Cumberlege Report

Debate between Caroline Nokes and Alec Shelbrooke

Thursday 3rd February 2022 Westminster Hall

[Caroline Nokes (Romsey and Southampton North) (Con)]

My right hon. Friend has made that point a number of a times during his speech, and it is worth highlighting. I know that my hon. Friend the Minister will do some great work on the women’s health strategy, but time and again my right hon. Friend has said that women’s voices are being ignored and dismissed. They are told that they are imagining things and that it is in their heads. It is not good enough.

[Alec Shelbrooke]

I completely agree with my right hon. Friend. In fact, I will later make a couple of points on what I have discovered about women’s health. The way women are treated is quite appalling.

Another person says:

“I had my TVT in Exeter 12 years ago. Exeter consultant in 2020 told me I couldn’t be referred to Bristol. He said he would refer me to UCLH but I never heard from them, I rang in 2021 to be told UCLH hadn’t received any referral but they then put me on their wait list from when I’d been told the referral was made. I then heard nothing from them for ages so I paid for a private consultant at Bristol to be told I could have been referred to Bristol on the NHS in the first place. Bristol requested NHS tests in Exeter which were done in August 2021 and they referred me back to Bristol in October, so I am now on Bristol NHS list for removal”.

Somebody else says:

“Took 4 years to be referred to specialist mesh centre, after a lot of pushing and pushing for it, referred to Royal Victoria Hospital in Newcastle upon Tyne. The mesh centre was no better, more lies, gaslighting and a really appalling treatment and total indifference, lots and lots of mistakes, cancelled appointments and no regard for any pain or suffering.”

Another person says:

“Told too dangerous to remove…left in agony...self-catheterising, lost job, pain management referral but they are behind 12 months …invisible and invalid is how I feel…is this my life at 54?”

Somebody else says:

“I went for a consultation for removal in 2020 had a scan then asked to contact his secretary when I’d had an MRI which I did in December 2020. Now still waiting for them to contact me. I leave messages and nothing happens.”

I could go on and on and on, and I am sure that many other right hon. and hon. Members will be raising similar cases. What I want the Minister to comment on in today’s debate is this. There is now, from the relevant royal colleges, the “Purpose Statement for the Mesh Complications Management Training Pathway”. That statement outlines several areas, but I will highlight just the “Mesh Complication Management credential”. Its subheading is “Professional Identity: Clinical Expert” and it states:

“The doctor has the knowledge, skills and attitudes required for clinical assessment of patients presenting with suspected mesh-implant complications…The doctor is able to investigate mesh complications, and interpret the results of tests, appropriately…The doctor is competent in non-surgical management of mesh complications…The doctor is competent to undertake mesh removal surgery as part of a multidisciplinary team”.

This is progress, but I think we can all understand that there is going to be a long time around that, so I say this to the Minister. Can the House please have regular updates on how this training process is going, within the royal colleges, for surgeons, because we need to understand what the process is and how long it is taking to try to deal with the main issue?

That brings me to the other parts of recommendation 5 in the report of the independent medicines and medical devices safety review. The written ministerial statement in response said:

“Recognising the need for enhanced data collection on pelvic mesh, the Government in 2018 announced the provision of £1.1 million for the development of a comprehensive database of urogynaecological procedures, including vaginal mesh, to treat pelvic organ prolapse and stress urinary incontinence. I can update the House that the pelvic floor information system has started to receive live data, including historical data from July 2017 onwards, with an initial focus on supporting specialist services to report every pelvic floor and comparative procedure to this national database.

The report of the IMMDS review also recommends that the information system is accompanied by a retrospective audit of mesh procedures, and by the development of a patient reported outcome measure (PROM) or patient reported experience measure (PREM). I am pleased to announce to the House today that the Government accept both these recommendations. NHS Digital has been commissioned to scope and deliver the retrospective audit. Subject to receiving high quality research bids, a new validated PROM for pelvic mesh procedures will be commissioned through the National Institute of Health Research in 2022.”—[Official Report, 21 July 2021; Vol. 699, c. 73WS.]

Again, I ask the Minister whether she can update us on progress in these areas and, after today’s debate, could she speak to her Department about ensuring, even if it is just through a written ministerial statement, that there is a regular update on the progress being made?

I will give a summary of the points that I have made. GPs are unaware of mesh complication centres and the referral process. Many patients are denied access and offered physio and pain management instead. They pay thousands of pounds for private care. They experience extremely long delays for appointments. Many women end up seeing their implanting surgeons, who then dismiss them. That leads to further deterioration in their physical and mental health. There is a lack of experience, particularly in mesh removal. There are only around four to five surgeons in the UK who can do mesh removal. There is no post-op aftercare.

More positively, on recommendations 6 and 7, the Government announced that the MHRA

“has initiated a substantial programme of work to improve how it listens and responds to patients and the public, to develop a more responsive system for reporting adverse incidents, and to strengthen the evidence to support timely and robust decisions that protect patient safety.”

Recommendation 7 was:

“A central patient-identifiable database should be created by collecting key details of the implantation of all devices at the time of the operation. This can be linked to specifically created registers to research and audit the outcomes both in terms of the device safety and patient reported outcomes measures.”

The Government accepted both recommendations. Again, I ask the Minister for an update.

