Oral Answers to Questions

Baroness Morgan of Cotes Excerpts

Tuesday 26th March 2019 Commons Chamber

[Stephen Hammond]

The hon. Gentleman will know that, in the winter funding round, extra ambulances were provided across the whole country. I am happy to meet him and discuss his proposals, which I will then consider carefully.

[Nicky Morgan (Loughborough) (Con)]

ADHD Solutions is a community interest company based in the constituency of the shadow Health Secretary that serves children and young people with ADHD across Leicester and Leicestershire. Fifty per cent. of its referrals come from the NHS, yet it does not get funding for those referrals; however, those NHS services are able to meet NICE guidelines because ADHD Solutions is doing the job. Will the Health Secretary meet me and the shadow Health Secretary to discuss that?

[Jackie Doyle-Price]

I have corresponded with my right hon. Friend and the hon. Member for Leicester South (Jonathan Ashworth), but I am more than happy to meet them to discuss that issue. From my perspective, services for people with ADHD are a bit of a Cinderella and I would like to do my best to address that, working with colleagues across the House.

Appropriate ME Treatment

Baroness Morgan of Cotes Excerpts

Thursday 24th January 2019 Commons Chamber

[Nicky Morgan (Loughborough) (Con)]

It was a pleasure to apply for this debate with the hon. Members for Glasgow North West (Carol Monaghan) and for Ceredigion (Ben Lake) and others. [Interruption.] How could I possibly forget the hon. Member for Ealing North (Stephen Pound)?

Like other Members, I will speak about my own constituents’ experiences. As we have already heard, so many Members are here on a Thursday afternoon to talk on behalf of their constituents. We held out for a debate on the Floor of the House, and we are debating not a “take note” motion but a substantive motion. This House debates many contentious issues, passions can run high and there can be many points of order, but hopefully we will see the House of Commons at its finest this afternoon as we do our job of bringing to the attention both of Ministers and of the wider public an issue of real importance that devastates the lives of our constituents and their families.

We have already heard about the issues of funding for biomedical research, and it is clear that, given the prevalence of the condition, there must now be an increase in funding not only to help advance our understanding of its underlying biology but to develop new diagnostic tests and better, more targeted treatments. The problems and dangers of graded exercise therapy and CBT have already been powerfully set out. My constituents have also called for NICE to take their concerns into account and to remove those treatments from its guidelines. We have heard the call for NICE to issue an immediate public statement on the harm that may be caused by the current guidelines for the period they remain active.

It is right that we want GPs and health professionals to know more.

[Paula Sherriff]

My constituent has to travel 40-odd miles to Manchester for treatment. With a condition such as ME, that is particularly distressing. Does the right hon. Lady agree that we need many more specialists throughout the country?

--- Later in debate ---

[Nicky Morgan]

I agree with the hon. Lady. We all know that resources may be constrained, but we want our constituents to be able to see specialists who really know about a condition. One of the most powerful things that we have heard is that not only are sufferers fighting a condition that makes them feel terrible, but they are not believed when they say what they are going through. That must compound the difficulties of the condition. Having a GP who not only believes them, but wants to help and understand, would make a huge difference. The same is true of other health professionals.

We have talked about children being affected. One of my constituents wrote to me to say that she had had ME since 2013, and had been left housebound. She added:

“As if having this illness wasn’t devastating enough, in 2016, my then 10 year old son became unwell and never got better, he has also been diagnosed with ME.”

We have heard today about the potential involvement of child protection services. In addition, some schools can deal with the condition, but some schools will struggle. I was contacted only this week, as the debate was being advertised, by another constituent. She talked about her daughter, Elisha, who is now 11 years old and has had ME for four years. Elisha has been discharged from the community paediatrician, physiotherapist and occupational therapist and left with no support or medical help, because there is no funding for paediatric ME care in Leicester or Leicestershire. She has missed most of her schooling in the last four years. Clearly, with children as well as with adults, people must be believed and the condition must be investigated. It is a considerable source of stress for parents and carers, but of course it has a negative effect on the child’s personal development and future life chances.

I have family experience of ME, but I want to pay tribute to the constituent who first brought the matter to my attention, Sarah Reed. Some Members, particularly Opposition Members, will know her as the wife of the former Labour MP, Andy Reed, who was my predecessor in Loughborough. Sarah has been a tireless campaigner for ME Action and for sufferers.

There are 250,000—a quarter of a million—sufferers of ME, or chronic fatigue syndrome, in the UK. With any other condition, we would not allow a situation in which people continue to struggle to have their voice heard, and the NICE guidance takes so long to be delivered. There are many examples, and it is time for the Government to respond.

Budget Resolutions

Baroness Morgan of Cotes Excerpts

Tuesday 30th October 2018 Commons Chamber

[Matt Hancock]

No. The £84 billion is the cash figure. The £20.5 billion is the real-terms increase by the end of the five years. If we add up all the extra money, we get £84 billion. It is there on page 36 of the Budget, if the hon. Lady wants to look. The biggest single cash increase comes next year, in 2019-20. It is all there in the Red Book.

[Nicky Morgan (Loughborough) (Con)]

I thank the Secretary of State for more good news for the midlands in the form of £70 million for the Defence and National Rehabilitation Centre just outside my constituency to help civilian rehabilitation. Can he share further details of that with us?

Oral Answers to Questions

Baroness Morgan of Cotes Excerpts

Tuesday 24th July 2018 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

Clearly, the sequence of events that the hon. Lady has outlined is completely unacceptable. We have obviously set out clear expectations on NHS England to commission sufficient beds to enable local placements where possible and specialist care where a more acute service is required. It is up to NHS England to ensure that sufficient services are commissioned and I will readily take up that case with NHS England.

