Medical Cannabis under Prescription

Charlie Elphicke Excerpts

Monday 20th May 2019 Commons Chamber

[Sir Mike Penning]

If I can, I will make a bit of progress, because there is plenty of time for colleagues. I am really chuffed that the Backbench Business Committee gave us this opportunity. When has the Backbench Business Committee ever had five hours for a debate on a Monday afternoon? I am simply thrilled, and I intend to use as much of that time as possible. I got a little note from the Clerks saying, “You should speak for 12 to 15 minutes, Mr Penning”—yeah, in your dreams. [Laughter.]

There is a blockage in the NHS if someone cannot pay for the prescription. There are consultants both within the NHS and outside, but if someone can pay for it in the private sector, private prescriptions are being honoured. The product is available in this country, perfectly legally, to those who can afford it, and that sticks strongly in my throat.

At the conclusion of the urgent question, although it is not in Hansard, I clearly heard Mr Speaker tell the Secretary of State for Health and Social Care that, whatever happens, we will not leave it—he was referring to me. We will go on and on about this until we get justice for these young people.

Looking beyond the small cohort of desperately ill children, there are others in the country who would clearly benefit from medical cannabis. I am not a doctor, but hundreds and hundreds of families have come to ask me whether this means they can get some help. The MS Society has sent an excellent briefing to colleagues today, and the Brain Tumour Charity and many others have also provided briefings.

Constituents come to my surgery, and I tell them that we need to make sure that their specialists, the experts in their area, are saying that they need medicinal cannabis, and then we can fight their corner. We have such specialists in the sector now who are saying that children and young people with epilepsy—my constituent has just turned 18, so their mum will want me to talk about post-18, too—get a tangible benefit from treating their seizures with these prescriptions, prescribed by a suitable specialist.

We know exactly what are in those pharmaceuticals, yet we still have a crazy situation in which hospitals are telling parents that if they bring these products on to a ward when their child is ill, as part of their ongoing medication, social services will be called to look into what they are doing with their family—for a product prescribed by a consultant.

My constituent has just turned 18. When I wrote on behalf of the family to her GP and the clinical commissioning group, which was blocking the prescription, they said, “We are not interested in homeopathic products.” What on earth is going on inside the medical profession in this country? If they do not know what it is, they should go and ask someone before they write stupid letters back to people and break their hearts. I had to send the letter on.

We should look carefully at what we can do to help. It is not for any politician in this House who is not suitably qualified to say to anybody that they deserve to have this product. What we must do is break down the blockages—that is what the Secretary of State alluded to in his answer to the UQ—and find out the reason for them.

[Charlie Elphicke (Dover) (Con)]

My right hon. Friend and I share a passion for this subject. Does he agree that the absurdity lying at the heart of it is that heroin is legally prescribed as morphine, which has been well understood for many years, but that a medical prejudice kicks in when using cannabis for medical purposes? Does that not highlight that there is an inconsistency that needs to be addressed—and addressed quickly?

[Sir Mike Penning]

I completely agree with my hon. Friend. I have been referring to Teagan, and he is her MP. As he knows, she got her medication seven days late, and I am convinced that she would not have got it if we had not secured the urgent question, which is why such debates are important.

I used to be a Minister, and I always panicked about UQs. I always asked, “Why don’t we just do a statement? It is a damn sight easier, and we can control the agenda going forward.” The business managers did not always agree with me on that point.

I might be wrong, but as far as I am aware from our investigations the only NHS prescription that has been issued was through the Home Office. Alfie Dingley got his medication through the panel the Home Secretary set up with the expert group in the Home Office. As far as I am aware, since we changed the law in November no NHS prescription has been honoured. We have had trusts clearly threatening consultants not to do this and we have had their professional bodies do the same—I have seen some of the correspondence. As I alluded to earlier, families have been threatened with social services for bringing the product into the hospital where their child was being treated, even though this was a prescribed drug that is perfectly legal in this country today.

The real issue is: why can only those who have the money, those who have a donor and those who have crowdfunded, or, as in the case of my constituents, those to whom one of the manufacturers has given it for free—there is no way in the world they could afford this, and I thank the manufacturer for doing that, particularly for the family—get this? In the country that is so proud of the NHS, how on earth have we got into a situation where those who are poor do not get it?

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[Charlie Elphicke (Dover) (Con)]

It is a pleasure to follow the hon. Member for Gower (Tonia Antoniazzi), who spoke so movingly and with such great sincerity on this important subject. I congratulate her and my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) on securing this debate, which is incredibly important to my constituents.

Teagan Appleby is just nine years old and lives in Aylesham. She is wheelchair-bound and can suffer up to 300 seizures a day. She was born with a rare condition, Isodicentric 15, a severe form of epilepsy. Last year, she required life-saving treatment five times in just eight days.

Teagan’s mum, Emma, who is in the Gallery this evening, has been a tireless fighter not just for little Teagan, but for the medicine that little Teagan needs. Emma has tried everything to ease Teagan’s pain. One thing she could not try was cannabis oil, despite NHS trials showing that it could dramatically reduce epileptic seizures. The alternative suggested by doctors was Teagan having risky procedures on her brain. Understandably, like any parent, Emma does not want the surgeons getting out the scalpel and starting to operate on her daughter when alternatives are available.

That is why, last year, I urged the Home Secretary to intervene in Teagan’s case, along with many others, including my right hon. Friend the Member for Hemel Hempstead, who fought on this and I welcome the fact that he did so. Last October, the Home Secretary announced that cannabis would be medically prescribed by specialist consultants, yet the reality was somewhat different. Teagan’s treatment was still delayed, first due to the restrictive guidelines drawn up by the NHS and then due to supply issues.

