The National Health Service

Debate between Andrew Selous and Philippa Whitford

Wednesday 23rd October 2019 Commons Chamber

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

Thank you very much indeed, Madam Deputy Speaker. Although I wish the House were completing the necessary Brexit legislation today, it is always a particular pleasure and, indeed, a responsibility to speak on the important subject of the NHS.

I, too, start by thanking every member of NHS staff —including two members of my own family—for what they do. The pressures on them are unrelenting, day in, day out, as all of us in this House must acknowledge. I, too, have a personal reason to be grateful to the NHS: when I was 24, I had a haemopneumothorax in the middle of the night, and the NHS saved my life with an emergency operation carried out in the hospital just over the river. Had it not been for the brilliant care I got some 30 years ago, I would not be here today making this speech.

When I met a number of presidents of royal colleges last month, they told me that they thought we needed to double the number of medical students in training. It is brilliant news that we recently increased their number by a quarter, but the ongoing NHS people review shows that demand is such that a doubling is needed. Another area we need to consider is highlighted by evidence that one to three hours a day of a doctor’s work could be done by non-clinical healthcare staff. Are we using our staff as effectively and appropriately as possible? I am worried by how many medical students we lose: having trained in this country at public expense, too many then go off to Australia, Dubai or elsewhere. Are there perverse incentives in the system? Where is the value for money for the taxpayer?

I hear from staff that sometimes they work with computers that take half an hour to warm up. Yes, we want to get rid of the fax machines and to use the latest technology, but computers that are just turned on and then work are vital for NHS staff under pressure. We need to put more nurses into care homes to curb inappropriate calls on accident and emergency services for residents. We need to make sure there are enough practice nurse courses in rural areas, where there are gaps that lead to poaching. Perhaps we could use the apprenticeship route.

I understand that 27% of medical school students who graduate go into general practice, yet the Royal College of General Practitioners says the percentage needs to be nearer 50% to meet the acute need for doctors in GP practices up and down the country. There is also great variation in the proportion of medical school students who go into general practice. We need to learn how to increase the proportion going into general practice, so acute is the need. I am also concerned that we do not have a proper career path for associate specialists, particularly in surgery, in our hospitals. They are valuable members of staff, but they can drift around the system a bit, and I understand that about 20% of them are leaving. We need to look after them better and plan for them more appropriately.

We need to link our health visitors more closely with the new primary care networks. Health visitors do invaluable work, but their national child measurement data is not transferred to GPs. That leads to problems and to childhood obesity not being tackled. As co-chair of the all-party group on obesity, it is great that we have chapter three of the childhood obesity plan, but I would just remind the Minister that the actions from chapter two, on watershed promotions and point of sale, have not yet been implemented. We need them to be implemented.

We also have a very bizarre issue in that the equality and outcomes framework does not cover children’s weight. In fact, it specifically excludes it—it covers only adults. Come on! We need to vary the contract to make sure it measures children’s weight.

We must do better on foetal alcohol syndrome disorder. It needs to be included in personal, social, health and economic education, and we need a massive public campaign. I am awaiting a letter back from the Secretary of State on that. It is a huge and growing issue that we do not talk about enough in this House.

We live in an obesogenic polluted environment, with unacceptably low levels of active travel. We need to design the healthy environments of the future if we are to relieve the NHS of the pressures that are otherwise going to overwhelm it.

We also need to be aware of the opportunities that NHS staff have to spot incidents of modern slavery. I would like to commend a very alert healthcare worker who last week, on the eve of Anti-Slavery Day, spotted the first victim of modern slavery in her hospital. She was alert to the symptoms and had done the training. NHS staff have a unique opportunity to bear down on modern slavery, and that is so important.

I was staggered to hear from the Scottish National party’s spokesman that the taxpayer is paying out £80 billion for £30 billion-worth of hospitals.

[Dr Whitford]

The figure is £13 billion.

[Andrew Selous]

It is even worse, then. Some trusts are paying up to 16% of their income on PFI payments. We really must learn from that and do much better.

