National Health Service Funding

Andrew Selous Excerpts

Tuesday 22nd November 2016 Commons Chamber

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

I want to make five constructive proposals to help NHS funding. The first relates to prevention, which we have not heard nearly enough about in the debate so far. It is wholly unacceptable that a third of our children are obese by the age of 11. We have learned today that many children typically consume the equivalent of a bathful of sugary drinks every year. We also know that England and Wales are ranked at D minus in the global fitness matrix, and that Scotland is ranked at F.

If we could get these things right early on in our children’s lifetimes, we would be in a much stronger position. One way of doing that would be to extend the excellent work of St Ninian’s primary school in Stirling, which has pioneered the use of the daily mile. All the children run—if they cannot manage that, they walk—a mile at some point each day. This has had dramatic results: not one of the school’s 57 children is overweight, and there has been a significant reduction in coughs and colds. The exercise has helped to develop the children’s social, emotional and mental wellbeing as well as their physical wellbeing. The idea has been taken up across the Netherlands and Belgium, and I would like to see a lot more of it across our own country.

Secondly, we need to do a huge amount of work on health literacy in relation to self-care. I commend to Members the report from the all-party parliamentary group on primary care and public health, which came out in March this year. It showed that there were 3.7 million visits to A&E and 52 million visits to GPs for self-treatable conditions in 2014. It is estimated that if we could deal with that by persuading people to go to the appropriate place, we could save the NHS more than £2 billion a year.

My third point relates to gatekeeping in our hospitals. I commend the initiative taken in Fife in Scotland, where having senior consultant input in A&E has led to a reduction of 30% in acute surgical admissions. My own local hospital, the Luton and Dunstable, has introduced a similar methodology for patients with acute conditions, and that is also bearing fruit.

My fourth point relates to quality, which we have not heard nearly enough about today. I urge Members to look more fully at the work of the Getting it Right First Time initiative, which the Government have now spread across 18 medical specialties. It started in orthopaedics, and the Government estimate that it will save £1.5 billion a year. This is about not only a financial saving, but better outcomes for patients, who may have undergone the wrong operation or received poor-quality care and had to have significant revisions. That project is getting data from across the country. For example, the rate of return for another procedure within 90 days following oral and maxillofacial cancer surgery varies from 8.33% in some hospitals to over 80% in others. That degree of variation is simply unacceptable. If we can get a higher level of quality, that can lead to much better outcomes for patients and the NHS saving money, too.

Finally, enhanced recovery programmes, such as the advanced transfer team in South Warwickshire, have led to significant increases in productivity with better outcomes for patients. We need to see much more of that across the country.

--- Later in debate ---

[Justin Madders (Ellesmere Port and Neston) (Lab)]

This has been at times a high-quality and passionate debate that has made clear the concerns across the House about the sustainability of our health service. The Chancellor sadly could not be with us this afternoon—I assume he has a few other things on right now—but had he been here to hear the contributions from Members on both sides of the House, he would be in no doubt about the severity of the challenges facing the health and social care sector, or about the dire consequences that will follow if he does not deliver the rescue package that is needed tomorrow.

We have heard some excellent contributions. As right hon. and hon. Members have said, while we might have our political differences, we all appreciate the work that our staff in the NHS do—as we do the work of all public sector workers—and we thank them for it. The hon. Member for Totnes (Dr Wollaston), the Chair of the Health Committee, calmly and clearly explained how cuts to the health budget were used to help the Secretary of State reach his figure of £10 billion. Despite the huge volley of figures he mentioned in his speech, he failed to mention that amount at all. The hon. Lady pointed out how many of the cuts will store up other problems in the long term, and she is right that the moving of the goal posts that has taken place does nobody any credit.

My hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh), who described the savings required in her area as implausible, is clearly going to fight the closure of St Helier hospital. She rightly pointed out that that closure will undermine other services and hospitals in her area, and I have no doubt that her constituents will be relieved to have such a doughty champion on their side. The hon. Member for Strangford (Jim Shannon) spoke with great sincerity and passion about the variations in cancer treatment and alarming statistics setting out anticipated increases in incidences of cancer. He also rightly highlighted the expenditure on emergency cancer treatments, showing that much more needs to be done on earlier detection.