I have visited Emma and Teagan at their home in Aylesham. It is incredible: all of us who are parents fight for our kids, yet somehow when we see someone in Emma’s situation looking after little Teagan we cannot help but think that some people fight harder than others. No one could fight harder than Emma does for Teagan. Teagan is so charming, and it seemed to me that things had improved, but Teagan was still suffering seizures during her sleep. Emma started fighting to get the stronger, THC form of cannabis, which has been discussed this evening, approved to see if it could stop the seizures entirely. She went to mainland Europe to get it, because she could not get it here, and it was seized on her return.

The latest position is that Teagan is getting better. She now goes whole days without seizures, which was extremely rare before. She can now walk short distances. Her doctor is so pleased that he has issued a fresh prescription, yet she still cannot get it on the NHS. The fact that it is legal but unlicensed means that Emma has to submit an individual funding request to the local clinical commissioning group. It takes weeks for those panels to meet, and weeks for them to make a decision. That is why, in the meantime, Emma has to fork out thousands of pounds for bottles of cannabis oil. The price almost doubles when we add the import duties—that is, of course, when she does not have the extra hassle of having the oil seized at the border. That is also why Emma is having to consider going to Holland again to get this much-needed medicine for little Teagan. I ask the House this: should she not be supported and helped? Should she not be understood as having the compassion that every parent has for their child? Is it not wrong that she is effectively being declared by the law to be acting as some kind of drugs mule? How can that be right? I do not think that it is right. There has to be change.

All of us understand that we need to have evidence and clinical trials. We understand the need for proper processes, but none of us can understand why this is taking so long. We cannot understand why we are so bad at dealing with pain management in this country. We are just not good enough at it at all.

[Matt Western (Warwick and Leamington) (Lab)]

The hon. Gentleman is making an important and powerful speech. Is he not as frustrated as all of us here and, particularly, the families are at just how long it is taking for all this to go through and for medical cannabis to be legalised so that GPs will be allowed to prescribe it? Products such as oxycodone—OxyContin—and other opioids are totally addictive, yet they are available, at great cost. Surely the time has come for medical cannabis to be made legitimate.

[Charlie Elphicke]

The hon. Gentleman makes a powerful point, with which I wholly agree.

This is not just about speed; it is also about consistency. We can go to the local supermarket and buy ibuprofen, which people say is safe. We can buy as much as we like, yet we need a prescription for naproxen, a similar drug, because it is meant to be more dangerous. This is despite the fact that an article in the British Medical Journal in 2016 showed that, following experiments, the evidence concluded that the risk of heart problems was higher for people taking ibuprofen than for those taking naproxen, and that naproxen was less problematic and had fewer side effects than ibuprofen. Nothing has happened about this.

[Luke Graham (Ochil and South Perthshire) (Con)]

My hon. Friend makes a strong point about consistency. Policy on the legalisation and decriminalisation of drugs is a reserved matter, in contrast to the delivery of health and social care, which is devolved. Does he agree that there should be consistent training and delivery programmes across the United Kingdom, so that people get the same standard of access to help for themselves and their families whether they are in England, Scotland, Wales or Northern Ireland?

[Charlie Elphicke]

I completely agree. The whole House knows that my hon. Friend is a true champion of his constituency and of the Union in which we live. It is important to have consistency so that anyone can go and practise, whether they are in England, Wales, Northern Ireland or Scotland. He makes an important point about the need to ensure that level of consistency.

It is also important to have consistency in the NHS, so that when the necessary evidence on drugs is available, the NHS takes action. It could, for example, look at the issue of naproxen and ibuprofen, rather than just carrying on regardless. It says that evidence is important, so it should be doing something about that. Indeed, in America, naproxen is not a prescription drug at all. People can just go and get it in their local drug store. In the same way, the NHS will not prescribe, or make it easy to prescribe, cannabis oil, yet it is easy to get codeine. For those with a bit more pain, it is easy to get tramadol, and for those with even more pain, there is morphine as well. Those opiates are legal and easy to get on prescription, yet we seem to have a mental barrier about cannabis and cannabis oil.

It is really important that we understand the importance of pain management and take it more seriously. We need to look at what can be done to ease pain for all people with all conditions, and we need to act swiftly and consistently on the evidence and without delay. That is why it is right that we should act to “End Our Pain.” We should act to help people such as Teagan and our many other constituents who are suffering. We need to act to end that suffering and pain, and to make it easier for them to get the medicines that they need to make a difference to their lives.

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[Seema Kennedy]

My hon. Friend raises an interesting point, as he always does. The normal NHS medicines governance systems apply, and they are being used to support good clinical practice and safe and effective prescribing, but we could of course do more to educate and support the health profession.

I want to pick up another point raised by my hon. Friend the Member for Henley, about who does the prescribing of these medicines. These are not frontline medicines, and it is right that specialists who have detailed knowledge of all the treatments available for these particularly difficult cases are the ones who should be responsible for prescribing. Cannabis-based products would not normally be considered until a patient was at the stage in their treatment pathway when they were under the treatment of a specialist.

On education, Health Education England has been commissioned to develop an online training package. The aim of the package is to familiarise those working in the health sector with the change in the law and provide straightforward information about the products and what is known about their mechanisms of action. It will support and underpin the knowledge and understanding gained by specialists as experience in prescribing these products grows.

[Charlie Elphicke]

My hon. Friend is being generous in taking interventions. She has set out the risks, but may I pay tribute to her and the Secretary of State, who have not simply looked at all the risks and roadblocks that medics put up, but have said how important it is to produce answers, find solutions and take things forward? I urge them to continue with this excellent work to make sure that progress is made, and to continue to push forward.