Integrated Care

Debate between Andrew Selous and Philippa Whitford

Thursday 6th September 2018 Westminster Hall

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

I, too, welcome the opening speech of the hon. Member for Totnes (Dr Wollaston), who is a superb Chair of the Committee. The marketisation in NHS England goes back more than 30 years—it has certainly been happening for most of my career. It started with terms such as “resource management”, and in 1990 the internal market—the purchaser-provider split—was introduced. In the early 2000s under Labour, private companies started to introduce independent treatment centres. The Health and Social Care Act 2012 turned it into a massive external market and created the pressure to put all possible contracts out to tender.

The problems are well known. If we base a system on competition and not on collaboration, we inevitably create fragmentation and destroy integration. That has broken up patient pathways and made the system very confusing, to the point that CCGs were looking to employ what they called primary providers, which would have been another layer of cost and health organisation, to try to join things up for patients. Thankfully that has been shelved, because there is a sense of going in a different direction, but up to now there has been a repeated sense that everything can be solved through a healthcare market. That is why, in Scotland, we have grave concerns. One of the 24 powers coming to Scotland is power over public procurement—we do not see the market as the solution to everything.

Just five years on from the actual on-the-ground changes of the Health and Social Care Act, NHS England is facing another big reorganisation. As other Members said, unfortunately the rushed sustainability and transformation plans and the lack of consultation with both the public and staff has created anxiety and fear. As is now recognised, the term “accountable care organisations”, which was copied from the American system, was a PR mistake of the highest order.

In 1999 in Scotland—after devolution—we simply went in a different direction. We merged trusts and then abolished them in 2004. We got rid of primary care trusts in about 2009. We already had an area-based health service for the entire population—not just for people registered with their GP—based on per-capita funding. That meant that we could start to look at how to integrate acute hospitals with community hospitals and even local village hospitals for step up and step down—not everyone who is unwell and cannot be at home needs to be in some big, shiny 10-storey block, and might just need a bit of extra care for a few days, so there is an argument for community hospitals.

In 2014, we started looking at integrating health and social care. Because of the fragmentation in NHS England, it will be necessary to integrate health first, and then integrate social care. Integrating social care is much more challenging because it is made up of different players in the market and is done in a different way. As the hon. Member for Totnes pointed out, the overarching difference between free healthcare and means-tested social care creates major challenges.

[Andrew Selous]

The hon. Lady used the term “village hospital”, as well as the term “community hospital”. “Village hospital” is a new one to me. Could she elaborate on what it means?

[Dr Whitford]

It is not a particularly formal term. I simply mean that there has been a tendency to think that, because community hospitals cannot provide the full range of acute healthcare, they have no place, whereas someone might require only a low-level of in-patient care, such as an elderly person who has a urine infection and lives on their own may need intravenous antibiotics, fluids or extra care. Such hospitals allow us to have much more healthcare—things such as minor injury units—close to the public. The more we take forward to people, the less worried they will be about the fact that we are coalescing specialist services. If they see services coming towards them, they will not have the sense that everything is being taken away. We have utterly failed to impress on the public that healthcare is not about buildings, but very much about people and services. That is what integrated care should be about.

Improving Air Quality

Debate between Andrew Selous and Philippa Whitford

Thursday 28th June 2018 Commons Chamber

[Andrew Selous]

I completely agree with the hon. Lady. In another guise, I co-chair the all-party group on cycling, so I absolutely get the importance of cycling and walking. They are not just good for our health and do not just cut congestion and pollution, but are good for our mental health, helping us to socialise and build community. There are so many reasons why what the hon. Lady said is absolutely right.

[Dr Whitford]

My home is on the west coast of Scotland, where I am lucky to have incredibly clean air, but when I am down here I normally walk or cycle to Parliament. If anyone else present suffers from asthma, they will know what a bad winter I have had, almost continuously since last November. It is no good telling people to get on their bikes or to walk when that then exposes them. We need to deal with the traffic to allow safe cycling.

