Children’s Oral Health

Colleen Fletcher Excerpts

Tuesday 31st October 2017 Westminster Hall

[Colleen Fletcher (Coventry North East) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone.

I congratulate my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) on securing this debate on child oral health and tooth decay. I agree with all his comments, in particular those about sugar consumption and supermarket offers on high-sugar products. Anyone who has been in a supermarket over the past couple of weeks will have seen the huge amount of Halloween offers on sugar products for children for trick or treating—“two for one” or “buy one and get four free” and so on.

Poor oral health is an extremely important yet too often ignored issue that represents a major public health challenge, both in relation to its adverse impact on our children’s health and wellbeing and to the NHS budget and wider resources. We have already heard that when it comes to oral health, too many of our children quite literally have nothing whatever to smile about. Every area of the country is affected by poor childhood oral health to varying degrees, including Coventry, the city that I represent. The proportion of five-year-olds in Coventry with tooth decay stands at almost 30%, which is considerably higher than the England national average of 25%. Worryingly, the proportion of hospital admissions for tooth extractions in the city has increased by a massive 60% since 2010.

Children with poor oral health are likely to have decayed, missing and filled teeth that can cause severe pain, infection, sleepless nights, weight loss and developmental problems. But not just their physical health is adversely affected; they also often experience psychological problems such as low self-esteem, a lack of confidence, conduct disorders, reduced school performance and social functioning, and an increase in bullying. These physical and psychological problems combined are likely to have a huge impact on a child’s life and even on their long-term life chances, as we have heard.

There are significant pressures on NHS services and finances. Tooth decay is the leading cause of hospital admissions for young children and the NHS wastes hundreds of hours and millions of pounds each year dealing with the consequences of the problem through tooth extractions that range from a single tooth to full mouth clearances—a dreadful thought in children so young. All that proves that the economic costs of childhood tooth decay are as unsustainable for the NHS as the human costs are unacceptable for the child.

We can stop tooth decay in its tracks, because it is almost entirely preventable, as we have heard. We can tackle the problem by providing better oral health education, by improving public awareness of and access to children’s dental services and by addressing poor diet—particularly excessive sugar consumption. I agree with all the measures to prevent tooth decay that have been mentioned. But clearly, the statistics show that more needs to be done. Simple preventive steps and accessible information can mitigate the impact of poor oral health both on the individual and on our health services. Surely we can all get behind that.

Tobacco Control Plan

Colleen Fletcher Excerpts

Thursday 19th October 2017 Commons Chamber

[Stephen Kerr (Stirling) (Con)]

With your kind permission, Madam Deputy Speaker, as a Scottish MP I hope to make a short contribution to the debate on a tobacco control plan for England. I shall make some reference to the situation in Scotland, to highlight the cost of smoking in human suffering and death, as well as the cost impact on public health budgets and the overall economy. I welcome the debate on this vitally important matter and congratulate the right hon. Member for Rother Valley (Sir Kevin Barron) on securing it. I also applaud the Backbench Business Committee for granting the time.

The tobacco control plan builds on the successes of the previous control plan, established by the coalition Government, and aims to herald a smoke-free generation—I say that while recognising that much yet needs to be done. I wholeheartedly support the principle of preventative spending on early intervention, which can prevent negative health outcomes later in life. I also welcome the investment in tackling ill health and recognise that it has the potential to save a significant amount of public spending in the long term and can help to reduce health inequalities. I do not underestimate the power of addiction. For that reason, I feel that where there is a will to stop smoking we should do everything possible to help people to help themselves.

I welcome recent falls in the number of adults who smoke in England and Scotland, and the number of children exposed to second-hand smoke. However, smoking rates in Scotland are still higher than in England, and we must be prepared to do much more to reduce this figure. Currently in Scotland, tobacco use is linked to 10,000 deaths a year.

On e-cigarettes, I am a firm supporter of having a robust regulatory framework, which ensures all devices are safe and acknowledges their potential use in smoking-cessation programmes. I welcome the fact that earlier this year the Scottish Parliament voted to ban the sale of e-cigarettes to under-18s and to limit advertising, moves I fully support because they will protect the health of our young people.

