Ebola

Barry Sheerman Excerpts

Monday 13th October 2014 Commons Chamber

[Mr Hunt]

My right hon. Friend makes an important point. I discussed this with United States Secretary Burwell today. The US is piloting a programme in Liberia, and we are doing the same thing in Sierra Leone. We are both providing the same response, which is to tackle the disease at source. We know that, if we can get 70% of the people who develop Ebola symptoms into treatment and care, we will contain the disease. At the moment, the disease is replicating at a rate of 1.7, which means that every 10 people infected are going on to infect another 17 people. That is why the virus is spreading so fast, and we can halt it only if we get people into treatment very rapidly. Community treatment centres are therefore an important part of the Department for International Development’s strategy to help to contain the virus, and that is why we are supporting the development of 700 beds in Sierra Leone.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

May I beg the Secretary of State to work across Europe and all the countries that can help? I have a daughter who has just returned from west Africa and she has reported to me and the family that the situation is critical—it is desperate. There is a lack of any kind of facility to control this disease. Parents are dying, leaving children with nobody to care for them. The situation is very grave, so will he redouble his efforts to persuade Europe, the World Health Organisation, the UN—all of us—to do something more significant and to do it now?

[Mr Hunt]

The hon. Gentleman speaks movingly and well about the incredible gravity of the situation, and he rightly says that we need full international support on it. In such a situation there are a number of things we are much better tackling as part of an international effort; we are very proud of our 659 NHS volunteers, but volunteers from the whole of Europe could go out and play a part. They need reassurance that they will be safe if they end up contracting the virus, because the truth is that there is no 100% guarantee of safety, even for people who follow the correct procedures—that is why these people are so brave. The hon. Gentleman is absolutely right in what he says, and I reassure him that that is exactly the conversation I have been having with international colleagues: we do need a co-ordinated effort.

Care Home Top-up Fees

Barry Sheerman Excerpts

Tuesday 22nd July 2014 Westminster Hall

[Paul Burstow (Sutton and Cheam) (LD)]

It is a pleasure to have the opportunity under your chairmanship, Mr Sanders, to debate an issue that is of growing importance and will increasingly find its way into the mailbags of hon. Members on both sides of the House. The issue is how much people pay for care in the 10,000 or more care homes up and down England and, in particular, whether the top-up payments that some residents and their relatives make to secure care home accommodation are fair and transparent. With the Department currently consulting on draft guidance for the Care Act 2014, this is a good time to turn the spotlight on these issues.

The legal framework setting out what local authorities need to do when a resident who qualifies for means-tested support enters a care home has been fairly clear for a long time. The “Charging for Residential Accommodation Guide” and the 2004 choice of accommodation directions are straightforward, at least in so far as they clarify that, if local authority-supported residents would like to move into more expensive accommodation—for example, they might want to secure a place in a home nearer their family—they can, provided that a third party, normally a relative, can pay a top-up payment, make that choice. The rules are also clear that if, for whatever reason, no care home places can be provided at the rate that the local authority would normally pay, it is the responsibility of the council, not the resident or their relatives, to pay more to secure reasonable care home accommodation.

The rules are clear. The trouble is that evidence is mounting that they are being broken. Local authorities are confused about how to apply the rules consistently, so that families can be informed about the rules on choice and choose more expensive accommodation, knowing that that will involve additional costs, while at the same time being protected from paying a top-up payment for essential care that it is the council’s responsibility to pay for and meet.

An estimated 54,000 local authority-funded adults are part-paying their care home fees. That is 28% paying top-up fees. Just over one in 10 of all care home placements involve someone paying a top-up fee.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I congratulate the right hon. Gentleman on securing the debate, because up and down the country and certainly in my constituency of Huddersfield, there is real concern about this issue. Does he agree with the finding of a recent survey that many councils do not know what is going on? It is not that it is malign; they just do not know what is going on.

[Paul Burstow]

That is really the thrust of this debate. Whether it is malign or not, it is ignorance, and when it comes to a local authority, that ignorance is not acceptable.

The problem is that the people I am talking about are often out of sight and out of mind. We do not know how many of the 54,000 people who pay a top-up know that a top-up is intended to allow relatives to pay a little extra for a care home place that is above and beyond the “standard” level available from the council. We do not know how many of the 54,000 people know that their council or care home should not be requesting a top-up for any care; it should request it only for a higher standard of accommodation.

Based on the evidence that I have seen, I believe that we need to examine whether the rules governing choice and charging for residential accommodation are working as intended and that we need to look again at what we can do to clarify local authorities’ responsibilities now that the legal framework is being strengthened by the Care Act. We need to get this right because top-ups look set to grow in number, not least with 35,000 more care home residents qualifying for some level of means-tested support when the upper capital threshold is increased to £118,000 from 2016. It is in councils’ interests to get it right because, again thanks to the Care Act, there will be a new appeals process for each local authority. Unless the often grey area of top-ups is sorted out, it is likely that a growing number of residents will be challenging the decisions that councils have made about care home fees. Councils can take steps to minimise the risk of legal challenges, but they need the Government to provide clear and practical guidance on what they are required to do and, crucially, what they cannot do.

[Mr Sheerman]

Will the right hon. Gentleman give way, just on that point?