[Andrew Selous]

I could not agree more. As someone who over the Easter recess cycled from my home to my constituency office along the busy A5, with juggernauts going fairly close to me, I completely understand what the hon. Lady says. We need safe cycling, and all the evidence shows that more people will cycle if it is safer. That is especially true for children going to school from all the new housing developments. When we build new housing, it is essential that we have safe cycle routes to the schools. That will result in healthier children, less childhood obesity and better communities.

Let me go quickly through the full list of health problems associated with poor air quality. It includes: premature birth; reduction in foetal growth; low birth weight; increased risk of death during the first year of life, particularly from respiratory illnesses; exacerbation of the effects of respiratory infections in young children; and effects on the normal growth of lung function during childhood. There is really shocking evidence that if a child’s lung capacity is damaged when it is young, it may never recover. From a social justice point of view, it is even worse, because it is the poorest kids who are breathing in the worst air. That is why this issue matters so much.

The list also includes cardiovascular disease, heart attacks, hypertension and stroke. Poor air quality also leads to chronic obstructive pulmonary disease; pneumonia; accelerated decline in lung function and lung cancer in adulthood; the development of early onset asthma, which the hon. Member for Central Ayrshire (Dr Whitford) mentioned just now, as well as exacerbating asthma in those already living with the condition; impaired cognition; dementia—a big Canadian study showed a link with dementia; and other neuro-degenerative disorders as well as type 2 diabetes, obesity and metabolic syndrome. I think that we can say that that is a pretty concerning list.

Public Health England is a very fine body, which I admire very greatly. Its chief executive, Duncan Selbie, does very good work, but we need more action from the organisation. It needs to be engaged in this issue. What it has done so far has been quite high level and quite strategic; it has not really come down to the level of the citizen, which is where we need it to be active.

One recommendation of the joint report of the Select Committees was that Public Health England should deliver an effective and appropriate campaign by this September, but Public Health England has told us that that is not possible in the timescale. That is despite the fact that the World Health Organisation has called this issue a public health emergency. I ask PHE to redouble its efforts on this issue and really try to get this information down to local levels so that people are, first, informed and, secondly, know what they can do to protect themselves best, and to stop being part of the problem and to start contributing to the issue.

I was pleased to see in the foreword to the Government’s 2018 clean air strategy, the statement by the Secretary of State that there would be a new goal that takes into account the World Health Organisation guidelines. There was also a commitment to primary legislation. I know that the Under-Secretary of State for Environment, Food and Rural Affairs, my hon. Friend the Member for Macclesfield (David Rutley), cares a lot about these matters. When he responds, could he please give us a little bit more detail on this issue? There are specific World Health Organisation guidelines on the amount of particulate matter—PM_2.5 —that we should not exceed on a daily basis. When the Government talk about taking into account the guidelines, I hope that they will go into that level of detail, bearing in mind what I said about the briefing from the British Heart Foundation about the increased risk of heart attack from elevated exposure to poor air quality just within a 24-hour period.

Winter pressure in the national health service is a huge issue that concerns every single Member here and I know the national health service is taking it extremely seriously as we head towards next winter. I have just been in the Upper Waiting Hall speaking to Dr Hugh Coe from Manchester University as part of evidence week, which is a very welcome intervention, as the top academics and scientists who know about these issues take the time and trouble to come down to Parliament to brief Members so that we are properly informed and can make good decisions on these matters. Dr Hugh Coe confirmed what the clinical chair of Bedfordshire clinical commissioning group said to me quite recently, which was that part of the increase in winter pressures, much of which is caused by older people going into hospital with respiratory problems, is from poor air quality. When we have cold weather in winter, the air is clammy and a bit foggy, which means that the pollution gets stuck in it. We breathe it in. It affects us more as we breathe it in. The same happens when it is very hot in the summer because the sun exacerbates the pollution. Again, I do not think that it is well known that there is this link between poor air quality, higher levels of respiratory problems and the winter pressures that we are all concerned about—a further reason for action.

My final issue is how we energise this issue at a local level. The Government talk about monitoring levels of air quality around schools. I would add old people’s homes as well. There are many other places where it is very important that we know the level of air quality. That information is really important to inform local residents, so that when they are looking to elect people to public office, either to Parliament or to local authorities, they can let them know how seriously they take this issue and the fact that they want something to be done about it.

