Accelerated Access Review

Alan Meale Excerpts

Tuesday 13th December 2016 Westminster Hall

[Several hon. Members]

rose—

[Sir Alan Meale (in the Chair)]

Six Members have made written requests to speak. Our plan, under the guidelines, is to bring in the Front-Bench spokespeople at 10.30 am, so we have little time left. If speakers and anyone making interventions are very succinct, we will get in as many Members as possible in this important debate.

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[Ben Howlett]

The right hon. Lady is quite right that pharmaceutical companies, in the rare diseases space in particular, find this country a very frustrating place to come to. The message that we are going to support the industry to bring drugs to market here is not loud and clear, and there have been a range of delays and process errors. I know that the Minister and previous Ministers have tried to address this issue, but it has been a very slow, difficult and arduous process, because the message has not been heard loudly and clearly enough.

The difficulty that Orkambi is currently facing in getting funded perfectly displays the problems faced by many other innovative drugs that aim to treat rare or genetic diseases. As chair of the APPG, I get contacted by many people across the country who are desperate to see potentially life-changing drugs approved by NICE. There is a clear deficiency in the process for this type of drug, so I hope that the Minister can today announce a pilot process to show that the UK is committed to leading in this field and providing hope for all those sufferers of rare and genetic diseases.

[Sir Alan Meale (in the Chair)]

Before we proceed, I say to Members that we are running very close to the line now. A number of Members have taken the trouble to write in and I need to try to call them all, so I ask each Member to restrict whatever they bring up to a maximum of five minutes, or hopefully less.

Social Media and Young People's Mental Health

Alan Meale Excerpts

Wednesday 2nd November 2016 Westminster Hall

[Alex Chalk]

That is absolutely right. At the end of my hon. Friend’s intervention, he hit on a particularly important point in mentioning the growing problem. Let us be clear: negative body image has long been with us. When I was growing up, the finger was pointed at hard-copy magazine publishers and the size zero models that were in those magazines, but once again social media have the power to magnify the impact.

Interestingly, a study compared the impact on women of Facebook images against those on a fashion website. It found that the former led to a greater desire among them to change aspects of their appearance. One can speculate about the reasons for that: is it because people think, “Well, I recognise that in a fashion magazine things may be airbrushed and stylised, but I do not expect that on a Facebook post,” so it is somehow more damaging? I offer that as a possibility but there may be plenty of others.

As well as body image concerns, there are issues about popularity and feeling inadequate. Anecdotally, it is clear that teenagers make a habit of comparing their own posts’ popularity with those of other people. We increasingly get the sense that young people fear that their existence compares unfavourably with others. Much—probably too much—gets read into the absence of “likes” or “views”.

Finally, there is the effect that social media have on sleep patterns. That might sound rather prosaic, but it is important. A study presented by the British Psychological Society in September last year in Manchester found that the need to be constantly available and responding 24/7 on social media accounts is linked to poor sleep quality. Research from the Headmasters’ and Headmistresses’ Conference that was tweeted to me this morning suggests that almost half—45%—of students admit that they check their mobile device after going to bed, and that a staggering 23% check it more than 10 times a night. The concern is not just that they turn up to school exhausted but that sleep deprivation is well known to be a trigger for depression.

I know that the Government are very mindful of that issue and that a lot of excellent work is being done to support parents and schools to help children to use social media safely. The Department for Education funded MindEd to set up a new site, MindEd for Families, which was launched earlier this year and which I have looked at. It provides free online advice on a range of mental health issues affecting children and young people; it includes, of course, a section on social media. This morning I read the Department’s advice sheet entitled “Advice for parents and carers on cyberbullying”. It is really helpful and very good. I also pay tribute to the fact that the Government are continuing to provide funding to the YoungMinds parents helpline, which is a national service providing free and confidential online and telephone support, information and advice.

That is all hugely welcome—there is great deal more as well, and I look forward to hearing about that from the Minister—but the fact remains that young people’s mental health does not appear to be moving in the right direction. Against that context, I will make two points. First, if we are going to maximise the effectiveness of our response, I believe we need a more thorough and scientific investigation of the causes, because although strong emerging evidence shows a correlation between social media use and declining mental health, the time has come to bottom it out with something more robust.

Back in February 2014, the House of Commons Health Committee launched an inquiry into child and adolescent mental health services. A subject it took evidence on was the impact of bullying and of digital culture. It recommended that

“in our view sufficient concern has been raised to warrant a more detailed consideration of the impact of the internet on children’s and young people’s mental health…and we recommend that the Department of Health/NHS England taskforce should take this forward”.

That was eminently sensible and I invite the Government to do so, if they have not already. Again, it may be that we will get more information, but I was a bit concerned that that view may not be finding favour, because in answer to a question from Lord Blencathra, the Government said:

“The Department does not itself conduct research, but funds research through the National Institute for Health Research…and the Department’s Policy Research Programme”,

which they said

“have not funded specific research into the possible mental and psychological impact on children of using Twitter and Facebook and have no plans to commission research on this topic.”

Of course, I entirely recognise that public funding is tight and we cannot fund every single project, but it seems to me that the sheer weight of the evidence is now sufficiently strong that it calls for that robust study to take place.

My next point echoes one that was made earlier: social media platforms need to face up to their responsibilities. We rightly hold headteachers accountable for bullying and abuse that takes place on their premises. Social media platforms also need to take their fair share of responsibility for what takes place on their own digital premises. Creating safety guides is not enough. Suspending people from Facebook or even expelling them is perfectly sensible in theory, but does it happen in practice?

As my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton), in an excellent debate last week, said about social media companies:

“They are huge companies employing many thousands of people, yet the numbers in their scrutiny and enforcement departments are woefully low.”—[Official Report, 27 October 2016; Vol. 616, c. 481.]

I am not here to beat up the social media companies. I think they do some important work and what happens is a fact of life, but I think they need to step up and face up to their responsibilities, because they have to recognise that they can be a force for good but that they can also be a force for something far less welcome.

In conclusion, social media are the phenomenon of our times. They have the ability to take all the ordinary experiences of growing up—the triumphs and disasters—and magnify them beyond anything we could ever have imagined a generation ago. They can create heroes in seconds, but they can crush people too. Their capacity to intensify bullying, enhance body anxiety and exaggerate exclusion is becoming increasingly clear. If we want a society that truly tackles those problems upstream, builds resilience in our young people and prevents as well as cures, the time has come to ramp up our response.

[Sir Alan Meale (in the Chair)]

This is only a 60-minute debate and seven Members of Parliament have written in to take part, if they can. As is laid down by the Chairman of Ways and Means, I have to provide the Front Benchers a total of 20 minutes of speaking time, which only leaves a short period for all the hon. Members who have indicated that they want to speak. Therefore, I will impose a time limit of four minutes per Member. If hon. Members go over that limit, I may drop the limit further.

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[Stuart Blair Donaldson]

rose—

[Sir Alan Meale (in the Chair)]

Order. Before I call Stuart Blair Donaldson, let me just tell you why you are being called last: because you intervened earlier and took some time. Do not think that your being new to the House goes against you in any way. You now have your four minutes.

[Stuart Blair Donaldson (West Aberdeenshire and Kincardine) (SNP)]

It is a pleasure to serve under your chairship, Sir Alan. As has been mentioned today, I speak as the youngest male MP and as someone who has grown up with social media—a digital native. I also speak as a vice-chair of the all-party group on body image and as someone with my own hashtag on Instagram—#instaMP, if anyone is interested.

I thank everyone who got in touch with me to share their stories and experiences of mental health and social media, particularly Vicky Kerr, who shared her dissertation on the subject. Social media can be a great tool in many ways, but platforms such as Instagram often portray a rose-tinted picture of a person’s life and can promote the idea of self-worth based on how many “likes” a picture gets.

The fact that young people can readily access at any time of the day pictures of famous people sharing their seemingly perfect lives can make them question their own self-worth. Additionally, the predominance of photos of those beautiful people present young people, mainly young girls, with a skewed vision of how they should look. The people they look at often look that way because of their job—they can dedicate time to it and will often have nutritionists, personal trainers and I dare say the odd bit of Photoshop. Most young people do not have access to such facilities, and famous people often do not acknowledge that they use them.

Constant exposure to those images and basing a positive self-image on likes can lead to significant deterioration in a young person’s mental health. In extreme cases, that can lead to the development of eating disorders such as anorexia nervosa or bulimia. That might be an over-simplification of a complex and serious illness, but the idealised body images so often portrayed in both conventional and social media have an effect on people at risk of suffering from it.

Unfortunately, social media often hinder rather than help people who suffer from significant mental health issues. Young people can often get caught up in eating disorder promotion on social media. Hashtags such as #thinspiration and #skipdinnerwakeupthinner allow people to connect and share tips on how to lose weight, purge and starve themselves. That makes the problems more severe and can have severe and tragic consequences. I have witnessed the devastating effects that losing a daughter to an eating disorder can have on a family, which is why I am incredibly grateful for the opportunity to speak in this debate and raise awareness—I wish I had more time to speak.

As a society, we could do a lot more to promote healthy body image and to talk about and be more open about our mental health, whatever age we are. I will leave Members with a quotation:

“The quickest way to get a bikini body is to put a bikini on”.

[Sir Alan Meale (in the Chair)]

Mr Donaldson, everybody gets worried and wants more time. Don’t worry about it.

[Dr Cameron]

rose—

[Sir Alan Meale (in the Chair)]

Dr Cameron, you have five minutes.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Alan. I congratulate the hon. Member for Cheltenham (Alex Chalk) on securing this important debate. I draw attention to the contributions made by my hon. Friends the Members for Neath (Christina Rees) and for Ogmore (Chris Elmore). There is not enough time for me to mention everybody who spoke because, as usual at the end of these short debates, we are tight for time, but I particularly thank the hon. Member for West Aberdeenshire and Kincardine (Stuart Blair Donaldson). He spoke of a painful experience, which is always so difficult to do.

Young people are growing up in an age in which online culture and social media are so central to everyday life. That is particularly true of social networking sites, to which more than 85% of children now belong. We have heard some interesting statistics relating to that throughout the debate. Commenting on social media and mental health, the Children’s Commissioner said:

“Excessive use of social media has been linked to poor mental health…When combined with bullying it can have a terrible effect.”

