NHS Winter Crisis

Andrew Selous Excerpts

Wednesday 10th January 2018 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

Like many Members, I wish to start by paying tribute to our primary care staff—the GPs, practice nurses, receptionists, community staff and district nurses; all those working in acute trusts in my local hospitals; mental health staff; social care workers; ambulance staff; and of course the volunteers, to whom we owe so much. They are a team, and any part of the NHS is weaker if one part is weaker, which is why I hugely welcome the change in the Secretary of State’s title, whereby we now have Department of Health and Social Care. That is a long overdue move, but we should all welcome it.

At my local Luton and Dunstable University Hospital NHS Foundation Trust, the increase in activity in recent years has been phenomenal: 83,000 more people were seen in under four hours in A&E in 2016-17 than in 2009-10; and 17,000 more operations and 46,000 more diagnostic tests were carried out in 2016-17 than in 2009-10. I pay tribute to the enormous amount of work. There are 166 more hospital doctors and 224 more nurses there now than in 2010. All that is welcome, as was the £1.116 million of extra winter pressure money put in.

I have spoken to the director of operations at the hospital this morning, and she told me that it was the busiest new year we have seen in a long time and that this situation had started two days before new year and gone on until this weekend. She said things have returned to a more normal basis now and, although there are a number of contingency beds open there, things are nothing like they were over the new year period. I pay tribute to the extraordinary way in which they coped with very difficult circumstances.

I received a letter on Monday from the East of England Ambulance Service NHS Trust, which said that on an average day it receives 3,000 calls but that on new year’s day, it received 4,800 calls. I defy any ambulance trust in the country to be able to cope with that significantly increased number of calls adequately. Indeed, I understand that on the days before and after the number of calls was also topping 4,000 a day. Our constituents want us to tell it as it is, and I received an email from a practice manager in one of my local surgeries saying that on 4 January there was a six-hour wait for a blue light ambulance. Just as the Prime Minister apologised, I would absolutely want to say, as a Member of Parliament, that I am not satisfied with that situation and we have to try to do better, notwithstanding the heroic efforts made.

We have committed to train 25% more doctors and 25% more nurses, and I hugely welcome the new nursing associates and nursing apprentices. What are we going to do, however, to put the NHS on more of an even keel? Let me briefly suggest six areas where we can make progress: first, it is unacceptable that nearly 10% of NHS England’s budget goes on type 2 diabetes; progress on tackling obesity is vital; more progress on the Getting It Right First Time scheme, which is saving billions for the NHS, will help; I make a further plea to the Treasury to make sure that we stop GPs leaving—those on the old pension scheme are disfavoured by the tax treatment; and we have to drive through the sustainability and transformation partnerships to really integrate health and social care.

NHS Winter Crisis

Andrew Selous Excerpts

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

I am always interested in what the former Health Minister has to say on these subjects, because he speaks with considerable authority. On ambulances, it is obviously unacceptable for there to be delays of that nature and leading to that kind of outcome, and we absolutely need to ensure that all trusts, when these incidents occur, look very carefully at trying to prevent them from occurring again. We have now—in part, in response to the pressures that the ambulance service has been under—set up a national ambulance control centre to try to help co-ordinate ambulance responses where services are not meeting the targets in certain parts of the country or our requirements in individual hospitals.

[Andrew Selous (South West Bedfordshire) (Con)]

It was back in 1994 that Germany got an integrated system of health and social care, with dedicated funding to pay for it. Will the Minister commit to moving forward, both at pace and at scale, with the sustainability and transformation partnerships, which are our answer to this problem?

[Mr Dunne]

That is absolutely our intention.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 19th December 2017 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

I warmly welcome the extra £1.1 million to help with winter pressures at Luton and Dunstable Hospital, and I can tell the ministerial team that the merger with Bedford Hospital is proceeding well, but it needs £150 million of capital. May I ask that favourable consideration be given to that in the allocation of the £3.5 billion announced in the Budget?

