Accident and Emergency Departments

Andrew Bridgen Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

I will of course look at that closely. I have been to Kettering hospital and recognise that it is very busy and that people there are working very hard, but I think that the staff are doing a fantastic job.

[Andrew Bridgen (North West Leicestershire) (Con)]

Will my right hon. Friend pledge to do everything in his power to undo the mess created by Labour’s 2004 GP contract give-away in order to help restore the essential link between patients and family doctors, which will lead to better patient outcomes and reduce pressure on our A and E departments?

[Mr Hunt]

My hon. Friend is absolutely right. I am astonished that the Labour party seeks to defend those changes to the GP contract, which got rid of named GPs, removed responsibility for out-of-hours services from them and broke the personal responsibility that the best GPs always wanted to feel for the people on their list. In fact, many brave practices refused to go along with those contract changes and continue to have named GPs. There is clear evidence that people who have named GPs use hospital services less. If we are going to give older people the right care, we need to undo those damaging changes.

Hospital Mortality Rates

Andrew Bridgen Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

As I have said many times, where there is not safe staffing we need to put that right. As I have also said, there are 8,000 more front-line staff under this Government than there were when the hon. Lady’s Government were in power. But those are not the only issues; we also need to address issues of leadership, of systems, which we talked about, and of clinical effectiveness. We need to sort out all those. On staffing numbers, I would just point out that plenty of hospitals under equivalent financial pressures are managing to deliver outstanding care, so a lot of this is about getting the right leadership in place at a board level.

[Andrew Bridgen (North West Leicestershire) (Con)]

On 1 July, just over two weeks ago, my aunt died unexpectedly and alone at Queen’s hospital, Burton. The Keogh review has now shown that hospital to have had a higher mortality rate than Stafford since at least 2005. Will my right hon. Friend pledge to work tirelessly to heal our NHS, so that my constituents, my friends and my relatives do not continue to die unnecessarily because of the failed policies of the previous Labour Government? [Interruption.]

[Mr Hunt]

This is the problem. [Interruption.] This is the denial we are getting from the Labour party; it is denying any responsibility for these deep-seated problems in some of our hospitals. As Health Secretary, I intend to do exactly as my hon. Friend describes. In order to try to measure the progress we are making, we will this year for the first time be asking every NHS in-patient whether they would recommend the quality of care that they received to a friend or a member of their family, because in the end that is what this is all about.

Stafford Hospital

Andrew Bridgen Excerpts

Thursday 4th July 2013 Commons Chamber

[Jeremy Lefroy]

I entirely agree with my hon. Friend, and I congratulate him on the huge amount of work that he has put into ensuring that Cannock Chase hospital can be better utilised.

The second part of co-operation involves community services. Instead of seeing acute hospitals as buildings into which people disappear and then re-emerge at some point, let us make them a full partner in community services. In fact, they should be a hub for those services. Stafford, Stoke and Cannock can be groundbreakers in this, and set an example to the rest of the country. In Stafford, we long for the chance to show the country that we provide the highest standards of care, and that we will never again let patients be treated in the shocking way that many experienced in the past.

[Andrew Bridgen (North West Leicestershire) (Con)]

I thank my hon. Friend for giving way, and I commend him for bringing this issue to the Floor of the House. Does he agree that we have a national health service, and that any loss of services at Stafford could send out ripples that would affect services at Burton-on-Trent—also in Staffordshire, and also a hospital under some financial pressure that services a large proportion of the medical needs of my constituents in North West Leicestershire?

[Jeremy Lefroy]

As usual, my hon. Friend makes a powerful point—that this debate is not just about a relatively small district general hospital, because it will have ripple effects. We have a pretty efficient national health service, but it does run on tight margins, so that if we take one acute hospital out, it could have effects right across the whole region. Local clinical commissioning groups have a vital part to play, and I want to pay tribute to the good work they are doing in developing community services in Stafford.

The third element of co-operation comes from Monitor itself. Under the Health and Social Care Act 2012, Monitor now has responsibility for setting tariffs, including those for emergency and acute services. It would be rather strange if Monitor were to continue the programme introduced in 2009 of constant 4% year-on-year real cuts in tariffs, and then be forced to pick up the pieces of acute foundation trusts around the country that fall into deficit as a result of the tariff cuts it has made. Monitor has the chance to challenge the assumption that acute services can continue to squeeze out annual efficiencies—in some cases, and not just in Stafford—of up to 7% a year, while elective services enjoy a relative feast.

