The National Health Service
Tom Tugendhat Excerpts(5 years, 2 months ago)
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Tom Tugendhat (Tonbridge and Malling) (Con)
The hon. Gentleman is right to identify the delays that are inevitable in a massive state-led system. Would he agree that there is a huge opportunity for individuals to get treatment in other ways? I have the privilege to represent a couple who have taken themselves to a hospital in Portugal, where they live half the year, and got care there. Their care has been refunded by the NHS at a rate significantly cheaper than that available in the UK. Should we not welcome individuals who are able to do this? Of course it is not for everybody, but should we not welcome it as a possibility?
Jonathan Ashworth
I am genuinely pleased for the hon. Gentleman’s constituents, but there are 4.4 million people on the waiting list. There used to be around 2 million. Every day, another 330 people wait longer than 18 weeks for treatment, and when people wait longer than 18 weeks, not only do they wait longer in pain, distress and anxiety, but they run the serious risk that their health will deteriorate further. That is what is going on in the NHS today under this Government.
The Queen’s Speech was heavily spun as being about—[Interruption.] The Secretary of State will get his chance in a moment. The Queen’s Speech was heavily spun as being about the NHS. [Interruption.] He says I am talking nonsense. These are the official figures. He wants to run away from his own failure, from the fact that so many more people are waiting beyond 18 weeks for treatment and from the A&E crisis that he is doing nothing about. He thinks an app will solve it all. That is not a serious approach to the NHS. [Interruption.] And he is not as good as George Osborne used to be.
The Queen’s Speech was heavily spun as being about the NHS, but in fact it was a missed opportunity to rebuild confidence in the NHS and provide the health services we want. We will scrutinise carefully the Bills in the Queen’s Speech and engage constructively. We are pleased that the Health Service Safety Investigations Bill has not been abandoned and is back. We will engage on it and explore with Ministers how to strengthen the independence and effectiveness of medical examiners.
If the Secretary of State wants to deliver safe care, however, we need safe staffing legislation and a fully funded workforce plan. Pressures on staff are immense. He will know that suicide rates for nurses are higher than the national average and that among doctors the rate is rising. I congratulate Clare Gerada on her leadership on mental health support, but yesterday the Secretary of State suggested on Twitter that all NHS staff would be eligible for this new mental health support, when it is actually just doctors and dentists. I hope he will clarify his remarks at the Dispatch Box and tell us when 24-hour support for all NHS staff will be available.
I also hope the Secretary of State will tell us how he will resolve the staffing crisis. As he knows, we have 100,000 vacancies across the NHS. We are short of over 40,000 nurses. Under this Government, we have seen cuts to community and district nurses, learning disability nurses, mental health nurses, health visitors and school nurses. On current trends, we will be short of 108,000 nurses in 10 years, according to the King’s Fund and the Nuffield Trust.
Matt Hancock
Hold on, I have not even answered the previous intervention. The truth is that the NHS has proposed measures that will make it easier to run the NHS, to reduce bureaucracy and to change the procurement rules that we discussed. Ultimately, these responses—there have been nearly 190,000 responses to the consultation—have the support of the royal colleges, the Local Government Association and the unions. They have all supported these legislative proposals, and we are working on the detailed plans. They do change some of the measures put forward in the Health and Social Care Act 2012. We will make sure we cut out that red tape and bureaucracy, streamline the procurement, support integration and make sure that the record investment we are putting in gets as much as possible to the frontline. They also help us with recruitment, and I can announce to the House the latest figures for GP recruitment, a matter that I know is of interest to lots of colleagues. Building on the record numbers in training last year, this year we have 3,530 GPs in training, which is the highest number in history. That is all part of our long-term plan.
The measures in the long-term plan Bill would also strengthen our approach to capital. We have discussed the 40 new hospitals in the health infrastructure plan, but I can also tell the House that the plan will not contain a single penny of funding by PFI—we have cancelled that. I have been doing a little research into the history and I want to let the House into a little secret that I have discovered. Who was working in Downing Street driving through Gordon Brown’s doomed PFI schemes, which have hampered hospitals for decades? I am talking about the PFI schemes that led to a £300 cost to change a lightbulb and that have meant millions being spent on debt, not on the frontline. Who was it, tucked away at the Treasury, hamstringing the hospitals? It was the hon. Member for Leicester South. So when we hear about privatisation in the NHS, we have culprit No. 1 sitting opposite us, who wasted all that money. We are cancelling PFI, and we are funding the new hospitals properly.
Tom Tugendhat
May I welcome the investment that my right hon. Friend is making in Kent, not just in hospitals, but in healthcare centres? We have a GP surgery that is no longer fit for purpose and, working alongside the county council, another wonderful Conservative institution, he is providing healthcare to people closer to home and nearer to where they want it. I welcome that enormously and urge him to do exactly the same for the hospital in Tonbridge, which he knows, because I keep nobbling him on this one, we need much more investment in, so that we can have those community beds close to home.
