Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 26th November 2013 Commons Chamber

[Dr Poulter]

My right hon. Friend raises important issues. I should like to pay tribute to the work that he did in expanding children’s talking therapies and IAPT—improving access to psychological therapies—services to make better provision for mental health support. He is right to highlight, as the CMO did, the fact that we do not have enough data on children’s mental health. That has been a historical problem, and we are looking at ways to improve the data so that we can use them to improve health outcomes in mental as well as physical health.

[Dr Sarah Wollaston (Totnes) (Con)]

In Devon and Cornwall since the beginning of this year there have been three occasions when children as young as 12 and 13 with acute mental illness have been detained in police cells instead of an appropriate place of safety, and 25 occasions when children of 17 and under have been so detained. Will the Minister meet me to discuss how we can end this appalling situation and make sure that all children who are detained under section 136 are seen in an appropriate location?

[Dr Poulter]

My hon. Friend is right to highlight this problem, which is unacceptable. My hon. Friend the Minister of State is looking into it. A lot of anecdotal evidence is stacking up that this practice is happening. We do not find it acceptable, and I or my hon. Friend will be happy to meet her to discuss the matter further and ensure that it is stopped.

Mid Staffordshire NHS Foundation Trust

Sarah Wollaston Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

As the hon. Lady knows, we are going through a process at the moment and the trust special administrator is drawing up detailed plans, so it is premature to say what will happen, but we will of course keep the House well informed and there will be plenty of opportunities for her to question me, or anyone else she wants to question, about any decisions that are eventually made.

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome the Secretary of State’s statement, which will help health professionals to get on with their jobs and improve openness and transparency across the NHS. I particularly welcome his recognition of the important role played by the 1.3 million health care assistants across health and social care. In implementing the vetting and barring scheme, will he ensure that individuals looking after people at home or in outside institutions can access that list to ensure that they have health care assistants who comply with the fundamental standards?

[Mr Hunt]

That is a very good point. I will take it away and look at whether that will be possible, because there is a powerful logic behind making that happen. As my hon. Friend has mentioned health care assistants, I would like to highlight the brilliant work they do, along with so many NHS staff. It has been a very challenging year for them to read about these examples of poor care, which are as shocking to them as they are to us. I agree that now is the time to get behind the people on the front line, who really want to change the culture for the better.

Tobacco Packaging

Sarah Wollaston Excerpts

Thursday 7th November 2013 Commons Chamber

[Bob Blackman]

The issue for us is that we want to remove the last aspects of advertising that are available to the tobacco industry. At the moment, there is still an attractive promotional aspect of tobacco, which is the packaging. We want all tobacco packs to be uniform, including the colour of the pack, and to allow the promotion of strong anti-smoking and pro-health messages. Evidence is emerging from Australia, but other parts of the globe are going ahead with standardisation of packaging, including Ireland.

[Dr Sarah Wollaston (Totnes) (Con)]

My hon. Friend is making a powerful point. Does he agree that use of the term “standard packaging” or “plain packaging” is a misnomer? We should be calling it “stark-staring truth packaging”. What it means is that we are handing someone a packet with a picture of gangrene. It is actually a crystal ball, and it counteracts the very powerful subliminal messages and the last legal form of tobacco marketing in this country.

[Bob Blackman]

The fact is that smoking is a lethal addiction. We know that. It is the one product in service in the world where, if used in the way it is intended, will lead directly to poor health and possibly death. Across England, 80,000 people a year die from smoking-related diseases. There are more premature deaths from smoking than from obesity, alcohol, illegal drug use and AIDS put together. It is the biggest single killer. In the long run, if we can get a fall of just one percentage point in smoking prevalence rates, we could save 1,800 lives per year. Who would not wish to save 1,800 lives per year? There cannot be an effective public health policy unless tobacco control is at its heart.

--- Later in debate ---

[Alex Cunningham]

I will congratulate any Government who are making the right decision on plain packaging.

I am aware that some Members fear that a fall in demand for tobacco will cost many of their constituents their jobs. I know that they will stand up and speak for the industry, but they will also be speaking for their constituents. I hope that the prospect of improved health, a smaller burden on the national health service and the protection of children will make them think again. I also hope that today’s debate will focus not on the cynical speculation that surrounds the drivers of tobacco policy and the influence that the tobacco lobbyists are able to exert, but on the decidedly positive effects that standardised packaging could bring, and the harm that is likely to result if the Government continue to insist on dragging their feet.