[Seema Kennedy]

I thank my hon. Friend. That is why, after the urgent question last month, the Secretary of State issued the process review. As I have said to my right hon. Friend the Member for Hemel Hempstead, that review will be reporting shortly.

We cannot be sure that cannabis-based products are safe or effective. There is a body of anecdotal evidence of therapeutic benefit, and the chief medical officer concluded that the evidence was sufficient to recommend that these products be considered for rescheduling from schedule 1 to schedule 2 under the Misuse of Drugs Regulations 2001, and that their medicinal benefits be further examined. All products in schedule 2 can be prescribed; cannabis-based products for medicinal use are no exception.

I want to talk quickly about the evidence base. Some people have talked about randomised controlled trials, which are what we normally use when there is anecdotal evidence. As hon. Members have said, parents are arbiters of this evidence. The normal procedure is that we do not base prescribing decisions on anecdotal evidence, which is why we have asked the NIHR to stimulate further research. We need to build up the existing evidence base, including through observational trials.

Access to Medical Cannabis

Charlie Elphicke Excerpts

Monday 8th April 2019 Commons Chamber

[Matt Hancock]

I entirely understand that sense of frustration. I went to meet some of the parents to hear directly from them the pain and suffering that they and their children are feeling, which I entirely understand. That is one of the reasons why we are pushing so hard to try to resolve this. Resolving the questions around the guidelines is also important but, as the hon. Gentleman knows, those guidelines are written independently of Ministers.

[Charlie Elphicke (Dover) (Con)]

My constituent Teagan Appleby suffers horrendously with one of the worst cases of child epilepsy in the United Kingdom. It has been heartrending to go round to her house to see her suffering. To see how her mother, Emma, copes with the challenge is inspiring.

Legal heroin, morphine, has been prescribed in this country for many decades. Why can we not have legal cannabis, too? Is it not high time that the NHS got on with changing the guidelines to make sure that medicinal cannabis is available, rather than wasting time arresting Emma at Southend airport, which is quite the wrong thing to see?

[Matt Hancock]

My hon. Friend represents Teagan Appleby, her family and her parents, and he speaks for the whole House in what he says. He has captured the essence of this debate. I am trying to resolve it to his satisfaction and to the family’s satisfaction as soon as possible. There are barriers to that resolution, and I am happy to work with him, with the APPG and with all others who have constituency cases to try to resolve this significant problem.

Kent & Canterbury Hospital

Charlie Elphicke Excerpts

Thursday 22nd June 2017 Commons Chamber

[Helen Whately (Faversham and Mid Kent) (Con)]

I would like to start by welcoming Ken Rogers and campaigners from Concern for Health in East Kent, who have come here today to hear this debate. Ken was born in 1948, the same year as the NHS. He was diagnosed with chronic lymphatic leukaemia when his daughter was 15 months old and told that he would not live to see her fifth birthday. That was in 1981. Thanks to Kent & Canterbury hospital, he is here today, listening to this debate. There are thousands of people with similar stories—people who would not be here today if it were not for Kent & Canterbury hospital, a treasured hospital with a history going back over two centuries, and for many years a top destination for junior doctors and aspiring consultants.

The hospital has an outstanding reputation in specialties such as urology, providing dialysis for patients across east and west Kent, neurology, neuro-rehabilitation and surgery, with surgeons using a state-of-the-art robot to carry out manoeuvres impossible with human hands. Last week, the Taylor ward was providing fantastic specialist care for cardiac patients and the hospital serves around 200,000 people in Canterbury, Faversham and surrounding villages, but people across that area are worried—very worried—because there is a big question mark over the future of the hospital.

The building is out of date—frankly, it is crumbling—and the hospital is struggling to recruit staff. I said that last week the Taylor ward was providing specialist cardiac care because, this week, that is no longer the case. On Monday, junior doctors were withdrawn from Canterbury and relocated to neighbouring hospitals, after Health Education England said that there were not enough consultants to oversee their training and there was too much reliance on locums. The shift of junior doctors means the shift of emergency care. Heart attack patients in my constituency, who previously faced a journey of under 20 minutes to get to the hospital in Canterbury from Faversham, will now have to travel to Ashford—a longer drive on winding roads, one of which will be closed all summer—or Margate, 40 minutes away. In rush hour or by public transport, these journeys are far, far longer. People are scared that they or a loved one will not make it in time, and that visiting will be harder, or impossible for some. Added to that is the confusion about the transfer of services, and the risk that the pressure to free up acute beds will mean patients being transferred between hospitals before they are ready or ending up in corridors. Nurses, some of whom are here today, are desperately worried about the risk for patients.

Then there is the impact on the staff. Some are now making longer journeys to work. Others are staying at Kent & Canterbury but are at risk of losing their specialist skills. No commitment has been made on when acute services will return to Canterbury. There is great scepticism about the efforts being made to recruit consultants. Public trust has been lost. The point is that these temporary changes must not become permanent. We must not allow the hospital to crumble further and drift towards a downgrade, when there is a real opportunity to seize this moment of change to form an ambitious long-term vision for healthcare in Kent.

What patients really need is a new acute hospital providing world-class care and a medical school attracting the brightest and best doctors and nurses, making east Kent a centre of excellence in healthcare. As a university city and a major population centre with good transport links, Canterbury is the right place for a major hospital and a medical school. The Kent and Medway sustainability and transformation plan is proposing to reconfigure acute services across east Kent’s three major hospitals into one emergency hub with specialist care and a trauma unit, a second emergency hospital also carrying out planned care and, at the third site, a rehabilitation hospital and a primary care-led urgent care centre. The STP is not specific about what will happen where, but all the signs are that Canterbury is the most likely to lose acute services, despite it being the obvious place to centralise specialist services.