Consultant child and adolescent psychiatrist Dr Sebastian Kraemer gave evidence to the Health Committee as part of the inquiry into young people’s mental health mentioned by the hon. Member for Cheltenham. On the impact that digital culture can have, he said:

“It makes intimidation more alarming and more chronic. You can be teased in the playground and it has gone with the wind, but if you have got your photograph on Facebook then it stays there forever…The medium is not the cause, but it certainly facilitates different ways of harming each other, of abusing each other, and that is what young children do.”

Parents are seeing the link. In a survey of more than 1,000 parents with children under 18, four fifths blamed social media for making their children more vulnerable to mental health problems. It seems that the excessive use of social media can be linked to depression and can play a role in heightening underlying anxieties and lowering self-esteem—we have heard about some interesting cases.

These days, there is much concern about body image and appearance, which is another potential cause of anxiety and low self-esteem. It is clear that social media can intensify such feelings. A small study in the United States found that teenagers were affected by the “like” culture, with photos with more likes being more attractive to them. This like culture was found to affect self-esteem, as the hon. Member for Cheltenham and my hon. Friend the Member for Ogmore both said.

The damaging impact of social media has been seen as one of the causes leading to the increase in the number of children and young people self-harming in the past 10 years. ChildLine has seen a 35% increase in the number of contacts from young people with anxiety. That increase has been linked to the rise of social media, which has increased the pressure to attain a so-called perfect life. With increasing numbers of young people self-harming or being diagnosed with depression or anxiety, will the Minister tell us what action is being taken to understand the possible links between social media and depression, anxiety and other mental health issues? I agree with the hon. Member for Cheltenham that we need a robust strategy and some research that proves the links.

We have heard much about cyber-bullying, which is a growing problem, with more than one in 10 young people admitting they have been affected by it. We heard about Declan; I am very glad to hear that he has moved past the bullying phase that was so affecting him. Bullying UK found that 43% of young people aged between 11 and 16 had been bullied via social networks. Bullying has been found to be a factor associated with children’s mental health issues. One study reported by the Office for National Statistics found that children who had been bullied at 13 were more than twice as likely to have depression at age 18.

Stress and anxiety have also been linked to cyber-bullying. Will the Minister outline what action the Government are taking to tackle cyber-bullying and what measures will be put in place to help young people who are affected? Following the debate on young people’s mental health in the main Chamber last week, my concern is that help is not getting through to children before mental health problems escalate. Indeed, in 2015 the Children’s Commissioner found that one in four young people experiencing serious emotional or psychological problems were being turned away from specialist mental health treatment.

Early intervention can help. Lorraine Khan of the Centre for Mental Health said:

“There is good evidence for a range of interventions to boost children’s mental health, and the sooner effective help is offered the more likely it is to work.”

However, Government cuts to local authority budgets have meant the loss of services for children and young people. Cuts have been made to the numbers of social work staff and educational psychologists, and to mental health services in schools, leading to a reduction in care and support for young people. In the face of such cuts to early intervention and prevention services, will the Minister outline what steps are being taken to develop better early intervention?

From pressures about body image to cyber-bulling and the pressures caused by social networking sites, it is clear that we need to do more research on the impact that social media are having on young people’s mental health. Although Ministers have pledged extra funding for mental health services, we know it is not reaching the front-line services that children and young people need. Schools and colleges must be supported to help their students to cope with the challenges of online culture that we have heard about in this debate. The internet and social media are clearly here to stay, so it is vital that the Government ensure that young people receive the help, support and guidance that they need in this digital age.

[Sir Alan Meale (in the Chair)]

Before you begin, Minister, may I ask you to be so kind as to consider leaving up to a minute at the end of your speech for Mr Chalk to sum up?

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

I shall do my utmost, Sir Alan. It is a pleasure to serve under your chairmanship.

I congratulate my hon. Friend the Member for Cheltenham (Alex Chalk) on securing this very important debate. Contributions have at times been distressing, but they have been hugely important. He is right to raise awareness about the impact of social media on young people’s mental health. I thank all constituents and colleagues who have bravely allowed their stories to be shared today; it does have an impact and it is important.

As the hon. Member for Strangford (Jim Shannon) said, in recognising the harms that are occurring on social media, we must not reject the positive role that social media can play. Instead, we have to put social media in their place and know that, like any tool, their impact is dependent on how they are used. How we use social media depends on our intentions, for good or ill, and on our skills.

For the disfranchised and those without a voice, social media have provided a powerful medium for advocacy and outreach, and at times messages that would not otherwise have been heard have found a global reach. Even for the most vulnerable groups, the evidence shows that by no means all influences on social media are negative, and that only a minority of people will use social media to exploit and harm others.

The Samaritans undertook a consultation as part of its Digital Futures project, which looked at how people use online sources in relation to suicidal and self-harm content. The study found that, as well as negative experiences, those who took part in the research also highlighted using the sites to build peer networks. Three quarters of those who took part said that they looked for support online.

If we can harness the power of online platforms, we can use them to deliver the effective prevention interventions that many Members have called for, to raise mental health awareness, and to provide advice and support. Indeed, many of the support organisations that help our young people and adults who experience emotional challenges and issues of poor mental health have a presence on social media. As the Minister with responsibility for public health and innovation, that is something I must encourage.

As constituency MPs and Members of this House, we can all cite examples of social media platforms being used to inflict harm, whether through grooming or cyber-bullying, or of the anxiety and low self-esteem caused through hyper-use, which some Members have described. The Government reject the laissez-faire attitude that says this is all just an inevitable by-product of our connected world and shrugs its shoulders. No child should be groomed, bullied or harassed online, or simply left without the skills they need to critically and sensibly engage with social media.

That is why we are working in partnership with industry, the community and schools to address the challenges. New technology and social media continue to be misused to exploit and target the vulnerable. We have been clear that we expect social media companies to respond quickly to incidents of abusive behaviour on their networks. We have robust legislation in place to deal with internet trolls, cyberstalking and harassment, and perpetrators of grossly offensive, obscene or menacing behaviour. We are absolutely clear that these are crimes, and will be treated as such.

The Child Exploitation and Online Protection Centre has available various resources, which can be accessed via its website. The “Thinkuknow” programme has web resources to educate and empower young people at risk of sexual abuse and exploitation. I hope that some of them may access that if they are watching the debate. We know that the worst cases of bullying, including cyber-bullying, can lead to serious depression and even thoughts of suicide. A recent study by the national inquiry into homicide and suicide found that bullying—the sense of there being “no escape” was articulated by many colleagues—was a factor in the suicide of children and young people. I particularly thank Declan, the constituent of the hon. Member for Glasgow South (Stewart Malcolm McDonald), for allowing his story to be told and may I say how sorry I am that he had to go through that experience. We know that we must do better.

That is why all schools are required by law to have a behaviour policy and measures to tackle bullying in all forms among their pupils. Schools are free to develop their strategies, but they are clearly held to account by Ofsted. That is also why the Government Equalities Office announced £4.4 million of extra money to tackle bullying, and why over the next two years four anti-bullying organisations will go in to support schools to tackle bullying and to improve the support that is available. In particular, the GEO has invested £500,000 in the UK Safer Internet Centre to provide advice to schools and professionals on how to keep children safe, and a further £75,000 in CEOP to support a national roll-out of Parent Info, which is delivered through schools, to stop parents feeling helpless because they are not digital natives. It is a free service and helps parents to show their children how to use the internet and mobile devices appropriately.

We are also working with the UK Council for Child Internet Safety, which brings together 200 organisations to form the digital resilience working group to take forward work to equip children and young people to identify and respond to risks online, including cyber-bullying and negative influences.

We know, as colleagues have said, that young people, as well as their parents and carers, continue to feel the impact of unrealistic representations of body image, which have a pervasive impact on social media. My hon. Friend the Member for Cheltenham may be aware that the Government launched a body confidence campaign in 2010, which publishes a regular progress report on how we are addressing negative body images to tackle the very “compare and despair” trap that he so rightly highlighted. I agree with him about the importance of prevention and resilience building. A great deal of work is under way to try to target the sources of online abuse and harmful content upstream, at source.

Central to tackling the challenges posed by online bullying, exploitation and self-image will be supporting young people, as well as those who care for them, to build resilience. This year, Public Health England’s £337,000 Rise Above campaign is intended to do just that, building the resilience of young people by providing online information and tackling issues that include body image and online stress.

Alongside supporting young people in developing resilience, we know that parents and schools have a role to play in preventing mental ill-health, and we will continue to work with the Department for Education to improve mental wellbeing in schools, and to support children and teachers in addressing mental health issues through educational resources and by providing single points of contacts for mental health in schools.

My hon. Friend rightly highlighted the good work of the DFE in developing the MindEd web-based tools for children and parents. We are looking for ways in which those tools can be developed further to support local areas and to improve online contact.

Underpinning all of that is the need to tackle the stigma around mental health in all areas of society. That is why we have increased funding for Time to Change, which is our national anti-stigma campaign, to ensure that young people are confident in coming forward to get the help that they need. Underpinning all of that is our programme to reform and improve mental health support for young people. That is why we have increased investment in mental health to £11.7 billion, and local clinical commissioning groups are required to increase spending on mental health each year. That is part of a holistic strategy to improve key areas of mental health services, such as perinatal mental health, services to tackle eating disorders and better crisis care resolution in the community, as laid out in “Future in mind” and “The Five Year Forward View for Mental Health”, so that we can give young people with mental health problems the care and support that they deserve.

My hon. Friend was right when he said that we need to have the proper research in place, because this is an emerging area. That is why the Mental Health Taskforce asked the Department of Health, working with relevant partners, to publish a report by February 2017 to set out a 10-year strategy for mental health research. The final 10-year strategy planned for publication will identify the needs of mental health research. It will include a specific focus on the mental health of children and young people.

We know that there is much more to do and my hon. Friend is aware that the Lords Select Committee inquiry into children’s access to and use of the internet is currently under way. We are watching that closely and will look at its recommendations about online safety and the role that the Government, regulators and media companies can play to protect our children online because we know that more needs to be done.

We recognise the challenge of social media for young people up and down this country. We are determined to do our part to equip them with the tools they need to meet that challenge, not only in terms of their mental health but to protect them online, to make them more resilient and alert to the risks, and to make them confident digital natives who can critically and sensibly harness the power of digital tech for good.

[Sir Alan Meale (in the Chair)]

I call Alex Chalk to sum up—briefly.

