Young-onset Parkinson’s Disease

Andrew Selous Excerpts

Monday 6th March 2017 Commons Chamber

[Nick Thomas-Symonds]

I am grateful to my hon. Friend for that point. The device sounds remarkable and could assist people with the condition.

Hayley spoke about the restless leg she experiences if her medication is not taken at the right time or if she is under stress. The way in which Hayley has dealt with the condition is inspirational. When I saw her yesterday in advance of this debate, she said that while those who fit into what is called the young-onset group have particular needs, there is a collective sense of need for everyone with the condition. The photographer who was with us yesterday, Ron McCann, also has Parkinson’s and is aged 69. Over the course of the weekend, I was contacted on social media by a member of the male voice choir in my hometown of Blaenavon, who spoke about a chorister in his 80s who is battling the condition and has found that singing has assisted him.

While there are issues that unite all with the condition, including access to the drug Duodopa, which was the subject of a recent debate in Parliament, those who are diagnosed at a younger age have specific needs. The first issue is with being diagnosed in the first place, because the condition can go undiagnosed. Those who have contacted Spotlight YOPD talk movingly about what happens at that moment of diagnosis. Keith from Newark says:

“Parkinson’s for younger people (under 50) is a different kettle of fish...It completely changes your life but you don’t know at the time and no one actually tells you.”

Gaynor from Rye says:

“I’ve never felt quite so lonely as when I was diagnosed. Mourning for the future I thought I had—suddenly old before my time with a fear of dependency—and no one there to gather me up; no one to depend on.”

Jordan, 21, an MSc student in Liverpool, says that

“the GP kept saying, ‘He’s too young, he’s too young,’ and said it was a psychological problem.”

Even when the diagnosis is established, there then comes a whole set of new challenges. On top of dealing with the condition, there are all the pressures of family and working life.

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

I am a huge admirer of the hon. Gentleman’s speech and I commend him on bringing this matter before the House. Does he agree that cases such as those that he has outlined can often be helped if there is a local support group? Such groups provide a lot of information and can effectively lobby local health services on matters such as Parkinson’s nurses? Would he recommend the setting up of such groups around the country?

[Nick Thomas-Symonds]

I entirely agree with the hon. Gentleman that local support groups are hugely important, which leads me on to the mental health issues that often come with Parkinson’s. Although access to a neurologist is highly important, we must not neglect access to mental health support.

Prescription charges remain a bone of contention in England. Pre-payment certificates are available to reduce costs, but there is still a cost. England could do with following the lead set by the Welsh Government in 2007 by abolishing prescription charges altogether.

There are also issues of engagement with medical services. Again, I can refer to specific cases. Jon, a father of three who was diagnosed at the age of 49, says:

“People with Parkinson’s can often have problems in hospital.”

Why? People with Parkinson’s are often deprived of their medication because, obviously, they hand in their medication when they go into hospital, yet maintaining a regular medication regime is very important and the person themselves is often best placed to do that.

I spoke a moment or two ago about access to neurological services. Alison, a mother of three based in Cheltenham, says:

“I feel let down by an NHS system that offers me one 10 minute appointment with a neurologist each year and I have to chase this to get it.”

Neurological services clearly need to be more accessible than that.

I do not make my next point in an ideological way, and I am pleased that the former Minister with responsibility for disabled people, the hon. Member for North Swindon (Justin Tomlinson), is in the Chamber. Irrespective of political views, I want to address the efficiency of the social security system as it actually works. I pay tribute to the work of Parkinson’s UK, and particularly to that of Natasha Burgess. On employment and support allowance, for example, which will involve a work capability assessment, the problem with something like Parkinson’s is that it is a variable condition.

Health and Social Care

Andrew Selous Excerpts

Monday 27th February 2017 Commons Chamber

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

It is a pleasure to follow the Chair of the Communities and Local Government Committee, the hon. Member for Sheffield South East (Mr Betts).

Notwithstanding the issues that have already been brought to the House’s attention, it is worth putting on the record the increase in the money—the extra £10 billion by 2020—that the Government are committing, with the 11,400 more doctors and 11,200 more nurses in the system, as well as the near eradication of mixed-sex wards and the huge reduction in hospital infections. I also note that health spending in England is nearly 1% higher than the OECD average.

