NHS Dentistry: Recovery and Reform

Bob Seely Excerpts
Wednesday 7th February 2024

(2 weeks, 2 days ago)

Commons Chamber
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Victoria Atkins Portrait Victoria Atkins
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The hon. Gentleman has quoted Healthwatch. I presume that he will also be gracious enough to acknowledge that the move to introduce 15 dental vans has, in fact, been welcomed by Healthwatch.

Bob Seely Portrait Bob Seely (Isle of Wight) (Con)
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We need more NHS dentistry on the Isle of Wight. I welcome this recovery plan, but can the Secretary of State tell me by when my constituents will see its benefits?

Victoria Atkins Portrait Victoria Atkins
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By 1 March, because that is when the new patient premium comes into force. Other aspects will take a little longer, but we are clear about the immediate benefits, and we want to get those out to people as quickly as possible.

Recovering Access to Primary Care

Bob Seely Excerpts
Tuesday 9th May 2023

(9 months, 2 weeks ago)

Commons Chamber
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Steve Barclay Portrait Steve Barclay
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As I said, there are more pharmacists than in 2010 and more people working in the pharmacy sector—the numbers have gone up by 24,000 since 2010—so to address the hon. Lady’s second question, there are more. On funding, as I said in my statement, this is new funding for primary care. That is the commitment that we made, and it should be welcomed in the primary care sector.

Bob Seely Portrait Bob Seely (Isle of Wight) (Con)
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I welcome the statement. I notice the difference in opinion on the Opposition Benches between the people who know what they are talking about and the people who do not.

Pharmacy First is a brilliant idea, and I thank the Secretary of State. I very much hope it will be welcomed by pharmacies in my patch. I want to reiterate some of the points that have been made. First, some of my pharmacies have been under a lot of financial pressure recently. Will the financial package be able to support them and make them feel valued, considering what extraordinarily good value for money they are? Related to that, will any financial support or grants be made available to pharmacies—especially the smaller ones in some of my rural areas and small towns—so that they can have a room to see patients and take advantage of this great Pharmacy First scheme?

Steve Barclay Portrait Steve Barclay
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I welcome my hon. Friend’s comments. There is £645 million of funding over the next two years to support the expansion of this work through Pharmacy First. As I said a moment ago, the estates programme is more an issue for the integrated care boards. We should not try to determine all the decisions on estates from Westminster; it is right that we let the 42 ICBs have more discretion over what is the right estate strategy in their area. I am sure that his local ICB will hear his representations.

Moles and Skin Tags: Testing for Cancer

Bob Seely Excerpts
Monday 12th December 2022

(1 year, 2 months ago)

Commons Chamber
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Bob Seely Portrait Bob Seely (Isle of Wight) (Con)
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I am delighted to initiate this debate on melanoma in memory of my constituent Zoe Panayi, after whom “Zoe’s law” is named.

Zoe died of skin cancer in May 2020 at the age of just 26, after having an unusual mole removed at a private beauty clinic. She had trained to become a carer before finding a rewarding role as an assistant to the radiography and CT department at St Mary’s Hospital in Newport, in my constituency. She was the mother of two boys, Theo-Jay and Tobias.

On the night of 3 April 2020, Zoe went home from work feeling poorly. By 11.30 pm she had been admitted back to St Mary’s hospital, where she worked, and it was then discovered that she was in the late stages of cancer. Biopsy results four days later found that the melanoma, which had started in a mole on her back, had spread to her lymph nodes, liver, bone marrow, pelvis, and spleen. Very sadly, after the biopsy Zoe survived for just 55 days.

Over the course of the two years prior to her death, Zoe had raised numerous concerns with GPs about the unusual mole on her back. She had been told on multiple occasions that there was nothing to be concerned about, and after being advised to see a beauty clinic to have the mole removed, staff again raised no concerns about the removal of the mole. Tragically, it was later found that the act of removing the mole probably caused the cancer to grow and spread more rapidly. Zoe’s family, and especially her mum, Eileen Punter, to whom I pay tribute in this debate, have campaigned tirelessly since then to raise awareness of melanoma cancer and to ensure that others do not have to go through the same pain. I will make two suggestions to the Minister in the course of this speech.

By way of background, malignant melanoma is the fifth most commonly diagnosed cancer in the UK, and there are thought to be some 111,000 people living with malignant melanomas in this country. Approximately 16,700 cases are diagnosed every year, and about 2,300 people die every year from this cancer. This should not be the case, because the good news is that since the 1970s, the five-year survival rate for cancers of this type has increased from 52% to about 90%—nine out of 10— especially if they are caught early.

Chris Bryant Portrait Chris Bryant (Rhondda) (Lab)
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I congratulate the hon. Gentleman on raising this subject. As he knows, I had a stage 3 melanoma and I was told that I would have a 40% chance of living a year, but the science has moved on dramatically in the nearly four years since then. My biggest anxiety is that we do not have enough histopathologists and pathologists, and that people are getting their results slowly. There are also not enough dermatologists in the country, and lots of GPs are simply not trained in recognising potentially malignant melanomas fast enough. Do we not need to do far more to ensure that this cancer is fully understood, because it can kill, and to ensure that we have enough staff in the NHS to be able to treat it?

--- Later in debate ---
Bob Seely Portrait Bob Seely
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I thank the hon. Gentleman for his intervention. I am going to follow up on several of those points, but I am delighted to see that he is one of the many people who have survived a malignant melanoma.

If Zoe’s mole had been diagnosed early—especially at stage 1 or 2, and possibly even at stage 3—she may have well survived. Just before I come to some of those suggestions, I must point out that these melanomas are a specific concern on the Isle of Wight, because we have one of the highest rates of skin cancer.

Jim Shannon Portrait Jim Shannon (Strangford) (DUP)
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I commend the hon. Gentleman for his assiduous attention to his constituents and to the family who have been bereaved. By his words today, we all recognise that he is deeply concerned and compassionate, and we thank him for that.

May I gently tell the hon. Gentleman—perhaps the Minister might take note of this as well—that in Northern Ireland a new mole mapping and melanoma service has been introduced in my local South Eastern Health and Social Care Trust? It is a nurse-led, two-year pilot project that offers an advanced mole mapping technique for specific patients identified by the clinical team as being at higher risk of developing melanoma skin cancer. I suggest that that should be a standard for everyone not just in my trust area but everywhere else, so that we do not have a postcode lottery. Would the hon. Gentleman be interested in that pilot scheme? If so, maybe the Minister will take note.

Bob Seely Portrait Bob Seely
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I thank the hon. Gentleman for yet another excellent intervention, and I completely agree. In fact, I will come to those points now.

The Isle of Wight is a specific hotspot for skin cancer. I think it has the worst skin cancer rates in the United Kingdom, primarily as a result of certain factors. First, we still have a very white population, and the paler your skin, the more likely you are to develop melanomas. Secondly, we have an ageing population, and melanomas are cumulative. Thirdly, we have a very outdoors lifestyle on the Island, with golf, sailing, a lot of community activity and a lot of gardening. For the Isle of Wight’s retirement community especially, to be out in the sun aged 60 or 70 doing activities such as sailing, which is very harsh on the skin because of the interaction of sun and water, encourages melanomas. Fortunately, we have one of the best dermatology centres in Britain at Newport’s Lighthouse clinic, and I thank its doctors and staff for doing an excellent job. I have been there myself in the past couple of years, and I know what a great job they do.

In the NHS long-term plan, the Government committed that the proportion of cancers diagnosed at stages 1 or 2 will rise from about half to three quarters of all cancer patients, meaning that some 55,000 more people a year should survive cancer for at least five years after diagnosis.

Pilot schemes in various parts of the country are trying to improve the diagnosis of skin cancers and melanomas. One option to improve this still further is what, on the Island, we call Zoe’s law, but it would effectively be a change of practice within the NHS. Eileen, Zoe’s mum, and her family are doing it in memory of Zoe, and it would require all moles and skin tags removed from the body to be tested for melanoma. I am not expecting an off-the-cuff answer from the Minister on this point, but I would very much like her to write to me so that I can pass on her comments to Eileen and the rest of Zoe’s family. If that cannot be done now, I would like to know why not.

I would also like to know what more could be done in future, because thousands of people are needlessly dying every year. Skin cancers kill more slowly than many other cancers and are certainly more treatable than cancers such as lung cancer and pancreatic cancer. Eileen said Zoe thought of everyone before herself. When Zoe was dying, she said, “The most important thing is that other people do not have to go through this”—she left two young kids.

The idea of testing all removed moles and skin tags is potentially very popular, and a petition started by the family has now reached some 35,000 signatures. Tanya Bleiker, the previous president of the British Association of Dermatologists, recommended that all skin lesions, even if removed for cosmetic reasons, as Zoe’s was, should be sent for histopathological testing to confirm that they are benign—the hon. Member for Rhondda (Chris Bryant) also made that recommendation—because they might be deep rooted in the skin. Mr Ashton, one of our consultant dermatologists on the Isle of Wight, explained to me on Friday that innocent-looking moles can sometimes be the most deadly. They might look benign on the surface, but underneath they are malignant and hide melanoma.

I urge the Government to set out further plans on raising awareness of moles, as this is relatively easy to do. If I understand correctly, including this in nurse training and general practitioner training, especially in sunnier parts of the country along the south coast—places like Cornwall, Devon, the Isle of Wight and Hampshire—could be exceptionally valuable.

Chris Bryant Portrait Chris Bryant
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No one can see the back of their own head, but their hairdresser can, and quite often they are the person who can spot a melanoma.

Bob Seely Portrait Bob Seely
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The hon. Gentleman reminds me of what Mr Ashton was telling me on Friday, because it is not only hairdressers but dentists. Dentists spend a lot of time looking at people’s faces, so they could potentially help to spot these things, too. Eileen, Zoe’s mum, spends a lot of her time trying to get this education process going, as she does not want other families to suffer as her family have.

At stage 1, a small and localised melanoma has a 97% five-year survival rate, which is extraordinarily high. By contrast, the five-year survival rate for a stage 2 melanoma is 76%, and it is 58% for a stage 3 melanoma, as the hon. Member for Rhondda had. By the time a cancer has spread from the skin to the lymph nodes, the bone marrow and other parts of the body, the five-year survival rate is only 15%. Sadly, Zoe was one of those who did not survive, because despite her worry, her visits to the GP and the fact that she had it removed, that cancer had been spreading all the time in her body.

I respectfully ask the Minister to write to me on the potential for 100% testing of moles for melanoma, cancer and whether they require further treatment. If there were such testing, some of the 2,341 people who died of the disease last year might have survived, including my constituent Zoe.

I pay tribute again to Zoe’s family, especially her mum for all the great work that she is doing. I ask the Minister to respond not only on the issue of testing for melanomas but on broader education for GPs, hairdressers, dentists and nurses, so that they are better able to spot cancerous moles before they spread.

Rural Healthcare

Bob Seely Excerpts
Wednesday 12th October 2022

(1 year, 4 months ago)

Westminster Hall
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Anne Marie Morris Portrait Anne Marie Morris
- Hansard - - - Excerpts

I absolutely agree, and it is an excellent suggestion. In a similar vein, when we are asking primary care networks and others to deal with the backlog, it is important that we try to give them much more freedom in how they address the problem. I talk to many of my local commissioners, and they say that they are having to make decisions that they know are right, even though they are not currently in the guidebook as best practice. We need to give them that trust to be able to do the right thing.