[Mr Dunne]

My hon. Friend will be aware that the Chancellor provided a package of £10 billion in the Budget last month to be invested in the NHS, of which £3.9 billion will come from the Treasury. All bids for capital are being assessed through the STP prism. The proposal that his area will be making will be assessed against others. As far as I am aware, no such proposal has yet been made to NHS England, but it will obviously be looked at in due course.

Maternity Safety Strategy

Andrew Selous Excerpts

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

I can absolutely confirm that for low-risk births that is the case, but it is also key to spot the births that are not low-risk, so that alternative provision can be made.

[Andrew Selous (South West Bedfordshire) (Con)]

Will the Secretary of State do everything possible to spread across the country the excellent “dads to be” courses that are part of the antenatal provision at Chelsea and Westminster and Kingston Hospitals? We know that they help solidify relationships between parents at a moment of strain and reduce family breakdown.

[Mr Hunt]

I am intrigued to hear that, because my three children were born at the Chelsea and Westminster, and my wife would have been delighted if I had done a “dads to be” course. I will certainly look into that course and, I am sure, actively promote it.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 14th November 2017 Commons Chamber

[Steve Brine]

Respiratory illness affects one in five people in the UK, and it is responsible for around 1 million hospital admissions annually, so it is very much in our interest, as I said to my hon. Friend the Member for Erewash (Maggie Throup), to implement the outcomes framework. I look forward to having further discussions with the hon. Member for East Londonderry (Mr Campbell), and I am happy to meet him if he wishes.

[Andrew Selous (South West Bedfordshire) (Con)]

Does the Minister, who cares deeply about these issues, share my concern that lung capacity often never recovers after being damaged in childhood? Is not that a powerful reason why we need to make significant progress on air quality issues?

[Steve Brine]

Absolutely. I have just returned from a meeting of G7 Health Ministers, and one of the subjects under discussion was environmental factors in climate change and its impact on human health. We had challenging discussions on many areas, but air quality and its impact on respiratory disease was not one of them.

Children’s Oral Health

Andrew Selous Excerpts

Tuesday 31st October 2017 Westminster Hall

[Andrew Selous (South West Bedfordshire) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bone.

As several speakers have said, this issue really matters, and it matters throughout people’s lives. A poor set of teeth can affect confidence, which can affect life chances significantly. It is shocking that the most common cause of hospital admission among five to nine-year-olds is tooth decay. According to a recent parliamentary answer, in 2015-16 some 917,346 tooth extractions were performed on children.

I note that in a recent publication the Royal College of Paediatrics and Child Health called for a child’s first dental check-up to be recorded in their personal child health record—that is supposed to happen by the age of one—and for paediatricians to include oral health in the assessment of all-round children’s health. If the first check-up happens by the time the child is one, we can set good habits in place and parents will carry on, knowing that dentistry is free for children.

On fluoridation of the water, which the hon. Member for Birmingham, Selly Oak (Steve McCabe) and my hon. Friend the Member for Mole Valley (Sir Paul Beresford) talked about, I will quote from a Public Health England document published on 14 June 2017. It says:

“An authority considering fluoridation will be met with claims that it does not work and that it causes harm. Both statements are untrue. PHE’s Water fluoridation: health monitoring report for England 2014 concluded that fluoridation is an effective community-wide public health intervention.”

We must be guided by the science in this issue. Many years ago, when I stood for election in Sunderland North, my Labour opponent came out with totally unscientific and untrue statements. We must be guided by the evidence, and I am pleased with what the hon. Gentleman and my hon. Friend said. The evidence seems to be clear that fluoridation is effective. Given the scale of the problem, we should do something about it.

Schools should be sugar-free zones as much as possible. I back banning the advertising of sugar products before 9 pm and would like to see an accelerated product reformulation programme. It is concerning that the reformulation data from August this year will not be made available until March next year. That is an area the Select Committee on Health is taking a close interest in.