Matt Hancock
My hon. Friend is absolutely right about getting community beds closer to home. I wish to mention four other measures in the Queen’s Speech—
The National Health Service
Tom Tugendhat Excerpts(5 years, 2 months ago)
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Dr Whitford
Well, it has not been sucking money for the past six or seven years because it was only declared open in February. I totally agree that it is a huge setback that, due to a failure within the health board’s tendering process for the build, it did not recognise the need for the level of ventilation in an intensive care unit. I would gently suggest to the hon. Gentleman that I do not think he would have wanted our Cabinet Secretary to simply go ahead putting babies and children in an intensive care unit where the ventilation was not considered safe.
In Scotland, so far our funding for the NHS has doubled in the past 10 years and will actually increase further next year. But it is not just about funding; it is about structure. What is happening in NHS England is fragmentation. It is not just that NHS hospitals are competing with private companies; they are competing with each other, and that undermines collaboration. We need to have collaboration, with the patient at the centre. Anything that fragments or undermines that collaboration is weakening the quality and safety of care.
Tom Tugendhat
The hon. Lady is speaking very powerfully on many issues, as usual. I would be interested in her point of view on other health providers, because as she knows, having worked around the world, many of them do things differently, particularly around Europe, for example, where many of the hospitals are not owned by the state. Many of those hospitals compete and services are provided by different bodies—private companies, charities or community groups. Will she comment on how that works, because the French and Germans seem extremely happy with their healthcare?
Dr Whitford
As people in the Chamber may know, my husband is German and therefore I know that system in Germany relatively well. I would point out that the hospitals do not collaborate there either. As it is about income for the hospital, surgeons and clinicians will not always refer a patient on even though they know there is an expert down the road. I would not particularly defend that. I lost my sister-in-law two years ago, and the bills were still coming in for almost a year. That is quite a stressful and upsetting system. Not everything is covered. Patients still, as in many insurance systems, have to cover a gap, which can be significant and quite painful for them. These systems could not generate the epidemiological data, or anything like the treatment and outcome data, that is generatable in all four of the UK health services, because they do not have a nationwide system.
When I was back on the Health Committee for a short time this spring, we heard talk about the changes to the Health and Social Care Act. It is critically important that those go ahead, because there are perverse incentives within that legislation. At the moment, the tariff is paid to a trust only if patients are admitted. That is a perverse incentive against managing people in the community, or even prevention. It is important that section 75 is done away with completely so that there is not pressure on commissioning groups to put things out to tender, because that is a wasteful process. I remember reading about £500 million wasted in Nottingham, where there were preparations for a tender, then the private company did not go ahead and then it did go ahead.
All this is taking money away from patient care. That is the basis of the argument about publicly provided services. I am sorry, but the quips about drugs and so on by the Secretary of State were childish. Was he suggesting that nurses and doctors go into the North sea to drill for oil, or that that is the suggestion from the Opposition Benches? It is not the suggestion from anyone on the Opposition Benches that drugs would not be purchased. It was just a childish response. Having private companies pulling NHS England apart undermines it, fragments it and makes it not patient-centred, and being patient-centred should be the goal of every single health service across the UK.
Age-related Macular Degeneration: NHS Funding
Tom Tugendhat Excerpts(5 years, 8 months ago)
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Bambos Charalambous
The hon. Gentleman makes an excellent point. Early diagnosis is so important, especially for wet AMD. The target requires people to be seen within 18 weeks of diagnosis, but that is unacceptable for people with wet AMD who should be seen within two weeks. Otherwise, their vision could suffer serious damage.
One concern is that the NHS has insufficient eye clinic capacity, due to delays and cancelled appointments that the British Ophthalmic Surveillance Unit has identified could lead to up to 22 patients a month losing their vision. The all-party group on eye health and visual impairment—I am pleased to see two members of the group here today—is supported by the Royal National Institute of Blind People, and in its inquiry, “See the Light”, published in June 2018, it identified 16 recommendations on which the Government should take action.
Three recommendations on which the APPG is still waiting to see progress include: the urgent need to increase the number of trainee ophthalmologists to keep pace with increasing demand; the need to ensure that sustainability and transformation partnerships—STPs—address current and future need; and the need to establish a national target to ensure that patients who require follow-up appointments are seen within a clinically appropriate time to prevent delayed and cancelled appointments.
