Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Lansley]

As we have set out clearly, we want to promote clinical networks more widely, not just in relation to cancer and stroke, as has been the case in the past. I shall write to the hon. Lady about whether it would be appropriate for neuromuscular conditions and whether it is embraced in any plans that the NHS Commissioning Board and commissioning groups have in place already.

[Mr Philip Hollobone (Kettering) (Con)]

T7. Northamptonshire residents are rightly concerned that in the county in the last four months of 2011 the East Midlands ambulance service reached fewer than 69% of category A calls within eight minutes. The target is 75%. What hope can my right hon. Friend offer to local residents that this poor performance will rapidly improve?

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

I hope that I can give some reassurance to my hon. Friend by telling him that East Midlands ambulance service is working with commissioners, hospital trusts, community health services and social care services in taking measures to address its response time performance. NHS Milton Keynes and NHS Northamptonshire have received £1.7 million in additional funding, and NHS Midlands and East advices me that some of that has been used to fund further measures to help improve EMAS response times, including through the provision of additional ambulance crews and the deployment of hospital-ambulance liaison officers in each accident and emergency department to improve handover and turnaround times.

Stoma Care

Philip Hollobone Excerpts

Wednesday 25th January 2012 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

Someone has asked me to explain the subject of this debate on sponsored nurses and off-script tendering in stoma care, but I do not know where to start, so thank goodness that the hon. Member for Cardiff North (Jonathan Evans) is here to reveal all and enlighten us.

--- Later in debate ---

[Jonathan Evans]

I am not going to propose the end of sponsorship, but we need more robust mechanisms of managing the potential conflicts of interest. I will develop that argument in the limited time available.

The Department of Health appears to take comfort in the professional code of nurses, which states:

“You must ensure that your professional judgement is not influenced by any commercial considerations.”

Surely, we can be sure that that code is being properly observed only if the Department undertakes, at least from time to time, some assessment of the commissioning decisions being made, but it has never done so.

In January 2001, The Guardian drew the practice to wider public attention, reporting that the NHS planned to crack down on these commercial sponsorship deals. The paper claimed that more than half of stoma nurses were funded by commercial deals that were worth— remember that this was a decade ago—up to £100,000 a year to each health trust. The RCN claimed that the manufacturers specified that a minimum percentage of patients had to be fitted with the commercial sponsor’s products.

The previous Government’s response to The Guardian’s revelations was to issue new guidance requiring NHS trusts to review all such arrangements in which suppliers met all or part of the cost of members of staff, discounts on drugs and equipment, or subsidised research and training as a condition of the contract. Nevertheless, Health Ministers maintained that they did not want to prevent collaborative partnerships between the NHS and private contractors—nor do I—but they also said that clinical decisions should always be based on evidence of what was best for the patient. I agree, but how do we know? Again, the Department did not undertake any assessment of its own to reassure itself that that was being done.

By 2003, sufficient concern was being expressed over these commercial deals that the then Government launched the first of what was to be a series of consultations on the arrangements for paying appliance contractors. By 23 January 2006, the Government issued a report on the consultation, noting:

“Specific and frequent mention was made of the issue of sponsored nursing posts in secondary care, with most parties”

—I stress, “most parties”—

“feeling that this practice was inappropriate, and that it should cease.”

The Department of Health’s response to that concern was to ignore it. It maintained its policy of resisting any assessment of impact of commercial sponsorship on commissioning decisions, and that strand of concern was, interestingly, subsequently eliminated from further consultation on these matters by Health Ministers.

In Scotland, the Scottish Executive took a completely different line. The Scottish Government decided that commercial sponsors could no longer directly subsidise specialist nurses in stoma care. The nurses were taken on and paid directly by the NHS. In fact, the British Healthcare Trades Association funded transitional support to the Scottish health boards for two years because of that dramatic financial change. The outcome was also dramatic. Free samples of stoma products were withdrawn from Scottish hospitals by the manufacturers that had always previously provided them, and it is estimated that, over the following five years, the number of specialist stoma nurses in Scotland fell by up to half.

In Scotland, therefore, the policy has been to ban commercial sponsorship—this addresses the concerns expressed by my hon. Friend the Member for Montgomeryshire and the hon. Member for Strangford (Jim Shannon)—with a consequential fall in both the quality and the availability of specialist stoma care to patients. By contrast, the policy of Health Ministers here has been to refuse to undertake any assessment whatsoever of the impact of commercial sponsorship on these arrangements within the rest of the UK.