Monitor has the opportunity to ensure that the necessary changes to the provision of acute services are done in such a way that will allow acute services to continue to be provided locally. Monitor itself could become an excellent example of joined-up government, and in doing so carry out its legal requirement under section 62 of the Health and Social Care Act 2012 to promote the

“provision of health care services which…is economic, efficient and effective, and…maintains or improves the quality of the services.”

Finally, the national Government have a vital role to play in co-operation.

Children’s Heart Surgery

Andrew Bridgen Excerpts

Wednesday 12th June 2013 Commons Chamber

[Mr Hunt]

The right hon. Gentleman makes an important point. Site selection needs to be done by people who are completely independent of any local interest in where the surgery should happen. That is the crucial point we need to learn, but the point about skills is also important.

[Andrew Bridgen (North West Leicestershire) (Con)]

May I praise my right hon. Friend for his brave and eminently sensible statement today on this most emotive of topics? However, will he assure the House that any future plans to remove children’s cardiac services from the Glenfield hospital in Leicester will take full account of the world-leading extra corporeal membrane oxygenation services which will also have to be moved? The Secretary of State is completely right on this issue and many others: we do not need a quick solution; we need the right solution.

[Mr Hunt]

I agree with my hon. Friend, but I would actually like a solution that happens as quickly as possible, provided the process is done properly. He will be pleased to know that the IRP report does say that the impact of suspending the review and thinking again should be borne in mind in respect of decisions that have already been made as to the siting of ECMO services, and I know that NHS England will be reflecting on that.

Oral Answers to Questions

Andrew Bridgen Excerpts

Tuesday 16th April 2013 Commons Chamber

[Dr Poulter]

The hon. Gentleman is absolutely right. The health and wellbeing boards in particular will be well placed to bring together and join up what goes on in early interventions and to break down some of the silos that have existed in education, social services and health care. It is through the health and wellbeing boards that a lot of the work being done by health visitors and others to improve the life chances of many children, particularly those in the poorest communities, can be taken forward locally in a much stronger way.

[Andrew Bridgen (North West Leicestershire) (Con)]

What steps are being taken to encourage and help local authorities to focus on illness prevention and help people to lead healthier lives?

[Dr Poulter]

My hon. Friend will be aware that local authorities are now receiving 40% of the public health budget. That allows local authorities to have a much more nuanced approach to how and where they direct their budgets. It is of course desirable to focus on the early years to give each and every child the best start in life, to set good and healthy eating patterns and to support the work being done in the health service in expanding the health visitor programme. This also allows local authorities to address other public health challenges in the area by focusing, for example, on areas with high rates of teenage pregnancy, smoking or cardiovascular disease death.

Immigrants (NHS Treatment)

Andrew Bridgen Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

We will work closely with the devolved authorities to ensure we have a co-ordinated response to the problem, but I agree that today’s announcement will be welcomed by the vast majority of people in the country, who will be astonished that the Labour party, even now, seeks to minimise the problem.

[Andrew Bridgen (North West Leicestershire) (Con)]

Given that the UK has one of very few genuine free-at-the-point-of-need health care systems, does my right hon. Friend agree that, without his sensible reforms, the UK will continue to be seen as the destination of choice for anyone around the world seeking high-quality, free medical treatment paid for by the UK taxpayer?

[Mr Hunt]

I agree with my hon. Friend. It is because I support the principle of free-at-the-point-of-use health care that I do not want anything to undermine it, and abuse of the system by people who are not entitled to free NHS care is the single thing that would most shake the public’s trust in an important part of what the NHS has to offer. That is why we must tackle this problem.

Liverpool Care Pathway

Andrew Bridgen Excerpts

Tuesday 8th January 2013 Westminster Hall

[Glyn Davies]

My hon. Friend makes a very important point about the need for training and expertise for all those who are responsible for putting people on the pathway and for looking after them when they are on it. I want to come to that later in my comments.