C is for care. Members will not be surprised to hear that the adult social care discharge fund, although welcome, is not going to be enough. The reality is that the bed count is often low in rural areas. In the south-west, we have the lowest bed count per head of population; I think it is the lowest in western Europe, although I am happy for the Minister to correct me. It seems to me that we used to be moving towards saying, just in time, “Let’s have care in the community.” However, because of the shortage of care in the community, and the lack of proper validation that it works other than whether people are readmitted, we need to put a halt to closing community hospitals and to look at how they can be used. Some could be repurposed. Perfection can often be the enemy of the good.

Teignmouth Community Hospital in my constituency is on the closure list, but to me that is not a wise decision. There are no nursing care homes in the area. Without that residential care, and without adequate care in the community, removing the only other source of beds is not the way to solve the backlog problem.

Bob Seely Portrait Bob Seely (Isle of Wight) (Con)
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I thank my hon. Friend for securing the debate and this important conversation. I also thank the Minister for the community diagnostic centre announced for the Isle of Wight this week. That is great, but we still have a problem similar to that of my hon. Friend the Member for Newton Abbot (Anne Marie Morris): unavoidably small hospitals. There are dozens of those in England and Wales, of which St Mary’s is the most isolated. We were able to work with the Government to improve the funding formula in 2019, so unavoidably small hospitals have got some more money. My concern—the same might be true for hospitals in my hon. Friend’s area—is that that is not enough to cope with the health needs and the demographics in our communities. It would be great if the Minister could meet some of us to discuss the future of unavoidably small hospitals in places such as Devon, Cornwall, Cumbria, Northumberland and the Isle of Wight to see what more we can do to support these important community centres.

--- Later in debate ---
Will Quince Portrait Will Quince
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I thank the hon. Member for his question. I am not going to make policy on the hoof, so I will not say yes now, but we are fast approaching the next GP contract, which will run from April 2024, so we have an opportunity to look at all these things in the round. I am passionate about securing access to GPs in rural and remote areas. Perhaps we can double-tag our meeting, make it twice as long and discuss that issue too. I will respond to some of the issues raised about GPs in a moment.

I reassure my hon. Friend the Member for Newton Abbot that we are in full agreement that the NHS needs to be flexible enough to respond to the particular needs of rural areas. That is vital, and that is why we passed the Health and Care Act 2022. The Act embeds the principle of joint working right at the heart of the system, promoting integration and allowing local areas the flexibility to design services that are right for them. Integrated care boards and integrated care partnerships give local areas forums through which to design innovative care models, bring together health and social care, and, importantly, prioritise resources to ensure that they best align with the needs of individual areas.

We are also enabling the NHS to establish place-based structures covering smaller areas than an integrated care system. That could match the local authority footprint, for example, or in some cases it could be even smaller—a sub-division based on local need. That is fully in line with the view expressed in the APPG report that the NHS should foster and empower local place-based flexibility. I think that is at the heart of the report.

As my hon. Friend knows, in establishing those models for the NHS to follow, we have set the framework but have left it to individual areas to tailor them to local needs. I think that is the right approach, because local areas know better than Ministers. We do not always hear Ministers say that, but I think local areas often know better than I do, sitting here in Whitehall, how best to organise themselves, and how to design and, importantly, deliver the best possible care for patients. While we in Westminster can support, guide, hold accountable and occasionally chest prod, it is right that we also protect local flexibility.

Bob Seely Portrait Bob Seely
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When the Minister talks about local flexibility, I interpret that through the guise of funding. Does he accept that there is a funding issue for the 12 unavoidably small hospitals in England and Wales, and will he look at the funding mechanism that was established in 2019? It gives more money to unavoidably small hospitals, but arguably only about 50% to 60% of what is needed.

Will Quince Portrait Will Quince
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I have made a note of my hon. Friend’s question and I am going to come to it in a moment. The answer is no, but only because it is not my responsibility. It is the Minister of State, Department of Health and Social Care, my right hon. Friend the Member for Newark (Robert Jenrick), who has responsibility for hospital funding, and in the next seven minutes I intend to commit him to lots of meetings with every single Member present.

Let me turn briefly to the question of resources, about which I know a number of Members are concerned, and which has just been raised by my hon. Friend the Member for Isle of Wight (Bob Seely). It is vital that we allocate resources fairly, as my hon. Friend the Member for Newton Abbot mentioned. That is why NHS England asked the Advisory Committee on Resource Allocation to consider the issue and provide a formula for allocations to integrated care boards. That formula took into account various factors, including population, age and deprivation —but we changed it.

In 2019-20, we produced a new element of the formula, recognising the points that my hon. Friend the Member for Newton Abbot makes, to better reflect the needs of some rural, coastal and remote areas, which on average tend to have a much older population. With an older population very often comes complex health needs. NHS England is using that formula to make allocations accordingly, but we recognise that some systems are significantly above or below target, and NHS England has a programme in place to manage convergence over several years. We also recognise the important challenge in ensuring that rural areas have the workforce—another point rightly raised at length—to provide the integrated patient-centred services that we all want to see.

We know that doctors are more likely to stay in the places where they trained, as my hon. Friend said. That is why, as part of a 25% expansion of medical school places between 2018 and 2020, we opened five new medical schools in rural and coastal locations that historically have been hard to recruit in: Sunderland, Lancashire, Chelmsford, Lincoln and Canterbury. I am conscious that my hon. Friend would want far more; that is perhaps a conversation to have at a later date. We hope—in fact, we expect—that graduates from those schools will stay in the area and will have a far greater understanding of the lives, needs and challenges of the people they serve in the locality.

My hon. Friend mentioned ambulances. As part of our plan for patients, which we launched in July, there is an extra £150 million for 2022-23 to address issues relating to ambulances. I hear what she says about differential pay rates, particularly in rural areas, between different blue light services, and I will take that away. Ambulances fall under the remit of my right hon. Friend the Member for Newark, and I know that he would be delighted to meet my hon. Friend the Member for Newton Abbot to discuss that issue.

On backlogs, I completely understand the points that my hon. Friend makes about recruitment challenges. I will take away her point about incentives not working, and I will look at other measures to attract people to rural and coastal areas, because we know that is a particular challenge.

The hon. Member for Westmorland and Lonsdale (Tim Farron) raised cancer wait time variance. As the Minister with responsibility for cancer, that absolutely concerns me. We are opening new diagnostic centres, but we have to look at more.

Unavoidably Small Hospitals

Bob Seely Excerpts
Tuesday 6th September 2022

(1 year, 5 months ago)

Westminster Hall
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Philip Hollobone Portrait Mr Philip Hollobone (in the Chair)
- Hansard - - - Excerpts

Welcome to Westminster Hall, and to the debate on unavoidably small hospitals. I call Bob Seely to move the motion.

Bob Seely Portrait Bob Seely (Isle of Wight) (Con)
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I beg to move,

That this House has considered unavoidably small hospitals.

Thank you very much, Mr Hollobone; as ever, it is a pleasure to serve under your chairmanship. I thank the Minister for being here, and I wish her luck in any coming reshuffle. I also thank colleagues from Yorkshire, Devon, Cornwall and other parts of the United Kingdom for being here. Indeed, we have two Members from Yorkshire—my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) and my right hon. Friend the Member for Richmond (Yorks) (Rishi Sunak). It is a delight to see them both. I saw one quite recently on the Isle of Wight, but sadly not both.

The debate was originally granted prior to the covid pandemic. Clearly, much has changed since then, but I also wonder whether the fundamentals of unavoidably small hospitals have changed. The reason why I called the debate back then, and why I want it now, is that I fear they are still the poorer cousins of larger district general hospitals.

I will make two points. Clearly, I am going to talk specifically about St Mary’s Hospital on the Island, because it is in my constituency, but there are broader points to be made about unavoidably small hospitals throughout the United Kingdom. I want specifically to ask the Minister to put as much information as possible about the funding processes for unavoidably small hospitals in the public domain. We were talking prior to the debate, and she said that some of that information rests with the new integrated care boards. That may well be the case, and that is fair enough, but they are not elected bodies. We know that the NHS can be rather top down and bureaucratic in some of its behaviours, and the more information she can put in the public domain to help Members with unavoidably small hospitals understand the situation, the better.

Before I address that further, let me put on record my thanks not only to staff at St Mary’s but to GPs on the Isle of Wight and their staff, and to the pharmacists, the dentists and all the staff in care homes, who do a no less valuable job. Some of the problems we are facing are because of a lack of integration with our adult social care system; the inability to find a home for the elderly and vulnerable that that system looks after puts additional pressure on hospitals.

Let me also put on record my thanks to the Government for the £48 million additional capital spending on the Island. Indeed, I suspect that the former Chancellor, my right hon. Friend the Member for Richmond (Yorks), deserves thanks for that, as well as for the fair funding formula reference for the Isle of Wight. I am delighted and very grateful that he did both those things. That £48 million was part of getting a better deal for the Island, which is clearly an ongoing project.

In England and Wales, there are 12 unavoidably small hospitals, which are defined as hospitals that, due to their location and the population they serve, and their distance from alternative hospitals, are unavoidably smaller than the “normal” size of a district general hospital. In the Isle of Wight’s case, we are about half the size—about 55% to 60%—of the population needed for a district general hospital.

I would argue that the pressures on these small hospitals are greater than elsewhere. They are smaller, so they are more easily overwhelmed due to their size, and they are under greater economic pressure, because the NHS funding model—we recognise that there has to be a funding model—is designed for an average-sized, “normal” district general hospital, rather than an undersized one. You cannot give birth on a helicopter or a ferry; on the Island, we need to run our maternity services and our A&E 24 hours a day, seven days a week. However, our income is based on national tariffs that do not equate to the size of our population. As the Island’s trust says,

“the Island’s population is around half of that normally needed to sustain a traditional district general hospital.”

The third pressure on unavoidably small hospitals is because they exist outside of major population centres. Without a shadow of a doubt, they are in some of the loveliest parts of England and Wales, but because they are outside of those major population centres, recruitment and retention of staff becomes more difficult, which adds pressure on the staff who are there and adds costs in terms of locums and agency staff, which can have a highly significant effect on budgets. Ferries aside—with the partial exception of the Scilly Isles—the pressures at St Mary’s on the Isle of Wight are shared by other unavoidably small hospitals. I think that helps to explain why, in the last decade, a number of unavoidably small hospitals have been put in special measures or have sadly failed, despite the best efforts of those people who work there.

Our hospital, St Mary’s, is classed as 100% remote, which is unique even by unavoidably small hospital standards, because it is accessible only by ferry—although, as far as I can see, accessibility by sea is not a factor in the definition of an unavoidably small hospital. On the Island, our need for healthcare is arguably higher than elsewhere in the United Kingdom. We struggle to get the national standard, but our need for that national standard is greater because over a quarter of our resident population is aged over 65 and, by 2028, over-65s will be one third of the population. Indeed, we have a particularly large cohort of 80 to 84-year-olds.

All the evidence and common sense suggests that that has a disproportionate effect on healthcare: older people, and especially the very old and frail, need healthcare more than young people. We on the Island are struggling—as, potentially, are other USH areas—to provide quality for that ageing population. In addition, the Island’s population doubles over the summer, because we have lots of lovely visitors. That impacts demand, which means that our A&E can be close to overflowing at times, even as efficiently run as it is.

I suggest that there is an additional factor: the impact of high levels of social isolation. People retire to the Island as a couple and one sadly dies, leaving the other isolated from family and social networks because they lived most of their life in other parts of the United Kingdom. That leads to increased reliance on statutory services.