On the tobacco control plan for England, I acknowledge that the previous plan reduced adult smoking rates in England from 20.1% to 15.5%. That is indeed progress. I also applaud the ambition in the plan to reduce adult smoking rates from 15.5% to 12% or less by 2022. It is welcome that the plan is supported by the British Heart Foundation, which recognises it as an important tool in reducing the rate of strokes and heart disease. I compliment the Government on the fact that the World Health Organisation has designated England as one of the best places in the world to give up smoking. The strategy is based on a joined-up approach between the NHS, the Department of Health and local government. That can only be good, too.

I welcome the ambition of the plan to reduce the number of 15-year-olds who regularly smoke from 8% to 3% or less; reduce the smoking rates among adults in England to 12% or less; reduce the inequality gap in smoking prevalence between those in lower paid, routine and manual occupations, and those in higher paid professional and managerial occupations; and reduce the prevalence of smoking in pregnancy from 10.7% to 6% or less. I also applaud making all mental health in-patient service sites smoke-free by 2018, as was mentioned by my hon. Friend the Member for Witney (Robert Courts). It has been a source of frustration for me for many years, as I am sure it has been for other Members, to visit hospitals for various reasons and find people congregated around the entrances, often having been escorted there by health workers who I am sure would prefer to be doing more productive things. I also welcome the ambition of permitting innovative technologies than minimise the risk of harm and maximise the availability of safer alternatives to smoking.

I hope we all support the idea of creating a smoke-free generation without any reservation. Effectively enforcing existing legislation on proxy purchasing and standardised packaging to reduce the uptake of smoking among young people is a very noble objective. Supporting pregnant smokers to quit, which will undoubtedly increase the life prospects of children yet unborn, and reviewing the sanctions for retailers who consistently break the law designated to protect young people from smoking, is welcome. As the right hon. Member for Rother Valley mentioned in his opening speech, in 2016 it was estimated that 2 million people had used e-cigarettes and had completely stopped smoking—that must be very good news—while at the time a further 470,000 were using them as an aid to quit.

In 2013, the Scottish Government introduced a five-year tobacco control strategy entitled “Creating a Tobacco-free Generation”. It set the target to reduce smoking prevalence in Scotland to 5% or less by 2034—again, a very ambitious and welcome target. The strategy set out a range of measures to support young people to choose not to smoke, to protect children and all people from second-hand smoke, and to continue to support those who do smoke to quit. Actions taken by the Scottish Parliament in recent years to control tobacco, and to limit and tackle the harm caused by tobacco, include legislation to prohibit smoking in public places, which came into effect in March 2006; raising the age of sale for tobacco from 16 to 18 in 2007; implementation of a tobacco retail register in 2011; a ban on self-service sales from vending machines in 2013; and the introduction of a tobacco display ban in shops from 2013.

I turn now to the impact of smoking. According to Scottish Government statistics, tobacco use in Scotland is associated with more than 10,000 deaths and about 128,000 hospital admissions every year. According to the Office for National Statistics, smoking prevalence in Scotland among over-16s was 17.7% in 2016—an estimated 942,644 smokers—compared with the UK-wide smoking prevalence of 15.8%. Smoking prevalence in Scotland fell between 2003 and 2013 but has remained fairly static since. Some 35% of adults in the most-deprived quintile of the Scottish index of multiple deprivation smoke compared with 11% in the least-deprived quintile.

According to ASH Scotland, on average lifelong smokers die about 10 years sooner than non-smokers. The estimated cost to the NHS in Scotland alone is £323 million. According to the Scottish Public Health Observatory, for every 1 percentage point by which smoking prevalence is reduced, the NHS could save £13.4 million. One last set of numbers underlines the cost of smoking: ASH Scotland estimates that smoking costs Scotland around £1.1 billion annually, including £271 million in healthcare costs, £692 million in productivity losses due to active smoking, £60 million in productivity losses due to passive smoking, £34 million in clearing smoking-related litter and £12 million in fires caused by smoking in commercial properties.

[Colleen Fletcher (Coventry North East) (Lab)]

As an ex-smoker who went cold turkey many years ago, I agree with most of what has been said. Like many others, however, I come from a family where parents and grandparents smoked. I welcome all measures to help people to stop smoking. Does the hon. Gentleman agree that we need more investment in prevention, not least through public health budgets, but that those are now in the hands of local authorities, the cuts to which have been abominable over the years? Does he agree that more money needs to be invested in public health?

