Progressive Supranuclear Palsy

Amber Rudd Excerpts

Wednesday 23rd January 2013 Westminster Hall

[Andrea Leadsom (South Northamptonshire) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bayley. I am delighted to have secured this debate, in which I will draw to the Chamber’s attention the needs of a specific group of people who need us to take action on their behalf.

In Towcester, in my constituency of South Northamptonshire, there is a national charity called the PSP Association, which is the only charity in the UK working solely for people with the neurological conditions progressive supranuclear palsy and the related disease corticobasal degeneration and those who care for them. PSP and CBD are diseases closely related to motor neurone disease and Parkinson’s disease.

[Amber Rudd (Hastings and Rye) (Con)]

Will my hon. Friend clarify how many people suffer from PSP compared with motor neurone disease?

[Andrea Leadsom]

I will address that later, but my hon. Friend is right to make that point, because it is believed that more people suffer from PSP than from MND, despite the fact that the latter disease is much more commonly known in general society.

PSP and CBD are similar diseases, and PSP is often used as shorthand for both conditions. In progressive supranuclear palsy, progressive means that it gets steadily worse over time; supranuclear means that it damages parts of the brain above the pea-sized nuclei that control eye movement; and palsy means that it causes weakness. Members may never have come across PSP before, but, sadly, it takes many lives.

PSP is caused by the progressive death of nerve cells in the brain, leading to difficulty with balance, movement, vision, speech and swallowing. Over time, PSP can rob people of the ability to walk, talk, feed themselves and communicate effectively. The average life expectancy is seven years from the point of diagnosis. Those who are diagnosed with PSP suffer severe and unpredictable impairments that have an enormous impact on the individual and their family. PSP is a dreadful disease.

I am pleased that since 2010, having written several times to the Department of Health, there is now better recording of PSP on death certificates, giving a clearer indication of the number of sufferers. Our attention, however, must now turn to diagnosis. Statistics show that some 4,000 people are living with PSP in the UK, but because diagnosis is still so uncertain, neurologists believe the figure could be as high as 10,000. Astonishingly, as my hon. Friend mentioned, there may be more PSP sufferers than sufferers of MND in the UK today.

EU Working Time Directive (NHS)

Amber Rudd Excerpts

Thursday 26th April 2012 Westminster Hall

[Amber Rudd (Hastings and Rye) (Con)]

It is a pleasure to follow my hon. Friend the Member for South Northamptonshire (Andrea Leadsom) who, as always, speaks with such authority on the relationship between this country and Europe. I was particularly interested to hear the relevant experience of my hon. Friend the Member for Totnes (Dr Wollaston). Most hon. Members have said that we do not want to go back to 100 hour weeks; her rather shocking and frightening examples remind us all why that is so. What we want is flexibility—F for flexibility, as the hon. Member for North Antrim (Ian Paisley) so helpfully put it—so that we can try to get a better outcome for everybody.

So much has already been said and covered, particularly by my hon. Friend the Member for Bristol North West (Charlotte Leslie), who did so well to secure the debate. As she made her remarks, I was concerned that she was going to cover absolutely everything. She pretty much did, so I will just concentrate on one area—surgery—where the effect of the working time directive has been particularly damaging.

Although, as some hon. Members have pointed out, the British Medical Association has said that all training can fit into 48 hours, surgeons I have spoken to are concerned. The body that represents trainee surgeons, the Association of Surgeons in Training, has stressed that surgery is very different from all other aspects of the medical profession. It has clearly taken on the BMA in trying to make that point. As the hon. Member for Vauxhall (Kate Hoey) said, surgery is a craft specialty like chefs, for example—a lot can be learnt from books, but in the end there is nothing like hands on practical experience. Operative and procedural skills define the surgical craft and they are finite in number, with the majority to be gained during working hours. By limiting those hours, we are working against their training and therefore their competency as future consultant surgeons. As the ASIT survey confirmed, the majority of surgical trainees would welcome the opportunity to work in excess of the hours permitted—we are not doing them any favours by restricting their hours.

The Royal College of Surgeons estimates that 400,000 hours of surgical time are lost every month. ASIT believes that the restrictions imposed by the directive will be detrimental to the quality of training for junior surgeons and, therefore, to the quality of surgical service and provision in the future. Ultimately, as said by many of my colleagues today, the restrictions will be harmful to patient care. We also risk deterring junior doctors from specialising in surgery, as they are only too aware of the consequences of the restrictions. The royal college and ASIT both call for flexibility to enable UK surgeons to work up to a maximum of 65 hours per week, including time spent on call.

In addition to the effect of the working time directive on doctors’ training, the legislation is impacting on the continuity and quality of patient care in our hospitals. According to a survey by the Royal College of Surgeons, 80% of consultant surgeons and 66% of surgical trainees said that patient care had deteriorated as a result of the directive. Those consequences are worrying, and we need to focus on them.