[Paul Burstow]

I cannot because—

[Mr Sheerman]

May I intervene very quickly just on that point, because it is very important?

[Mr Adrian Sanders (in the Chair)]

Order. It is for the Member who secured the debate to give way.

[Paul Burstow]

I will give way, but I need to stress to the hon. Gentleman that this is a half-hour debate and I need to make quite a few points myself.

[Mr Sheerman]

I was trying to intervene on this point only because it means so much to some of my constituents. Some of them have said that the trade association for care homes, which is a very powerful one, should have a charter of rights. As someone goes into a home, it should be there and should show the clear responsibilities and clear duties of care.

[Paul Burstow]

That is a very good point and one that I am sure Care England and other organisations representing care homes would want to take on board.

It is important to understand the scale of the problem. Research carried out last year by the charity Independent Age highlighted the fact that 72% of local authorities—there was a very high response rate to this freedom of information request—were unable to demonstrate that they met their legal obligations with an overview of top-up payments in their area. In other words, they were not routinely monitoring and reviewing whether third parties remained “able and willing” to make top-up payments. That is a core requirement of the existing guidance. The onus is on councils to check that families are not unwittingly making top-up payments for care that should be paid for and met by the council as part of its duties to meet assessed, eligible needs. Those payments can range anywhere from £31 a week to perhaps £131 a week. In some cases, it is probably even higher than that.

The research also found that just under 30% of councils said that they did not hold or collect information about top-up fees in their area. This was a typical quote from a council:

“As a Council we’ve never had any involvement in top-up care home fees...The Council does not know how many top-ups are in place, in any financial year”.

Perhaps most disturbing was that so few councils knew what was taking place in terms of top-up fees arranged between care homes and families in their area. Almost 80% of councils did not routinely check up on the health of top-up payments as part of their annual reviews, and 75% of councils did not signpost families of care home residents to independent advice before entering into third party top-up agreements.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

I congratulate my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) on securing the debate. It would be wrong for the debate to be an exclusively Liberal Democrat affair, so I am delighted to see the hon. Member for Huddersfield (Mr Sheerman) in his place. This debate is, in some ways, a unique event.

My right hon. Friend raises an important issue. He provided two case studies, which almost smack of exploitation of vulnerable older people. The ratcheting up by a care home of the top-up fee for someone in the latter stages of their life who suffers from dementia is completely unacceptable exploitation of that individual, and it should be condemned.

Equally, the idea that it is suitable or appropriate to shove someone into a home far away from London but a long way from where she wants to be goes against the central principle of the Care Act 2014: the individual’s well-being. I know that my right hon. Friend is committed to upholding that principle. The issue that he raises is of real importance, and the findings of the local government ombudsman’s report from last year, to which he referred, are of real concern.

People should have a choice over the establishment in which they receive care and support. That establishment will, after all, become their home. Where the local authority is involved, it has a responsibility to ensure that the establishment meets the person’s needs without costing more than it needs to. However, another important principle, which we must respect, is that people or their loved ones should have the choice to use their own resources as they see fit. If by doing so they can improve their surroundings by having a bigger room or a better view, they should have that choice. I emphasise that that must be a positive choice on the individual’s part—something that they understand the costs and consequences of, never something that they feel pushed into.

[Mr Sheerman]

Will the Minister give way?

[Norman Lamb]

Very briefly.

[Mr Sheerman]

The right hon. Member for Sutton and Cheam (Paul Burstow) put his finger on it when he talked about secrecy. There are many excellent people in this field doing a fantastic job—my mother-in-law is in a care situation—but a certain percentage of people do not know what is going on. They need to know, and it should be in the public domain.

[Norman Lamb]

I agree with the hon. Gentleman. He will find that the Care Act has a much greater focus on transparency, and it strengthens the legal obligation by providing that personal budgets must reflect the cost to the local authority of meeting the adult’s needs. That is a legal requirement in the Care Act, whereas previously it had been guidance.

Oral Answers to Questions

Barry Sheerman Excerpts

Tuesday 10th June 2014 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for her work to promote good health care in her area. I very much enjoyed meeting her local GPs. I was disappointed that it was only for about five minutes. I very much hope to go back and have a proper discussion. They were very enthusiastic about the Prime Minister’s challenge fund, and are making some very innovative changes.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

May I push the Secretary of State on this matter? What my constituents want is to be able to get to see a GP when they really need one; they do not want to turn up in A and E just because they cannot get an appointment for a week. Is not poor management of GP surgeries—poor management from top to bottom—at the heart of this problem?

[Mr Hunt]

Actually, I agree with the hon. Gentleman. I think that we do have a problem. We have some fantastically good GP surgeries and some brilliant GPs, but we have not in the past had structures in place to make sure that we deal quickly with underperforming GP surgeries and, indeed, underperforming GPs. We need to have much more transparency of data so that we can see where the problems are. We have introduced a rigorous new inspection regime, with a new chief inspector of general practice, and I hope that that will go some way to addressing the issues he raises.

Health

Barry Sheerman Excerpts

Monday 9th June 2014 Commons Chamber

[Andy Burnham]

I am quite clear in what I said. I said that the finding of the Francis report was that it was a local failure, but of course there were lessons to be learned. That is why I brought in Robert Francis in the first place to begin inquiries at Stafford. The claim that we just brushed everything under the carpet could not be more wrong. The Secretary of State needs to drop it and start dealing responsibly with these issues.

