Christmas Adjournment
Baroness Brown of Silvertown Excerpts(11 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lyn Brown (West Ham) (Lab)
It is an honour to follow the hon. Member for Stafford (Jeremy Lefroy), who has entertained us with a very thoughtful speech this afternoon. I am going to follow up the health theme, but my discussion of it is going to be a little more graphic. If any hon. Ladies or hon. Gentlemen wish to leave, I shall not take it as a personal affront. They might find it more comfortable to go off and get a cup of tea.
I want to talk about hysteroscopy, particularly when undertaken without anaesthetic. This topic was brought to my attention by my constituent, Debbie, who lives in Plaistow. She was diagnosed with womb cancer or uterine cancer last year. She contacted me because the process of diagnosis, rather than the cancer itself, caused her
“the most distressing and painful experience”
of her life. Debbie underwent a procedure called hysteroscopy, which looks inside a patient’s uterus and is used to investigate symptoms such as pelvic pain, abnormal bleeding and infertility. Biopsies are often taken and tissue is often removed. The patient’s vagina is opened with a speculum, as during a cervical smear test, and a hysteroscope is inserted. A hysteroscope is a thin tube with a light and camera on the end, as well as any other instruments that might be needed. As I am sure I need hardly point out, this procedure is highly uncomfortable and clearly has the potential to be very painful indeed.
At present, the NHS Choices website explains
“a hysteroscopy should not hurt, but women may want to take a pain killer such as ibuprofen beforehand”.
As well as a hysteroscopy being an out-patient procedure, the NHS website says that
“the procedure can also be carried out under general anaesthetic, which may be recommended if your surgeon expects to do extensive treatment at the same time or if you request it.”
So far, this sounds fairly reasonable: it will not necessarily be pleasant, but there are options and the procedure can be carried out with or without pain relief and with or without local or general anaesthetic.
Let me tell Debbie’s story in more detail. Through Debbie, I have also heard stories from other women across the country. Debbie told me:
“I was in absolute agony. The consultant who performed my procedure knew I was in pain but carried on regardless. A nurse had to push me back down on the bed as I stiffened like a board. She had to hold me there and had hold of my hands too as I was trying to reach down and stop the procedure. All I could think was that if I made the consultant stop, I would have to come back and endure the whole thing again. This procedure, without anaesthesia, is barbaric. It is absolute torture. It needs to be stopped. At the very least, the patient should be informed that it could be extremely painful and have options explained and open for her. That way, she can make an informed decision as to whether to go ahead without anaesthesia.”
Bob Stewart
That sounds absolutely horrific. The hon. Lady did not explain whether Debbie was asked whether she would like a general anaesthetic. I presume that she was not asked and that the procedure went ahead without it.
Lyn Brown
Her very next sentence explains that:
“I was given no options. I have complained to the PALS department and to be quite honest I am not happy with their reply. At one point it mentions that the hospital gets more money for the procedure to be done as an outpatient! Is this what it boils down to? Money? Disgusting!”
Jan from Cheshire said:
“I had a hysteroscopy in Cheshire. This hospital is a private hospital but I was there as an NHS patient, as it was the hospital that my doctor could get me into the quickest, for investigations into abnormal bleeding. I saw the consultant in September of 2011, and was given an evening appointment to attend for a hysteroscopy, and was told that the procedure would be done under local anaesthetic. At the evening appointment, I was given a local anaesthetic, but after several attempts at performing the hysteroscopy, the consultant apologised and said that she was unable to perform the procedure and did not want to attempt it again under a local anaesthetic as, in her words, ‘it would be inhumane to continue under a local’. I was sent home and told to take co-codamol for pain relief, and that I was to return the next day for the procedure to be done under a general anaesthetic. I have got to say that even though I had a local anaesthetic”—
if Members have been paying attention, they will know that my constituent Debbie was not offered that—
“the procedure was still very uncomfortable and painful. I have to say that I think offering a hysteroscopy without any form of anaesthetic is barbaric.”
Jo from Chesterfield said:
“I had already had biopsies done in clinic with no anaesthetic, done like a smear with swabs but going through the cervix. I had found this painful but nothing prepared me for what was to come. I had been given a leaflet to outline the procedure but it mentioned nothing about pain or discomfort. I was asked to go behind a make-shift cubicle in the corner, take everything off and put on a gown. I was then asked to sit in a contraption that looked like some Victorian birthing chair, it was very uncomfortable and awkward to sit in. I felt so undignified…I have never felt such pain. I felt like my whole abdomen had been blown up, the pressure was so intense, then sharp prodding pains, I had tears in my eyes, the nurse did come and hold my hand. I just looked at the ceiling and held my breath, praying for it to be over.
When he’d done, the doctor asked ‘did you find that a bit painful?’. I replied ‘no it was excruciating’, he just remarked that most women are fine with it but perhaps I had a low pain threshold and that if I were to need further treatment I would need a General Anaesthetic as I was sensitive. I was quite gob smacked and in so much pain I didn’t really reply. I struggled to my car and drove home, I was in agony for days. I felt almost like I’d been violated, like a piece of meat, but thought perhaps it was just me, perhaps I was being a wuss. It wasn’t till I spoke to other ladies that I discovered it needn’t have been this way. My treatment on a whole I feel was done very wrongly, cutting corners and saving money, at my expense. The hysteroscopy should not have been done this way, it’s almost inhumane.”