All this has been noted. The former Health Secretary, my right hon. Friend the Member for West Suffolk (Matt Hancock), confirmed his concerns to me in July 2019, telling the House:

“As for Island healthcare costs, my hon. Friend is right to say that the Isle of Wight is unique in its health geography, and that there are places in this country—almost certainly including the Isle of Wight—where healthcare costs are”—[Official Report, 1 July 2019; Vol. 662, c. 943.]

increased.

I am not saying that we are the only place like that. There is isolation in other parts of the country, including Yorkshire, Cornwall, Devon and Cumbria, but in the Island’s case the situation is cut and dried because of our separation by sea from the mainland. In its January 2019 sustainability plan, the Isle of Wight NHS Trust estimated that the annual cost of providing a similar—I stress to the Minister that this is the critical element—standard of healthcare and provision of 24/7 acute services, including maternity and A&E, on the Island to that enjoyed by mainland residents would be an additional £9 million. These are 2019 figures.

The estimated cost of providing additional ambulance services, including coastguard helicopter ambulance services, was about £1.5 million. In the Scilly Isles, patient travel is funded out of the clinical commissioning group—now the ICB—budget. Ours is not. Our patient travel budget comes from ferry discounts and council contributions, and it was estimated to be £560,000. In total, one is looking at between £10 million and £12 million at 2019 figures.

Either because they were going to do so anyway or, hopefully, because of representations from myself and others, the Government have recognised since then that unavoidably small hospitals need a funding model that serves them, because there is no alternative but to keep those hospitals open to serve those populations in a way that is ethical and, frankly, legal nowadays.

I am proud of our efforts to highlight the plight of unavoidably small hospitals to the Government, and I thank them for listening and for trying to put in place a package of support for them. I say to the Minister that this is where I would welcome more facts being put in the public domain. I have trawled through NHS documents for the last couple of days, and the last figure I can see for the unavoidably small hospital uplift for St Mary’s on the Isle of Wight is that from 2019, when we received £5.3 million. That is roughly half of what we think we need to run a national level service, so we are grateful that the Government have recognised the need for an uplift for unavoidably small hospitals. Will the Minister please update me on how much money St Mary’s has had as an unavoidably small hospital since 2019, given that we have clearly had issues with covid?

According to page 13 of the NHS “Technical Guide to Allocation Formulae and Pace of Change” for 2019-20 to 2023-24, that money was given in 2019 due to

“higher costs over and above those covered by the”

market forces factor. I cannot see other figures in the public domain. I do not quite understand how the Government could calculate that figure in 2019 when the advisory committee said in January 2019 that it was

“unable to find evidence of unavoidable costs faced in remote areas that are quantifiable and nationally consistent such that they could be factored into allocations”.

That is from the NHS England document “Note on CCG allocations 2019/20-2023/24”.

The Government say that they cannot work out how much extra to give unavoidably small hospitals, while at the same time a different NHS document says, “We are going to do some calculations, and here is the rough calculation.” Can the Government work out the additional costs or can they not? They are basically saying the same thing in two separate documents.

Kevin Hollinrake Portrait Kevin Hollinrake (Thirsk and Malton) (Con)
- Hansard - - - Excerpts

I congratulate my hon. Friend on securing this important debate. May I give an example of how the Government might calculate the figure? A hospital in my constituency in Scarborough is run by the York and Scarborough Teaching Hospitals NHS Foundation Trust, which tells me that it has to pay extra to get consultants to travel to Scarborough and stay overnight, as well as paying their hotel bills. However we factor this stuff in, we have to be able to make a calculation that allows those trusts properly to fund these hospitals.

Bob Seely Portrait Bob Seely
- Hansard - -

I thank my hon. Friend for that valuable intervention. We have exactly the same problem. I will come on to how we are trying to solve it, but we have the same issue getting consultants over from Portsmouth, although we are very close to Portsmouth and Southampton. It is difficult for a consultant with a speciality to work in a small NHS trust, because there is no opportunity to practise that speciality effectively enough to keep their ticket to do their very valuable and worthwhile job.

Although I am delighted that the previous Conservative Government recognised the additional costs and gave the Isle of Wight nearly £50 million in additional capital expenditure, my trust assesses that the funds given are roughly half what is needed. I stress that we are not just sitting on the Island saying, “We want money.” We understand that we need to sort out these problems for ourselves. Our trust was in special measures and is now rated good, due to some fantastic hard work by Maggie Oldham and other health leaders, who have come in and turned our hospital around, really helping to make a difference. I thank everybody, from the cleaning staff to the most junior nurse and the most junior doctor, for the great work they have done.

We are now rated good and have been looking at ways to provide better services on the Island, without just waiting for the Government to provide funding. We are integrating. We have deepened our relationship with Portsmouth general hospital, our university hospital, the idea being that when it hires a consultant, we share that consultant for 10% or 25% of their time. A world-leading consultant in an area of medical expertise will therefore spend some of their time looking after folks on the Isle of Wight.

We have reformed our mental health services, and we are reforming our ambulance service too, to ensure that we have more ambulances out there to treat more people, more quickly. Along with everywhere else, we are integrating adult social care as part of the Government’s plans. We want to be pioneers in that. Because of our age demographic, we want to be at the front of the queue. I have sadly learned that, if the Island is not first, it tends to be last, because it comes as an afterthought. I always want to ensure that the Island gets to the front of the queue, so that when the Government look to test pilot schemes, they come to us first.

We are looking at chances to pilot new schemes. We did it with Test and Trace, and we are adopting telemedicine as fast as we can. We are working with the University of Southampton to pilot using drones to deliver cancer care. The drone testing started during covid and, as of a couple of months ago, it is now a regular service that brings just-in-time cancer medicine to the Isle of Wight. That is a really good way to see that advanced technology is helping folks on the Island and, indeed, helping the NHS to provide a better-quality service.

I will round up, as I am mindful that other people want to speak on this issue and it is important that the Minister hears other voices. In January 2019, the NHS long-term plan set out a 10-year strategy for the NHS in England. For smaller acute hospitals such as St Mary’s, the plan stated that the NHS will

“develop a standard model of delivery”.

It would be great to hear from the Minister what has happened to that plan for a standard model of delivery. Is that now the funding formula that is included in the new integrated care boards? If so, will the Minister please outline how that funding formula works and is calculated, as my hon. Friend the Member for Thirsk and Malton and I have asked? It is in the public interest that the formula is as transparent as possible.

Will the Minister please explain why, if someone travels from the Scilly Isles to the mainland for care, it is paid for out of a central budget? If someone has prostate cancer or another form of cancer, they often need to be treated in Portsmouth or, occasionally, Southampton. That funding does not come from the Government. Why is that? Why is there a double standard that affects the Isle of Wight negatively?

Finally, the Minister mentioned before the debate that the funding formula details are held by the new integrated care boards. For the 20 Members of Parliament in England and Wales who are within the remit of an unavoidably small hospital, those figures should not be held at ICB level but should be shared between Ministers and interested Members, so that we can all see how these very important institutions in our communities are funded. By doing so, I hope that we can increase the funding for them or at least increase the Government’s understanding that just because such hospitals are the smaller cousins of larger district general hospitals, they should not be treated worse but should be given extra care and attention to make sure that folks in our communities can have the same standard of care as other people throughout the rest of England and Wales.

None Portrait Several hon. Members rose—
- Hansard -

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Kevin Hollinrake Portrait Kevin Hollinrake (Thirsk and Malton) (Con)
- Hansard - - - Excerpts

It is a pleasure to speak in this debate with you in the Chair, Mr Hollobone. I thank my hon. Friend the Member for Isle of Wight (Bob Seely) for tenaciously following up on this very important issue, which I and my right hon. Friends the Members for Scarborough and Whitby (Sir Robert Goodwill) and for Richmond (Yorks) (Rishi Sunak) have been following closely over the years.

My hon. Friend concluded in exactly the right place. The issue is not hard numbers in terms of cash, deficits or whatever; this is about patients and patient care. We have experienced two challenges in respect of Scarborough Hospital and the Friarage Hospital in Northallerton in particular. Yes, as my hon. Friend set out, there is the issue of funding and the extra costs of delivering services in places such as Scarborough, but there is also the fact that these hospitals are run by trusts that run a number of hospitals, and the small hospitals are, of course, not necessarily their largest hospitals. Because the trusts are faced with the extra costs of running the smaller hospitals, there is a natural tendency for them to try to centralise care in one of the other hospitals. When they talk to the public—they tend to talk to their customer base before they make changes—they ask them, “Would you be prepared to travel for better health outcomes?” Who would not say yes to that? Of course! But it is a leading question.

I have a couple of examples of how it works in practice. A number of my constituents have written to me. One of them had to go to York Hospital from Scarborough. They did not have transport—they did not have a car—and they had to go for an appointment at 7.30 in the morning for treatment for a brain tumour, and were then discharged at 11 o’clock that night, without transport. It is not just that people have to travel for extra care and that they are deprived of local care for treatment that would have been available at Scarborough at one point; it is the fact that there is no real consideration of some of the challenges of living in a rural area. Some of my constituents have had to travel to York from Scarborough on the east coast—from Filey in my patch—to stay in a hotel overnight because there is no public transport to get to early morning appointments in York Hospital. Those are direct consequences of centralisation.

Bob Seely Portrait Bob Seely
- Hansard - -

The problem is clearly significant in my hon. Friend’s patch, but does he understand that when people are separated by sea from the mainland it becomes an even greater problem? There are even greater logistics if people need a car and then a ferry to the bus and so on.

Kevin Hollinrake Portrait Kevin Hollinrake
- Hansard - - - Excerpts

My hon. Friend is absolutely right. His challenge may be even greater than ours in rural parts of North Yorkshire.

Centralisation is a natural tendency for any organisation, of course. A person sat in a larger hospital in York will think, “Let’s have all the services over here. It is easier and cheaper to employ consultants over here.” Centralisation is easier, but it is much worse for patients. It is not fair on them, given the complexity of travel and the effect on local communities.

The principal trust that runs the hospitals in my area is the York and Scarborough Teaching Hospitals NHS Foundation Trust, which runs Malton Community Hospital, Scarborough General Hospital and St Monica’s Easingwold, which is a small cottage hospital. It is easier for the management to centralise things, and it is cheaper, given that it is more expensive to provide healthcare in more remote locations. I said earlier that because remote hospitals have difficulty recruiting people, they tend either to close services down or provide additional remuneration for the consultants who work there, so there is a double whammy of cost.

The other issue in my constituency is that it is 40 miles from Scarborough Hospital to York, and on a good day it takes an hour to travel on the A64 all the way to York as it is a single carriageway for most of its stretch and is often logjammed with traffic. The dualling of that carriageway has been the subject of many pleas to the former Chancellor, my right hon. Friend the Member for Richmond (Yorks), and many others, and hopefully we will get that in the not-too-distant future. This is serious stuff, of course, for anyone who needs emergency treatment.

The stroke unit at Scarborough was relocated to York some time ago, so if someone has a stroke in Scarborough, they have to get to York, and they might be in an ambulance for two hours on that road. It is unfair. I understand that they may get better treatment at the hyper-acute stroke unit at York, but nevertheless there are potentially direct impacts on people’s healthcare when services are centralised in distant locations.

It is not just stroke care that has been centralised in other hospitals, but outpatient physiotherapy, dermatology and pain clinics. Breast cancer oncology was moved away from Scarborough some time ago owing to the difficulties of recruitment. It is easier to employ consultants in a hospital that has more money than to incentivise them to go to more remote locations. The A&E unit at the Friarage Hospital in Northallerton, in the patch of my right hon. Friend the Member for Richmond (Yorks)—he will talk more about it—was downgraded to urgent care treatment, and we were told that one of the reasons was that it was difficult to recruit anaesthetists.

