NHS Long-Term Plan: Implementation

Chris Leslie Excerpts

Monday 1st July 2019 Commons Chamber

[Matt Hancock]

Yes, my hon. Friend is absolutely right. The plan is of the NHS by the NHS for the NHS. We in Government will absolutely facilitate it and support it, and of course we are putting in the money, but the NHS as a whole should be very proud of what this plan proposes and the way the implementation is being done in such a rigorous fashion.

[Mr Chris Leslie (Nottingham East) (Change UK)]

May I press the Secretary of State a little further on the section of the plan that relates to prevention and early intervention? We are all waiting still for the prevention Green Paper. In particular, there are some diseases and illnesses, such as stroke, where apparently four out of five cases could be prevented by such early action, whether it is diagnosis of atrial fibrillation, or blood pressure and cholesterol testing devices. What more can be done for this Government to show they are serious about preventing ill health, such as stroke?

[Matt Hancock]

I completely agree with the hon. Gentleman. The whole plan—the whole NHS long-term plan—is about prevention as well as cure. The focus of the NHS needs to switch more towards prevention as well as, of course, helping people get better when they get ill. Taking the example of stroke, there is a lot on the prevention of stroke in the draft prevention Green Paper—just to give him a bit of a teaser for that. At the core of improving prevention of stroke is both behaviour change but also better use of data, because being able to spot people who have symptoms that are likely to lead to stroke can then help much more targeted interventions. I find it striking that with the big stroke charities, as with the big heart charities, their big ask is for better and more access to data.

Oral Answers to Questions

Chris Leslie Excerpts

Tuesday 19th February 2019 Commons Chamber

[Caroline Dinenage]

I do not agree with the hon. Lady. What the Government have done is try to tackle the geographical inequalities in care across the country. We have increased councils’ access to funding by up to £10 billion. That is a 9% real-terms increase in funding, but in addition to that, we have established a national threshold that defines the care needs that local authorities must meet under the Care Act. That has really started the work of eliminating the eligibility postcode lottery across England.

[Mr Chris Leslie (Nottingham East) (Ind)]

It is two years since the Government promised the social care Green Paper. In that space of time, we have had a lot of words from the Government, but we have also had a lot of neglect from them on this particular issue. Does not this delay, this prevarication, putting long-term issues to the back burner, typify what is wrong with the broken politics in this country?

[Caroline Dinenage]

First, I welcome the hon. Gentleman to his new location in the Chamber. From that location, he might recognise that actually, there has been a failure of successive Governments to get to grips with this very thorny issue of the long-term funding of adult social care. We are the Government who have decided to tackle the issue. We will no longer put it in the “too difficult” pile, and we will be publishing this document shortly.

Social Care

Chris Leslie Excerpts

Thursday 7th December 2017 Commons Chamber

[Jackie Doyle-Price]

I am very keen to approach this matter through consensus. To be frank, I do not think that we can deliver change without consensus. We have written to all-party groups in the first instance to engage with them. Over the course of the next six months, I hope to engage in conversations and discussions with Members from all parts of the House.

[Mr Chris Leslie (Nottingham East) (Lab/Co-op)]

Of course, there is a short-term series of pressures. The Minister has cited the CQC’s state of social care report, which talks about decreasing numbers of beds in nursing homes and contracts being handed back to local authorities because of the acute financial pressure. She has also recognised that there is a longer-term issue that all Members have alluded to—the need to set aside some of the yah-boo party politicking and find a cross-party way forward. The hon. Member for Totnes (Dr Wollaston), the right hon. Member for North Norfolk (Norman Lamb) and my hon. Friend the Member for Leicester West (Liz Kendall) wrote to the Prime Minister saying, “Let’s have a convention across all the parties on social care reform.” Please will the Minister talk again to the Prime Minister? Let us do that, because it is the only way that we will really crack through this problem.

[Jackie Doyle-Price]

I welcome the spirit in which the hon. Gentleman makes his comments. It is fair to say that we are hearing exactly the same sort of plea from local authorities, which are at the front end of dealing with this problem. He is absolutely right that we need to separate the short-term pressures from the long term, and we ought to be able to have a more sensible conversation on the long-term pressures. Yes, let us save the politics for the short term and have consensus for the long term.

Oral Answers to Questions

Chris Leslie Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. We want to attract the brightest and best into the NHS from all over the world, wherever they come from, if there is a need. The only caveat I would make is that we have imported a number of doctors from very, very poor countries that actually need those skills back home. We have to recognise that we have international responsibilities to make sure that we train the number of doctors and nurses we need ourselves.