Alcohol Consumption Guidelines

Alan Meale Excerpts

Tuesday 28th June 2016 Westminster Hall

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The hon. Gentleman talks about the alcohol guidelines as social engineering, when they are actually designed to bear down on the health harms from alcohol consumption. How can he call it social engineering when the Government are trying to ensure that our fellow citizens are healthier and live longer?

[Sir Alan Meale (in the Chair)]

Order. Before the hon. Gentleman resumes, it pains me to do so but I have to point out that it is not in order for the Front Bench spokesperson to participate in questioning. The hon. Member for Hackney North and Stoke Newington (Ms Abbott) will get time to sum up for the Opposition at the end.

[Byron Davies]

I am grateful for that guidance, Sir Alan. The proposed new guidelines do not reflect the full international evidence base on alcohol and health, and actively downplay decades of epidemiological evidence that shows the protective effects of low to moderate drinking against cardiovascular disease, stroke, type 2 diabetes and cognitive—

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[Sir Alan Meale (in the Chair)]

I have a few guidelines for Members before we continue. We have overrun quite a bit, and we are now scheduled to conclude at 6.27 pm. It is normal practice to give a couple of minutes to the mover at the end to wind up, with the Minister getting 10 minutes and the two Opposition spokespeople five minutes each, which takes us to 6 o’clock. We do not have much time left for Back Benchers, but there is sufficient time for Members to get their message across.

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[Andrew Griffiths (Burton) (Con)]

It is a great pleasure to serve under your chairmanship, Sir Alan, and to address the issues raised by my hon. Friend the Member for Gower (Byron Davies). They are hugely important issues and he got into the detail of them.

I am also pleased to take part in a debate with the Minister, because she has worked really constructively with the industry during her time in office. The work that she has done in lowering the alcohol by volume in drinks, as a result of working closely with the industry, has taken a billion units out of consumption. That shows that constructive working can have a huge impact on the nation’s health and the nation’s drinking habits.

I should declare an interest as the chairman of the all-party group on beer, and colleagues should see my entry in the Register of Members’ Financial Interests; I am also the patron of a drug and alcohol rehabilitation centre in my constituency. I want to see a healthy drinks industry and a healthy population, and those two things are not mutually exclusive.

In Government, we used to have something called “the nudge unit”, to try to persuade people and help them to make the right choices. However, we are seeing “Project Fear” in this approach and we saw in the referendum that that approach simply does not work. At a stroke, we have made 2.5 million people problem drinkers. Let me tell the tale of my auntie, Irene. She died at the age of 88. Before she died, she used to enjoy a bottle of Mackeson Stout every evening. According to these guidelines, she was a problem drinker. That is what we have done. These guidelines are so against the grain of the way that people live their lives that we risk people ignoring them and ignoring other advice, and going on regardless, so that the guidelines become absolutely pointless.

For instance, Sir Alan, you will be surprised to know that according to these guidelines the Minister can drink exactly the same amount of alcohol as my right hon. Friend the Member for Brentwood and Ongar (Sir Eric Pickles). I have never been drinking with the Minister, but that does not seem to make any sense at all. Size, and the way in which men and women absorb alcohol at different rates—none of that is being taken into consideration.

It is interesting that in a written answer to my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) the Minister said that, although we have specific guidelines on calorie intake for men and for women—that guidance is differentiated—we do not have them for the intake of alcohol. That just shows that there is absolutely no sense in the way this guidance is being proposed.

My hon. Friend the Member for Gower referred to the concerns that exist about the way this report was drawn up and about the organisations that took part in the research, including those involved in the temperance movement. I am also concerned that in a written answer to my hon. Friend the Minister wrote that

“The National Institute for Health Research has awarded funding to The University of Sheffield… to evaluate the new drinking guidelines.”

That is a case of people marking their own homework, and we should all be very concerned about that. There are real concerns about the rigour with which this information has been compiled and we risk people turning off and not taking any notice, which could damage the health of the nation.

I realise that other Members wish to speak and that time is pressing. I appreciate the efforts that the Minister has made to work with the drinks industry, but this guidance came as a bolt from the blue. The industry knew nothing about it. There was no consultation. Nobody from the alcohol industry was involved in peer-reviewing the evidence, so I hope that we will reconsider. I realise that it is an independent report, but I urge the Minister to reconsider the validity of the evidence, because it just does not stack up.

[Sir Alan Meale (in the Chair)]

Before I call the last two speakers, I should inform you that, as I said before, we will have to start the winding-up speeches at five minutes past 6, so if you can, please share the time remaining.

Lewy Body Dementia

Alan Meale Excerpts

Tuesday 26th April 2016 Westminster Hall

[Sir Alan Meale (in the Chair)]

Could hon. Members leave quietly? We are about to start the next debate. I would be grateful if you could remove yourselves swiftly and quietly.

[Conor McGinn (St Helens North) (Lab)]

I beg to move,

That this House has considered awareness and recognition of dementia with Lewy bodies.

It is a pleasure to have secured this debate, under your chairmanship, Sir Alan, on dementia with Lewy bodies, or DLB as it is known, and as I will refer to it henceforth. May I start by congratulating the Minister on his very significant achievement on Sunday in completing the London marathon? Well done to him for the moneys that he raised for his charities. In the same vein, it is with some pride that I declare that I was recently appointed an ambassador for the Lewy Body Society, a charity whose mission is to raise awareness of DLB among the general public and educate those in the medical profession and decision-making positions about all aspects of the disease, as well as to support and fund research into it. For 10 years, the LBS has raised awareness, provided support and information, and funded research into DLB, which is the second most frequent cause of age-related neurodegenerative dementia. I am delighted that some of those involved in the campaign are in Parliament today.

It might be helpful if I say a little about DLB. Lewy bodies are abnormal aggregates of protein that develop inside nerve cells in Parkinson’s disease, DLB and some other disorders. They were first discovered by Dr Frederick Lewy as far back as 1912, but incredibly, despite that, DLB was virtually unknown until the late 1980s, when advances in techniques made it possible to identify Lewy bodies under a microscope.

Every case of DLB is as individual as the person living with it. Different people show different combinations of symptoms. At present, a diagnosis of DLB can be confirmed only by autopsy, but a careful clinical evaluation of the patient and their symptoms can in many cases form the basis for making a reasonably confident lifetime diagnosis. There are also technological advances in imaging and research into biomarkers that it is hoped will result in earlier and more accurate diagnoses.

The central symptom of DLB is dementia, which is defined as progressive mental decline that is serious enough to interfere with normal daily activities such as eating, washing, dressing, cooking, shopping and managing finances. Significant memory loss may not develop until later. There may also be problems with executive function in respect of attention, problem solving and spatial awareness. This can easily be mistaken for Alzheimer’s disease.

Additional symptoms that may lead to a diagnosis of probable DLB are, first, disturbances in REM—rapid eye movement—sleep. The impact of that on a family carer is terrible. The carer is unable to sleep themselves and therefore becomes unable to support the person with DLB. REM sleep is the deep sleep in which people dream. A certain amount of good, REM sleep is necessary for people to function efficiently. DLB sufferers may talk in their sleep or act out their dreams. Sometimes that is so marked that the sufferer falls off the bed.

Secondly, there is severe sensitivity to neuroleptic drugs. Sometimes people with DLB are prescribed neuroleptic—antipsychotic—drugs to help with their symptoms. That should be done only by someone experienced in the illness, as many of those drugs can be extremely harmful or even fatal to people with DLB. That problem has been recorded.

Despite the importance of correct diagnosis and treatment of DLB, the disease is often not recognised, identified or diagnosed.

IVF: Welfare of Women

Alan Meale Excerpts

Wednesday 20th January 2016 Westminster Hall

On resuming—

[Sir Alan Meale (in the Chair)]

The debate may continue until 4.42 pm but could conclude before then if circumstances permit.

[Jane Ellison]

If the debate has to conclude early, which would be a great shame, I shall certainly undertake to write in detail to the hon. Member for Mitcham and Morden, to respond to the various points she made in her speech.

As I was saying, thankfully, very severe incidents for women undergoing IVF are very rare. There are more than 60,000 cycles of IVF each year, and around 150 to 200 instances of what would be regarded as more serious incidents. That represents 0.33% of all cycles. To put that in context, in 2013-14, there were four grade A incidents that involved a serious threat to health, while in 2012-13 there were none. It is helpful to explain that.

It would also be helpful for me to put on the record that ovarian stimulatory drugs are generally self-administered after being prescribed, and each patient is given instruction from the clinic with appropriate warnings about side effect symptoms to be aware of. Patients are monitored at the clinic through regular ultrasound scans and blood tests to check how the ovarian stimulation is progressing and to look out for any signs of OHSS.

I note the suggestion from the hon. Lady about amending the Human Fertilisation and Embryology Act 1990 to require the UK regulator to collect data on the dosage of drugs prescribed to women during fertility treatment and birth rates and information on any adverse outcomes for the patient. That proposal would also place a duty on all fertility clinics to consider the welfare of women proposing to undergo these treatments. It is important to put on the record that drug dosage levels do not determine the risk to individual women of OHSS. Patients react differently and individually to the same dosage levels, so it is not possible to identify those who may be at the highest risk of an adverse reaction.

In response to the suggestions made, I want to stress that all clinicians have a general duty to consider the welfare of patients when deciding whether it is appropriate to offer any treatment service. The 1990 Act also requires that same assessment to be made of any child born as a result of fertility treatment and any existing children who might be affected by it.

The prescription of stimulatory drugs is not an activity regulated by the HFE Act 1990, as amended, or by the HFEA. Prescribing is a matter for clinical judgment, taking account of professional guidance, of which there is a considerable amount, and the individual circumstances of the patient. All patients who undergo ovarian stimulation as part of their IVF treatment are given information on the symptoms to look out for and are advised to contact clinics immediately if they suspect they may be developing the condition. That includes being given contact details for out-of-hours arrangements, so that they can report immediately. In addition, it is a requirement under the 1990 Act that a woman shall not be provided with treatment services unless she has been provided with information relevant to the treatment, including the potential side effects, and a suitable opportunity to receive counselling about the implications.

Although the HFEA does not collect data about the overall incidence of OHSS, clinics are asked to report treatment cycles to the HFEA where a cycle has been abandoned due to there being a risk of the patient developing OHSS. All severe cases of OHSS must be reported to the HFEA as a serious adverse incident. Depending on the nature of the incident and the patient outcome, the HFEA will either expect an incident report from the clinic or will conduct an incident review itself. The HFEA publishes a detailed annual analysis of the data it receives, and information is also available on the HFEA’s website on outcome rates for each clinic, including information on live birth rates as a percentage of embryo transfers.