Services are being closed down. The Lambert Hospital in Thirsk in my constituency, which provided respite and elderly care, was completely closed down because it could not recruit in that location. Our suspicion was that the trust did not really try all that hard to recruit people because it is more difficult to run services in remote locations.

On costs, I can give my hon. Friend the Member for Isle of Wight a direct comparison. When the York and Scarborough Teaching Hospitals NHS Foundation Trust took over Scarborough back in 2012, it was given £10 million a year for the extra costs of providing services in that location. That ended in 2018. A small amount has been provided to make up for the loss of £10 million—£2.6 million of funding through the clinical commissioning group—but, as a consequence, services are diminishing.

There is some good news: my right hon. Friend the Member for Scarborough and Whitby and I campaigned, and the Health Ministers were very supportive. There has been £40 million of extra investment in the A&E at Scarborough, but nevertheless there are some real concerns about the services, which are reduced as a consequence of underfunding. I would like to hear from the Minister exactly what we are doing about it now and what we will do in the future to improve the situation.

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Bob Seely Portrait Bob Seely
- Hansard - -

I thank all those who spoke in the debate. I will absolutely follow up with the Minister, both in the request for greater transparency and with regard to the integrated care boards. I will also continue to raise with her the issue of equality of funding for getting folks from the mainland, which is a specific Island issue, and to ensure that unavoidably small hospitals can offer the same level of service as others, especially—as several Members have highlighted—in the light of the seasonal nature of the pressures that they are under and, sadly, the higher health demands and greater health vulnerabilities that coastal communities can have.

Smaller hospitals tend to be special places in special communities. I am delighted that the Minister is so engaged with them. They need to be given care and attention to succeed, and that is what we all want.

Question put and agreed to.

Resolved,

That this House has considered unavoidably small hospitals.

Dentist Industry and NHS Backlogs

Bob Seely Excerpts
Monday 7th February 2022

(2 years ago)

Commons Chamber
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Bob Seely Portrait Bob Seely (Isle of Wight) (Con)
- Hansard - -

It is always a pleasure to follow my hon. Friend the Member for Clacton (Giles Watling). I thank my hon. Friend the Member for Warrington South (Andy Carter) for securing this debate on an important subject both for the country as a whole and for my constituents, because we are one of the coastal, rural communities badly affected by the lack of NHS dentists. Islanders are facing a serious dentistry issue. I have raised this with the previous Minister and the Secretary of State on a number of occasions. Frankly, it is now almost impossible to find an NHS dentist on the Island if you do not already have one. Some Islanders have written to me about having to go into the mainland as far as Surrey. That stretches a family budget, because we have some of the most expensive ferries on the planet, so it is a painful decision.

As my hon. Friend the Member for Clacton said, 85% of dental practices across the country are closed to new patients, and seven out of 10 people find it difficult to access an NHS dentist. This does not only have immediate consequences such as toothache but is dangerous, because there will be a significant rise in oral cancer cases, which are increasing in the UK. In 2020, 2,700 Brits lost their lives to mouth cancer. The lack of dental appointments means that we will not be able to spot those cancers early on, so those figures are likely to increase. We had a case on the Isle of Wight of somebody who was sadly diagnosed late and then misdiagnosed, who now has untreatable cancer. We also know there is a correlation between gum disease and heart disease. There is no doubt that a significant knock on will feed through from the lack of appointments.

Dental practices were clearly facing challenges before covid, and it is, in part, a workforce challenge. The British Dental Association has found that 75% of dental practices are struggling to fill vacancies, on which I will make some suggestions shortly. More than half of NHS dentists under the age of 35 are thinking of leaving the NHS in the next five years, which is a potentially serious and significant problem that will only make the issues more acute. It is one reason why areas such as Clacton and the Isle of Wight are significantly suffering from a lack of NHS dentists.

I will not take up too much time, because so much has been said so eloquently by my hon. Friend the Member for Warrington South, but I conclude with some constructive suggestions. It would be great if the Minister could address some of them. If she cannot, and I understand that I am bouncing her into this, I would be grateful if she could write to me. I wrote to the Secretary of State on this issue a couple of months ago, and I know the Department is very busy, but I have yet to receive a reply.

First, we should introduce a section 60 order to increase the General Dental Council’s discretion on recognising overseas dental qualifications. Secondly, we should develop a 12-month UK adaptation course for experienced, qualified overseas dentists to gain GDC recognition. Thirdly, we should maintain the mutual recognition of professional qualifications with European economic area countries indefinitely, and we should extend it to overseas territories, potentially as part of future free trade agreements.

Fourthly, and this is potentially the most important, we should fund a catch-up programme of overseas registration exams to make up for missed opportunities during the pandemic, with a view to recruiting 1,000 additional dentists within 12 months. This could specifically target the Indian subcontinent, which, according to all the dentists and dental experts I speak to, produces a very high standard of dentists and overproduces the number of dentists it needs. We are not talking about depriving another country of its dentists; we are talking about getting a job lot of 1,000 subcontinent dentists who speak English and who are very well trained. Some of them will be eager to work in this country, and we will get them here now.

Fifthly, we should introduce an expedited six-month performers’ list validation by experience programme for candidates with more than 1,500 hours of dental experience. Finally, we should accelerate changes to dental therapists’ scope of practice to allow courses of treatment without prescription from a dentist.

Others have spoken eloquently about the need to change the contract, so I am focusing on how, in the short and medium term, we can dramatically increase the number of dentists in this country. All these ideas were suggested to me by the Association of Dental Groups because, like others I have spoken to about this, it thinks they could be brought in relatively quickly and could have a reasonable, and potentially significant, impact in the next 12 months.

These are not unreasonable requests and, as we all have in this debate, I stress that the NHS was established on three significant and unalienable principles: that it meets the needs of everyone; that it is free at the point of delivery; and that it is based on clinical need, not the ability to pay. Certainly with NHS dentistry, we are struggling. We see that not only in kids’ and adults’ teeth being untreated but in serious diseases not being recognised as a result, potentially costing us far more not only in lives but in the money spent when cases come in as an NHS emergency, rather than as dental treatment that should be part and parcel of everyone’s rights in this country.

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Maria Caulfield Portrait Maria Caulfield
- Hansard - - - Excerpts

I take my hon. Friend’s point of view, but during the pandemic there has been significant support that many other sectors did not get. That is not to detract from the problems that dentists are facing, however, and no one is a bigger supporter of dentists than I.

I will just move on to some of the other points that my hon. Friend raised. We are not up to 100% of pre-pandemic activity simply because of covid, and that is taking a toll on access to NHS dentistry. A number of patients have waited and waited during the pandemic and now need urgent care, and we are seeing that reflected in A&E attendance and in surgical elective lists, because patients have got to a stage where they need surgery to rectify some of their problems.

I fully take on board many of the issues that have been raised in the debate this evening, but I reassure colleagues that we are trying to support dentistry as much as possible. NHS England is providing local commissioners with help and support to direct patients to where there is availability. It may have been my hon. Friend who mentioned this, but dentists have been asked recently to update their information on the NHS website that records where NHS dentists are, so that we can direct patients to those surgeries that are taking patients. Dentists have also been asked to operate a cancellation list, so that, should someone pull out, the next person on the list is proactively contacted to be offered that appointment. It is difficult for patients to navigate the system and find out where NHS dentists are.

Members may be aware—I hope they are—that just a few days ago, a one-off additional £50 million was secured for NHS dental services, the first pot of money that they have received in a long time. It is specifically focused on this financial year, so it has to be spent by April. It is targeted at those NHS dental teams to ask them what availability they have in increasing capacity, so that those waiting for treatment can start to access some of it. My hon. Friend’s area in the north-west has been allocated £7.3 million to be spent by April. NHS England is working at pace with local commissioners to deliver that and to try to tackle some of the backlog.

The difference between that funding and the contract is that the rates of pay are significantly different, and we are seeing huge uptake from dentists who are keen to do NHS work when they are rewarded accordingly. That additional £50 million will secure up to 350,000 additional dental appointments and will be targeted at those in most urgent need of dental treatments, whether it is oral pain, disease or infections, to help them get the care they need. Children, who a couple of Members mentioned, are being prioritised, as are other vulnerable groups. We are seeing some take-up of that offer, and I hope that shortly we will be able to update colleagues on where exactly that take-up has happened and the difference it has made in accessing NHS dental provision.

I will move on to some of the longer-term dental issues, which have been eloquently set out this evening.

Bob Seely Portrait Bob Seely
- Hansard - -

I do not want to interrupt my hon. Friend as she goes on to these important long-term structural issues. There were a bunch of short-term ideas to get dentists into this country in the next year or two to help with the immediate crisis and the lack of NHS dentists. Can she assure us that she and her Department are looking at some of those options, rather than looking purely at the long term?

Vaccination: Condition of Deployment

Bob Seely Excerpts
Monday 31st January 2022

(2 years ago)

Commons Chamber
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Sajid Javid Portrait Sajid Javid
- Parliament Live - Hansard - - - Excerpts

The regulators I referred to are independent, so all I can do is ask them to review their regulations. My hon. Friend might be aware that some regulators, such as the General Medical Council, already have requirements for vaccinations in certain settings, which is a decision for them. As he will know, however, the independent regulators usually set out guidance and allow some flexibility in how it is interpreted in certain settings.

Bob Seely Portrait Bob Seely (Isle of Wight) (Con)
- Parliament Live - Hansard - -

I thank the Secretary of State for this decision. I opposed the policy in December for reasons that have been eloquently laid out by Members such as my hon. Friend the Member for Broxbourne (Sir Charles Walker), although I was respectful of the Government’s position. Overall, persuasion is better than coercion, and honesty is better than the manipulative games that we now hear the nudge unit was playing and that were entirely counterproductive. Will the Secretary of State reassure me that, now we have some breathing space, we can do a bit of forward thinking and prepare a plan for this winter that protects the vulnerable and enables the NHS to continue to treat people but does so without resorting to lockdowns? The idea that lockdown is a cost-free, risk-free option is absolutely untrue, as we have now seen from the 100,000 children who have come off school rolls and disappeared. Lockdown carries an extraordinarily heavy price, and frankly a lot of the modelling and forecasting behind it have been extremely flawed.

Sajid Javid Portrait Sajid Javid
- Parliament Live - Hansard - - - Excerpts

If we look at the experience from the omicron wave, we can see that we had the fewest restrictions on people’s freedom of any large country in Europe, yet we have been the first country to come out of the omicron wave and hit the peak. I believe the main reason for that is that we rightly focused on pharmaceutical defences: vaccines in particular, of course, as well as antivirals and testing. There is a lot to be learned from that.

Covid-19: Forecasting and Modelling

Bob Seely Excerpts
Tuesday 18th January 2022

(2 years, 1 month ago)

Westminster Hall
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.

Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.

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Bob Seely Portrait Bob Seely (Isle of Wight) (Con)
- Hansard - -

I beg to move,

That this House has considered forecasting and modelling during covid-19.

It is a pleasure to speak under your chairmanship, Sir Edward. I speak not to bury science, but to praise it. During the covid pandemic, there has been some remarkable, wonderful science; I just question to what extent that includes the modelling and forecasts that have come from it. Thanks to some questionable modelling that was poorly presented and often misrepresented, never before has so much harm been done to so many by so few based on so little questionable and potentially flawed data.