[Dr Murrison]

I am sorry to intervene on my hon. Friend so early in his speech. Does he agree with me that the OECD average is probably a specious comparator? It covers countries—such as Mexico and Turkey, and former eastern bloc countries—whose health economies, laudable though they may be, are not ones with which most people in this country would wish ours to be compared.

[Andrew Selous]

My hon. Friend makes a fair point. I will outline some areas in which I think more spending is necessary.

I want to start by focusing on an individual case—it is not from my constituency—which highlights many of the issues that have been raised so far. It concerns a 98-year-old lady who was admitted to a hospital in one of our major cities on 22 January. Unfortunately, she died in that hospital on 31 January. It was made clear to the hospital on 25 January that the nursing home she had come from—she had been in its residential part—had nursing facilities, and it would have been able to take her back and deal with the deterioration in her health. Despite that, no action was taken to remove her back to the nursing home, which resulted in an extra six days’ stay in hospital.

The relatives who drew this true case to my attention asked me to raise two points. First, they thought it was not really good enough that the hospital concerned did not have a good knowledge of the fact that in addition to the residential facilities, the nursing home had facilities that would have been able to care for the elderly lady and thus free up a hospital bed. Secondly, they were disappointed that because her period in hospital spanned a weekend, they were told by several of the nursing staff that no doctor was available to make a decision about moving her back to the nursing floor of the home she had come from and where she had always wanted to end her days. That story illustrates some of the issues—I know Health Ministers are aware of them—of making sure that there is knowledge of what residential and nursing facilities are available in the community for elderly or frail people who go into hospital, and of making sure that there is weekend cover so that appropriate decisions can be taken and beds are not unnecessarily taken up in hospitals.

A couple of weeks ago, I sat down with a number of social care providers covering both residential and domiciliary care in Bedfordshire, and I asked them what they thought they needed to attract enough people into care provision. As the Chair of the Select Committee has just told us, there is a 27% turnover rate, and I learned that the providers cannot always attract people of the calibre they would like. For domiciliary care, I was told very clearly that the ability to offer a salary—perhaps of £16,000 to £18,000 a year—rather than paying people on an hourly basis when they provide care, would go a very long way to attracting the right sort of people into this profession.

That domiciliary care provider, which is one of the better ones in my area, pays 30p a mile for travel costs. All of us, as Members of Parliament, get paid 45p a mile when we travel in our constituencies. Frankly, I find it an affront that there is a division between rates for travel within the public sector. Social care staff do an incredibly important job and, frankly, it is not right that they are lucky to be offered 30p a mile, when Members of Parliament get 45p a mile. I am not just asking local authorities to put up what they pay to such a level straightaway. We must be realistic, and I fully recognise that that would come with a price tag that would have to be provided through taxation. However, having a salary of £16,000 to £18,000 a year, rather than hourly rates of pay that do not include travel time, and having travel properly paid for—it is currently paid for at a very miserly rate compared with what other people in the public sector get—would go a long way.

One of the issues that has not been highlighted so far in the estimates is the revaluation of the NHS litigation costs. There has been an increase of some £8 billion, which is a fairly large figure. It is worth focusing on that because litigation costs mean a couple of things. First, they mean that patients have not got the right quality of care first time around, and secondly, they mean that money is going out the door of the NHS, often to lawyers, that could be better used doing the job correctly the first time.

In that regard, I make no apologies for again drawing the House’s attention to the Getting it Right First Time initiative, which seeks to embed quality in clinical care across the NHS. I often find that we do not focus sufficiently on that in this House. Variability in the rates of infection and of the revision surgery that is required are significant across the NHS. If we could raise the quality of clinical care to the level of the best across the NHS, we could get the amount for litigation down substantially.