Reducing the prevalence of tobacco use is a key public health priority. None of us needs reminding of the consequences of smoking, which remains the leading cause of preventable mortality in the UK. Half the number of lifetime smokers will die from smoking-related diseases, which means that there may be 100,000 preventable deaths each year. One in five adults continues to smoke, and many people continue to take up the habit, including 573 children aged between 11 and 15 each and every day.

[Dr Wollaston]

Does it not strike the hon. Gentleman as strange that the Government claim to be delaying the introduction of standardised packaging because they want to wait for more evidence, but at the same time are virtually rushing into regulation to make e-cigarettes a medicinal product, although there is mounting evidence that, if anything, they could cause harm?

[Alex Cunningham]

I agree that we also need to look into the issues surrounding the smoking of electronic cigarettes.

The Government should be acting on this matter. The evidence has already been presented to the House today. It is unquestionable that we need to take action now, and save children and young people from an addictive habit that will devastate their lives.

As I have said many times before, while I disagreed with the former Health Secretary, the right hon. Member for South Cambridgeshire (Mr Lansley), about a number of issues, I believe that the best thing he ever said was that he wanted the tobacco industry to have “no business” in the UK. I hope that the new Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), shares that goal, and will pursue it with the vigour that it deserves. I welcome her recent assertion that

“Stopping children and young people smoking is a priority for us all”.

However, actions speak louder than words.

Since the Government’s consultation closed 15 months ago, Australia has become the first country to introduce standardised packaging for tobacco products. That is already changing attitudes. Our own Government’s inaction in failing to enact measures similar to those in Australia poses a major threat to tobacco control. However, I was pleased to hear the new Under-Secretary of State tell the House during Health questions last month that

“new information ... not just from this country but from around the world… is under very active consideration.” —[Official Report, 22 October 2013; Vol. 569, c. 132.]

I should welcome her confirmation of the timetable for the completion of that consideration and the making of a definitive decision.

I have no doubt that standardised packaging for tobacco products is necessary to quell demand. Smoking is an addiction that begins in childhood, and tobacco packaging is designed to be attractive, catching the eye of young people in particular. I am aware of the damage that this horrible habit is doing to people in my constituency, young and old alike, many of whom live in some of the most deprived wards in the country. We need to take active steps to reduce the incidence of smoking, and to implement measures to prevent future uptake. The decision to delay progress with standard packaging will needlessly condemn hundreds of thousands more to a life of addiction because some think it “cool” to smoke. Plain packaging fits the bill. Not only is there a real need for it, but it is a solution that is wanted and workable.

It is worth noting that, during a Westminster Hall debate in September, the former Under-Secretary of State for Public Health, the hon. Member for Broxtowe (Anna Soubry), recounted her own experiences of tobacco addiction and its horrendous consequences. Fortunately, she was able to kick the habit. It is significant that she recalled the “power of the packet”, and spoke openly of choosing a particular brand of cigarette for her first pack

“because they were green, gorgeous and a symbol of glamour.”—[Official Report, 3 September 2013; Vol. 567, c. 23WH.]

Indeed, she made a superb case for standardised packaging as a means of preventing future uptake. I hope that that, along with evidence provided by fellow Members today, will remind the Health Secretary of the strong supporting evidence, and persuade him to delay no more. Perhaps he will even go so far as to do the right thing and give Members the right to vote on the issue, thus allowing the will of Parliament to be implemented.

The United Kingdom has previously taken a leading role in this regard, certainly in Europe. It has some of the most comprehensive tobacco control policies in the world, not least the tobacco control plan, which led to the introduction of smoke-free public places and the banning of displays on retail premises. It is clear that the current Government have recognised, at least to some degree, the raft of negative consequences that can arise from ready access to branded packaging, yet Ministers remain adamant that the evidence we have is not substantial enough, and continue to insist that non-legislative solutions are better suited to the task in hand.

There is already a wealth of evidence that standardised packaging works, and new evidence is being published all the time. A systematic review of 37 peer-reviewed studies, carried out by the university of Stirling for the Department of Health, found standard packaging to be less attractive while also improving the effectiveness of health warnings, thereby reducing smoking uptake among young people. The review also found that standardised packs were perceived as having less “clutter” to detract from the all-important health warnings, with the monotony and sincerity of the packaging serving to enhance their seriousness and believability. Since then at least 12 additional studies have been published, and the growing body of research consistently reports that standardised packaging would reduce the appeal of tobacco products and increase the effectiveness of health warnings.