Recommendation 8 states:

“'Transparency of payments made to clinicians needs to improve. The register of the General Medical Council (GMC) should be expanded to include a list of financial and non-pecuniary interests for all doctors, as well as doctors' particular clinical interests and their recognised and accredited specialisms. In addition, there should be mandatory reporting for the pharmaceutical and medical device industries of payments made to teaching hospitals, research institutions and individual clinicians.”

The Government said that they accepted the recommendation in principle:

“We agree that lists of doctors’ interests should be publicly available, but we do not think that the GMC register is the best place to hold this information”,

so “publications of interest” should be held by healthcare providers. Having approved the recommendation, how is that progressing and how easy is patient access?

Finally, we get to recommendation 9:

“The government should immediately set up a task force to implement this Review's recommendations. Its first task should be to set out a timeline for their implementation.”

The Government accepted the recommendation in part.

Having probed the recommendations to open the debate, I ask the Minister whether she and her Department are able to say positively that they are meeting recommendation 9. Are the recommendations being implemented properly and is she revisiting the recommendations rejected by the Department initially? We can all recognise from the examples that I have given that the mesh centres are not working, that people’s lives have been destroyed and that they will need to support throughout their lives. We cannot just draw a line, have a year zero and say that we hope such things do not happen again. We have to move forward.

Drawing on what my right hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) said and on my research, it is clear to me that the NHS is constantly failing women. During the pandemic, I read a report—unfortunately, I have not been able to reference this since, so it is open to challenge—stating that gynaecological surgeons were taken off their operating theatres for longer than any other surgeons, being kept on the frontline of the covid wards.

That says exactly where the problem in the NHS lies. That comes up not just in this debate, but next week, in another debate, on problems with endometriosis. It seems that the NHS is—I do not say this in a positive way—gender-blind to the needs of women and the complications that occur. It is an attitude, a built-in psychology, that we will have to address, and we can only start to do so if we take all the aspects of this report seriously.

Although men have mesh issues too, this debate is dominated fundamentally by women’s health. It speaks to that wider assessment of NHS priorities on women. We have to start doing something about that. We must stand up and say that we are not afraid to criticise areas of the NHS, because I am sure that as we go through the debate we will have example after example from which we can draw only one conclusion: women are being failed.

My hon. Friend the Minister, as a practising nurse, will know the importance and vocation of patient care. With her professional eyes, will she allow the NHS to ignore the plight of people who are suffering every day? To be blunt, her predecessor appeared to. I ask her to apply her considerable and dedicated professional expertise to get the Government to direct the NHS to adopt the recommendations, or at least to mirror them. That is the least we can do for the terrible and horrific damage that the NHS has caused to so many people. To finish: the NHS did this, so the NHS must fix this.

Renewable Energy

Debate between Caroline Nokes and Alec Shelbrooke

Wednesday 29th February 2012 Westminster Hall

[Caroline Nokes]

My hon. Friend makes an excellent point. That is exactly what I shall focus on, albeit in Hampshire rather than Kent.

To date, the main focus of attention on energy from waste appears to have been on large-scale industrial production of waste-sourced energy. Advanced gasification is a key part of securing green energy and decreasing landfill: it is a carbon-lean process involving the efficient, high-temperature conversion of waste to base-load electricity. After the August 2010 announcement that energy from waste can be sold to the national grid, there is now real discussion about how local authorities in particular can secure income sources by selling green energy. For example, Air Products, a leading provider of industrial gases and environmental systems, has been granted permission for a 49 MW advanced gasification plant in Teesside, the building of which will begin next year. That development will create 700 jobs, divert up to 350,000 tonnes of waste from landfill and produce enough predictable, clean power for 50,000 homes. Air Products is precisely the sort of provider of clean energy that we should be encouraging to meet our renewables obligations.

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

Does my hon. Friend agree that it is vital, in any incineration or gasification process, that the end result comes from harvesting recycled material along the way?

[Caroline Nokes]

Indeed; my hon. Friend is correct.

I should like to explore a number of issues facing the development of the renewable energy from waste industry outside the large industrial-scale plants that I have mentioned. I want to show how the current incentives are working and how we could adjust them to accelerate awareness and the development of the industry, particularly harnessing the potential for small-scale production, as well as production on an industrial scale.

I have called this debate because incentivising small-scale production could develop valuable employment opportunities, help small businesses and local communities generate their own green energy, grow UK exports and, most importantly, assist the Government to achieve secure, diverse and green energy.

As a country, we continue to produce too much waste and we need to promote better uses for our unwanted produce. Producing more energy from waste is therefore a win-win policy, but it needs to be carefully explained to the general public, as the subject is easy to misunderstand, especially when anaerobic digestion is not well communicated.

Anaerobic digestion is the process whereby biowaste from plant and animal material is converted by micro-organisms in the absence of air into biogas, which can in turn be used to generate green electricity and heat. Anaerobic digestion can help reduce fossil fuel consumption and greenhouse gas emissions—two essential goals in our fight against climate change. Almost any biowaste can be processed in that way, including food waste, energy-producing crops and crop residues, slurry and manure. The process can accept waste from our homes, supermarkets, industry and farms, ensuring that significantly less is sent to landfill.