Katharine from Bath said:
“My GP referred me for day-case hysteroscopy under local anaesthetic…He told me to pay for a course of Cognitive Behavioural Therapy to lower my Blood Pressure to qualify me for NHS day-care surgery as opposed to more expensive NHS inpatient surgery. During the Cognitive Behavioural Therapy the psychologist told me to go straight to the gynae-oncology surgeon at the hospital and have my persistent inter-menstrual bleeding properly investigated. My GP was furious at this suggestion but eventually gave in. The gynae-oncology surgeon told me that ‘you’ve had it for so long it won’t be anything sinister’. He eventually agreed to an inpatient hysteroscopy under General anaesthetic. I waited months for the operation. It showed late stage womb cancer which had spread to the lymph nodes. I had a radical hysterectomy and a long course of external radiotherapy”.
Jenny from Barnsley said:
“I went into the clinic and was given an ultrasound and very quickly was approached by a senior registrar who said I had a very thick womb but they could do a biopsy there and then.
My GP had mentioned that this procedure can be difficult but they would give me a local anaesthetic.
To be honest I was in such shock. I was led into a room where there was a very nice sister and nurse. I sat in a chair and the senior registrar began by filling my womb with water.
Then the hell began when they inserted whatever and did the biopsy. I have not experienced such pain even in childbirth and I told her so. I also said my GP had said they would give me some local anaesthetic and then she asked if I wanted some. Rather like closing the stable door after the horse has bolted. It was too late then as they were in there.
The sister told me she nearly stopped the doctor. They were very caring then but only offered me one paracetamol. They said to me don’t let the woman who is waiting outside see you or it might put her off.”
The 21-year-old sister of Michelle, from Scotland, went for a hysteroscopy after noticing some bleeding after intercourse. The gynaecologist asked a nurse to assist while he proceeded to perform a rather forceful examination, and then carried out the hysteroscopy with no warning or pain relief. Michelle received a phone call from her distraught sister, who had gone into shock in the car park, had passed out next to her car, and was bleeding.
Gillian in Leeds said:
“Before the procedure, I received a leaflet with my appointment letter—no mention of any general or local anaesthetic, but after what the doctor had told me I wasn’t expecting it to be too bad”.
She said that the nurse
“managed to get the hysteroscope through my cervical opening…when she took each sample—6 in total—my pain level shot through the roof.
“What...infuriates me most is the fact that SOME people are given pain relief as a matter of course at their hospitals…why the hell should I, and others, have to suffer just because of which hospital we went to?”
Patricia from Fife said:
“I was offered no pain relief and the Dr. who did it didn’t get enough in the end so I had to go under general anaesthetic to get it done again.”
The procedure that she experienced, while conscious,
“was very traumatic and painful…I felt them cutting away the biopsy inside…afterwards the nurse who had held me down said to me ‘I wouldn’t have let them do that to me without a general anaesthetic’ so why did she let me go through it?’”
Maureen from Norwich said:
“The letter…advised I took either ibuprofen, or paracetamol about two hours before the appointment. The scan showed something abnormal, so I waited and then saw a very nice lady doctor. I then went on to endure the procedure, it took about fifteen minutes and it was certainly a lot more than uncomfortable.”
She felt very sick, and was in pain, but
“the nurse who was there kept saying how well I was doing. I was at the limit of my endurance, only the thought of having to go back again stopped me from asking the procedure to be stopped.”
I have received so much correspondence about this issue, via my friend Debbie, that I could speak at length and give many more examples, because what I wanted to do today was give those women a voice. However, I think that the House will understand the direction in which I am going.
Some women have received no pain treatment at all—no anaesthetic to dull the pain. Some have received a local anaesthetic, but, given the severity of their conditions, a number of them have found that that is not enough. Others have received a general anaesthetic, either on request or because their doctors were aware that the procedure involved might be more extensive than had been expected. A study of a group of women conducted over five years in Melbourne established that over 10% of the group would not accept a local anaesthetic again, because of the pain and the need for the procedure to be repeated owing to a failure to secure a biopsy sample.
I have found it difficult to obtain information about this issue, but I think that certain facts are clear. Some women are being given no pain relief options at all. That aspect is not being explained to them by the doctor when they get to the hospital. Some feel that they are not being treated with compassion and respect, and that very little or no consideration is given to their dignity or their well-being. Some are experiencing a procedure that fails and needs to be repeated. One has to ask how often that happens, and what the cost is to the NHS.
Some women are clearly receiving treatment that is not in line with the guidelines issued by the Royal College of Obstetricians and Gynaecologists, which acknowledges that
“outpatient hysteroscopy can be associated with significant pain, anxiety and embarrassment”.
While the RCOG’s guidelines emphasise throughout that it is possible for women to have an acceptable out-patient experience, and some women do, there is clearly a serious problem, in that the current standard practice is failing a significant group of women very badly. It is appalling that, in some cases, no pain relief is even offered. I have read a range of the information leaflets that various hospitals offer to support their hysteroscopy out-patient clinics, and I am glad to note that local anaesthetic is mentioned in almost all of them, but they are not open enough about the pain that women may experience during and after the procedure, and there is inadequate reference to the option of undergoing the procedure with a general anaesthetic.
