Ambulance Services and National Heatwave Emergency

Alex Chalk Excerpts

Wednesday 13th July 2022 Commons Chamber

[Maria Caulfield]

I am sorry that the hon. Lady did not hear my response. I specifically mentioned social care as well as the integrated care boards that we have set up to bring health and social care together—I think Labour Members voted against that. As I said, one factor affecting ambulance delays is the bed occupancy issue. Part of that—not all of it—is about delayed discharges and lengths of stay are 16% higher. We have a plan for fixing social care and it is unfortunate that Labour Members voted against it.

[Alex Chalk (Cheltenham) (Con)]

Cheltenham General Hospital’s A&E was saved from a trust plan to close it, thanks to the fantastic support of more than 20,000 of my constituents. Does my hon. Friend agree that, in addressing the enormous challenge of the demands we face, capacity is important as well as flow through the system? In the light of that demand, the decision of the trust, and indeed the Government, to keep Cheltenham’s A&E open has been vindicated.

[Maria Caulfield]

I am pleased that my hon. and learned Friend is already seeing the benefits of the A&E in Cheltenham staying open. He is very modest—I am sure he played a significant part in ensuring that it stayed open. This is absolutely about capacity and there is no magic bullet that will make the pressures on the ambulance and emergency services any easier. This is multi-faceted and capacity at A&E is crucial. I am meeting the ambulance trusts to find out where good practice is making a difference, so we can help to share that across the country.

Wuhan Coronavirus

Alex Chalk Excerpts

Tuesday 11th February 2020 Commons Chamber

[Matt Hancock]

This is a really good point, and I want to make two points on it. First, those who have contracted the virus are ill and deserve our sympathy and support. I know from the incredible way they have responded to the need to undertake contact tracing that all those in the UK who we have been working with because they have tested positive have acted in an exemplary way and done everything that society could have asked of them to make sure the virus is contained. I pay tribute to the way they have responded to public health officials and the NHS and thank them for doing that.

On a second connected point, anybody who thinks it appropriate, in response to this challenge, to demonise or abuse anybody from the British-Chinese community, or anybody of Chinese or east Asian origin, is completely wrong and is being counter-productive to the efforts being made across the country and the world to tackle this virus.

[Alex Chalk (Cheltenham) (Con)]

I thank the Secretary of State for his measured statement. Does he agree that we should not allow our proper focus on the risk from coronavirus to blunt our efforts in respect of seasonal flu, which, as the chief medical officer indicated, kills around 8,000 people a year? In those circumstances, the precautions taken—handwashing and observing basic hygiene—are important for all sorts of good reasons.

[Matt Hancock]

It is absolutely true that handwashing and “catch it, bin it, kill it” are the right responses to flu as well as coronavirus. We are coming towards the end of the traditional flu season, which this year in England came early, in December, and thus far—touch wood—has thankfully been largely mitigated and gone away. Next year, of course, we will be even more vigilant than normal.

NHS Funding Bill

Alex Chalk Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Andrew Bowie (West Aberdeenshire and Kincardine) (Con)]

Thank you very much, Mr Deputy Speaker. I was not expecting to be called this early. [Interruption.] It is unusual for me to be called this early. I am getting used to this new age.

[Alex Chalk (Cheltenham) (Con)]

He has not written his speech yet.

[Andrew Bowie]

I am perfecting it. I am delighted to be called to speak at this time in this debate on a Bill that demonstrates our commitment to implementing our promise to the British people in the last election to invest in our NHS: to invest a record amount in our NHS. In fact, we are talking about the biggest cash increase in the history of the NHS, delivering new hospitals, more nurses, more doctors, more primary care professionals in general practice and millions more appointments in GP surgeries every year across England; we are demonstrating once and for all that the NHS is safe in the Conservatives’ hands and putting an end, I hope, to the disgraceful, lazy, scaremongering trotted out every election by the parties opposite, which is in place of—in fact, caused by—a dearth of realistic policy proposals that appeal to the British people.

This is a debate about NHS funding. It has been rightly certified as relating exclusively to England, as this matter is fully devolved, and it has focused on the areas— how and where—the extra money will be best spent south of the border. However, it would be remiss of this House to let this Bill pass on Second Reading today without at least mentioning the effect that this transformative amount of money being invested in the NHS, coupled with decisions on funding in education, local government and policing taken by this Conservative Government, will have north of the border in Scotland.