I reiterate that the administration of drugs is a matter for clinical judgment. The HFEA’s code of practice advises licensed fertility clinics to provide women seeking treatment with information on the likely outcomes of the proposed treatment and the nature and potential risks of that treatment. That includes the risk of children conceived having, for example, developmental defects, as well as the potential side effects and risks for the woman, including OHSS. That requirement is examined as part of the HFEA inspection regime. The HFEA also asks to see a clinic’s OHSS management protocols before a licensed renewal inspection, so it is part of the regulatory process for each clinic.

In its fertility guidelines, the National Institute for Health and Care Excellence advises clinics that they should inform patients about any potential long-term safety implications associated with IVF. That includes specific reference to limiting the use of ovulation induction or ovarian stimulation agents to the lowest effective dose and duration of use. In addition, the HFEA code of practice sets out the expectation that clinics should follow relevant and appropriate professional guidance in the care of patients, which obviously includes NICE guidance. Clinicians must have the clinical discretion to make decisions about the care of individual patients, taking account of their individual circumstances.

I want to give the hon. Lady assurance about some of the work the HFEA has in the pipeline. In its business plan, the HFEA sets out an intention to increase focus on learning from incidents and adverse events through, for example, publication of a report on clinical incidents between 2010 and 2012; dialogue with the sector about how best to learn from incidents and adverse events; and exploring, with professional groups, whether more data need to be collected better to understand factors contributing to ovarian hyperstimulation syndrome, in order to reduce its incidence. That is in the HFEA’s business plan, which is publicly available.

I would like again to thank the hon. Lady for raising this important and complex subject. I understand and appreciate the concerns she rightly has about the possible impact on women’s health of a reaction to stimulatory drugs during the process of fertility treatment and the consequences. However, I believe that the existing UK regulatory system is second to none in its approach to safeguarding women’s health. I am assured that, within its statutory and regulatory remit, the HFEA is taking proportionate action.

I know that the debate must end here, Sir Alan, so I will write to the hon. Lady with responses to additional points made in her speech.

Question put and agreed to.

Hand Hygiene: NHS

Alan Meale Excerpts

Wednesday 13th January 2016 Westminster Hall

[Nigel Mills (Amber Valley) (Con)]

I beg to move,

That this House has considered hand hygiene in the NHS.

I am grateful for the chance to raise these concerns. It is a pleasure to serve under your chairmanship, Sir Alan. I secured this debate to highlight some important issues. The germs that cause infections are spread to patients primarily on the hands of healthcare workers, so cleaning hands is the No. 1 way of reducing the spread of infection. Guidelines and rules are already in place, but they are not followed closely enough and the inspection regimes do not do their job and do not produce meaningful data about hand hygiene compliance levels. This serious issue has a dramatic effect on the health of many thousands of patients a year. For many of them, it could be avoided. There is a way of dramatically improving this issue for patients.

The data on this issue are scary. The 2011 prevalence survey showed that 6.4% of hospital patients—one in every 16—contracted an infection while in hospital. Imagine going to a restaurant where one in 16 customers was made ill by the food. No one would go back again; we would not allow it to stay open. But that is what the data showed for our hospitals five years ago. We should not be willing to accept that.

Infections contracted in hospitals affect 300,000 patients every year and cause 5,000 deaths. They have a dramatic impact on those individuals and a significant impact on the NHS, because patients who contract such infections remain in hospital on average two and a half times longer than patients who do not. They spend an average of 11, and a maximum of 25, extra days in hospital at an estimated cost of about £1 billion a year. It is estimated that 30% of such infections can be avoided simply by better applying the existing rules and practices.

The NHS must improve its performance on this fundamental issue. We should not be willing to accept that level of unnecessary infection. I am not saying that such infections are caused by people deliberately not washing their hands enough. They probably do not realise what they are doing, and their behaviour is not corrected. I suspect that most people in the NHS do not realise how many times they should wash their hands when they see a patient and do not know that they are not doing all they can. I am sure most people are extremely keen to do everything they can to fix this problem and prevent such infections. We must look at what more we can do to put systems in place and enforce them. We should give people support, training, peer pressure and peer reviews to ensure it is happening, rather than blame individuals. This issue will become increasingly important as the problem of antimicrobial resistance grows. We cannot rely on antibiotics to fix such infections and tackle the problem, so it is important that we stop the infections in the first place and prevent the situation from getting worse.

I want to talk about the existing hand-washing rules, the systems for monitoring them and why they do not work. I will look at some things that can be done to improve the situation. I hope the Minister will accept that I do not intend these ideas to be controversial or costly; they are ways of enforcing the rules that are already in place and of using the existing systems.

There is a generally accepted international standard for the number of hand-washing moments when nurses and doctors treat patients. It is not controversial; all nurses and doctors are taught it as part of their training. It is an accepted standard in the NHS and most hospitals around the world. I am not asking for a super gold standard for the UK. I do not want to create anything new, different or complicated. That set of moments when hand-washing is needed is accepted by everybody; it is just a question of how many of them are acted upon.

The National Institute for Health and Care Excellence put in place rules for hospitals to assess compliance with that number of hand-washing moments, so we do not need a new framework or a new duty on hospitals. Hospitals already have a duty to assess how well their staff comply with the rules for the five hand-washing moments when they deal with patients. When the Care Quality Commission audits hospitals, it checks how well those rules are enforced, so the systems are there but they are not working and we are not getting the outcomes we ought to have.

One of the problems is that hospitals check the compliance of their staff mainly through observations carried out by a member of staff on the ward or a member of the team. Normally, a nurse who happens to have half an hour spare one day is asked to review how well her colleagues are performing the five hand-washing moments. If I am doing a job and someone tells me, “Right, today you’re being observed on these criteria,” my performance goes up a bit because I know I am being observed and I do everything I can to comply—far in excess of my normal behaviour.

Another issue is that the staff members conducting the review are not trained in how to do it. They may not be entirely familiar with how many hand-washing moments there are or how many arise in the care of patients, so there is a combination of effects. If the people reviewing their colleagues, perhaps their friends, have not been trained to do so—they are not specialists—and are not fully familiar with the rules, it is not surprising that we do not end up with the most reliable data.

The vast majority of the observations show that the nurses and doctors observed are somewhere in the high 90s for compliance, which means they clean their hands more than 96% of the time, as they are meant to. The problem is that independent assessments carried out by people in a more reliable way suggest that compliance is significantly lower. Those data suggest that the actual compliance levels are somewhere between 18% and 40%. There is a set of rules and a system for checking compliance, but it is producing a dramatic false positive. It suggests that we are in the very high 90s for compliance, when we are nearer 20% compliant. It overstates the results by a factor of nearly five, with the terrible effect that there are more infections than there need to be and patients are suffering.

The NHS and other international health bodies accept that the levels of compliance with the hand-washing rules in the high 90s cannot possibly be right. Everybody knows they are false positives, but they give excessive reassurance to the boards of trusts that their staff are compliant, so further action is not taken. Everybody accepts that there has been progress in recent years in tackling infections, which have been reduced from even higher levels. The measures that were adopted to tackle infections had an effect on clostridium difficile and MRSA, but the problem is that we do not track instances of other infections, so it is hard to get data on how many are being tackled.

There have been various studies to try to assess levels of hand hygiene compliance to see what can be done to improve it. I am grateful to the Deb Group, one of the large employers in my constituency, which has an interest in this issue because it makes hand hygiene gel. It has some innovative ideas about how we can monitor hand hygiene compliance. I am grateful for the information it gave me for this debate. I should be clear that I am not advocating any one solution or product; we need a greater recognition in the NHS that this is an issue, and that there are better ways of assessing compliance. We need to encourage greater compliance.

As for recognition of the issue, Sir Mike Richards, the chief inspector of hospitals at the CQC, has highlighted the inaccuracy of local hand hygiene audits, so one would think that action is required. If we recognise that hand hygiene is important and if we recognise that we are nowhere near as compliant as we ought to be, one would think that many hospital trusts would be taking action to try to improve the situation. Sadly, that is not the case. Trusts have a lot on their plates and there are many issues, financial and others, to deal with, so they may decide that an area with compliance levels in the high 90s is not a stone that they want to turn over. They may fear that some proper audits might lead to the discovery that they are only 25% compliant and thus incur some unnecessary wrath.

However, the experience is that hospitals that take the matter seriously do get positive feedback. The CQC report on Burton Hospitals NHS Foundation Trust, which was in special measures until last year and is not too far from my constituency, highlights its use of a method to count the number of hand hygiene moments and the number of times ward staff were complying with the rules. It received some positive feedback in the letter from the chief inspector of hospitals in the report, which states that the hospital was using

“innovative practice to increase hand hygiene, using the latest technology monitoring the use of alcohol in sanitising gel.”

They were not marked down for having discovered an issue; they were complimented. The report states:

“We saw innovation in practice on ward 11 (male surgical ward) where the infection control nurses had worked with staff to reduce infection control risks and increase hand hygiene. The team implemented technology which counted the use of alcohol sanitising gel and compared it against the target of how often it should be used. This was in response to hand hygiene audits which needed improvement.”

On action that the trust must take to improve, the report states:

“The trust must ensure that ward assurance targets, such as hand hygiene practice and recording of patient observations, is achieved at a consistent level in the emergency department.”

We can see from that that if hospitals take the matter seriously, recognise that they are not as compliant as they ought to be and take action, that helps them in these audits.

The big ask here is what more we can do to ensure that CQC reviews identify that hospitals are perhaps fooling themselves into thinking that they are compliant when they are not. Perhaps asking, “Are you really doing accurate and competent monitoring of whether your staff are complying with the hand hygiene rules? Do you have any independent assurance that that data is accurate or are you just relying on surveys done in an idle half an hour by a member of staff who is not really trained, which can produce false positives?” should be a regular feature of all inspections. Work done over a long period to improve levels of hand hygiene compliance in hospitals has produced data showing that when hospitals improve performance and increase the number of hand hygiene moments, infections decrease at a pretty similar rate to the increase in hand hygiene moments. Data exists in the public domain that shows that that is not just a coincidence. If a hospital can increase compliance, infection rates can come down, improving outcomes for patients and reducing costs to the NHS.

