(5 years, 5 months ago)
Commons ChamberThe hon. Lady and the hon. Member for Hammersmith (Andy Slaughter), who is sitting next to her, have run, over a number of years, totally inappropriate scare stories about what they said were potential changes to A&E in west London as part of “Shaping a healthier future”. It has been one of the worst aspects of local parliamentary campaigning and I am absolutely clear that the changes in A&E in west London as part of “Shaping a healthier future” will not happen. However, there are elements of “Shaping a healthier future” that are about more community services and treating more people in the community. We look forward to working with the local NHS on those parts of the proposal.
Will the Secretary of State, on behalf of this House, thank doctors and nurses in the NHS for the amazing news that death rates from breast cancer are falling at a faster rate here than in the six largest countries in Europe and that, since 2010, death rates have fallen by 17.7%? He will know that I raised the issue of my constituent Nicola Morgan Dingley, who is suffering from terminal breast cancer. He very kindly wrote to me. Will he agree to meet Nicola so that she can describe to him the challenges faced by women with triple negative breast cancer?
Yes, of course, I would be delighted to meet my hon. Friend and his constituent. He is right that the fall in deaths from breast cancer is huge progress that we have made as a country. I pay tribute to the work of the NHS on that but, of course, every such death is a tragedy and we need to do yet more.
(8 years, 2 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
It is a great pleasure to serve under your chairmanship, Sir Alan, and to address the issues raised by my hon. Friend the Member for Gower (Byron Davies). They are hugely important issues and he got into the detail of them.
I am also pleased to take part in a debate with the Minister, because she has worked really constructively with the industry during her time in office. The work that she has done in lowering the alcohol by volume in drinks, as a result of working closely with the industry, has taken a billion units out of consumption. That shows that constructive working can have a huge impact on the nation’s health and the nation’s drinking habits.
I should declare an interest as the chairman of the all-party group on beer, and colleagues should see my entry in the Register of Members’ Financial Interests; I am also the patron of a drug and alcohol rehabilitation centre in my constituency. I want to see a healthy drinks industry and a healthy population, and those two things are not mutually exclusive.
In Government, we used to have something called “the nudge unit”, to try to persuade people and help them to make the right choices. However, we are seeing “Project Fear” in this approach and we saw in the referendum that that approach simply does not work. At a stroke, we have made 2.5 million people problem drinkers. Let me tell the tale of my auntie, Irene. She died at the age of 88. Before she died, she used to enjoy a bottle of Mackeson Stout every evening. According to these guidelines, she was a problem drinker. That is what we have done. These guidelines are so against the grain of the way that people live their lives that we risk people ignoring them and ignoring other advice, and going on regardless, so that the guidelines become absolutely pointless.
For instance, Sir Alan, you will be surprised to know that according to these guidelines the Minister can drink exactly the same amount of alcohol as my right hon. Friend the Member for Brentwood and Ongar (Sir Eric Pickles). I have never been drinking with the Minister, but that does not seem to make any sense at all. Size, and the way in which men and women absorb alcohol at different rates—none of that is being taken into consideration.
It is interesting that in a written answer to my hon. Friend the Member for East Worthing and Shoreham (Tim Loughton) the Minister said that, although we have specific guidelines on calorie intake for men and for women—that guidance is differentiated—we do not have them for the intake of alcohol. That just shows that there is absolutely no sense in the way this guidance is being proposed.
My hon. Friend the Member for Gower referred to the concerns that exist about the way this report was drawn up and about the organisations that took part in the research, including those involved in the temperance movement. I am also concerned that in a written answer to my hon. Friend the Minister wrote that
“The National Institute for Health Research has awarded funding to The University of Sheffield… to evaluate the new drinking guidelines.”
That is a case of people marking their own homework, and we should all be very concerned about that. There are real concerns about the rigour with which this information has been compiled and we risk people turning off and not taking any notice, which could damage the health of the nation.
I realise that other Members wish to speak and that time is pressing. I appreciate the efforts that the Minister has made to work with the drinks industry, but this guidance came as a bolt from the blue. The industry knew nothing about it. There was no consultation. Nobody from the alcohol industry was involved in peer-reviewing the evidence, so I hope that we will reconsider. I realise that it is an independent report, but I urge the Minister to reconsider the validity of the evidence, because it just does not stack up.
Before I call the last two speakers, I should inform you that, as I said before, we will have to start the winding-up speeches at five minutes past 6, so if you can, please share the time remaining.
It is a pleasure to be able to speak in this debate. I congratulate the hon. Member for Gower (Byron Davies) on securing it.
This debate has highlighted the fact that statistics can be used to prove just about anything. It is important that people out there have confidence in the statistics and the guidance that they are given, and I am concerned that the Royal Statistical Society seems to have a bit of a worry about the guidance that has been put forward—particularly on the issue to do with intake for women and men. There is evidence to suggest that women’s and men’s bodies absorb alcohol slightly differently, and that really ought to be acknowledged so that each individual gets the best advice possible.
The hon. Member for Burton (Andrew Griffiths) talked about the differences between people. My brother is 6 feet 4 inches and his girlfriend is about 5 feet 2 inches, and there are obviously stark differences between them. Having said that, unless people are going to have a personalised alcohol prescription, it is quite difficult to be specific. We have to have general guidelines that give people an idea of what they can expect. People have to know their limits, as the hon. Member for Strangford (Jim Shannon) said. He also said that 60% of alcohol sales are to problem drinkers, which is an issue that we have had in Glasgow and the west of Scotland. As my hon. Friend the Member for North Ayrshire and Arran (Patricia Gibson) said, alcohol consumption significantly blights families.
Organisations such as the Glasgow Council on Alcohol, through their community work, seek to get people talking about the impact that alcohol has on communities. As the Glasgow Centre for Population Health has found, inequality has a significant effect. In Glasgow, the most deprived communities have five times more of a problem with alcohol than the least deprived communities.
Alcohol guidelines are not just about pubs, as the hon. Member for Gower seemed to be suggesting. I very much support the real ale industry, and CAMRA does really good work and has transformed the way people look at alcohol—they go for quality rather than quantity in some cases—but the fact remains that many people, particularly in deprived communities, are not going to a nice, cosy real ale pub; they are going to the local shop on the high street and buying large volumes of alcohol, which will do them significant damage.
I agree with much of what the hon. Lady is saying. Does she share my concern about telling people that alcohol can cause them to misjudge risky situations, cause accidents and cause them to lose self-control, and giving them advice about drinking alcohol before going up a ladder? That is not the kind of advice about alcohol that people expect, and the risk is that the general public will have no confidence in the guidelines.
We need to be aware of the impact of alcohol generally. The hon. Member for Henley (John Howell) spoke earlier about alcohol in the House of Commons, which is still a concern for me. I was at an event earlier celebrating tennis—a nice, healthy activity—and there was booze. I could get a drink at lunchtime. I do not think that is acceptable. The House of Commons should consider whether it is appropriate for people to have a drink with their lunch at events that take place during a working day. I am not convinced that it is.
The Scottish Government have a framework for action on alcohol. We pursued the Alcohol (Minimum Pricing) (Scotland) Act 2012, which, due to the alcohol industry, has been bogged down in a legal dispute. Importantly, it is about trying to cut down the number of people buying large volumes of alcohol. We are trying to change that behaviour and get people to think about how their drinking is affecting their health.
Evidence that organisations such as the Glasgow Centre for Population Health have looked at suggests that we need a change in attitude. There are people who are damaging their health severely every day. This is not about an auntie who drinks a wee drink before she goes to bed or anything like that. It is about people who are drinking more than they should and drinking in unhealthy ways, which has an impact on their health and their ability to go about their business safely.
I saw a study from the Glasgow Centre for Population Health a few years ago that suggested that, in the most deprived areas of Glasgow, people who drink quite a lot end up in hospital more than people who drink an equivalent amount in better-off areas, because their lifestyles and the things around them do not keep them safe. Someone in a well-off area might be having a bottle of wine every night, whereas someone in a poorer area having something else is far more likely to come to harm. There are serious considerations not only about public health but about how we think about alcohol in general, and about the guidelines that are put in place to get people to think about how much they are drinking and what they can do to reduce their intake, be healthy and happy and have a good role in their families and communities.
Can the hon. Lady tell me of just one sentence today in which any Member has said that they are not concerned about the effects on health, or about domestic violence or alcoholism? This is a ridiculous speech—I realise that she is new in her position, but I suggest that in future she does a little more research before she comes to the Chamber.
I have to advise the hon. Gentleman that I was a spokesperson on public health for three years for the Labour party. Not only did I do research on the health issues around alcohol, but I visited other countries—notably Scandinavian countries—to see what they had done. My point is that if hon. Members are willing to come here without spelling out the issues that I am describing, it must suggest to anybody listening to or reading the debate that they put them below the interests of the pub trade.