Thanks to this Conservative Government, the block grant to Scotland will increase by an unprecedented £1.1 billion this year, to £29.3 billion, with £635 million of that increase due to our commitment, cemented here today, to boost spending on health to record levels, as it could be transformational. Indeed, it needs to be, for despite the bluff and bluster of the Scottish National party—or, in fact, because of the bluff and bluster of a Scottish National party obsessed with stoking division and grievance, and foisting upon the Scottish people another referendum that they do not want—the health service in Scotland is suffering.

Before I go on, I wish to put on record my thanks to the amazing people who work in NHS Scotland, particularly those at NHS Grampian. They do incredible work, going above and beyond to serve the people of Scotland and north-east Scotland. Their service and sacrifice are something that everybody in this Chamber is grateful for, and I include the hon. Member for Central Ayrshire (Dr Whitford) in that, not just for her service in Scotland, but her service overseas. My admiration for what she has done in Palestine knows no bounds. However, I do think that health service workers are being let down by the Scottish Government, for whom everything—investment in our NHS, the education of our children and the delivery of policing—plays second fiddle to the obsession of separation from the rest of the United Kingdom.

The story of the SNP’s management of Scotland’s NHS is, sadly, one of underfunding. Spending on the NHS in England increased by 17.6% between 2012-13 and 2017-18, whereas it increased by only 13.1% in Scotland in the same period.

The National Health Service

Alex Chalk Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Matt Hancock]

I will tell the House exactly what happened. My hon. Friend invited me to Burton, and I looked at the changes that needed to happen. I talked to the NHS and we then announced not one but two upgrades as a result, thanks to his campaigning.

[Alex Chalk (Cheltenham) (Con)]

Gloucestershire health managers, supported by around £50 million of public money, are in the process of reconfiguring hospital services in Gloucestershire. In the light of evidence suggesting that A&E in Cheltenham might be earmarked for closure, I, together with my hon. Friends the Members for Tewkesbury (Mr Robertson) and for The Cotswolds (Sir Geoffrey Clifton-Brown), have led a campaign to keep A&E at Cheltenham. I know that my right hon. Friend the Secretary of State has taken a close interest in this issue. Can he now give us an update from the Dispatch Box on the issue, which is so important to me, my constituents, my hon. Friends and, indeed, everyone in Gloucestershire?

[Matt Hancock]

Yes, I can. In the light of the extensive representations that my hon. Friend made regarding the A&E in Cheltenham, I have spoken to the chief executive of Gloucestershire Hospitals NHS Foundation Trust and I can announce that the A&E will remain open and that no proposals to close the A&E at Cheltenham will be part of the forthcoming consultation.

NHS Long-Term Plan: Implementation

Alex Chalk Excerpts

Monday 1st July 2019 Commons Chamber

[Matt Hancock]

The statement was about the implementation of the NHS long-term plan, to which of course the future of social care is vital, which is one reason why the spending power available within social care has risen by more than 10% over the past three years. We continue to work on the long-term future of social care. We will have to wait for a new Prime Minister before publishing the Green Paper—I think that is fairly obvious—but it would also be good to get a bit of cross-party collaboration. When my right hon. Friend the Member for Ashford (Damian Green) made some proposals that were in line with the cross-party work of two Select Committees of this House, within half an hour the shadow Secretary of State’s friend, the shadow Chancellor, had rubbished the idea—I do not think he took the time even to read it. We could do with a bit of cross-party work on the future of social care in this country.

[Alex Chalk (Cheltenham) (Con)]

Thanks to the record funding boost for the NHS, Cheltenham General Hospital can plan for the future with confidence, but local trust managers consistently cite difficulties with recruiting emergency medicine doctors as a reason for not being able to expand A&E provision. Does the Secretary of State agree that some of the additional resources must go into training additional A&E doctors so that we can give Cheltenham General Hospital the resources it requires?