[Nicky Morgan (Loughborough) (Con)]

I welcome my right hon. Friend to his new position.

On Friday, a retired NHS consultant visited my surgery to talk about carpal tunnel syndrome. It appears that some of the operations are not going to happen now, and he said that they can happen at general practice level for about a third of the cost that they happen at hospital level. Is there an opportunity, yes, to save money but also to do things better by moving surgery out to community facilities? Can we explore such opportunities before these decisions are taken?

[The Minister for Health (Stephen Barclay)]

My right hon. Friend raises an important point about ensuring that procedures are done in the right place at the right cost, but primarily in a way that is best for the patient. I am happy to meet her to discuss the specifics of that and to see whether a change can be made.

PACE Trial: People with ME

Baroness Morgan of Cotes Excerpts

Tuesday 20th February 2018 Westminster Hall

[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your stewardship, Mr Hollobone. I congratulate the hon. Member for Glasgow North West (Carol Monaghan) on securing today’s debate. As she has articulated so beautifully, the situation is clearly very concerning. I know that she has done an enormous amount of work in this area, and has met people, both in her constituency and more widely, affected by the condition, and with expertise on the condition, to hear about its impact on individuals’ lives. As MPs, we all know people in our constituencies who are affected by the condition.

As we have heard, chronic fatigue syndrome, also known as myalgic encephalomyelitis or encephalopathy, is a debilitating and very poorly understood condition, which is estimated to affect more than 200,000 people in England. We do not understand the underlying causes of it, there is no one diagnostic test to identify it, and although patients can improve and recover, there is no cure for it. The condition, which for brevity and to avoid covering you in a thin layer of spittle, Mr Hollobone, I shall refer to in the abbreviated form CFS/ME, can stop a life in its tracks, leaving sufferers unable to carry out the most basic tasks. In the most serious cases, people can be bedbound for weeks at a time. It has a complex range of symptoms, including a very disabling, flu-like fatigue and malaise, and neurological problems. Of course, the impact on friends, families and carers can be significant as well.

It is also true that the difficulties in diagnosis mean that patients with CFS/ME often experience delays in getting the treatment and support that they need. In recognising the need for GPs to be aware of the condition, the Royal College of General Practitioners identified CFS/ME as a key area of technical knowledge that GPs should have as part of their qualifying exams, which answers a question raised by the hon. Lady.

The recommended treatments for CFS/ME, namely cognitive behavioural therapy, or CBT, and graded exercise therapy, or GET, and the evidence for them are the subject of today’s debate. Those treatments were first recommended for patients with mild or moderate CFS/ME in 2007 in the NICE guidance, in line with the best available evidence, which showed that the treatments offered benefits. The guidance sets out that there is no one form of treatment to suit every patient and that the personal needs and preferences of patients should be taken into account. Doctors should explain that no single strategy will be successful for all patients; that in common with all people receiving NHS care, CFS/ME patients have the right to refuse or withdraw from any part of their treatment; and that those with severe symptoms may require access to a wider range of support, managed by a CFS/ME specialist.

The results of the PACE trail, which examined pacing therapy, cognitive behavioural therapy, graded exercise and specialist medical care for chronic fatigue syndrome, were published four years after the NICE guidance. The trial ran from 2005 to 2011 and, contrary to what the hon. Lady said, was primarily funded by the Medical Research Council, not the DWP. Total funding was £5 million and the MRC contributed almost £3 million.

The study was undertaken by the Queen Mary University of London. It was the largest ever trial for CFS/ME, including more than 600 participants in England and Scotland. It sought to assess and compare the effectiveness of the four main treatments for CFS/ME—adaptive pacing therapy, CBT, GET and standardised specialist medical care.

The peer-reviewed trial results published in The Lancet in 2011 found, as the hon. Lady said, that 60% of patients with CFS/ME benefited from CBT and GET when provided alongside specialist medical care. CBT and GET were found to be better than pacing therapy or specialist medical care alone in improving both symptoms and disability, and a follow-up study looking at recovery after one year further supported the benefits of interventions. The trial had ethical approval from the NHS research ethics committee and had ongoing oversight from an independent trial steering committee, which included patient representatives. Trial reports were regularly provided to a data monitoring and ethics committee that had the power to halt the trial if harm was indicated. NICE considered the PACE results in 2011 and concluded that they supported its existing recommendations on both CBT and GET.

The Government are aware that the use of CBT and GET in treating CFS/ME has long been a controversial issue for patient groups, charities and some clinicians. That began with the publication of the NICE guidance 10 years ago and continued with the PACE trial. Since 2011, PACE trial data has been shared with many independent scientists as part of normal research collaboration, including the internationally respected research organisation Cochrane, which independently validated the findings. However, in the last 18 months, the attention on the trial has increased substantially, following a tribunal ruling in August 2016 ordering the release of the trial data to a member of the public, which the hon. Lady referred to. The data has since been examined more widely and critics, including some clinical academics, have suggested that it shows that CBT and GET are not as effective as the trial results suggested.

[Nicky Morgan (Loughborough) (Con)]

This is clearly a very important debate. I think both the hon. Member for Glasgow North West and the Minister would agree that it is not possible to do justice to the concerns raised by all our constituents, and the 200,000 sufferers that the Minister has identified, in half an hour. Does the Minister agree that this is a subject worthy of wider debate in the House of Commons? Constituents such as Sarah Reed, who have written to me, say that because of the belief in CBT and GET, and because academics believe in the results, many other treatments have not been pursued. Does the Minister feel angry about that?

[Caroline Dinenage]

I thank my right hon. Friend for her intervention. As has already been said, it is important that we listen to patients. As I will go on to explain, NICE is now looking at reviewing its guidance on this and, in the light of that, it may well be worth discussing the issue more fully.