I was pleased to join a meeting that the Chair of the Public Accounts Committee, the hon. Member for Hackney South and Shoreditch (Meg Hillier), held a couple of weeks ago on the “Manifesto for a healthy and health-creating society”. It was led by Lord Crisp, the former permanent secretary of the Department of Health, with colleagues in the House of Lords and others. Although that may seem a long-term approach to the acute problems we face today—the Chair of the Communities and Local Government Committee is right to say that we need action now to get the preventive issues right, because not everyone will be around in the longer term—it is incredibly important, none the less, that we take a lot of the ideas in the report seriously to try to reduce the strains on the NHS and to create a healthier population in the years to come.

There are already some very good examples of such ideas. The St Paul’s Way transformation project in Poplar in the east end is doing sterling work. The Well North initiative, which is supported by Public Health England, is focusing on 10 cities in the north of England that have poor health outcomes and bad levels of health inequality. It is all about creating what it calls vibrant and well-connected communities to deal with issues such as debt, jobs, training, missed educational opportunities, poor housing and loneliness. Our late lamented colleague Jo Cox focused on the issue of loneliness, and many of us in the House are determined to carry on her work in that important area. Such long-term preventive work to increase the resilience and health of society is absolutely fundamental to all the issues we are talking about tonight.

On the sustainability and transformation plans, I have spent time with both GPs and hospital staff during the past couple of weeks, and I observed that clinicians in hospitals often point to the work that they thought should have been done but had not been done by GPs, while GPs pointed out that they do quite a lot of work that in the past they would have expected hospitals to undertake. As we move forward with the sustainability and transformation plans, there would be some merit in making sure that those in time turn into accountable care organisations, so that we get a proper join-up between the different parts of the system and such finger pointing between different parts of the health system becomes a thing of the past.

Finally and briefly on the issue of beds, I totally understand the Government’s correct focus on shifting more care to the community, but we have 8,000 fewer beds than we had five years ago, while the occupancy rate has increased from 84% to 87%. At times, operating theatres stand idle because of delayed discharges for care. I should like Ministers to reflect on that.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

I recognise that it is not a sustainable position to have to do that. Pressures on the frontline meant that it had to happen, but we do need to invest for the future and I agree with the hon. Lady that capital budgets are very important.

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

Young people with severe anxiety can spend years out of school and become very isolated. Does the Secretary of State agree that we need to think more imaginatively about community and voluntary solutions to reach out to those young people, whose futures we must not give up on?

[Mr Hunt]

I absolutely agree. About 3% of schoolchildren have severe anxiety, but if we get treatment to them quickly, often we cure the condition and it does not come back. My hon. Friend is absolutely right that we need to be as imaginative as possible.

Agenda for Change: NHS Pay Restraint

Andrew Selous Excerpts

Monday 30th January 2017 Westminster Hall

[Catherine McKinnell]

The hon. Gentleman raises some important points. I would never admit to having strayed into the subject of Brexit in this important debate on the NHS, but his comments are on the record and should be noted by the Minister. As NHS Employers stated in its 2017-18 submissions to the NHS Pay Review Body:

“The NHS continues to face unprecedented financial and service challenges. The majority of trusts fell into deficit during 2015-16 and the overall shortfall has now reached over £2.5 billion… The financial settlement for the NHS up to 2020 is extremely challenging, with employers set ambitious targets to deliver efficiency savings. At the same time, demand for services continues to rise. Performance indicators show the service is under great pressure as demands for care increase and other public services reduce provision.”

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

Does the hon. Lady agree that the physical demands of nursing, as a family member who worked as a healthcare assistant over the summer reflected to me, mean that sometimes conscientious nurses might be tempted to lift patients on their own, such are the demands of the job, and seriously strain their backs? That is something we should have regard to.

[Catherine McKinnell]

I very much agree. That is a factor right across the NHS and the social care sector, and it is an issue we see arising increasingly as staff come under increasing pressure, with the increased pressure to make efficiency savings, which ultimately compromises the health and safety of staff who find themselves in such situations.

Just last week the National Audit Office published its report into NHS ambulance services, which concluded, among other things, that:

“Increased funding for urgent and emergency activity has not matched rising demand, and future settlements are likely to be tougher”.

Crucially, in the context of this debate, it also concluded that:

“Ambulance trusts face resourcing challenges that are limiting their ability to meet rising demand. Most trusts are struggling to recruit the staff they need and then retain them. The reasons people cite for leaving are varied and include pay and reward, and the stressful nature of the job.”