NHS Pensions

Alex Chalk Excerpts

Wednesday 26th June 2019 Westminster Hall

[Sir Robert Syms]

Thank you, Mr Gray. This is an important subject, and the more I learn about it, the more I realise its implications for the national health service. I had originally been told that the Treasury would respond to the debate, but I understand that the Department of Health and Social Care has manfully stepped up to the plate—the first example I have seen of a hospital pass to a Department.

The subject has devastating implications for the NHS, dental services and many other services in this country unless it is addressed by the Government. When the coalition Government came into office in 2010-11, they were quite right to reduce the amount of money that could be put into pension funds. At that time, someone could put £255,000 into a pension fund tax free; clearly, if they had such resources, it was unfair on the lower paid. The Government moved to reduce the tax leakage by reducing a number of the allowances.

The problem today is that the Government have drawn the allowances too tight, and in 2015-16 they also introduced a taper to the annual allowance. All that is having a pernicious effect on the NHS and creating what the British Medical Association has called a “perfect storm”. The lifetime allowance, which is just over £1,055,000, is such that most senior doctors and general practitioners get pulled into additional tax, paid at 55%. That raises the question whether they should continue working or retire early; there is a lot of evidence that members of the medical profession are deliberately retiring early because of the implications of working longer.

The annual allowance of £40,000 is creating problems of supplementary tax bills, which are falling at the doors of consultants, doctors and senior nurses. That £40,000 is made up of the increase in the fund and contributions, in a slightly convoluted formula, but the introduction of the taper and the way that it operates cause particular havoc. For higher earners, a strict regime applies to annual contributions, which is known as tapered annual allowance. It applies to people who have both adjusted income over £150,000 per year, which is total taxable income plus the real growth in value of pension rights over the year, and threshold income above £110,000 per year, which is essentially total taxable income, but net the value of any employee pension contributions.

Where an individual ticks both boxes, for every £2 of adjusted income that they receive above the £150,000 level, their annual allowance is reduced by £1. This means that those with an adjusted income of £210,000 have their annual allowance tapered down from £40,000 to £10,000, the lowest level to which tapering can reduce the annual allowance. That tapered allowance was introduced in 2016-17. The ability to carry forward unused allowances for years before the taper was enforced has so far helped to dampen down its impact, but in 2019-20, carry-forward will be from no earlier than 2016-17, when the taper came into force. That will reduce the number of people with significant amounts of underused annual allowance available, and as a result the taper will bite rather more than in earlier years.

If we look at the figures, we see the number of people who exceed annual allowance or hit the taper multiplying each year, pulling many more people into the system. Many senior doctors earn enough money from their core hours plus additional shifts to be potentially affected by the tapered annual allowance. In addition, because of the relative generosity of the NHS pension scheme, pension rights can be built up quite quickly, especially for those who have experienced a step-up in pension rights because of a promotion. Paradoxically, in most cases overtime shifts are not pensionable. That means that a doctor can find that, by working more, he or she has built up no extra pension but, because of the operation of the tapered annual allowance, has reduced the amount of pension that he or she can build up within the tax relief limits.

All that leads to more complexity within the system. It is extremely difficult for someone to work out whether they have an annual allowance issue; that is true for any high earner, but may be particularly true for those in the NHS, because they have rights under different sections of NHS pension schemes—for example, a final salary pension and a career average pension. Those rights are tested against annual allowance, but a negative accrual in one scheme cannot be set against a positive accrual in another scheme.

[Alex Chalk (Cheltenham) (Con)]

My hon. Friend is making an excellent speech on an area that is technical, but has enormous implications. I have been contacted by a consultant in emergency medicine at Gloucestershire Hospitals NHS Foundation Trust, who has indicated that because of the perverse incentives of this scheme, he will not be taking on an extra shift and out-of-hours work, which reduces that vital expertise. Does my hon. Friend agree that we must turn this around so that we have frontline medics doing what they should be doing—caring for our patients?

[Sir Robert Syms]

Almost anybody I talk to in any hospital anywhere has an example of the impact of this additional taxation biting, and its impact on working methods. I know my hon. Friend has tried to get a debate on a similar subject, because we are ultimately talking not about consultants, but about the patients and the impact this has on delivering services.