I thank colleagues for bearing with our rather interrupted debate. I am fairly confident that I will not have time to discuss all the issues in my response, but as some colleagues are aware, my door is always open, and I have a proposal towards the end of my speech for how we might continue the discussion.
First, I congratulate my hon. Friend the Member for Gower (Byron Davies) on securing this debate and on opening it so authoritatively. We are all aware of the impact of alcohol misuse, which was well summed up by the shadow Minister, who is knowledgeable about that. She reminded us of some of the pressure it puts on our vital public services. It is right that we give this issue our attention.
I know that people have asked why we need new guidelines when alcohol consumption is falling. My hon. Friend, in introducing the debate, talked about some of the areas in which we have had welcome improvements in the statistics. The majority of people drink alcohol in an entirely responsible way. In 2014, 59%—just over 25 million adults—drank within the new guidelines, so it is important to stress that quite a lot of people drink that amount or less at the moment.
As a Government who believe in informed and empowered consumers, we have a responsibility to provide clear information to help people make informed choices about their drinking. The guidelines are not about preventing those who want to enjoy a drink from doing so. Goodness knows, as a passionate remainer, I can certainly say that guidelines of all sorts have been suspended in my household for the past week or so. This is about ensuring that people get common-sense advice and practical information, and some of that will be about things like taking days off from drinking. There is an appetite for that; we know that from the research we have done with people.
The new low-risk drinking guidelines are the means by which the four UK chief medical officers, working together, provide the public with the latest and most up-to-date information about the health risks of different levels and patterns of drinking. Let me clarify at the outset, in case I run out of time, what the guidelines are not. Nobody has said that more than 14 units is considered harmful or problem drinking. It is just not recommended as low risk. To be clear, there is no public policy on abstinence. The guidelines are not about the rate at which alcohol affects men and women in terms of intoxication, but how it affects their long-term health.
If colleagues will forgive me, I have very little time. I will not even have 10 minutes. I will give way, but it means I will not get through my speech.
I have a very simple question. Does the Minister think there is no such thing as safe drinking?
I will come on to deal with some of the issues, but I will also make a suggestion for how we take this discussion forward. The issue outlined was about the extent to which alcohol affects people. The second part of the consultation, to which a response has not yet been published—I will come on to talk about that—is about how we express and communicate the new guidelines. That is slightly different from the science that sits behind them. I want to try to pull those two things apart. Clearly we have a job of communication to do, because we want to be helpful to the public.
Perhaps it would be useful to remind Members how we arrived at this review. It was not Ministers who asked the chief medical officers to do it but Parliament. The previous guidelines came out in 1995, and in 2012 the Science and Technology Committee recommended that they should be reviewed because they had not been for so long. It is fair to say that there are a lot of places around the world where such guidelines have not been looked at for a long time, so the evidence base is not as up to date as it could be. There was a lot of parliamentary interest, especially in the previous Parliament, in guidelines—for example, in the harmonisation of the pregnancy guidelines when we had debates about foetal alcohol syndrome.
At the request of the four UK chief medical officers, three independent groups of experts have met since 2013 to look at both the scientific and the behavioural evidence of the health effects of alcohol. Those groups were made up of international experts in the field of epidemiology, public health, liver disease, behavioural science, science communications and evidence-based alcohol policy. None of those people were members of the temperance movement.
To ensure that the guidelines are as practical as possible, after their publication the Government held a public consultation to gather views on their clarity, expression and usefulness. I should clarify something that is important: the Royal Statistical Society supported the evidence review and the conclusions. It was very specific in its challenge about how the Department of Health presented it in the launch. That is exactly why there was then a consultation about how we express and discuss the guidelines. To be clear, though, the RSS did not question the evidence review or its conclusions.
As part of the consultation process, Public Health England has undertaken market research to test understanding and acceptance of the guidelines—just the points that colleagues have asked about. Overall, the results were positive, showing that the language was understood and accepted and the tone appropriately informational. That is the tone we are trying to achieve: informational, not hectoring or nannying. The expert group has now reviewed the consultation responses and market research and has put its final recommendations to the four CMOs for their consideration. We intend to publish the final guidelines and the Government response to the consultation as soon as possible.
We of course recognise that industry has a key role in communicating the new information to consumers, particularly through labelling. I thank my hon. Friend the Member for Burton (Andrew Griffiths) for his remarks. As he knows, as a Back Bencher in the previous Parliament I was an active member of the all-party groups on pubs and beer. I had the honour of being the guest judge of the pale ale category at the Battersea beer festival on more than one occasion. To declare an interest, I am a member of the Campaign for Real Ale. I could not agree more that a well-run pub or bar can be a great way to help people to drink responsibly while maintaining social contact.
Nevertheless, the industry needs to enable those who want to moderate what they drink to do so. It has done some really good work on that. The work with the industry in the previous Parliament on alcohol units was very useful. I always have a further challenge for the industry. One thing we can do to reduce the number of units people consume and to develop that wider choice is to put more emphasis on lower-alcohol products. When I have spoken to them, I have always been very honest with industry spokesmen that greater promotion of lower-alcohol drinks can help people to get into healthier habits. Simple switches can help. I want to put on the record that just by swapping from a pint of beer or lager at 6% strength to a pint at 4% strength, people could cut their units by a third—that is, they could take out 1.1 units. They could still enjoy their pint but cut their alcohol intake by a third.
The chief medical officer had a successful meeting with the Portman Group yesterday, confirming willingness on both sides to continue to work constructively together and to deliver benefits to the public and good information to our constituents. There are reasons for optimism in some of the alcohol statistics, but the shadow Minister is right that there are some significant and often highly concentrated problems. We need to give people the best and most up-to-date advice. We recognise that it is not for the Government to tell adults what to do in their private lives, but we do have a role in enabling the public to make informed decisions about their health based on up-to-date guidelines and the best science.
I am grateful to the chief medical officer, who has confirmed that she is happy to hold a parliamentary drop-in briefing for colleagues to discuss the matter further. It simply is not possible to pick up many of the detailed points that have been made on the various international studies in the time available. For the record, the review scrutinised all the available high-quality evidence and covered the findings of 63 systematic reviews from the evidence worldwide. It was a major undertaking. I think it would be useful for colleagues to be able to come along and discuss some of the studies that have been cited. Some of them are in different countries and some, it must be said, are based on different situations in terms of the nature of the national health service and the health support in those countries. I do not have time to go into that factor, but it is relevant for some of the comparative remarks that were made.
I hope I have reassured colleagues that we want to move forward in a sensible way. We want to give people the best information and we want to communicate it with clarity. Change will not happen overnight, but we want to raise awareness of the health risks, particularly around some of the links, such as between breast cancer and alcohol. We have a vastly better understanding of that than we did in 1995, and that has come through in recent years. It is important that we reflect that and continue to communicate it. I hope we can move forward constructively from here. I will set up the meeting that I offered. I sense from the Chamber that there is an interest in having further constructive dialogue. I leave a couple of minutes to my hon. Friend the Member for Gower to close the debate.
(9 years, 2 months ago)
Commons ChamberI thank my hon. Friend. He has been a huge support in all these matters, which have at times been extremely difficult. He is absolutely right. I have come across cases of agency workers charging absolutely extortionate fees. I could give the Minister in private—he would be shocked to hear them—one or two examples of what I consider to be close to blackmail.
Another question is raised: if these important services are moving, without mention in the information to my constituents, are other moves planned of which we have no information? The loss of emergency surgery, consultant-led maternity, full level 3 critical care and in-patient paediatrics was—even if most were the wrong decisions—at least clearly set out and communicated with my constituents. These acute in-patient services were not. What we therefore need, and what I have been asking for since last summer, is a clear summary of exactly what services will be available and where.
Of course, this is primarily the responsibility of the UHNM Trust. However, it is grossly unfair to place this burden entirely on it. It has been asked to do a huge job in bringing together two acute hospitals, one of which has been the subject of a major public inquiry. It needs the full support of the NHS through the NHS Trust Development Authority and NHS England. I am asking the Minister to make it his responsibility to do precisely that.
I will now turn to the tender for cancer and end-of-life services throughout the west of Staffordshire and Stoke-on-Trent. The proposal has been developed by NHS England, the four clinical commissioning groups covering North Staffordshire, Stoke-on-Trent, Stafford and surrounds, and Cannock Chase, and Macmillan Cancer Care. The objective is clear: to improve cancer outcomes, which are currently below the average for England and well below the European best, so that survival rates are among the best in England by 2025 and subsequently among the best in Europe.
I commend my hon. Friend for securing this debate and for the fantastic work he has done over the last five years, both for his constituents and for people across Staffordshire. We welcome the work he does, and I am sure he would join me in thanking the doctors, nurses and clinical staff across Staffordshire who have worked so hard to get improved care across our county. Does he agree that we still have a fragile healthcare economy in Staffordshire? I managed to secure £8 million for East Staffordshire CCG thanks to the help of the previous Health Minister, but that is for just one year, so does my hon. Friend agree that we need to move towards fairer funding in Staffordshire?