The right hon. Gentleman wanted to distract the House from what I was saying—that a Bill should have been brought forward in this Gracious Speech to modernise professional regulation in the NHS. I quoted strong sentiments from Niall Dickson and Jackie Smith. There was no room for such a Bill, but it is hard to find measures in the rest of the Gracious Speech that may be considered more important than that Bill. The Speech found space, for instance, for measures on pubs and plastic bags, but not on patient safety. There was a time when the Prime Minister used to say that his priorities could be summed up in three letters—NHS. Not any more. Those letters did not appear in the Gracious Speech and received only a cursory mention when the Prime Minister addressed this House.

So what explains the relegation of health down the Government’s list of priorities? One commentator writing last Thursday offered an explanation. He said that

“there was no mention of the health service in the Queen’s Speech. Indeed, the Tories have had little to say on the subject at all recently.

I’m told that there is a precise reason for this: Lynton Crosby has ordered them not to.”

I do not know whether that is true, but it does not look good, does it? It creates the clear impression that the shape of the Gracious Speech had more to do with the political interests of the Conservative party than the public interest of the country.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Is not another explanation for the absence of any mention of the NHS in the Queen’s Speech that the Government do not want it? They are quietly privatising the NHS by the back door, so they do not need legislation.

[Andy Burnham]

I think that that is exactly the reason. They introduced a reorganisation that nobody wanted, that nobody voted for, that put the wrong values at the heart of the NHS and that has dragged the NHS down, and all the while they are softening it up for accelerating privatisation. That is the record on which they will have to stand before the country in less than 12 months’ time. If the Secretary of State can justify that record and breaking the coalition agreement to his constituents, I would be very surprised indeed.

--- Later in debate ---

[Alun Cairns]

rose—

[Mr Sheerman]

rose—

[Andy Burnham]

I give way to my hon. Friend.

[Mr Sheerman]

Does my right hon. Friend agree that this destabilisation has reached such an extent that very good hospitals, such as those in Huddersfield and Halifax, have a cloud over them because they might lose their A and E departments? What does that do for morale and culture, which have been so good in those two hospitals? Up and down the country, morale has been shaken to the roots.

[Andy Burnham]

What I find surprising is that all over the country plans are being developed to close A and E departments. How can that make sense when we are in the middle of an A and E crisis? In west London my hon. Friend the Member for Hammersmith (Mr Slaughter) has done much work to raise concerns about the changes to hospitals there.

Care Homes

Barry Sheerman Excerpts

Thursday 1st May 2014 Commons Chamber

[Norman Lamb]

Thank you, Mr Speaker, for your gentle guidance. I will do my best.

The hon. Gentleman makes an incredibly important point. One cannot change the culture of an organisation overnight. The Care Quality Commission was a dysfunctional organisation, but it now has really good leadership in the form of David Behan and its chairman, David Prior. They understand the importance of changing the culture and ensuring that they are always the champion of the patient.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I say to the Minister and all colleagues in the House that this is not good enough. It is disgraceful. We had it before and we had similar answers. We have to stop this. There are wonderful carers out there—most carers are wonderful—but they need support, good skills training and to be paid properly. Surely we ought to have a charter in every home that says, “These are your rights. Don’t let them be infringed. They are clear.” Every good hotel and business has such a charter hanging up where everyone can see it. Can we not have that tomorrow?

[Norman Lamb]

Many care homes are signing up to exactly those standards. The more that happens, the more we should applaud and encourage it. The hon. Gentleman is right that we should all be completely intolerant of such abuse and neglect. It is a challenge for the whole of society. Whichever Government are in power need to hold the line of being absolutely intolerant of any failures of care and must demonstrate that when they happen, there are real consequences that will hold people to account.

Oral Answers to Questions

Barry Sheerman Excerpts

Tuesday 1st April 2014 Commons Chamber

[Dr Poulter]

That is a good point. On screening, we have to listen to the advice of the national screening committee, as I am sure hon. Members on both sides of the House would agree, but on the enriched culture medium test, I have had further meetings with Group B Strep Support and with the former editor of the obstetricians and gynaecologists journal, the BJOG. On the back of that meeting I have written to the Royal College of Obstetricians and Gynaecologists to ask it to look at the clinical evidence on that test, and it will take the matter forward.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I thought that answers to questions were improving after 12 noon, but the last answer on post-natal depression was not as good as I expected. We have a campaign on post-natal depression, which is the biggest killer of healthy young women through suicide. The Minister is being complacent. Early diagnosis and good GPs are essential. What is he really doing about that?

[Dr Poulter]

The hon. Gentleman is absolutely right. I thought it was disgraceful, when we came to power and inherited the legacy of the previous Government on post-natal depression, that only 50% of maternity units had perinatal mental health support. That was not good enough, and that is why I have ensured that in the mandate to Health Education England, and working with NHS commissioners, all maternity units will have specialist perinatal support by 2017. There is more training going in for the work of the Royal College of General Practitioners on mental health support for GPs in helping women, and we are now increasing the number of health visitors by almost 2,000, and health visitors do a fantastic job in providing perinatal mental health support to so many women.