For defined benefit pension rights, the test against annual allowance is complex. The growth in rights over the year must be adjusted to strip out any increase that simply keeps pace with inflation, and is then multiplied by 16 added to any additional lump sum accrual before being tested. Whether the tapered annual allowance applies depends not just on whether someone’s adjusted income is over £150,000, but on whether their threshold income is over £110,000. These two measures are quite different, and adjusted income in particular is calculated in a very complicated way.

That creates unpredictability. A tapered allowance works by using income from the current year to determine the size of the annual allowance for the current year. Many NHS doctors work extra NHS shifts and many do private work; they may have little idea what their income for the year will be until very late in the year. Sometimes, NHS trusts get additional money released at the end of the year, leading to more operations. Sometimes, NHS trusts pay at a rather slow rate, and they may pay in a different year from that in which an operation was undertaken. As a result, doctors who take on a lot of extra work late in the year can suddenly find they have an annual allowance issue.

There is also a cliff edge issue. Although the tapered annual allowance result is a gradual reduction in annual allowance for each £1 of adjusted income over £150,000 per year, the fact that the whole system switches on abruptly for threshold income above £110,000 can create a violent cliff edge effect. For example, those with threshold income that is 1p below £110,000 can effectively ignore the tapered annual allowance, but those with income that is 1p above it can find themselves caught with a rather large tax bill. For the latter group, not only does each extra £1 attract income tax at 40p and a loss of personal allowance equivalent to another 20p in the pound, but they can suddenly face a big drop in their annual allowance.

Some people can be worse off overall by working an extra shift. I have heard testimony to that effect from many doctors who say they have done additional work and ended up worse off.

--- Later in debate ---

[Ruth Jones (Newport West) (Lab)]

I commend the hon. Member for Poole (Sir Robert Syms) for bringing this important debate to the Chamber. I did not intend to speak, but I feel obliged to do so now. I understand why this scheme was brought forward. It is not the scheme that I have problems with but its implementation and the unintended consequences, which have already been raised.

The situation in the NHS is complex. We have three NHS pension schemes, and it is really difficult to work out; I am part of two of them and I struggle to work out what I am supposed to be doing. We understand that it is difficult. The taper comes in at £110,000. The Chancellor told me in the Chamber that it is £150,000, but it is not. This is important, because although these wages seem a lot to some people, they are not that high compared with those of senior businesspeople. The taper will affect people such as consultants, GPs and medical academics. These are our leaders, and we need to ensure that there is succession planning. If these people leave abruptly because they realise the tax implications, there is no chance for succession planning.

[Alex Chalk]

The hon. Lady is making a good speech. It is true that senior consultants are often relatively well paid, but they cannot afford sometimes four, five or six-figure tax bills suddenly arriving on their doormats, which provide the most profound disincentive to their doing what they want to do: care for patients.

[Ruth Jones]

Absolutely. The hon. Gentleman makes an excellent point, and much more eloquently than I could. These things are coming in at the end of people’s working lives, and it is difficult for people to budget for them when they do not know what will land on the doormat. When we enter working life and take on board pensions, we know what we are signing up to. These changes are being made in the latter stages of people’s working lives, so it is really difficult to budget and plan for them.

Several constituents who work at the Aneurin Bevan University Health Board in my constituency have written to me to say that they will finish work early or cut down on the number of sessions because of these punitive tax bills. Although obviously the health service in Wales is devolved, pensions are not, so it is important that we look at this issue in the round and across the UK. We need to make sure that we retain these doctors across the board.

I commend the hon. Member for Poole for introducing the debate. I ask the Government to look again at this situation.

Mental Capacity (Amendment) Bill [ Lords ] (Fifth sitting)

Alex Chalk Excerpts

Tuesday 22nd January 2019 Public Bill Committees

[Alex Cunningham]

That is most certainly the case. I go back to my Second Reading speech. This is about the individual. This is about one of the most serious things we can do as a nation to somebody—take away their liberty. We should do anything and everything we can do to ensure that they have every single piece of support before that decision is taken, effectively, to lock them up. I agree with my hon. Friend.

I was quoting Age UK, which believes that everybody should have access to an advocate and that a person who chooses not be represented can then opt out. The quote continues:

“This will greatly improve the Bill and give clarity to the cared for person and the responsible body.”