That very much ties in with the concerns the hon. Gentleman raised.

NHS Fertility Services

Andrew Selous Excerpts

Thursday 19th January 2017 Westminster Hall

[Steve McCabe (Birmingham, Selly Oak) (Lab)]

I beg to move,

That this House has considered decommissioning of in vitro fertilisation and other NHS fertility services.

It is a pleasure to serve under your chairmanship today, Mrs Gillan.

I am grateful to the Backbench Business Committee for granting this debate; to the right hon. Members for Carshalton and Wallington (Tom Brake), and for Wantage (Mr Vaizey), for their support in securing it; and to the many other Members who are either here today or who have indicated their support for a debate on IVF. Change is urgently needed in this area, and we have broad, cross-party support for such change.

I know that it is not customary, Mrs Gillan, to refer to the Public Gallery during debates such as this one, but perhaps I can just say in passing that I am told that a number of people have travelled here today because of the importance they attach to this issue, and because of their strong feelings that what is going on is not fair and needs to change. It is through listening to their experiences that I have begun to understand the extent to which the present arrangements are not working.

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

Does the hon. Gentleman agree that, rather than imposing a postcode lottery on our constituents by withdrawing these services, the areas under financial pressure need to become more efficient and to look at how other areas manage their health systems better to make efficiencies, so that in vitro fertilisation can be provided everywhere?

[Steve McCabe]

I certainly agree with the hon. Gentleman about a postcode lottery; there is a massive variation in service, so we must strive to achieve a cost-efficient system that is genuinely national in the way it is delivered. I agree with that absolutely.

This debate is about IVF and related services. At a time of so much concern about the NHS generally, the debate could easily drift towards becoming a series of questions about other aspects of the NHS, but I am clear that we asked for this debate to raise concerns associated with those who need treatment for infertility issues.

Infertility is a problem that does not get a lot of Government or parliamentary attention; in fact, it was not debated at all in the previous Parliament. Yet we know that it is an issue that affects one in six couples in the UK and is the second most common reason for a woman to visit her GP. The problems of infertility are recognised by the World Health Organisation as a condition for which medical treatment should be provided, but that is not how we approach the matter today in England.

I am immensely grateful to my constituent Louise Jackson for bringing this issue to my attention and for giving me permission to share some of her experience with people today. Louise and her partner have been together for more than 13 years and have been trying for a baby for nearly six years. After tests confirmed that they would need IVF treatment, they were refused it because Louise’s partner already had a child, as a result of a previous relationship in 1975. That child is actually older than Louise herself, who has said:

“Anyone who is experiencing fertility problems will understand the agonising pain and upset it brings on a daily basis. The fact that we have been refused treatment on the NHS just adds to the anguish. We cannot express enough how hard it is to not be able to have children naturally, never mind being faced with the fact we’ve been saving for years for the thousands needed for this treatment. I hope one day these laws will be changed for couples like us and others in the near future.”

My information is that four clinical commissioning groups in England—Mid Essex, North East Essex, Basildon and Brentwood, and South Norfolk—have already decommissioned their assisted conception services, essentially as a cost-saving measure. Also, more than one in 10 CCGs in England are currently consulting on reducing or entirely decommissioning NHS fertility treatment. That means that more than 60 Members of Parliament represent seats where the provision of IVF services is at risk.

The guidelines produced by the National Institute for Health and Care Excellence are fairly clear on the provision of IVF services. NICE recommends that all those women who are eligible for IVF should have access to three full cycles of IVF if the woman is aged under 40, and in 2013 it updated its guidance to recommend further that women aged between 40 and 42, and who meet some additional criteria, should have access to one full cycle.

Fertility Fairness is an umbrella body that has the support of several organisations, including the Royal College of Nursing, the Association of Clinical Embryologists, the British Fertility Society, the National Gamete Donation Trust and the Miscarriage Association. In 2016, it undertook an audit of every CCG in England and found that only 16% of CCGs offer three cycles of IVF, which is the NICE recommendation. That was down from 24% in 2013, while the number of CCGs offering just one cycle of NHS-funded IVF treatment has leapt to 60%. The Minister is on record as saying that she finds the decommissioning of such services “unacceptable”, so she will not be surprised if I ask her what she plans to do in response to these figures.