Bob Stewart
May I ask what percentage of women feel no pain whatsoever? Is there such a percentage, or does everyone experience pain—in which case, we must sort the matter out?
Lyn Brown
I honestly cannot answer that question, although I can say that at the different times in my life when I have had internal examinations the pain has varied, and that as I have got older, the examinations have become more painful. I have been told by some women who have had babies—which, sadly, I have failed to do—that they have found the examinations less painful after their pregnancies. However, some have told me that they become more painful with the menopause. Indeed, when my mother had a similar examination, she told me that it had been excruciating, and that was when she was quite old.
I am not sure that there are any research findings out there that would answer the hon. Gentleman’s very sympathetic question—certainly I have not found any—and I think that this is something that we need to know more about. However, a study published by the British Medical Journal in 2009 concluded that a local anaesthetic injection was the best method of pain control for women undergoing hysteroscopies as out-patients.
I have struggled to decide what I need to ask the Government to do in order to ensure that women receive the best possible care and treatment while undergoing this procedure. It is difficult for me to know that, because I am not a medic. However, I do think it is reasonable to ask the Government to use all the influence they have over policy in this area to require the National Institute for Health and Care Excellence to work with the Royal College of Obstetricians and Gynaecologists to issue authoritative guidelines. I also think the Care Quality Commission may well have a role to play in ensuring that best practice is delivered locally at each hospital.
Bob Blackman
I have listened with horror to these terrible experiences suffered by women. Is the hon. Lady aware of any other such treatments to either men or women where anaesthetics are not provided yet people are in such pain on such a general basis? That would clearly be a matter of the whole health service not doing a proper job, compared with a narrow field that we can possibly deal with very quickly.
John McDonnell
A fair amount of survey work was done in respect of the all-party group on endometriosis, which produced very similar findings of inconsistent practices and practices that were incompatible with the well-being of the individuals.
Lyn Brown
I am grateful to my hon. Friend for that intervention and I will look at that research if he signposts me towards it.
I promised Debbie that I would make her voice and the voice of other women who have had similar experiences heard today, and I hope I have done that, but merely hearing the voices is not enough. This Government have the mantra of no decisions about me, without me, and that policy needs to be adopted in gynaecological procedures so that I and other hon. Members do not have more Debbies coming to our surgeries to tell us about their horrific experiences. I am hoping that the Deputy Leader of the House will take this to the Department of Health on Debbie’s behalf and on behalf of the other women, and I would hope that I will receive some communication from it in the new year telling me that Debbie, Jan, Jo, Katharine, Jenny, Michelle, Gillian, Patricia, Maureen and the many other women I have heard from will be well and truly heard.
May I thank hon. Members for staying in the Chamber for my contribution this afternoon and may I also wish everyone, including the staff of this House, a happy Christmas and a very happy and prosperous new year?
Bob Blackman
When we were gathering evidence for our report, the Communities and Local Government Committee went to Berlin, where people have much longer tenancies and where a partnership approach is taken between the tenant and the landlord. That is a much more appropriate way of dealing with these matters. Unfortunately, the use of six-month assured shorthold tenancies has grown in this country, more often than not to protect landlords by giving them the right to evict a tenant and recover the property if they so choose. These concerns clearly need to be addressed. We need longer tenancies that give greater assurance to tenants and place greater responsibility on landlords. It would also be helpful if landlords became members of the housing ombudsman service. In that way, they would be more likely to carry out the necessary work and the tenant would have a means of complaining if that did not happen.
I am sure that all hon. Members have houses in multiple occupation in their constituencies. When five or more persons form two or more households in a building, it is a requirement for the landlord to register that property as an HMO. Unfortunately, there can be all sorts of issues involved, including whether fire safety standards are being met. It is a fact of life that, under the terms of the Housing Act 1985, the maximum penalty for operating an unlicensed HMO is currently £20,000. In my borough, there are 89 registered HMOs. I encountered a case three weeks ago in which a three-bedroom semi-detached property was found to be housing no fewer than 11 adults, none of whom was connected in a family sense. They were sharing bedrooms and all the other facilities, and they were each paying £160 a week in rent. That was a nice little earner for the landlord. The property was not registered as an HMO. There are now 100 such cases under investigation in Harrow, and I believe that they represent the tip of a very large iceberg.
Lyn Brown
I recognise much of what the hon. Gentleman is saying. Those problems are certainly replicated in Newham. During the last Parliament, I tried to get HMOs reclassified according to the actual occupancy, rather than to the size of the house. Does he agree that such a reclassification would be very helpful?
Bob Blackman
I agree completely that that is one remedy we have to take on board.
I cannot speak about what is happening outside London, but in London the charges for HMO applications vary: Harrow council charges £1,200 for an application, which lasts for five years, and then there is an £850 renewal fee; Brent, our near neighbour, charges between £800 and £1,200, depending on the licence length; Ealing charges £970 plus £30 per habitable room; and Lewisham charges £180 per unit of accommodation, up to £1,800. Non-London authorities seem to charge much less. The fee seems to be discretionary and a council could drop it to encourage registrations, thus enabling properties to be examined and tenants to be protected.