We are at a crunch point, but this should not, and must not, be treated as a foregone conclusion. This is not the time for another short-term compromise. It is time to reverse the direction of travel and make the case for a long-term, visionary answer to the challenges of healthcare in Kent. A new hospital is not a panacea; it is not the answer to all Kent’s healthcare problems. We still need to invest in primary care and bring more services out of hospitals and into places such as the Encompass Vanguard in Whitstable and Faversham cottage hospital.

[Charlie Elphicke (Dover) (Con)]

On behalf of all the MPs in east Kent, I absolutely support my hon. Friend in making a powerful case for a new, state-of-the-art acute hospital in east Kent. Does she agree that cottage hospitals such as Buckland hospital in Dover make a great deal of difference and that we ought to have more services locally, wherever possible?

[Helen Whately]

I completely agree with my hon. Friend. In addition to the fantastic acute hospitals, community and cottage hospitals are really important. Patients who do not need acute care can be looked after closer to home and be given a different sort of care in the environment of a local community hospital such as the one in his constituency or Faversham cottage hospital in my own, which is deeply loved and enormously valued by the community.

The new hospital that I am asking for will take time, so it will not fix the immediate challenges that the NHS is facing in Kent, but now is the time to look to the future. It has been suggested that the STP consultation is looking merely at the next five years. That is totally inadequate; it is far too short a timeframe. We need to put politics aside and think further ahead than the next parliamentary term, just as we are putting party allegiance aside for this campaign. I am pleased to be working with my colleague, the new hon. Member for Canterbury (Rosie Duffield). She is taking up this campaign from her predecessor, Sir Julian Brazier, who fought hard for many years for Kent & Canterbury hospital.

In conclusion, I shall turn to the specific requests that I want to make of my hon. Friend the Minister. I ask him to note that Kent & Canterbury hospital has strong support in the community, represented here today by members of CHEK, and across the political parties. I ask him to look closely at the temporary changes to services, to challenge the hospital on its contingency plans and to make absolutely sure that, in the short term, these services are safe for patients. I ask him to ensure that these changes do not become permanent. I also ask him to look favourably on the case for a medical school in Kent, and to ensure that the STP consultation takes into account the connection between the medical school proposal and the decision about acute sites.

I have been told many times that one barrier to the idea of a new Canterbury hospital is a lack of capital. I ask my hon. Friend to help us here. More capital has been promised for the NHS, so will he make it clear to the local NHS leaders driving the process that if they, and we in Kent, can make the case, capital will be available. There is a risk that the consultation on Kent’s STP will be presented to the public with no option for an acute hospital at Canterbury. If none of the options propose keeping acute services at Canterbury, it cannot be called a true consultation.

Finally, will my hon. Friend please require STP leaders to look to the long-term, to be ambitious in their plans, and to aim for excellence? There is an opportunity here for Kent—specifically east Kent—to bring an end to the drift of services away from the area, to downgrading, and to the struggle to recruit and retrain staff. Instead, Kent could become a centre of excellence, making the most of the combined assets of the NHS, local universities and the strong life sciences research sector in east Kent to offer people in Kent brilliant patient care, to develop innovative treatments and pathways, and to set an example for the whole country of how we can provide excellent, sustainable healthcare.

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[Mr Dunne]

One of my ministerial responsibilities is to support the Secretary of State in having an oversight of trusts that are in special measures. The East Kent trust has been in special measures and is currently in financial special measures, so I take a close interest in what is happening in that trust. In view of my hon. Friend’s request and the events that have happened this week, I assure her that I will take a particular interest to ensure that the existing facilities at Ashford and Margate are up to scratch to cope with the increased demand they will undoubtedly have to manage.

I want to make it clear to the House and to the representatives on both sides who look after constituents in Kent that this issue is about maintaining the supervision of junior medical staff and ensuring that we have safe staffing levels for patients from central Kent; it is not about clinical practice or the competence of the hard-working staff in the hospital. I have been assured that before taking this decision every effort was made to identify appropriate senior staff cover from neighbouring trusts. The challenge has been to ensure that an adequate number of consultants were on duty at Kent & Canterbury hospital to allow junior doctors to have senior colleagues to refer to in the event of issues they felt uncomfortable dealing with. The problem that the trust has had is that it has been over-reliant on locum consultant cover in the hospital and there has been an inability to recruit to substantive posts in the hospital over a prolonged period, which has given rise to this concern on the part of HEE and the GMC that the training conditions for junior doctors were not adequate. That is what has led to this decision, rather than any criticism of the individual doctors or other staff members in the hospital.

I am also assured that the concerns of both HEE and the GMC are being addressed as quickly as possible. That will form part of any public consultation that follows from the development of the STP that is being worked up for the area.

I will not go into any great detail about the specifics of what has happened over the last few days as my hon. Friend the Member for Faversham and Mid Kent has already done so, but our expectation is that this temporary relocation is likely to affect approximately 50 of the 900 patients who visit Kent & Canterbury hospital each and every day. It is important to recognise that there has not been a full A&E unit at Kent & Canterbury hospital since 2005, when services at the trust were reconfigured, and it was established as an emergency care centre. Trauma and general surgical emergency cases had already been sent to sites in Margate and Ashford for some time prior to the recent temporary changes, and I believe it was in 2016 that the emergency care centre itself was turned into an urgent care centre, which again had an impact on services at that time.