[Stephen Kerr]

I note in the plan the £16 billion commitment to funding public health programmes, in conjunction with local authorities in England, which is surely welcome news.

Preventing Avoidable Sight Loss

Colleen Fletcher Excerpts

Tuesday 28th March 2017 Westminster Hall

[Nusrat Ghani]

Of course. I will go on to mention children and the fact that it is necessary for them to be tested earlier than we previously believed they should be.

Wet age-related macular degeneration affects the retina and causes changes to central vision. In October last year, Jean Rugg’s eye clinic consultant told her that she needed follow-up treatment. She was told by the receptionist to expect the appointment in the post, but nothing arrived. By December, Jean was continually contacting the booking department and being turned away. She was told that she would not be booked in because the department was just too busy. Time passed. Jean noticed changes in her vision and was extremely worried about permanent damage to her sight. She was getting nowhere, so she contacted her consultant’s secretary and, after much urging, managed to secure an appointment with him to discuss her sight.

By that time, three months had passed. Jean’s consultant was alarmed that she had not received treatment sooner and explained that her vision could well have deteriorated due to the delay, as there had been further leakage of fluid into her eye. Jean needed an urgent course of injections, so the consultant took her to the booking department to try to secure an appointment that same week. They were both told that there were simply no spaces in the injection clinic. After repeatedly explaining the urgency of the matter, the consultant was eventually able to obtain an appointment for Jean the following week.

I am sure that the Minister agrees that that is just not good enough. That delay and lack of responsibility and urgency is just not acceptable. There are many more Jeans across the country. A 2014 survey by the Royal National Institute of Blind People showed that 86.5% of the public were more fearful of losing their sight than any other sense. As I said, 50% of all sight loss is potentially avoidable if treated early, yet NHS England does not give eye health the profile it deserves. There is no overarching NHS England-led strategy to govern it and push for more prevention of avoidable sight loss. There are equivalent strategies for hearing loss and dementia.

[Colleen Fletcher (Coventry North East) (Lab)]

The hon. Lady mentioned dementia, which is a growing problem, especially among elderly people, although not all elderly people. Sight loss can exacerbate or even mask symptoms for people with dementia. Correcting vision loss can help reduce the impact of dementia, at least in the early stages, and improve quality of life. Does she agree that policy makers and commissioners must seek to prioritise addressing sight loss for people who have dementia or are suffering its early onset?

[Nusrat Ghani]

I agree. We most definitely need to prioritise sight loss for all vulnerable people, including older people, who might also have mental health illnesses.

There are eye health strategies in place in Scotland, Wales and Northern Ireland; England is an anomaly. I therefore ask the Government to consider developing and implementing a national strategy for eye health in England. That would not require additional funding, but would be a commitment to improving the efficiency of eye care services and ensuring consistency across the country. It would enable the development of improved clinical leadership at clinical commissioning group level to prevent eye health from slipping down local commissioning agendas, enable closer partnerships between CCGs and local eye health networks, and aid commissioners to identify eye health priorities that respond to the needs of local populations.

The Department of Health and NHS England already do great work to support the voluntary sector-led England Vision strategy, but that is, by definition, limited in its ability to bring together all the relevant organisations in a joined-up way. In response to a written question that I tabled last week, the Department rightly explained that England’s size

“and the diversity of the health needs of different communities”

mean that commissioning is best “owned and managed locally”. I completely agree, but that should not be incompatible with strategic thinking from above by people who see the bigger picture, or establishing principles that local areas can fit to their circumstances.

Local commissioning must be coupled with national leadership. Leaving things to local commissioners is not working as well as it should. There is significant variation in the quality and quantity of services. For example, someone in Luton will wait for 15 days between their first attendance at a hospital out-patient clinic and their cataract surgery, but if they were in Swindon, they would wait not 15, 50 or even 150 days, but 180 days. That is a shocking difference. No doubt the Minister agrees that, again, that is just not good enough.

