall

[Bridget Phillipson]

I am sure the experience of my hon. Friend’s constituent is happening up and down the country. We want to ensure that people can access quality healthcare close to home. It is neither cost-effective nor in the best interest of patients to have to travel further to hospital for things that could be dealt with more readily within a GP’s practice.

More and more local people are telling me that they have to attend accident and emergency to get the treatment they need, because they cannot get an appointment with their GP or their local practice is closed when they need it. We saw record numbers at Sunderland Royal Hospital A&E this winter, when the entire NHS was stretched to breaking point. It is extremely worrying in that context that so many people are turning to emergency services simply to access the care that family doctors might ordinarily provide.

[John Howell (Henley) (Con)]

The hon. Lady has made a brilliant start to her speech. I did a similar survey to the one she describes in my own constituency, and I found that access to GPs was almost instantaneous provided that people did not specify the GP they wanted to see. My own practice consists of a number of GPs. I think the results are patchy around the country. Is this not a time to look at the old partnership structure of GPs, to avoid the situation where a young doctor has to find £100,000 or £200,000 in order to go into practice?

[Bridget Phillipson]

The hon. Gentleman raises a fair point about patchiness, and I hope the Minister will be able to respond to it in his summing-up. There are big regional variations, and differences even within cities and towns, and we need to try to even out access to general practice. He raises an important point about routes into the profession and the barriers that they sometimes place in the way of those seeking to work in general practice, and I hope the Minister will say a bit more about what the Department will seek to do to take away some of those barriers.

Patient Safety

John Howell Excerpts

Wednesday 28th March 2018 Commons Chamber

[Dr Johnson]

I congratulate my hon. Friend on passing that private Member’s Bill, which has undoubtedly saved many lives.

I am proud to work in a health service that, just last year, was rated the best and safest healthcare system in the world by the independent Commonwealth Fund think-tank. To err is human: we all make mistakes. The consequences of a doctor’s error, though, are potentially catastrophic. Doctors live with that responsibility and, as a doctor, I live in fear of making a mistake because I do not wish for anyone to suffer harm.

[John Howell (Henley) (Con)]

My hon. Friend may have seen that the Medical Protection Society is asking for the bar to be lifted on criminal proceedings and for the General Medical Council to be shaken up a bit to improve its approach to dealing with this issue. Does she have any sympathy with that?

[Dr Johnson]

I will come on to that later, but I agree with my hon. Friend.

I have worked with at least two colleagues who made significant errors. Many lessons were learned and widely disseminated. Training was provided to stop recurrence, but neither doctor was prosecuted. Throughout my career it has been the case that, if a doctor does their best but makes a genuine error, they will not face criminal charges. Gross negligence manslaughter was seen to be an appropriate sanction for the doctor who refuses to see a patient, who turns up intoxicated or who deliberately does something wrong. That facilitates a no-blame or airline safety-style culture, promoted by the Secretary of State, in which errors are identified and continuous improvements are made.

Following the case of Dr Bawa-Garba, that safety culture and those improvements to patient care are now in jeopardy. Although she was newly back from maternity leave, had not received induction, was covering two people’s jobs, had inexperienced junior staff to supervise and had reduced consultant cover, a very busy unit and a broken IT results system to contend with, Dr Bawa-Garba was convicted of gross negligence manslaughter and, more recently, struck off the medical register by the GMC. Those events followed the very sad and tragic death of a little boy, which of course saddens all of us in this House and is something from which his family will never truly recover.

Whatever the rights and wrongs of this particular case, many professionals have seen sufficient ambiguity in the decision that Dr Bawa-Garba was criminally culpable that it has shaken their confidence that they understand the boundary between a genuine error of medical judgment and conduct so exceptionally bad that it amounts to criminal behaviour. It has, in the words of the chair of the Royal College of General Practitioners,

“shaken the entire medical community”.