Lest there be any doubt, let me add that the evidence from Australia confirms those findings. Not only do those who smoke cigarettes from standardised packs perceive their cigarettes to be of a lower quality than those from branded packs, but there is a demonstrated tendency to perceive cigarettes as less satisfying.

Changes to Health Services in London

Sarah Wollaston Excerpts

Wednesday 30th October 2013 Commons Chamber

[Mr Hunt]

I hope the hon. Gentleman will be pleased that today the death sentence on A and E at Ealing has been not just reprieved, but cancelled; it will keep its A and E. The definition of A and E is not something that politicians decide. We said in the statement that what the A and Es at Ealing and Charing Cross contain must be consistent with Professor Sir Bruce Keogh’s review of A and E services across the country, which they will be, and that any changes made in service provision must have full consultation with his constituents, which will happen. On the basis of an IRP report that simply says, “More work needs to be done,” I cannot answer all his questions, but I hope I can give him greater certainty than he had this morning that there will be an A and E for his constituents in Ealing.

[Dr Sarah Wollaston (Totnes) (Con)]

Clinically led, evidence-based changes to services save lives. That is straightforward and clear. It is also clear that we have to make these changes happen if we are to live within our means and the health service budget. How are we going to make reconfigurations such as this one more straightforward, because the cost and time are unacceptable? Likewise with mergers, how are we going to streamline this process?

[Mr Hunt]

My hon. Friend speaks wisely. It concerns me, as it does her, that these processes take so long. When it comes to changes in A and E and maternity services, exhaustive public consultation is necessary, because they cause such great public concern, but we also need to deal with these issues in a much more timely way, particularly when it involves sorting out the problems of failing hospitals. I agree with her, therefore, and I am looking at what can be done to speed up all these processes, while retaining the appropriate consultation with the public.

Accident and Emergency Departments

Sarah Wollaston Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

The fact is that one thing we need to do is to address why people go to A and E instead of the alternatives, such as walk-in centres. Communication about the alternatives to A and E is not as good as it needs to be. We are addressing those issues, but I must say to the right hon. Gentleman that the previous Government failed to address this problem when he was Health Minister and the difficult issue of the reconfiguration of services was never fully grasped. We are grasping it and that is why Professor Sir Bruce Keogh is undertaking his review right now.

[Dr Sarah Wollaston (Totnes) (Con)]

I congratulate the Secretary of State on his welcome stand on continuity of care and the role that that plays in reducing A and E admissions. Could he go further in stating how he will ensure that we have more doctors trained from medical school in both A and E and general practice?

[Mr Hunt]

My hon. Friend is right and staff recruitment is critical. We have already said that we want another 2,000 GPs and are considering whether that is enough. We recognise the fact that general practice is very stretched, that we need GPs to offer more services and that we need more people to do that. Professor Keogh’s review is considering A and E departments, and one thing we are asking is why we are one of the only countries in Europe to have an emergency medicine specialty. Other countries do not do that and ask all doctors to spend time in A and E. We are also considering what we need to do to make A and E a more attractive profession for people to go into, given the antisocial hours that come with the territory. That is not an easy problem to solve, but we recognise that it is incredibly important that we crack it.

Tobacco Products (Plain Packaging)

Sarah Wollaston Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Bob Blackman]

The key issue, to which I will come, is not discouraging current smokers but preventing children from smoking in the first place.

[Dr Sarah Wollaston (Totnes) (Con)]

Will my hon. Friend give way?

[Bob Blackman]

I will give way a bit later, as I have been directed by the Chairman not to take too many interventions.

My view was reinforced by a recent Observer article revealing that Philip Morris, one of the big tobacco companies, set out in 2012 to persuade the Government to

“wait and see what happens in Australia”

two or three years down the line. That is undesirable. Most smokers begin when they are children. Two thirds of existing adult smokers report that they started before age 18, and almost two in five started before age 16. I have no objection if people choose to put a cigarette in their mouth, light it and help kill themselves—if that is what they choose to do, they have that right. However, I object to innocent children starting the habit and then not being able to give it up.