The negative coverage in our national media has probably increased awareness of the Liverpool care pathway. To that extent, I think that it has been a very good thing, but because I do not believe that the scale of the pathway is widely known, I think that it is right to say something about what the Liverpool care pathway is and what it is not in order to set out the context of the debate,. It is certainly not and must never be any form of “euthanasia by the back door”—a phrase that I have heard—nor is it a form of clinical treatment or even any specific type of care. It does not instruct doctors or nurses to provide this or that treatment. What it does is prompt them to consider whether certain treatments are appropriate in individual circumstances. It supports—it does not replace—clinical care. It is no more than a framework of good practice, backed up by training and education, to guide doctors, nurses and other health professionals towards delivering the high levels of palliative care that have been available in hospices for many years. It enables them to be transferred to hospitals, care homes and patients’ homes. It is about the appropriate way to look after a patient who is clearly dying through the last few days and hours of life.

Some other points should be made in this debate. The Liverpool care pathway does not recommend, as some have suggested, that dying patients should be deprived of food and water, although food and water may be withdrawn in individual cases if clinicians believe that that is the right step to take. The Liverpool care pathway does recommend to doctors and nurses that they explain to dying patients, or more often their next of kin, exactly what is happening and why. Secrecy forms no part of the Liverpool care pathway whatever.

It is also important to emphasise that there is nothing irreversible about being placed on the Liverpool care pathway.

[Andrew Bridgen (North West Leicestershire) (Con)]

Will my hon. Friend give way on that point?

[Glyn Davies]

On that point, I will, yes.

[Andrew Bridgen]

I thank my hon. Friend for calling this very important debate. I, too, share some of his concerns about the consistency with which the Liverpool care pathway is implemented across the country. I made some inquiries in the hospitals that serve my constituents, but information seemed to be lacking on the implementation of the care pathway. I am particularly concerned that patients placed on the pathway may have no opportunity to be taken off it if they improve. There are no figures on the number of patients for whom care has been reintroduced after being placed on the pathway. One of the hospitals told me, anecdotally, that no one there could remember anyone being taken off the pathway. I find that worrying.

[Glyn Davies]

My hon. Friend makes a very good point. Patients on the pathway should be monitored regularly, and if the patient shows signs of rallying, as does happen in a minority of cases, the treatment should be modified to support recovery. If that is not happening, the pathway is not being implemented properly. The Liverpool care pathway is not a pathway to death —a phrase I have seen used often, but which I think is unbelievably awful. It is a travesty of the truth to describe it as a form of euthanasia.

Why have we reached the point of huge public controversy, which has caused so much angst and fear? It has arisen from allegations—serious allegations, some of them from doctors and nurses—that the pattern of end-of-life care I have described has not been followed in some cases. There have been stories of dying patients being deprived of the food and water they needed and others being kept continuously sedated until they died; and of patients being placed on the pathway without consultation with them or their families, or to meet targets. The fear of that is especially shocking, and I hope the Minister will comment specifically on the issue of targets.

Let me look at some of the allegations in more detail. According to the Daily Mail in June last year,

“NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds”.

The report is based on a presentation to the Royal Society of Medicine by Professor Patrick Pullicino, a consultant neurologist. He stated:

“The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway.”

That is the debate being led by the Daily Mail. Professor Pullicino continued:

“Very likely many elderly patients who could live substantially longer are being killed by the LCP.”

Imagine how a frail elderly person entering hospital a few weeks after reading that would feel. Professor Pullicino added:

“Patients are frequently put on the pathway without a proper analysis of their condition.”

According to the Daily Telegraph, in September, a group of experts stated in a letter that

“dying patients…can…have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.”

The letter—again according to the Daily Telegraph—spoke of a “national crisis” in patient care, and

“a national wave of discontent…building up, as family and friends witness the denial of fluids and food to patients.”

According to the newspaper, some patients were wrongly being put on the pathway, which created a “self-fulfilling prophecy” that they would die. The report continued:

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway”,

and,

“many doctors were not checking the progress of patients enough to notice improvement in their condition.”

Those are shockingly serious allegations. If they are true, urgent corrective action is needed.

There is another side to the equation, however. More than 20 respected organisations, including the Department of Health, Age UK, the Alzheimer’s Society, Macmillan Cancer Support, and the Royal Colleges of Physicians, General Practitioners and Nursing, have signed a declaration that

“Since the late 1990s, the Liverpool Care Pathway has been helping to spread elements of the hospice model of care into other healthcare settings”.

It mentions:

“Published misconceptions and often inaccurate information”—

referring, I think, to the stories in national newspapers I have quoted. Our task and the Minister’s is to reconcile the support of all those organisations for the Liverpool care pathway with the allegations made—in good faith, I am sure—by people who believe that the pathway is what they call a pathway to death.