My suggestion is not particularly complicated or expensive. It would not lead to the creation of new rules or new burdens that people have not been trained for. I am simply asking that hospital trusts around the country comply with the rules that are already there and monitor whether their staff are complying with the standards that they have been trained in. The NICE guidelines could be tightened up so that hospitals must not only monitor whether staff are compliant, but do so in a competent, independent and impartial manner and not rely on the occasional untrained observation by members of the same team.

When the CQC goes around hospitals assessing cleanliness and patient safety, we should expect it to check whether competent work has been done. If it has not, it should encourage and instruct hospitals to take the matter seriously. When hospitals show higher than average instances of infections, it should check that they took this issue seriously and that the relatively simple and low-cost measures that can be taken to reduce infection were applied. When hospitals are not doing that, it should be regarded as a serious issue.

There are many things in health that we cannot control or fix or that are incredibly expensive, but what we have here is a set of rules that already exist. It is a simple thing that most people are trained in. By doing everything that we can to comply with it, we could save a lot of money and a lot of patient suffering. There is the potential for real improvement. I hope the Minister will accept that this is a serious situation, and that there is more that NICE and the CQC can do and more that hospital trusts can be expected to do, so that the prevalence of infections in the next report is at the lowest possible level.

[Sir Alan Meale (in the Chair)]

As the debate is only an hour long and we have three quarters of an hour remaining, I want to inform Members that I intend to call Back Benchers first, then the Front-Bench Spokespeople and then the Minister. I will call the Back Benchers who stand.

--- Later in debate ---

[Jim Shannon (Strangford) (DUP)]

It is always a pleasure to serve under your chairmanship, Sir Alan. It was especially nice to hear the hon. Member for Amber Valley (Nigel Mills) introduce the debate, and it is good to participate in it. I would like to give some personal knowledge and put forward some viewpoints.

I congratulate the hon. Gentleman on so succinctly setting the scene for the rest of us to follow. To add a bit of background to the debate, patients in the NHS today have a 6.4% chance of catching an infection in UK hospitals. There are 300,000 healthcare-acquired infections annually, of which 5,000 result in mortality. We cannot ignore the mortality rate—5,000 people dying in our hospitals is 5,000 too many. If the figure was one, that would be one too many. If we can take steps to prevent those deaths, we should do so.

Although our figures are below the European average, many other developed countries perform better, including the United States at 4.5%, Italy at 4.6%, Slovenia at 4.6% and Norway at 5.1%. I know that the Minister will address that in his response, but if the States, Italy, Norway and Slovenia can do it better, I am sure that we can achieve their levels, which would be a two percentage point drop or thereabouts from our current figure.

Not all healthcare-acquired infections are preventable, but it is believed that approximately 30% of them could be avoided by better application of existing knowledge and realistic infection control practices. Hand hygiene is an essential component of that.

I remember when my brother was in an accident. He liked racing motorbikes, but unfortunately 11 years ago he had a very serious accident that resulted in him being in a coma and in intensive care for some 19 weeks, followed by 2 years of rehabilitation. Whenever we visited him in the Royal Victoria hospital in Belfast, we all had to wash our hands. He was not able to respond to us at that stage, but his family and other people who knew him wanted to go and see him because of the severity of his injury. The nurse was clear: she said, “You have to wash your hands every time you go to that bed, because the risk of infection for someone in that extreme circumstance is very real.” Every time we left the bed and went outside the ward, we had to wash our hands before we went back to the bed—that was clearly outlined.

To me it was clear: we do that because we want to visit the person in the bed, but we may unwittingly have infections on our hands. The hon. Member for Bridgend (Mrs Moon) spoke earlier about sneezing. Unwittingly, we cover our mouth with our hand and then rub our hands. Then we might stick our hands in our pockets and rub them on the pockets. Even when using a hanky, there will still be infection on the hands. That is the point I am trying to make. It is clear that we have to do something.

The infection prevention and control sector claims that basic hand hygiene standards are not being met on many NHS wards. If that is the case, a clear guide needs to be given to those on wards to ensure compliance. The Deb Group claims that although 90% to 100% compliance with hand hygiene standards was reported by UK hospitals—it is easy to say that—the true figures are between 18% and 40%.

As health is a devolved matter, I have asked the Minister responsible for health back home questions on MRSA infections in hospitals, because even though we have few infections, it is clear that something needs to be done. Back home—it is probably the same elsewhere—many would say, “If you’re ill, be careful in hospital, because you have people with open wounds and people whose immune systems are down. If you bring in your colds, flus and coughs, or whatever it may be, that can have an impact.”

Deb also argues that the data collection method is flawed and that direct observation artificially inflates compliance, as nurses observe colleagues meeting the requirements and undertake a tick-box exercise. There needs to be more than that. NICE issues guidance on hand-washing in hospitals and encourages strict hand-washing practices, but it does not include a demand that accurate data be recorded. We want to ensure that that happens. If we record the data, we are making an effort and, if we are doing that, we are washing our hands. There may be some weight to Deb’s concerns, and that should be extremely worrying for all of us.

Good hand hygiene practice in hospitals is the single most effective way to prevent the spread of infection, and we should take action to ensure that more effective records of hand-washing on NHS wards are made in future. That is a simple yet effective way of making our hospitals safer, and with the recent growth in antimicrobial resistance we need to act sooner rather than later to ensure that poor hand hygiene does not further increase the severity of HAIs.

We have had an extensive hand hygiene strategy in Northern Ireland since 2008, and although some problems persist—in all honesty, we cannot stop all infections—we have seen results from simply adopting a thorough hand hygiene regime in our hospitals, with education on the importance and effectiveness of hand hygiene being an essential part of the Department of Health, Social Services and Public Safety’s regional infection control strategy. Like in Scotland and in some individual trusts, we are taking action to address the issue.

Accurate records are the starting point for addressing the problem. There are many examples across the world, but a recent three-year pilot in a hospital in South Carolina in the United States of America found that once staff were trained in how to use electronic hand monitoring systems, compliance with best practice increased and MRSA rates dropped. That saved the hospital $433,644 from April 2014 to March 2015. There was therefore also a financial advantage, and although that is not the reason to do it, it is an example of what can be done to stop infections and address costs.

As we seek to have a more streamlined and cost-effective NHS, those are the sorts of approaches we need to look into. Indeed, the introduction of such a system at Burton Hospitals NHS Foundation Trust drove up hand hygiene compliance by up to 50% in just three months. That is an example from this country, which shows what we can do if we put in the effort.

With 5,000 people dying each year as a result of HAIs, it is clear that action must be taken. With resistance to antimicrobial treatment increasing, we need to get on top of the issue before it is too late. Hand hygiene is the simplest and most effective way to do that, so let us make sure hospitals are doing that right and doing it well.

[Sir Alan Meale (in the Chair)]

We now move to the Front-Bench Members, and we have only until 5.30 pm. I therefore ask Members to be succinct. Minister, if it is possible, could you give a minute or so at the end to the Member who moved the motion to allow him to wind up the debate?

Nurses and Midwives: Fees

Alan Meale Excerpts

Monday 23rd March 2015 Westminster Hall

[Mr Anderson]

That is central to the discussion. I have been struck by the fact that nurses who are relatively well paid and work full time will have to pay exactly the same registration fee as those who work short hours. That may make things quite comfortable for the NMC’s bureaucracy, because the organisation will know exactly how much money it will have, but it does nothing for people who are worried about where the next pay packet is going to come from. My hon. Friend is right to say that it is a real problem.

[Sir Alan Meale (Mansfield) (Lab)]

From my hon. Friend’s contribution to the debate so far, it is clear that a poll tax model has been adopted in respect of the gathering of funds for the Professional Standards Authority. Doctors and dentists will be paying the same fee as nurses. Does he not think that that is quite unfair, given the wage structure in the national health service?

[Mr Anderson]

That seems unfair to me, as it does to the nurses. As I will try to bring out in the debate, the important thing is not only the money that people are paying—for some, that is a real issue—but the value for money that they receive. Two years ago, the Government had to step in and give the NMC £20 million to prevent a fee increase. Of course, the nurses and midwives welcomed that, but it means that the taxpayer is subsidising the NMC because it has failed to do its job properly. My hon. Friend is right to say that there is an imbalance in what it is doing.

[Sir Alan Meale]

It is about not only the position but the numbers. There are far more nurses and midwives than doctors and dentists. The fee increase is disproportionate and quite unfair.

[Mr Anderson]

The fee increase is disproportionate, but the numbers of disciplinary and fitness-to-practise cases are also disproportionate. As we will hear, the number of nurses facing fitness-to-practise issues is grossly more than the number of doctors facing such cases. That means there is less money to spend on education and training to increase registration standards for nurses, which is what we all want.

Nurses lose at every level through the way in which the system is run. The review was not just about people saying, “Please don’t make me pay more money”; it was about, “Can we have a root and branch investigation into how this organisation is run? Can we make it run better? Can we make it run in everyone’s interest?”

--- Later in debate ---

[Mr Anderson]

My hon. Friend is obviously reading my mind, because that is the point that I was going to come on to next. She is absolutely correct that part-time workers, who are mainly women, are being hit disproportionately because they are in part-time work, and there could well be equality issues around that.

The decision to increase fees will have a catastrophic impact on nurses’ and midwives’ future decisions, which will have a direct result on work force planning and patient care. At present, 30% of nurses and midwives in practice have protected pension rights, so they are eligible to retire at 55 with their full pension. Many do that, and, after a brief period of absence, return to part-time practice. That has gone on for decades and is something that the health service has welcomed and plans for.

I have been told by many people who work in nursing and midwifery that it would not be economic for them to return to work after they retire if registration fees rise and continue to do so. That was borne out by the Unison survey, which found that 51% of respondents would not return to practice if fees increased. That would be a double whammy for the health service. We would lose people with experience who were prepared to come back to work part time; they will not do that because of that block put in front of them.

We already have a chronic shortage of supply of nurses and midwives in the UK, which is made worse by the Government’s decision to cut the number of nurses and midwives in training. That shortage is demonstrated by the increasing numbers being recruited from Europe. A reduction in those returning to practice will have a devastating impact on patient care. It is essential that service and staff implications are taken into account by the NMC and the Government. Without that, it will be impossible for the NHS to plan its work force properly.