Atrial Fibrillation

Barry Sheerman Excerpts

Wednesday 12th March 2014 Westminster Hall

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

I hope that colleagues from Yorkshire who have been listening to the debate on trans-Pennine rail would like to stay for this important debate on atrial fibrillation, but in truth I know that many would ask what on earth atrial fibrillation is. Part of the purpose of the debate, therefore, is to open up our understanding and knowledge of the condition. I am sure that some colleagues at least will know that atrial fibrillation is a disease of the heart—[Interruption.] Excuse me, Mr Turner; I thought that that was the Division bell. Atrial fibrillation is a disease that causes an irregular heartbeat. It can often lead to a stroke and therefore to either a disabling long-term disability or death.

I called for this debate because 750,000 people in this country have atrial fibrillation. We know that because they have been tested for it. They may or may not be receiving treatment, but we know about them. It is estimated that another 750,000 suffer from atrial fibrillation but are undiagnosed, so we do not know where they are, although we have an idea because we can do the stats. If we know the average number of AF sufferers in a given area, we can extrapolate the numbers across the country. Where we see very low diagnosis numbers, we know that the local GPs and health service are not getting to grips with discovering who has AF, checking them out and treating them.

I would like to tell a little fairy story. There is a fantasy world in which a dreadful heart condition affects more than a million people in our country. A great deal of research is carried out, because no one really knows how to tackle it, and then there is an enormous breakthrough: we discover a new class of drugs that can not only help people to avoid having a stroke in the first place, but allow them to live a good, full and healthy life. However, the wicked godmother arrives and says, “Thou shalt not have any of these wonderful drugs, even though the National Institute for Health and Care Excellence says that they are good and should be available.”

I remind Members that the NHS constitution states that patients have a right to

“treatments that have been recommended by NICE”

when they are deemed “clinically appropriate”. That is the right of your constituents, Mr Turner, and mine. However, the fact is that most people with AF in this country are not getting the opportunity to receive such drugs. There is a real problem: we have a new generation of drugs that are recommended by NICE, but they are not available. What is the barrier? The barrier is the clinical commissioning groups and GPs.

If someone is a sufferer of AF—my wife is, which is why I know something about the condition—they are traditionally treated with warfarin, which is a very popular drug in this country. You will not be surprised to hear, Mr Turner, that even on the Isle of Wight GPs know—because they are highly skilled and knowledgeable —that warfarin is very cheap indeed. It is one of the cheapest drugs that can be prescribed.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Gentleman for bringing such an important matter to the attention of Westminster Hall and of the Minister. Warfarin can be used to treat hyperthyroidism, as well as many other conditions. The issue that comes to my attention is that of GPs and their training, and their ability to administer to atrial fibrillation as required. Does the hon. Gentleman feel that GPs can do more in their own surgeries?

[Mr Sheerman]

The hon. Gentleman is absolutely right. I was going to come on to that issue and I am grateful to him for making that point. The fact of the matter is that a very high percentage of people who are diagnosed with atrial fibrillation are currently either not treated with anti-coagulants, or they are given aspirin. Everyone knows that aspirin is very cheap but not effective as an anti-coagulant.

People with AF may also be given warfarin, which is a good treatment. I can say that from the heart. I have watched a close member of my family—it does not get any closer than one’s wife—undergo treatment that must be evaluated day in, day out. It is quite complicated to ensure that the dosage is right. If someone does not have a home testing kit, they will have to go regularly to the hospital for their blood to be tested and their dosage evaluated. If they have a full-time job or family responsibilities, that is an onerous requirement. As a result, many of the people who are taking warfarin are not taking it in the right dosage and so are not getting the proper, balanced treatment.

It is a scandal that 8.5% of atrial fibrillation patients are not receiving treatment, 35% are receiving aspirin, and only 56.9% are receiving oral anti-coagulation treatment. What is more, we now have three drugs that could be prescribed. We should be saying, “Isn’t it wonderful? We’ve had a breakthrough!” I hope that I can pronounce them properly—they are dabigatran, rivaroxaban and apixaban. However, compared to the 3p that it costs for a dose of warfarin, they are more expensive—I have seen an estimate that treatment would cost around £800 a year.

That might be considered an excessive cost compared to the tiny amount that warfarin costs, but strokes cost this country £2.5 billion a year. If we really want to wreck the national health service, we should not treat people with AF properly. They will have a stroke and end up in long-term care, making great use of hospital beds and highly qualified medical staff. Such a burden on the health service could be avoided.

I have been a member of the all-party group on atrial fibrillation for some time now, and I know that its chair, the hon. Member for Montgomeryshire (Glyn Davies), is going to speak after me. We served together on the Education and Skills Committee, Mr Turner—do you remember when we had a very good Clerk working for us? I think he is sitting on your left-hand side. When we were on that Select Committee, you will have heard me articulate many times the watchwords, “I like evidence-based policy.” The atrial fibrillation campaign is the one, against all others, for which the evidence shows that if we have a drug that can sort out the condition, it should be used.

