NHS Long-Term Plan: Implementation
Martin Vickers Excerpts(4 years, 10 months ago)
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Matt Hancock
Yes, the hon. Gentleman is absolutely right. I agree with what he says. There is a need for the whole medical profession to be constantly up to date with the latest treatment and diagnostic science. I am determined that part of the drive for early diagnosis is about not just diagnosis once referred, but better referral. We all have a part to play in that—wider society, as well as primary care.
Martin Vickers (Cleethorpes) (Con)
Many people in my constituency find it difficult to obtain NHS dentistry. While that is part of the short-term plan, on the ambitions outlined in the plan for long-term improvements to oral health, what assurance can the Secretary of State give that NHS dentists will be in place to deliver them?
Matt Hancock
NHS dentistry is incredibly important. Ultimately, dentistry is part of prevention; it prevents oral ill health. We are doing a lot of work on what further we can do to support oral health. In fact, I had a meeting with the Minister with responsibility for public health on that subject this morning. I would love to meet my hon. Friend to discuss it further.
Oral Answers to Questions
Martin Vickers Excerpts(4 years, 12 months ago)
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Martin Vickers (Cleethorpes) (Con)
The Minister for Care (Caroline Dinenage)
We are absolutely committed to making this the best country in the world in which to live with dementia by 2020. Already, more than two thirds of people with dementia receive a diagnosis; there are 2.85 million dementia friends and 346 areas in England are dementia friendly; and the £250 million dementia discovery fund is the largest venture fund in the world aimed at discovering and developing therapies for dementia.
Martin Vickers
I thank the Minister for her reply. I recently met representatives of the Alzheimer’s Society, which is, as the Minister will know, pushing forward with a campaign for more support for those suffering from dementia. Can she assure me that, despite what she has just said, this will be one of the main focuses of her Department during the comprehensive spending review?
Caroline Dinenage
We are absolutely committed to ensuring that everybody, including those who live with dementia, has access to the care and support that they need. We have noted the very important contributions of the Alzheimer’s Society and of a number of other reports. We are considering a number of different funding options and are keen to draw on the best practice of what works so that no one ends up spending their life savings on their care.
The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
The issue that the hon. Lady raises is very concerning. I would be more than happy to meet her to look at that.
Martin Vickers (Cleethorpes) (Con)
The Minister for Care (Caroline Dinenage)
Yes. By 2020, we expect all relevant staff to have received appropriate dementia training.
Oral Answers to Questions
Martin Vickers Excerpts(5 years, 2 months ago)
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Jackie Doyle-Price
I am grateful to the hon. Gentleman for raising the matter. Through the military covenant, we have an absolute duty to provide the best possible care to those who have made that commitment to service on our behalf. Through NHS England’s commissioning of specialised services, we are determined to ensure that we have the right provision for all our veterans and servicemen. I am in contact with the Ministry of Defence to ensure that we do all we can for them.
Martin Vickers (Cleethorpes) (Con)
The Minister for Care (Caroline Dinenage)
In December, NHS England announced plans to increase funding for children’s palliative care services to as much as £25 million a year over the next five years through match funding investment from clinical commissioning groups.
Martin Vickers
St Andrew’s children’s hospice, based in Grimsby, which serves my constituency and the wider Lincolnshire area, is greatly valued and much treasured by the local community. Will the Minister clarify exactly how the funding will be delivered and how St Andrew’s can benefit?
Caroline Dinenage
I am grateful to my hon. Friend for mentioning his local hospice. We all have wonderful stories about the fantastic care delivered by hospices, particularly children’s hospices, in our local area. NHS England will match fund clinical commissioning groups that commit to increase their investment in all children’s palliative and end-of-life care services by up to £7 million a year by 2023-24. This, added to the children’s hospice grant, which is currently £11 million a year, could therefore more than double NHS support to a combined total of £25 million.
NHS Long-term Plan
Martin Vickers Excerpts(5 years, 3 months ago)
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Matt Hancock
There is £16 billion ring-fenced for public health in this spending review. Crucially, we want the whole NHS to be focused on keeping people healthy as well as curing them when they are ill. Yes, of course it is a matter for that one budget in the spending review process, but it is also a matter of the whole £148 billion a year that will be going into the NHS.