Although the GMC is an independent organisation, the Government will be aware of concerns raised about its decision making on this case. Perhaps the most high-profile concern was raised earlier this month at the local medical committees conference, where GP leaders passed a vote of no confidence in the GMC. I would be grateful if the Minister elaborated on what the Government are doing in their work with the GMC to ensure it is executing its functions correctly and to restore medical and public confidence in it.

It is right that individuals are held accountable for their actions, but there is always a balance to be struck between accountability and blame. Where the balance is tipped towards blame, individuals become fearful and may attempt to cover their mistakes, preventing them and others from learning; the same errors will therefore be repeated. Since the case of Dr Bawa-Garba, many doctors have become fearful. That culture of fear means that some doctors are being advised to anonymise reflective practice and to avoid uploading those reflective practices on to their e-portfolio. They might unnecessarily escalate decisions previously undertaken themselves or refuse to do more than contracted. That cannot be good for patient safety.

Eating Disorders Awareness Week

John Howell Excerpts

Tuesday 27th February 2018 Commons Chamber

[Edward Argar]

The hon. Gentleman makes a very important point. This is one of those issues on which I would hope we can see the widest engagement across the UK, across all involved in government and the provision of services, to come up with a coherent and common approach to beating eating disorders.

[John Howell (Henley) (Con)]

My hon. Friend is making a very good point. I wonder whether he has a feeling for how much extra training GPs will require to be able to spot the signs of these disorders.

[Edward Argar]

My hon. Friend makes a very important point and if he will perhaps be patient for a few more minutes, I will turn to, among other things, exactly that point.

At the launch that I referred to, I met and heard from some impressive and inspiring people, who had grappled with eating disorders and who wanted to share their experience and raise awareness. I subsequently met Beat to discuss its work and what more needs to be done. The people I met at Beat’s launch event did something important and brave in speaking out, but they had already done something brave in seeking help for their illness in the first place.

Diabetes

John Howell Excerpts

Monday 26th February 2018 Commons Chamber

[Liz McInnes]

I completely agree, and I will discuss FreeStyle Libre patches later on. I am beginning to feel like everybody here has had sight of my speech before I have even delivered it.

The next point arising from the survey is that people living with diabetes want better access to healthcare professionals who understand diabetes. Many respondents said that they felt they were being treated as a condition and a set of symptoms rather than as a human being.

[John Howell (Henley) (Con)]

I feel I want to ask a question just to participate. Given that lifestyle choices play a big part in type 2 diabetes, what value does the hon. Lady put on the information courses that are made available to people to help them to manage such lifestyle choices?

[Liz McInnes]

The information and education courses are really important in helping to manage the condition. I will come on to talk about that very subject later in my speech.

To go back to the role of specialists, I know from my involvement with the all-party group on diabetes that the role of the diabetes specialist nurse is valued by many. Evidence shows that diabetes specialist nurses are cost-effective, improve clinical outcomes and reduce the length of stay in hospital. With rising numbers of diagnoses of diabetes, I ask the Minister to encourage employers to respond to this with appropriate workforce planning.

The third point from the survey is that people want better access to technology and treatments. Diabetes treatment is ever evolving and advancing, but 28% of those who took part in the survey reported problems in getting the medication or equipment they needed to manage their diabetes. The Minister may recall that last year the Prime Minister was seen at an event wearing a FreeStyle Libre glucose monitoring device, which has already been mentioned. It is this type of non-invasive device that makes life so much easier and more manageable for those living with diabetes, and it is a great example of the technological advances taking place today. This device is designed to liberate patients from the hassles of routine finger prick testing. However, so far, only one third of CCGs and health boards have placed FreeStyle Libre on the formulary, demonstrating the problem faced by many in obtaining access to new technology.

The fourth point is that there is also a need for education and information to be widely available. No one should be given a diagnosis of diabetes without also being informed of where to go for information and support. People’s ability to self-manage is essential for the successful management of diabetes. Self-management reduces the risk of complications and demand on health and care services.