I am advised that local NHS leaders have fully explored the risks of temporarily relocating services and have put in place mitigating action and contingency plans when required. The decision has been an exercise in the balance of risk: it is clearly not desirable, and nor is it either common or unique, for the regulators to take action such as this when they have concerns about both patient and staff safety, and it is not a decision taken lightly or comfortably, but the trust has come to the view that the risk to patient safety outweighed maintaining the status quo and seeking to continue with, frankly, unsustainable levels of senior support.

My hon. Friend rightly raised concerns that this might presage a future closure of the site, and I want to try to reassure her: the trust board has been left in no doubt whatsoever that it should not regard this as a step on the road to a permanent solution and that it needs to consider the requirements of the population of mid-Kent in the round when looking at the provision for the future to be undertaken through the STP. The hon. Lady raised a perfectly reasonable concern that the STP horizon of five years is not long enough. If the STP were to consider a more wide-ranging reconfiguration, that absolutely would have to look at the long-term horizon for healthcare provision in the area and not just at meeting the immediate objectives of the next five years.

[Charlie Elphicke]

I thank the Minister for making this important speech, but may I gently press him on the issue of a new hospital? Is there not a cost-benefit analysis between the efficiency savings to be had from a new, state-of-the-art hospital, which can operate much more efficiently and do much more with much better use of resources, versus the cost in capital? How would the Minister and his Department strike that balance, and can they carry forward a feasibility study to look at the very interesting case being put by my hon. Friend the Member for Faversham and Mid Kent (Helen Whately)?

[Mr Dunne]

I was going to come on to the suggestion of my hon. Friend the Member for Faversham and Mid Kent about both allocation of capital and the possibility of a new hospital. I was starting to develop the point that this matter needs to be assessed in the light of the overall requirements of the healthcare economy of mid-Kent and the East Kent trust through the STP process. Capital is currently constrained throughout the NHS. As hon. Members will know, in the March Budget we announced a capital allocation of some £325 million over the next three years to support the first phase of STPs. Fairly shortly, we should have made sufficient progress in deciding which of the STP proposals should be supported to secure that capital. Other capital pots are available to the NHS for what we refer to as business as usual, and there are always opportunities for trusts to make capital proposals to the NHS.

Right now, it is not appropriate for me to explain the basis on which future capital allocation decisions will be made. One can look to the recent past to identify some significant new hospital builds that are now in progress. There is currently a significant capital investment not far around the coast from Kent, in Brighton, and there is another closer to my constituency, in Sandwell in Birmingham. Such builds are few and far between, and bearing in mind the kind of major capital investment we are talking about, I think both my hon. Friends from different parts of Kent are arguing for space to undertake a study to consider whether a major build is appropriate to meet the needs of the mid-Kent population.

Generally, as can be identified from the two significant builds that are currently under way, which have been allocated hundreds of millions of pounds of capital each, a certain density of population is required to be served. Such builds are therefore most likely to occur in major cities rather than in less densely populated areas. That said, it is not for me to make suggestions as to what would or would not be appropriate. I urge my hon. Friend the Member for Faversham and Mid Kent to discuss the matter, as I know she has already, with her STP leaders. If there is a desire among Kent MPs and the Kent community to consider whether in future a more holistic approach to satisfying healthcare needs should be taken in the county as a whole, perhaps my hon. Friend should work in conjunction with other hon. Members.

The right forums are the STPs, which are bringing together NHS providers and commissioners from throughout their regions to try to arrange provision to meet the future healthcare needs of their populations. Whether or not my hon. Friend is successful in persuading the STP that a new hospital in Canterbury is the right solution, that is a matter for her to take forward with the STP. Such an effort would carry more weight were it supported by other colleagues from the area.

Francis Report: Update and Response

Charlie Elphicke Excerpts

Wednesday 11th February 2015 Commons Chamber

[Mr Hunt]

I think it is very simple—there is a lot of agreement between us about what needs to happen. I recognise that the shadow Secretary of State is not personally responsible for what happens in Wales, but his party is, and a Keogh review of high mortality hospitals, a chief inspector of hospitals for Wales and a commitment to the whistleblowing measures announced today would do a lot to allay the concerns of my hon. Friend’s constituents that the lessons about openness are not being learned across the border.

[Charlie Elphicke (Dover) (Con)]

Does the Secretary of State recall that the Care Quality Commission found that in East Kent hospitals senior management and the front line were disconnected, there were problems with bullying and harassment, and people would not say how things could be improved, including in terms of clinical risk? Does that not indicate that this is not just about whistleblowers, but that it is important that management sets a culture of openness, and listens and hears the staff voice?

[Mr Hunt]

My hon. Friend is absolutely right, and I thank him for his interest in his local hospitals and his campaign for them. In the end, culture comes from the top. When people start a job they look at the values of their direct line manager and they copy them, because they think that is what it takes to get on, and the line manager looks to the chief executive and the chief executive in the end looks up to the Secretary of State, so it is very important—[Interruption.] I grant that that may not be the best thing. It is important that right from the top we set the right example about these issues.

NHS (Government Spending)

Charlie Elphicke Excerpts

Wednesday 28th January 2015 Commons Chamber

[Chris Leslie]

The right hon. Gentleman raises a number of issues there. He has plenty to puzzle over, and he will always be a puzzled individual. The bigger question is where is the Secretary of State for Health when we are talking about these particular issues? [Hon. Members: “There!”] There he is. He is so anonymous he just did not make any impact on me whatever. I am delighted that he has walked in. He is quite unforgettable, isn’t he?

The NHS has experienced problems not just in accident and emergency departments, as has been said, but across a series of services: missed cancer treatment targets for three successive quarters—15,000 people having to wait longer than the recommended 62 days to start their cancer treatment in the past year. It has not always been like this.