As we have seen, we also face a challenge on beds in sheds. The Prime Minister was taken this week to a property in Southall that would have disgraced a third world country, yet a number of individuals were being forced to live in incredible conditions there. The Government have taken some action to try to close down beds in sheds, but often we are talking about illegal immigrants in accommodation tied to a job they are undertaking, which is provided through gangmasters and the equivalent. In addition, service providers such as local authorities and the health service are being forced to provide services without any income coming in; these properties will attract a certain amount of council tax, but not the sort of sum they should, given the number of people living in them.
Last May, £1.8 million was given to nine councils to tackle the problem of beds in shed: Brent, Ealing, Hillingdon, Hounslow, Newham, Peterborough, Redbridge, Slough and Southwark were all given money. The trouble is that that addresses only the tip of the iceberg; it does not address all the other boroughs where the problem is occurring. Ealing subsequently stated that it had carried out 4,500 site inspections in a year, in addition to unannounced fortnightly raids, but unfortunately the landlords were running rings around the officers.
In February, a BBC “Inside Out” investigation found two high street estate agents renting out beds in sheds without residential planning permission, including one in Willesden Green, in Brent. Rent payments of £1,000 per month were being taken. It was noted that the owners often claim that these converted buildings are more than four years old and so cannot have planning enforcement taken against them by the local authority.
Some actions have been taken across England on this issue. Slough borough council spent £24,000 on conducting a heat map across the borough during the early hours of the morning. That identified 6,139 properties where it was believed that beds in sheds were operating—that is just in one borough, which shows the extent of the scandal. The hon. Member for West Ham referred to Newham, and the Communities and Local Government Committee has taken evidence about the action that its mayor and council are taking to identify and take enforcement action against the outhouses that are being put up without planning approval. I believe that that work has been extended to tackle other illegal activities by landlords. I understand that over the past year the council has taken 80 enforcement actions on beds in sheds, but a further 230 are still pending against properties in multiple occupation, which shows the extent of the problem in one London borough. We might have extended negotiations with landlords, but it seems as if these rogue landlords, who give other private landlords a bad name, need to have stringent action taken against them.
We must also consider the fire risk. The London fire brigade has estimated that over the past four years there have been 341 fires in buildings that appear to have had people living in them when they should not have been. Those blazes have caused nine deaths and 58 serious injuries.
I have mentioned the fact that illegal immigrants are often in such properties. We might reason why that would be. Migrants who are not here legally are often given low-paid jobs, are paid in cash and have insufficient income to pay the normal rents for accommodation, so they take accommodation from the employer or gangmaster in order to maintain their presence here. They also want to be able to send money home to their families. They are kept in poor conditions, under threat of being reported to the authorities and sent home. There is a lot of anecdotal evidence of people traffickers accommodating their victims in illegal structures, particularly in the London borough of Ealing. Furthermore, if the trafficked victims escape and get work as undocumented migrants, they may resort to living in illegal structures anyway because the rents are often lower and more affordable from their low earnings.
Lyn Brown
I thank the hon. Gentleman for his kind words about Newham. The action that the council has taken over the past couple of years has been important and effective in probably saving lives. We had a death in a shed from a fire way back before 2010. Local schools tell me anecdotally that people who are here legally and who have status are not necessarily aware of their rights. People who have come from abroad and are living here on very low incomes are exploited by the unscrupulous landlords he has been talking about.
Bob Blackman
Clearly, as the hon. Lady says, people who are here legally and have the proper status are often not aware of their complete rights and therefore are exploited by unscrupulous individuals acting as landlords.
One of the consequences of the changes in housing benefit has been to encourage young people under the age of 35 to go into shared accommodation because that is the only rate of housing benefit they will qualify for. I welcome that as a move towards ensuring that accommodation is used properly, but as more and more people share housing in the private rented sector, there is the unfortunate consequence of overuse and overcrowding of such properties.
Under the right circumstances a local authority may be able to force a landlord to repay rent or housing benefits if an HMO is unlicensed. Unfortunately, it appears that this is not well known among the public or even among London authorities or councils outside London. If it were known about, it would immediately dissuade landlords from taking in vulnerable people on benefits and exploiting them.
What do we do about the problem? It is up to local authorities to enforce the rules. If a landlord is operating an HMO—I have written to my council about a huge number of properties that I suspect are HMOs but are unlicensed—appropriate and stringent enforcement action needs to be taken to fine the landlord and to make sure that the properties are brought up to a decent standard. A clear attitude should be adopted towards rogue landlords who give good landlords a terrible name.
Proper advice needs to be given to people who rent properties so that they understand their rights, what they can demand and what they can take on. There should be accreditation and licensing for private landlords, particularly those that choose to operate HMOs. It should be for Government and the Department to ensure that tenants and landlords are educated about their rights and responsibilities.
There is hope on the horizon. There was a case in which a landlord, who happens to live in my constituency, was operating a property empire in the neighbouring borough of Brent, where he put 28 flats into four houses. He was prosecuted and ordered to pay £303,112 under the Proceeds of Crime Act 2002. This demonstrates that local authorities can use their power to stop rogue landlords in their tracks and take appropriate action. Rogue landlords will listen to only one thing: losing their income and assets. We must ensure that the people living in those properties are given decent facilities to live in.