Mencap believes, as I do, that independent advocacy is vital to help vulnerable people to understand and exercise their rights under the law. We have had several examples of that this morning.

Rethink Mental Illness is also on board with the amendment. I appeal to the Minister to provide an opt-out approach, which would greatly improve this Bill, as others have said, and give clarity to service users and providers.

I mentioned care home managers, but the risk of independent hospitals being responsible for assessments is another concern about the Bill, and as we said the other day, we hope the Minister will ramp up the assurances in this area. I have another real-life example for her. A man was held in hospital for almost a year—with no advocate for 10 months. He was angry because he wanted to go back to his two-bedroom home, but the local authority wanted him to move into accommodation with 24-hour support and to not return home. The reason given was that the brother had moved into the spare room at the cared-for person’s home and there had to be a spare room for any overnight carer, should the man return home.

What did the advocate find out by talking to the cared-for person? They found that, when he had been living at home, he had been sleeping in a chair in the lounge while his brother had his room and his carer had the spare bed. Then he had fallen and not been found for two days, as a succession of carers had failed to attend. The cared-for person’s statements were not taken into account by the social worker involved. If they had been, the process might have been very different. The man needed an advocate from day one.

The case eventually went to court, and the judge accepted evidence from the advocate and ordered the cared-for person to be returned home—[Interruption.] Bless you!

[Alex Chalk (Cheltenham) (Con)]

I wonder how Hansard records a sneeze.

[Mr Dhesi]

That is now a matter of record.

Oral Answers to Questions

Alex Chalk Excerpts

Tuesday 24th July 2018 Commons Chamber

[Steve Brine]

They are linked but separate issues. Yes, the HPV vaccine is very important for adolescent boys, for men who have sex with men and for people before their sexual debut. Sexual health is of course a huge challenge. We work closely with local authorities—top-tier local authorities are all public health authorities—and, through the ring-fenced public health grant, which is £16 billion during this spending review period, we are providing those services.

[Alex Chalk (Cheltenham) (Con)]

Cancer survival rates are now at an all-time high thanks to the brilliant and dedicated work of clinicians, including at Cheltenham General Hospital, but prevention is better than cure. Will the Secretary of State direct his customary energy towards prevention work, including vaccinations, but also tackling risk factors such as obesity?

[Steve Brine]

Yes, he will. I am pleased to say that prevention is one of the Secretary of State’s three key priorities. The HPV vaccine is a key prevention measure, while one of the drivers behind the child obesity plan was Cancer Research UK’s very clear advice that being overweight was one of the big risk factors, alongside diabetes, in cancer. Yes, prevention is always better than cure.

ME: Treatment and Research

Alex Chalk Excerpts

Thursday 21st June 2018 Westminster Hall

[Alex Chalk (Cheltenham) (Con)]

It is a great pleasure to serve under your chairmanship, Mr Rosindell. Like other hon. Members, I pay tribute to the hon. Member for Glasgow North West (Carol Monaghan), who has shown great stamina in fighting for this cause and who set out the position at the outset of the debate with great detail and authority. I therefore do not want to repeat what she said, but will just make a few points.

I said in the application for the debate that the reason why I thought we needed to have it was that ME has terrible PR. That was a slightly flippant thing to say, but the real point I wanted to make was that it is a forgotten illness—and I think it is forgotten for two reasons. The first is that the symptoms are relatively intangible, and the second is that the condition has been disparagingly referred to in the past by a name that has stuck. The hon. Lady referred to it—yuppie flu. It is important that we debate this condition today, not because there are not other illnesses out there—of course there are—but because the sufferers, some of whom we see in the Public Gallery, have been voiceless too long and it is for Parliament to give them their voice.

I want to take this opportunity to thank three remarkable ladies in my constituency: Louise Beaton, Linda Hending and Rachel Ephgrave. With their courage, dignity and stamina, they have educated me and given me the opportunity to speak on their behalf. With that opportunity, let me begin by slaying some myths. The first myth is that of yuppie flu. ME is a thing. The US Institute of Medicine published in 2015 a report that analysed more than 9,000 scientific articles about ME. What did it conclude? It stated:

“The primary message of this report is that ME/CFS is a serious, chronic, complex, multisystem disease”.