I believe that the use of modelling is pretty much getting to be a national scandal. That is not just the fault of the modellers; it is how their work was interpreted by public health officials and the media—and yes, by politicians, including the Government, sadly. Modelling and forecasts were the ammunition that drove lockdown and created a climate of manipulated fear. I believe that that creation of fear was pretty despicable and unforgivable. I do not doubt that modelling is important or that there has been some good modelling, but too often it has been drowned out by hysterical forecasts. I am not, as Professor Ferguson implied, one of those with an “axe to grind”. I do, however, care about truth and believe that if someone influences policy, as the modellers and Imperial College London have done, they should be questioned. Frankly, they have not been questioned enough.

Above all, I want to understand why Government, parts of the media and the public health establishment became addicted to these doomsday scenarios, and then normalised them in our country with such depressing and upsetting consequences for many. I do not pretend to be an expert; I am not. I defended my own PhD at the end of last year, but it is not in epidemiology and I do not pretend to be particularly knowledgeable about that. But depending on time—I know others want to come in as well—I will quote from 13 academic papers and 22 articles authored by a total of approximately 100 academics.

This is a story of three scandals, and the first one took place 21 years ago. In 2001, we faced the foot and mouth emergency. We reacted drastically by slaughtering and burning millions of animals, and farmer suicides and bankruptcies followed. That policy was allegedly heavily influenced by Imperial College modelling and Professor Ferguson. Since foot and mouth, two peer-reviewed studies examined the method behind that particular madness. I quote from them now to show there are practical and ethical questions over modelling going back two decades.

In a 2006 paper, and I apologise for these wordy, long titles, titled “Use and abuse of mathematical models: an illustration from the 2001 foot and mouth disease epidemic in the United Kingdom”—they are not that catchy—the authors confirmed that Ferguson’s model

“probably had the most influence on early policy decisions”

and

“specifically, the introduction of the pre-emptive contiguous culling policy”.

That is the mass slaughter of animals near infected farms. The authors said that the consequences were “severe” and

“the models were not fit for the purpose of predicting the course of the epidemic”

—not a good start. They remain “unvalidated”. Their use was “imprudent” and amounted to

“the abuse of predictive models”.

Devastatingly, the authors wrote

“The UK experience provides a salutary warning of how models can be abused in the interests of scientific opportunism.”

It is difficult to find a more damning criticism of one group of scientists by another.

A 2011 paper, “Destructive tension: mathematics versus experience—the progress and control of the 2001 foot and mouth disease epidemic in Great Britain”—bit of a mouthful—by four academics said the models that supported the culling policy were “severely flawed” and based on flawed data with “highly improbable biological assumptions”. The models were

“at best, crude estimations that could not differentiate risk”.

That is not a very good “at best”. At worst, they were “inaccurate representations”.

Sadly, the paper said, impatience for results

“provided the opportunity for self-styled ‘experts’, including some veterinarians, biologists and mathematicians, to publicise unproven novel options.”

Some of the scientific work—some of it modelling, some of it not, with some modelling by Ferguson and some not—was cited as “unvalidated” and “severely flawed”, with inaccurate data on “highly improbable assumptions” leading to “scientific opportunism”. Is anybody reminded of anything more recent that would suggest the same?

I scroll forward 20 years. As with foot and mouth, with covid we had a nervous Government presented with doomsday scenarios by Imperial—the 500,000 dead prediction—that panicked them into a course of profound action with shocking outcomes. After the lockdown had gone ahead, Imperial publicised on 8 June a study by, I think, seven of them arguing the justification for lockdown. It claimed that non-pharmaceutical interventions saved more than 3 million lives in Europe. Effectively, Imperial marked its own homework and gave itself a big slap on the back.

That work is now being challenged. Because of time, I will quote only a small selection. In a paper entitled, “The effect of interventions on COVID-19”, 13 Swedish academics—Ferguson ain’t popular in Sweden, I can tell Members that much—said that the conclusions of the Imperial study were not justified and went beyond the data. Regensburg and Leibniz university academics directly refuted Imperial College in a paper entitled “The illusory effects of non-pharmaceutical interventions on COVID-19 in Europe”, which said that the authors of the Imperial study

“allege that non-pharmaceutical interventions imposed by 11 European countries saved millions of lives. We show that their methods involve circular reasoning. The purported effects are pure artefacts, which contradict the data. Moreover, we demonstrate that the United Kingdom’s lockdown was both superfluous and ineffective.”

I am not saying that this stuff is right; I am just saying that there is a growing body of work that is, frankly, taking apart Imperial’s. Remember, we spent £370 billion on lockdown that we will never get back. I could continue with other quotes, but I think Members get the flavour.

Moreover, a substantial number of other papers now question not Imperial per se but the worth generally of lockdowns. A pre-print article by four authors, “Effects of non-pharmaceutical interventions on COVID-19: A Tale of Three Models”, said:

“Claimed benefits of lockdown appear grossly exaggerated.”

In another paper, three authors found no clear, significant benefit of lockdowns on case growth in any country. Other papers continue that theme. I will quote one more, on adults living with kids. Remember: we shut schools because we were scared that kids would come home and infect older people, who would then die. This paper, in The BMJ, found

“no evidence of an increased risk of severe COVID-19 outcomes.”

We shut down society and schools just in case, doing extraordinary harm to people’s lives, especially young people. I am not a lockdown sceptic, as Ferguson casually describes some of his critics, but I am becoming so. Do you know why, Sir Edward? Because I read the evidence, and there is a growing body of it. In fact, there is one quote that I did not read out. There was a study of lots of countries that had lockdowns and lots that did not, and the data was inconclusive.

The third element of the scandal is the recent modelling. Swedish epidemiologists looked at Imperial’s work and compared it with their own experience. Chief epidemiologist Anders Tegnell said of Imperial’s work that

“the variables…were quite extreme…We were always quite doubtful”.

Former chief epidemiologist Johan Giesecke said Ferguson’s model was “almost hysterical”. In the House of Lords, Viscount Ridley talked of a huge discrepancy and flaws in the model and the modelling. John Ioannidis from Stanford University said that the “assumptions and estimates” seemed “substantially inflated”.

There was a second example last summer. In July 2021, the good Professor Ferguson predicted that hitting 100,000 cases was “almost inevitable”. He told the BBC that the real question was whether we got to double that or even higher. That is where the crystal ball starts to fail: we got nowhere near 200,000, and we got nowhere near 100,000. There was nothing inevitable about Professor Ferguson’s inevitability, and his crystal ball must have gone missing from the start. In The Times, he blamed the Euros for messing up his modelling because—shock horror—people went to pubs a lot to watch the games during the competition. When the tournament finished—shock horror—they did not. That seems to be the fundamental problem: where reality comes up against models, reality steamrollers them because models cannot cope with the complexity of real life. To pretend that they can and even that they are useful, when so many of them have proved not to be, is concerning.

Ferguson is only one of many people in Independent SAGE especially, but also SAGE, who did not cover themselves in glory. Raghib Ali—a friend of my hon. Friend the Member for Wycombe (Mr Baker), who I am delighted is present—is one of the heroes of covid. He noted that many left-wing SAGE members

“repeatedly made inaccurate forecasts overestimating infections”.

Very often, they were falsely described on the BBC.

Steve Baker Portrait Mr Steve Baker (Wycombe) (Con)
- Hansard - - - Excerpts

I am grateful to my hon. Friend for mentioning my friend and constituent Raghib Ali, who has indeed been one of the absolute heroes of this pandemic—not only in his advice to us all, including online, but through his service in hospitals. I hope my hon. Friend will not mind my saying that I do not think any of us can speak for Raghib about his opinion of modelling, and I know my hon. Friend is not trying to.

Bob Seely Portrait Bob Seely
- Hansard - -

I quite agree, and I thank my hon. Friend for that, but I am deeply grateful to Raghib and other people for speaking out. Just for the record, the communist Susan Michie, who is quoted quite often by the BBC, is not a medical doctor, a virologist or an epidemiologist. She is a health psychologist, so why on earth is she talking about epidemiology?

The third scandal took place this winter. Imperial, the London School of Hygiene and Tropical Medicine and others—I think they included Warwick—predicted 5,000 daily covid deaths, with 3,000 daily deaths as the best-case scenario. They were hopelessly inaccurate, and at this point the tide really begins to turn. Dr Clive Dix, a former vaccine taskforce head, said:

“It’s bad science, and I think they’re being irresponsible. They have a duty to reflect the true risks, but this just headline grabbing.”

As I say, the tide is turning. Oncology professor Angus Dalgleish describes Ferguson’s modelling as “lurid predictions” and “spectacularly wrong”. The great Carl Heneghan, another scientist who has emerged with great credit for his honesty and fairness of comment, says:

“it’s becoming clearer all that ministers see is the worst-case scenario”.

Professor Brendan Wren says:

“Dodgy data and flawed forecasts have become the hallmarks of much of the scientific establishment 2”—

what a damning quote!—

“which has traded almost exclusively in worst-case scenarios...this must stop now.”

I agree.

I will wind up in the next two to three minutes—I will speak for no longer than 15 minutes because other people wish to get in, and I am always mindful of that. What is the result of all this? The result, as UCL’s Professor Francois Balloux notes, is a

“loss of trust in government and public institutions for crying wolf.”

That is just it. We have had hysterical forecasts, models taken out of context, and worst-case scenarios normalised.

In the Army, there is something called the most dangerous course of action, and there is something called the most likely course of action. To sum up in one sentence how we got this wrong, we have effectively taken the most dangerous course of action and collectively—the politicians, media, scientists and health professionals—presented that as the most likely course of action, but it was not. Why did politicians say, “Follow the science” as a way of shutting down debate, when we know that science is complex and that our outputs are dependent on our inputs? It was down to public-health types, whose defensive decision making would only ever cost other people’s jobs, other people’s health, other people’s sanity, other people’s education and other people’s life chances.

We know that the Opposition supported lockdown from the word go, but a little more opposing might have been helpful. The BBC and the Guardian have been salivating at state control and doomsday scenarios. Against this tsunami of hysteria and fear, thank God for The Spectator, The Telegraph and, yes, the Daily Mail for keeping alive freedom of speech and putting forward an alternative, which is now being increasingly scientifically vindicated. I accept that lockdown was understandable at first—I get that—but I believe the continuation of lockdown after that first summer was an increasingly flawed decision.

In wrapping up, I have some questions. To Professor Ferguson and the doomsday modellers: why are so many of your fellow academics disputing your work and your findings? To the BBC, as our state broadcaster: why did you so rarely challenge Ferguson, SAGE or Independent SAGE? Why did we misrepresent experts, and why did the BBC allow itself to become the propaganda arm of the lockdown state? To the Government: how could we have been so blinkered that we thought that following the science meant shutting down scientific debate? Why did we never use other datasets in contexts with the British people, or even in contexts in which these profound and enormous decisions were made? Why did we think that it was in our nation’s interests to create a grotesque sense of fear to manipulate behaviour? SAGE and Independent SAGE kept on getting it wrong. To the public health types, I quote from Professor Angus Dalgleish again:

“Flailing around, wallowing in hysteria, adopting impractical policies and subverting democracy, the Chief Medical Officer is out of his depth. He has to go if we are ever to escape this nightmare.”

He is not a journalist; he is an oncologist—a senior oncologist.

Twice in 20 years, we have made some pretty profound and significant errors of judgment, using modelling as a sort of glorified guesswork. I suggest respectfully to the Government that, after foot and mouth and covid, never again should they rely on dubious modelling, regardless of the source and regardless of the best intent. I am sure that Imperial and all these other people do the best that they can, and am very happy to state that publicly. However, why has so much of their work been described—and I will use the words of other academics—as “unvalidated”, “flawed”, “not fit for purpose”, “improbable”, “almost hysterical”, “overconfident”, “lurid”, “inflated”, “pessimistic”, “spectacularly wrong”, “fraudulent” and as “scientific opportunism”?