[Mr Chris Leslie (Nottingham East) (Lab/Co-op)]

The Secretary of State should know that staff shortages are not just bad for patients—they are also costing a lot more, in Nottingham and elsewhere, because of locum and agency costs. Is it not clear that if we start restricting access from the EU for staffing purposes, it will cost the NHS an absolute fortune more?

[Mr Hunt]

Let me reassure the hon. Gentleman that there is no intention to restrict access to vital professions such as the clinical professions in the NHS post-Brexit. We have said many times that we will have a pragmatic immigration policy. The long-term solution is not to depend on being able to import doctors and nurses from anywhere, because the World Health Organisation says that there is a worldwide shortage of about 2 million clinical professionals; we are not the only people facing the challenge of an ageing population.

NHS Shared Business Services

Chris Leslie Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

I am very happy to do so. Clearly, when we are all able to access our health records electronically, there are potentially huge benefits for patients. In particular, people with long-term conditions who use the NHS a lot would be able to take more control of what happens and also to spot mistakes, which sometimes happen in medical records—that is one of the big findings from the US, where people have had more widespread access to electronic records for longer. The issue is the security with which people access those records online, and we are looking very closely at the systems used by banks, for example. Those are pretty robust, but we are looking at whether we can have systems that are even more robust, because it is very important that patients have confidence that only they and those they give permission to can access those records.

[Chris Leslie (Nottingham East) (Lab/Co-op)]

Can the Secretary of State tell us a little more about which areas in the east midlands have been particularly affected? Given the opaque and byzantine structures of the NHS, can he specifically tell the House which member of his ministerial team had the job of keeping watch on NHS Shared Business Services?

[Mr Hunt]

The Minister responsible is the Under-Secretary, my hon. Friend the Member for Oxford West and Abingdon. This case happened before she was in post, so I took personal responsibility given it was such an important issue. I will write to the hon. Gentleman with more details about how the east midlands has been affected.

Mental Health and NHS Performance

Chris Leslie Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I would probably use the word “streaming”, rather than gatekeeper, to ensure that we have good, alternative offers for people who do not need to be in A&E. Frankly, it is not safe for an A&E department to have people there for six, seven or eight hours with a minor injury and no urgent health need. It is distracting for staff and can make it more difficult for them to deal with people who have more immediate needs.

On distances travelled, as the Prime Minister said this morning it is completely unacceptable for people to have to go 400 miles for a mental health bed. What is the solution? We are commissioning more beds, but the actual solution is to intervene earlier so that people do not get to that stage in treatment where they need in-patient care. We know that if we intervene earlier we can in many cases head off that need and help people to get better more quickly.

[Chris Leslie (Nottingham East) (Lab/Co-op)]

This afternoon, patients at Nottingham’s Queen’s Medical Centre emergency department are waiting on average for more than four hours. In the last month for which figures are available, 3,500 people had to wait for more than four hours in the emergency department. We cannot go on like this, so will the Secretary of State agree to fast-track the capital we need to increase capacity at Nottingham’s emergency department?

[Mr Hunt]

I will happily take a look at that. Obviously, when it comes to the allocation of capital, we prioritise any projects that will help us to improve the situation in A&E departments and reduce the stresses.

Oral Answers to Questions

Chris Leslie Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Dunne]

We believe that the right approach to securing procurement savings is to take advantage of the immense amount of data available across the NHS. That is why we have set up the purchasing price index benchmarking tool. Data on more than £8 billion of expenditure, covering over 30 million separate procurement transactions, has been collated and will be analysed. We will use that information judiciously to save the taxpayer money. We think that that is the right way to start, rather than naming and shaming.

[Chris Leslie (Nottingham East) (Lab/Co-op)]

I urge the Minister, when thinking about national procurement and national commissioning, to look at the national strategies that can underpin them—for example, at why we need to renew the national stroke strategy. Some 100,000 people a year suffer a stroke, and nearly 1 million people in this country have had a stroke. They care very much about rehabilitation and other services.

[Mr Speaker]

The Minister’s challenge is to relate that very important matter to the equally important issue that happens to be the subject of the question: procurement.

Oral Answers to Questions

Chris Leslie Excerpts

Tuesday 5th July 2016 Commons Chamber

[Jane Ellison]

The hon. Gentleman, who knows a great deal about these matters, is right. Incentivising discovery is absolutely at the heart of the O’Neill review. O’Neill has made a series of recommendations about unblocking the drugs pipeline, and we will respond to that in full. It is a critical issue. In the meantime, conservation of the antibiotics we have and sensible prescribing is critical to making sure that, as the hon. Gentleman says, drug-resistant strains of gonorrhoea, for example, do not take hold.