Business of the House
Baroness Brown of Silvertown Excerpts(12 years, 8 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
I understand my hon. Friend’s point. It is important that urban areas, which often find it easier to deliver superfast broadband on a commercial or near-commercial basis, recognise that in putting together their schemes they have a responsibility not to marginalise rural areas, where the commercial case for delivering superfast broadband is obviously much harder to make. That is why we are setting such ambitious targets for 2015. Broadband Delivery UK is supporting that, but, as I know from my authority, this requires not only resources from BDUK, but substantial additional funding. My local authority and others are getting together to make that happen.
Lyn Brown (West Ham) (Lab)
I am sure that the Leader of the House will recall my asking for a general debate recently on the proliferation of betting shops. May I reiterate that call and request that the debate be framed in the context of the implementation of the Portas review and the Government’s localism agenda?
Mr Lansley
The hon. Lady will be aware that, following the Portas pilots funding, we are taking these forward along with additional packages, such as the high street innovation fund and the national markets fortnight campaign. Many of the 300 towns that did not get direct access to the Portas pilots are taking forward elements of their original plans across their high streets. I do not know whether the hon. Lady has taken the opportunity to encourage her colleagues across the House to make a submission to the Backbench Business Committee—as I think we discussed previously—but this seems to be exactly the sort of opportunity it might look for.
Business of the House
Baroness Brown of Silvertown Excerpts(12 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
My hon. Friend makes an important point admirably. I hope that in our further debate on the Welfare Benefits Up-rating Bill, people will recognise that the changes to personal tax allowances will take a lot of low-income workers out of tax altogether and reduce the tax bill for many millions of people.
Lyn Brown (West Ham) (Lab)
I attended Culture, Media and Sport questions this morning in the hope of asking a question about the gambling prevalence survey, but there was so much interest in that matter that it was oversubscribed. I therefore ask the Leader of the House to consider having a debate in Government time on the proliferation of betting shops on the high street in the hope that the concern will ensure that the Government put into action their rhetoric on localism and allow local authorities the right to control the number of betting shops on their high streets.
Mr Lansley
If I may, I will ask my colleagues at the Department for Communities and Local Government to respond. I am aware that it has considered issues relating to the licensing of betting shops in local areas, so it is perhaps best that it replies on that specific matter. Given the comments from across the House, this might be an issue that the hon. Lady and other Members would like to invite the Backbench Business Committee to pursue.
Mr Lansley
Perhaps other Members, with the hon. Lady’s support, would like to ask the Backbench Business Committee whether this issue can be brought forward for discussion.
HEALTH
Baroness Brown of Silvertown Excerpts(12 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Simon Hughes (Bermondsey and Old Southwark) (LD)
Thank you very much, Mr Deputy Speaker, for presiding over our last debate before Christmas. I have one specific subject that I want to raise, and a couple of very little things that I shall mention at the end.
A lot of my constituency casework—about 40%—relates to the Home Office and to the UK Border Agency, and many of the cases involve people who are here legitimately and who want to renew their visas. The process is simply not working, and we need to sort that out. All sorts of people are affected, including people who are working here and need to renew their visa in order to carry on doing their job, and people who came here as spouses and need to renew their status to be able to continue to live with their wife, husband or partner.
People can choose how to apply to renew their visas. They can apply by post, or in person after booking an appointment online. The applications are not free. The minimum cost is about £300 and the maximum is about £2,000, so people are making a significant contribution. Both application systems have problems, and they are causing my constituents, and those of many other colleagues, severe inconvenience. It is possible to use the premium same-day service, and it costs between £300 and £400 more to apply in person than to apply by post.
My constituents tell me that the system often releases new appointments at midnight, which is inconvenient, and because everyone logs on to the website at midnight, the system regularly crashes. The website also has basic technical errors. One constituent, a friend of mine named Selcuk Akinci, found that it was offering appointments only for 2020, which was not particularly useful. There are rarely any appointments available within two months, although that fact is not advertised anywhere. Most people, quite reasonably, think about applying to extend their stay only one or two months before their current visa is due to expire. Many therefore find that they cannot get an appointment before their leave expires. They then have to apply by post, which often means a six-month wait without being able to travel. People will not have expected that, and it can cause real problems for them, especially if they need to visit family regularly or if their work involves frequent travel. This problem can often prevent people from doing their job, if they need to travel for work.
Appointments can be made at any of the seven public inquiry offices in the UK. The system tells people where the next available appointment is, and they might find that they have to go from south London to Glasgow or Birmingham. Many people have to travel a long way for their appointment. When they arrive, even if they have booked the premium same-day service, there is no guarantee that the application will be processed on the same day. If the UKBA decides that further checks are necessary, the application is taken out of the premium service queue and put into the postal applications queue, which means that it could take up to six months to process. There is no refund of the premium fee in those circumstances.
People have no way of knowing whether their case will require further checks, which can be triggered by many different factors. There can be genuinely good reasons for carrying out such checks. For example, the person’s name might generate a hit on the police national computer, they might have used a different identity in the past, or they might have no leave to remain at the time of their application. However, further checks are sometimes triggered for bad reasons. Whatever the reason, the person concerned is not allowed to talk to anyone. They are taken out of the premium application process and told that their case has gone into the postal system and that they have to go home and wait, perhaps for more than three months. The case is placed in a kind of “cannot process it today” queue and sent away to a casework centre.