None Portrait Several hon. Members rose—
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Steve Baker Portrait Mr Steve Baker (Wycombe) (Con)
- Hansard - - - Excerpts

Thank you very much, Sir Edward. I begin by referring to the declarations that I have made in connection to the Covid Recovery Group.

I am a professional aerospace and software engineer—at least I was in my former life. I have an MSc in computer science, and am very interested in models. However, there is an old joke among engineers, which derives from a “Dilbert” cartoon, that the career goal of every engineer is not to be blamed for a major catastrophe. I wonder whether that spirit infuses not only expert advice but modelling in particular. We are all indebted to The Spectator for its data hub, which shows how data has worked out against models. As anyone can see by going to data.spectator.co.uk, it is the same story again and again: enormous great molehills of death projections, and underneath them the reality of much lower lines. I will leave it to people to look for themselves at the data, rather than trying to characterise the curves for Hansard.

There is a great deal to be done in terms of institutional reform of the way in which modelling is done and informs public policy. That is a very old problem; I found a great article in Foreign Affairs that goes back a long time, to the post-war era, about this problem. It is time we did something about it, through institutional reform. The situation is now perfectly plain: under the Public Health (Control of Disease) Act 1984, even our most basic liberties can be taken away with a stroke of a pen if a Minister has been shown sufficiently persuasive modelling—not even data—that tells them that there is trouble ahead.

I have put this on the record before, and I hope that my right hon. Friend the Prime Minister will not mind. Before we went into the 2020 lockdown, he called me; I was amazed to be at home and to have the Prime Minister of the UK call me. “Steve, I have been shown death projections—4,500 people a day and the hospitals overwhelmed.” I gave him two pieces of advice: “First, if you really believe that we are going to have 4,500 people a day die, you’d better do whatever it takes to prevent that from happening,” which is not advice that anyone would have expected me to give, but that is what I said, and, “Secondly, for goodness’ sake, go and challenge the advice—the data.”

That is why Carl Heneghan, Raghib Ali, Tim Spector and I, whether in person or virtually, were seen in Downing Street, and were there to challenge the data. By Monday, Carl Heneghan had taken the wheels off those death projections, by which the Prime Minister had, disgracefully, been bounced, using a leak, into the lockdown. That is absolutely no way to conduct public policy. However, the reason someone—we will not speculate who—bounced the Prime Minister is that they had been shown those terrifying death projections, which could not possibly be tolerated. Those projections were wrong.

It is monstrous that millions of people have been locked down—effectively under house arrest—have had their businesses destroyed and have had their children prevented from getting an education. Any of us who visit nursery schools meet children, two-year-olds, who have barely socialised. We cannot even begin to understand the effects on the rest of their lives. It is not the modellers’ fault, and I do not wish to condemn modellers. They are technical people, doing a job they are asked to do. We have to ask them to do a different and better job—one which does not leave them, like the old joke about engineers, afraid of being responsible for a major catastrophe.

As my friend Professor Roger Koppl said in his book “Expert Failure”, experts have all the incentives to be pessimistic because if they are pessimistic and events turn out better, they are not blamed. I am sorry: I am not blaming them personally, but I am blaming the whole system for allowing this to arise. The extraordinarily pessimistic models plus the bouncing of a Prime Minister did so much harm.

We need to conduct institutional reform. In relation to models, Mike Hearn, a very senior software engineer, has published a paper available on my website. It is a summary of methodological issues in epidemiology. There are about seven points—an extraordinary set of arguments: things such as poor characterisation, statistical uncertainty and so on, which I have no time to get into. The fundamental point is that we must now have an office of research integrity. The job of that office would be to demand—to insist—that the assumptions going into models and the nature of the models themselves were of a far higher quality.

Finally, to go back to an area of my own expertise, I encourage any software engineer to look at the model code that was released.

Bob Seely Portrait Bob Seely
- Hansard - -

Where does my hon. Friend believe that body should sit: within BEIS or a separate scientific institution?

Steve Baker Portrait Mr Baker
- Hansard - - - Excerpts

I think it should be in the Cabinet Office, because we see that scientific advice applies right across Government.

The code quality of the model that was released was really not fit for a hobbyist. The irony is that the universities that do modelling will overwhelmingly have computer science departments. For goodness’ sake, I say to modellers, go and talk to software engineers and produce good quality code. For goodness’ sake, stop using C++. People are using, as they so often do, the fastest computer programming language, but also the most sophisticated and dangerous. As a professional software engineer, the first thing I would say is, “Don’t use C++ if you don’t have to. Models don’t need to; they can run a bit slower. Use something where you can’t make the desperately poor quality coding errors that were in that released model code”. That is really inexcusable and fulfils all the prejudices of software engineers against scientists hacking out poor quality code not fit for hobbyists. As I think people can tell, I feel quite strongly about that, precisely because these poor modellers have had unacceptable burdens placed on them. All the incentives for them to be pessimistic can now be seen in the data. This all has to be changed with an office of research integrity.

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Aaron Bell Portrait Aaron Bell (Newcastle-under-Lyme) (Con)
- Hansard - - - Excerpts

It is a pleasure to see you in the Chair, Sir Edward, and to follow all my hon. Friends, who I note have usually been in a different Lobby from me on most coronavirus measures. I am sure the Minister will be grateful to have somebody speaking from the Government Benches who has been supporting the Government on coronavirus throughout.

However, I too have issues with modelling, which is why I chose to speak in today’s debate. I have more sympathy with modelling, and I will be offering some sort of partial defence and explanation of it in my remarks, because before I was an MP, I was a modeller myself—a software engineer. I wrote in Visual Basic.NET, which is nice and simple: engineers can see what the code does. I worked for bet365, and I used to write models that worked out the chance of somebody winning a tennis match, a team winning a baseball game, or whatever. I had some advantages that Neil Ferguson and these models do not have, in that there are many tennis matches, and I could repeat the model again and again and calibrate it. If I got my model wrong, there were people out there who would tell me that it was wrong by beating me and winning money off me, so my models got better and better.

The problem we have with covid is that we cannot repeat that exercise—there is no counterfactual. We have heard the phrase “marking your own homework”.

Bob Seely Portrait Bob Seely
- Hansard - -

I am deeply impressed by all this stuff— I do not quite understand what my hon. Friends are talking about, but it sounds fantastic. However, there is a counterfactual. The counterfactual is when people say, “We are not going to follow the lockdown,” and hey presto! we do not get 3,000 or 5,000 deaths a day and all the people who predicted that are proved wrong. There is a counterfactual called real life.

Aaron Bell Portrait Aaron Bell
- Hansard - - - Excerpts

I thank my hon. Friend for his point, and I accept it, but the problem is that none of these models model changes in human behaviour. We discussed this issue during our debate on the measures that we brought in before Christmas, and as I said at the time, the reality was that people were not going to the pub, the supermarket or anything because they were changing their behaviour in the face of the virus. If the models do not take that into account, they cannot know where the peak will be. The models show what would happen if nobody changed their behaviour at all, but of course, the reality is that people do. We have not got good enough at modelling that, because we do not know exactly how people change their behaviour.

As a tangential point, behavioural science has had a really bad pandemic. We were told that people would not stand for lockdowns, but—to the chagrin, I am sure, of many of my hon. Friends—people did stand for them. Looking at the polling, they were incredibly popular: they were incredibly damaging, as colleagues have said, but people were prepared to live with lockdowns for longer than the scientists thought they would. There was initially an attempt to time the lockdown, because people would not last for that long. In reality, that is not what happened, so behavioural science also has a lot to answer for as a result of the pandemic.

I think that models still have value. My biggest concern arising from the experience of the pandemic is the bad parameters that have gone into those models at times—I will refer to two particular examples.

The time when I was nearest to following my colleagues into the Lobby was the extension to freedom day in June, because on that day we had a session of the Science and Technology Committee, which has taken excellent evidence throughout; it has a session on reproducibility in science tomorrow, where we will also look at this sort of thing. On the day of that vote, I was questioning Susan Hopkins and we were considering vaccine effectiveness. Public Health England had just produced figures showing that the actual effectiveness against hospitalisation of the Pfizer vaccine was 96%, yet the model that we were being asked to rely on for the vote that day said it was 89%. Now, 89 to 96 may not sound like a huge difference, but it is the difference between 4% of people going to hospital and 11%, which is three times higher. It was ludicrous that that data was available on that day but had not yet been plugged into the models. As I said to my hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates), that was one of the reasons that I said in the Chamber that the case was getting weaker and weaker, and that if the Government tried to push it back any further, I would join my colleagues in the Lobby on the next occasion.

The other case is with omicron. Just before Christmas, we had these models that basically assumed that omicron was as severe as delta. We already had some evidence from South Africa that it was not, and since then we have discovered that it was even better than we thought. That feeds into what my hon. Friend was saying about the total number of people who are susceptible. The fact that omicron has peaked early is not because people have changed their behaviour but because the susceptible population was not as big as we thought: more people had been exposed, more people have had asymptomatic disease. There are all those sorts of problems there.

More philosophically, my models when I worked for a bookmaker were about probabilities. Too often we focus on a single line and too often that has been the so-called worst-case scenario. Well, the worst-case scenario is very black indeed at all times, but Governments cannot work purely on a worst-case scenario; they have to come up with a reasonable percentile to work with, whether it is 95% or 90%. Obviously, it must be tempered by how bad the scenario would be for the country. The precautionary principle is important and we should take measures to protect against scenarios that have only a 5% chance of happening or indeed a 2% chance, but we should do that only if the insurance price that we pay––the premium for doing that––is worth paying. That comes down to the fact that not many economic models have been plugged in, as my hon. Friend the Member for Wycombe (Mr Baker) has repeatedly said in the Chamber and elsewhere throughout.

Any Government must try to predict the course of a pandemic to make sensible plans and I believe that the best tool for that is still modelling, but we must learn the lessons of this pandemic. We must learn from shortcomings such as the failure to understand human behaviour properly, the failure to make code open source so that other people can interrogate a model and change the parameters, and the failure to enter the right parameters and update the model at the moment politicians are being asked to vote on it. For all those reasons, I am grateful for today’s debate and look forward to hearing the Opposition spokespeople and the Minister. I thank my hon. Friend the Member for Wycombe for today’s debate.

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Brendan O'Hara Portrait Brendan O'Hara
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No, I will not. The libertarian right have had enough of a kick at the ball in this debate. [Interruption.] No, I will not give way. At least half of those who have spoken today are not wearing face coverings.

I know that it is customary at this point to thank the Member who secured the debate but, in a break from tradition, I will start by thanking the scientists––the analysts, the medical professionals, the health experts, the clinicians and everyone else who stopped what they were doing two years ago and dedicated their lives to trying to work out and predict where the global pandemic might go and the impact that it could have on us. Two years ago, when tasked with working out this brand-new virus, every step that they took was a step into the unknown. There was no textbook to chart the route of this pandemic and every decision that they took was a new decision. They knew that every piece of advice they gave could have serious consequences for the population. The pressure of doing real-time covid-19 analysis must have been enormous. I, for one, really appreciate that scientists erred on the side of caution in the midst of a global pandemic in which tens of thousands of people were dying when there were no vaccines or booster protection. To all the SAGE officials, scientists, medical staff and public health experts who have done a remarkable job in keeping us safe, I say a huge and unequivocal thank you.