[Debbie Abrahams]

In an earlier intervention, I referred to the systematic review. I appreciate that surveys give a certain amount of one-off evidence, but systematic reviews are the strongest form of evidence, and there were no conclusive results regarding an impact on patient outcomes. Whatever action we take, it surely should be based on the strongest evidence and not on evidence of lesser quality.

[Amber Rudd]

I am talking about evidence, and every Member present has been talking about their own evidence—

[Debbie Abrahams]

But not the strongest form of evidence.

[Amber Rudd]

Anecdotal evidence is absolutely relevant. We get such evidence from talking in our hospitals to consultants, patients and surgeons. That is much more relevant sometimes than the box-ticking consequences from a more desk-driven survey.

Our 24-hour health service has had to make dramatic changes to how hospitals are staffed. The effects of the reduction in hours have been further compounded by the Jaeger and SiMAP rulings of the European Court of Justice, referred to by my hon. Friend the Member for Bristol North West. Those decree that all time spent in the workplace should be regarded as work, whether at rest or not, which is a dramatic change from previous arrangements. As a result, hospitals have had to scrap all on-call arrangements in favour of full shift rotas, which is creating a multitude of problems. Consultants at the Conquest hospital in Hastings told me that, in order to staff a full shift rota in one department, they now need eight people instead of the six they used to have on the old on-call system. Sometimes there is not even enough work. Indeed, the exposure of each doctor to training opportunities in the day is diluted, and the extra doctors are employed purely to service a working time-compliant rota.

The rota and the system are driving health arrangements, which is surely wrong. It is an inefficient and costly way to manage doctors, and it is damaging to the quality of their training. It is particularly harmful for district general hospitals such as my own, the Conquest, which find that they are no longer able to support certain specialties, such as the neurology department in my example, which has now largely moved to the nearby Eastbourne general hospital. Unfortunately, as we have heard from other Members, the same impact on certain specialties is being experienced in their district hospitals. The doctors at the Conquest do a fantastic job, and I am extremely grateful for the hard work and commitment that they put in; but, from my conversations with the consultants, I know that those doctors are being stretched too thin.

[Sarah Newton (Truro and Falmouth) (Con)]

I have the privilege of representing a constituency in which the Royal Cornwall Hospitals Trust has another of the district general hospitals described by my hon. Friend. Does she agree that in remote rural areas with sparse populations, the impact on patient care of having to travel many miles to access specialist care will have a detrimental effect on treatment?

[Amber Rudd]

I wholly agree with my hon. Friend, who makes an important point about that particular problem for rural hospitals.

The shift system means that, instead of continuity of care, patients see—as we heard earlier, and I shall repeat the unpleasant phrase—a conveyor belt of doctors. Doctors do not get what they want either, which is to see patients through to treatment. Each time one shift ends and another begins, we have the handover process. As a consultant surgeon from the Conquest hospital said to me, someone unfortunate enough to be admitted to hospital at 7 pm on a Sunday evening would see four different sets of surgeons in just 24 hours. I know that there have always been handovers, but there are now more than ever, and each handover creates a risk of vital information being missed. We heard earlier about Chinese whispers, when expertise and important details may be lost. What is more, doctors are now under time pressure to clock off, so the chances of further mistakes are increased.

The Health and Social Care Act 2012 rightly puts doctors at the heart of the NHS, because they are best placed to manage the service and to deliver better results for patients. It is the doctors who are calling out for regulation to be relaxed, and it is essential that we listen to their cries for help. I am calling for a compromise and some flexibility that allows individual doctors and departments to make sensible decisions. Surgeons are asking for a maximum of 65 hours a week, including time spent on call, and that seems sensible.

We also need flexibility in how on-call time and compensatory rest for trainees are calculated. If a trainee wants to stay after their shift to watch an operation, to learn, and to benefit their training, they should be able to do so. We all want tomorrow’s doctors to be as good and as experienced as today’s doctors, so we must allow them to be the doctors that we expect them to be. We trust doctors with our lives, so we should trust them when they tell us they need more time to train.

Oral Answers to Questions

Amber Rudd Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Burns]

The assurance I can give the hon. Gentleman is that the siting of A and E departments will be a matter of clinical judgment. I can also assure him that £900,000 will be invested in the A and E department at Bassetlaw hospital for improvements, including the creation of a three-bay resuscitation room, a larger waiting area for patients and other improvements to enhance the quality of care for his constituents.

[Amber Rudd (Hastings and Rye) (Con)]

At a recent surprise visit to my local A and E department, at the Conquest hospital, I was delighted to find a very high quality of care. Will the Minister reassure me that any local reconfiguration puts high-quality patient care at the centre of delivery?