Cases are sometimes referred for further checks for illegitimate reasons. My senior caseworker, James Harper, deals with such cases every day in our Bermondsey office, and I deal with them often. For example, a person’s records might not have been properly updated on the UKBA database. In a recent case, a Ghanaian couple travelled all the way to Birmingham so that the husband could apply to extend his marriage visa in the normal way. However, Mr Kusi’s records had not been properly updated on the Home Office system to show his existing leave to remain. It therefore appeared to the officers at the inquiry office that he had no right to apply, even though he did, and the couple were turned away and left with only three days to apply by post before his existing visa expired. The couple pleaded with the officers to ring the visa office that had dealt with the original application, but were told that that was not possible and that they would have to leave. This is really unacceptable.
In a further case, an Iranian woman in my constituency was applying to extend her stay as the wife of a British citizen. Her case was referred for further checks because it was believed that she did not have high enough English language test scores: level 4.0 on the IELTS—International English Language Testing System—scale in reading and writing. In fact, this was a misinterpretation of the rules, as level 4.0 is required only in speaking and listening. My constituent qualified and her case was sent on, but it was subject to a long delay; only after we intervened did the UKBA admit that an error had been made and then refund the additional premium fee.
Lyn Brown (West Ham) (Lab)
This is quite unusual, but I find myself in agreement with the right hon. Gentleman for the second time in two weeks. In the spirit of Christmas, may I offer him another minute?
Simon Hughes
I am grateful, and I hope there will be a lot of common ground on these issues.
When people apply by post, the system often takes far too long. We need a system whereby people have certainty, because they are trying to organise their lives, and UKBA gets its act together.
I offer some suggestions for a solution. First, if someone has paid the premium fee and gone to the office but a question arises, they should not automatically be told, “It’s going off to the casework centre.” A real person should speak to the individual and seek to resolve the question there and then—it cannot be beyond the wit of people to sort that out—as with any other normal customer service operation.
Secondly, when people have paid a premium fee, they are entitled to expect a quicker service than if they had applied by post without paying the premium fee, even if their case is referred for further checks. That does not happen, but it should do, and I hope UKBA will change it, as such cases should not just go into the same pool as the postal applications. Lastly, if it emerges that somebody’s case has been referred for further checks in error, as is frequently the case, there should at least be a partial refund of the premium fee, if not a total refund.
I hope that this part of the UKBA operation, which is clearly not fit for purpose, can get its act together. I will be grateful to the Deputy Leader of the House of Commons, my right hon. Friend the Member for Carshalton and Wallington (Tom Brake), for taking this matter away with him, passing it to the Home Office and, hopefully, getting it sorted soon.
To finish quickly, I entirely endorse the comments of the hon. Member for Walsall South (Valerie Vaz): the Government should be very careful about reducing the judicial review system. We have developed administrative law in this country for a purpose. There are many more Government decisions so we need to be careful about taking away people’s rights to challenge administrative decisions. I shall certainly put in my submission, and I hope that the Government will pay heed to it.
I join in the congratulations to the Government on at last and belatedly announcing the honour for the Arctic convoys veterans. I have regularly raised the issue with Ministers, and constituents have regularly raised it with me. These brave people, who went through the most difficult circumstances to make sure that the lifeline between us and our Russian allies was kept open, did a phenomenal job. They rightfully deserve to be honoured. Thank God some of them are still alive to enjoy that honour.
This year has been not only jubilee year and a fantastic Olympic and Paralympic year, but the 200th anniversary of the birth of Charles Dickens. I end with a quote from him:
“I will honour Christmas in my heart, and keep it all year.”
Thus said Dickens, who had big Southwark connections. To that, I add greetings to you, Mr Deputy Speaker, and to all my colleagues, and my thanks to House staff for looking after us so well. I also give my particular best wishes to two people: the oldest woman in Britain, a constituent of mine who became 113 on 7 December and who still lives in her own council flat in Bermondsey; and my older brother, who has a significant birthday tomorrow.
Business of the House
Baroness Brown of Silvertown Excerpts(12 years, 10 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Lansley
It is important to recognise that the Government have put in place partnership funding arrangements with local authorities that are contributing to substantial enabling schemes to deter flooding. We expect to exceed our objective of 145,000 households being better protected by March 2015. In addition, I will talk to the Secretary of State for Environment, Food and Rural Affairs because it is important not only that we have adequate flood protection, but that the means by which we provide it are environmentally sensitive. In the wake of the flooding in my constituency in 2001, we were able to recreate some floodplains, which was an environmentally responsible way to provide flood protection.
Lyn Brown (West Ham) (Lab)
Given the Government’s 20% cut to policing, which has necessitated a cut in the number of front-line police officers of 15,000 nationally and 100 in Croydon, may I echo the request of my hon. Friend the Member for Westminster North (Ms Buck) for an urgent debate on policing in London so that voters have the unequivocal facts before they go to the polls next week?
Mr Lansley
I encourage the hon. Lady to look in the Official Report at the questions that the Home Secretary answered last Monday, because I do not recognise her figures on the number of front-line police officers. Indeed, the proportion of officers on the front line is increasing, as is their effectiveness, as we can see from the further reduction in crime across the country that was reported recently. The first thing we should do is express our appreciation of the effectiveness with which police forces across the country are addressing the necessity of managing within reduced budgets. We should support police and crime commissioners in taking that forward and in responding to local priorities.