Martin Vickers (Cleethorpes) (Con)
I welcome the Secretary of State’s plan. He will be aware that our constituents value receiving treatment as locally as possible. Will he give an assurance that he will do all he can to ensure that district general hospitals are there to provide most of these crucial services?
Matt Hancock
Yes. I am a strong supporter of district general hospitals and community hospitals. So often, local matters because it matters to patients and their families. If someone is having a highly complicated procedure, they will want to be in the very best place in the country—or, indeed, in the world—but often they will want to be close to home as well. That matters for small hospitals and district general hospitals such as the one on which my hon. Friend’s constituents rely so much.
Oral Answers to Questions
Martin Vickers Excerpts(5 years, 9 months ago)
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Jackie Doyle-Price
The hon. Lady will be aware of the proposals that we have in the children and young people’s mental health Green Paper. We have very ambitious plans to roll out a whole new workforce to work in schools to support children at an earlier stage of mental ill health. Why we have these proposals is that we readily admit that an insufficient number of children are able to access services at present, and that is why we are making this investment.
Martin Vickers (Cleethorpes) (Con)
My constituent, Aaron Winstanley, from Barton-upon-Humber is currently in Germany receiving immunotherapy treatment for a rare form of cancer. The local community has reacted magnificently, raising around half of the £300,000 that this treatment costs. Could the Minister outline what is being done to introduce this treatment into England?
The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)
I wish my hon. Friend’s constituent well and pay tribute to the money that the local community has raised. I will connect my hon. Friend to the office of Cally Palmer, the national cancer director. As we write the new long-term plan for the NHS—to which the cancer stream is so central—we will ensure that innovative new technologies and treatments that were not thought of even a few years ago are also at its centre.
Oral Answers to Questions
Martin Vickers Excerpts(5 years, 10 months ago)
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Mr Hunt
May I gently remind the hon. Lady that it was this Conservative Government who introduced the national living wage, and we did that on the basis of transforming the economy, championing policies that were by and large opposed every step of the way by the Scottish National party?
Martin Vickers (Cleethorpes) (Con)
The Minister of State visited my hospital trust last month. Is he in a position to support its requests, and will he say whether he is satisfied with the progress it is making to remove itself from special measures?
The Minister for Health (Stephen Barclay)
I very much enjoyed visiting the trust with my hon. Friend. As he will be aware from our discussion during that visit a process for capital bids is under way. As my right hon. Friend the Secretary of State set out, the date for that is mid-July and I look forward to seeing the bid from my hon. Friend’s trust.
NHS Long-Term Plan
Martin Vickers Excerpts(5 years, 10 months ago)
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Martin Vickers (Cleethorpes) (Con)
I welcome the Secretary of State’s statement and congratulate him on securing cross-Government support for his proposals. He rightly said that every pound must be spent wisely, and he will know that there is great variation in procurement across the NHS. What will he do to ensure better procurement?
Privatisation of NHS Services
Martin Vickers Excerpts(6 years ago)
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Martin Vickers (Cleethorpes) (Con)
It is a pleasure to serve under your chairmanship in this important debate, Mr Hosie. Many people who signed the petition have genuine concerns about the NHS. I make it clear from the outset, just in case my remarks are deliberately misconstrued, that I am opposed to privatising the NHS, like my hon. Friends. My family and I rely on it. I support keeping the service free at the point of need, whatever the individual’s circumstances.
We need to establish what we mean when we talk about privatisation. To me, it means what we did in the 1980s with British Telecom, British Gas and so on— selling the shares to the public. We sold their assets lock, stock and barrel and handed them over to the private sector. That is not what is happening when we talk about an individual service in the NHS being privatised.
It is important to remember that having private providers in the NHS is not new. As other hon. Members have said, there has been a role for private provision since the service was established 70 years ago, most notably in the form of GPs. Other private engagement includes businesses, charities and independent contractors.