As I hope I have made clear, I am not arguing for the Government to follow the Scottish policy. Patient groups have made it clear to me—this is endorsed by the words of my hon. Friend the Member for Montgomeryshire—that they recognise that the quality and the availability of stoma care in Scotland has fallen markedly. I want to make it clear that I am not questioning in any way the commitment or the concern of stoma nurses. Again, I can say that patient groups who have briefed me for this debate have made it clear that they deeply value the services that are provided by stoma nurses.

Nevertheless, as I indicated to the hon. Member for Strangford, there are real questions about conflict of interest, which successive Governments, sadly, have ignored. Let me draw an analogy with another sector that we debate a lot in the House: the financial services sector. Today, all financial services companies are required to satisfy the regulator that they have robust processes in place that are fully understood by all staff for managing conflicts of interest. Can we imagine a Minister standing at the Dispatch Box talking about concerns with financial services and saying that he is entirely satisfied there is no need for robust conflict of interest processes because he is satisfied that the professional code of those who work in financial services will always require them to act properly? That is a ludicrous proposition. There is a need for the management of conflicts to be subject to a similarly robust process in terms of stoma care.

In March 2011, Health Ministers were asked by parliamentary colleagues some basic questions to glean information on the number of stoma care nursing posts sponsored in the UK. No helpful response was provided, and the Department had no statistics to share with colleagues. So, for this debate, I have had to turn to the British Healthcare Trades Association for the figures. According to the association, stoma care manufacturers sponsor more than 200 of the 337 departments in England at a cost of £10 million a year. However, some of those manufacturers share the same concerns about commercial sponsorship that I am outlining. They only maintain their sponsorship for fear that other suppliers will otherwise corner the market. Those manufacturers have even expressed their concern to me that the current commercial arrangements might fall foul of the new Bribery Act 2010. Have Ministers undertaken any assessment of that?

On 15 October, I wrote to the Minister and received a response from him on 9 November confirming again that the Department had not made any assessment of the commissioning decisions of PCT employees sponsored by private enterprises. Again, he highlighted the fact that Ministers relied on the code of professional conduct, but he said in his letter that he was satisfied that that was a concern and that he had asked his officials to make further studies into the activity. I hope that the Minister can tell us the outcome of those studies.

The issues that I have raised relate to the maintenance of patient choice in the appliances that are prescribed for stoma care, and the concerns are shared by patients, charities and several manufacturers. Such concerns have been shown to be very well-founded by reports of recent discussions between major manufacturers of stoma care products and PCTs about what has come to be called off-script tendering, which you mentioned in the second part of your comment, Mr Hollobone. What is being proposed is that preferred or single supplier agreements are made between commissioners and manufacturers, in which the commissioning body would get a bulk discount for requiring all patients to take one manufacturer’s products. The arrangements would then bypass the operation of the drug tariff for the provision of such products, which is regularly reviewed on an annual basis by the Department.

Currently, a GP or suitably qualified nurse issues a patient with a prescription—an FP10—and the patient is free to take that to the manufacturer of their choice to have the product dispensed by a pharmacy contractor or an appliance contractor. The drug tariff industry forum considers the advantages of that system to be patient choice, cost and value for money, quality of products and a centralised system working on a local basis. The British Healthcare Trades Association has obtained legal advice that suggests the off-script arrangements being discussed by big manufacturers might be beyond the powers of health trusts. However, the question arises whether such arrangements could be taken forward as part of the Government’s health reform.

Those questions were raised by the Urology Trade Association, which is a body representing 95% of manufacturers, and by the Urology User Group Coalition on behalf of patients in evidence given last year to the Select Committee on Health. Unfortunately, follow-up questions by parliamentary colleagues confirmed the long-standing Department of Health response that no assessment of those issues had been undertaken either.

The thousands of patients who suffer bowel or bladder cancer and require ongoing stoma care deserve better. They should be assured that the Government will defend patient choice and maintain robust processes for managing real or perceived conflicts of interest in the commissioning of services. The Government should ensure the continued provision of specialist nursing advice and support and reassure us that it is in no way influenced by financial or commercial considerations.

[Mr Philip Hollobone (in the Chair)]

All has become clear. What are the Government going to do about it?

Breast Implants

Philip Hollobone Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

We have been very clear about the advice we have given to women, and I hope that, through the NHS, any woman in those circumstances would go and see their general practitioner, who will have full access, from the chief medical officer, to the expert advice we have disseminated. I know that the Harley Medical Group has not shared with others the view that it can match the NHS’s standard of care; but given that, the professions are suggesting to surgeons that they should honour requests for replacement surgery free of surgical charge. I hope that gives a basis on which more of the private providers will now meet their full obligation of a duty of care.