According to NICE, a full cycle of IVF treatment should include one round of ovarian stimulation and the transfer of all resultant fresh and frozen embryos, but only four out of 209 CCGs comply with the NICE definition of a “full cycle”. As a result, in many parts of England, these efforts to provide IVF on the cheap are—perversely—wasting resources, because this incomplete offer is rarely successful and compromises the cost-effectiveness of IVF as a treatment. It is a bit like giving less than the recommended dosage of any other drug or treatment.

As I have said, NICE offers guidance on age appropriateness for IVF. However, without being required to offer any kind of explanation, some CCGs have lowered the maximum age for IVF to 35; others have introduced non-medical criteria, such as refusing couples treatment if one of them has a child from a previous relationship, as happened in the case of my constituent, Louise Jackson; and apparently even more criteria are applied for same-sex couples, including a requirement to demonstrate that they have already paid privately for six cycles of treatment before they can be considered by the NHS. Those requirements do not look like medical criteria to me; they look like crude, discriminatory rationing, based on pseudo-moralistic prejudices.

In Birmingham, CCGs justify their approach by testing their proposals via public consultation, and in 2014 a consultation covering the criteria for eight CCGs across the west midlands was undertaken. Of the 351 people who responded, 40% were against providing IVF to a couple where one party has a child from a previous relationship; 40% disagreed with that view; and 20% did not know. Nevertheless, those proposals are now the criteria that must be met. I cannot imagine such a crude approach being adopted for determining treatment eligibility for any other medical condition, but that of course is part of the problem.

Too many people think, in defiance of the World Health Organisation, that it is a lifestyle issue and not a medical condition. That is not helped by the fact that the Department of Health merely asks that CCGs “have regard to” the NICE guidelines. This recognised medical condition can have a number of related impacts. If left untreated, it can result in stress, anxiety, depression and the breakdown of relationships. A recent survey of almost 1,000 people with infertility problems conducted by Middlesex University found that 90% of respondents reported feeling depressed and 42% reported feeling suicidal, which was up from 20% when a similar study was conducted in 1997. Some 70% reported a detrimental impact on their relationship, and 15% said that it had led to the break-up of their relationship.

The debate is not about statistics, though; it is about real people and the devastating impact that being denied treatment for infertility problems can have on their lives. On Monday afternoon, I took part in a digital debate with many members of the public, and they helped contribute to our debate today. Hundreds of people shared their experiences. I cannot name them all, but I would like to take this opportunity to thank them for their contributions. I want to briefly share just a few examples that illustrate the kind of problems that mean we need to see some significant change in the delivery of this service.

Kelly Da Silva from south Derbyshire said:

“This is such an important issue for me, the anxiety and depression caused as a direct result of infertility and involuntary childlessness has affected every aspect of my life and caused me to leave a successful 12-year teaching career. The emotional and social impacts are absolutely devastating.”

Becky Thomas is from Hertfordshire, and comes under the direction of a Cambridgeshire CCG. She said:

“My local CCG cut the amount of cycles they offer from three down to one and are considering getting rid altogether. I live in one area that actually offers three full cycles however I come under a completely different CCG. It shouldn’t be a postcode lottery. It’s not a lifestyle choice. It’s a medical condition.”

Erin Nina Desirae from Sheffield said:

“I am in a same-sex marriage. My wife and I have been together for six years and have always talked about having children. We assumed that the law in this country would support us and enable us to try for a family with help from the NHS. Unfortunately, we were surprised and hurt to find that same-sex couples are not offered fertility treatment on the NHS until we have first self-funded at least six cycles ourselves. Whilst a heterosexual couple can receive NHS treatment after two years of trying to conceive. This feels like discrimination. Why should we be treated differently?”