I entirely agree with my hon. Friend and reiterate his remarks about the excellent work done in my constituency by staff at the County hospital to recover the situation, which a few years ago was extremely difficult, to one where the quality of care offered is of a very high standard.
To return to cancer and end-of-life services, the real concern has been over the method being used. To quote Macmillan:
“We think a procurement process is the best way to integrate the fragmented cancer and end of life services we have in Staffordshire. A procurement process is needed because at the moment there is no one organisation with overall control of cancer or end of life services.”
My argument has always been: in that case, what are CCGs for? They are there to commission, so why can they not commission? In the last Parliament, we gave them the ability to work together to procure services, so why cannot the four CCGs involved, together with Macmillan, simply make that happen? The answer I was given at the time was that the constraints on CCGs’ own administration costs—a reducing amount of funding per head—meant that it was impossible. Sometimes I am puzzled. We see this all over Government and have done for many years and across many Departments: we constrain spending on so-called bureaucracy and then, in order to get necessary things done, pay large sums of money to consultants to do precisely the kind of bureaucratic work that we forbid the experts from doing—in this case the CCGs—but, because it is called consultancy or programme work rather than overheads, it is allowed. There is a problem that needs to be solved—I do not deny that—and it affects the lives of my constituents and those of other Members, so it must be solved.
Macmillan says about the first two years of the contract:
“The main responsibility of the integrator will be to address the current inadequate data about pathway activity and the real cost of this activity. Much increased investment over the last decade has arguably been wasted by poor contract accountability and a lack of reliable data and analytics.”
That is important, but it is a research and advisory role. I have no problem with the CCGs calling in experts to offer them such research and advice, whether it is a private company, university or, indeed, another arm of the NHS. A fee will be paid for that work. Again, I have no problem with that, but I would like the Minister to say how much it is likely to be. As local MPs, we have a right to know, on behalf of our constituents, or at least have a rough idea.
According to Macmillan, after 18 months the integrator —I would say consultant—will be expected to
“present a more detailed strategy as to how they expect to achieve improved service outcomes. If the evidence is robust, arrangements will be made for all contracts to be transferred to the Service Integrator from the beginning of year 3. If not, the contract with the Integrator could be terminated and the Service integrator will be required to repay all (or a significant part) of their fee to date.”
That is where I do not see the logic. What makes an organisation that is good at research and advice the right body to run cancer services for our constituents? Why can it not simply be thanked for its advice and that advice, if it is good, be followed by the CCGs, working in co-operation with the providers? The risk is that the vital work that patients, the CCGs and Macmillan have done, with the very best of intentions, will be damaged by contractual arrangements that do not make sense and may put a private organisation with a somewhat different ethos in charge of commissioning NHS providers for services, rather than the other way round.
I have no problem at all with a private organisation producing a much better plan for cancer and end-of-life services, nor do I have a problem with social enterprises or private providers being involved in delivering certain elements of that plan, as they do now and have done under Labour, coalition and Conservative Governments. However, I do not see the logic in the organisation producing that plan becoming another bureaucratic tier between the CCGs, providers and patients. I therefore ask the Minister to take up the proposed contract with the CCGs.
The state of general practice is gradually becoming critical in our area. Many GPs are retiring or approaching retirement. I welcome the Government’s plans to train more GPs, but we will also have to train more medical students or rely on recruiting from overseas.
(9 years, 6 months ago)
Commons ChamberI am very much aware of the work that my right hon. Friend and my hon. Friend the Member for Colchester (Sir Bob Russell) have done on this. It is interesting that all the other 10 pilots have continued. They are part of NHS trusts. This is the only one run by a voluntary sector organisation. It is an incredibly valuable service. I was struck by the extent to which people said how much they had reduced their hospital in-patient admissions as a result of the incredibly impressive preventive work that this service provides, and I want to look into it further.
14. What support the Government are giving to people with Ehlers-Danlos syndrome.
The Government acknowledge the challenge posed in supporting patients with Ehlers-Danlos syndrome, which encompasses a complex range of conditions with a wide variety of symptoms. Diagnosis and investigation of suspected EDS takes place in dedicated regional genetics clinics, with specialist clinics, as my hon. Friend will know, at Sheffield Children’s NHS Foundation Trust and London North West Healthcare NHS Trust.
People in Burton have raised £130,000 to pay for a life-saving operation that is not available in the UK for Nina Parsons, my constituent, who suffers from EDS. I have another constituent, Sarah Pugh, who is having to pay for vital physiotherapy and an MRI scan. Will my hon. Friend look at what more can be done to help people suffering the misery of EDS, and will she agree to meet some sufferers to discuss the matter further?
I am certainly very happy to talk to my hon. Friend about his particular constituents. I am aware of the work that he has done in his local area. He will be interested to know that in 2013 the Government published “The UK Strategy for Rare Diseases” precisely to address such issues and the complexities around them, and aspects of that strategy speak directly to the challenges that he has just outlined. May I also take this opportunity to mention that there is an event tomorrow in Parliament organised by Rare Disease UK to mark rare disease day, at which the Under-Secretary of State for Women and Equalities, my hon. Friend the Member for East Dunbartonshire (Jo Swinson), will be speaking?
(10 years, 2 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
It is a great pleasure to serve under your chairmanship, Mr Hollobone. I look forward to your advice throughout this important debate, and I am also grateful to hon. Members for joining me for it today.
I think it was Daniel Defoe who in 1726 said that the only certainties in life are death and taxes. That is true. These are issues that none of us really wants to talk about, but unfortunately, death touches us all. All of us in the Chamber and anyone watching will no doubt have been touched by the loss of a loved one. Many of us will have lost parents. Some will have lost a partner or a child, a son or a daughter. Those are terrible things to cope with—the sense of loss, and the pain and anguish that come with that terrible event.
The idea that, at such a sad and low time, when people’s world collapses, they should have the forethought, integrity and generosity to make the decision to give the organs of their loved one to support the lives of others is a very difficult thing for us all to contemplate, and we would all struggle with that question when asked. However, I have also spoken to people who have done exactly that: they have given the organs of their loved one for the use of others, to give life to others, and they tell me of the incredible meaning that it gives to the traumatic loss of a loved one. It puts that loss into context. In the words of one parent who spoke to me, their son will always live on. That is a tremendous thing for anybody to contemplate.
However, the reality is that in Britain today, some 7,000 people are currently on the waiting list for an organ transplant—right now, they are at home, ill, waiting for the phone to ring, waiting for the hospital to call, waiting for the chance of a new life. It is hard to put ourselves in their situation, but their lives depend on that phone call and on that organ being made available. The figures show that 1,300 of the people on the list will die. They will become too sick to receive a transplant. That is unacceptable, and it is what I hope we can address in today’s debate.
Last year, 1,323 people became organ donors, compared with 1,164 the previous year. That is good news; it is an increase of 13.7%. Transplants from those donors have risen by a third to more than 3,000. Currently, just under a third of the population of the UK are on the organ donation register. On 12 June this year, it was more than 20 million people—20 million people who have sat down and made the choice that after their death they would like to give life to others. I commend them for that choice and I hope that, by raising the issue today, we can encourage more to do the same.
I congratulate both this Government and the previous Government on the successes that have been achieved over recent years. There is a good news story to tell on organ donation. We saw a 50% rise in donor numbers by 2013 on the previous five years. Thanks to the implementation of the recommendations published by the organ donation taskforce in 2008 under the previous Government, transplants from those donors have jumped by a third. However, there is much that we can do, and much more that we must do if we are to give as many of those 7,000 people as we can the opportunity of life.
The numbers on the registers are still too low—pitifully low. As I mentioned earlier, just under a third of the people in the UK are now registered. In the UK, we have 13 donors per 1 million people, which is still one of the lowest rates in Europe. Compare us, for instance, with Spain, which has an opt-in system, rather than an opt-out system. There, the figure is 35 per 1 million people, which is almost three times as high.
So why are people in the UK not signing up? All the evidence shows—the surveys show—that 96% of the population support the principle of organ donation, yet only 30% of the population register, so what has happened to the remaining 66% or so? The rate of sign-up to the register varies dramatically across the UK. The highest sign-up rate to the register is, of course, in Scotland, where 41% of the population is a registered organ donor. I commend them north of the border, but why is it that in England and Wales, those signed up are only 30% and 31% respectively? Why is the figure so much higher north of the border?
I have been told that some of that is attributable to a simple, but hard-hitting television advertising campaign, encouraging people to sign up as a donor, and more importantly, to discuss their decision with their loved ones. The advert is very simple. A man in front of a camera suggests that people watching tell those they are with about their wishes for organ donation—“Right there, right now, look at everybody in the room and tell them. Make sure that your wishes are clear.” It is a hard-hitting advert, which is clear and effective.