[Mr Philip Hollobone (Kettering) (Con)]

What is the Department of Health’s central estimate of the number of women who have had breast implants through private clinics who will seek their removal through the NHS?

[Mr Lansley]

I am sorry to disappoint my hon. Friend but I cannot offer him such an estimate. We know that some 37,000 women had PIP breast implants. Clearly, not all those will necessarily want removal, and on advice, it might be any proportion of those; I cannot tell him what that figure would be. As we see in France, recommending the removal of implants does not mean that all women will have them removed.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 10th January 2012 Commons Chamber

[Mr Lansley]

I am grateful to my hon. Friend for her question. She rightly talks about this increasing number of older people in the community and rightly says that we want to support them to be independent and to improve their quality of life.

The whole system demonstrator programme was the largest trial of telehealth systems anywhere in the world. In the three pilot areas of Kent, Cornwall and Newham, it demonstrated a reduction in mortality among older people of 45%; a 21% reduction in emergency admissions; a 24% reduction in planned admissions to hospital; and a 15% reduction in emergency department visits. Those are dramatic benefits, which is why we are so determined to ensure, over the next five years, that we reach out to older people who are living at home with long-term conditions and improve their quality of life in this way.

[Mr Philip Hollobone (Kettering) (Con)]

9. If he will consider proposals to introduce a national screening programme to detect group B streptococcus in pregnant women.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

The UK National Screening Committee is reviewing the evidence for screening for group B streptococcus carriage in pregnant women, and I am sure that my hon. Friend will be pleased to hear about that. The committee will review the international literature, and a public consultation on the results will open in spring 2012.

[Mr Hollobone]

Group B streptococcus is the UK’s most common cause of life-threatening infection for newborn babies. Will my hon. Friend agree to meet me and Group B Strep Support, the excellent campaign group, to see how calls for a national screening programme might best be advanced?

[Anne Milton]

I am certainly happy to meet my hon. Friend. I should point out that the Royal College of Obstetricians and Gynaecologists is updating its guidelines and that NICE is also developing guidance. The issue is complex, however, and even testing is not 100% effective. Women who produce a positive result during pregnancy might be negative during labour and, more importantly, those who are negative during pregnancy might be positive during labour. It is important that we get the most up-to-date evidence and ensure that we reduce the tragic consequences of this infection.

--- Later in debate ---

[Mr Lansley]

As the hon. Gentleman knows, following the independent reconfiguration panel report, which I accepted in full, the Barking, Havering and Redbridge Trust is looking to manage safely its maternity services, while improving the quality at Queen’s. It is doing that in close co-operation with NHS London and, indeed, with the advice of the Care Quality Commission, following the commission’s inspections. I will continue to be closely involved in that, and we will continue to support the Barking, Havering and Redbridge Trust in improving services for the hon. Gentleman’s constituents and others.

[Mr Philip Hollobone (Kettering) (Con)]

In north Northamptonshire in 2010-11, there were 6,164 alcohol-related hospital admissions. That is four times the number just eight years before. What more can be done to tackle this horrendous increase in booze drinking?

[Mr Lansley]

Time does not permit me to mention all the things that could be achieved, but let me just say that we are clear about the need, for example, to tackle below-cost selling of alcohol, and we are doing that; to stimulate more community alcohol partnerships, and we are doing that; and to accelerate public understanding of the consequences of alcohol abuse, and we are doing that, not least through Change4Life, additionally, during this year. There is more, but we will say much more in our alcohol strategy soon.

Stafford Hospital

Philip Hollobone Excerpts

Tuesday 20th December 2011 Westminster Hall

[Mr William Cash (Stone) (Con)]

I will be fairly brief. I congratulate my hon. Friend the Member for Stafford (Jeremy Lefroy) on securing this debate. Since becoming the Member of Parliament for Stafford, he has transformed the attitudes and policy towards Stafford hospital. I pay tribute to the work that he does on behalf of the hospital and all his constituents. The issue has a direct bearing on my constituency, as well as those of my hon. Friends the Members for Cannock Chase (Mr Burley) and for South Staffordshire (Gavin Williamson). Indeed, it also has a bearing on other parts of Staffordshire where the hospital is used by constituents from neighbouring areas.