Finally, we had a meeting on air quality and active travel in my constituency not so long ago. An older lady who had never smoked and who had led a pretty healthy life came up to me and said, “I am here today. I have just been diagnosed with chronic obstructive pulmonary disease. Where did that come from?” She had never smoked. The chances were, I am afraid, that she got it from breathing in poor quality air. That will greatly affect the last years of her life. Sometimes we talk in statistics and percentages, but I want to end my contribution with that one lady and the impact on her remaining years.

--- Later in debate ---

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

One of the first big steps forward on air quality came after the great smog of 1952, when 4,000 people died within five days and 8,000 died in the following weeks. From that came the Clean Air Act 1956, which reduced pollution, particularly from coal, coming from industrial and domestic sources. However, in the 50 years since, traffic pollution has soared. Some 70% of UK towns and cities are defined as unsafe, with 37 out of 43 clean air zones failing on nitrous dioxides. There is a road in Lambeth that, every single year since 2010, has reached the number of breaches it is allowed in a year by the end of January.

The issue is not only about nitrous dioxides. Particulates have been mentioned—the 10 micrometres, and, more particularly, the 2.5 micrometres. These tiny particles get much further into the lungs and cause more damage. As the hon. Member for Strangford (Jim Shannon) mentioned, that damage particularly affects children and older people. Some 4.5 million children—a third of them—are exposed to unsafe levels. If they live near a busy road, they have twice the rate of respiratory problems. We are talking not only about asthma, the obvious one, but about reduced lung development and—if mothers were exposed during pregnancy—reduced brain development. Such things will lay down the quality of a child’s life before they are even born. Among older people, particulates increase the deterioration in lung function, as well as causing ischemic heart disease, increased rates of dementia and stroke.

Pressure in this country has developed only because of the threat of legal action from the EU last year; the can has been kicked down the road for years. The UK and eight other countries are facing legal action from the EU unless they get serious and radical. We would consider countries such as Germany and France, particularly Germany, to have good public transport. There is a particular need to invest in trains and trams—and in rural areas, in buses. Since transport was deregulated in the 1980s, Strathclyde in the west of Scotland has gone from having an integrated network of trains, tubes and buses to simply a free-for-all of ancient diesel buses all crowding the same roads. We have gone backwards in the past 40 years, and we need to go forwards. In rural areas, it is buses that are important. When it is just left to private companies, small villages quickly lose their bus services, which is not acceptable. We should be radical, and we should look at cities such as Copenhagen, which ripped up a ring road and turned it into a safe cycle route. We need things like that.

We heard from the right hon. Member for Exeter (Mr Bradshaw) that the cost of lung disease caused by poor air quality is £20 billion, yet we invest less than 5% of that amount in active travel infrastructure. As I said in an intervention, it comes down to health in all policies.

[Andrew Selous]

The hon. Lady has mentioned Copenhagen. Is she aware that 30% of all journeys in Amsterdam are by bicycle, compared with 2% in London? That came about through a real effort of political will many years ago to recreate the city to be fit for cycling.

[Dr Whitford]

I thank the hon. Gentleman for his intervention. My understanding is that 50% of journeys in Copenhagen are now made by bicycle. But this does require investment in infrastructure.

The hon. Member for Poplar and Limehouse (Jim Fitzpatrick) mentioned a new tunnel at Silvertown. The Clyde tunnel was finished in 1963 and it consists of two circular tunnels, with the road deck about a third of the way up and room for cyclists, pedestrians and ventilation underneath. That was back in the ’60s. We need to make sure we are not investing in hugely expensive tunnels that go against active transport.