Just under 8% of NHS spending goes to the independent sector, which is money spent on supporting NHS patients. That includes spending on elective surgery, diagnostics and pathology services, clinical home healthcare and community and primary healthcare. In many cases, private providers are used to cut waste and provide essential services, such as catering and cleaning. To use a trivial example, would the Opposition recommend that we prevent private sector companies from running the coffee shop in a hospital? If we say no to any private sector involvement, that is what we are doing. The local window cleaner could not come to clean the hospital windows. It would be a nonsense.
Stephen Pound
I respect the hon. Gentleman, but the point made by my hon. Friend the Member for Leeds North West (Alex Sobel) was about the added value brought by people who work in the NHS. When I was a porter for 10 years at the Middlesex Hospital, we finished at 10 o’clock on Saturday night and started again at 6 o’clock on Sunday morning. We worked a rotating three shift system.
The Middlesex Hospital is now a hole in the ground, but when I last went to see former colleagues from the ancillary staffs council, I was told about the agency workers who turn up to do a day’s shift. They have no emotional connection with the hospital, or any feeling for it, so they simply cannot make the same commitment. Surely the hon. Gentleman, who is far from being a fool—he is actually a humane man—recognises that some people bring an immense amount of added value by working for the NHS rather than for an agency that works for the NHS.
Martin Vickers
I agree with the hon. Gentleman. I am not arguing for privatisation. I am arguing that privatising some services improves patient care, which is surely what we are all interested in.
Dr Whitford
Having graduated in 1982, I know that the first services that were outsourced were the cleaners. That has been blamed for contributing to later hospital-acquired infections such as MRSA.
Martin Vickers
The hon. Lady is obviously very knowledgeable, as we heard earlier. I cannot compete with 33 years’ experience, although I recognise those faults and I can recall the stories of dirty hospitals, which may have had something to do with poor procurement and bad management.
However, the reality is that the private sector has a role to play. Are we seriously suggesting that we should inconvenience people by forbidding Boots, Superdrug or a supermarket from administering prescriptions? Obviously not. Should we preclude social enterprise operations from taking part in NHS services? Surely not, because they can be extremely valuable and improve patient care.
Richard Graham
My hon. Friend makes some good points. Does he agree that the hon. Member for Ealing North (Stephen Pound) makes a different argument from that of his colleagues, who argue against companies that are subsidiaries of the NHS by definition? There is a considerable difference between someone who works for an agency that works for the NHS and someone who works for an NHS subsidiary company.
Martin Vickers
I thank my hon. Friend for that timely and helpful intervention.
The King’s Fund report, “Is the NHS being privatised?”, determined that the gradual increase in the use of private providers has improved the choice and service for patients. That must be for the good of everyone. It is the patients who are important; scaremongering does not help them. A focus on process rather than patient outcomes is unwise and a distraction from the real issues. The best interests of the patient are what matters. We must ensure that as much as possible of the resources that are made available goes into patient care.
The Leader of the Opposition has made repeated pledges to “save the NHS”. Frequently, those on the left whip up hysteria about how the Government of the day are doing something that will fundamentally alter healthcare in this country and bring the NHS to an end, but when exactly have these warnings been accurate? Were they accurate in April 1997, when Tony Blair famously declared that we only had
“24 hours to save the NHS”,
or when union leaders have spoken out about the NHS? Such reports have always proved false. As was said earlier, the reality is that the Conservative party has led government for 43 of the 70 years that the NHS has been in existence, so if the aim was to destroy the NHS, we have done a pretty poor job. The reality is that the Conservative party is as committed as any other party in this House to the continuation of the NHS.
What we see is outrageous hyperbole that is designed to prey on the worries of those who rely on the NHS, which—let us face it—is virtually all of us. That is irresponsible and in some cases cruel. Furthermore, it adds to a climate in which we cannot have a sensible discussion about the future of healthcare in this country. Within our politics, there is a paranoid conspiracy theory surrounding the motives of the Conservatives in relation to the NHS. It goes something like this: “Conservatives hate the NHS for ideological reasons, but given the toxicity of the subject and the reverence with which the public quite rightly regard the NHS, they realise the only way to implement privatisation is by stealth.” That is absolute and complete nonsense.