According to statistics from the Industry Vision Group, last year three out of 44 STPs identified ophthalmology as a priority service, and only seven out of 44 met the 18-week referral target every month between January 2017 and January 2018. Early intervention for wet AMD is crucial to avoid blindness, and even the 18-week target that I mentioned to the hon. Member for Strangford (Jim Shannon) is not suitable for people with wet AMD, which requires treatment within two weeks. There is still a need to collect robust data on ophthalmology at clinical commissioning group level in order to assess performance and learn from best practice. Some of the issues relating to delay or the cancellation of appointments may be due to systems and processes, and not necessarily to funding.
Ophthalmology has the second highest outpatient attendance of any speciality, with 7.6 million appointments in England in 2017-18 accounting for 10% of all outpatient appointments. As we are all living longer, that figure is projected to increase by up to 40% over the next 20 years. The Government could do a number of things to help improve the situation for people with AMD and other sight-threatening conditions. First, we need a national eye health strategy—that point was raised by my hon. Friend the Member for Battersea (Marsha De Cordova). Unlike Scotland and Wales, England does not have a national eye health strategy, but one is needed to address workforce capacity issues and health inequalities, and to enable better care and improvements to the quality of life for those with AMD.
Tom Tugendhat (Tonbridge and Malling) (Con)
The hon. Gentleman is making a good point. In my community the Kent Association for the Blind has done a lot of work on this issue, and I was proud to visit it recently. I also congratulate my hon. Friend the Minister on her new appointment, and on her liberation in finding her voice again and being able to express her own views, albeit of course measured through those of the Government.
Bambos Charalambous
I am pleased to hear of the excellent work taking place in the hon. Gentleman’s constituency.
Contained within the strategy should be a minimum commitment to research similar to that given in the Government’s dementia 2020 challenge, which committed £60 million a year to dementia research, resulting in significant advances for those suffering with dementia. It is unclear how much funding has been set aside for ophthalmology from the £20 billion announced in the Government’s NHS long-term plan. I would be curious to hear from the Minister whether it is part of the plan or not.
There is also a need for the establishment of a national ophthalmology database to collect and analyse data for the purpose of improving outcomes, better decision making, and allocating resources. At present, there is fragmented data collection, such as that by the health quality improvement partnership, administered by the Royal College of Ophthalmologists, which covers only cataract surgery. A database that routinely collects information on AMD would greatly assist research and the planning of clinical care for those with AMD.
All STPs and integrated care schemes should be held accountable for developing and implanting integrated ophthalmology plans. Three years ago, the Department of Health commissioned a number of “Getting It Right First Time” reports into a series of areas, including ophthalmology. Unfortunately, that report is yet to be published, but hopefully when that happens it could inform the integrated ophthalmology plan, along with other sources such as the Royal College of Ophthalmologists’ “Way Forward” reports.
Oral Answers to Questions
Tom Tugendhat Excerpts(5 years, 10 months ago)
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Matt Hancock
Of course the nature of being in a GP practice is changing. For a long time practices, which are essentially private businesses, also had the benefit of rising property prices that brought additional income on top of their income from the NHS. That is no longer the case because property is so expensive, so many people are changing the way that GPs are employed, so they are directly employed rather than through practices. That move is happening, but it is just one of the many changes we are seeing to try to make sure that being a GP is sustainable, and clearly things are starting to improve because a record number of people are choosing to become GPs.
Tom Tugendhat (Tonbridge and Malling) (Con)
The Minister for Health (Stephen Hammond)
My hon. Friend has been absolutely passionate about securing the best possible outcome for his constituents. As he knows, the Edenbridge War Memorial Hospital is held by NHS Property Services on behalf of my right hon. Friend the Secretary of State. Local NHS bodies in Kent are considering the future of services in the Sevenoaks area, including their nature and possible funding. I am sure that my hon. Friend will recognise that I cannot intervene directly, but I would be happy to meet him to discuss this further.
Oral Answers to Questions
Tom Tugendhat Excerpts(6 years, 7 months ago)
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Mr Speaker
The hon. Member for Tonbridge and Malling (Tom Tugendhat) has beetled into the Chamber like a perspiring postman just in time. It is very good to see the fellow.
Tom Tugendhat (Tonbridge and Malling) (Con)
The Secretary of State for Health and Social Care (Mr Jeremy Hunt)
We want all NHS patients to be able to access appointments in the evenings and at weekends. Thanks to our programme, 40% of the population currently do so, and that will rise to 100% next October.
Tom Tugendhat
Forgive me for rushing in; I was tied up with Committee matters.
My right hon. Friend has set out a great vision for the national health service over recent years, and I very much welcome it, but does he agree that, in local areas, some of the GP provision could do with a little more work? I am particularly thinking of West Malling in my own constituency where a large element of the community is finding it harder to get access, and there is a danger that the GP surgery may leave the high street.