Small changes to guidelines and legislation would streamline the process for many patients. For example—my hon. Friend the Member for Twickenham (Dr Mathias) may have to help me out with my pronunciation—allowing orthoptists to sign hospital eye service spectacle prescriptions, rather than requiring ophthalmologists to sign them, would allow the delivery of effective patient care and reduce the number of appointments required to access spectacles.

Stem Cell Transplants

Colleen Fletcher Excerpts

Tuesday 24th January 2017 Commons Chamber

[Mark Tami]

Yes, I do. This is to do with how we assess the cost of treatment. I fully accept that the up-front cost of the transplant is a lot of money, but if that works the longer-term cost is not so great. However, we seem willing and able to fund drugs that might not cure people or extend their lives by very much, although the cost of them, when added up, might be more than the transplant. It is not right that we are saying to these people, “No, we’re not going to fund a second transplant”.

Sasha’s case is not unique, and there will be many more like hers if we do not change our position. Will the Minister please respond directly regarding Sasha’s case and those of others in the same situation? In the months and years ahead, there will be other people in this situation, and their voices need to be heard.

[Colleen Fletcher (Coventry North East) (Lab)]

I declare an interest in that my husband had a successful stem cell transplant in 2014. Does my hon. Friend agree that for patients with blood cancer, the fear of relapse causes great anxiety? Patients speak of a common feeling of dread when they go to collect routine blood results—that certainly resonates with me. Following NHS England’s decision, the thousands of patients who have received a first stem cell transplant now have the added fear that if the worst happens and they relapse, the NHS will not provide them with the treatment that would save their lives. I hope my hon. Friend and the Minister will acknowledge that this decision affects not only the 20 desperately ill patients a year who need a second transplant to survive, but the many thousands who live in fear of relapse every day.

[Mark Tami]

I certainly agree with my hon. Friend. From personal experience, I know that that is always a fear. Every time someone goes for a check-up on their blood, there is obviously a feeling at the back of their mind, “Let’s hope that everything’s okay.” It is a very rocky road.

I am sure that the whole House will wish Sasha well as she continues her journey. I pay tribute to my hon. Friend the Member for Erith and Thamesmead (Teresa Pearce), who has been working tirelessly to support Sasha and her family at this incredibly difficult time.

The Department of Health must accept responsibility in this case and others. Over the past few weeks, we have been told about the enormous pressures that the NHS is under during this winter crisis, with hospitals on black alert across the country, A&E waiting times being missed and cancer patients having their operations cancelled. Treatments such as second stem cell transplants are being rationed. I accept that the NHS is underfunded—perhaps it always will be, as I accept that it is always possible to spend more money—but we are now reaching a crisis. We really need to start to be honest and address issues such as social care. Until we do that and we are honest with everyone, we will not sort out the funding situation for the NHS. I am not making political points; I just want to say that we need to stand up for patients such as Sasha whose lives—it really is their lives—are at risk.

When NHS England originally announced its decision not to fund second stem cell transplants in July 2016, it caused outrage among patients and their families. More than 6,500 people wrote to their MPs and 18,000 signed a letter to the Secretary of State for Health in a bid to get the decision changed. In addition, 30 leading clinicians wrote to the editor of The Times saying:

“NHS England is ignoring the advice of the clinical community, thereby effectively handing most of these patients a death sentence”.

They were all ignored. As we know, NHS England confirmed its decision in December 2016.

On a positive note, the good news is that there is a chance to make things right. NHS England will look again at what it funds in the spring. I therefore urge the Minister and her Department to intervene to ensure that every patient who needs a second transplant can access one. As I said, we are not talking about huge numbers, but for the small number of people who are affected, this is their only chance.

I do not wish to pre-empt the Minister’s remarks, but I suspect that she may highlight that this was a decision taken by NHS England, not the Government. However, the Department of Health is ultimately responsible for the treatment that patients receive, and in the case of second stem cell transplants, access to that treatment has been denied.

I want to make three important points. First, as I have explained, second stem cell transplants are supported by the evidence. The treatment is standard practice in many countries, yet NHS England seems to have ignored that completely. It has also ignored the potential to offset much of the cost of a second stem cell transplant, as was pointed out earlier, owing to the cost of alternative treatments.