Maternity Services (Hastings)

Amber Rudd Excerpts

Thursday 24th March 2011 Commons Chamber

[Amber Rudd (Hastings and Rye) (Con)]

I am worried and my constituents are worried. There are many issues that Members of Parliament campaign on in their constituencies, but those to do with health provision must be the most important. We can all agree that maternity services deserve to be a high priority in health planning. This is about the safety of mothers and babies.

Our hospital in Hastings, the Conquest, has a full-service, consultant-led maternity unit. Within East Sussex Hospitals NHS Trust, which we are part of, Eastbourne also has a full-service maternity unit. Four years ago, it was proposed that one of those units should close, and that we should have one midwife-led service and only one full maternity service for the area. The community rose up in arms. We campaigned in our thousands. We marched with babies and with prams. Every local MP objected, and we did not let up until we won—and win we did. I would like to pay tribute to the able, determined and dedicated campaign leaders, Margaret Williams and Liz Walke.

In September 2008, the decision was made by the Independent Reconfiguration Panel, which advised the then Secretary of State for Health, that both units should stay open with their full service. The chair of the IRP said:

“The needs of local women and their families were at the heart of this review…we concluded that women’s access to and choice of services would be seriously compromised if the proposals were implemented.”

The campaigners already knew that, but we were reassured and, indeed, jubilant that the final decision makers also took that view. This was nearly three years ago. Some people might, ask “What’s the issue now?” or “Why are you campaigning when there is no formal proposal for closure of either units currently on the table?” They would not share my concern—my unease—about the latest information coming out of East Sussex Hospitals NHS Trust. It is being signalled that there may be change in the air. It is not change itself we are frightened of, but the possible outcomes for mothers and babies.

The Care Quality Commission visited both hospitals in February this year, and it has raised concerns about the maternity services. The hospital trust, to its credit, was swift to contact stakeholders and MPs to inform them of this and to reassure us that action was immediately being taken to ensure high standards of safety and to address the concerns that the CQC had raised. I would like to thank the chief executive of the trust, Darren Grayson, for his swift action in disclosing this important information. I must confess, however, that we are not entirely reassured. We, the campaigners—my constituents—are still worried. I am not reading any motive or plan into the trust’s response to the CQC; I am simply here to highlight, once more, that the outcome of these concerns must not lead us down the very road we have travelled before—namely, having to protect our full-service maternity units.

We do not want to stick our heads in the sand. If there are problems with the maternity units that might impact on safety in any way, we must address them. However, this must not be a shortcut back on to the damaging road of trying to shut one of our units. We will not accept that. I urge the trust not to present that as the answer to the current problems. I would like the Minister to consider that in her response.

There are other answers, and they are in the very problem that the trust is highlighting—namely, staffing. The original decision to maintain both units urged the trust to address the issue of staffing by getting the right and safe mix of experience and qualifications among the doctors and consultants. The report of three years ago accepted that staffing was a problem, but critically it urged the PCT to

“consider alternative staffing models which have not been explored so far”.

It stated:

“It is incumbent on the local NHS to explore the potential of these roles to develop midwifery careers and support doctors’ roles locally.”

It agreed that there was a problem, but urged the local NHS to develop a strategy to deal with it. But here we are. As was anticipated by the report three years ago, we have a staffing problem that may be impacting on the service, and in such a way that doubt is once more being cast on the viability of having two full-service units.

Each hospital handles about 2,000 births a year. I am pleased to say that the strategic health authority recently commissioned an external head of midwifery to review midwifery, leadership and staffing levels, and she confirmed that the trust was safe. The latest annual regional report also praised the trust for having the lowest caesarean section rates in the region, thereby supporting women to experience a normal birth.

Eleven consultants cover both sites, and we have our designated number of junior doctors. However, we are short of middle grade doctors. There should be eight at each site, but there are only seven at the Conquest hospital and six at the Eastbourne district general hospital. The gap is filled by locums, which is expensive. An agency locum costs approximately £79 per hour, which equates to £18,000 per agency doctor per month, as against a trust doctor, who costs approximately £9,000 per month. In these times of increased pressure on funds, even though NHS funding is ring-fenced the NHS is still being asked to make efficiency savings and to improve services. The locum costs are therefore an unpleasant and substantial addition to the hospital overheads.

Unfortunately, the staffing issue is exacerbated by the European working time directive. I know that the arguments against the directive for parts of the medical profession are being examined, but in the meantime the outcome of restricting working time to 48 hours per week simply puts yet more pressure on the staffing levels in these units.

I appreciate that some might say that I am panicking early. We have been reassured by the trust’s chief executive that there are currently no plans to close either unit, and a consultation is about to be launched on how to maintain a top service at both units. In this reassurance, there is a sting. It signals that the challenges of staffing may require a change. I fear that that could include the closure of one of the units. We must not let that happen.