Mr Hunt
My hon. Friend is right to draw attention to that issue. He does have, I think, 28 more GPs in the west Kent clinical commissioning group area than in 2010, but there is a particular issue over premises. The need to invest in premises is deterring younger GPs from becoming partners, and sometimes making GP surgeries unviable. We are looking at that problem now.
Hormone Pregnancy Tests
Tom Tugendhat Excerpts(7 years ago)
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Joan Ryan (Enfield North) (Lab)
I congratulate the right hon. Member for Hemel Hempstead (Sir Mike Penning) on securing this debate. Like many Members, I represent families who strongly believe that their lives were forever changed because of the drug Primodos.
Today I speak on behalf of my constituents Chris Gooch and her daughter Emma Gooch. They have given me permission to share their story about how hard life has been over the past four decades, their criticisms of the expert working group’s report, and why they will continue to fight for justice, and they are with us here today.
In June 1970, Chris Gooch was prescribed Primodos by her GP to find out whether or not she was pregnant. Like any of us, Chris trusted the words of her GP and had no idea that the drug might be unsafe, or that it had been linked to deformities. It was only when Chris’s daughter, Emma, was born seven months later on 28 January 1971, that she was found to have limb deformities in her hands and feet, with both sets of fingers foreshortened and her toes webbed and foreshortened. Her mum, Chris, told me about how Emma has struggled to live with those deformities for her entire life. She said:
“There are many things that Emma would have liked to have done, like playing the piano or guitar, but she has been unable to do so because of limited mobility in her hands. This also came to impact her education and at secondary school she became school-phobic and was physically sick every morning before going to school. Emma has always suffered from severe back problems and has to live in intense pain all the time. She has sought treatment and scans confirmed that she has spinal deterioration, for which she was offered a spinal fusion. This only had a limited chance of success and risked making her condition worse. Emma refused this and is trying to come to terms with her long-term prognosis. She can’t work full time, has to pay for all her medications and has even been refused a blue badge, despite having to use a stick to walk and having no proper fingers or toes. Emma will be 47 next month and can now only manage to work for three days a week and even this she finds extremely draining. She is worried about her ability to keep working in the future, and the implications this has for her financially and socially.”
When I met Emma, she told me:
“Myself and many others have to live with the devastating results of our mothers being given hormone pregnancy tests like Primodos. Whilst the effects on me were much less severe than on some victims, I was born with very specific deformities which I have only ever seen shared by fellow Primodos victims, so in my mind this can be the only possible cause.”
Tom Tugendhat (Tonbridge and Malling) (Con)
The right hon. Lady is speaking very powerfully. Does she agree that there are many who are not as severely affected as her constituent, about whom she speaks so courageously, but who are similarly affected and nevertheless feel great pain? I speak of people I have the privilege to represent.
Joan Ryan
I absolutely agree. Members across the Chamber today have given examples, but there are many victims with different levels of disability, illness and deformity as a result of this drug.
When I asked Chris and Emma what they thought about the expert working group’s report and how the inquiry process had been handled over the past three years, their criticisms could not have been clearer. Chris told me:
“I feel angry that they treated us like idiots. We have been treated appallingly. The Expert Working Group produced a report in October and then, following a meeting with our Chair, Marie Lyon, they removed some material and re-issued it a month later. They said it was to make it more readable. They found no causal link, which they weren’t even requested to look for. They only gave us a day’s notice to organise a visit to hear the report’s findings and I am sure that is because they hoped no one would turn up to hear them. Now nearly 50 years on, our children, the ones who are still alive, are still suffering. I am angry that for Emma, and for many other members of the Association for Children Damaged by Hormone Pregnancy Tests, life is a constant struggle and we still haven’t really been heard.”
Emma herself told me that she
“cannot help but feel angry that for decades we have waited for an independent and unbiased enquiry, but the Expert Working Group’s obviously flawed report feels like an attempt to discredit us and instead protect the powerful companies and authorities that were at fault.”
Since I was first made aware of the issues surrounding the drug Primodos, I have been reminded of the thalidomide and contaminated blood scandals. I am reminded of the fact that it took decades of tireless campaigning before the truth and natural justice were reached. The inquiry has been accused of failing to consider all the evidence fairly, failing to have the trust and confidence of the victims for whom it was set up, and failing to be transparent and open in its due process. The inquiry failed to consider any evidence regarding systematic regulatory failures of Government bodies at the time. Campaigners have widely dismissed the inquiry as “seriously flawed”. I therefore join the cross-party calls for a public inquiry into the use of Primodos and its connection to deformities and other birth defects. I shall end by once again quoting the words of my constituent Emma Gooch, as I believe that her determination will be shared by Members on both sides of the House. She said:
“Sadly it is too late for some, but the victims and parents still deserve justice and we will continue to fight for it.”