I believe that we should have a simple, hard-hitting campaign just like that in England and Wales, and I push the Minister on it. I have previously written to the Secretary of State for Health encouraging him to do exactly that, and I urge the Minister to look again. Perhaps she could tell us whether she has any thoughts on an advertising campaign, because we all recognise that education, and talking about those things and raising awareness are key.
Education is a key way of encouraging people to sign up, and our schools also have a part to play. The “Give and Let Live” resource pack has been used in schools since 2007. It helps teachers to introduce 14 to 16-year-olds to the concept of organ donation, but it is not compulsory on the national curriculum. I am not suggesting that it should be; I recognise that we have to give head teachers the autonomy to make those decisions and to decide what is taught in personal, social, health and economic education lessons. However, raising awareness about the campaign and encouraging teachers to use the resource will encourage young people not only to sign up and get on the organ donor register, but to talk to their parents about it. That is also important. If we can get this conversation going on around the breakfast table between children and their parents, we will have much more chance of not only getting more people to sign up, but getting people to accept the wishes of their loved ones when that difficult question and difficult moment arises.
The use of the Driver and Vehicle Licensing Agency has also been incredibly successful in encouraging people to become organ donors. People are asked when they apply for a driving licence whether they also wish to join the organ donation register. It has been fantastic; over half a million people sign up every year as a result of that simple question, which takes seconds to answer.
I pay tribute to the Cabinet Office’s behavioural insights team—or “the nudge team”, as the press like to call it. They have done a study of this issue. It is a very interesting piece of work about the most effective way to frame the question to encourage people to sign up. Through a pilot that they ran, they found that just a slight change in the wording could lead to an additional 96,000 sign-ups every year. It is incredible how the human mind works and how it is affected by the questions that are asked. It is important that the Government think logically in that way to encourage people to do the right thing.
Of course, there is another important element to this. It is important not just to get people on the register. Also important is what happens once they are on the register and, sadly, in a position to become an organ donor. It is important that we convert people on the register into donors. We must increase the consent rates among the families. UK donation consent rates remain among the lowest in Europe. Four out of 10 families said no to a deceased relative’s organs being donated even when they were on the register. There has been no overall improvement in the consent rate since the organ donation register was introduced in 1994. How to deal with that is, for me, an important question.
It is interesting that as a person—I hope that the Minister would agree—of sound mind and body, I can decide to donate my organs after my death, yet my family can take that decision away from me and I have no choice about that. We do not do that in any other walk of life. We do not say that I can sign my will, saying that I am going to donate all my money to the Conservative party to secure Conservative elections in years to come, and that my family can then override that will, unless they can prove that for some reason I was not of sound mind and body. We must empower people to make the decision for themselves. Yes, it is important that they discuss it with their family, with their loved ones, but we must recognise that, as a free individual, I have the right to choose to donate my organs and no one should be allowed to take that right away from me. I would be interested to know whether the Minister has any thoughts on that.
The aim of the NHS Blood and Transplant strategy, “Taking Organ Transplantation to 2020”, published last year, is to increase the UK’s consent rate for donations from 58.6% to 80%. That is a very big jump. It is an ambitious target, and I hope that we can meet it. In contrast, Spain has the highest consent rate in Europe, at 84%. Last year, the consent rate in the UK increased by only 2%, from 56.5% the year before.
There is a startling difference between what happens when donation has been openly discussed with family members beforehand and what happens when the decision comes as a shock or surprise. In 2013, 94% of families in the UK agreed to an organ donation when their loved one was registered and had discussed their wishes with them. That fell away to 80% when they were on the register but had not discussed that with their family, but most worryingly it fell to 43.5% when the person’s wishes were not known at all. That clearly demonstrates the need not only to get people on the register, but to ensure that people talk about that when they are. We must ensure, under the system as it stands at the moment, that it is not a solitary decision. If we do not encourage people to let their families know about their decision, unfortunately their wishes, their intentions, the good that they wish to do will be denied.
Of the 20 million people in the UK who have put themselves on the organ donation register, only 60% have told their families that they have done so. We can do the maths: the wishes of 40% of the people who have the potential to give new life to another human being are being denied simply because they did not tell their wife, their husband or their partner what they wanted to happen after their death.
In 2012-13, 115 families overruled their relative’s consent for their organs to be used. I understand why they did that. I understand the pressure, the grief, the pain that those people are going through, but we cannot allow a situation in which those 115 deaths were for nothing. Those 115 deaths, with the conversion rate for organ donation, could have given more than 300 people a fresh lease of life. That is what we must focus on.
The UK will never achieve its potential for donation and transplantation when more than 40% of families refuse to allow donation, sometimes against the wishes of the patient. Obviously, when anyone has lost a loved one, it is a difficult and emotional time, but if the deceased had expressed a clear wish to donate their organs, it seems odd that the family can overrule that. That is why I urge the Minister to think about changing the law so that we can make a choice for ourselves to do the right thing and donate our organs.
The Welsh Government, as the Minister will know, are seeking to deal with the issue. From December 2015, they are introducing an opt-out system of presumed consent unless a deceased person had expressed a wish not to donate their organs. A similar system has produced incredible results in Spain. I recognise that this is a hugely controversial issue. It has been characterised as a case of “Who owns your organs?” I recognise that there are deep and heartfelt reasons why people would oppose such a system. I am also aware that previously the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), said that the Government had no plans to introduce it elsewhere in the UK, because of those cultural, ethical and legal issues.
I thank my hon. Friend for allowing me to intervene; I hope that later I will catch your eye, Mr Hollobone, and can make a contribution. This is the first point on which I completely disagree with my hon. Friend. Does he accept that there is no evidence whatever that changing to an opt-out system, even in Spain, which I will deal with in my speech, has delivered more organs? To consider it an ethical issue—the Opposition and many of us base our view on the efficacy of such a change, rather than on the ethical position—is, I think, a mistake.
I thank my hon. Friend for that intervention. Perhaps he is just a little presumptuous. I was not intending to argue for the opt-out system. All I was going to urge the Minister to do was to look at these issues on the evidence. What I suggest is not that we should come forward with a similar proposal for England and Wales, but that we should follow the evidence. We should look closely at how the system is implemented in Wales and at its impact. My hon. Friend has said that he will talk about the situation in Spain. In Spain, there was a delay before there was an increase in the number of donor organs available, but all the evidence seems to suggest that the system has led to a big increase.
Not only is the debate important, but it raises awareness of organ donation. It gets people talking; it stimulates discussion, which is important. My hon. Friend will know that the principle of the opt-out system is supported by a number of organisations, including the British Medical Association, the British Heart Foundation and Kidney Research UK. As I said, I hope that the Government will look closely at the evidence—at the results of changing the law in Wales—and look to reconsider their position as the evidence develops. My hon. Friend may well be right that there will be no marked increase in the number of organs available for donation, but we do have to follow the evidence, look at the results and decide what we do in the rest of the UK as a consequence.
There was a call by those involved in organ donation committees in our hospitals to look at the issue of the lack of family consent overriding the wishes of the deceased.
I congratulate the hon. Gentleman on obtaining this debate on what can be a very controversial issue. Does he agree that we should exhaust every possible avenue, whether it be schools or the driving licence organisation or whatever, before we even look at going down the road of an opt-out system, because it is a very controversial issue? In Northern Ireland, 527,000 people—32%—are on the register. The figure is increasing every month. A consultation is ongoing. I understand that in October a consultation will also be carried out on an opt-out system. I think that we need to exhaust every other avenue and then have further debate on that issue.
I agree with the hon. Gentleman; he talks a great deal of sense. The issue is very sensitive and we do not want a backlash in the form of people deliberately coming off the organ register because of ethical and moral concerns. I agree that there is more that we can do. I congratulate the Government on what they have achieved so far, but we can do a great deal more. The issue is important not only because lives are at stake, but because it has a massive impact on NHS costs, which I hope to touch on towards the end of my speech. I completely agree with the hon. Gentleman.
I want to address organ donation in the black and minority ethnic community. I am the Member of Parliament for Burton, which has a large Muslim population—mainly Pakistani and Kashmiri diaspora—who contribute massively to the community. However, there is no doubt that there is a problem with organ donation among BME communities. There is particular concern about the lack of donors coming forward from BME backgrounds. The startling truth is that people from BME backgrounds are up to three times more likely to need an organ but are less likely to donate; they need it more, but they donate less. Only 3.6% of people on the organ donation register are from ethnic minority backgrounds, despite their making up 10.8% of the population and a staggering 27% of the waiting list. Those figures show how skewed the numbers are and how desperate it is that we do something about the issue.
More than 30% of people listed for a kidney transplant are BME, compared with just 5.6% of deceased kidney donors in 2013. Why is that important? NHS blood and transplant statistics show that, on average, people from black and Asian backgrounds have to wait a year longer for a kidney transplant: between 2006 and 2010, the median waiting time for a kidney transplant in the UK for a white person was two years and 363 days, yet for a black or Asian person the wait was three years and 320 days. That is a whole year longer, just because of someone’s ethnicity. Family refusal rates among ethnic minority backgrounds also play a big part. The Minister will know that those rates are much higher than for the population as a whole, with 30% of BME families giving their consent to organ donation, compared with 68.5% of the white population—more than twice as many. That is why it is so important that we tackle the issue of organ donation among the BME community.