In addition, as we have heard, the World Health Organisation has categorised it as a neurological condition in paragraph G93.3. Let the message go out today to those people who may have a dim awareness of ME that it is a condition; it is recognised as a condition; and it deserves to be treated as a condition.

The hon. Member for Glasgow North West has already referred to the impacts of the condition. I will not repeat those points, other than to note this. When we talk about its affecting an estimated 250,000 adults and children in the UK, that is important because it allows us to put it in context with other conditions and the way they are treated. For example, there are 11,000 or so new cases of brain tumours each year, according to Cancer Research UK. The late and much missed Baroness Tessa Jowell did a brilliant job of encouraging the Government to fund additional research into brain cancer, and none of us, least of all anyone in the Public Gallery, would begrudge that a penny, but £40-odd million has gone into that and it is right to note that the number of ME sufferers in the UK is considerably more than 11,000.

I also want to slay the myth about the kinds of people who suffer from this condition. I happen to know from my own constituency that the people we are talking about include former GCHQ workers, lawyers and teachers. It is heartbreaking to see lives curtailed and potential going to waste.

The symptoms of ME have already been referred to, but they bear emphasis. They include post-exertional malaise, muscle and joint pain, cognitive difficulties, noise and light sensitivities and digestive problems. We know all that, but there is one additional point that I want to mention. Although ME patients, contrary to another myth, are no more likely to suffer from poor mental health or emotional problems than the general population, adults with ME are six times more likely to die by suicide—six times more likely. When one considers the impact of the issues referred to very expertly by the hon. Lady—noise and light sensitivities and so on—one might be forgiven for saying, “Well, it’s not that serious, is it?” But the cumulative effect is so oppressive that it can lead people to take their own lives.

In the time left to me, I want to underscore two points. First, on welfare benefits, the overwhelming majority of respondents to an Action for ME survey on the issue felt that assessors had insufficient expertise. We of course understand that assessors cannot be expected to be experts in every single condition, but they do need to understand in respect of ME that the way someone presents on a particular day could give an entirely misleading picture of their condition. Why? Because the sheer effort of going to present themselves on that occasion can have long-term implications, and also the effects can be cumulative. People have good days and bad days, but that variability is not currently taken into account sufficiently and it must be.

That brings me to the second point. The issue about the NICE guidelines has been very well traversed by other hon. Members and I will not say anything further, other than to add this. Clinicians and experts will say, “Follow the evidence,” and of course they are right. Most of us in this Chamber believe in experts; we value experts and expert evidence, but patient experience is also evidence. It is quite wrong to put it in a category of material that can somehow be overlooked or, indeed, disparaged. It seems to me that there is an overwhelming body of material that suggests that the 2007 guidelines, which happily are now being reviewed, have to be seen in the context of a large body of evidence from patients that suggests that they are not working as they should. Patient evidence is evidence—that is the key point.

My final point is in respect of research. In the United States, a huge amount of research is taking place. There will be those who say, “Look, public money is extremely precious; public resources are precious.” That is absolutely right, but we know from the United States that research is having an impact. Work in the United States has led to new insights into the metabolic, immunological and neurological abnormalities of ME. Although the Department of Health and Social Care has repeatedly cited a lack of high-quality research proposals for the lack of investment, I hope that it will be able to take into account what is coming from the United States to give it some encouragement that there is scope for real advances. I underscore the point that £40 million is going into brain cancer research following the wonderful advocacy of Tessa Jowell; that places the lack of investment going into ME research in rather sharp focus.

I conclude by paying tribute to the silent sufferers of this cruel disease in our country. Let the word go out from the House of Commons: they shall be silent no longer.

Complex Regional Pain Syndrome

Alex Chalk Excerpts

Tuesday 19th June 2018 Commons Chamber

[Ruth George (High Peak) (Lab)]

It gives me great pleasure to speak in my first Adjournment debate since being elected last year.