[Charlie Elphicke (Dover) (Con)]

rose—

[Chris Leslie]

The Government inherited a situation in which 98% of patients were seen in accident and emergency departments within four hours. While one in four patients is now waiting a week to see their GP, when Labour left office the vast majority were seen within 48 hours. In January, we know that 14 NHS trusts declared major incident status. [Interruption.] The urgent question today did not really provide the opportunity to clarify the exact words in the NHS England document, so I want to take this opportunity to do so on behalf of my right hon. Friend the shadow Secretary of State.

[Charlie Elphicke]

rose—

[Mr Speaker]

Order. Members shouting, and then expecting to intervene, do not display great wisdom. The hon. Gentleman can probably do better, and he should certainly try to do so, within the limits of his capacity.

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[Chris Leslie]

I am glad that my hon. Friend mentions the situation with GP numbers, which is another factor in the NHS infrastructure being under such pressure.

Let us look at what has been happening with GP numbers, which are not keeping up with demand in the rising population. In 2009, there were 62 GPs for every 100,000 people; that has now fallen to 59 and a half GPs per 100,000 people. We have also seen cuts to GP training. It is no wonder that the Government ditched the 48-hour guarantee for people to be able to see a GP.

[Charlie Elphicke]

rose—

[Chris Leslie]

I will give way to the hon. Gentleman if he can explain why the Government dropped the pledge that patients, including his constituents in Dover, should be able to see their GP within 48 hours.

[Charlie Elphicke]

Can the hon. Gentleman explain why he, rather than the shadow Health Secretary, is leading this debate? Is it because the shadow Health Secretary is reported to be clinging to his job, without any guarantees from the Leader of the Opposition?

[Chris Leslie]

There you have it, Madam Deputy Speaker. Government Members are not concerned in any way about the state of the NHS or about GPs, but only about asking questions about procedure and process. I am here today because the shadow Treasury team, like every shadow departmental team on the Labour Front Bench, is committed to supporting our NHS and to making sure that we get the investment that is needed.

Why is the situation so fragile? The Government scrapped NHS Direct and fragmented it into 46 separate, cut-price 111 contracts, which does not ensure that 60% of calls are dealt with by medical staff. That figure is now down to 20%. It is no wonder patients are so quickly being driven back to—[Interruption.]

--- Later in debate ---

[Dr Poulter]

I am going to make some progress. I will give way to the right hon. Gentleman later. I have been very generous and I need to make some progress. I remind him that under the previous Labour Government, as my hon. Friend the Member for St Austell and Newquay (Stephen Gilbert) highlighted quite rightly, NHS providers were paid less than private sector providers. The right hon. Gentleman and the previous Labour Government paid the private sector 11% more than the NHS for performing the same NHS operations—something we have clearly outlawed under our legislation.

If we needed a further reminder of what Labour does when it runs the health service we need only look at Wales today, where almost every indicator of NHS performance shows that the Welsh NHS, run by Labour, is performing poorly when compared with the NHS in England. While we protected and increased our NHS budget in England, Labour in Wales has cut the NHS budget and patients are paying the price. Thanks to Labour in Wales, people have to wait about 100 days longer than patients in England for knee and hip operations. On finances and on care, Labour has let down our hard-working NHS staff and patients in Wales by its lack of investment in front-line services.

[Charlie Elphicke]

Will my hon. Friend give way?

[Dr Poulter]

I will give way one more time, but I do need to make some progress.

[Charlie Elphicke]

I am sure the Minister would agree that the shadow Health Secretary could have opened this debate, rather than trying to intervene now in a desperate way. Does my hon. Friend also recall the shadow Secretary of State, when he was Health Secretary in 2009, saying that we can

“move beyond the polarising debates of the last decade over private or public sector provision”?

That is what he said then. What does he say these days?

[Dr Poulter]

My hon. Friend is absolutely right. The fact that the shadow Health Secretary’s colleague, the hon. Member for Nottingham East, opened the debate perhaps shows a lack of confidence. The shadow Health Secretary’s record is very difficult to defend.

--- Later in debate ---

[Charlie Elphicke (Dover) (Con)]

When I was first campaigning in Dover and Deal, I found that the previous Government’s legacy was that they had run down the much-loved Buckland hospital in Dover. Wards had been axed one by one; services had been withdrawn one by one; and the hospital had been decimated for more than a decade. There had been talk of plans to build a new hospital, but they had gone nowhere for the better part of a decade. It was a total disgrace; we did not get a fair share of health care in Dover and Deal.

In addition, an agreement appeared to have been made by the hospital trust in 2006 to take away the out-patient services at Deal’s hospital. There were claims of a consultation with the then MP and the then elected representatives to withdraw those out-patient services. So when I was elected I faced a situation where the hospital trust wanted to axe out-patient services and people were very concerned that Deal’s hospital was so undermined that it would be lost altogether. That was unacceptable.

What did the Conservatives do about it? Thanks to our funding of the NHS—the amount of money we have put in and the increase in spending in real terms—we managed to get a new hospital built and it opens in March. That is a real achievement, ensuring that we will have a fairer share of health care back in Dover. After the years of going backwards, we will go forwards, and people in our community will be able to be seen and cared for in our community. Rather than have Deal’s hospital being run down and closed, as people feared, because Labour left it teetering on the edge, we campaigned hard.

I undertook a large survey across the whole of Deal and I listened to people’s views. Thousands responded and we had hundreds in a meeting in a church to listen to the doctors and put the case for keeping the hospital, and now the clinical commissioning group, using its new funding powers, is ensuring that that hospital is safeguarded for the future. In that way, under the Conservatives, we have safeguarded Deal’s hospital and we are getting a new Dover hospital.