Let us face it, there have been changes to the NHS throughout its existence. We have had mention of fragmentation; I suggest that some of the fragmentation took place during the Blair and Brown Administrations. We spend around 8% of our GDP on healthcare, which is in line with countries such as Belgium and more than is spent by the likes of Australia and Canada, which have large private sector involvement. If, as we are told, we are underfunding healthcare to undermine support for the public system, what would be the motive for the apparent underfunding of healthcare systems elsewhere? The NHS turns 70 this year and, as I have said, the Conservatives have been in power for the majority of that time. There is no masterplan to replace the NHS with a privatised alternative.
There is also the question of what we mean by “privatisation”, which I mentioned earlier. “Privatisation” is a buzzword for ideologues to spread fear and embed an inefficient system that fails patients. Is Germany a private system, or is Switzerland? The answer is no. However, Germany and Switzerland embrace the market, while ensuring that no one slips through the net.
The German system shows that a healthcare system can be fully funded in the style of a pension system. The situation in Switzerland proves that even considerable levels of out-of-pocket patient charges need not be regressive. We can trust people to choose from a range of health insurance plans and identify the best option for them. Throughout Europe, healthcare systems offer universal high-quality care that is free at the point of use. In many cases, they make use of a greater number of private providers than our own NHS.
Social health insurance does not have to clash with the principles of the NHS that are so greatly entrenched in our society. We can still have a universal system of healthcare that is free at the point of use. We may have been the first country to establish a healthcare system based on those principles, but we are no longer unique in that respect. Virtually every developed country has some form of coverage.
The United States is an outlier in this regard. Canada offers universal healthcare that is free at the point of use. Germany offers universal healthcare, and while patients there may have to pay a small amount to see a doctor—around £10—the poorest in society are often reimbursed.
Dr Whitford
My husband is German and we lost his sister at this time last year, so I can point out that actually the German insurance system covers only 80% of costs and the bills continued to arrive for about six months after her death.
Martin Vickers
I thank the hon. Lady for that intervention. My understanding, and she will correct me if I am wrong, is that that 20% of costs could be reimbursed, depending on the individual’s circumstances.
Dr Whitford
If a member of the public in Germany wants to cover that other 20%, they take out additional insurance to cover it.
Martin Vickers
I thank the hon. Lady for her intervention and for her correction, which I am very happy to acknowledge.
The debate over healthcare in this country is insular and inward-looking. It is ruined by a counterproductive tendency to pretend that the only imaginable alternative to the NHS is the American system. That is the go-to response for the vast majority of those who oppose reform. In reality, opposition to the US system is the one thing that unites us all. We can deliver meaningful NHS reform while maintaining the principle of universal coverage, as well as ensuring that the NHS remains free at the point of need.
Another area in which there has been considerable scaremongering relates to accountable care organisations. These organisations are hugely important in ensuring that patients have access to high-quality care that is orientated around their individual needs. While a different name for them would have been helpful, it is the substance that matters. Again, we are often told that ACOs are a move towards the US system of healthcare, but other than the name they have little in common with the US system.
ACOs will not alter the universality of healthcare in this country, nor will they prevent services from being free at the point of use. To suggest otherwise is dishonest and unfair on patients, and causes needless worry for those who are in difficulties and worried about their future healthcare needs. Claims that sustainability and transformation partnerships and ACOs are vehicles for NHS privatisation or the Americanisation of the health service have been refuted by all the key health organisations, including the King’s Fund and NHS England.
Only 10 days ago I visited the excellent St Hugh’s Hospital in Grimsby, which serves patients from my neighbouring constituency. It is a private hospital, but 83% of its patients are from the NHS. Ashley Brown, the hospital’s director, explained to me how private providers are held to at least the same standards as public providers, and often—as in his hospital’s case—to higher standards. Private providers are subject to the same rigorous inspections as public ones and they receive ratings from the Care Quality Commission, which holds all providers to the very highest standards. As a result, 70% of independent hospitals are rated by the CQC as “good” or “outstanding”. Furthermore, the punishments for failing to meet targets are far stronger in the private sector. I was told that if St Hugh’s Hospital missed its 18-week target for referral it would face a significant fine.