My hon. Friend the Member for Darlington (Jenny Chapman) said that there seemed to be a focus in her area on consolidating services where there was no problem with clinical outcomes, and she made it clear that her constituents would not be fooled into accepting a downgrade in their local hospital. Her local health chiefs have won the award for the worst use of management speak today by calling patients “passive recipients of care”. My hon. Friend the Member for Tooting (Dr Allin-Khan) brought her recent experiences of the health service to the Chamber and said of the NHS that everywhere we look the answer is a lack of funding. She told us that staff and patient morale were now at all-time lows, and she should know what she is talking about.

We also heard from the hon. Members for South West Bedfordshire (Andrew Selous), for South West Wiltshire (Dr Murrison), for Calder Valley (Craig Whittaker), for Henley (John Howell) and for Bosworth (David Tredinnick), although none of them referred to the deficits their own STPs were facing—perhaps they do not think there is a problem. I can tell the House, however, that in South West Bedfordshire, the deficit is £311 million; in South West Wiltshire it is £490 million; in Calder Valley it is a staggering £1.07 billion; in Henley it is £479 million; and in Bosworth it is £700 million.

[Andrew Selous]

I am well aware of the financial challenges in my own area, but I noted in my STP the 26% increase in funding up to 2020-21, which I think is quite commendable.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 15th November 2016 Commons Chamber

[Mr Hunt]

We are working very carefully with all STP areas to make sure that their plans are balanced so that we can live within the extra funding we are putting into the NHS—an extra £10 billion—by 2020-21. We will look at that plan and do everything we can to help to make sure that it works out.

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

T3. Will the Secretary of State join me in thanking Dr Ollie O’Toole of the Kirby Road surgery in Dunstable for representing all of the very best in a family doctor? Will he also explain what more we can do to encourage people to go into general practice rather than working for locum companies, which so many seem to want to do at the moment?

[Mr Hunt]

I am happy to do that, and I would like to pass on my congratulations to Dr O’Toole, who obviously does a fantastic job for my hon. Friend’s constituents. We are investing significantly in general practice, with a 14% increase in real terms over this Parliament and our ambition to provide an extra 5,000 doctors working in general practice. This will mean that the need for locums will become much less and we can have much more continuity of care for patients.

Health Service Medical Supplies (Costs) Bill (Second sitting)

Andrew Selous Excerpts

Committee Debate: 2nd sitting: House of Commons
Tuesday 15th November 2016 Public Bill Committees

That is a big step forward for the Government. It is almost Churchillian for the Minister and the Secretary of State to say that the Conservative Government are going to embrace price controls—something I am not sure any Conservative Government has done since 1945 when we had price controls during the war. I warmly commend the Government on the Bill, particularly as crystallised in the design of, and powers under, clause 3, which ensures that the Secretary of State has the power to make a statutory scheme, which can limit not only prices but profits.

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

Many Conservative Members may see the Bill as limiting the ability of drug companies to rip off the Government in a wholly unacceptable way, rather than as introducing price controls in the manner to which the hon. Gentleman refers.

[Rob Marris]

With respect to the hon. Gentleman, that is precisely what price controls do: they stop rip-offs. If one has price controls for other reasons, that is a separate debate. The price controls discussed in the Bill and in the 2006 Act are, as I understand it, precisely to stop rip offs. It appears that the Secretary of State for Business, Energy and Industrial Strategy is now looking at the same thing, as the newspaper quote suggested. It may be an incorrect quote—I give that caveat—but it is a direct quote from the Secretary of State to say that the Government are looking at these things. That does not necessarily mean that they will do them, but it is an ideological watershed for a Conservative Government to look quite rightly at legislating to stop rip-off Britain with regard to prices, but also with regard to limiting profits.

That is what a statutory scheme has the power to do under section 263(1) of the 2006 Act. As I understand it—the Minister can correct me if I am wrong—clause 3, which is at the heart of this provision, does not say, “There has been a debate about whether we can have a statutory scheme or not”. For the sake of certainty, we are saying in clause 3 that the Government will have the power to make a statutory scheme, but I do not hear the Minister going on to say, “But that statutory scheme will have nothing to do with limiting profits.”

In the absence of the Minister’s saying that, he appears ideologically to encompass the concept that I embrace, which is that, in certain circumstances in capitalism, it is incumbent and right for a Government to intervene in the market to limit not only prices—rip-off Britain and so on—but profits. On certain occasions, the Government should have that power, and I think a pharmaceutical supplier to the NHS is one such example. There is a very narrow range of things I could see this happening in, but in pharmaceuticals it is possible.