NICE says that we should use it, and it is clear that it is the right of patients to have it. The people getting in the way are GPs—not because they are malign, but because the cost means that they are leant on by their practices about prescribing it. Also, a very substantial population of GPs do not understand the treatments and their effectiveness—which treatments work and which do not. It is a scandal that people suffering from AF are prescribed either nothing or aspirin by their doctors. That is a very serious problem for the profession, and we have been taking it up with the Royal College of General Practitioners.

There is a second barrier, which is that even with the cheapest of the drugs—warfarin—the sophistication of the treatment and the monitoring are very difficult for very large numbers of our population to deal with. My constituents and your constituents, Mr Turner, find it very difficult to get the right dosage and to maintain the quality of treatment.

The third barrier is the clinical commissioning groups. There is no doubt that the clinical commissioning groups are a barrier to this spending. These are relatively new drugs. They were approved by NICE about 18 months ago—I am looking at the chair of the all-party group in case that is not correct—and NICE said that by now it would expect about 20% of AF sufferers to be on the new anti-coagulants, but only 3.4% of sufferers are on them. Even NICE, projecting forward, thought that the figure would already be 20%.

I do not want to talk for too long, because other hon. Members want to speak, but it is a national scandal that people are dying today, are dying every day and are having incapacitating strokes, and that that is costing the national health service an enormous amount of money and requiring the use of an enormous amount of expertise. It is a burden on the national health service that should not be there.

There is an easy resolution. It is based on science, based on research, based on evidence. It is about time that the ministerial team took the lead on this matter, that GPs woke up, and that clinical commissioning groups heard the hard words that we will not allow our constituents unnecessarily to die or suffer long-term disability just because of the inactivity of the system. We are seeing this short-term saving, this mean-minded pettiness of saving a bit of money on the balance sheet of a CCG today, when the real cost to the health service is a generic one right across our country.

This is the beginning of a campaign. We have been campaigning for a long time, but it is at a new level. We are not going to let this issue go away. This is not party political. We will chase the Minister, chase the Secretary of State and chase the Prime Minister, because this issue is important and we cannot allow this injustice to continue any longer.

--- Later in debate ---

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

It is a pleasure to serve under your chairmanship for the second time, Mr Turner. It is also a pleasure to congratulate the hon. Member for Huddersfield (Mr Sheerman) on securing the debate, and to thank my hon. Friend the Member for Montgomeryshire (Glyn Davies) for his important contribution about his own experiences of atrial fibrillation and its consequences. Although he spoke about the cardioversion treatment he received for sudden onset AF, much of the debate today has been about those who have chronic AF, which is often undiagnosed. The debate provides a good opportunity to raise such issues and ensure that those who are listening—in particular, bodies such as the Royal College of General Practitioners —take away messages about what more they can do to support GPs in earlier detection and diagnosis, where that is possible, and to make sure that the right treatment pathways and proper medications are provided to patients.

It may be useful if I talk briefly about the condition. The heart is not my area of medical expertise, but as a junior doctor I looked after several patients with AF, some of whom came through the front door of the hospital in a similar condition to that described by my hon. Friend the Member for Montgomeryshire, so I have seen it at first hand. AF is the most common sustained heart rhythm disturbance, and it occurs as a result of rapid, disorganised electrical activity in the heart’s upper chambers—known as the atria, hence atrial fibrillation—which results in an irregular heart rhythm. As we have heard, AF is a major predisposing factor for stroke and it accounts for approximately 14% of all strokes.

[Mr Sheerman]

On that point, would it not be a fine idea for the Minister or one of his colleagues to write to every Member of Parliament with the statistics? In the Calderdale and Huddersfield NHS Foundation Trust in my constituency, liaison between hospitals and GPs is not as good as it should be. When someone such as the hon. Member for Montgomeryshire (Glyn Davies) comes out of hospital after having an episode, there is no linkage of treatment between the hospital and the GP. Would it not be a fine idea to send a letter to every Member of Parliament giving them the statistics and urging them to talk to their clinical commissioning groups and GPs about the matter?

[Dr Poulter]

The hon. Gentleman is absolutely right about the importance of raising awareness of AF. He is also right to point out that co-ordination between primary and secondary care is not always as strong as it could be, not only in this area but throughout the NHS. Part of the reason the Government are investing in the £3.8 billion integrated health fund is to ensure that health and social care are better joined up, to achieve a more co-ordinated and holistic approach that is about individuals’ needs.

If someone has been diagnosed in hospital, it is important that they are given the right support in general practice and in the community. There is a lot of good practice out there, and there are a lot of good and well informed GPs. NICE is producing new guidelines and new draft recommendations on treatment—it has been looking at issues such as the use of anti-coagulants—and it is important that that information is disseminated quickly and effectively. My commitment to the hon. Member for Huddersfield is that I am happy to write to NHS England, which oversees CCGs, to raise the matter and ask it to disseminate NICE guidelines to CCGs and ensure that they are mindful of them.

[Mr Sheerman]

That is excellent news, but as someone with medical training, is the Minister not shocked that 36% of those with AF are being prescribed nothing or aspirin? Was he shocked to find out that rather than the 20% that NICE expected, only 3.4% of sufferers were on the new anti-coagulants?