[Chris Leslie (Nottingham East) (Lab/Co-op)]

This is an incredibly important issue on which I urge the Minister to communicate with the public more effectively, because inappropriate use of antibiotics could have severe effects. Some of the medical interventions that are reliant on antibiotics, whether gut surgery, joint replacements, caesarean sections or chemotherapies, could become too dangerous to perform if we do not get this right.

[Jane Ellison]

That is exactly right. Things we take for granted now could become risky procedures again. Globally, old diseases could make a comeback because of drug resistance—diseases such as TB which, around the world, people are winning the battle against. This is why it is so important to pay tribute to the Prime Minister’s foresight in commissioning the independent review and taking this issue global. The Government, along with the chief medical officer, are championing this at an international level, but, at the same time, we are not resting closer to home, where we are working with GPs and so on to deal with the prescribing issue. However, it is a big challenge and the hon. Gentleman is right to highlight it.

Defending Public Services

Chris Leslie Excerpts

Monday 23rd May 2016 Commons Chamber

[Mr Hunt]

My right hon. and learned Friend speaks with great wisdom, as he did during the junior doctors’ strike. Perhaps that is based on his experience of featuring in a BMA poster, which was put up across the country, as someone who ignored medical advice, because he smoked his cigar.

My right hon. and learned Friend is absolutely right. The crucial issue for the future of the NHS is the simple statistic that by the end of this Parliament we will have 1 million more over-70s to look after in England, and their needs are very different from those of the population whom we had to look after 20, 30 or 40 years ago. In particular, their need to be looked after well at home, before they need expensive hospital treatment, is a transformation. That is why a core part of what we are doing is to transform the services offered in mental health and in general practice, which I will come on to a bit later.

[Chris Leslie (Nottingham East) (Lab/Co-op)]

While the Secretary of State is talking about transformation, let me say that I agree with the right hon. and learned Member for Rushcliffe (Mr Clarke) that we have to start focusing on quality. In the east midlands, for example, the ambulance service has just been judged by the Care Quality Commission to be inadequate when it comes to patient safety. Things are in a real state of difficulty in our NHS. Ambulance services need improvement; what is he going to do about it?

[Mr Hunt]

I absolutely agree with the hon. Gentleman. In fact, I wanted to come on to talk about that perceived tension between money and the quality of care. Until three years ago, we did not have an independent inspection regime to go around ambulance services and tell the service, the public, constituents and Members of Parliament how good the quality of care is in each area. The first step is to have that inspection regime so that we know the truth, and then things start to happen, as is beginning to be the case in ambulance services across the country.

The big point—this is precisely what I wanted to move on to—is the worry, which is shared by many people, that an efficiency ask of this scale might impact on patient care. They should listen to the chief inspector of hospitals, Professor Sir Mike Richards, who points out that financial rigour is one of the routes to excellent quality, and that there is a positive correlation between hospitals offering the best care and those with the lowest deficits. In other words, it is not a choice between good care and good finances; we need both.

ACCESS TO MEDICAL TREATMENTS (INNOVATION) BILL

Chris Leslie Excerpts

Wednesday 16th December 2015 Public Bill Committees

I want to make two other comments. One is about need, and the extent to which fear of negligence is a barrier to innovation. As you may know, Mr Streeter, if I went on “Mastermind”, one of my chosen subjects would be barriers to innovation in the late 20th and early 21st century NHS. I do not want to detain the Committee with—

[Chris Leslie (Nottingham East) (Lab/Co-op)]

You’ve started, so you should finish.

[George Freeman]

As the hon. Gentleman says, I have started so I had better finish. Let me wrap up a lifetime’s work by saying that there are many barriers to the uptake of innovation in the system. It is clear from pretty substantial anecdotal evidence from people on the frontline that latterly, the fear of unreasonable charges of negligent practice features in their consideration. Some institutions—partly for other reasons to do with tightening up commissioning processes and clarifying and rationalising—have given clinicians instructions such as, “We don’t want you to do anything other than these things; by the way, if you did, you might put us in a difficult position and we’d have to make sure we could defend possible litigation claims.” That is often used, anecdotally and apocryphally, to support a more general presumption about sticking to what we know works and what we have always done.

My hon. Friend the Member for Daventry is partly trying to tackle a culture that is rather difficult to prove and ill-evidenced, but that we none the less picked up in the consultation. In my 15-year career, clinicians said to me, “We used to have a culture that was a bit more conducive to innovation, but we’re all now slightly treading on eggshells and worried about any attempt being misconstrued.” I do not want to suggest that such fear is the No. 1 issue or the most important priority. This is a private Member’s Bill. If I were introducing a Government Bill on access to innovative medicine, I would have measures on a number of other issues before that one, but I respect that there is a cultural fear that innovative practice is less encouraged, promoted and supported, which we picked up in the consultation.