What of the costs? Evidence suggests that many of the decommissioning and service reduction decisions are driven largely by budget considerations. Reports show that the cost to CCGs of commissioning one cycle of IVF can range from £1,300 to £6,000. It varies dramatically across the country. For example, it is much cheaper in Newcastle than it is in Birmingham, without any obvious explanation. What kind of way is that to run a health service and provide a vital treatment? Is it not a classic example of the fragmentation of the NHS that many predicted would follow the Lansley reorganisation?

In England, more than 200 CCGs are responsible for setting their own criteria and commissioning their own IVF services. To make matters worse, research suggests that the high cost of IVF in the private sector is forcing people to travel to such countries as the Czech Republic, where IVF treatment is far cheaper. The problem is that IVF is not anywhere near as well regulated in those countries as it is in the UK. As a direct result of reducing services in the UK, the NHS is being saddled with the high cost of complicated multiple pregnancies and births and other postnatal issues. There is also the additional cost to mental health services, which I touched on earlier. [Interruption.] As you can see, Mrs Gillan, I have successfully transposed a page of my notes. I hope you will bear with me for one second.

NHS and Social Care Funding

Andrew Selous Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dr Whitford]

I totally agree, but in fact the chance that their doctor will be on duty would actually be lower on a Saturday morning or a Sunday afternoon. One of the things we have done in Scotland with SPARRA—Scottish patients at risk of readmission and admission—data is to identify that 40% of admissions involve 5% of the patients. Those patients are all automatically flagged and will get a double appointment no matter what they ring up about, because it will not just be a case of a chest infection or a urine infection, but of having to look at all their other comorbidities.

That is the challenge we face; it is not a catastrophe of people living longer. All of us in the House with a medical background will remember that that was definitely the point of why we went into medicine, and it is the point of the NHS. However, we are not ageing very well. From about 40 or 50 onwards, people start to accumulate conditions that they may not have survived in the past, so that by the time they are 70 they have four or five comorbidities that make it a challenge to treat even something quite simple. My colleagues and friends who are still working on the frontline say that it is a question not just of numbers, but of complexity. Someone may come in with what sounds like an easy issue, but given their diabetes, renal failure and previous heart attack, it is in fact a complex issue.

That is part of the problem we face, and we need to look forward to prepare for it. We need to think about designing STPs around older people, not around young people who can come in and have an operation as a day case and then go away, because that is not what we are facing. Older people need longer in hospital, even medically, before they reach the point of being able to go home. It takes them a couple of days longer to be strong enough to do so. They probably live alone and do not have family near them, so they will need a degree of convalescent support and they may need social care. That is really where the nub of the problem lies. Social care funding has gone down, and therefore more people are stuck in hospital or more people end up in hospital who did not actually need to be there in the first place.

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

On the frailties of older people, does the hon. Lady think that just as Scotland led the way with St Ninian’s primary school in Stirling introducing the daily mile, there is something we could learn from countries, such an Andorra, that have a real focus on exercise for older people, so that they are a lot less frail in their 70s and 80s?

[Dr Whitford]

The whole prevention and public health message is crucial, and that is one of our other challenges. I am very grateful to the Secretary of State for no longer talking about a figure of £10 billion, because the increase in the Department of Health’s budget is actually £4.5 billion. Part of that relates to the reduction in public health funding, just at a time when we need to move it on to a totally different scale. Whether that is children or, indeed, adults doing the daily mile—perhaps we should run up to Trafalgar Square and back every lunchtime, which I am sure would do us all a power of good—we need to invest in such preventive measures. One of my points is that when we end up desperate—patching up how the NHS runs, or dealing with illnesses we did not bother to prevent—we always end up spending more money.

--- Later in debate ---

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

Many of my constituents are extremely fortunate to be served by Luton and Dunstable hospital—the hospital that was name-checked twice by the Secretary of State in his statement on Monday. One thing it does extremely well is its excellent streaming process in A&E, with good alternatives when A&E provision is not appropriate. That has helped the hospital to provide very high standards. I am also fortunate that my constituents’ social care is provided by Central Bedfordshire Council, which has been extremely innovative in building extra care court provision for older people. I visited those provisions, which are hugely popular and in central locations. They are much cheaper than residential care and provide a much better living environment for older people. That is exactly the sort of thing that we need a lot more of across the country. Those are two examples of really good individual practice within the NHS and social care. We need to be much better at spreading that good practice across the whole country.