On revalidation, the NMC ignored the heavy opposition it received and decided to go ahead with its proposal to increase fees regardless. For any nurse or midwife whose registration payment is due by the end of February 2015 or later, the new fee applies. The bodies and unions sought reassurance from the regulator that fees would not increase further, but the NMC has offered no guarantees about coming years.

Later this year, the NMC will introduce a new revalidation process for registrants, which will place additional requirements on those who wish to stay on the register and continue to work. I support the work on revalidation, and I know colleagues on the Health Committee have been critical of the failure to move faster on that, but many nurses and midwives are concerned that those changes could result in further fee increases. It is not clear what the cost impact will be.

[Sir Alan Meale]

The papers that I have read make it clear that the NMC gathers most of the PSA’s funds, yet it seems to have little say in its budget. Does my hon. Friend agree that that is probably the main reason for the re-evaluation?

[Mr Anderson]

Absolutely. I will come on to discuss the PSA before I sit down, which my hon. Friend will be glad to hear will not be long now.

Professional bodies and trade unions are working hard with the NMC to ensure that the development and introduction of the new process is as successful as possible and that lessons are learnt from the pilot sites. That process will be extensive and require significant efforts from registrants, but it surely cannot lead to further unjustifiable fee increases for hard-working midwives and nurses.

The NMC could take measures to prevent future fee rises for registrants, but it is not the only one that should beheld responsible. The Government could have taken measures to reduce further fee increases, but they chose not to.

First, the NMC has the most unwieldy legislation of all regulators despite being the largest. By contrast, the General Medical Council and the Health and Care Professions Council have more flexible legislation, which allows them to be more efficient and cost-effective. That prompts the question: why should midwives and nurses be treated differently from doctors and occupational therapists?

In April 2014, the Law Commission published a draft regulation of health and social care professionals Bill, which included reforms that would have helped the NMC keep costs down. If implemented, the draft Bill would offer the NMC the opportunity to speed its processes up and give it flexibility to amend rules without having to seek Parliament’s permission.

The Mid Staffordshire NHS Foundation Trust public inquiry called for regulators to focus on promoting safe, compassionate care, rather than intervening only after patients have suffered harm. The draft Bill would have allowed the NMC to focus more resources on education, effective registration and promoting professional standards, which would have done exactly what the inquiry called for. Currently, it is impossible for the nine health regulators to work together: there are nine different pieces of legislation, nine different codes of conduct and nine different fitness-to-practise procedures. It is not clear to me why we are treating health workers differently when the main objective of all health regulators is surely the same—public protection.

The draft Bill would enable and require regulators to co-operate more closely with each other, which would ensure consistency. It would help the NMC and all the regulators to keep their costs down collectively. However, this Government failed to include it in the Queen’s Speech, which meant it could not be debated or passed into law. It would be interesting to hear from the Minister what he thinks of that decision.

Registrants should not be punished for the Government’s failure in that respect. Likewise, the NMC should not use it to justify or push through any future fee increases. The NMC has joined representatives of patients’ groups, nursing and midwifery professional bodies, and trade unions to call on politicians, such as us here today, to commit to introducing the draft Bill to reform health care and its professional regulation.

In addition, following a review in 2010, the Government decided that the Professional Standards Authority, the body responsible for the oversight of the health professions’ regulators, would no longer continue to be funded by the Government and the devolved Administrations. Instead, the review recommended that the PSA should be funded through a compulsory levy or fee on the regulatory bodies that it oversees. So, rather than consult on whether there should be a levy or on who should pay it, the Government decided to consult on how the PSA levy on the regulatory bodies should be calculated. Rather than saying, “Should we do it?” they said, “How will we pay for it?”

Professional bodies and trade unions quite rightly argued against this levy; it is another hammer blow for the people working in the service. However, their concerns were ignored by the Government who, in their response to the consultation, decided to determine the fee based on the number of registrants that a regulator has. Again, this unduly disadvantages the NMC, which will bear a disproportionate amount of the cost because, as I said earlier, it is the largest regulator in the world. Based on the current size of the NMC’s register, the first £1.7 million levy to the PSA equates to £2.50 per registrant. The upcoming fee rise has already resulted in 12.5% of this additional sum effectively going straight to fund an external organisation, which is doing nothing to protect the public or to help to educate or protect the staff working in the service.

Because the NMC has no other source of income, these costs will almost inevitably be passed on to registrants, who include some of the lowest-paid professionals regulated by the health regulators. As I said before, approximately 90% of the NMC’s registrants are women, so the PSA levy will have an adverse impact on equality, as the hon. Member for South Down said. Also, many NMC registrants work in part-time roles, and so frequently they are not high-income earners. If the NMC is forced to increase the annual registration fee in order to pay the PSA, which in some respects it already has, that will have an impact on equality, as those in this group will be financially worse off. The poorest will pay the most, which is not unusual under this Government.

Over the years, all the NMC’s efforts have been directed at dealing with fitness-to-practise cases. This has had a detrimental impact on the level of service provided by the NMC to its registrants. For example, the NMC has failed to provide effective and up-to-date guidance on key issues, and there has been a lack of professional advice to registrants who have queries or concerns about how to interpret the requirements of or guidance on the code of conduct. Given the overwhelming, and appropriate, focus of professional regulation on public protection, and the diminution in professional advice, it could be argued that it is unfair to expect registrants to continue to bear the sole financial burden of the NMC’s professional regulation activities.

Furthermore, if the body overseeing the regulators is funded by the regulators, the public will lack confidence. Consequently, the funding arrangement for the PSA, which is based entirely on registrant funding, is flawed. At a time of ongoing financial austerity, the additional bureaucracy is undesirable, particularly when there are already existing mechanisms to scrutinise and hold regulators to account, for example, the annual accountability hearing by the Health Committee, which enables the people in this building to scrutinise what the regulators are getting up to.

For these reasons, I urge the Government not to implement the levy on the nine health regulators, and for the Government and the devolved Administrations to continue to fund the PSA until it is included in the draft Law Commission Bill.

It is appalling that the NMC decided to increase its fees despite the heavy opposition from hard-working nurses and midwives. It is tough enough to be a nurse or midwife without having to be penalised for coming to work. They are working in an increasingly difficult environment, which has been made worse by public sector cuts, chronic understaffing and continued pay restraint that means their pay is lagging well behind cost of living increases. If the NMC’s fees continue to increase, it will result in nurses leaving the profession, exacerbating existing problems in the health system, which is already struggling to cope.

To ensure that future fee increases are not made, it is essential that the following steps are taken. First, the NMC should undertake a full review of all fitness-to-practise referrals that do not proceed to a full hearing, and use that information to sit down with the employers and trade unions to ensure that all referrals to the NMC are in the interest of patient safety and public protection, and not just an excuse for employers to carry out internal disciplinary procedures. That would have a positive impact by reducing the number of referrals and the overall cost thereof.

Secondly, the NMC should shift resources into promoting awareness and the development of guidance that would help registrants to understand better how to act within the NMC’s code of conduct in their practice. That would help to reduce the number of fitness-to-practise referrals, which would be a win-win for everybody concerned.

Thirdly, the NMC should consider a reduced fee for new registrants, part-time workers and those nearing retirement age, to reflect better registrants’ income throughout their careers. There should be a phased fee for all concerned.

Fourthly, the Government should not implement the PSA levy on regulators and should continue to fund it centrally, at least until it is included in the draft Law Commission Bill.

Finally, the draft Law Commission Bill must be given adequate parliamentary time by the next Government to be debated and passed, to enable the NMC and other health regulators to reduce costs, in the interests of all concerned.

We count on nurses and midwives every day.

--- Later in debate ---

[Grahame M. Morris]

I agree wholeheartedly. All across the country—certainly in my area—efforts are made, and have been made consistently, to recruit good quality staff. Often recruitment is done overseas, with adverts being placed in newspapers in countries that train good quality nurses and midwives, but have a surplus. It often strikes me as bizarre that although we have a reservoir of women returners, we not making it as easy as possible for them to return. Doing that would be in the interests of the service and of the country. It would be a false economy to continue doing what we are doing.

[Sir Alan Meale]

I am here today because my sister is a midwife and has been a nurse all her adult life. This is not just about times of restraint and restrictions on pay; there has also been a thorough re-grading of the whole nursing and midwifery system throughout the UK, which has already re-graded many nurses to lower grades than previously. They are experiencing a double whammy, and this is the third time they have been hit with a fee rise. We should not approve it.

[Grahame M. Morris]

I am grateful for my hon. Friend’s intervention. That is another excellent point, well made. Pressures are being placed on the NMC, including increases in its costs, that are placing a greater strain and burden on nurses and midwives. The Government have to recognise that. I know that my hon. Friend the Member for Blaydon has reservations about whether the Government supporting the NMC with one-off grants would impact on its impartiality. I do not think that should necessarily follow. We should recognise the considerable pressures being placed on it financially, not least those arising out of public concerns and the recommendations of the Francis report. We want the public to be confident that the profession is properly regulated and that the fitness-to-practise procedures are operating properly and effectively. However, I agree with my hon. Friend. There was a ministerial statement last Thursday regarding untoward practices highlighted in a report, including bullying of staff and so on, in a hospital in east London—I think it was the Barts Health Trust. If fitness-to-practise referrals are being used by employers in that way, it is reprehensible and is adding to the strains and pressures on the NMC.

The latest fee increases are being imposed on nurses and midwives who were extensively consulted about them. My hon. Friend mentioned the overwhelming numbers: 96%—many of us would be over the moon to have that as a vote of confidence in the general election—voted against those recommendations. However, it seems that the consultation served little purpose, other than to antagonise nurses and midwives, because the Nursing and Midwifery Council has, apparently, taken little or no regard of the views of NHS staff and has pressed ahead with the fee increase.

The Nursing and Midwifery Council has also failed to provide any assurances that the latest increase will not be followed up by further increases in coming years. As my hon. Friend the Member for Mansfield (Sir Alan Meale) mentioned earlier, if we are to encourage people to come back into the profession, they have to know that the regulator has a reasonable, cost-effective process in place. The Nursing and Midwifery Council stated in evidence to the Health Committee last year that it had introduced an

“annual formal review of the fee level”,

so it is not necessarily an ongoing commitment. However, we have to ask: why has there been such a huge increase, of more than 50%, in a relatively short period?