As a nation, we have to wake up to the importance of child oral health and not be leisurely about it. It is a public health emergency and there is a degree of urgency to the issue that I want to see reflected in the Department of Health. We could ensure that all sports, education and health settings refused to put sugary drinks in vending machines.

[Catherine West]

The hon. Gentleman is making some excellent points. Does he agree with me that the amount of sugary drinks and products for sale in leisure centres and hospitals seems to send a mixed message?

[Andrew Selous]

I agree with that. Some of the food companies set a lot of store by their links with sport. Of course sport is a good thing—we should all take more exercise—but the key is good oral preventive hygiene and consuming less sugar. When we consider that five-year-olds are consuming their own weight in sugar, we begin to see the scale of the problem. I agree with the point made by the hon. Lady.

I have the pleasure of serving on the Health Committee with the hon. Member for Central Ayrshire (Dr Whitford), who will shortly be speaking for the Scottish National party. She has often told us that Scotland has got certain things better than England, and some of the time she may have been right. On this issue, we can learn from what is happening in Scotland, as my hon. Friend the Member for Mole Valley said as well.

Chapter 3 of the report from the Royal College of Paediatrics and Child Health, which I quoted from earlier, includes some graphs that show improvement in children’s oral hygiene. Somewhat irritatingly, the graphs end in 2013, but the rate of improvement in Scotland is clearly shown to be superior to the rate in England, Wales or Northern Ireland, as a result of the Childsmile programme, which I understand costs £17 per child. Set that cost against the £836 average cost of a child tooth extraction and, for my money, I would rather put more focus on prevention. I want to see the English treated as well as other parts of the United Kingdom.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

The hon. Gentleman cites a figure of £17. That is an average and is obviously not how the money is spent. It is very much targeted at children in areas of deprivation.

--- Later in debate ---

[Andrew Selous]

I am grateful to the hon. Lady for that clarification.

We now have a number of breakfast clubs before school, and the introduction of tooth brushing in them would be a good idea. I was pleased to hear my hon. Friend the Member for Mole Valley talk about the importance of education. Only a few years ago my own dentist told me about the importance of interdental brushes, which I do not think any other Member has mentioned yet. I do not know how effective they are for children—perhaps the Minister’s officials know and he will tell us when he winds up. Mouthwash is also important. Just getting the best possible prevention practice out there, including what we and in particular children should do, is really important if we are to make progress.

Social Care

Andrew Selous Excerpts

Wednesday 25th October 2017 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

As part of my self-imposed induction into membership of the Health Committee, I undertook a tour of various institutions in my constituency in order to understand health and social care better, and learnt about the new concept of independent living schemes. Earlier this year the Queen and the Duke of Edinburgh opened Priory View, which operates an independent living scheme in Dunstable. It presents a model of the way forward for social care. Older people are not isolated or lonely: there are exercise classes and loads of other activities. We need to get accommodation for such people right for the future, as Central Bedfordshire council has done.

I also visited Orchard Lodge care home in Tilsworth, and was struck by the very high standard of care. It has been rated “good” by the Care Quality Commission, and I was incredibly impressed by the dedication of all its staff. Another home, Rosewood Court in Dunstable, a beautiful building with wonderful facilities, closed this year because the owners could not find managers and staff to run it. That obviously caused a huge amount of stress and upset to residents and to their families, who had to move them at very short notice.

I also met some care providers in my constituency. I remember most clearly a conversation with a lady who ran one of the providers. She ran it very well, and is a former nurse who is working in care for all the right reasons. She said, “I would be too ashamed to go into a school to try to attract young people to come into my profession.” That is not right; we must not have such a situation. I asked, “What would it take for you to attract them?” She said, “A salary would be nice.” I asked, “How much?” She said, “£16,000 to £18,000 a year.” That is not much to ask for people looking after us in our old age.

On travel costs, I have said before and will say again that it should shame every one of us in this House that MPs get 45p a mile when we travel on parliamentary business, yet carers are often lucky to get 30p. What is good enough for an MP is good enough for a careworker. We need to sort that out.