We also had difficult times in our local hospital trust—the East Kent Hospitals University NHS Foundation Trust had the CQC come in and investigate. In the past there would have been a cover-up and things would all have been swept under the carpet, just as they were in Staffordshire. That was the disgrace under the previous Government; the shadow Health Secretary oversaw that shameful episode. This Government have been open, honest and frank about the situation, and have ensured that special measures are taken and that we will have more nurses, more investment and better health care as a result. That is an important milestone. It shows not only that we have a new Dover hospital and that we have safeguarded Deal’s hospital, but that we have a better trust thanks to the reforms the Government have put in place.

But I think we should go further. I want to see five-star health care in Dover and Deal, so that rather than the cold wards of old, we should have new individual care and recovery suites, which can enable flexibility. People could be there for short-time observation; for step-down care for a week or two, rather than blocking up the acute hospital; for re-ambulation over a two to three-month period; or for much longer-term palliative care or perhaps end-of-life care. I am working with Kent county council, the local CCG and other health stakeholders to examine how we can bring forward that sort of innovative proposal. It will help with NHS funding because it will save money lost through bed-blocking; it will save money because its beds will be less expensive than elsewhere in the NHS; and it will provide a better experience for patients because they will be able to get better and recover within the community.

We need to rethink A and E more generally, by having more local emergency centres. My plan is that at the new Dover Buckland hospital, which opens in March, we should see a local emergency centre being used as an out-of-hours base for the doctors and CCG. It should be beefed up so that it has a much more emergency flavour to it, rather than a minor injuries one, so that more people use it, more people have trust and confidence in it and fewer people will inappropriately admit themselves to A and E down the road in Ashford. In that way, we will be able to get the right kind of cascading, the right level of treatment and the right places, given how our health system works. Such an approach would allow simpler stuff to be carried out more locally in our communities, whereas the more complicated accident and emergency problems would be dealt with in a more centralised A and E unit. That kind of modernisation in how we deal with out-of-hours care and A and E-type care is something I hope we will think about and see more of in future. I do not see this as a left/right issue, just as I do not see community hospitals, which I believe in, as a left/right issue. I see it as being about people who are concerned about localism, and the localisation of health care and bringing it closer to the patient and to the community. That is the way we should be building the future of our NHS. It is a great shame we have seen so much politicisation and weaponisation of this—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. I call Grahame M. Morris. You have five minutes.

[Grahame M. Morris (Easington) (Lab)]

I am pleased to follow the hon. Member for Dover (Charlie Elphicke). I wish to make it clear that I have chosen to be here in the Chamber today to participate in this important debate rather than attend the Health Committee, which is also considering important matters, because I feel that we need to set out our view of the direction of the health service.

I was very interested in some of the hon. Gentleman’s views about fair funding. Having experienced NHS funding under the Conservatives and Liberal Democrats, I must say that my view is rather different. After the general election in 2010, the funding for a brand-new hospital that would have served my constituency—it was to be funded not through the private finance initiative scheme but by NHS capital—was cancelled by the present Government. It is an absolute disgrace that we still do not have modern facilities to serve my constituents and those of neighbouring constituencies. It prompts us to ask whether fair funding or some kind of gerrymandering is being applied.

The hon. Gentleman was talking about opening urgent treatment centres. That is a revelation to me because the two centres that opened in my constituency under the previous Labour Government are now threatened with closure. We have neither a modern hospital nor modern facilities.

I am proud to say that, although I am not a doctor, I did work in the health service. Like my hon. Friend the Member for Heywood and Middleton (Liz McInnes), I worked in a pathology laboratory, doing some important diagnostic work. I am proud of the people who deliver that service; I think they deserve enormous credit.

The creation of the NHS is Labour’s proudest achievement. More than anything else—more than football or cricket—it is what binds us together as a nation. The principle of a free national health service, which is free at the point of use, has huge popular support among the general public.

When the Prime Minister said that his priorities could be summarised in three letters—NHS—we might have been forgiven for thinking that the Conservatives had been transformed and had come to cherish the NHS as much as the British people do. But, with fewer than 100 days to the general election, it is apparent that his words were nothing more than a smokescreen. It is clear that the Government knew that they could never go into a general election stating their true intentions. Now, we have been accused of weaponising the NHS.

[Charlie Elphicke]

Yes, you have.

[Grahame M. Morris]

I would rather weaponise it than privatise it, which is what I accuse the Government of doing. That would not have been possible without the active support of the Liberal Democrat party—talking of which, the hon. Member for Redcar (Ian Swales) has just taken his place in the Chamber. I feel bitter about what has happened. The hon. Gentleman and I both served on the Health and Social Care Bill, which has now been enacted. The lead advocates were the right hon. Members for Chelmsford (Mr Burns) and for Sutton and Cheam (Paul Burstow). That Act was a really dangerous move, because part 3 opened up our national health service to the full force of competition. Conservatives may say that the difference is only marginal, but the truth is that that Act allows hospital trusts to have up to 49% of their income come from private patients.

I know that we are desperately short of time, but I want to set out some political dividing lines. Labour and the Conservatives are making very different offerings for the NHS. Labour’s offering is that it will provide more nurses and GPs, and I think it will find favour. In the next general election—

Oral Answers to Questions

Charlie Elphicke Excerpts

Tuesday 13th January 2015 Commons Chamber

[Charlie Elphicke (Dover) (Con)]

6. What assessment he has made of the level of improvement made by East Kent Hospitals NHS Trust since it was put into special measures.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I am pleased to report that East Kent Hospitals NHS Trust has started to make good progress since it was placed in special measures last August. That includes improved incident reporting rates, a revised policy enabling staff to raise concerns, and the creation of a cultural change programme.