--- Later in debate ---

[Bob Blackman]

I will come to packaging later in my speech. The key issue is the risk of counterfeiting under the current arrangements, and it has yet to be proven what action can be taken about that. With standardised packaging, measures are possible to make it harder for the illicit trade to continue.

The illnesses are awful—lung cancer, other cancers, emphysema, peripheral vascular disease. Doctors and medical professionals do not support tobacco control measures, including standardisation of packaging, out of some perverse desire to control people and tell them what to do; they support tobacco control because they have seen hundreds of patients dying from terrible and preventable diseases. They want that dreadful waste of life to end, and we should listen to them. I declare a personal interest: both my parents died of cancer when I was young, because of tobacco and no other reason.

Children in poorer communities in particular—high-risk groups, specifically—are more likely to smoke. For example, 45% of smokers in routine and manual occupations report that they began to smoke before the age of 16; 57% of teenage mothers smoked during pregnancy; and in 2002, the Office for National Statistics reported that a truly shocking 69% of children in residential care were smokers. Starting to smoke is associated with a range of key risk factors, including smoking by parents, siblings and friends, and exposure to tobacco marketing. In my judgment, most people start smoking at stressful times in their lives.

Packaging is used by the tobacco industry as a residual form of advertising, since all other forms are now unlawful. Smokers display the branding every time they take their pack out to smoke. The industry understands that well. Helpfully, Philip Morris International’s submission to the Government consultation on the future of tobacco control stated:

“Packaging is…a means of communicating to consumers about what brands are on sale and in particular the goodwill”—

to use the term literally—

“associated with our trademarks, indicating brand value and quality.”

Nowhere else would someone get away with a product that kills people being advertised in such a way.

Peer-reviewed studies, summarised in the systematic review of evidence cited in the Department of Health’s consultation document, have found that standard packaging, compared with branded cigarettes, is less attractive to young people, improves the effectiveness of health warnings, reduces mistaken beliefs that some brands are safer than others and is, therefore, likely to reduce smoking uptake among children and young people. That evidence is from the Department of Health, which is not yet acting on it. More recent evidence from Australia is that smokers using standard packs are more likely to rate quitting as a higher priority in their lives than smokers using brand packs. That is only the early evidence.

[Dr Wollaston]

So-called plain packaging is actually “stark staring truth” packaging, and has nothing to do with mystique. It will not increase mystique; such packaging will simply help vulnerable children stop being the new recruits for an industry that is killing its customers.

[Bob Blackman]

Indeed. In Australia, we have seen immediately that standard packs, which are often described as plain, are anything but. Colleagues in the House and members of the public have been confused into thinking that standard packs would be grey or white, with no markings at all. That impression has been deliberately fostered by the tobacco industry—for example, by Japan Tobacco in its grossly misleading newspaper adverts, which were rightly condemned by the Advertising Standards Authority. In fact, as in Australia, standard packs would be highly designed, with images of the likely health effects of smoking. No wonder the industry is determined to stop such packaging.

The evidence we already have amounts to a strong enough reason for action now. Are there any arguments against that? There are certainly a number of myths, endlessly repeated by the tobacco industry and its front groups. High on that list is the argument that standardised packs will increase the level of the illicit trade, as has been mentioned. That is fiction. In fact, data from Her Majesty’s Revenue and Customs show clearly that the illicit trade in cigarettes fell from around one in five consumed in the UK in 2000 to fewer than one in 10 by 2010-11. That represents a great success for HMRC and the Government as a whole, partly as a result of the sensible decision by the Government to protect the funding for that area of HMRC’s work in the previous spending round.

People may ask whether standardised packaging would reverse that welcome trend, but there is no good reason to believe so. I invite any hon. Member who does to consider this fact: the three key security features on a pack of cigarettes are the numerical coding system printed at the bottom of the pack, which will continue; a covert anti-counterfeit mark in the middle of the pack, which can be read by a hand-held scanner and would also remain; and some features of cigarette design, in particular the distinctive marks on filter papers, which would continue. All those features would continue with standard packs.

Andy Leggett, the deputy director for tobacco and alcohol strategy at HMRC, said that

“there is no evidence that that risk”—

of an increase in the illicit trade—

“would materialise to any significant degree.”