That is one thing that I, as a Minister, am keen to tackle through our work at the Department of Health to sponsor the National Institute for Health Research. The Prime Minister and I have set out a strategic objective: every hospital a research hospital, and every patient a research patient. We do not mean that every patient should be experimented on; we mean that, in an intelligent health system, we should be learning from every moment that we treat patients in the NHS.

I do not think fear of litigation is the No. 1 barrier to innovation, but equally, in an open democracy, Members are free to promote legislation on their own account. I have supported the attempt of my hon. Friend the Member for Daventry to have a debate and find a way of accelerating the uptake of innovation because it is a noble purpose.

I hope that what I have said is helpful and clarifies where I think the barriers are and are not. The bigger barriers are siloed funding, strict and specific commissioning structures, organisational barriers between people who diagnose and people who treat and a lack of integrated funding—all the things we spend our time trying to tackle. It is important that the chief medical officer supports the Bill and that Sir Bruce Keogh has said he is absolutely sure that it is safe; he has advised the Secretary of State and I to that effect.

The Bill was in some ways preceded by a different one: Lord Saatchi’s Bill in the House of Lords, which generated a lot of attention and interest. This is a very different Bill. Lord Saatchi’s Bill set out provisions for a registry, which came late in the process of Lords scrutiny of that Bill, with the thinking being, “Oh, we’d better keep a register of innovations that flow as a result of this Bill.”

If I understand it correctly, my hon. Friend’s purpose is different, and I support him strongly in it, because this is another passion of mine. It is not about creating conditions in which every medic is exhorted and encouraged to experiment and record that in a database—that is absolutely not the right approach or what the Bill seeks to do. Importantly, the wording of the preamble in the opening clause focuses the Bill on something quite different, which I support: the provision of information to clinicians on innovative medicines coming on stream that are either in research trials, which doctors might want to enrolling their patents in, or off-label uses of drugs. No clinician can be expected to keep in their head 24/7 information about all the innovative medicines out there or, indeed, unlicensed medicines that might be available through the early access to medicines scheme that I launched. That wording intends to clarify that the Bill is different from Lord Saatchi’s Bill, with a focus on giving clinicians access to information about treatments that they consider their patient might be eligible for. For me, that is the best bit of the Bill, and I would strongly support the Committee in continuing to debate it.

The hon. Member for Torfaen proposed a Bill, which did not get a Second Reading, that sought to promote off-label use of medicines. A database for clinicians that gave them, at the click of a mouse, access on their desktop to information about innovative medicines that are available—or, indeed, about off-label, innovative uses of existing medicines—would be a powerful tool to help promote innovation.

[Chris Leslie]

I am focused on the amendments. Will the Minister give us his view on whether he supports amendments 1 to 4? That would help.

[George Freeman]

I do not. I am politely winding my way round to saying that. However, the reasons are important. It is not that I object to amendments at all—I hope the Bill will be heavily amended in Committee to reach that nirvana of all the parties—but, because the clause is important and helps to clarify the Bill’s intention, I suggest that the amendments should not be pressed. However, we might work on a package of amendments on Report that tackle giving clinicians access to information about innovative medicines and the important points made by the hon. Gentleman.

--- Later in debate ---

[Justin Madders]

On amendments 3 and 4, I am happy to work with the hon. Gentleman and, if necessary, table an amendment on Report. I take what he says about this being a conferring Bill, but I think it was important for us to place on record our views about the importance of patient experience. We can have further conversations on that, and if we consider it necessary we will re-table those amendments. However, we will press amendments 1 and 2 to a vote.

I appreciate what the Minister said about the need to focus on innovation barriers. There is something in what he said about it being a cultural issue—there is no doubt about that. I do not think, however, that a piece of legislation of this nature is the right way to tackle that cultural issue. As I said in my opening comments, the Bill carries the risk of unintended consequences. We can all work together to try to tackle some of the barriers, but the Bill is not the way to do it.

Of course, the Minister has had the benefit of legal advice that I have not had on the impact on existing medical negligence law, but I am sure all members of the Committee have seen the representations from Nigel Poole QC, who is the leading authority on clinical negligence in this country. His view is that the Bill does make changes. We cannot get into a debate about who is right or wrong about that, but I focus on what the Minister said about how, even if the Bill only changes the perception of patient safety, that is important in itself. That alone is reason for us to pause and look again at the Bill, and that is why I will press amendments 1 and 2 to a vote.

[Chris Leslie]

To be absolutely clear on the effect of the amendments, as I read them, amendments 1 and 2 would delete the provisions about access to innovative treatment, but would retain the creation of the database. Have I got it right?

[Justin Madders]

Yes, my hon. Friend is absolutely correct. That is why we spent some time talking about those issues. They are really at the heart of the concerns.