Another concern that is frequently raised regarding the NHS is about profit. We are told that no one should profit from someone being ill. However, if someone needs an urgent operation, do they actually care whether the person carrying out that operation, or indeed the hospital that it is being carried out in, might make a profit from it? They have provided the capital costs of the investment. What matters is the quality of care for the individual. As I have said three or four times, patient care is absolutely critical.
Across the UK, about 10 million NHS patients are treated by the private sector every year. If we were to remove the private sector from the NHS altogether, there would be an additional 10 million people on NHS waiting lists, which, as we know, are strained to the limit already.
People value the benefits that private provision can allow. The British social attitudes survey found that there were more people—43%—who did not have a preference between receiving care from the NHS or from a private company than people who would prefer NHS treatment. Furthermore, at a time when mental health has finally reached the top of the political agenda, it is worth noting that more than one third of acute in-patient psychiatric beds are provided by the private sector. There are calls to strip back the private sector, but that would have a detrimental effect on patients in that area.
Not enough is done to publicise the fact that patients now have a legal right to choose where they receive treatment. They can choose any NHS or private hospital in the country. If they opt for a private provider, they will not have to pay a penny. That places the power in patients’ hands, giving them the opportunity to make personal healthcare decisions, as well as helping to keep NHS waiting times down.
The NHS can benefit from working with the private sector. That should not be viewed as providers competing in a zero-sum game. If the two co-operate and realise how they can spread the burden of work, they can radically improve patient outcomes overall. Provided that the service delivered is of the highest quality and remains free at the point of use, who provides it is irrelevant to a patient in urgent need. We are rightly proud of the NHS and the excellent service it provides, but if it is to remain sustainable as a service that is free at the point of need for our children and grandchildren, we must acknowledge that we need a sensible debate about how we achieve that.
I suggest that with our electoral system there are only four possible outcomes of elections in the foreseeable future—a Conservative or a Labour Government, or one of them in coalition with the Lib Dems. I can guarantee that none of them would be elected if they included privatising the NHS in their manifesto. It may have escaped everyone’s notice, but Governments quite like to be re-elected, so if, during their administration, they had made moves towards privatising the NHS, they simply would not be re-elected. Those who signed the petition need have no fear of privatisation from this Government. As I said at the beginning of my contribution, privatisation is a myth peddled for party political advantage, and nothing more.
Autism
Martin Vickers Excerpts(6 years, 1 month ago)
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Martin Vickers (Cleethorpes) (Con)
Like many colleagues, I suspect, I started to take a particular interest in how we as a society deal with those who have autism as a result of parents coming to my constituency surgery to describe the challenges that they face, and the obstacles that they must overcome to ensure that their children receive what we all want for our children: a good education, healthcare and so on. What struck me was the strength and determination of those parents. They felt that they had to be strong, determined and sometimes—I am sure that they will not mind me saying this—downright difficult to get the best for their children. We need to ensure that they do not have to be downright difficult to get what their children need, and that we provide for their needs—not necessarily without question, but certainly not in a way that appears obstructive.
Meeting these parents encouraged me to bring forward my ten-minute rule Bill in November 2016. As the motion said, it was a Bill
“to make provision about the access to education, school admissions and support for special educational needs, with particular reference to children diagnosed with autism”.
I noted in my speech that the Equality Act 2010 exists to protect people of all ages from discrimination. It should prevent disabled people from being treated unfairly because of their disability, but in some respects, sadly, there is still a long way to go. I went on to note what an irony it was that the Equality Act was being used to discriminate against children with autism. The National Autistic Society told me at the time that it believed that too many schools did not fully understand their duties towards children and young people with the condition. The law requires them to make reasonable adjustments for disabled and special educational needs pupils so that they may achieve their full potential. “Reasonable adjustments” mean ensuring that a disabled child or one with special needs can do what their non-disabled peers do, and it is important to recognise that while children with autism may behave in a manner that looks like bad behaviour, it is often an expression of anxiety. Unfortunately, as has been said, not all teachers have received specialist training that would enable them to identify it as such.