His opinion was shared by serving police officers, senior trading standards officers and a representative of the EU anti-fraud office, OLAF, when they gave evidence to the inquiry on the illicit trade conducted by the all-party group on smoking and health, of which I am secretary.

Standardised packaging is not a party political issue. It is strongly supported by politicians of all parties, many of whom are present for this debate. It is also popular with the public. Contrary to what my hon. Friend the Member for Aldershot (Sir Gerald Howarth) said, a February 2013 poll on the issue found that, overall, 64% of adults in Great Britain were in favour of standardised packaging—great public support.

A further poll by YouGov, conducted in March, showed support for the policy from 62% of Conservative supporters, 63% of Labour supporters and 60% of Liberal Democrats. There was majority support from all ages, genders, classes and political parties. Were there a free vote in the House of Commons, I believe that a significant majority of MPs would support legislation on standardised packs. I also firmly believe that Parliament should debate and decide the matter.

I remember, before I was elected, the 2006 debate on smoke-free public places, support for which was passed by a majority of more than 200. That piece of legislation has proven to be highly successful and popular, enabling people to enjoy restaurants, pubs and other facilities without having to endure smoke. That legislation was achieved in part because it was seen to be beyond conventional party politics. I strongly urge the Government and my hon. Friend the Minister to introduce a debate in the main Chamber so that we can discuss it and take a decision, with a vote, on standardised packs.

To sum up, fundamentally the issue is simple: smoking tobacco is a lethal addiction. Cigarettes are the only legal product sold in the UK that kills consumers when used exactly as the manufacturer intends. Why should any company be allowed to promote such a product through advertising and marketing? The tobacco industry has made a great fuss about its intellectual property rights, but why should we allow any such claimed rights to trump the requirements of child protection and public health? The nub of the debate is that children, and the most vulnerable groups of children in particular, need protection from the tobacco industry and its never ending search for new consumers.

Care Quality Commission (Morecambe Bay Hospitals)

Sarah Wollaston Excerpts

Wednesday 19th June 2013 Commons Chamber

[Mr Hunt]

I could not agree more with my right hon. Friend. What happened beggars belief, and I very much agreed with his comments on that on the radio this morning. The point about duty of candour is that there will be a criminal liability for boards that do not tell patients or their families where there has been harm and that do not tell the regulator; boards will have a responsibility to be honest, open and transparent about their record. That has to be the starting point if we are going to turn this around.

[Dr Sarah Wollaston (Totnes) (Con)]

The public will be horrified, but probably not surprised, to hear that Ministers were leaning on the CQC not to criticise NHS hospitals. Leadership has to start at the top, so will the Secretary of State confirm that he will be fearless in standing up for whistleblowers and those protecting patients in the NHS? [Interruption.]

[Mr Hunt]

I thank my hon. Friend for that. She is absolutely right to say that the biggest responsibility Ministers have when faced with such tragedies is to be open and transparent about the scale of the problems; otherwise, they will never be addressed. Let me put it this way: people who love the NHS and are proud of it are the people who most want to sort out these problems when they arise. That is why it is incredibly important that we are open and candid. [Interruption.] The right hon. Member for Leigh (Andy Burnham) has stood up and criticised me in the media every single time I have given a speech drawing attention to some of the problems facing the NHS. He needs to be very careful every time he does that, because I will continue to do this, and I do it because I want the NHS to get better and believe it can be better.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 11th June 2013 Commons Chamber

[Anna Soubry]

Unfortunately, I do not have enough time to advance all the arguments, but I am more than happy to meet my hon. Friend to discuss this with him at length and show him a packet of the said cigarettes from Australia, and he may see the light.

[Dr Sarah Wollaston (Totnes) (Con)]

Does the Minister agree that there is nothing plain about plain packaging? It just shows the reality of gangrene of the foot with graphic images, which is not very attractive to hand round at a party.

[Anna Soubry]

Yes.

Augmentative and Alternative Communication Services

Sarah Wollaston Excerpts

Thursday 6th June 2013 Commons Chamber

[Paul Maynard]

Indeed. We disagree on many things, but on that issue the hon. Gentleman and I can agree. In Highfurlong, we have an excellent provider of specialist communication provision, so I hope he shares my concern at the proposals, which look to be coming from the local council, that could result in Highfurlong being shut. It causes me great concern, as it does many parents in his constituency and mine, so I hope he will join me in ensuring that Highfurlong is not threatened in the way it might be.