It is worth putting on the record that since this time last year, we have more than 1,600 more doctors and 3,100 more hospital nurses. Since 2010, we have over 11,000 more doctors and 11,000 more nurses. The proportion of patients harmed by the NHS fell by more than a third between 2012 and 2015, and cases of infection are 50% lower than they were one year ago, which is a tremendous achievement. Health spending in England is actually 1% higher than the OECD average and the UK is spending more on long-term care as a percentage of GDP than Germany, Canada and the USA. The King’s Fund has said that STPs are the “best hope” for the future of the NHS in England, and Chris Hopson, the head of NHS Providers, has said that the system as a whole is doing “slightly better” than this time last year.

All that is dependent on having a strong economy, and I would argue that the Conservative party has demonstrated its competence in running the economy. Of course, I am not complacent, and I recognise that there is, in a sense, an arms race between the extra provision I am proud the Government have put in and the increasing demands on the NHS.

One issue that continually disappoints me is that we do not have enough of a focus on quality in these debates—they are always about funding. However, I draw attention again to the “Getting it Right First Time” initiative brought in by the Government just before Christmas, which is projected to save £1.5 billion that could be redirected back towards frontline patient care across 18 specialties. That will result in fewer infections and fewer revision operations, and we are using the data to shine a spotlight on variability, which is absolutely key for our constituents.

On mental health and the very welcome statement by the Prime Minister on Monday, I was delighted to hear the emphasis on first aid for mental health—something that will take place in our schools. However, as important, if not more important, is the issue of keeping fit for mental health. What do we all need to do to maintain good mental health? The Mental Health Foundation says we need to talk about our feelings, eat well, keep in touch with family and friends, take a break, accept who we are, keep active, drink sensibly, ask for help, do something we are good at and care for others. I do not think those 10 pointers from the Mental Health Foundation are as well known as they should be, so I am pleased to have put them on the record. It is crucial that we all look after our mental health, and that will help to reduce the stigma in this area.

Another issue I am passionate about is doing something about obesity, because although we have a national health service, we do not do enough to keep our fellow citizens healthy. I would like to see more emphasis placed on the excellent work of Dr Susan Jebb, an academic at the University of Oxford. She published an article in The Lancet just before Christmas showing that where GPs offered obese patients a referral to 12 weekly one-hour sessions, there was a significant reduction in the patients’ obesity.

[Stephen Pound]

I am sure the hon. Gentleman, like me, is a regular reader of the Daily Mail, and he will have noticed the proposal in yesterday’s paper that people who are obese, heavy smokers or even, God forbid, both should be denied medical treatment until they lose weight or stop the filthy habit of smoking. Would he like to recommend to those on his Front Bench the adoption of that policy?

[Andrew Selous]

What I am focusing on is what we can do to keep ourselves healthy and to reduce the demands on the NHS by behaving responsibly, and that is what I want to put the emphasis on.

That is important because a quarter of adults are obese, as are 14% of children between the ages of two and 15, and 18% of children in lower income households. Those figures should shame us all, and that is why I intervened on the hon. Member for Central Ayrshire (Dr Whitford) and mentioned the daily mile, which was brought in by St Ninian’s Primary School in Stirling. We need to see more of that and, frankly, a strengthened obesity policy.

My daily newspaper at the moment is the China Daily—it happens to be delivered free to my office. I was intrigued to see that students at universities in China actually have to take a physical fitness test lasting 50 minutes at the beginning of each new semester or they will not be given a graduation certificate. I am not necessarily suggesting that we introduce that here, but we should look around the world to see what other countries are doing to promote the health of their populations—to keep them fit and healthy—and to reduce the pressure on health services.