In its own impact assessment, NHS England acknowledged that the mortality rate among patients who were given alternative treatments “was extremely high”, and that, while the costs of such treatments were always “difficult to quantify” and varied according to patients’ circumstances, there was “considerable scope” to offset some of the costs of transplants if the costs incurred over a patient’s lifetime were taken into account. Moreover, a patient who had had a successful transplant was far more likely to return to, or join, the workforce, and pay back some of the costs. It is important to factor that in.

Secondly, NHS England has not been remotely transparent in its decision making. All it has said is that second stem cell transplants are

“not currently affordable and will not be routinely commissioned at this time”.

That tells us nothing about how NHS England reached its decision. Neither the minutes of the Clinical Priorities Advisory Group nor those of the Specialised Services Commissioning Committee are publicly available. The Government agreed with the Public Accounts Committee when it said that NHS England’s decision making in relation to specialised services should be far more transparent. Will the Minister please ensure that the minutes of those two groups are published on NHS England’s website in future?

Thirdly, the way in which NHS England’s decision has been communicated to patients has been shocking. It consists of a single bullet point retrospectively added to the bottom of a press release under the heading “Further information”. Does the Minister agree that that is unacceptable, and that far more needs to be done to ensure that decisions that could cost patients their lives are shared in a sensitive and caring manner, rather than merely being added as some sort of footnote?

With all that in mind, let me now ask the Minster the most important question. Does she accept that her Department must do more to hold NHS England to account, and will she agree to take steps to ensure that every patient who needs a second stem cell transplant has access to one?

I suspect that the Minister may say that, despite NHS England’s decision not to routinely commission second stem cell transplants, patients will be able to access the potentially life-saving treatment that they need by taking the individual funding request route. However, patients and their doctors know that, in reality, the chances of success through that route are very slim indeed. In November 2016, the all-party parliamentary group on stem cell transplantation had the pleasure of meeting Emma Paine. Emma was diagnosed with a blood disorder called severe aplastic anaemia in 2005. After her first transplant she relapsed, and, as with Sasha, her doctors recommended a second stem cell transplant. They tried to organise that via the individual funding request route, which meant that Emma had to prove that she was an exceptional case.

Emma was left waiting in the dark for four months, and her doctors had to fight her corner. During that time she was very unwell with infections, and her consultant decided to gamble and start her chemotherapy in preparation for a second stem cell transplant early, fearing that she would die if it did not start then. Although Emma eventually heard from her doctor the good news that the request had been successful, she did not receive her second stem cell transplant until January 2016, some six months after she had relapsed.

Emma said:

“I always assumed that if there was one treatment that could save my life, I would be offered it without question, and the biggest barrier to having my second transplant would be to find another donor—not having to fight the NHS to get it funded...I thought, ‘I’m a 28 year old woman, and a panel of people will decide whether I get to live or die’”.

Does the Minister agree that the individual funding request route will never be successful for all the patients who need a second stem cell transplant, and that even for those for whom it is successful, it is an incredibly tortuous route?

I close by urging the Minister, and indeed the whole House, to remember the patients caught up in all this—not just those who are waiting for a second stem cell transplant today, but the countless individuals who will be left without the chance of a second stem cell transplant in future, and therefore will be left without their last hope of a cure. I hope that the Minister will not wash her hands of the problem—I am sure she will not—and will instead fully accept that her Department has to play a key role in this, to make sure that action is taken to ensure that every patient who needs a second stem cell transplant can access one. The lives of people like Sasha and Emma depend on it.

NHS Fertility Services

Colleen Fletcher Excerpts

Thursday 19th January 2017 Westminster Hall

[Colleen Fletcher (Coventry North East) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate my hon. Friend the Member for Birmingham, Selly Oak (Steve McCabe) and the right hon. Members for Carshalton and Wallington (Tom Brake) and for Wantage (Mr Vaizey) on securing this extremely important and timely debate. As we have heard, difficulty conceiving is a problem that will affect around one in six couples in the UK. I want to highlight the experience of one couple whom I know personally, although many elements of their story will resonate with others who have been affected by fertility problems and experienced difficulties accessing IVF treatment on the NHS.