Constituents have also raised the issue of the private subsidy of local authority places. It is not right that some people pay much more for the same place in order to subsidise local authorities. Constituents also tell me that they want even more rigour in the quality of care provided, so that we have real respect for those cared for and also real respect and proper career progression for carers.

We must also break down the division between nursing and social care. Simon Stevens has in the past described these as two great tribes of the healthcare system. There could, in a properly regulated way, often be more co-operation; they could do more together, which would be more efficient.

I have called for a number of steps that will cost money, and we need real honesty in this debate, because it will cost. I am very impressed by what I have read in both the Communities and Local Government Committee report on adult social care published in March this year and the House of Lords Select Committee report on the long-term sustainability of the NHS and adult social care. Both Committees of this Parliament have in reports published this year pointed us to what is happening in Germany and Japan. Those countries have mandatory social insurance mechanisms, which have been in place for a long time; the German system was put in place in 1994. It is not only Germany and Japan who have got their acts together on funding; so, too, have France and the Netherlands. This is not a recent problem; it did not arise in 2010 or 2015. It has been with us for a long time, and parties on both sides of the House have failed to grasp the nettle.

So I say to the two Ministers on the Front Bench, for whom I have the greatest respect—my hon. Friends the Members for Thurrock (Jackie Doyle-Price) and for Nuneaton (Mr Jones)—that there must be urgency on this issue, and there is a willingness among our constituents for it to be grasped in a fair way. People are prepared to pay more; we know that there is public support for hypothecated taxes—people know that what they pay is going to look after them later in life.

Some of the social insurance systems—those in Germany and Japan in particular— can point the way forward. So I say to the Ministers, “Get on an aeroplane now, go to Japan, go to Germany, and do the preparatory work, so that when we have the Green Paper in January, we can have some really good ideas, and we can grasp the nettle, take this forward and give people the care they deserve.”

NHS Pay

Andrew Selous Excerpts

Wednesday 13th September 2017 Commons Chamber

[Andrew Selous (South West Bedfordshire) (Con)]

I warmly congratulate the hon. Member for Portsmouth South (Stephen Morgan) on a polished maiden speech, and we all wish him the very best in his time in this House.

Conservative Members agree with what the hon. Gentleman said about the wonderful work that public sector workers do, not least in our NHS. The NHS saved my life when I was 24. I have two children heading to work in the NHS, one of whom worked as a healthcare assistant over the summer. Members of my family are also frequent users of the NHS.

Over the last few months, I have had the pleasure of spending a day at the Bassett Road GP practice in Leighton Buzzard, and I am full of admiration for the doctors and practice nurses I saw working there. I also spent time at my local hospital, the Luton and Dunstable, which has the best accident and emergency service in the country, and we are learning lessons from it all around the country, which are being spread by the Department of Health. Really importantly, I have also spent time with the social care staff of Central Bedfordshire Council and elsewhere, and seen the independent living schemes that will be key to the sustainability and transformation plans in my area.

In these debates, we seem to focus entirely on the top line of departmental budgets. In 2016-17, the Department of Health had a departmental expenditure limit of £120.6 billion and annually managed expenditure of £16.2 billion—£136 billion in total. We need to reflect on the words of Jon Thompson, a permanent under-secretary at the Ministry of Defence, speaking to the Institute of Government recently about the attitude, often, of Select Committee members from across this House:

“They seem to live in a resource unconstrained world…in the end I’ve got a limited amount of money and I have to prioritise.”

Those are words we need to hear.

There is another way to free up money within that £136 billion and improve outcomes for patients that could lead to our having more money for NHS staff— that is, to focus on improving quality, something that hardly ever gets a look-in in this House. If we look at the work that the Government are doing with the Getting It Right First Time programme, we see a 25-fold variation in infection rates for patients. Not only is going through that a deeply unpleasant experience for a patient, but the cost of surgical infections can vary from £75,000 to £100,000. If we get this right, not only do we treat patients better but there is more money to put into staff pay.