I had made a note that Department for Education figures show that autistic children are three times more likely to be excluded than children who do not have special educational needs, but the Chair of the Education Committee, my right hon. Friend the Member for Harlow (Robert Halfon), said earlier that they were four times more likely to be excluded. I suspect he is even better informed than the report from which I obtained my figure.
After presenting my Bill, I had a meeting with the then Minister, Edward Timpson, who launched a consultation on whether changes to the guidelines were needed. It would be nice to think that whatever changes resulted have cured the problem, and things might have improved, but cases in my Cleethorpes constituency indicate that it is not clear that that has indeed happened.
In that speech that I made 16 months ago, I said:
“There appears to be a loophole in the law that does not consider challenging behaviour linked to a child’s disability as an impairment. If their disability could result in aggressive behaviour towards others in the school, the law on disability discrimination does not help them, and some governing bodies use ‘tendency to physical abuse of others’ as a reason not to meet the needs of an autistic child”.—[Official Report, 1 November 2016; Vol. 616, c. 810.]
Sadly, it is then much easier to exclude such children. Of course governors have a duty to others in the school, but exclusion is sometimes the easy option.
This week I received letter from a constituent, who wrote:
“my daughter has been banned from the end of school Prom because she has ‘physically assaulted teachers and students’, no offer of being chaperoned was offered. I feel that the school has let her down by restricting her studies and as a result she is only taking four GCSE’s whereas prior to the school’s action she could have potentially got 5 pass grades.”
As I said, I received that letter only this week, so I have not yet had an opportunity to take the matter up with the school, but the fact that a parent felt it necessary to contact their MP about it rather than discussing it as part of the normal processes does not bode well.
A recent article in my local newspaper, the Grimsby Telegraph, set out the problems faced by parents of autistic children. It reported:
“Parents have…hit out at what they perceive as local services blaming them for the condition of their children, often being told that they are just poorly behaved, with the parents being told that they would have to go on a parenting course before they could get an autism assessment”.
That is unacceptable. The report continued:
“The main criticism has been levied against CAMHs, the national service commissioned by North East Lincolnshire Council that is meant to provide an autism pathway to help support children…Parents feel that while this service is meant to be available, they have had numerous troubles in trying to access it…Cora Leeson”—
a constituent of mine—
“has been campaigning for better autism services in the area for a number of years, and believes that a recent freedom of information request she has received a response to shows that there has been a very low number of people in the area actually receiving a diagnosis of being on the autism spectrum.
Her figures showed that from September 1, 2016, to May 31, 2017, there were 36 assessments…carried out by CAMHS…Only seven of these resulted in a diagnosis of autism.”
My aim is not to be critical of North East Lincolnshire Council or the local clinical commissioning group. Improvements have been made, many people are working hard to deliver a better service, and I recognise that there are resource implications. Moreover, society has moved a long way in improving the lives of those with disabilities or special needs. Nevertheless, in my constituency and elsewhere, there is clearly more to be done. A system that is designed—as it has to be—to provide for a vast range of people and needs must have enough flexibility to enable the needs of all to be dealt with. I welcome the opportunity to highlight once again the needs of those with autism.
Acute and Community Health
Martin Vickers Excerpts(6 years, 2 months ago)
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Stephen Barclay
I am happy to reassure the hon. Gentleman, but he has raised an important point. The question of people moving within the United Kingdom is not the only issue; another potential issue is the question of people moving to a charity or a private company that is providing services for the NHS, or taking up other roles in the healthcare landscape.
Martin Vickers (Cleethorpes) (Con)
May I press the Minister a little further on his worrying suggestion that revolving doors are often facilitated by those who are tasked with regulating them? Will he also look at democratic accountability not just in the appointments of officials, but more widely in the NHS?
Stephen Barclay
I referred earlier to my desire to work on these issues with members of the Health Committee, who include my hon. Friend, and I shall be happy to look into the points that he has raised. The previous statement was about the culture in the House of Commons. I think that what goes to the heart of my hon. Friend’s question and the matters that we are discussing is that issue of culture, and the need for the culture in pockets of the NHS to change. My right hon. Friend the Secretary of State has done a great deal to bring about such change, particularly in respect of patient safety, but I shall be happy to work with my hon. Friend to take that further.