Ethnicity is hugely important in organ donation because a person is much more likely to find a match with someone from a similar ethnicity. It is vital that we do more to encourage people from BME backgrounds to sign up to the organ donation register. That is not the only answer; it is also vital that we break down the cultural barriers that prevent BME families from consenting. I commend the Government on the NHS blood and transplant team’s faith and organ donation summit in May last year. It was a good event, and it was agreed that sustained engagement on organ donation by and in ethnic minority communities is needed.
Those are all good words, but I am not seeing them reflected in my community. I am not seeing organ donation being discussed in churches, mosques and community centres. I am not seeing our imams and priests talking to their communities and encouraging them to come forward and donate—to do the right thing by signing up to the organ donation register. None of the major religions object in principle to organ donations, but of course opinions in communities differ. Organ donation is often not discussed, or is called, for example, un-Islamic. We must address such things if we are to break down prejudice and save lives in BME communities as a result. Leaflets have been distributed among different faith communities to that effect, but I hope the Minister will agree that much more can be done.
One way to increase donation that has been advocated is through the use of specialist nurses in organ donation—there is a wonderful acronym: SN-ODs—who were introduced following the 2008 recommendations. We now have 250 SN-ODs, who are there to support people going through the organ donation process and to raise awareness of donating. The National Black, Asian and Minority Ethnic Transplant Alliance is calling for more SN-ODs to come from ethnic minority backgrounds, and I agree with it on that. I am not sure whether the Minister is aware that of those 250 SN-ODs throughout the country, just one is from a BME background. Is it any wonder that we are failing to break down cultural barriers at that terrible moment of loss, when we have only one person from a BME background to engage with people who are suffering such loss, and to encourage them to give life to others?
The proposed action plan arising from the summit in May last year featured a number of criteria on increasing engagement with ethnic minority communities. The aim was to fulfil them before September this year, and other criteria by a year hence. I would be grateful if the Minister would give us a little more information about what she and the Department are doing regarding those important criteria.
I know that other Members wish to speak, so I will soon draw my remarks to a close, but I want first to touch on a few points. First, I called for this debate at the request of William Saunders, the chairman of the organ transplant committee at Queen’s hospital in my constituency. It is fantastic to see William and his team, like others throughout the country, engaging as members of the community to try to encourage others to do the right thing and sign up to the organ transplant register. I hope that the Minister agrees that such people are doing a fantastic job in our community and that more must be done.
I also called for this debate because of a constituent, Katherine Sinfield, who sadly was diagnosed with leukaemia. My local newspaper, the Burton Mail, has done a huge amount to highlight Katherine’s case and to encourage people to come forward and undergo stem cell testing in order to find her a match. I am delighted to say that she has now found a match and had her treatment. We all wish her well, and she is doing incredibly well.
Through the Burton Mail’s campaign, I have seen the difference that raising awareness can make. The work of the Burton Mail and the Anthony Nolan trust has resulted in a large increase in the number of Burton residents who have come forward to be tested and who want to do their bit. It has also raised a huge amount of money for the Anthony Nolan trust. If we can encourage similar activity across the country—if Members will raise the issue in their constituencies—we can all play our part in raising awareness.
In conclusion, with such a high level of support for organ donation among the general public—96%—it is surprising that there is such difficulty in finding enough donors to meet the demand for transplants. It is clear that more work must be done. Despite these times of constrained public spending—we all recognise the difficulties in which the Government find themselves—I believe we can do more to solve this problem. Indeed, the “Taking Organ Transplantation to 2020” strategy says clearly that
“no additional funding is likely to be needed to move forward: much of what needs to be done is about working differently rather than increasing resources.”
I am sure that that is music to the Treasury’s ear, but I know that the Minister will put her shoulder to the wheel and help.
Without meaning to put it in crude terms, transplants save the NHS money in the long term. The entire transplant programme saves the NHS £316 million a year, which is money that would otherwise be spent on treatment. A successful kidney transplant operation, for example, costs £17,000, with a future cost of some £5,000 a year. A year’s dialysis for a patient with kidney failure, on the other hand, costs £30,800. The NHS blood and transplant service predicts that, for every year a kidney transplant remains functional, it saves the NHS £24,100 per patient while saving the patient’s life. If ever there was a win-win, that is it. From a financial perspective, it makes perfect sense to want to increase the number of organ donations if they can deliver such savings for the NHS, but more importantly, from a personal perspective, if any of us or one of our loved ones needed a transplant, we would do everything possible to ensure that we found a donor. We would move heaven and earth to give our loved one that chance.
I join the call of the organ donation committee at Queen’s hospital in my constituency and others across the country in saying that more needs to be done to increase the number of people on the organ donation register. Sign up; it saves lives.
Thank you, Mr Hollobone, for calling me to speak in this important debate on an issue that has featured strongly in my life. I congratulate my hon. Friend the Member for Burton (Andrew Griffiths) on securing the debate, and on the reasoned and comprehensive way in which he presented his case. I apologise to him and to you, Mr Hollobone; I did not notice that this debate was taking place until about five minutes before it started, so I have not prepared. I apologise if my comments are in any way disjointed.
Donating an organ is just about the greatest gift that anybody can make. It is great to do so on death, but it is perhaps even greater in life, such as when people donate kidneys altruistically. I know several people who have done so, and it is one of the greatest things that one can do. This is a particularly good day to discuss organ donation; the night before last, we watched Erik Compton, who has had two heart transplants, come second in the US Open golf championship. It demonstrates how a transplant can not only give life but allow the recipient to live a life that is completely full and to do the most amazing things. Coming second in the US Open is a pretty amazing thing to have done.
My own interest started with a woman I knew, Trudy, who was a constituent, although I was not the MP then. She had one of the first heart and lung transplants at Papworth. She was a most amazing person. Together, we worked to deliver kidney dialysis in Montgomeryshire, where there was none. A unit has now been approved and built, and is delivering a terrific service. Trudy died a couple of years ago, but the dialysis unit stands as a monument to the fantastic woman that she was.
I am a trustee of the Kidney Wales Foundation. One of my disappointments is that I disagree with the foundation—I am the only trustee who takes this view. I disagree completely with what the Welsh Government have done in changing the law to introduce presumed consent. I have always been a bit disappointed by that. The aim of every trustee—me and all the others, although we disagree—is to increase the number of organ donations and the number of organs available. I have always been driven by the evidence. I have never been influenced by the ethical debates; I am influenced only by where the evidence takes me in terms of how to deliver the most organs. I firmly believe that what the Welsh Government have done will absolutely not deliver more organs, despite what they say.
The only time I ever feel resentful in this sensitive debate is when, as has so often happened on the numerous times when I have been invited to speak about this issue in the media, somebody in desperate need of a new organ is interviewed and I am then asked why I want to prevent them from having an organ. I am utterly appalled by the media’s lack of objectivity and the lack of reference to evidence when dealing with the issue.
We need to move forward as best we can and I want to focus on policy for the future. I will make some specific points. We must look at what happened in Spain. Spain has been referred to in this debate on several occasions and it is a huge success story. However, it is often incorrectly referred to as a country that introduced an opt-out system. That claim is absolutely false, even if the Welsh Government used it as part of the basis for their argument. Despite people writing to them—I have written to them—to tell them that that claim is false, it is still what they base their consultation on. It was a disgrace to conduct a consultation on those terms.
What happened in Spain was that opt-out legislation was introduced in 1979. Twelve months later, it was pretty well abandoned. It remains on the books, but like a lot of laws it has never been implemented. Ten years later the Spanish Government realised that the legislation was not working and they introduced a series of other changes. I believe that it is those changes that we should concentrate on if we are to make a difference.
We should also learn from the organ donation taskforce, which my hon. Friend referred to several times. It did a terrific job under its great chair, Elizabeth Buggins, who is one of the most expert people on this issue. The taskforce considered the issue for two or three years. Everyone assumed that the taskforce would recommend a change to presumed consent. However, when it produced a report, all its members had changed their minds because they had looked at the evidence. The person who has taken over from me in Montgomeryshire believed that changing to presumed consent was a way forward. I said, “Look at the evidence.” As soon as she studied that evidence, she changed her mind.
There are things we should do and that we should learn.
I thank my hon. Friend not only for attending the debate, but for making such an important and heartfelt contribution; I think that we all value that. I understand what he is saying about the opt-in system versus the opt-out system and the need to follow the evidence. However, does he agree that ultimately organ donation should be my choice? It should be the individual’s choice as to whether their organs are used for donation after they die, and nobody else’s choice.
I thank my hon. Friend for that intervention, because that is a perfectly reasonable position to take. I do not know what the figures are—I do not know how often this situation happens—but I want to know them. I am interested in them because the situation seems wrong.