We know and can accept that forecasting and modelling during a pandemic are not an exact science but based on the best available evidence and a series of scenarios, presented from the best to the worst case. As Professor Adam Kucharski of the London School of Hygiene and Tropical Medicine said,

“a model is a structured way of thinking about the dynamics of an epidemic. It allows us to take the knowledge we have, make some plausible assumptions based on that knowledge, then look at the logical implications of those assumptions.”

As the much-maligned Professor Ferguson told the Science and Technology Committee,

“Models can only be as reliable as the data that is feeding into them.”

Of course such models have their limitations. They are not forecasting modelling but mathematical projections based on the data available to modellers. If the tests are not being done, or tests are not being registered as positive, for example, the data modelling and forecasting can be affected. It is important to remember, however, that while the hon. Member for Isle of Wight (Bob Seely) was telling anyone who would listen that modelling predictions were a national scandal, Professor Chris Whitty was telling the Science and Technology Committee that

“a lot of the advice that I have given is not based on significant forward modelling. It is based on what has happened and what is observable.”

Advice on lockdown and other public health measures was given by SAGE and others on the basis of observable data, not on forecasting modelling alone. I put it to the hon. Member for Isle of Wight that he was quite wrong when he told GB News that

“So much of what’s happened since with…inhuman conditions that many of us struggled with”

was

“built on some really questionable science.”

Professor Whitty said clearly that he did not base his advice on that; rather, he based it on what he could see around him.

The primary purpose of modelling is simply to offer a sense of the impact of different restrictions. A report by researchers for the journal Nature found that the first lockdown saved up to 3 million lives in Europe, including 470,000 in the UK. The success of disease modelling was in predicting how many deaths there would have been if lockdown had not happened. SAGE officials, scientists and medical staff have done a remarkable job to keep us all safe, and many people across these islands owe their lives to them. I believe that the work that those people have done under enormous pressure should be applauded and appreciated, not undermined by the far-right libertarian Tories we have today.

Bob Seely Portrait Bob Seely
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Shame!

Brendan O'Hara Portrait Brendan O'Hara
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Oh, I am glad that you shout, “Shame!”

Bob Seely Portrait Bob Seely
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rose—

Edward Leigh Portrait Sir Edward Leigh (in the Chair)
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Order. Bob, will you calm down, please? Will everybody calm down?

Bob Seely Portrait Bob Seely
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I do not appreciate being called “far right”.

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Fleur Anderson Portrait Fleur Anderson
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No. The PACAC report makes it clear that no one in Government has taken responsibility for communicating the data. The report states:

“Ministerial accountability for ensuring decisions are underpinned by data has not been clear. Ministers have passed responsibility between the Cabinet Office and Department of Health and Social Care,”.

That is why, as a member of the shadow Cabinet, I am responding to this debate. There are questions about the use and communication of the data.

I want to come to why we needed to rely on modelling and forecasting. Significant mistakes made throughout the last 10 years of Conservative government are the problem. There could have been much better information, and we could have been much better informed, if there had been better pandemic and emergency preparedness.

Bob Seely Portrait Bob Seely
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Will the hon. Member give way?

Greg Smith Portrait Greg Smith
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Will the hon. Member give way?

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Bob Seely Portrait Bob Seely
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I think with one exception that was a very good debate. We all agree that we need good science, and we all agree that scientists have power, like politicians. We have the right, in the public interest, to question these people. It was fascinating listening to some of my hon. Friends—I am not quite sure what they were saying, but it sounded amazing. I am also delighted to agree with the hon. Member for Putney (Fleur Anderson) that, as part of the inquiry, we need to look into the use of modelling, so that if mistakes have been made—with great respect to those who try to say it—we can learn from that experience, we do not make those mistakes again, and the modelling works for the public good, as all good science and all good policy should do.

Public Health

Bob Seely Excerpts
Tuesday 14th December 2021

(2 years, 2 months ago)

Commons Chamber
Read Full debate Read Hansard Text Read Debate Ministerial Extracts
Sajid Javid Portrait Sajid Javid
- Parliament Live - Hansard - - - Excerpts

I will do so later.

In England, 10 people are confirmed to have been hospitalised with the omicron variant. I know that some hon. Members have said that, because confirmed hospitalisations from omicron are low, we do not need to act, but it is the fact that omicron hospitalisations are low that means now is the best time to act. We have seen during previous waves—we have already seen this—that the lag between infections and hospitalisations is about two weeks. When infections are rising so quickly, we are likely to see a substantial rise in hospitalisations before any measure starts to have an impact, so there really is no time to lose.

Bob Seely Portrait Bob Seely (Isle of Wight) (Con)
- Hansard - -

I understand the nuanced point that my right hon. Friend is making, but on the forecasts, does he accept that many academics have doubted the previous forecasts, describing them as “hysterical”, “substantially inflated”, “consistently overconfident”, “lurid” and “severely flawed”? We have had a problem with inaccurate forecasts. Does he accept that point?

Sajid Javid Portrait Sajid Javid
- Parliament Live - Hansard - - - Excerpts

Yes, I absolutely accept that point. With previous variants of covid, we have seen forecasts and estimates—whether from academics, think-tanks or others—that have been completely off the mark, but all I would say, gently, to my hon. Friend and other hon. Members is that, just because several forecasts in the past have been wrong, it does not mean that every estimate or forecast is always wrong. I hope my hon. Friend will note that.

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Wes Streeting Portrait Wes Streeting
- Parliament Live - Hansard - - - Excerpts

I wholeheartedly agree with my hon. Friend. This comes back to the point I made about the Government engaging with the staff trade unions and the royal colleges. Whatever their policy position on having mandatory vaccination, the Secretary of State will find in them willing allies who want to help the Government to persuade colleagues to engage with them and to deal with some of these dangerous conspiracy theories that are knocking public confidence, and creating real fear and anxiety entirely without basis. When the Minister for the Cabinet Office concludes later, I hope that he will set out how the Government plan to engage and that he will give an undertaking to work with the staff trade unions and the royal colleges, because that would do so much to achieve the objectives that we all share, but also to raise morale in the workforce, who often feel that they are slogging their guts out for the Government, but do not get the hearing they deserve.

Bob Seely Portrait Bob Seely
- Parliament Live - Hansard - -

The hon. Gentleman is making a very good speech, and I apologise for interrupting him, but on a point of science, will he just accept that he has got it a little bit wrong? Someone having the vaccine does not stop them spreading it; it just makes it much less likely that it will harm them badly. Someone can have the vaccine and still spread it, and to imply otherwise is just wrong.

Wes Streeting Portrait Wes Streeting
- Hansard - - - Excerpts

The hon. Gentleman has called repeatedly from a sedentary position that I do not know the science, but I have said nothing of any sort to contradict the points he has just made.

With respect to Conservative Members, particularly those who oppose these measures, what they are missing is that it is indisputable that the booster does provide greater protection than the first and second jabs, that vaccination—full stop—provides better protection, and that if we are talking about NHS pressures and workforce pressures, the biggest danger is that the virus sweeps through the health and social care workforce, knocks a load of people out in the middle of the busiest period for the NHS, and then the system topples over. I do not know why it has to be explained again and again to Conservative Members that the objective is to protect the NHS and to stop it toppling over at a critical time. The points about the severity of the virus and the efficacy of the vaccine in preventing transmission or serious illness are largely secondary. We know that the virus is spreading, and doing so rapidly, and we know that if it rips through the health and social care workforce, that is the biggest risk to the NHS—that is what will topple it over. Conservative Members’ constituents will not thank them one bit if they allow that to happen.

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Bob Seely Portrait Bob Seely (Isle of Wight) (Con)
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Me? I am sorry, Madam Deputy Speaker, I could not hear you over the appreciation for the speech of my hon. Friend the Member for Penistone and Stocksbridge (Miriam Cates).

I strongly support getting vaccinated. I had my booster jab two weeks ago. I thank all Islanders who are engaged in the vaccination process in my constituency. I congratulate the Government on an ambitious booster programme. When it comes to the vote tonight, I will accept and trust what they say on face masks and on the daily tests, which seem infinitely more sensible than locking people down in hotels. I will not support them on passports or mandatory jabs. Threatening the jobs of 73,000 NHS staff seems an odd way to support the NHS.

I want to raise a wider issue with those on the Front Bench, which has somewhat coloured my judgment. I have heard nothing to reassure me on the following points. I am fed up with dubious forecasts and ridiculous extrapolations the kind of which many hon. Members have talked about. Academics—I am not quoting myself—have talked about Imperial College London’s forecast being “hysterical”, “inflated”, “consistently over-confident”, “lurid”, “flawed” and “spectacularly wrong”. What do the Government have to say about the incredibly questionable extrapolations that they have used?

I am tired of all the leaks. It was leaked that omicron could kill 75,000. It could, but it may not. All these doomsday forecasts, leaked at critical moments, erode public trust.

Thirdly, we are told we have to follow the science. Of course we have to follow the science, but it is a misleading statement as science is shaped by the inputs and by the desired outcome. For example, we had 70 pages of evidence from Scotland on vaccine passports, but there was no evidence to support their value for uptake, so why are we introducing them? We are doing so because of the precautionary principle. That is not science.

One of the most disturbing things is the lack of context for the statistics that have been used. Was that to increase knowledge or to increase fear? My right hon. Friend the Member for New Forest West (Sir Desmond Swayne) said that between 500 and 1,000 people die each day in this country, and people die of flu all the time. It is about putting this information in context, and I fear that the result of too much of this has been to scare people, especially the old and now the young. They are petrified of covid without taking account of more genuine and potentially more damaging threats such as the appalling impact on education.

I will vote against the Government on two of the motions tonight, but my decision to do so has been coloured by the past 18 months of policy, which we need to improve.

Public Health

Bob Seely Excerpts
Tuesday 30th November 2021

(2 years, 2 months ago)

Commons Chamber
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Bob Seely Portrait Bob Seely (Isle of Wight) (Con)
- Parliament Live - Hansard - -

It is pleasure to follow my hon. Friend the Member for Wycombe (Mr Baker) and my right hon. Friend the Member for Forest of Dean (Mr Harper). I thank them for their fantastic leadership on this issue.

I want to develop one point specifically: I believe that Government must take a balanced view. I accept the argument made by various people, including the hon. Member for St Albans (Daisy Cooper), that the precautionary principle is good. I think we can be criticised for potentially not acting quickly enough at the beginning of the pandemic two years ago, but overreaction is not good. We have had a damaging obsession with a very narrow view of what we perceive to be health. The poorer you are and the younger you are in this society, the higher the price you have paid, and that is not acceptable.

I look at this debate and this motion in the context of some dreadful forecasts and dreadful assessments that have driven Government’s nervousness. I want to explore them and put them on record because I believe it is in the public interest, but I do so within the terms of the motion. I want to look particularly at Imperial College and Professor Ferguson. I have a great deal of respect for them and I will be careful how I phrase this, but I am concerned that some of the forecasting we have had has had a track record in, frankly, getting it wrong repeatedly. In 2001, Professor Ferguson predicted 150,000 human deaths from foot-and-mouth; under 200 died. In 2002, he predicted between 50 and 50,000 deaths from BSE; in the end, 177 died. In 2005, he said that 150 million people could be killed by bird flu; 282 died. In 2009, a Government estimate based on his advice said that a “reasonable worst-case scenario” for swine flu would lead to 65,000 British deaths; in the end, 457 people died. I am happy to be corrected on any of those points, but that is the publicly available information.