The funding decisions being made have consequences for the proposed hub-and-spoke model. I would welcome a commitment from the Minister that clinical commissioning groups should not interpret the existence of specialist hubs as a justification for winding down their investment in local spokes. That, to me, is crucial, if only because of the issue of complexity. The hon. Member for Blackpool South (Mr Marsden) alluded to that.

[Dr Sarah Wollaston (Totnes) (Con)]

Does my hon. Friend agree with me and my constituents with children using these important assisted technologies that what matters is not just providing the equipment, but the cost of providing training and support, without which children and adults cannot benefit fully from these important technologies?

[Paul Maynard]

I thank my hon. Friend for that perceptive contribution. The concern is that NHS England’s budget for AAC will not be sufficient for training. The only way that the hub-and-spoke model can work effectively is if the hub can train up more people in the spokes to deliver the more complex tools. Complexity is at the heart of the problem in the structure. AAC is one of five areas for which complex disability equipment is to be commissioned nationally—incidentally, another is artificial eyes, the national centre for which is based in my constituency. It would be remiss of me not to congratulate that centre during an Adjournment debate on a parallel issue. As I was saying, though, complexity is the key: it determines whether a patient is treated at the hub or at the spoke.

A stroke patient will receive a relatively straightforward medical diagnosis—it might be a devastating incident in their personal life, but its medical nature is relatively simple. None the less, what will restore the power of communication to someone who has lost it will be a complex piece of kit, yet under the current rules, as I understand them, it would be commissioned in the spoke. If the skills are not there to utilise that piece of equipment, that stroke patient will not benefit, so complexity of need has to be balanced by the complexity of the product being supplied. That is crucial.

The other issue on which I want to draw out the Minister is the concerns of worried providers in the voluntary sector about their ability to bid for commissions from NHS England. There has been a long-running battle over whether AAC should be based in the education or the health sector. It is now clear that it will be based in the health sector, but one of the key elements of what NHS England seeks to commission is an educational component in a multi-disciplinary team. That component is most often found in organisations such as the ACE Centre, the Dame Hannah Rogers Trust, near the constituency of my hon. Friend the Member for Totnes (Dr Wollaston), or the Percy Hedley school, up in the constituency of the hon. Member for Blaydon (Mr Anderson). They all have immense expertise, yet they greatly fear that the mood music emanating from NHS England suggests that they will be unable to bid for such provision, because of an understanding that it must be supplied by an NHS provider. That seems strange, given all that the Government have said down the years about trying to ensure a broader spectrum of provision—that more civil society organisations can provide such services. I hope the Minister can provide some reassurance on that.

I would also like a commitment from the Minister—this is another fundamental aspect—that this really is a health issue and no longer just an education issue. I hear far too many heartbreaking stories of children who are equipped with complex equipment when in school but, because it is funded by the Department for Education, lose it when they leave. It is not just a piece of kit they are losing; it is their ability to express themselves as fully formed adults. That is why it is so important that this becomes a health issue, not just an education issue.

My final query is rather technical—I beg the Minister’s forgiveness, but this goes back to acting like a statin in NHS England. A clinical reference group has been set up, but it has yet to meet—it is in a form of limbo, as it were. There is yet greater uncertainty, not merely because it has not met, but because the gentleman who chairs it, one Dr Thursfield, is shortly to retire from his academic post at the University of Birmingham. There is grave concern that his uncertain status in the clinical reference group is imperilling its ability to meet, take decisions and do its job. Alexis Egerton—the gentleman I mentioned earlier—was disappointed not to be appointed as a patient representative on the clinical reference group. I have known Alexis since my youngest days. He did his PhD on the funding of AAC provision, and it would be immensely valuable to the Government and the nation as a whole if we could find a way to allow him to play a role in that.

Finally—I want to ensure that the Minister has time to respond fully—will he bear in mind that the right to have a voice is a fundamental human right? We have an opportunity in this place to represent our constituents. If, in doing so, we give a voice to some who hitherto did not have one, we will have spent a useful half-hour in this debate. I look forward to hearing the Minister’s response.