I congratulate the Government on coming over to a socialist perspective, not only on pharmaceuticals but apparently, if The Times report is right, coming our way on energy companies. Long may that continue. Perhaps we can look at rail fares next. Will the Minister have a word with his fellow Ministers on that?

SELECT COMMITTEE ON HEALTH

Andrew Selous Excerpts

Thursday 3rd November 2016 Commons Chamber

Dr Wollaston

- Hansard - - Excerpts

Certainly, the evidence we heard in our inquiry was that there is grave concern about the level of existing pressure. As the right hon. Gentleman says, if we see a very cold winter, and the flu vaccine does not work as well as it did last winter, we are in serious difficulties. But I stress again that the Committee was very clear that we want to see the four-hour waiting time standard continued, because it is a good measure of whole-system pressure, and if people are facing very long waits that leads to a deterioration in patient safety. So it is a quality issue, as well as an issue about patient experience.

Andrew Selous (South West Bedfordshire) (Con)

- Hansard -

I note what the Chair of the Health Committee says about social care and delayed transfers of care. Would she commend an initiative taken in hospitals in Fife, where the most senior consultants were put into accident and emergency, which led to a 30% reduction in admissions to the hospital? Does she not agree that more junior staff are sometimes perhaps slightly more risk-averse because they do not have the experience? Does she not think that, where Fife has led, other hospitals around the UK could usefully follow?

Dr Wollaston

- Hansard - - Excerpts

I thank my hon. Friend, and I welcome him to the Health Committee. Yes, he is absolutely right that one of the initiatives that has been put forward is to look at streaming at the front door, but what we heard is that this is quite nuanced. If very senior staff are tied up seeing every single person at the front door, that can be a waste of resources. However, if the patients who are most at risk of needing admission—the sickest individuals —are identified early on and seen by the most senior doctors available, then yes, absolutely, that makes a difference.

A&E Departments: Winter Pressure

Andrew Selous Excerpts

Thursday 3rd November 2016 Commons Chamber

[Dr Wollaston]

Certainly, the evidence we heard in our inquiry was that there is grave concern about the level of existing pressure. As the right hon. Gentleman says, if we see a very cold winter, and the flu vaccine does not work as well as it did last winter, we are in serious difficulties. But I stress again that the Committee was very clear that we want to see the four-hour waiting time standard continued, because it is a good measure of whole-system pressure, and if people are facing very long waits that leads to a deterioration in patient safety. So it is a quality issue, as well as an issue about patient experience.

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

I note what the Chair of the Health Committee says about social care and delayed transfers of care. Would she commend an initiative taken in hospitals in Fife, where the most senior consultants were put into accident and emergency, which led to a 30% reduction in admissions to the hospital? Does she not agree that more junior staff are sometimes perhaps slightly more risk-averse because they do not have the experience? Does she not think that, where Fife has led, other hospitals around the UK could usefully follow?

[Dr Wollaston]

I thank my hon. Friend, and I welcome him to the Health Committee. Yes, he is absolutely right that one of the initiatives that has been put forward is to look at streaming at the front door, but what we heard is that this is quite nuanced. If very senior staff are tied up seeing every single person at the front door, that can be a waste of resources. However, if the patients who are most at risk of needing admission—the sickest individuals —are identified early on and seen by the most senior doctors available, then yes, absolutely, that makes a difference.

NHS Funding

Andrew Selous Excerpts

Monday 31st October 2016 Commons Chamber

[Mr Hunt]

I will tell the hon. Lady when that rhetoric became reality. We now have the highest dementia diagnosis rates in the world, according to some estimates. We are treating three quarters of a million more people with talking therapies every year than we were in 2010. Every single day, we are treating 1,400 more mental health patients. By the end of this Parliament, because of our spending plans, we will be spending £1 billion more on mental health every single year, treating 1 million more people. I think that that is pretty good.

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

Is not one way to help the NHS to deal with its financial pressures by focusing on improving quality and using proper data? Professor Tim Briggs’s report, “Getting it Right First Time” is already improving patient outcomes and saving the NHS money.

[Mr Hunt]

I thank my hon. Friend for bringing Professor Briggs to meet me. He is an extremely inspiring man. He has established that every time someone has an infection during an orthopaedic operation, it costs the NHS £100,000 to put it right, but that is happening 0.5% of the time in the case of some surgeons and 4% of the time in the case of others. Dealing with variation of that kind is a way not just to reduce costs, but to avoid enormous human heartache.