It goes on and on. Many hospitals are not using the right hip implants—they are using more expensive non-cemented hip implants. We get better outcomes with cemented implants that actually cost less.

[Dr Whitford]

It is really important that we are very careful about things that will be implanted permanently in a patient. We have had debates about mesh in this place, and we will be having debates about Essure, which is designed to obstruct the fallopian tubes and is also causing problems. Non-cemented implants are for younger people who may need another implant later on. I would be very careful—think of the PIP breast implants scandal—about cutting the quality of what is left in a patient.

[Andrew Selous]

I am talking about the data available in the national registry, now, for the first time ever, being properly compiled in every hospital. We should follow the evidence and look at the clinical outcomes, as the hon. Lady has done herself on the Health Committee.

Forty-five per cent. of surgeons are doing five or fewer complex hip and knee revisions, yet we know that clinical outcomes are better where surgeons do 35 or more a year. As a result of doing only a few operations with worse outcomes, which cost more, they also have to hire in expensive loan kits. Hospitals are spending, on average, some £200,000 a year on loan kits—some hospitals, £750,000 a year. Professor Tim Briggs, with whom I have had the honour of working over the past nine years on the Getting It Right First Time programme, said that

“there is no way right now I would ask for more money for the NHS. The waste and variation out there is unbelievable and we have got to get our act together across all the specialties to improve quality and unwarranted variation and complications. And it is not just orthopaedics.”

We are now, for the first time ever, looking at variations in litigation rates—huge amounts of money go out on litigation—in infection rates, and in revision rates. We are making progress, because litigation rates, which went up by 8% in orthopaedics in 2013-14, are down by 5% in 2014-15 and down by 8% in 2015-16.

This is a really powerful way to get better outcomes for patients and make sure that there is more money for NHS staff. That is exactly what the sustainability and transformation plans are there to do. As Simon Stevens has said, this is

“the biggest national move to integrating care of any major western country.”

If we can end our fragmented, silo-ed care through a massive expansion of out-of-hospital care, we will get better outcomes, save money, prioritise prevention, and keep patients out of hospital. If we do that, we will free up precious budget in order to pay NHS staff the decent rates we all want to pay them.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

I think the answer is that this varies from area to area. The CCGs grew up organically following the Health and Social Care Act 2012. Some parts of the country are discovering that the groups can be more effective if they combine forces, but these things have to be decided locally.

[Andrew Selous (South West Bedfordshire) (Con)]

In addition to the Government’s welcome focus on mental health first aid, may we have equal focus on mental health keep fit, looking particularly at the Mental Health Foundation’s 10 pointers, so that we can all keep our mental health in good condition?

[Mr Hunt]

As ever, my hon. Friend makes an important point. I think that every child should leave school as knowledgeable about how to remain mentally resilient as about how to be physically healthy.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

The hon. Lady is absolutely right that areas such as Lincolnshire find it particularly difficult to attract GP recruits, which is why we have set up a fund that gives new GP trainees a financial incentive to move to some of the more remote parts of the country. This is beginning to have some effect, and I am happy to write to her with more details.

[Andrew Selous (South West Bedfordshire) (Con)]

I warmly welcome the Secretary of State’s efforts to recruit more GPs, and I know that he wants all GPs and, indeed, doctors to have high levels of job satisfaction. Is he aware of the fact that reasonable numbers of doctors are leaving the UK to work overseas? Given the cost of medical training and the money that taxpayers put into that education, will he look at that issue, perhaps by requiring a certain commitment to the NHS?

[Mr Hunt]

My hon. Friend raises an important point. There is currently no evidence of an increase in the number of doctors going to work abroad, but there is an issue of fairness because it costs around £230,000 to train a doctor over five years. In return for that, there should be some commitment to spend some time working in the NHS, and we are consulting on that at the moment.