When that couple made the decision to start a family of their own, there was no doubt in their minds that they would have a child together. Even as the early months of trying yielded no success and as many of the people around them, their friends, family members and colleagues, started to fall pregnant, they remained hopeful and expected that it would simply be a matter of time until they themselves conceived. After more than a year without success, and as the doubts that were absent at the beginning started to emerge, the expected did not happen and a sense of heartache, frustration and anxiety began to replace the hope that had gone before. They visited their GP to ask for help and advice, and so ensued a lengthy process involving tests, hospital referrals, and invasive and non-invasive procedures alike, yet the root cause of the problem remained unexplained.

Just as the couple had all but given up hope of conceiving naturally, they fell pregnant, nearly three years after initially making the decision to start a family together. Here, amid the darkness of their difficult journey towards prospective parenthood, emerged a shining beacon of hope. Yet, as we know, beacons can be so easily and cruelly extinguished, and so it was that only 10 weeks later they endured a devastating and heartbreaking miscarriage. The almost one and a half years that followed the miscarriage were punctuated by a continued inability to conceive, further visits to their GP, more tests and, ultimately, referral back to the hospital. The couple were eventually told in November of last year, nearly five years after starting their journey, that their last, best hope of conceiving was through IVF treatment.

More devastating news was to follow, however, because the couple were told that, despite having a clear clinical need for treatment, they were ineligible to access IVF on the NHS in their area. The reason: their local CCG uses arbitrary access criteria that are not applied in other areas of the country in order to ration access to treatment for financial reasons. A miscarriage in the previous three years is one of the criteria used to deny funding—in essence penalising our couple for experiencing a tragic event over which they had absolutely no control.

The unfairness of the situation is further exacerbated by the knowledge that were the couple to live in a different part of the country—my own area of Coventry, for example—they would be eligible for at least one fully funded cycle of IVF on the NHS. In other areas, they would be eligible for three fully funded cycles. That inequitable postcode lottery adds insult to injury for a couple who, like many others, are already trying to cope with the distressing effects of infertility. The couple are now faced with a situation in which their only opportunity for treatment comes with an enormous financial outlay. Therefore, treatment is reduced to a simple financial decision: those who can afford it have the treatment they need, and those who cannot do not—hardly a just system.

That couple, like many other couples throughout the country who are experiencing fertility problems, deserve fair and equal access to treatment. They deserve an NHS that fulfils its guiding principle of delivering care and treatment free at the point of delivery and according to need. To achieve that, the Government must act to eliminate the regional variations in IVF treatment provision, including the use of arbitrary access criteria, and ultimately seek to ensure that all CCGs routinely commission fertility treatment in line with NICE guidelines. That would mean eligible couples having access to three full cycles of IVF, which would significantly increase the chance of successful conception. I hope that the Minister will make such a commitment.

[Mrs Cheryl Gillan (in the Chair)]

As no other Members are seeking to catch my eye, I will now move to the winding-up speeches. I call the Opposition spokesman, Mr Justin Madders.

Capita Contract (Coventry)

Colleen Fletcher Excerpts

Tuesday 8th November 2016 Commons Chamber

[Mr Robinson]

Well, we learn something every day. I did not know that, and I am grateful to my hon. Friend for bringing it to my attention. That fact was not mentioned to me in Coventry, where people felt that the new system had been sprung on them completely without trial. When I was a Minister, I was a great supporter of the idea of trialling programmes. After all, we trialled them for a purpose, which was to see whether we were ready for them and whether the contractor was able to provide them. However, that seems to have been ignored in this instance. I shall say a few words at the end of my short contribution about learning lessons. This is not the first time we have been in this position. It is not as though we have suddenly discovered that contracts are not easily transferred, and there are lessons to be learned.

[Colleen Fletcher (Coventry North East) (Lab)]

Does my hon. Friend agree that this problem does not just affect GP practices in Coventry? It has also had an adverse impact on individual residents, including people who have requested a copy of a late relative’s medical records from the primary care support service. Partly because of the service’s failure to appoint a medical adviser to deal with such requests in the Coventry area, many of those people have been forced to wait for more than twice the maximum 40 days that it should take to process such a request. It is utterly unacceptable to put anyone through that kind of delay, but it is inexcusable for it to happen to anyone who is already in an extremely vulnerable position following the death of a relative.