I endorse everything that my hon. Friend the Member for Stafford has said, but I should like to add another factor, which is highly relevant to a constituency such as mine. The Stafford part of my constituency has some deeply rural areas, such as High Offley, that are very much more remote than the streets of Stafford and other towns with good arterial connections to the M6. I have heard figures quoted about how quickly people can get to UHNS and other hospitals. I simply make the point that somebody might have a stroke, or a farmer might be caught in some dreadful tragedy in a dark field in a remote area.

My hon. Friend is completely right when he says that we need a full accident and emergency service. At the moment, we are going through a hiatus, but let it not remain long because we need a proper full service, especially for those deeply rural areas, as well as for the more built-up areas in the urban parts of Stafford and the adjacent areas.

[Mr Philip Hollobone (in the Chair)]

Order. This debate is clearly important for Stafford and the surrounding area. I call the Minister to respond.

--- Later in debate ---

[Anne Milton]

I thank my hon. Friend for his imaginative use of this debate to point out that I joined with him to fight a long, hard battle to save our hospital in the Guildford constituency. It is important, of course, to extend our thanks and tributes to staff working not only in our own constituencies, but across the country. On the first question, there is no doubt that lessons need to be learned, and I think that we sometimes feel that the NHS is slow to learn the lessons it should.

Work is being carried out nationally to address the skills mix, by developing non-medical roles within A and E departments. Enhanced nursing roles have genuine potential, and in countries with very remote populations, such as Canada and the USA, they are an extremely important part of the general skills mix. Emergency nurse practitioners who can look at the minor injuries and illnesses that in most departments account for 40% of the work load can be a major contribution to ensuring that A and E services remain available for local people, and advanced clinical practitioners, such as nurses and paramedics, can therefore treat many more of the major conditions.

I thank my hon. Friend the Member for Stafford for securing this debate, and other hon. Members for attending on the last day before recess. A number of Staffordshire MPs have met with the Minister of State, Department of Health, my right hon. Friend the Member for Chelmsford (Mr Burns), and I know that he will continue to keep in close touch, but should any new concerns arise I am sure that my hon. Friend the Member for Stafford will raise them with him. That leaves to me just to wish you, Mr Hollobone, and all the House of Commons staff a very happy Christmas and a prosperous and safe new year.

[Mr Philip Hollobone (in the Chair)]

I thank all Members for taking part in this debate and I, too, wish everyone a very merry Christmas.

Question put and agreed to.

Life Sciences

Philip Hollobone Excerpts

Monday 5th December 2011 Commons Chamber

[Mr Lansley]

I would instance two things in that respect, the first of which is the developing collaborations that were started under the academic health science centres and that will be continued through the networks that we want to extend. Those partnerships are specifically designed—£800 million was allocated in August, based on a competition—to enable the translation of discovery into new medicines in this country.

Secondly, the £180 million catalyst fund, which the MRC and Technology Strategy Board will implement, is specifically designed to take those ideas—the MRC says that it has some 360 such potential developments in medicines and treatments—through to the point at which they can be developed. Of course, that will be in this country.

[Mr Philip Hollobone (Kettering) (Con)]

Given that Northamptonshire has one of the most rapidly growing populations of patients in older age of anywhere in the country, I am sure my constituents will welcome the Secretary of State’s commitment that this country will become the global leader in the management of chronic and long-term conditions. We want to realise that praiseworthy ambition, but how far behind the curve are we at the moment?

[Mr Lansley]

The answer to that question varies depending on which conditions one is talking about. When one looks at the OECD “Health at a Glance” data that was published on 23 November, one sees how relatively poor are our mortality outcomes in relation to respiratory and chronic obstructive pulmonary diseases. By contrast, we are slightly better than average in relation to diabetes. However, I have seen for myself how well patients with COPD can manage their conditions at home. For example, they can see their blood oxygen levels day-by-day and have supplies of medicines at home, including steroids. They can therefore anticipate and deal with any exacerbations of their condition so that they do not end up in an ambulance going to hospital late at night.

Organ Donation

Philip Hollobone Excerpts

Wednesday 30th November 2011 Westminster Hall

[Mr Philip Hollobone (Kettering) (Con)]

In October 2006, my constituent Mrs Jeanette Crizzle very sadly died from acute myeloid leukaemia. Her husband Adam decided to set up the Jeanette Crizzle Trust, of which I have the privilege to be a trustee, to promote what has become NHS Blood and Transplant’s give and let live education programme for schools. At that time, we went to see the then Health Minister—she is now the Labour Chief Whip—and she kindly agreed to get the programme under way. Young people are the donors of the future and it is vital that we reach them. They are the ones who will keep future blood stocks healthy and provide life-saving organs in years to come.