Whitsun Recess
Baroness Brown of Silvertown Excerpts(13 years, 4 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lyn Brown (West Ham) (Lab)
I hope that hon. Members will be gentle, because my voice is not as strong as it usually is. I also hope that I can be heard today. It is an honour to follow the hon. Member for Argyll and Bute (Mr Reid), who made an excellent speech about VAT on static caravans. Those of us on the Opposition Benches support much of what he said. I hope that his Government were listening to that speech, which really was rather excellent.
I want to take this opportunity to speak about an issue of increasing concern—breast cancer. I want to focus on three areas: diagnosis, treatment and mortality in my constituency; worrying comparisons with other countries, which raise issues about the effectiveness of cancer services in the UK; and a specific concern about radiotherapy, on which we perform rather badly, compared with other countries.
Let me first set the scene with some facts about breast cancer. As many colleagues will know, it is the most common cancer in the UK, with some 48,000 new cases diagnosed every year. Around 12,000 women and 90 men will die from breast cancer this year. The good news—relatively speaking—is that a generation ago, only half the people with breast cancer survived for five years after diagnosis. Today, eight out of 10 people are still alive after five years or more. That improvement is due to the unprecedented investment made in the NHS, with a shift in emphasis—the right shift—towards prevention and early detection, and the establishment of cancer networks, bringing together specialists to improve the quality of care.
Advances in research, new treatments, earlier diagnosis, breast screening and greater public awareness have all played a part, but it is essential that we keep up the momentum if we are to avoid slipping back. I have spoken in the House before about the inequality in health outcomes that is characteristic of my constituency and other areas with high poverty, poor housing, a poor environment and low educational achievement. Things are improving and health outcomes are getting better, but the gap remains. Although I have a huge hope that the legacy of the Olympic and the Paralympic games will bring an even greater health improvement to my area, as well as economic regeneration, we have to do more, rather than just sitting back and waiting to see whether that happens.
Claire Perry
Let me give the hon. Lady a chance to rest her voice. I am grateful to her for bringing this incredibly important subject to the Floor of the House. Would she like to join me in the Race for Life at the beginning of June? We can put on our pink T-shirts, and although I am afraid that I will be walking, she can walk with me and we can raise some money for a worthy cause.
Lyn Brown
That is possibly an offer that I cannot refuse. I think that sounds like an excellent thing to do together.
Newham has a lower incidence of cancer than many other areas, but sadly our mortality rate is higher. The London-wide cancer mortality rate is about 112 deaths per 100,000 cases. In Newham it is 123 deaths per 100,000 cases, which is a significantly higher rate than we ought to find. That is clearly unacceptable. The five-year survival rate for women in Newham who have had breast cancer is 75%, which is significantly lower than the UK average of 83.4%. The reason is illustrated, in part, by the take-up rate of breast-screening services. In 2009-10, the take-up rate across England was 73%. Across London it was 62%, but in Newham it was 50%.
Early detection enables treatment in early stages, when the cancer is easier to treat and when women’s chances of survival are higher. In my area, the combination of late presentation and late diagnosis leads to treatment that is, of necessity, more complex and less successful. That is causing the unnecessary deaths of too many women. Those deaths are, frankly, preventable. I will be seeking to ensure that a consequence of the Health and Social Care Act 2012 is not a visible deterioration in health screening services in my constituency. In fact, I will be hoping to see the 50% uptake of screening in Newham increase in the years to come.
I want to turn to international comparisons. I have before me some statistics, which were helpfully provided by the House of Commons Library. These data are drawn from a cancer epidemiology research project on the survival of cancer patients in 24 European countries. The figures need to be treated with some care, given that the most recent are for survival rates for those diagnosed between 1995 and 1999, but they provide a useful snapshot of the five-year survival rate. For England, the survival rate for all cancers at five years was 47.3%, ranking us 17th out of the 24 countries. The survival rate at five years for breast cancer was somewhat better, at 79.7%, but this still ranks us just 13th out of the 24 countries. That international comparison raises some disturbing questions about the effectiveness of our screening, diagnosis and treatment services, and I intend to return to that matter in the future.
One issue that I want to explore further today is the use in treatment of radiotherapy and, specifically, of new and advanced forms of radiotherapy such as intensity-modulated radiation therapy—IMRT. Radiotherapy treatment is more effective in treating all forms of cancer, including breast cancer, especially when the cancer is diagnosed early. It can be targeted on the cancer much more effectively, thus limiting the damage caused to non-cancerous tissue. It is far less invasive than other treatments, it leads to better outcomes and it is a much better experience for the patient.
The use of radiotherapy is more advanced in Scotland and Wales. London is marginally better provided for than the rest of England, but that does not alter the fact that the UK as a whole is woefully behind the best-performing countries in the rest of Europe and the US in using advanced radiotherapy as an effective tool against cancer. Access rates to existing radiotherapy services are already lower than the 50% of cancer patients who it is generally agreed should receive the treatment. We do not even know how many breast cancer patients are able to access the more advanced IMRT.