Any tool is only as good as the workman who uses it. The declaration states clearly that the Liverpool care pathway

“Relies on staff being trained to have a thorough understanding of how to care for people who are in their last days or hours of life.”

We have to face the fact that, in most professions, there are instances of excellence and malpractice, and health care is no exception. It would be surprising if, when 130,000 people a year are dying on the Liverpool care pathway, there were no cases in which the pathway had been misapplied. That applies to every branch of medicine and, indeed, every occupation. There are good and less good doctors and nurses; there are well run and less well run hospitals; but to lay the blame at the door of the Liverpool care pathway is like tearing up “The Highway Code” because there are some bad drivers. Where there is bad practice and poor care, it should be rooted out and replaced with good care.

It seems to me that the review the Government recently launched provides an excellent opportunity to consider thoroughly all those issues. It is urgently needed. The review should call for any evidence of poor end-of-life care. We need the Minister to assure us this afternoon that the stories I have quoted will not simply be taken at face value, but will be investigated in detail, so that we can establish the scale of poor end-of-life care, and understand the causes and correct them.

Oral Answers to Questions

Andrew Bridgen Excerpts

Tuesday 27th November 2012 Commons Chamber

[Mr Hunt]

With respect to the hon. Gentleman, a 39% fall in consultancy expenditure compared to the last year of the previous Administration is something that we are rather proud of. If he wants to know what the Health Secretary is directly responsible for, direct Department of Health expenditure on consultancy in the past year was £3 million. In the last year of the previous Government it was £108 million.

[Andrew Bridgen (North West Leicestershire) (Con)]

Has my right hon. Friend made any recent assessment of the total efficiency savings achieved in the NHS over the past two years under the Nicholson challenge?

[Mr Hunt]

We are making good progress on the Nicholson challenge. This year we expect to save £5.8 billion under that important programme to improve efficiency in the NHS so that we can treat more people.

Oral Answers to Questions

Andrew Bridgen Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Mr Hunt]

I am extremely concerned about what happened on 27 September. I can confirm to the hon. Gentleman that all the red 1 calls on that day were met within the target time of eight minutes, but the delays were completely unacceptable. I know that the trust is taking measures to ensure that the problems are not repeated, particularly looking forward to the winter time when there is likely to be extra pressure on ambulance services. I will follow the matter very closely, and I expect the trust to come up with measures to ensure that his constituents are properly safeguarded.

[Andrew Bridgen (North West Leicestershire) (Con)]

In the summer, I spent an interesting and thought-provoking day observing the work of a crew of the East Midlands ambulance service. Can my right hon. Friend confirm that ambulance trusts across the country, including the East Midlands ambulance service, are performing well in meeting their response time targets?

[Mr Hunt]

I can absolutely confirm that. In fact, I was extremely pleased to see last week that all the standards are being met for both eight-minute category A calls— red 1 and red 2 calls—and 19-minute calls. That is as it should be, but it is no grounds for complacency. Although that is a country-wide picture, there are parts of the country where those standards are not being met in the way that we would like. We will continue to monitor the situation closely.

Children’s Cardiac Surgery (Glenfield)

Andrew Bridgen Excerpts

Monday 22nd October 2012 Westminster Hall

[Andrew Bridgen (North West Leicestershire) (Con)]

It is a great pleasure to serve under your chairmanship, Mr Hollobone. I welcome my hon. Friend the Minister to her post and congratulate my hon. and learned Friend the Member for Harborough (Sir Edward Garnier) on securing this important debate.

As the Member for North West Leicestershire, I speak for a constituency roughly equidistant, in distance and travel time, from the Glenfield site and the Birmingham children’s hospital site. For my constituents, there is nothing to choose between the two, so I have a position of relative impartiality. I am interested in patient outcomes.

I recently toured the congenital heart centre at Glenfield, and two main concerns from the report were raised with me. The first was the issue of capacity and demand, which was raised by the hon. Member for Leicester South (Jonathan Ashworth) and my hon. Friend the Member for Bosworth (David Tredinnick). The figures given by the Department of Health were queried. It has been calculated that Birmingham children’s hospital will be expected to deal with 611 cases a year. However, clinical teams have suggested that it could be 900 to 1,000 procedures a year. Birmingham children’s hospital, having done its own modelling, expects the number of procedures to be more than 900.