Health Service Medical Supplies (Costs) Bill

Andrew Selous Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

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

It is a pleasure to follow the extremely well informed speech given by the hon. Member for Central Ayrshire (Dr Whitford). I hope that Ministers will continue to study what happens in Scotland, as they do elsewhere around the world so that we can share information and copy best practice, whether in Scotland or elsewhere. I am aware of Scotland’s fine medical tradition and what it contributes to the United Kingdom.

I pay tribute to The Times for the investigation that it began on 3 June. We often have cause to complain about the press in Parliament. We are often the subject of their inquiries, which we may find unwelcome, and from time to time the press are irresponsible, and should be more responsible. In this case, we can all thank The Times for shining a spotlight on unacceptable practice in the pharmaceutical industry in the UK, which has huge implications for the NHS, which we all love and have been sent here to protect and improve.

[Rob Marris]

The hon. Gentleman is extolling the work that The Times did in a series of articles this June. May I remind him and the House that in discussing the earlier adoption of drugs, we should bear in mind the work that The Times did in the 1960s to uncover thalidomide as a terrible drug? It was never licensed in the USA because of concerns that testing was not adequate. Yes, we want things to go to market earlier when that is possible, but we have to be extremely careful.

[Andrew Selous]

If memory serves, it was a team of investigative journalists from The Sunday Times that focused on that issue. However, the hon. Gentleman is right: we should pause and reflect, and be thankful for the tremendous tradition of British investigative journalism, which helps us and is our ally in Parliament. It is important to put that on the record. What The Times did contributed to the Secretary of State launching the Competition and Markets Authority inquiry. I am pleased that that happened.

A number of speakers have made a valid point, with which I strongly agree, that it is absolutely vital that we continue to have a strong pharmaceutical industry in the UK. In the months before she was appointed, the Prime Minister said:

“It is hard to think of an industry of greater strategic importance to Britain”

than the pharmaceutical industry, and she was absolutely right. The briefing from the House of Commons Library says that the output of the pharmaceutical industry in 2015 was £12.7 billion, which amounts to 8% of the UK’s entire manufacturing output. Let us look at one or two of the larger players.

GlaxoSmithKline is active in more than 150 markets around the world, and has 110,000 employees globally. It has 80 manufacturing sites, and it is the largest vaccines business in the world. Of particular significance is the fact that it conducts all its research in two research hubs: one in Philadelphia and the other in Stevenage in the United Kingdom, where a number of my constituents are proud to work. AstraZeneca is another large pharmaceutical company that is active in the UK. It has 6,700 UK employees, and supports a further 35,000 jobs in the UK. It operates across seven sites, including one in Luton, close to my constituency. Again, a number of my constituents are rightly proud to work there.

As the Secretary of State said, the medicines bill for NHS England, at £15.2 billion in 2015-16, is the second largest cost for the organisation, after staff costs, so it is absolutely vital that we secure value for money in this huge area of spend. It is a concern that the CMA has spoken of “excessive and unfair prices” and has referred to companies that have “abused a dominant position”. There have been incidences of no competition or insufficient competition, so it is right that the Government have stepped in to deal with the issue. That touches on a broader philosophical point. We had a brief exchange on this earlier. In a response to me only a couple of days ago on the morality of business behaviour, the Prime Minister wrote:

“we need to ensure that the free market has an ethical basis”.

I absolutely agree.

The Library briefing for the debate looks at the top 11 medicine price increases, ranging from ascorbic acid, with an eye-watering 1,012% price rise, right up to Doxepin, which had a 5,281% price rise. In some cases—if some of the ingredients and some of the raw material for a particular drug are suddenly in short supply—a price increase such as that may be justified, but the Department knows that, in the majority of cases, there is no valid reason for the huge increases. That is why the Government have, properly, acted. Therefore, I welcome the Bill’s powers to reduce prices, to impose price controls and, importantly, to gather information. However, I have a couple of questions for my hon. Friend the Minister on gathering information.

Getting information is vital, and I am pleased that the Government have included measures in the Bill to obtain complete information. Is the Minister satisfied that there is sufficient analytical ability in his Department to really know what is going on? I ask that for this reason. I have had the huge privilege of working with members of the senior civil service in a different Department in the past two years, but sometimes we expect civil servants to have a range of skills that it is not fair of us to expect them to have. Is there the necessary commercial expertise in his Department to really work out what is going on with the additional information that he and his officials will have at their fingertips? Is there a scheme for secondments between pharmaceutical businesses and the Department of Health, so that his officials really know how the market works and any particular games that might be played? That is important.