Complex regional pain syndrome—CRPS—is one of the most painful conditions known, registering a staggering 42 out of 50 on the McGill pain scale. That is worse than the pain of the amputation of a finger or toe with no anaesthetic, which registers as 40 out of 50, and it is worse than childbirth—the Minister may sympathise with me on that. CRPS is not a short-term pain that will heal in time. The most excruciating part is that the pain is long-term, and likely to be for life. In fact, CRPS is known as the world’s most painful incurable condition. In the United States, it is referred to as the “suicide disease” as it can lead sufferers to resort to suicide as the only means to escape the huge pain that they bear.

CRPS is a chronic neuropathic pain condition—a disease of the nervous system—and it usually starts with a minor injury or fracture to a limb. The major indicator is the huge amount of pain involved, which is out of all proportion with the original injury. The affected limb can swell, change colour and change in temperature and, instead of reducing in time, the pain just gets worse. It can lead to weakness of the limb, ulceration of the skin, wasting tissue and bone thinning. The pain caused by CRPS spreads over time and may even develop in the opposite limb or in other limbs. Patients with CRPS most likely live with anxiety and depression because of the amount of high-level pain they are in 24/7.

CRPS is not a well-known condition, although awareness of it is increasing thanks to the national charities that work hard to support sufferers and to promote the need for treatment. Six months ago, I was not aware of CRPS, so I want to pay tribute to my constituent Victoria Abbott-Fleming, whom I have met. Victoria qualified as a barrister, but six months after a minor accident at work, at the age of just 24, she received a diagnosis of CRPS. The symptoms included a burning, severe pain in her lower leg, a freezing cold sensation, and a stabbing feeling that she said was like 1,000 ice picks pushed into the skin and bone. Victoria described it as like having petrol put through one’s veins and set alight. Her other symptoms included major swelling, hair and nail loss, hypersensitivity, temperature change and stiffness that prevented her from walking.

[Alex Chalk (Cheltenham) (Con)]

The hon. Lady, through her constituent’s experience, is painting a vivid picture of the pain. Does she agree that hearing accounts such as that of my constituent Helena Stone—she said it was like barbed wire being tightened across one’s leg—give an insight into the viciousness of this debilitating condition and make it all the more important that we raise awareness of it?

[Ruth George]

I thank the hon. Gentleman for his intervention. While we can listen to descriptions of the pain, we can never really have any idea of what it is like. The worst thing about CRPS is that the pain is not occasional and something that a person knows will get better—they know it may be with them for the rest of their life.

[Ruth George]

I thank the hon. Gentleman for his intervention, and I know that he has made inquiries and asked questions about CRPS over the years. All the sufferers thank every MP who raises the issue and helps them to feel that they have hope.

Apart from the physical and mental pain suffered due to CRPS, a severe part of the torture that my constituent Victoria experienced was the judgmental attitudes of medical professionals who did not understand or were not aware of the condition and the shame that she felt. She says, “The medical profession sometimes don’t believe your symptoms, or try to fob you off by saying, ‘Are you sure it is not in your head?’ or, ‘You look well. Are you sure you’re actually ill?’” Those problems are even worse now that we see children being diagnosed with CRPS, because children are often not believed when they say that they are in excruciating pain.

[Alex Chalk]

The hon. Lady is being extremely generous in giving way. My constituent experienced the problem of not being believed. Does the hon. Lady agree it is all the more galling that the NHS website recognises the condition and states that it is “poorly understood”? Does that not make the point that the situation needs to change?

[Ruth George]

The hon. Gentleman makes the pertinent point that CRPS is poorly understood, and that more understanding and awareness is needed from medical professionals.

After Victoria developed ulcers and total skin breakdown, she was told in 2006 that she needed to have her leg amputated above the knee at just 27 years old. Like many CRPS sufferers, she was unable to use a prosthetic limb because the prosthetic was too tight, pressing hard on the hypersensitive skin where she had had CRPS and inducing excruciating pain in her stump.

Victoria was left wheelchair-bound and unable to work as a barrister because many courts are completely inaccessible to wheelchair users, and because of her strong medication and her mental unwellness due to her situation. She pays tribute to her husband Michael, who saw her through the toughest of times and still supports her.

In 2014, Victoria received the even more devastating news that the condition had spread to her remaining leg, which she needed to have amputated. Amazingly, as a dual amputee, she has come through the experience and set up a national charity, Burning Nights, which offers support, understanding and explanation to CRPS sufferers. The charity offers a voice at the end of the phone, as well as very important advice when sufferers feel they cannot take any more.