What assessment have the Government made of the impact of the Health and Social Care Act on the commissioning of radiotherapy, and on the supply of suitably trained radiotherapists? From my perspective, it is entirely unclear where responsibility for the commissioning of radiotherapy will sit in the future arrangements of the NHS. The clinical commissioning groups are far too small effectively to manage it, and the position of the NHS Commissioning Board is obscure.
For radiotherapy, there is no is no equivalent of the big campaigns that we see in our newspapers. It has no equivalent of a big pharmaceutical company to promote it and lobby for new treatments, because there is no profit to be made from it. Radiotherapy is an effective treatment that is widely used in other countries, but it is patchily under-utilised here, to the detriment of cancer patients, and that is likely to be contributing to our relatively poor survival rates. In the absence of an external lobby promoting radiotherapy, I humbly suggest to the House that that responsibility lies here with us.
The issues that I have outlined today go to the heart of the quality of cancer care in this country. They need to be explored in more detail and subjected to more scrutiny so that the service offered across the country can be improved to the level of the very best, and not just the very best in this country, but the very best by international standards.
Sittings of the House (20 and 23 March)
Baroness Brown of Silvertown Excerpts(13 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Angela Smith
I think the hon. Gentleman asked that question only a few minutes ago—[Hon. Members: “You didn’t answer.”] The question was answered.
Lyn Brown (West Ham) (Lab)
I am moved to suggest to my hon. Friend that one of the reasons that the previous Prime Minister felt able to leave the Wednesday Question Time to his deputy was that he trusted her.
Angela Smith
I absolutely agree with my hon. Friend. That is another reason for my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown) finding it impossible, on occasion, to get to the Dispatch Box. He gave global leadership in the credit crunch, and he trusted his deputy. Whether this current Prime Minister trusts his deputy is open to question.
All the evidence suggests the opposite of what we have heard, and that our Prime Minister is a leader who cannot get his facts straight and who is increasingly running scared of being held to account on the detail of his Government’s policies. With your indulgence, Mr Deputy Speaker, I will illustrate this point with examples. Let us take, for instance, what the Prime Minister claimed only the other week:
“The proportion of police officers on the front line is up”.—[Official Report, 8 February 2012; Vol. 540, c. 295.]
That is a misleading claim, if ever there was one. Of course, his reference was to the proportions of front-line officers rather than their overall numbers. Thus, where perhaps 12 front-line officers were assisted in their work by six support staff, there might now be only six front-line officers and only two support staff. The proportion would be higher, but the number of front-line officers would have been cut by 50%. In the end, the Prime Minister will not be able to continue to defend the line that front-line policing is being protected when budgets are being cut by 20%. About 16,000 police officers are likely to lose their jobs, and the Prime Minister knows that he will be called to account for that at Prime Minister’s questions.
The Prime Minister has, of course, already been called to account at the Dispatch Box by the Leader of the Opposition for his Government’s disastrous Health and Social Care Bill. Only yesterday, we witnessed in this Chamber the Prime Minister thrashing around, desperately trying to trade insults and to deploy soundbites in an attempt to deflect attention from his unpopular and unwanted top-down reorganisation of the NHS.
Two weeks earlier, just before the recess, the Prime Minister claimed at Prime Minister’s Question Time that 100,000 more patients are being treated every month. It was possible to make that claim, however, only if one compared May 2010 with November 2011. If one compares May 2010 to May 2011 and November 2010 to November 2011, one finds that the figures are, in fact, static. Equally, the Prime Minister claimed that there were 4,000 extra doctors since the election. That is true, of course, but it is not something that he can take credit for. After all, it takes between five and seven years to train a doctor and the extra numbers are therefore a legacy of the previous Labour Government.
So there we have it—a Prime Minister who knows that his cavalier approach to answering the questions posed to him by this House is under pressure, who knows that his slapdash approach to Prime Minister’s questions is being increasingly exposed, thereby revealing him and his Government as incompetent and not up to the task of taking this country through the very challenging times in which it finds itself. No wonder this Government want to avoid Prime Minister’s questions wherever possible. It is the one occasion every week when the spotlight is on everything they do, and they increasingly worry that they will be found wanting. In the interests of accountability and democracy, we oppose the motion.
Business of the House
Baroness Brown of Silvertown Excerpts(15 years, 2 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Lyn Brown (West Ham) (Lab)
Newham is to have an estimated 1,300 fewer secondary school places, due in part to the loss of 14 Building Schools for the Future projects. I attended yesterday’s Westminster Hall debate to request that the Under-Secretary of State for Education, the hon. Member for East Worthing and Shoreham (Tim Loughton) meet me to discuss the impact of that. Sadly, despite my numerous attempts, he refused to take my intervention. May I ask that we have a debate on this important issue on the Floor of this House? We need an opportunity not only to discuss the impact of that programme, but for the Minister to be more gracious.
Sir George Young
As the hon. Lady said, we have just had a 90-minute debate in Westminster Hall on the Building Schools for the Future programme. I will convey her particular request for a meeting with my hon. Friend the Under-Secretary. I know that, as a rule, he is more than happy to meet hon. Members from both sides of the House, and I am sure that he will readily agree, particularly when he reads Hansard tomorrow morning, that a meeting with the hon. Lady would be appropriate.