Clearly the Nursing and Midwifery Council must meet its statutory obligations. We would expect that as Members of Parliament—and the public would certainly expect that—for maintaining professional standards. Certainly more needs to be done to remove the constraints it faces through the fitness-to-practise process—a number of hon. Members have highlighted that—which is too costly. Seventy-seven per cent of the Nursing and Midwifery Council’s income of more than £70 million is being spent investigating less than 1% of the nurses and midwives on the register. That is an incredible sum of money, and I find it difficult to comprehend how that can be an efficient use of resources.

The Nursing and Midwifery Council is making progress—I recognise that, and certainly the Committee recognised it, although it said it thought the progress was “fragile”. The NMC recognises past failures—not least in IT systems—and is seeking to overcome some of them, but it is clear that further improvement is required. An assessment by the Professional Standards Authority for Health and Social Care—the organisation that oversees all the professional regulators—has found that the Nursing and Midwifery Council is failing to meet seven of the 24 standards of good regulation. By any measure, I would suggest that there is still a long way to go in bringing it up to standard. Of those seven failures, two relate to fitness to practise.

While it is important that improvements continue to be made, it is wrong to expect nurses and midwives to bear the burden of the costs by themselves, particularly when we have seen the value of their pay fall in real terms over the life of this Parliament. The Government cannot sit idly by and allow continual increases in fees without taking action or giving some guidance. We hear Ministers time and again praising the hard work and dedication of nurses, and I hope the Minister will do that at the conclusion of the debate. Nurses do an amazing job in the most difficult circumstances, but when it comes to pay, pensions or professional fees, the kind words of Ministers seem to be rarely followed up by practical action that would help NHS staff.

In conclusion, I hope the Minister will say what steps he is taking to support the Nursing and Midwifery Council to ensure that it can continue to drive through the improvements we all want to see without having to increase the fees and the cost of employment for nurses and midwives. I also hope that he will address the points made by my hon. and right hon. Friends on the need to speedily bring forward the law commissioners’ sensible and well thought out proposals on the NMC. I would be interested if he could explain why they have not been brought forward before now.

Royal National Orthopaedic Hospital (Stanmore)

Alan Meale Excerpts

Wednesday 4th March 2015 Westminster Hall

[Bob Blackman (Harrow East) (Con)]

It is a pleasure to serve under your chairmanship, Sir Alan, in this vital debate that is important not only locally in my constituency, but nationally. The Royal National Orthopaedic hospital in Stanmore is a national and international institution par excellence. I will use a quote that I gleaned when doing some research. The RNOH delivers

“Outstanding clinical outcomes for patients”

in premises that are

“not fit for purpose—it does not provide an adequate environment to care and treat patients.”

I and the staff of the hospital could not have put it better. That is a direct quote from the most recent inspection by the Care Quality Commission in August 2014.

The hospital premises were built during the second world war to house airmen who were defending our shores and to ensure that facilities were available to treat our brave soldiers, airmen and seafarers returning home. Sadly, we still have the same premises that existed during the second world war. I want to put on the record my tribute to the brilliant work that is done by all the medical staff, all the clerical staff and the entire team who provide facilities and services at the hospital. Many charities that are associated with the work of the hospital also operate from the site.

I wanted this debate today because I took the then shadow Secretary of State for Health to Stanmore in January 2010 to see the hospital at first hand. He gave a commitment to the board, the staff and everyone associated with the hospital that, were there to be a Conservative Government after the election in May 2010, the hospital would be rebuilt.

Just before the election, in March 2010, the then Secretary of State for Health, who is now the shadow Secretary of State for Health, announced funding for the redevelopment. It is fair to say that immediately after the election, when hon. Friends discovered there was no money left at the Treasury, I had to work very hard with civil servants and elected politicians at the Treasury to ensure that the promised funding for the rebuilding of the hospital was safeguarded in the emergency Budget that took place immediately after the election.

Here we are now, four and a half to five years on, and there has been very little progress on the rebuilding work. The trust that runs the hospital—I have worked with the board of the trust and others—has responded to every question posed by the trust development authority. It seems almost impossible to get through the positively Kafkaesque process of repeated reviews. The only beneficiaries of that process are the management consultancy firms. Patients and the medical staff have not benefited one iota.

I believe—I stand to be corrected if this is not so—that some £75 million has been spent on management consultants. It has not been spent on the consultants who treat patients, but the people who come and do management studies. I think that that is a disgrace and a waste of public money. All 13 independent reviews have concluded that the orthopaedic hospital offers excellent, high-quality, world-class care. The CQC has rated outcomes as “outstanding”, and the trust is regularly in the top 10% of all hospitals in respect of infection control and friends and family tests.

All independent reviews concerning the hospital’s geographical location have concluded that there are no better alternatives to having the hospital on the Stanmore site. All independent reviews concerning the financial risks associated with the redevelopment have concluded that the Stanmore site development offers the best value for money and that no “more affordable” option is available.

In the meantime, the future of the trust continues to be reviewed, debated and deferred. As I have said, more than £70 million of costs have been incurred, with a severe waste of money on project fees of £20 million, maintenance costs of keeping these rotten buildings going of some £15 million and the lost efficiency opportunity of some £35 million. In this modern day and age, that cannot be right.

By way of background, the hospital is a centre of international expertise in the diagnosis and treatment of neuromusculoskeletal conditions, which include acute spinal injury, bone tumour and complex joint reconstruction. This centre of expertise is not replicated anywhere else within the national health service. It has the largest spinal surgery service in Europe, with a third of UK spinal scoliosis surgery and two thirds of specialist nerve injury work being carried out on the site.

Some 95% of patients rate the care as “good” or “excellent”, and 90% of staff and patients would recommend the hospital to their friends or relatives. The hospital was the longest-standing in London with no MRSA infections in the past five years. Without question, this hospital delivers services and medical treatment that are the best in class. The clinical excellence and innovation are beyond doubt. The problem is that the buildings were built to last for a limited period, but that has stretched to 70 years. It cannot be right that we insist on brilliant medical staff operating in substandard conditions that would shame the third world.

We need to ensure that the rebuilding takes place. I understand completely that the health service has a process for business cases and has to offer value for money. We would all support that in principle. However, as this is a specialist hospital of international renown, it has a special place within the national health service. Successive Governments and the health service have prevaricated on the future of the RNOH for decades—literally 30 years. We have to have a different, more proactive approach to resolve the problem. It is clear that the board that runs the trust will have to conclude at some stage that it can no longer offer safety to patients in the substandard conditions in which it operates.

The creditability of the Government, the national health service and everyone involved is on the line here. Political leadership is required to ensure the best interests of patients and taxpayers. I look to my hon. Friend the Minister for some suitable answers, because this has been going on publicly and privately for the past five years that I have been involved, and, before that, for the past 30 years.

So the RNOH has a track record of delivering financial and performance targets. It responds time and again, updating and revising financial plans and risk assessments and refreshing commissioner support. Every time the board responds, it appears that we do not move forward, but backward. That cannot be allowed to continue and we must reach an appropriate arrangement. We need an innovative and alternative financing option—that is not encouraged through the current NHS process—to ensure that the hospital is delivered.

We should be clear that the key to resolving this matter is the top-up of public money by capital or a loan of some £20 million. It should be understood that the board will build a private hospital alongside the NHS hospital, and that will generate income. The board will also sell off land for housing development, which the area needs, but the board takes the sensible view that it will realise the land receipts gradually as the need arises for the programme’s funding. That will maximise their value and provide a decent level of housing in the local area. Both those things have been positively embraced. The RNOH and the trust development agency have been developing the outline business case since September 2014. In March 2015, we are still waiting to see whether it will be approved and action taken, so that the redevelopment can take place.

It is time that the Department of Health acknowledged that highly specialist hospitals and providers such as the RNOH need a different approach from that taken with the generality of NHS providers. It cannot be right that a super, specialist organisation with such excellent results is denied facilities for the want of a relatively small amount of public money.

In summary, the RNOH is a vital national provider of treatment for the most complex orthopaedic conditions and the rehabilitation for people with life-threatening conditions, such as spinal cord injuries. It does vital work on the innovation of new treatments, leading-edge research and development, the manufacture of state-of-the-art prosthetics and the training of future orthopaedic specialists. The hospital has treated many famous individuals, including Lord Tebbit’s wife after the Brighton bombing and Princess Eugenie. Moreover, the RNOH recognises the financial constraints it operates within and has continuously demonstrated that mitigations to affordability risks are available. Demand for services grows every day. Major land sale receipts will be available. Planning permission is in place; there is no hold-up on that. Housing and employment for the local population will be increased by the proposal, and major private patient income will come in.

The RNOH has a track record of delivery against every target that it has ever been set. It has responded time and again to the requirements of the TDA and every other aspect of the health service. It is clear that every time there has been a step forward, there have been two steps back. Every time proposals have come forward on alternative financing options, we have just ended up spending more public money. If that £75 million had been invested in the project, we would now be looking at new hospital facilities on the site. We would have first-rate, world-class facilities for world-class medical professionals.

No one believes that anyone wants to see the facility closed down, but the reality is that the Department of Health has to move forward and instruct the TDA to abandon the position that it has adopted, so that the RNOH can move forward to development. If we do not do that, we might as well close the hospital. That would be an absolute tragedy for all the specialists, medical staff and patients. By bringing those services together, the medical professionals have developed world-class techniques and an ability to cure individuals of very serious problems. Indeed, the medical staff of the RNOH provide national and international services way beyond the bounds of the hospital. I urge the Minister to give us some good news and to ensure that we get the funding required for the hospital to be rebuilt and for facilities to be provided for the brilliant staff, who do a brilliant job for the patients.

[Sir Alan Meale (in the Chair)]

Before you begin, Minister, I want to pass a message on. Generally when debates are answered in this place, the Parliamentary Private Secretary is present. There was not a PPS in the last debate or this debate, and that might happen in the next debate, because I see the Minister for it standing by. When a PPS for the Minister is not present, it is usual for someone from the Whip’s Office to be involved. Sometimes mysterious pieces of advice appear from other places and have to be passed forward to the Minister. When those people are not present to do that, we have to rely on House of Commons staff. They have enough to do, and we should try to help them where possible. I am not saying that it is anything to do with the Minister, but I would be grateful if he could pass that expectation on to the Whips or the PPSs.

Newark Hospital

Alan Meale Excerpts

Monday 7th January 2013 Commons Chamber

[Patrick Mercer]

The answer to that question is, of course, Lincoln, but it is by no means true that all the serious cases in Newark go there. I shall say more about that shortly.