[Dr Poulter]

The statistics that I am aware of are slightly less positive than those that the hon. Gentleman has cited. It is not for us in this place to micromanage medical professionals or to do their jobs for them. However, it is our job to raise legitimate concerns about care for AF or any other health conditions. We must do our best, as stewards of the health system, to push for good local commissioning that is mindful of best practice. I have undertaken to write to NHS England about that, and I will be happy to share the reply that I receive with the hon. Member for Huddersfield and other hon. Members and hon. Friends.

The exact causes of AF are unclear, but it is important to get the diagnosis right and to diagnose the condition as quickly as possible. We believe that some 18% of cases of AF are undetected, so there is more work to be done. NHS England has recognised that, and has suggested that CCGs should work with local practices to target people who are at risk from AF. The issue is already on NHS England’s radar, but I will write to obtain further assurances that it is being taken as seriously as it should be; I am sure that that is the case.

Research is under way into the condition. The National Institute for Health Research is funding a study into automatic diagnosis of AF in primary care using a hand-held device, which may help identify more patients who have AF and reduce the number of related strokes. If someone does not know that they have the condition, they do not know that they need to see a GP to get help. We must do as much as we can to support people to recognise that they have a medical condition and that help and treatment are available. I hope that the research into that technology provides better early detection of AF, and that that comes forward in a rapid and timely manner.

[Dr Poulter]

My hon. Friend is absolutely right to highlight that work. When NICE draws up guidelines, it consults best practice and tries to engage with key stakeholders. In addition, the Royal College of Physicians has developed some national clinical guidelines for stroke with the objective of encouraging higher levels of anti-coagulation. That is directly linked to some of the things we have debated today.

It is a testament to the work of groups such as the Atrial Fibrillation Association that we are helping to raise the profile of the condition and to get early support and help for people. There is clearly more to do, and NICE must continue to develop strong guidelines to support understanding of the best care and pathways for people who have AF. NICE is updating guidelines at the moment and developing a quality standard on AF, which will set out what a high-quality AF service should look like and drive improvement locally by helping local commissioners and CCGs understand what good looks like in AF care.

[Mr Sheerman]

Before the Minister, who is uniquely qualified to have an opinion, sits down, does he agree that more people should be on the new generation of drugs that will keep them alive and prevent them from having strokes?

[Dr Poulter]

It is not my medical specialty, but if new medication is developed, we need to evaluate it. The priority must be to give treatment according to clinical need. I, as a doctor, the Government and hon. Members on both sides of the House believe that it is right to treat patients according to clinical need and clinical priority. It is for CCGs to work with national guidelines, and we look forward to seeing the NICE quality standard on AF, which I hope will put CCGs in a much better position. I have already committed to writing to NHS England to ensure that it puts the matter high on its priority list, and that it supports and encourages all clinical commissioning groups to take AF seriously and make it a priority across the country.

Points of Order

Barry Sheerman Excerpts

Monday 3rd March 2014 Commons Chamber

[Mr Speaker]

I am extremely grateful to the Minister for what she said. It does seem to constitute a most full apology to and an explanation for the benefit of the House. We will leave the matter there. [Interruption.] We will not have a “further to” I am afraid. This matter has been fully addressed. If Members have totally unrelated points of order on completely different subjects, we will hear from them—in other words, for the avoidance of doubt, on matters not appertaining to that which has just been said. The hon. Member for Huddersfield (Mr Sheerman) intends to embark on entirely new terrain.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

On a point of order, Mr Speaker. As you know, I have been in this House a reasonable length of time, but something happened to me last Thursday that I do not recall having experienced before. I tabled a question, which in the preliminary agenda was signified as being question No. 7 for the next day. It was a question about my calling for the setting up of a royal commission on the link between climate change and flooding. By the time I got here on Thursday, the full agenda for the day—the Order Paper—had eliminated that question, and transferred it elsewhere. It was clearly a question to a climate change Minister. Why did it disappear and who allowed it to disappear?

[Mr Speaker]

What I would say to the hon. Gentleman, who has indeed been in the House for a goodly number of years—it will be 35, to be precise, on 4 May this year—is as follows, and I hope that he will take it in the appropriate spirit. It is entirely a matter for Ministers as to whether they make transfers. The transfer that took place, though immensely disagreeable to the hon. Gentleman, was entirely orderly, and I conclude by saying in the friendliest possible way to him that there are Members who do have something about which to complain but are disinclined to do so and there are Members who sometimes have very little about which to complain but make a very considerable meal out of doing so. It is my firm conviction that the hon. Gentleman has precious little about which to complain, and he is doing his best to make a very large mountain out of an extremely small molehill. [Interruption.] The hon. Gentleman is chuntering from a sedentary position about what I did when I was a Back Bencher, but that was then and this is now.

Early Childhood Development

Barry Sheerman Excerpts

Thursday 30th January 2014 Westminster Hall

[Damian Hinds]

Clearly, there is a link—a range of studies suggest different ways in which that link manifests itself—and I do not think that any commentator argues about its existence, but there is nothing inevitable about that; it ought to be possible to equalise children’s life chances. Of course, there are examples of both brilliant and awful parenting in every income bracket. Children’s development is no respecter of the home they happen to have been born into. As the right hon. Member for Birkenhead (Mr Field) says,

“it is primarily parents who shape their children’s outcomes—a healthy pregnancy, good mental health, the way that they parent and whether the home environment is educational”.

As he and many others say, what parents do is much more important than who they are.