It is about health in all policies. Decisions are made in silos, even in this place. We make decisions on different days that counteract each other, which is frustrating. If we had physical health and mental wellbeing as an overarching principle like human rights, people sitting in our town halls and here would focus not on cars, on how they drive and how they park—that is the focus in our towns and cities at the moment—but on people. We would design safe, segregated cycle routes, and we would have much wider pavements on which children could ride their scooters, and on which people with prams or wheelchairs would not be crowded out—people would not need to step into the roadway to pass them. When we have such glorious and, in Scotland, very unusual sunny weather, it would also create an environment in which cafés could be outside. People would walk around their town centres and meet their neighbours, which would contribute to a sense of belonging and community. I would love to see health and wellbeing as the driving force in every decision made by town halls, national Government and Westminster on how we design our towns and cities.

Privatisation of NHS Services

Debate between Andrew Selous and Philippa Whitford

Monday 23rd April 2018 Westminster Hall

[Andrew Selous]

Will the hon. Lady give way on that point?

[Dr Whitford]

No, because there is very little time.

[Andrew Selous]

We have 35 minutes left.

Austerity: Life Expectancy

Debate between Andrew Selous and Philippa Whitford

Wednesday 18th April 2018 Westminster Hall

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

I pay tribute to the hon. Member for Sheffield, Heeley (Louise Haigh) for bringing this important matter before the House.

I will start with the economics, because the debate relates to austerity and life expectancy. Government Members would probably talk about living within our means and would put to the hon. Lady the argument that the consequences for the poor and the vulnerable of a country continuing to live beyond its means are very grave. Economic history tells us that when countries lose control of their finances, it is not the well-to-do or the comfortable who suffer, but the poor and the vulnerable. That needs to be put very firmly on the record.

It is also worth noting that the Commonwealth Fund, which is an independent body, last year pointed out that our NHS was the best health system of the 11 different health systems it looked at. If we look at our outcomes on strokes, heart attacks and cancer, we see that they are getting better—there are 7,000 people alive today who would not be alive had we not seen that improvement in cancer outcomes.

Looking at the data across Europe, we see that what is happening in the UK is part of a trend, because life expectancy is also falling in Italy, Spain, France and Germany. Some of those countries spend quite a lot more on health than we do. France and Germany spend one percentage point of GDP more on health than we do, yet they have also seen that downward trend.

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

Will the hon. Gentleman give way?

[Andrew Selous]

I will in a moment. There has been no austerity in Germany, because the Germans live within their means and run a big budget surplus. They have a trade surplus with China. However, life expectancy is falling in Germany as well. We need to look at these wider factors and at the European context. I will now of course give way, with great pleasure, to my former colleague on the Health Committee.

[Dr Whitford]

Does the hon. Gentleman also recognise from the data that there is not a similar fall in life expectancy in the Scandinavian countries and that it is wrong to look narrowly at health services, because the biggest driver in relation to life expectancy is poverty?

[Andrew Selous]

I will come on to those very important public health issues and what we need to do about them, because I care passionately about them, as probably everyone in the Chamber does. As the hon. Lady is from Scotland, it is also worth looking at what is happening there, because Scotland offers free adult social care and spends a higher amount on healthcare per head than England, yet still has a lower life expectancy than England. We need to get those issues firmly—

Children’s Oral Health

Debate between Andrew Selous and Philippa Whitford

Tuesday 31st October 2017 Westminster Hall

[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.

NHS Pay

Debate between Andrew Selous and Philippa Whitford

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.

NHS and Social Care Funding

Debate between Andrew Selous and Philippa Whitford

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.

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

Debate between Andrew Selous and Philippa Whitford

Committee Debate: 1st sitting: House of Commons
Tuesday 8th November 2016 Public Bill Committees

[Dr Whitford]

Q Do you think that the Bill as it stands will deal with that, or do some of these more specialist areas need to be highlighted?

David Watson: I do not think that the Bill will perhaps ever be clear enough about the circumstances in which one price rise is right or wrong, but I think that we agree with the need for the Department to have adequate powers to go after those cases—though of course to do so it needs adequate resources as well. But we agree with the principle that the Department should be able to look at price.

[Andrew Selous]

Q I am tempted to have another go, because you used the phrase “reasonable return” in your answer to Dr Whitford. You would not give me a figure on that earlier. Are you prepared to say anything further on that?

David Watson: I could make up some figures, but companies, depending on their skill and their pipeline—