The trouble is that we do not know how many people are living with CRPS. When I asked a parliamentary question, I was shocked to be told that the Department of Health and Social Care does not collect data on the number of people diagnosed with CRPS as it

“is not classifiable within the ICD10 clinical coding”.

That means that a box on an NHS computer cannot be ticked for CRPS. Various statistics have been suggested by the health profession and in the light of experience in other countries, but the most widely accepted figure is that there are about 26 people in 100,000 living with CRPS, which would equate to more than 15,000 sufferers in the UK. That means that CRPS does not even qualify as a rare disease but, as other hon. Members have said, many medical professionals have not even heard of it, let alone are aware of its symptoms and signs that would lead to diagnosis.

Too many patients are made to feel that they are making a fuss when they are actually in agony. That is not surprising, given that only 20 minutes during a medical degree concentrate on chronic pain—it is only 90 minutes for physios, who deal with people in pain all the time. Diagnosis takes an average of six months, but it may take even longer, especially for children, who are less likely to be believed when they are in severe pain. Once a diagnosis has occurred, it can take two years, or even three in some parts of the country, for a referral to a specialist pain clinic. I cannot imagine the pain of CRPS, let alone the added pain of knowing that nothing will be done to help for two or three years when every day, and especially every night, is agony—that does not bear thinking about.

Many treatments are effective only in the early stages of the disease, such as neuromodulation or DRG—dorsal root ganglion—treatment. Pain clinics usually offer medication and some physio for about six months, but sufferers are then usually discharged and told that there is nothing more that can be done. Unsurprisingly, they therefore may seek whatever they can, and in some cases that is amputation. I am afraid that private surgeons are offering amputations to people with CRPS at the knockdown price of £5,000 below the knee and £10,000 above it. People with CRPS are in such agony that they are prepared to undergo such an amputation because they think it may get rid of their pain. Unfortunately, as my constituent Victoria has told me, it does not, and often the pain does not go away. However, serious problems can arise when such amputations and major surgery are carried out by private surgeons. At the moment, the NHS picks up the bill for that. I very much hope that it will continue to do so, but this really makes the case that what we actually need is some hope, proper diagnosis and proper support, and a clinical pathway for people with CRPS that will see them through not only their diagnosis, but long-term and lifelong treatment.

I have various proposals for the Minister, as I am sure she was expecting. They are based on the parliamentary questions I have been asking over the past few months. The first and perhaps most important is for her to put that tick-box on the NHS computer so that we can collect data for CRPS diagnoses. Without data on diagnoses, it is difficult to make a proper case for research and for the increased training and awareness of the medical profession that is needed.

In response to my parliamentary question about research, the Minister said:

“The NIHR is committed to maximising the potential impact of research that it funds for patients and the public. Applications to NIHR for research funding are subject to scientific peer review, with awards being made on the basis of value for money, scientific quality and the importance of the topic to patients and health and care services.”

Unless we know the numbers of patients who are suffering, however, it is impossible to decide whether an application for research is value for money.

My second request is on the protocols for diagnosis. Yes, we need to raise awareness among health professionals, as other Members have stated, but we also need to introduce protocols such as the one used at Liverpool’s fracture clinic. CRPS is common after a fracture, and at Liverpool the limb is checked after a plaster cast comes off if it looks unusual, or if unusual pain is reported. In that way, a diagnosis can be made early.

My third request is for an increase in the capacity of pain clinics. It is not acceptable that people have to wait an average of two years, and up to three years, to get the support that they so desperately need. That would probably help to address my fourth request, which is for mental health support for CRPS sufferers, with a 24-hour helpline—the pain is particularly excruciating at night—to help them to get through without feeling that they have to resort to amputation or even suicide.

My final request is for the Minister to meet my constituent, Victoria Abbott-Fleming. In spite of the difficulty involved in travelling with her condition, she has come down from Derbyshire to hear the debate. She has done so much to support and fight for other sufferers. CRPS is not a diagnosis that we would wish on anyone, and I hope that the Minister can offer some hope to its thousands of sufferers.