Let me continue my brief history. Last autumn, Monitor delivered a devastating report on the private finance initiative and on Sherwood Forest Hospitals NHS Foundation Trust, which includes King’s Mill and Newark hospitals, drawing attention to serious financial problems. It pointed out that Newark hospital was underutilised by 55% at times, that it was closed for admissions after 6 pm, and that many members of the board had resigned as a result. There is no doubt that good has come of that, but on top of all those difficulties, East Midlands Ambulance Service NHS Trust has decided to close Newark ambulance station. I shall say more about that shortly as well.

Where does the problem lie at the moment? First, let me nail a couple of misapprehensions. I am sure that the Minister will not be surprised by my raising them. First, in certain malicious quarters in the town, rumours—more than rumours—have been stoked that the hospital will close. I do not believe that it will close; I see no reason for that to happen. Indeed, Chris Mellor, the new acting chief executive of Sherwood Forest Hospitals NHS Foundation Trust, has made it clear that if the hospital does close, it will be a liability for the next 28 years no matter what, because there can be no withdrawal from the PFI in which Newark hospital is engaged with King’s Mill. Secondly, we still hear forlorn and ill-informed voices talking about the reopening of an A and E unit. No one who understands the problem could think for a minute that Newark will have an A and E unit. That really is not the issue at hand, and, given that the subject will no doubt arise during our continuing conversations, I want to reassure the Minister that, in my opinion at least, it will not happen.

Since the new team has taken over—and I appreciate that it is only a temporary team—some refreshing views have been expressed following the hammer blows of last autumn’s Monitor report. For instance, Eric Morton, who is running the administration of the hospital, albeit temporarily, has responded to a request from me and others for Newark’s minor injuries unit to receive further resources, so that it can at least provide level 2 critical care and become a sort of MIU-plus or A and E-minus—the terms are confusing—and we can be seen as comparable with smaller towns and, indeed, towns of similar size, such as Worksop and Grantham. I have suggested that if a clinical case can be made, there is no reason why such a system should not be introduced at Newark—why, in other words, our services should not be improved.

The GPs with whom I have had some interesting friction over the last couple of weeks—constructive friction, I hope; I say that with the greatest respect to those GPs—have a rather different view. They think that the system would be extremely difficult to implement. I do not know; I cannot judge. I am not a doctor, a clinician or a medical man of any sort. I should greatly appreciate it if the Minister gave me his unequivocal but detached view on exactly how realistic the proposal is, bearing in mind all that I have said about the increasing size of the town, the fact that there seem to be no plans to increase the size of the hospital in line with that, and the fact that it sits on major routes, both rail and road, which are always susceptible to the mass casualties which we see frequently during the year.

[Sir Alan Meale (Mansfield) (Lab)]

I congratulate the hon. Member for Newark (Patrick Mercer), whose tenacity on this issue is well worth the effort and appreciated by many of us who reside in the area covered by the Sherwood Forest trust. I have been closely involved with the trust for many years, and his description and analysis are honest and probably mostly correct. I believe that the Newark part of the trust has been let down badly in recent years by the reorganisation, and his description of the situation that led to the resignation of most of the trust’s board some time ago was an exact and correct one. I assure him that I and other colleagues in the north of the county will do whatever we can to support his effort not only to keep Newark hospital open, but to build on the services that are required for the growing population in that part of Nottinghamshire.

[Patrick Mercer]

I am most grateful to my hon. Friend who sits on the Opposition Benches. His view is always valued by me and certainly by the people of Newark. I have tried to keep politics out of this, and my stand has been consistent under the last Government and this Government. I really appreciate his comments, because this issue, more than anything else, stands above party politics.

One of the benefits of having an upgraded minor injuries unit is that more cases could be dealt with in Newark. GPs and others would be more willing to send patients to Newark, rather than hospitals some way away from the town, and this will have a direct effect on availability of the ambulances—their reaction times and their number—needed to cover Newark and the rural areas. For instance, if we ensured that the transfer times for all green 1 to 4 and urgent minor emergencies could be covered locally, the effect would be felt by East Midlands ambulance service right the way across Nottinghamshire.

That brings me neatly on to the point about EMAS and the service it provides, particularly in Newark town and the rural area. As well as all the other difficulties I have mentioned, which the Minister will recognise, we are currently going through a consultation about exactly how the ambulance service in Newark should be reconfigured. The ambulance service’s boss, Mr Phil Milligan, has helpfully admitted that the ambulance service is not performing to the necessary standard and that there are difficulties with EMAS, particularly in the Nottinghamshire area. The details are there to be seen.

I ask the Minister to look carefully at the need, or otherwise, for a hub inside or adjacent to Newark and at the positioning of the two community ambulance points that we are being promised, again either in or adjacent to Newark. We can have the best hospital in the world in Newark, but, unless we have an ambulance service that can take people with whom it cannot deal quickly, effectively and properly to other hospitals, the health care model will not work. That lies at the heart of the two issues here: the upgrading of the MIU and provision of further critical services, and the improvement —not continuation of the status quo—of the ambulance service. Those two major issues, with all their interlocking threats, lie at the heart of the problem of health care across the Newark area.

It is not all doom and gloom. I visit the hospital regularly—I there last on Christmas day and shall be there again on Friday—and am always impressed by the nurses, doctors, support staff, ambulance drivers and clinicians who deal in Newark. Anybody treated in Newark will say that we have an excellent hospital and that the services it provides are second to none, but we must not allow it to dwindle. When I visit, I am always impressed to find people from Lincolnshire and Derbyshire who are electing to be dealt with in that hospital. That raises the question why, when King’s Mill hospital runs out of beds, as it has over the past couple of months, it is not the customary practice for patients to be taken straight to Newark hospital. Surely if the money follows the patient, too many Newark patients are being taken “abroad”, with the money being paid out to different health trusts around and adjacent to ours, including to King’s Mill. Why does the arrangement not work properly in the other direction? That is exactly the point Chris Mellor made to me when he took over in his new job.

There is no doubt that improvements have been made: a bus service now runs between our hospital and King’s Mill; and we have reopened what used to be called the Friary ward, providing extra beds, particularly for the elderly. Those good things have to be celebrated, not sneered at, as certain individuals in the town have done. I look forward to such improvements being replicated throughout the hospital and in the different authority—the different aegis—of the East Midlands ambulance service.

I also look forward to the meeting that the Minister has kindly agreed to have with me on 4 February—it might be on 5 February, but we will tie the date down. I am grateful to him for that, and I have no doubt that we will talk and talk about these issues. However, I hope I can leave him in absolutely no doubt about the isolation that many of my constituents feel in respect of the hospital. The resources of the hospital and its ability to cope with the sick, the halt, the lame, the deaf and the blind have been seriously diminished over the past couple of years and perhaps even longer. To that end, I ask him not only to address these specific points, but, if he has the time, to visit Newark. I would like him to talk to not only the staff of the hospital and the ambulance service, but to the people of Newark, so that he can gauge for himself how strongly we feel about the hospital, how close it is to our hearts and how we hope it will continue to improve in the future.

Adult Social Care

Alan Meale Excerpts

Thursday 8th March 2012 Commons Chamber

[Sir Alan Meale (Mansfield) (Lab)]

I congratulate the hon. Member for Truro and Falmouth (Sarah Newton) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) on their tenacity in securing this debate. Hon. Members from all parts of this House should give them credit for their hard work and effort.

In this important debate, I wish briefly to raise the issue of people suffering from autism and Asperger’s syndrome. As hon. Members will be fully aware, those conditions are extremely serious. Both are lifelong disabilities and they affect sufferers in a number of different ways. I fully accept that some people who have either of those conditions are able to live semi-independent lives, with only partial support, but others—indeed most—need a range of specialist support throughout their lives. Although they do not represent everybody who needs adult social care, I am not talking about a small number of people. Approximately 1% of people in the UK have autism, and they and their families account for at least 2 million involved citizens in the UK, which represents, on average, approximately 3,000 people in every constituency in Britain.

Yet, even given those numbers, the National Autistic Society says that sufferers routinely struggle to access the services they need and that when they do access them the outcomes are largely poor. NAS research also shows: two thirds of all adults with autism say that they do not have enough support to meet their needs; more than 60% of these adults rely absolutely on their families for financial support, with approximately 40% of them having to live at home with their parents; and only 15% of people with autism are able to find full-time work.

Failures to provide such support are also very expensive to the ordinary taxpayer. According to the National Audit Office, if local services supported only 4% of adults with high-functioning autism, that would be cost-neutral, and if they supported only 8%, that would save the Government at least £67 million a year. As a number of hon. Members have said, the Dilnot commission on funding of care and support stated a number of good things, in particular that the present system was both unfair and underfunded. It called on the Government to increase spending on social care and to limit the cost and charges for those who need it.

The report’s key recommendations included the need for national eligibility criteria, with all those who enter adulthood with health and social need being eligible for free state support immediately rather than being expected to pay themselves. This is where I have a slight difference with the Minister, who said that it is not only about money. For many people who come to my surgery at their wits’ end, it is about money. Indeed, even those who had money do not have very much left in their late adulthood to spend either on themselves or on their loved ones, so money is very important.

In conclusion, I believe that the adoption of the Dilnot recommendations would lead to an entirely fresh approach that would deliver greater awareness of autism, and in particular of the sufferers’ needs, care and, of course, support. It would also put in place measures to relieve the short-term crisis in funding in social care.

[Mr Robert Buckland (South Swindon) (Con)]

The hon. Gentleman is quite right to raise important statistics about people with autism, but may I urge him, when he speaks passionately about it, not to refer to people as suffering from the condition but rather to acknowledge that they have the condition and have great potential and that what we should all be doing through the care system is ensuring that they realise that potential? Does he accept that?

[Sir Alan Meale]

I fully understand the direction that the hon. Gentleman is coming from, but let me just say that I am the son of a permanently and seriously disabled person and he was that way all of my life. I also served as a board member of the Portland training college for the disabled in Nottinghamshire and have been deeply engaged in matters connected with the seriously disabled for years. Believe me, when I use the terms “suffering” and “sufferers”, I mean them not in a derogatory sense but to highlight the plight of the people who I am talking about.

In conclusion, I believe that adopting Dilnot would put in place measures to relieve the short-term crisis in social care funding and, most importantly, establish sustainability for care and support in the longer term.