[Mr Robinson]

I entirely agree with my hon. Friend, who puts her finger on another aspect of the situation that reveals the true motives of private sector contractors. They are not in it to improve the service and make real savings; they are in it for short-term profit. I have nothing against the private sector making profits—I am all for it—but the irony is that the companies cannot make a profit from a proper service, so they turn to such measures as imposing a £40 charge for access to a deceased relative’s records, as my hon. Friend mentions. They do not have to impose that charge—I think it used to be left to the GP’s discretion—but they now insist on it, and people have to pay postage and delivery charges on top, which is a disgraceful pursuit of short-term gain at the expense of the people they are meant to serve.

--- Later in debate ---

[Mr Jim Cunningham (Coventry South) (Lab)]

I will just make one or two observations because my hon. Friend the Member for Coventry North West (Mr Robinson) has covered the subject very well. Like him, I have received representations. Since the last reorganisation of the NHS, problems such as this seem to be coming to light. There is a pattern. There was the problem with Concentrix and benefits, which of course is nothing to do with the NHS. We had debates about that a couple of weeks ago. Now this problem with Capita and primary care support is emerging.

When the Government look at such companies, they should look at a schedule of terms and conditions for the service they are going to deliver, the people they are going to employ and their qualifications, and whether people will be employed on zero-hours contracts. I have heard all sorts of stories about companies that subcontract out to smaller companies. That is where the problems start to arise.

There was a ruling a couple of weeks ago on taxis after a case was brought by a trade union. It may well mean that there will be a problem with zero-hour contracts, holiday pay and so on. The Government should look at that when they award contracts.

Like my hon. Friend, I have had GPs in Coventry complain to me about the inadequacy of the services, delays across the board and records being lost. Even the British Medical Association has accused Capita of failures. These delays are making it impossible for GPs’ surgeries in my constituency and across the country to do their job properly. For example, a surgery in my constituency faced delays in receiving patients’ notes. As my hon. Friend has mentioned, that can go on for a long time, and if someone is terminally ill, the situation can be life-threatening. Doctors sometimes have to meet patients without records or knowledge of their medical history, so they have to rely on the patient to provide their history. Patients at the end of the day are not doctors; they can only express in layman’s terms what they think is wrong with them. They need qualified doctors.

[Colleen Fletcher]

Does my hon. Friend agree that the difficulties experienced by GP practices are being compounded by the inability of Primary Care Support England service centres to deal with inquiries about ongoing problems either by phone or email? Staff from one practice in Coventry said that any response to emails was unusual, long-awaited and often failed to address the question posed. This type of comment is echoed time and again by exasperated practice staff across the city.

[Mr Cunningham]

My hon. Friend puts it very adequately. I and all my colleagues behind me have all experienced that and the Minister as a constituency MP may well have experienced something like that because it is widespread.

At the end of the day, GPs are having to bear the brunt of the failings of Capita. It is unacceptable that a private company can bid for an NHS contract without the infrastructure in place to deliver. I have already explained to the Minister what that means. Will she allow GPs to be given additional support and help to cope with overstretched services? As I said, a lot of this came about with the last reorganisation of the health service. When people provide a service that is funded on the basis of a policy of cuts, they can expect people to take shortcuts. The patient is important, the GPs are important, but the employment rights of those people who are subcontractors or sub-subcontractors should be upheld.

The Minister should really look into this. I detect a pattern of Government contracting out of services and problems developing with those services. I have already mentioned the problems with the benefit service. Sometimes services are contracted out because Ministers do not want to be answerable at the Dispatch Box. We have had that in the past. The Minister says, “I am not responsible.” We try to get through to the company that is providing the service for the public; we cannot get through to them and the Government pass the buck. I had that last Christmas with Concentrix, but that is another debate. I will end my comments there.

Oral Answers to Questions

Colleen Fletcher Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Dunne]

The hon. Gentleman stood on a manifesto 18 months ago in which his party was not prepared to commit the funding that our party was prepared to commit. Labour committed £5.5 billion to the NHS; we committed £8 billion, and we have delivered £10 billion.

[Colleen Fletcher (Coventry North East) (Lab)]

13. What steps his Department is taking to reduce the number of men who take their own life.

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

Tragically, suicide is now the biggest single cause of death in men under 50. There are 13 suicides every day, of which three quarters are men. I am currently reviewing our suicide strategy to make sure we leave no stone unturned in trying to reduce the totally unacceptable level of these tragedies.