Home life is difficult territory for the state. I suggest that we need to think harder about how to communicate what is known about successful, positive ways to parent—a quite substantial body of evidence—in a way that does not come across as, and in fact is not, telling people how to bring up their children.

Geography, as well as income group, reveals other interesting differences in early child development. There is a particular difference in London. When people are told this, they assume that child development is worse in London than elsewhere, because of all the issues in a big city like this. However, that is not so. There was another report last week about the different school results of children growing up in London, versus those growing up elsewhere. That is often attributed to the London Challenge, which started in 2003. There are a number of reasons to believe that the London Challenge was not the sole or primary cause of those improvements. One reason to disbelieve that is that the difference in attainment scores for disadvantaged children is apparent way before they get to secondary school; in fact, it is apparent even in pre-school assessments: on average, disadvantaged children in London seem to do about 20% better on the “good level of development” scale than disadvantaged children in the rest of the country. A bunch of things are different about London children and families.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Excuse my missing the beginning of the hon. Gentleman’s speech, Mr Weir. As someone who was involved in the London Challenge, I should like to know what the relationship is. I am not clear about that. If it was not the London Challenge, what made the difference?

[Damian Hinds]

The hon. Gentleman asks a big question. I do not want to test your patience, Mr Weir, by debating the London Challenge, rather than early child development. I will talk in a minute about societal differences that may or may not be driving factors. The honest answer is that we do not know, but there are reasons to disbelieve that the simple explanation for London’s improvement is the London Challenge. First, the differences are apparent long before children reach secondary school, and the hon. Gentleman will recall that it only started in 2003. Secondly, when translated from London to the black country and Manchester, there were not the same results. Thirdly, so many other things that are different about London are worth looking into.

--- Later in debate ---

[Luciana Berger (Liverpool, Wavertree) (Lab/Co-op)]

I commend and congratulate the hon. Member for South Northamptonshire (Andrea Leadsom) on securing this debate. I also congratulate the hon. Member for Brighton, Pavilion (Caroline Lucas), my right hon. Friend the Member for Birkenhead (Mr Field) and the right hon. Member for Sutton and Cheam (Paul Burstow) on their work in developing this manifesto and promoting the ideas within it. This debate has been constructive and well-informed. Many excellent points have been made that will resonate strongly with those on both sides of this Chamber.

When the first national health service hospital opened its doors in 1948, it was conceived as part of an all-encompassing system of social security, supporting everyone in our society from cradle to grave. Only in recent years, more than 60 years on, have we have come to understand just how much that short time in the cradle—those very first few months—can ultimately decide how long, healthy and happy a life a newborn baby will enjoy.

We must do everything we can to give all babies born in Britain today the best possible start in life. That was underlined earlier this week in an open letter to The Times from 23 of the UK’s leading child health experts. They warned that, for the first time since the Victorian age, it is predicted that living standards for children will be lower than for their parents and that child mortality is still stubbornly higher in Britain than in other western European countries. They called for a greater focus on younger generations. We have heard some powerful and encouraging contributions to that debate today; I want to build on what other hon. Members have said and focus on some of the challenges that we must address. I want to focus on early intervention, maternal support and care, and general help for all mums and dads. That is by no means a comprehensive list of what I would like to cover, but it is most fitting for the debate.

All hon. Members who spoke referred to the importance of early intervention. The maxim that prevention is better than cure is one of the most enduring in public health. As the “The 1001 Critical Days” manifesto details, more than a quarter of all babies in the UK are estimated to be living in complex family situations that present heightened risks to their well-being. The sad reality is that babies are far more likely to suffer from abuse and neglect, and up to seven times more likely to die in distressing circumstances, than older children.

We have a duty to reach out to families in difficult circumstances and to maximise opportunities for them to access support. Not only is it the right thing to do, but it is the best thing for the public purse. According to the Royal College of Paediatrics and Child Health, there is increasing evidence to show that spending on early-years intervention can yield a return on investment as high as 6% to 10%. If it is done in the right way, early intervention can save money, save lives and improve the well-being of parents and children.

An example is the pioneering work by Manchester city council and its partners. They have created a scheme in which midwives, outreach workers and health visitors work together to identify at the earliest opportunity the families most in need. It is an inspiring project, with which my hon. Friend the Member for Manchester Central (Lucy Powell), the shadow Minister with responsibility for children and child care, has been closely associated. We heard from the hon. Member for South Northamptonshire about how the programme is making a difference when it comes to registering a child’s birth.

Under the scheme, every new mother is visited eight times from about 12 weeks before the birth of their child until just before the child’s fifth birthday. Crucially, all the professionals who are supporting those mothers hold joint fortnightly meetings and can let each other know if a parent needs additional help. Their work is integrated and intelligence is shared between organisations —a very strong theme in the “The 1001 Critical Days” manifesto. It is a world away from some of the haphazard experiences of the past. Hon. Members may have heard the anecdote about how health visitors in the past would wait by the nappy aisle in supermarkets to identify expectant mothers; we must do more to encourage close working and data-sharing, so that that is no longer necessary.

[Mr Sheerman]

I totally support the work of the 1,001 group. All the work done—certainly during my chairmanship of the Select Committee on Children, Schools and Families—indicates that early intervention is vital. It is also vital that such intervention is regular, persistent and delivered by highly skilled, well-trained people. The problem is that that is expensive.