At the other end of the age spectrum, we need to do a lot more to keep older people fit and healthy, as many of the issues with social care would be greatly lessened if older people were able to stay healthier into later life. I am proud to be associated with the Buzzards 50+ organisation in my constituency, which helps older people to take regular exercise at our local leisure centres. In Andorra, which I mentioned earlier, that is normal for the whole population. Older people in their 70s and 80s will regularly take part in water aerobics classes and go to the gym. When a BBC correspondent went there a few years ago, women in their 70s taking part in these exercises said, “There’s no point in spending your retirement shut up at home. What’s more important than keeping yourself fit? If you don’t keep your body moving, you won’t keep your mind in shape.” Frankly, we need a lot more of that type of activity in our own country to lessen the pressures on our social care system.

Mental Health and NHS Performance

Andrew Selous Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I will write to the hon. Gentleman with the figures.

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

More than a third of A&E attendances at peak times are caused by drunkenness. Behaviour on such a scale is as unacceptable as it is irresponsible. What more can be done to reduce that proportion hugely by this time next year?

[Mr Hunt]

My hon. Friend has raised an issue of public accountability. These are our national health services, and we need to treat them in a responsible way. It is selfish to behave irresponsibly and impose pressure on an A&E department, because someone else who needs help may not be able to get it.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Hunt]

I will tell the hon. Lady what I take responsibility for: more doctors, more nurses and more funding than ever before in the history of the NHS. We know that the highest standards are often achieved when there is strong clinical leadership. Only 54% of managers in this country are clinicians, compared with 74% in Canada and 94% in Sweden. That is why it is right that we do everything we can to encourage more clinicians into leadership roles.

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

Does the Secretary of State agree that the clinical leadership involved in the Getting It Right First Time initiative is important, not only because it will save £1.5 billion, which could be put back into patient care, but because patients will be in less pain and will end up having fewer revision operations, and some will even survive treatment that they would not otherwise have survived?

[Mr Hunt]

My hon. Friend is absolutely right. I thank him for bringing Professor Tim Briggs to see me to explain just how superb this programme is. Infection rates for orthopaedic surgery vary between one in 20 patients in some trusts to one in 500 in others. Getting this right can transform care for patients and save money at the same time.

CQC: NHS Deaths Review

Andrew Selous Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

I want to put on the record that the right hon. Gentleman was a big champion for people with learning disabilities when he was in my ministerial team, in particular over issues such as Winterbourne View, which he brought to my attention and did a huge amount of positive work on.

I have met Sara Ryan. I spoke to her again yesterday. I repeat what I said in my statement: that without her campaigning we would not now be making the huge changes on a national level that we are. I wholeheartedly agree with the right hon. Gentleman’s other comments.

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

The review found that acute and community trusts do not always record whether a patient has a mental health illness or learning disability. What steps will we take—such as, for example, the expansion of liaison psychiatry services—to make sure there is proper join-up and real parity of esteem?

[Mr Hunt]

My hon. Friend makes a very good point. We are making sure that all A&Es have liaison psychiatry services by the end of this Parliament. The critical issue is that someone with a severe mental health problem or learning disability who turns up in an A&E has special needs, and has bigger needs than the other patients there, but unless that is recognised early in the process, they are unlikely to get the care they need. If a tragedy then happens and they go on to die—as sadly happens sometimes—but the illness or disability is not known about, people do not realise that there are other potential issues. That is why the report is very clear that all acute trusts are required to know when patients have learning disabilities or mental health problems and to pay particular attention in any mortality investigations that happen regarding those patients.

Social Care Funding

Andrew Selous Excerpts

Monday 12th December 2016 Commons Chamber

[Mr Speaker]

Order. I should advise the House that there are three urgent questions to be taken today and I want all to be properly contributed to, but it is important that we also provide time for subsequent business, so I am looking at finishing the UQs by 5.30 or thereabouts. Perhaps colleagues could tailor their contributions accordingly. We will be led in this matter by Mr Andrew Selous.

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

Thank you, Mr Speaker. I hope that in looking at co-ordinated policy across Government, the Minister will look not only at good join-up between the Department of Health and local government, but at other policies, such as lifetime homes, family strengthening and flexible employment policies, all of which will help us deal with these issues. Can he give us some encouragement on that score?

[David Mowat]

My hon. Friend is right. There is a raft of measures that need to be taken on informal carers and on the holy grail of better integration of health and social care funding, and we are pursuing that vigorously.