The significance of that for this debate is that my constituent Mr Adam Crizzle, once his wife had very sadly passed away, did not leap to the conclusion that we should have a system of presumed consent; he leaped to the conclusion that we should increase awareness to encourage people to become donors in the future. That is something that I am very happy to support.

I am sure that we can all agree with the comments made by the hon. Member for Strangford (Jim Shannon) showing that the present system is not working well enough. Where we might disagree is how to make it work better. I come down firmly on the side of arguing that there is plenty more opportunity to increase the awareness and to encourage people to become donors.

I take this opportunity to praise NHS Blood and Transplant for the give and let live donor education programme. I am pleased that the Health Minister has agreed to meet Mr Adam Crizzle next month to explore ways in which that programme can be further advanced and improved. Some three quarters of schools are involved in the programme, which is targeted at 14 to 16-year-olds. However, many schools have not yet been reached, and I am sure that the Department of Health can build on the initial successes in the early years of the programme to ensure that it is extended even further.

I apologise to you, Mr Crausby, for not being able to stay to the end of the debate to hear the Minister’s remarks. However, I praise my hon. Friend the Member for Montgomeryshire (Glyn Davies) for securing this debate and for highlighting this important issue, and I pay tribute to all hon. Members who have contributed their passionate views to the debate.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Burns]

The report that was published at the weekend is deeply flawed. It is outrageous for an organisation to seek to scare people for the sake of cheap publicity. That report is as flawed as the report that was published a year ago. Far from there being the 50,000 cuts to which it referred, since May 2010 the number of doctors has risen by 3,500, the number of consultants by 1,600, the number of registrars by 2,100 and the number of qualified radiography staff by 549. Moreover, the number of managers and administration officers has fallen by 14,000 to release money for improved health care.

[Mr Philip Hollobone (Kettering) (Con)]

Front-line staffing levels come under particular pressure in the winter months because of the incidence of winter flu. Does my right hon. Friend welcome the news that at Kettering general hospital, almost 60% of front-line staff have now been inoculated against flu? That compares very well with last year’s national average of 35%.

[Mr Burns]

I join my hon. Friend in congratulating staff at Kettering general hospital on their responsible attitude, and urge other NHS staff throughout the country to follow their example. I am heartened to note that, as a result of the planning and activity that has taken place in the NHS, more staff are having flu jabs than did so last year.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 18th October 2011 Commons Chamber

[Anne Milton]

The Government will examine thoroughly the detail of any Assembly Bill when it is laid before the Assembly, but I urge Wales to look at the evidence. We can look back to what happened in Spain, where there was presumed consent for 10 years without any shift in organ donation rates. The issue is more complex than that. It is about organ donor transplant co-ordinators and increasing donations from emergency medicine. A number of measures need to be put in place to increase those rates.

[Mr Philip Hollobone (Kettering) (Con)]

Will my hon. Friend be kind enough to meet Mr Adam Crizzle, who was the original inspiration behind the Give and Let Live organ donation programme in schools, to see how the promotion of this excellent scheme might be further improved?

[Anne Milton]

I would be very happy to meet that gentleman. There is no doubt that promoting this in schools has a profound impact and is an opportunity to change people’s attitudes to organ donation and, more importantly, makes families discuss it, which is critical. It is not just about signing on to the register.

Reform of Social Care

Philip Hollobone Excerpts

Monday 4th July 2011 Commons Chamber

[Mr Lansley]

In the past, Governments received advice from the regulator about the desirability of their being able to undertake proper scrutiny of the financial circumstances—the financial viability and sustainability—of organisations. No powers in that regard have been taken in the past, but we are seeking such powers in the Health and Social Care Bill, and one of the debates that we will need to have concerns the extent to which it will be right for us to use them in the future.

[Mr Philip Hollobone (Kettering) (Con)]

How will the Secretary of State ensure that the very best examples of the hospice movement, such as Cransley hospice in Kettering, can become involved in the establishment of the new framework for palliative care, so that best practice is extended throughout the country?

[Mr Lansley]

As my hon. Friend will know, Tom Hughes-Hallett, the chief executive of Marie Curie Cancer Care—who is leading the palliative care review—has engaged fully with Help the Hospices and the hospice movement. I understand from my conversations with hospice representatives over a number of years that they do not want their funding to be subject to the vagaries of public expenditure. Individual block grants that vary from year to year give them no confidence about the services that they provide. They do not want additional resources as much as clarity about what resources will be provided for the individuals who seek their care. They particularly hope that there will be a corresponding transfer of resources to hospices which provide services that replace the NHS and support people at home, as many are increasingly doing.