[Luciana Berger]

My hon. Friend makes knowledgeable points that, given his experience on the Children, Schools and Families Committee, he is well placed to make. The example that I shared with the House—this is separate from the 1,001 days manifesto—shows that there are many activities going on around the country to address some of the issues, but the challenge is that the activity is not happening everywhere. We need to lead from best-case examples, which is why data sharing is so vital to make a difference. Will the Minister comment on what steps the Government are taking to encourage these activities to happen throughout the country?

I am also keen for the Minister to address the point made by my hon. Friend the Member for Rotherham (Sarah Champion), who is no longer in her place. She mentioned the early intervention grant, which has funded many of the programmes that we are discussing. When the fund was first introduced, it totalled nearly £3 billion, but by 2015 it will have almost halved to around £1.5 billion. We have had contributions this afternoon about Sure Start centres, many of which have relied on the funding of the early intervention grant, and it is a blow that 576 such centres have had to close their doors since the last election. The hon. Member for East Hampshire (Damian Hinds) commented that he did not know what Sure Start was for—

--- Later in debate ---

[Luciana Berger]

I thank the hon. Gentleman for his clarification. I apologise if I misrepresented his words.

[Mr Sheerman]

I, too, found that fascinating. When we first started looking at Sure Start children’s centres, they were concentrated in the 500 wards with the greatest poverty. We soon realised that more families in poverty were outside those 500, so we had to change the policy totally.

[Luciana Berger]

The point that I wanted to make about Sure Start, as a result of what has been said by both Government and Opposition Members, is that it is widely acknowledged that the centres have made a real difference to families. I have Sure Start centres in my constituency; Liverpool city council has gone out of its way to do everything possible to keep all centres throughout the city open—it has had to remodel and look at a hub-and-spokes model, given that we will have experienced cuts of 54% by 2016-17—all because of the centres’ importance to communities.

In one of the most deprived wards in my constituency, the Sure Start centre is giving vital support to parents in the most deprived households. It is providing meal packets for £1—fresh food with recipes—to encourage parents to cook for their children. That is making a real difference to those children’s nutrition, in particular in their early years. In another, more affluent, part of my constituency, the children’s centre is tailoring its services to the need in that area, because this ward has a high incidence of multiple births. That Sure Start centre is providing a vital support service for mothers who have twins and triplets—for parents contending with the challenges presented by a multiple birth.

Those centres are making a real difference in my constituency. Their staff—including Liz Parsons, a manager in the Picton Sure Start centre, to name just one person—provide vital hands-on support to parents, often first-time parents or parents with lots of children. The centres provide support, including parenting support, to many families in my constituency.

--- Later in debate ---

[Luciana Berger]

I thank the hon. Lady for her intervention. I will now seek to conclude.

[Mr Sheerman]

My hon. Friend briefly alluded to smoking and children’s exposure to smoking in cars. There was good news this morning from the Government: there will be a free vote on the issue. Back in the mists of time, my very first private Member’s Bill was on banning children from being carried unrestrained in cars. There was a tremendous backlash against that Bill in certain parts of the House; people said that it breached human and individual rights. We won that battle, and I hope that we can win the next one. It is wrong that a child, who has no choice, has to go in a smoky environment and breathe in dreadful fumes that can affect their health for the rest of their life.

[Luciana Berger]

My hon. Friend’s intervention has given me the opportunity to expand on this serious political issue, with which we are engaging in the House at the moment. He rightly points out the opposition there was to rules on wearing seat belts. The discussions on that issue are relevant to our discussions about banning smoking in cars when children are present. When we had no rules on wearing seat belts, only 25% of the population wore one; since the introduction of the rules, more than 90% of the population wear a seat belt, and that has made a massive contribution to safe car travel.

It is worth noting that there is overwhelming public support for banning smoking in cars when children are present. Around 80% of the public think that we should deal with the issue, and it will be interesting to see what happens in the vote. It is also worth putting on record that when there was a vote on a private Member’s Bill on the issue in 2011, 22 MPs from the coalition supported it, including a current Health Minister. I welcome the free vote, and I hope that we are successful when the proposal comes before the House on, I believe, 10 February.

To conclude, a broad, holistic approach will ultimately make the difference for children, and for future generations.

Oral Answers to Questions

Barry Sheerman Excerpts

Tuesday 14th January 2014 Commons Chamber

[Jane Ellison]

NICE has issued technology appraisal guidance to the NHS on the use of newer anticoagulants—I think there were three in 2012—for the treatment of atrial fibrillation. NHS commissioners are legally required to fund treatments recommended by NICE in its technology appraisal guidance.

[Mr Barry Sheerman (Huddersfield) (Lab/Co-op)]

Mr Speaker, there is a crisis here. The fact is that half of those who suffer from AF—as a member of my family does—do not know they are suffering from it and are not diagnosed. If they are not diagnosed, that leads to great expense to the health service because they are very prone to having a stroke. Even when doctors know about AF, they say inappropriately, “Have an aspirin as part of your medication.” Some 25% of doctors recommend aspirin, and that is very dangerous. When will the Minister wake up? AF is a dangerous condition and it is very expensive.