I accept the point that has been made, but the one counterpoint is that sometimes people can change their minds even though they are carrying an organ donor card. However, if people have joined a campaign, we should assume that that is their view. I would be surprised if there are many instances where a family would overrule an individual’s decision; it would be interesting if the Minister could give us the figures to show how often that happens. If it is a major issue, we should address it; I agree with that point.
The first issue that we must deal with is the specialist nurses for organ donation. That is what made a huge difference in Spain, and it is the area where we really need to concentrate. That is what has made the big difference here. Since the organ donation taskforce reported, the number of donations has increased by 50%, which was the target. That is good news, but it is the specialist nurses who have made the difference.
I spent some time talking to the specialist nurse in Shropshire and indeed he has agreed to visit local schools and to organise discussions and debates. We can use specialist nurses to help people to understand this debate, because it is such a sensitive time to talk to people. Talking to people when the person who perhaps they love most looks as if they are alive, because their bodies are still breathing, even though they are brain-dead, and saying that that person’s support system should be switched off and their organs taken is a hugely traumatic experience. We need trained nurses who have the skills to communicate with people in those difficult circumstances. It is the specialist nurses for organ donation who can do that.
Four out of 10 families refuse consent when they are asked to give it.
I think that that is a repetition of the previous intervention. However, the point is interesting and I would like the Minister to give us the figures to show to what extent that situation actually happens, and whether a specialist nurse in organ donation was involved in individual cases.
The second thing that is crucial, particularly in Wales, is the number of intensive care beds. A lot of people assume that an organ can be donated when there is a road accident or when somebody is suddenly killed in another way, but there can only be a donation when the person is in an intensive care bed and there is the facility to take a donation. We have a shortage of intensive care beds. The number of such beds in Spain is huge. It is much higher than the number in the UK, and in Wales the number is particularly low. That is the sector where the investment needs to go to ensure that there are intensive care beds. I know that in the last year there have been cases in Wales of organs that were available for donation but they were simply not used because there was not an intensive care bed to allow the donation to happen.
The final point I want to make is, I think, the reason why my hon. Friend the Member for Burton secured this debate today. It is about the issue of awareness. We should put every effort we can into campaigns to have everybody tell their next of kin their view on donation. That is what I say to people in schools when I talk to them; I say to people, “Tell your family what your view is, so that they know clearly.” Carrying an organ donation card is helpful in that respect, because it very much gives an indication of someone’s view. That is why I was interested in the point that my hon. Friend has made in his interventions on me.
What we really need, and the Government can afford it, is a big advertising campaign based on the message, “Tell the family. Make sure your next of kin know your wishes.” If we had such a campaign, we would raise the number of consenting next of kin. If we can increase the number of people in Britain who consent to organ donation to the level it is in Spain, we will not have the thousands of people dying that we have now.
(10 years, 4 months ago)
Commons ChamberAs our colleagues rush to watch the second half of the Manchester United match, I should like to raise an issue of somewhat greater importance to my constituents. Although the title of the debate is narrow and focuses on the effect on my Tamworth constituency, the wider implications for users of Burton Hospitals NHS Foundation Trust also affect the constituents of my hon. Friends the Members for Lichfield (Michael Fabricant), for North West Leicestershire (Andrew Bridgen), for South Derbyshire (Heather Wheeler) and for Burton (Andrew Griffiths)—I see that my hon. Friend the Member for Burton is in his place.
I thank my hon. Friend for giving way and congratulate him on securing this debate and for being a doughty fighter on behalf of his constituents in the provision of health care. He will know that Queen’s hospital has a deficit of some £3.1 million. It has already saved £9.8 million but needs to save a further £10 million in 2013-14. Given that my own east Staffordshire clinical commissioning group inherited a deficit of £8 million—
Order. If the hon. Gentleman is making an intervention, I am sure he will wish to be brief. If he wishes to make a speech, he will have to have permission to do so.
I am grateful to you for that advice, Madam Deputy Speaker. I was just about to get to the crux of the matter. Given that the area is £12 million away from fairer funding, does my hon. Friend agree that the health care economy is incredibly fragile locally and that something needs to be done to help us bridge that gap in the short term?
I quite agree with my hon. Friend and suggest that we find that way forward, in the first case by seeking a meeting with the Secretary of State to discuss our concerns about the trust.
In nearly four years as a Member of Parliament, this is the first Adjournment debate I have applied for in the Chamber. I hope that gives you, Madam Deputy Speaker, and those on the Treasury Bench some indication of the importance that I and my constituents attach to the subject.
The Sir Robert Peel community hospital at Mile Oak in my constituency provides services for people living in and around Tamworth including a round-the-clock minor injuries unit, an X-ray and ultrasound department, an endoscopy unit and out-patient and day surgery. It also provides award-winning rehabilitation services, care of older people and palliative care services. Indeed, the award to staff for their innovative work on rehabilitation was received only two weeks ago.
The hospital is an important and valued service in our community. Local residents are very attached to it and the medical support it offers to a growing town. They want to be a part of its future, yet as a result of a review that many feel was conducted behind closed doors, Burton Hospitals NHS Foundation Trust, which runs the Peel, has decided to close its day case theatre and surgical ward and is considering withdrawing its endoscopy service. A decision on that service will be made next month. The closure of the day case theatre alone will affect about 1,400 patients each year.
Although no institution, including the NHS, can be set in aspic and although hospitals can and must be prepared to adapt to meet the changing demands of NHS users—for example, the growth in the number of elderly patient means that hospitals need to make more provision for dementia and palliative care—I am concerned that the proposals for the Robert Peel are being hurried through without the fullest consultation and certainly without the fullest involvement of the local community in Tamworth and Fazeley. Although local people are now being invited to so-called listening events, they are about the options for future service provision and not the decisions that have already been made. It appears that the Burton trust has closed its ears to concerns about its plans for day surgery.
The trust has form. A year ago, it introduced parking charges at the Peel hospital with no public consultation and with very little notice. The system it introduced was ill-conceived and badly signed, resulting in a large number of unwarranted fines being levied on some of the most vulnerable people: the old and frail, concerned relatives and the lowest paid. Many of those fines have been overturned. More than 3,000 people signed my petition calling on the trust to rethink its parking proposals and the trust, to its credit, recognised public concern and is now in the process of developing a revised parking system, yet, like the Bourbons, it seems to have learned nothing and forgotten nothing from that experience.
On 5 February, staff at the Peel hospital were called to a meeting to be told that, following what was described as an “extensive review”, the surgical ward would be closed in as little as 12 weeks. They knew nothing of that review, and neither did anyone else—not me, not the local health scrutiny committee, and certainly not the wider community. The review took place between October and January behind closed doors and no one was told. The first the wider community knew was when the story was broken in the Tamworth Herald on 13 February. Yet it was not until 25 March that the trust answered detailed public questions at the Healthy Staffordshire scrutiny meeting, which took place not in Tamworth, but in Stafford. The impression left is that the trust has talked to itself, but not to anyone else.
I have met the chief executive and the operations manager at the Burton Hospitals NHS Foundation Trust and they have assured me that the Robert Peel will not close, that minor injury services will be unaffected, and indeed that new services, such as pressure ulcer clinics, may be run out of the hospital. However, I am concerned that the very thing my hon. Friend the Minister was at pains to stress during the debate on amendments to the Care Bill on 11 March—indeed, he made the point directly to me during my intervention—that proper patient and community consultation must take place before decisions are made, is just not happening at the Peel hospital. As a result, patients, staff, hospital users, local councillors and the local community feel that changes are being done to them rather than along with them after recognising their concerns and their advice.
Burton Hospitals NHS Foundation Trust says that demand for the day case theatre has dropped by 30% in the last five years and that 40% of current capacity can be dealt with in GP surgeries. That may well be true. It may also be true that commissioning services in GP surgeries is cheaper and more convenient for my local clinical commissioning group. However, I remain concerned that if this decision is hurried through without proper consideration and consultation, the problems the hospital discovered with its car parking arrangements could be replicated on a far more serious level—that of patient care. We cannot be sure that all local GPs have the necessary equipment, experience and time to undertake all the new procedures they may be called upon to deliver. We need to be sure that Queen's hospital in Burton and the Good Hope in Birmingham have the scope to add to their already demanding schedules without affecting patient waiting times. At the very least it means some people may need to travel further, and spend more on their journey, for their scheduled minor surgery. For an operation at Queen's hospital in Burton, that means travelling some 18 miles along the A38, which, when it is blocked, tends to stay blocked.
I hope my hon. Friend will agree with me that if Burton Hospitals NHS Foundation Trust believes that services at the Robert Peel must be adapted to meet changing needs in the community it serves, it must make those changes having first clearly and openly discussed its proposals with the wider community. A handful of local councillors, important as they undoubtedly are, simply is not good enough, and it must be careful to analyse and accept the sensible advice of the community, including the friends of the local hospital who do so much good work with it. Making its decision at the start of the consultation process, rather than at its end, does nothing to engage public confidence; indeed, it makes a mockery of any consultation.