Moving forward to covid, Ferguson predicted 85,000 deaths in Sweden; in fact, 6,000 Swedes have died. Anders Tegnell, Sweden’s chief epidemiologist, said in September 2020:

“We looked at the”

Imperial

“model and we could see that the variables that were put into the model were quite extreme...Why did you choose the variables that gave extreme results?

I love experts—don’t get me wrong; I know we sometimes have our issues with them—but it is helpful if they are right, if only very occasionally. Johan Giesecke, Sweden’s former chief epidemiologist, said that Ferguson’s models were “not very good”. The Washington Post quoted Giesecke as saying that Imperial’s forecasts were “almost hysterical”. This is the forecasting that has been, in part, driving Government action.

In this country, oncology professor Angus Dalgleish, in this country, described Ferguson’s modelling as “lurid predictions”. He said that Ferguson and his colleagues were getting it “spectacularly wrong”. He said:

“Unfortunately, we have a Sage committee advising a government that is devoid of any scientific expertise, on speculative concepts such as the R number”—

which we now all know is the reproductive rate—

“and the need for everyone to stay indoors, even though the evidence strongly suggests that people are less likely to catch Covid-19 outside.”

So some of the scientific evidence may have actually driven the rising covid rates in the same way that going into hospital may have been the place that people caught covid and died from it.

Viscount Ridley has criticised Ferguson’s modelling. Lund University has applied Ferguson’s models and found a massive difference between his predictions and what actually happened. Professor Michael Thrusfield from Edinburgh University said that Ferguson’s previous modelling of foot-and-mouth was “severely flawed”.

Sammy Wilson Portrait Sammy Wilson (East Antrim) (DUP)
- Parliament Live - Hansard - - - Excerpts

The hon. Gentleman is absolutely right in highlighting the predictions that are wrong, but the unfortunate thing is that politicians then jump on to them and quote them. For example, the Health Minister in Northern Ireland, on the basis of Mr Ferguson’s predictions, talked about deaths “of biblical proportions” and scared the life out of people.

Bob Seely Portrait Bob Seely
- Parliament Live - Hansard - -

The hon. Gentleman makes the point most eloquently. Politicians then become fearful. They think, “What if the worst-case scenario is right?”, and lose faith in more balanced predictions.

John Ioannides from Stanford University said of Ferguson’s modelling that

“major assumptions and estimates that are built in the calculations seem to be substantially inflated”.

He is a serious customer, Professor Ferguson, and Imperial has an impeccable reputation. I pay respect, overall, to their work, and I do not seek to criticise for the sake of it; I want to highlight that bad forecasting and bad modelling drives bad Government decisions that then become illiberal and intolerant of other people who have more balanced views.

More recently, in July 2021, Ferguson predicted 100,000 cases, saying that it was “almost inevitable”. Yet we got nowhere near there. The US forecaster Nate Silver, who is very good at predicting US elections, said:

“I don’t care that the prediction is wrong, I’m sure this stuff is hard to predict. It’s that he’s consistently so overconfident.”



The political scientist Professor Philip Tetlock agreed with Nate Silver, adding:

“Expect even top forecasters to make lots of mistakes…When smart forecasters are consistently over-confident, start suspecting”

other factors in play, such as

“publicity or policy-advocacy games”.

I make no such allegations.

More recently, I understand that this summer Professor Ferguson predicted upwards of 100,000 cases. They topped at just over 30,000. In an interview with The Times, the good professor said that his prediction was off because the football messed up his modelling. That for me comes to the essence of the problem with forecasting. When someone can predict 100 million deaths and no one dies but someone gets a sore thumb, they can say mitigations were taken by Government. When a forecaster’s work becomes verifiable, we can see when he predicts and gets it wrong. When that forecast comes up against reality, reality kicks in and makes a fool of the forecast and sometimes, sadly, a fool of the forecaster. Every time Professor Ferguson’s forecasts have been verifiable, they have been seen to be very badly flawed, and this is a serious man and a serious university.

To sum up, if we look at the forecasts made about covid, just like the forecasts for so many other things, reality changes those forecasts and very often undermines their credibility, so we need another set of factors to guide us. Members on the Opposition Benches and on this side have said we need principles. We need a precautionary principle, but we need a sense of balance so that we do not overstep the mark, damage our society, damage our young people and damage poorer people by seeking to control when we need to learn to live with this. My final question to the Minister is: will the Government look into forecasting and perhaps hold an inquiry into the success of forecasting and what we can learn from it, so that we do it less badly in future?

Finally, going from the theoretical to the very practicable, and on a point related to the Isle of Wight, we are not getting the boosters in the Riverside Centre. My hon. Friend the Member for Winchester (Steve Brine) raised a specific point about his constituency, and in the same way, will the Minister please look at getting more booster jabs to the Isle of Wight and our Riverside Centre?

Nigel Evans Portrait Mr Deputy Speaker (Mr Nigel Evans)
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The last contribution before the Minister responds is from Dr Andrew Murrison.

Andrew Murrison Portrait Dr Andrew Murrison (South West Wiltshire) (Con)
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I record my interest as a practising doctor. I agree with my hon. Friend the Member for Isle of Wight (Bob Seely) that there appears to be a problem with the availability of slots for vaccinations, and that was before the Government announced this week that we were to expedite the booster programme. I am concerned about that, and I hope the Minister, who has commented briefly on that already, can confirm she has a cunning plan to ensure that people who need to be vaccinated are vaccinated and in particular that those vaccines reach the elderly and the vulnerable. At the moment, I have severe concerns about the availability of those slots, if not the vaccines themselves.

I will be supporting SI No. 1340 today on face coverings. I am mindful that we have to rely on the best available evidence. The evidence for a lot of these non-pharmaceutical interventions is more common-sense than actual. It seems to me to be a minor imposition to ask people to wear a face mask, particularly given the evidence published by The BMJ last week on this matter, which we have referred to already. The hon. Member for Central Ayrshire (Dr Whitford) in particular spoke about it.

I am more concerned about SI No. 1338 for two reasons. While SI No. 1340 expires on 20 December—or, at least, Ministers can decide whether to continue it on that date—there is no such luxury contained within SI No. 1338. That seems to be illogical. When pressed earlier, I regret to say that the Minister, who was very good at taking interventions from hon. and right hon. Members, did not address that point. She needs to explain to my satisfaction, and that of other Members, why 20 December stands in SI No. 1340, but it is 24 March for SI No. 1338. It seems that there is an appetite in the House to return here, if necessary, to reconfirm or refute the need for these measures to continue into the new year. I hope that the Minister has heard that loud and clear.

I for one would be more than happy to be here well past the time at which we rise, and right up to Christmas if necessary, and the reason for that is this: the things we have been discussing today touch heavily on the liberties and livelihoods of our constituents. These things are not trivial; they are of vital importance, and all actions have consequences. I am worried about things like this because of the messaging it gives off. It will be very difficult for businesses deciding whether to invest. They will look at SI No. 1338 and think, “Good gracious me, this will go on and on and on.” While they have been happy to go along with some of the impositions that we have had over the past 18 months, they are now coming to the point where they are thinking, “This could basically be the new normal. This will go on and on, and on what basis will we continue to invest in our businesses if every few months we have these kinds of things and goodness knows what else that may follow?” I am worried about that.

I am also deeply worried, as other hon. and right hon. Members have pointed out, about this “suspected of” bit. That seems to me to be rather clumsy and I am not comfortable with it. Presumably, anybody showing any coronavirus symptoms could be “suspected of” having the omicron variant.

The World Health Organisation touched on a potential solution to that at the weekend, which is the Thermo Fisher PCR test. I assume that it relies on the detection of the S-gene dropout that has been referred to, which could expedite the diagnosis of omicron as opposed to straightforward coronavirus. I wonder whether the Minister could reflect on that and say whether her understanding is that such a test would be the basis on which we would decide whether somebody was suspected of having it, because that could shorten the length of time that people are required to be out of action and might make No. 1338 slightly more palatable for those of us who have concerns about it.

I disagree with some hon. Members about what will change in three weeks’ time, because I think a great deal will change, as a number of international authorities have made clear. Indeed, the doctor who first found the variant, Angelique Coetzee, seemed to be of that view in her upbeat assessment of how it is affecting her patients, as is Dr Anthony Fauci, the adviser to the President of the United States. Many international authorities are saying that in two weeks’ time, we should be a lot further along the journey of understanding how the variant behaves.

That makes sense because, in two weeks’ time, if the variant is a problem, we will presumably see an uptick in hospitalisation at least among the vulnerable population. It is wrong to suggest that everybody in South Africa is young and vibrant; of course it has its fair share of elderly, vulnerable and frail people and of people with comorbidities. In two weeks, I expect there will be at least some indication of whether it will be a problem. We should also keep in mind that it might be part of the salvation, rather than the problem, because we do not know how the virus will behave. Some viruses mutate downwards and others mutate upwards. We must hope for the former not the latter, but at the moment we simply do not know, which is the basis of my support for No. 1340.

There is an assumption that perhaps southern Africa is not sophisticated in healthcare terms, but I gently make the point that the Republic of South Africa certainly is sophisticated. It has been the victim of its own generosity in having invested heavily in sequencing. It is a bit like the UK in relation the Kent variant: if we look, we will find. We need to be careful about suggesting that other healthcare economies are not up to spec, because I do not think that is necessarily the case for South Africa.

I also observe that yesterday, 25 deaths were attributed to covid-19 in South Africa and the seven day average is 35 deaths. Many of us are captivated by the covid graphs; I check them daily. I confess that I do not generally obsess about South Africa, but recent events have made one focus on its graph, which is bumping along the bottom. We are in no way seeing a wave as yet, although we may yet do so, but we need to be careful about suggesting it will be a major problem, as Angelique Coetzee and others have been.

The Government are right to be cautious—of course they are—but we also need a sense of proportion. We need to understand that everything we do in this place with regard to regulation has a consequence for liberty and livelihoods, for the economy in general and for young people in particular. I made that point in connection with the apparent suggestion of the hon. Member for St Albans (Daisy Cooper) that it was a no-cost measure. We need to be careful about the impact that it all has on young people and especially on mental health.

Bob Seely Portrait Bob Seely
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Does my right hon. Friend share my frustration that we have all these charts about covid, but we have never had them in context—how many people are born, how many people die, how many people die of flu, how many people die of other illnesses—so we have become fixated by something when there are many other causes of death in this country that, frankly, claim many more people, and by taking this out of context we create unnecessary fear?

Andrew Murrison Portrait Dr Murrison
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Yes, I absolutely agree with my hon. Friend. The point about that is of course that the national health service at the moment is running very fast to catch up because for the past 18 months, necessarily, it has not been doing a lot of the elective work in particular that it would have wanted to do. That is actually going to be a problem, I think, for years to come. What I would say is that there seems to me to be very little likelihood of our NHS being overwhelmed this winter. There are always pressures at this time of the year, and an overwhelmed NHS was the absolute cornerstone of Government policy towards this particular public health emergency at the start. Those things are not there now, and I think that we just need to contextualise a lot of what is going on.

Of course we need to reduce the number of admissions to the NHS, particularly to ITUs, for covid-19. It is a huge burden for the NHS, and it prevents us from doing other things, but we are certainly not in the position now that we were in this time last year. So while I will certainly be supporting No. 1340, I am afraid that I will not be able to support the Government in respect of No. 1338, because of the lack of a sunset provision similar to that enjoyed by No. 1340 and also because I am very concerned about “suspected of” and what that might mean in terms of a chilling effect on schooling, the economy, liberty and livelihood.