The town of Hastings in my constituency has high levels of deprivation. Its teenage pregnancy rate is one of the highest in the country and, as we know, this country has the highest rate in Europe. Some 22% of its residents are in the bottom 10% according to assessments of deprivation. Local doctors, to whom I speak regularly, tell me that young women can be reluctant to attend antenatal classes and often miss their appointments. These are the women who may encounter unforeseen difficulties, and who may need a full-service maternity unit at their hospital. They are not the women who are likely to hop in their car to go to Eastbourne for their check-up. In fact, in many parts of Hastings car ownership is running at only 40%, so many would have to rely on the local bus services and the local roads. If the maternity service were closed, it would effectively put up barriers to safety for that group of young women.

I wish to say a word about the local roads, on which I hope to secure a separate debate. If we look on the map, we see that Hastings is just over 20 miles from Eastbourne, and the AA tells us that the journey can be done in approximately 20 to 30 minutes. It is quite wrong. It is in fact the equivalent of a 40 or 50-mile journey elsewhere, and in my experience it takes at least an hour. The Royal College of Obstetricians and Gynaecologists recognises the need for investment to support smaller units, such as ours, where there are significant distances involved. That is what we have in Hastings and Eastbourne—because of the nature of the roads, the towns are a significant distance apart.

Those of us who campaigned on the issue before know the arguments well, but we are up against what feels like the establishment. It is creating a tide that pushes us one way—to super-size maternity units, beloved of managers and some doctors but not particularly of mothers. Expectant women want choice, safety and accessibility. I can quite understand management’s preference for large units. It is easier to manage a larger group of people, more efficient for those delivering the service, more convenient for the consultants who are in overall charge and more flexible for training junior and middle-ranking doctors. However, we must not let the one-size-fits-all principle dominate our maternity services. We must remain aware of local issues that are relevant to any changes in configuration. In Hastings, I have mentioned geography, deprivation and the particular needs of some of the youngest, most vulnerable mothers in my constituency.

Although I speak up for the residents of my constituency, I urge the Minister to pay attention to the trend of addressing staffing issues in hospitals by moving towards super-sized units, particularly maternity units. “Bigger is not necessarily better”—that may sound like an extract from a nursery rhyme, but it is actually part of the name of a highly respected paper about the centralisation of hospital services. Even the well respected King’s Fund questions the assumption that outcomes are improved in bigger units.

Despite the conflicting views about smaller or larger maternity units, one thing is clear: the staffing issue is about preparing and planning. That was highlighted to the health trust more than three years ago in Hastings. We must demand more from our trust now, and we do not accept that closure should be considered for either of our full-service sites. We need the complete service. We need in our communities the delivery of a safe, efficient local service, for the continued delivery of safe and healthy babies.

Oral Answers to Questions

Amber Rudd Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Mr Simon Burns]

I am not sure whether the hon. Gentleman was here earlier, but we explained in great detail about the target that never existed. The latest figures show that the median time has gone from 1.7 weeks to 1.9 weeks, but that is because those figures were for the period between June and August—the holiday time—when many people changed their bookings or appointments to fit in with the school holidays or their own holidays. The figures for September are already on course to get us back to the median for that time of the year.

[Amber Rudd (Hastings and Rye) (Con)]

I know that the Secretary of State is aware of the high level of teenage pregnancies in this country, and particularly in Hastings in my constituency. What action are we going to take to support those young women? We all know of the negative health outcomes that come with those young pregnancies.

[Mr Lansley]

Yes, indeed I do. It is sad to report that we have the highest rate of teenage pregnancies in western Europe. At the heart of this is the fact that we must have community strategies that are geared not least to improving the self-confidence and self-esteem of young people, so that they are able to make better decisions. We must assist them in doing that, but I would also mention the importance of ensuring that we have long-acting reversible contraception available for young people.

Maidstone Hospital (Maternity Services)

Amber Rudd Excerpts

Tuesday 14th September 2010 Westminster Hall

[Amber Rudd (Hastings and Rye) (Con)]

I know my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) well, because he was the resident registrar at our local hospital, the Conquest. We had a major maternity campaign there two to three years ago to save our consultant-led service, and we stressed safety, which I know is a main issue for the Government. However, I would also like to stress, in support of my hon. Friend the Member for Maidstone and The Weald (Mrs Grant), that supporting the vulnerable is very important to the coalition Government and it is sometimes the vulnerable who are most left out of the sort of decisions that we are discussing. Vulnerable young women are sometimes not able to think ahead and plan their pregnancies. They find themselves in difficult circumstances and particularly need the support of consultants and obstetricians. I therefore support my hon. Friend in this debate, and place particular emphasis on the vulnerable; that is the issue that we led with in Hastings when we saved our service.