NHS Staff: Oxfordshire

John Howell Excerpts

Tuesday 20th February 2018 Westminster Hall

[John Howell (Henley) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing this debate, and I echo her praise for NHS staff who do a fantastic job—indeed, only the other day I was approached in the street by a constituent who told me just how fantastic his NHS treatment had been.

The issue under discussion is not a new problem or something that started only in the past year. I have chaired a group of Oxfordshire MPs and the clinical commissioning group for a number of years, and this issue has been there from the beginning. If I can segment the NHS market a bit, perhaps we can consider how different elements of the NHS can play their part. First, however, let me say that the release of information to The Times by Churchill Hospital must be opposed. It created much stress among patients, and it bore no resemblance to the policies of that hospital. We should send a firm message to Churchill Hospital that the way it behaved was unacceptable.

Perhaps my constituency is very fortunate, but on several occasions I have been told by constituents that a surgery is full and can take no more people, and that that is all down to new housing. Each time I rang the GP surgery, however, I was assured that that is not the case and it still had a tremendous amount of room to take more people. Nevertheless, that does not reflect the current problem with the GP practice system which, however we look at it, we must admit is in need of considerable reform. There are at least two reasons for that. First, we have the problem of young doctors who are unable or unwilling to take on the stress burden created by taking out the loans necessary to buy into the surgery. Secondly, there is a limitation on the ability of GP practices to do some of the minor operations that they have done in the past, and which allowed them to carry on the excellent work that they do for their communities. I urge the Minister to look at that, and perhaps to remove some of the restrictions that apply to the ability to operate in GP surgeries.

Of course GPs need to adapt to new ways of working, and they need to use the internet in a much better way. My own results from what is, I hasten to say, a minor health issue are dealt with by the internet. I email the information in on a regular basis, and the results come back on the internet—fortunately they come back clear each time. [Interruption.]

[Mr Edward Vaizey (Wantage) (Con)]

We are all speculating now.

[John Howell]

I know, and I will leave that issue there.

Social care has been mentioned in terms of its competition with the retail sector in Oxford, which I think is a very real threat. Another issue goes back to one of the more substantial points in the Care Quality Commission report, which is that the joining up and interlinking of different aspects of social care in Oxfordshire leaves a lot to be desired. For example, the amount that was paid by the NHS health trust was different to the sum paid by the county council for the same number of people doing the same amount of work. Evening up that difference must be something to concentrate on, and I wish people success in doing that.

The income of the clinical commissioning group amounts to about £880 million. Staff costs are about 70% of that, at just over £600 million. A 1% pay increase means at least £6 million to £7 million as an unfunded pressure on the health care system, and that is not a very productive way forward. There is no getting away from the fact that the biggest problem with recruitment and retention is living costs in Oxfordshire. There are a number of ways that we can tackle that problem, such as by building more houses—the Oxford-Milton Keynes-Cambridge express way is a good joined-up process for dealing with that, and I hope it comes to fruition.

The second thing we can do, I am afraid to say, is change the housing policies in Oxford city. That goes back to conversations that I had ad nauseam with the predecessor of the hon. Member for Oxford East (Anneliese Dodds). We were known for our fighting over the green belt, and I am glad to infer from what the hon. Lady has said that Oxford is changing the way it deals with issues of planning and housing.

We are talking about a marginal increase across the board, and the uplift that that will bring will not have a big impact on retention and recruitment. It would be much better for us to focus any increase in funds on the issue itself. I ask the Minister, formally, to agree to a weighting for Oxfordshire that gives it some of the strength that London has. As we have already heard, housing costs in Oxfordshire are at least as great as those in London, and that must be tackled. We need a specific weighting, not a marginal increase in pay, and since there will be only a limited pot of resources for increasing pay, it makes a lot of sense to concentrate the impact of that in those places with more intractable problems, such as the housing market and living costs in the city.