[Charlie Elphicke]

Does not the Secretary of State’s answer highlight the fact that the best way of dealing with long-term and deep-set problems is to put patients first and ensure that there is a culture of transparency? Does that not contrast sharply with the denial and cover-ups that we have seen too often in the past?

[Mr Hunt]

Absolutely. I think that what shocks people is Labour trying to make political capital out of winter pressures in the NHS, and then sweeping the poor care that happened on its watch under the carpet. We are making great progress at East Kent Hospitals NHS Trust: there are 82 more nurses, and more than 100 more doctors. That is because we are facing up to the problems, not running away from them.

A and E and Ambulance Services

Charlie Elphicke Excerpts

Thursday 18th December 2014 Commons Chamber

[Mr Hunt]

We are doing a number of things. I have spoken to people in the Bristol area about what we need to do to improve the situation there and I assure the hon. Lady that we are focusing on it. It is partly why we are putting in £700 million this year to help hospitals to cope with those pressures. We have a brand-new hospital in Bristol as well, and it has had some teething problems, but I am confident that the staff there are working incredibly hard to turn the situation around.

[Charlie Elphicke (Dover) (Con)]

In Dover, we are looking at ways of reducing the pressure on A and E through the Prime Minister’s “8 till 8” challenge fund, and at upgrading the minor injuries unit to create a local emergency centre. Is that not a more fruitful thing to do than simply revelling in the winter problems in the NHS, as the Opposition have been doing?

[Mr Hunt]

My hon. Friend is right. The NHS wants to know that it has a Government who have a long-term plan for the NHS, who are prepared to fund that plan and who have thought about the long-term solutions. Better access to GPs is one of the key things, as is access to a GP who actually knows about the patient and their condition. Sadly, we lost named GPs following the changes to the GP contract in 2004, but I am proud to say that, from next April, we will be bringing them back.

Oral Answers to Questions

Charlie Elphicke Excerpts

Tuesday 25th November 2014 Commons Chamber

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

I will absolutely look at that case, and I am happy to talk to the hon. Gentleman about it. This is precisely why we are introducing, for the first time ever, an access standard—a maximum waiting time of six weeks for access to psychological therapies from next April.

[Charlie Elphicke (Dover) (Con)]

T8. After all the cover-ups of the past, what is being done to ensure that the culture of the NHS is always improving, particularly in that patients are treated with dignity and respect and always have the highest standards of safety?

[Mr Hunt]

I thank my hon. Friend for his question. After the Francis report, we now have 5,000 more nurses on our hospital wards. The scores that patients themselves are giving for whether they are treated with dignity and respect are up by 10%. We want to put poor care behind us and behind the NHS. It is time that Labour got on board with this agenda instead of constantly saying that we are running down the NHS by sorting out poor care.

Five Year Forward View

Charlie Elphicke Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

I am very happy to look into that. I recognise that all clinical commissioning groups face very real financial challenges to balance their books. That is why the report is so important, because it says that we cannot go on like this for ever and we have to look at changing the model decisively. It addresses the three things that could give hope to the hon. Gentleman’s CCG: increased real-terms funding based on a strong economy; more imagination in looking for efficiencies; and innovation and technology. We are absolutely committed to doing those things.

[Charlie Elphicke (Dover) (Con)]

In my constituency Deal hospital was left under threat of closure. It has now been safeguarded. Our acute hospitals had a Care Quality Commission inspection to identify problems, which have been dealt with; they were not covered up. Dover hospital, which was wrecked, is now being rebuilt. Will my right hon. Friend take a forward view of his diary and consider reopening that hospital at the opening ceremony in the spring?

[Mr Hunt]

If I possibly can, I will be delighted to do so. This is the pattern in many parts of the NHS that we do not hear from the Opposition Benches—where there have been problems in care year after year, they are finally being addressed. In my hon. Friend’s constituency and the hospitals that serve it he will be seeing more nurses and more doctors being employed and giving a higher standard of care, particularly to vulnerable older people. That is the kind of NHS that we should all welcome wholeheartedly.

Oral Answers to Questions

Charlie Elphicke Excerpts

Tuesday 21st October 2014 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. I just say to the Labour party that the time people wait to be seen at A and Es has reduced while the number of people going to A and Es has increased, but in the end it will not be sustainable unless we invest in out-of-hospital care, which is why we need more personal care by GPs. That is why we have brought back named GPs and why we have 1,000 more GPs than we did four years ago.

[Charlie Elphicke (Dover) (Con)]

May I welcome the outstanding treatment provided at the A and E at the William Harvey hospital—part of East Kent Hospitals University NHS Foundation Trust—which I attended on a family emergency during the summer, and note that the Care Quality Commission is getting striking improvements in East Kent, rather than the sort of cover-ups we used to see in the past?

--- Later in debate ---

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

Even in very difficult times this year, all NHS staff, either through their increments or through the 1% increase, will be getting a pay rise. Of course, we would like to do more, but the NHS finances are under pressure, and our priority is to ensure that we employ as many front-line staff as we can. We now have more than 13,000 more front-line staff working in the NHS than we did when we came into government.

[Charlie Elphicke (Dover) (Con)]

T6. Can the Secretary of State confirm to the House whether there are any plans to sell off the NHS and will the NHS remain free at the point of delivery?

[Mr Jeremy Hunt]

I can confirm that there are no such plans and it will remain free at the point of delivery. Nor do we have any plans to pay private providers 11% more than NHS providers, as happened under the previous Labour Government.