I understand that senior commissioners acknowledge that the number is likely to be significantly higher than the figure of 611 used in the review, as does Sir Roger Boyle, the recently retired cardiac tsar, who initiated the project. The calculations demonstrating that the closure was a safe and sustainable option for the midlands, which considered travel, access, quality, deliverability, sustainability and affordability, were based on 611 operations, not 900 or 1,000. Doctors at Glenfield doubt very much that Birmingham children’s hospital has the capacity to handle that volume of work. In addition, Birmingham children’s hospital has stated that it wishes to move to a new site within 10 years, as it has already reached the limit of what can be achieved in the space that it has. Based on that, I would like the points that I have raised to be addressed to ensure that the Safe and Sustainable exercise was carried out using the correct data.

I turn to extracorporeal membrane oxygenation, or ECMO, a life support service currently delivered at Glenfield. There is a strong argument that the value of the service has not been fully appreciated throughout the review. Glenfield pioneered ECMO treatment in the UK and delivers education, training and clinical support to other ECMO centres in the UK and abroad. Survival after ECMO treatment in the Glenfield unit is far more likely than in other UK and international centres—that is, more children survive.

Several concerns have been raised with me about the Safe and Sustainable process for assessing the risks and practicalities of moving the service. I understand that only two experts were consulted about moving ECMO, and that the Swedish ECMO expert Kenneth Palmer, of the Karolinska Institute, has publicly expressed his anger at how his views have been used to justify the move from Glenfield, and has withdrawn his support for the process. Another issue is how a Sea King helicopter carrying a patient might land in central Birmingham. Glenfield can handle that, because it designed a system to accommodate it. Although the use of a Sea King helicopter is rare, we have heard that when they are used, as in the recent fire in Wales, they are life-savers. I would welcome a further review of the matter.

I remain concerned that Birmingham children’s hospital will not see ECMO as a strategic priority and might contemplate splitting the service among other providers, which would defeat the principles of the Safe and Sustainable review and put at risk the world-class results that we are achieving. The review’s aim is to concentrate expertise and deliver more positive outcomes. However, there are no plans for any other ECMO provider, including Birmingham children’s hospital, to use what my hon. and learned Friend the Member for Harborough termed the mobile retrieval service. That goes against the principle of the whole review.

The mobile retrieval service that Glenfield provides is a fundamental aspect of the service, and it partly explains why Glenfield produces so many positive outcomes. Its team travel by ambulance to the hospital where the sick child is located, taking all the necessary kit with them to start ECMO treatment. ECMO is then started on site and continued in the ambulance on the way back to Glenfield, ensuring that children receive the treatment as soon as possible at a time when their life expectancy without treatment might be measured in hours rather than days, and avoiding a much riskier ambulance journey on a simple ventilator. If that aspect of the service is not taken up by others in Glenfield’s absence, there is a danger that fewer children will survive horrific illnesses.

Will the Minister clarify the level of scrutiny of the results achieved at Glenfield and Birmingham children’s hospital? Since the decision was made, the unit has stated that it invited various members of the Safe and Sustainable review to Glenfield to show them the results of the past 10 years, which, it believes, demonstrate the success of its service. It has no record of that data being shared previously, and I would welcome clarification on what data were looked at during the initial review process.

A significant concern, highlighted by my hon. and learned Friend the Member for Harborough and the hon. Member for Leicester South, is the fact that it cannot be assumed that the staff who deliver the service at Glenfield will relocate to Birmingham. Many live east of Leicester and will find the commute to Birmingham unviable. I understand from Glenfield hospital’s own surveys that a number of staff have indicated that they are unwilling to move to the new unit.

There is also concern regarding the air of uncertainty that surrounds these units. Once a unit is earmarked for closure, the most able and gifted personnel quickly find jobs in other areas. That puts the process under great strain and leads to a rise in mortality rates. I hope the Minister gets on with this review as quickly as possible, so that we have a rapid resolution and can provide some reassurance to staff to ensure that we keep the service at its superb, world-class level.

We need to ensure that the conclusions of the Safe and Sustainable review are safe and sustainable—not only for the remaining structure of the NHS, but for my constituents in North West Leicestershire and all constituents in Leicester, Leicestershire, the east midlands and the midlands as a whole. I hope the Minister will take account of that.