I hope that my hon. Friend is prepared to send a clear message to Burton Hospitals NHS Foundation Trust, and to others, that while they must continually monitor their services so that they remain relevant to and focused on need and so that they deliver the very best patient care, decisions made behind closed doors long before anyone is asked their view are not acceptable. The trust board must agree to the widest local consultation, must collate and publish feedback from its consultation and must be prepared to act on the considered advice of all local stakeholders. Only then will people believe that their local hospital is truly their own.
I congratulate my hon. Friend the Member for Tamworth (Christopher Pincher) on securing the debate. I am well aware of his long-standing interest in matters affecting his constituency, including his well-documented support for the Sharon Fox cancer centre. I fully understand why he has raised the matter of the Sir Robert Peel hospital today. I hope that the discussion about the future of services in Tamworth and the surrounding area will move forward constructively following this debate—certainly more constructively than it might have done recently.
Before looking at the local situation in detail, it is important to say a few words about the importance of high-quality engagement between the NHS—in this case the trust—and local patients and commissioners. Decisions about patient care and NHS services should, where possible, be taken in as open and transparent a way as possible. It is important that patient groups and the wider public are properly consulted in decisions about local NHS services. That is clearly outlined in the tests for reconfiguration laid down by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) when he was Health Secretary earlier in this Parliament. My hon. Friend was right to highlight the importance of public and patient engagement in the design of local NHS services, in this case for the benefit of his constituents in Tamworth.
The situation at the Sir Robert Peel hospital is of course complicated by events that have taken place with the Keogh review, to which I will return in a moment. The hospital is part of the Burton Hospitals NHS Foundation Trust. It might help the House to understand the situation better if I briefly describe the foundation trust and some of the issues relating to the way the Keogh review is affecting services. The foundation trust provides hospital-based services from four main sites: Burton Hospitals NHS Foundation Trust in Burton-on-Trent, with acute hospital services including an emergency department; the treatment centre on the Burton Hospitals site, a dedicated centre for day case surgery and treatments; the Samuel Johnson community hospital in Lichfield, with local services, including a midwifery-led maternity unit and a 24/7 minor injuries unit; and the Sir Robert Peel community hospital in Tamworth. I will say a little more about those services in a moment.
The foundation trust provides a wide range of services to a population of around 360,000 across south Staffordshire, south Derbyshire and north-west Leicestershire. Over 47,000 planned and emergency admissions, more than 70,000 A and E attendances and around 13,000 day case procedures take place each year in the foundation trust hospitals across all the hospital sites. The Samuel Johnson hospital in Lichfield, as a community hospital, provides services that are similar to those provided by the Sir Robert Peel hospital in Tamworth. Both community hospitals had previously been run by the South Staffordshire primary care trust. The issue for the foundation trust is therefore much wider than the Sir Robert Peel hospital, because it is required to look across the entire population it serves and, on the basis of the services commissioned, provide a safe and high-quality service for the benefit of patients. The trust has only comparatively recently become responsible for the two community hospitals it operates, both of which it took over in 2011.
The Minister mentioned that Queen’s hospital is a Keogh hospital. The staff there are working incredibly hard to improve standards and are taking big strides forward. The Minister will have heard about the precarious situation in relation to Queen’s and the East Staffordshire clinical commissioning group. My hon. Friend the Member for Tamworth (Christopher Pincher) requested a meeting. Will the Minister agree to meet me, other colleagues and the team from Queen’s hospital and the CCG in order to discuss our concerns and find a solution that improves services locally.
I will be delighted to meet my hon. Friends to talk further about local issues. There are long-standing concerns, not least the processes triggered by the Keogh review in the trust and the wider health economy.
I turn to the local reconfiguration process. To ensure that the foundation trust would continue to provide the best level of service to the local population, the trust commissioned a report from Deloitte in December 2012. The intention was to address the long-term challenges faced by the trust by refocusing community services, such as those provided at the Sir Robert Peel community hospital, and concentrating on the most vulnerable patient groups.
The Deloitte report set out a number of options. However, as we are all aware, in 2013 the trust was inspected under the Keogh review, which we took forward following the Francis report on Mid Staffordshire foundation trust. Burton was inspected because it had higher than expected mortality rates. The Keogh review was not reassured by what it found. As a result of the inspection, the foundation trust was placed in special measures by Monitor, the regulator of foundation trusts. Monitor continues to work with foundation trusts in special measures to ensure that they return to safe and efficient services as soon as possible. The Keogh review made six urgent recommendations for Burton. Those recommendations have been the drivers for the changes at Burton and at the Sir Robert Peel community hospital.
Sir Bruce Keogh challenged the foundation trust on what its long-term plans would be for the community hospitals. For example, patient activity at both sites in Lichfield and Tamworth has been decreasing across minor injuries, in-patient and out-patient services for a number of years, and is, I understand, on a steadily decreasing trend. There is a need to make changes because, as well as the higher than expected mortality rates, the trust and its local commissioners believe that the health needs of the population they serve are changing.
As a nation, we face changing challenges in health care—for example, the demographic pressures imposed by an ageing population. As the health needs of the population change, it is right that the services provided at local hospitals and in the local health economy also change and that a more integrated approach is taken between local authorities and the NHS in delivering more personalised care, particularly for the frail elderly, and more care in people’s homes and communities.
The foundation trust has already responded to the Keogh review challenge, although much is still to be done. I understand that the reconfiguration to which my hon. Friend the Member for Tamworth refers follows on from and continues the response to the Keogh review. Certainly, the aims are the same—to ensure that health care services are of high quality and meet the needs of local patients.
The Keogh review has affected the Sir Robert Peel community hospital, which currently offers local services for people living in and around Tamworth—including, for example, a 24/7 minor injuries unit, in-patient, X-ray and ultrasound department, and an out-patient service. There is one ward providing rehabilitation, care of older people, general medical care and palliative care. Consultant and nurse-led clinics accommodate consultations, investigations, minor procedures, post-treatment follow-up and health promotion.
That is not the full range of services that one would expect at larger NHS hospitals. However, having close-to-home community-based facilities is an important part of meeting the challenge of looking after older people in their own homes. Some such facilities are found at Sir Robert Peel community hospital. I am sure that the local population welcome that and believe it important in delivering high-quality health care in the months and years ahead.
There are currently discussions about the relocation of day case surgery and there is a review of endoscopy. I understand that that would affect about 30 patients a week, with services moving to local GP surgeries, Good Hope hospital at Sutton Coldfield about eight miles away, or the main trust site at Burton.
I understand that further changes are being considered in response to Keogh. However, planning is at a very early stage. I understand that the trust board will be receiving an outline paper this coming Thursday and that no decisions have yet been taken. I am sure that my hon. Friend will agree that it would be highly inappropriate for me to speculate about what option or options might be considered or chosen by the local NHS. I would certainly not want to suggest that there is a Government-preferred option that should be followed; I am not in a position to do that. Whitehall micro-management of the local NHS invariably leads to bad things happening; that is what we have tried to avoid through the health reforms that we instigated in 2012. As I said a few minutes ago, such decisions are local decisions and must be seen to be taken by the local NHS and local commissioners, in consultation with local patients.
(10 years, 5 months ago)
Commons ChamberMy right hon. Friend makes an extremely important point. Indeed, the clinical commissioning groups have backed the changes, but the local population has not. The clinical commissioning groups are in a difficult position, because they have a budget, and the budget in Staffordshire, as in many other rural areas, is much lower than the national average for England. They are told that if they want to commission services that cost more than the tariff—as maternity services almost always do because maternity tariffs are simply not high enough—they will have to pay the extra. To some extent, the clinical commissioning groups are caught between a rock and a hard place. They may wish to commission those services, but in doing so they will have to stop commissioning others.
It is in the spirit of unity that I ask both the Secretary of State for Health and his shadow to visit Stafford and Cannock Chase hospitals to speak to patients and staff and to hear first hand what they have gone through. I also urge that same co-operation in approaching the long-term challenges facing our health service. The increasing specialisation of services—62 specialties as against 30 in Norway—is driving up costs and resulting in clinicians knowing more and more about less and less.
In Stafford, we have been told that we cannot continue with our consultant-led paediatric service, because we have too few consultants—five or six as opposed to the eight to 10 that the Royal College of Paediatrics and Child Health says are needed to maintain a rota. By that standard, some 50 or more other consultant-led departments in England should close. Instead of a proper national review with full political co-operation, however, we see the gradual picking off of departments in trusts that have financial difficulties. The same is true with maternity services.