Accident and Emergency Waiting Times

Sarah Wollaston Excerpts

Wednesday 5th June 2013 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

This is an enormously complex issue and we must not look at A and E in isolation. We also have to be very careful about the way we use data. I recommend that all Members look at the King’s Fund blog on this to see how the way in which the codings were changed and the data recorded to include walk-in centres and minor injuries units between 2003-04 gives a different perspective to the debate.

Given that complexity, we need to look at the solutions, which need to come by ensuring that people can see the right professional at the right time in the right place. That is key to this. But as my right hon. Friend the Member for Charnwood (Mr Dorrell) said, we must also recognise that the key driver for demand in this is our ageing population. If we look at the impact within general practice, we see a 75% increase in the number of consultations during a 13-year period. This is not just within general practice. The patients who are arriving are much sicker and have much greater complexity, and that is the root of the problem. It is a cause for celebration that we are all living longer, but dealing with that needs detailed planning.

[Mr David Lammy (Tottenham) (Lab)]

I am grateful to the hon. Lady for giving way, given her expertise in these areas. Does she recognise the work of Sir George Alberti a few years ago and the establishment of emergency care collaboratives that were very engaged with social care and local councils, and that the further cuts expected in local authorities will make this worse for elderly communities throughout the country?

[Dr Wollaston]

The reality that we face is that there is a limited amount of public funding. We can spend that pot of public money only once, so we must spend it in the right place, and that often means that we need to spend more of it within social care. That is why I welcome the fact that some of the health budget has been shifted to social care, and that is very important. I also commend Torbay. My constituency covers Brixham and Paignton, and Torbay has been nationally and internationally recognised for its work on integrating health and social care. It is no coincidence that it does so well on A and E waiting times, and we should be looking at what it has achieved.

But how will we keep people out of our A and E centres? In the Health Committee, we heard evidence about the effect that paramedic crews have. If the paramedic crew in an ambulance are highly skilled, the person they treat is less likely to need to go to casualty in the first place because the expertise is there to keep them at home. There needs to be better access to records. We need to consider how we can improve IT so that the patient owns their record and every part of the system can safely access their drug and medical history—with their consent, of course.

[Mr Bradshaw]

Given the hon. Lady’s previous distinguished career as a Devon GP, does she, like me, deplore the comments made today by a Government Minister, who sought to blame the current crisis in the NHS on the growth in the number of women doctors?

--- Later in debate ---

[Dr Wollaston]

I commented on that on Twitter. The remark was unfortunate; I think women GPs contribute enormously, but there we are. I would say that, wouldn’t I?

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

rose—

[Dr Wollaston]

I am short of time, I am afraid.

I go back to how we get people directed to the right place. We need NHS 111 to do the job it is intended to do—direct and signpost people to the right place. Some 42% of people do not know how to access their out-of-hours service; they will go to where the lights are on. We need to make sure that there is good-quality information about how to see the right professional in the right place at the right time and about communication in all parts of the system.

We also need to consider how commissioners can be supported to keep people at home, which is the right place for frail elderly people, by using community resources. There are some wonderful organisations in my area—Brixham Does Care, Totnes Caring, Saltstone Caring and Dartmouth Caring. Having the flexibility to commission small local units is vital, rather than there being a push to commission larger units that do not have that local focus. The issue is about local focus helping to have local solutions. What works in Lewisham will not work in rural Devon, so let us get the solutions right and have flexibility.

Let us make sure that we address the delays within casualty departments and the pressures that cause that. Very often the issue is to do with diagnostics. Let us look at the groups of people who constantly re-attend. I do not want to bore the House too much with my views on minimum pricing, but anybody who wants to spend a Friday or Saturday night in an inner-city casualty department will see what the delays are due to. I hope to win my bet eventually with the right hon. Member for Exeter (Mr Bradshaw).

Let us have a sensible policy that considers mental health, for example. A huge number of readmissions in casualty departments involve people with mental illness. In the west midlands, liaison psychiatry is being used to help reduce readmissions among those with mental illness—again, it is about getting people the right support at the right time in the right place. Some 5.6% of bed days in the NHS are taken up by people who have been readmitted within a week of discharge. That is simply not acceptable.

There is also the issue of designing the tariffs. I was pleased to hear the Secretary of State refer to tariff reform. If the financial drivers are in the wrong place, we will not solve the problem. Let us try to take the party politics out of this debate and focus entirely on how we can support NHS England and our clinical commissioning groups to get the right care in the right place at the right time.