I am aware that one permanent secretary in post at the moment had a secondment earlier in his civil service career to Diageo, but it is important that the Minister and the permanent secretary ensure that there is that capability in their Department. If it is not there, I hope that he and the ministerial team will take steps to ensure that it is. I say that because, if we look at some of the emails that came into the public domain as a result of the investigation by The Times—some were brought to light through freedom of information requests—it seems that there was not quite the level of serious analysis, probing and inquiry that we would all, including the Minister, have liked to see.

The Government have introduced the Bill because they care passionately about the future of our NHS. They will do everything necessary to protect it and that very much includes getting value for money from the drugs that the NHS pays for. On the Conservative Benches, we value and care about the role of the free market. We know that it is the greatest economic mechanism in the history of mankind for creating wealth and for relieving poverty. It is because we care about it that we will act to reform where that is necessary, whether that be in the interests of the NHS or any other part of our country.

Oral Answers to Questions

Andrew Selous Excerpts

Tuesday 15th July 2014 Commons Chamber

[Jane Ellison]

I am sure that, like me, the hon. Lady welcomes the news this morning that food price inflation is at an annual rate of 0%, so food prices are at the same level as last year. On the issue that she raises, that is exactly why programmes such as Change4Life are important. It is also important that we see other measures across government. The school food plan is important for its emphasis on nutrition, as are free school meals and the Healthy Start programme. The Government are doing lots of things to try to make it easier for less well-off families to eat healthily.

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

Will the Minister applaud the work of Colin Kaye in my constituency, who, on his own farm, is producing cheap, good quality food to help reduce the cost of food so that people can eat more healthily and have lower food bills?

[Jane Ellison]

That sounds like a fantastic local initiative, and I thank my hon. Friend for highlighting it. Taken together with our advice and support for families on how to use healthy food to make healthy meals, initiatives such as that are to be applauded.

--- Later in debate ---

[Mr Jeremy Hunt]

NICE has taken the sensible decision to issue its guidance. It does so independently, but we are not making it mandatory on the advice of the chief nursing officer and many other chief nurses across the country for the simple reason that if we have a mandatory minimum, that can become the maximum that trusts invest in and many wards need more than 1:8. That is why NICE’s guidance was so important today.

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

T5. The Chavasse report on improving care for members of the armed services and veterans builds on the improvements that we have already made and has been welcomed by the Department of Health and indeed the Ministry of Defence. We owe it to our armed services to carry on making improvements to their care, so will the Minister encourage NHS England to look favourably on its recommendations?

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

My hon. Friend is right to highlight the importance of the Chavasse report. Its focus on improving care for veterans is warmly welcomed. There is a lot that we can work with to deliver better care and build on the specialist care centres already in place for veterans who have lost limbs and need prosthetic services and to provide additional support for veterans with mental health problems.

Patient Safety

Andrew Selous Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

I very much agree with my hon. Friend, and he will know that one of the things we have introduced this year is the duty of candour, which makes it a legal requirement for trusts to be honest with patients and their families when harm or avoidable death has occurred. He is absolutely right that we have to tackle this, and he will also know that when trusts are open and transparent, relatives are less likely to sue, because they recognise the good will and spirit involved.

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

Will the Secretary of State join me in commending the initiative of Bedfordshire clinical commissioning group, under the excellent leadership of Dunstable GP Dr Paul Hassan, which has instituted unannounced checks on the wards of local hospitals by local GPs?

[Mr Hunt]

I do commend that, and it is excellent to see CCGs taking responsibility, because they control the NHS budgets. I think that is an excellent initiative, and I hope that other CCGs follow suit.

Care Homes

Andrew Selous Excerpts

Thursday 1st May 2014 Commons Chamber

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

Yet again, it has taken undercover reporting by the BBC and covert recording by families to shine a spotlight on these appalling abuses. Given that people with dementia, in particular, cannot tell their own story—in some recent cases, that has involved their being slapped—should not the CQC not only make unannounced visits, but seriously consider undercover work to record these terrible abuses?

[Norman Lamb]

I agree with my hon. Friend. I have spoken to the chair of the CQC, David Prior, specifically about this matter. It is looking at both the use of hidden cameras in appropriate circumstances and at mystery shopping—going into care homes, finding out what is going on and getting a real picture, rather than things perhaps being hidden away from view when a named inspector turns up. All these mechanisms have to be used. We have to be prepared to do these things to ensure that people in very vulnerable situations, particularly people with dementia, are cared for with dignity.