I echo the point made by my hon. Friend the Member for Bracknell and urge the Government and Opposition to come together with the royal colleges and resolve this matter and much else. The British public are not stupid. They understand that they cannot have every service just around the corner. However, they do not understand why a consultant-led maternity department or paediatrics department in one place must close on safety grounds because it does not have a large enough rota, whereas another with a smaller rota remains open. They also understand the need for more services in the community, but the idea of “slashing” hospital budgets, as Sir David Nicholson is reported in The Guardian as saying, is both incomprehensible and deeply worrying to those whose A and E departments are heaving, whose wards are full and whose children face travelling long distances even to receive general treatment.
I thank my hon. Friend and neighbour for giving way, and I commend him for his work on this issue. He will know that Queen’s hospital in Burton has dealt with some of the overflow from Stafford hospital following the closure of facilities and services there. Does he share my concern that the special administrators have not met any of the management at Queen’s hospital, and have ignored its letter of concern, stating that closure of the emergency department will mean that it will require an additional 18 to 34 beds? The hospital has heard nothing in response to that letter.
I am grateful to my hon. Friend for making that point, which is one of the things that needs to be discussed. I am talking about special administrators liaising with other trusts such as the University Hospital of North Staffordshire NHS Trust, the Burton Hospitals NHS Trust, Walsall Healthcare NHS Trust and the Royal Wolverhampton Hospitals NHS Trust. We are part of an integrated health economy; what affects one affects many others in the region.
Many in the profession have put it to me that we are at risk of gradually losing the skills of general medicine and surgery. That is not to downplay specialisms, because they are vital. However, unless we maintain our district general hospitals, with their ability to deal with the majority of non-specialist cases, we will end up with our specialist hospitals being overwhelmed and without doctors with vital general skills.
It would be disingenuous of me to make such points without raising the matter of NHS funding. The Government are right to have maintained NHS funding in real terms during extremely testing times. They are also right to insist that waste is rooted out. Payments of thousands of pounds to locums for a shift are not uncommon. I could cite many other examples, but there is no time. There is little doubt in my mind that we need to allocate a little more of our GDP to health than we do currently, as we are below the level in France and Germany. However, that is a question for lengthy debate on another day.
As I have said in the House before, we need to take the NHS budget out of general Government spending and convert national insurance into a national health insurance, which will still be progressive and still based on payment according to income, so that we can maintain a first-class health service alongside a competitive tax system.
The Francis report is already having an important and positive effect on the national health service and will do so for years to come. I pay tribute to my right hon. Friend the Health Secretary and his team for all they have done on that and the seriousness with which they have taken the matter. The emphasis on the safety of patients and quality of care seems obvious to us now, but sadly it was not always a priority. The report not only provides answers and makes recommendations, but asks fundamental questions about the future of our NHS. I have tried to outline some of those questions today. I urge all parties to come together to tackle them for the good of our nation.
(10 years, 7 months ago)
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I thank the hon. Lady for her intervention and I entirely agree with that point. There is no point in Stafford’s merging with Stoke if the consequence is that we have a trust that will be financially failing in the future.
The administrators rightly place emphasis on the need for swift action, and I believe that the dissolution of MSFT in the autumn of this year should be possible—indeed, it should be possible even earlier. In fact, I would go further. MSFT has improved greatly in recent years following the huge failings brought to light through the vital work of Cure the NHS and documented in the Francis report. Its recently published hospital standardised mortality ratio figures were the best in the west midlands, but it is fragile and finds it difficult to recruit in some areas. We need the overall arrangements to take immediate effect, even in shadow form. In recent weeks I have detected less engagement than is necessary, because of the uncertainties of the administration process. That needs to stop.
This is all taxpayers’ money. It is our national health service. It is time to work together.
I congratulate my hon. Friend on securing this debate and on the work that he has done in recent years. He used the words “fragility” and “uncertainty”. He understands the fragility and uncertainty of the health care economy in Staffordshire. Queen’s hospital, in my constituency, is a Keogh hospital, which has huge financial debts and is struggling to survive. Does my hon. Friend agree that it is essential that this reorganisation takes place and is properly funded? If not, the knock-on effect on other hospitals, such as Queen’s, and on the wider health economy, could be damaging and have a domino effect, with other hospitals falling over.
My hon. Friend is right. We must make sure that we do not jump from the frying pan into the fire. We must get to a sustainable condition for the health economy. These new overall arrangements must take immediate effect. I urge the Minister to make that clear today, to give the various managements confidence to get on with their work.
I shall make one final point about the future UHNS and the Royal Wolverhampton hospital. The Secretary of State has rightly emphasised patient safety and care since the publication of the Francis report. The new expanded trusts have the opportunity to become national leaders in zero-harm health care, so I urge Monitor and the Secretary of State to seize the opportunity to support them in doing so at this time. Let this administration not be a dry legal exercise. Let it be the chance for Stoke, Stafford, Cannock, Wolverhampton and Walsall to become, even more, shining examples of the best 21st-century health care.
(11 years, 1 month ago)
Commons ChamberThat is exactly the reason why we are introducing measures to make sure—[Interruption.] Well, the Francis report was introduced to this House on 6 February, and we have said we will change legislation this year. We have already appointed a chief inspector of hospitals. I do not think we could go much faster. The trouble for the Labour party is not that we are going too slowly but that we are going too fast and exposing all sorts of problems which it wishes did not happen.
I thank the Secretary of State for shining a light on to the health care provided by Queen’s hospital in Burton. Although Queen’s has a lower unexpected death rate than other hospitals, any unnecessary death is a tragedy for the family concerned. Given that since 2005 Queen’s hospital had a higher mortality rate than Stafford hospital, does he understand the anger of my constituents who have seen their loved ones die unnecessarily and these concerns ignored by Labour?
My hon. Friend’s hospital had excess mortality rates for five of the nine years leading up to 2010 and not enough action was taken, and that is what today is all about. I hope that what his constituents will take from today is that this Government are committed to turning around failing hospitals and putting in place the right leadership, and the reassurance that when their loved ones go to Queen’s hospital or anywhere else in the country, they can get the kind of care they would want for themselves.
(11 years, 10 months ago)
Commons ChamberMay I begin by thanking you, Mr Deputy Speaker, and Mr Speaker for allowing me to make a brief contribution to this Adjournment debate? I congratulate my hon. Friend the Member for Enfield North (Nick de Bois) on the work that he has done on this important issue. He talked about the support group, and I am delighted to say that he has been a great friend of the PiXiEs. His continued support in raising the issue has gone a long way to reassure sufferers that somebody is taking notice and that somebody cares about the terrible situation in which they find themselves.
As my hon. Friend said, I come to this debate because of a constituency case. Mrs Dawn Thomas came to my constituency surgery a few months ago. Hon. and right hon. Members will know that MPs’ surgeries are quite often the destination of last resort. People come to us in desperation when they have tried every other avenue and taken every other opportunity. They have asked everybody else they can think of for help; they then come to their MP and expect us to deliver what others have not been able to deliver. Often we are put in a difficult position, but I can honestly tell the House that when I was confronted by Mrs Thomas and her husband my heart went out to them. Theirs was a desperate situation, and one that in the 21st century we surely cannot allow to continue.
Let me put the matter in context. Mrs Thomas is a young woman—she is 44 years old—and she is a mother. She plays an active role in her community. She works as a secretary in a local haulage company. She enjoys playing darts. She has never claimed benefits; she pays her taxes. She has done everything right in playing her part in the big society, yet she was diagnosed with PXE at the age of 21—I congratulate my hon. Friend on his dexterity in using the technical terminology in his speech, but I will take the easy option and refer to it as PXE. In the meantime, Mrs Thomas lost the sight of her left eye as a result of another illness. She had no real symptoms of PXE until about two months ago, when her sight began to deteriorate rapidly. In desperation, she went to her GP, who referred her to a consultant. The consultant gave her the devastating news that she had PXE and that she would go blind.
There was hope, however, in that there was a treatment out there that could save Mrs Thomas’s sight and allow her to lead her life as she knew it. She applied for the treatment but was refused by the primary care trust. She appealed, and received a devastating, formal, bureaucratic letter that told her in no uncertain terms that she would go blind. To receive such a letter must be a dreadful experience for a wife and mum. That is why she came to see me.
The story was taken up by my local newspaper, the Burton Mail, which campaigned on Mrs Thomas’s behalf, and by the national press. I am grateful to South Staffordshire PCT for looking again at her case. At the first appeal, however, it said that her case was not exceptional enough. I would say that anyone’s sight was exceptional, and that we should do all that we can to save it. I am delighted to say that the PCT reviewed her case, and that she is now receiving the treatment that she deserves.
The PCT has confirmed to me that the cost of treating Mrs Thomas with Lucentis is £18,000, while the cost of Avastin is just £8,000. Let us compare either of those sums to the cost to the taxpayer if she were to go blind. She would be unable to work, and she would be forced to claim benefits. Surely it makes economic sense for the Government to give her the treatment that she needs at an early stage, so that she can keep her sight and continue to lead the life that she loves. I am sure that the House will understand that no MP wants to be in the situation that I found myself in when I had to tell Mrs Thomas that the NHS could not help her, and that she was facing blindness.