[Colleen Fletcher]

Yesterday marked the launch of the mental health awareness and suicide prevention campaign called “It takes balls to talk” across Coventry and Warwickshire. The campaign is a public information programme targeted at male-dominated sporting venues, which aims to direct men to help and support when they need it to promote positive mental health and reduce the incidence of male suicide. With suicide being the single most common cause of death in men under 45, will the Secretary of State take the opportunity to welcome and support this important new campaign?

[Mr Hunt]

I am happy to do just that. I would like to thank the hon. Lady for bringing up this very important and difficult issue. We are making progress in reducing suicide rates, but we can do an awful lot better. The thing that troubles me most is that nearly three quarters of people who kill themselves have had no contact with specialist NHS mental health services in the previous year, even though in many cases we actually know who they are because, sadly, most of them have tried before. I am very happy to commend the “It takes balls to talk” campaign. She may want to put the campaign in touch with the national sport mental health charter, which is another scheme designed to use sport to try to boost the psychological wellbeing of men.

Blood Cancers

Colleen Fletcher Excerpts

Thursday 7th July 2016 Westminster Hall

[Colleen Fletcher (Coventry North East) (Lab)]

It is a pleasure as always to serve under your chairmanship, Mr Walker. I should start by saying that I am a joint vice-chair of the new all-party group on blood cancer and a member of the all-party group on stem cell transplantation. I am pleased to have the opportunity to speak in this important debate on blood cancer and the cancer drugs fund. I thank the hon. Members for Strangford (Jim Shannon) and for Crawley (Henry Smith) for affording me this opportunity by securing the debate. I also thank the previous speaker, the hon. Member for Erewash (Maggie Throup). I agree with much of what she said, including about the need for more clinical research.

It is true that since its introduction in 2010, the cancer drugs fund has enabled many blood cancer patients in England to access treatments that are unavailable in the mainstream NHS. That has undoubtedly benefited and saved the lives of thousands of patients. However, it is equally true that, latterly, the CDF has also fostered a great deal of uncertainty for many blood cancer patients and their families.

Some have experienced a rollercoaster of emotions as the life-saving treatments they rely on have been made unavailable, then available and then unavailable again in a matter of a few months. That was most acute during the 2015 delisting process, which resulted in 16 indications for seven blood cancer drugs being removed from the CDF. There is considerable concern that under the new system more and more blood cancer drugs will become unavailable as the CDF moves away from being the safety net for patients that it was designed to be. That concern is reinforced by the retention of the flawed process used by NICE for assessing drugs, which has resulted in many blood cancer drugs becoming unavailable. I hope the Minister will offer assurances that blood cancer patients will be able to access the drugs they need under the new process for reviewing and appraising medicines.

We must not forget that the drugs offered through the CDF are just one of many treatment options available for patients with blood cancer. I want to turn briefly to one of those: stem cell transplantation. I intend to make a few points about the inconsistencies in care for blood cancer patients post-transplant. I declare an interest, as my husband Ian was diagnosed with acute myeloid leukaemia in 2014 and received a stem cell transplant soon after in the same year through Anthony Nolan. I have been to its research labs, where his DNA is stored—he got a 10:10 match, so we were hugely excited about that. I was with Ian when he was told he had a life-threatening disease and also when he was told that he had been cured. I therefore know a bit about despair and hope and inconsistency. I travelled with him throughout the journey. Although he is cured, it is a journey that is not entirely over, but the light of hope now outshines the darkness of despair in his case.

If we are to make use of the cutting-edge research that allowed his cure, we surely need to look at the inconsistencies of post-transplant care. It is vital that blood cancer patients who undergo stem cell transplants have access to the care and support they need after their transplants, as well as before and during. Currently, however, there is no long-term patient pathway and as such the provision of services varies greatly across the country, leaving vulnerable patients at the mercy of the postcode lottery, where some get very good support but others get very little.

The problem arises because the transplant period is defined as 30 days before transplant until just 100 days post-transplant. Variations in care and support occur after that period when commissioning responsibility transfers from NHS England to clinical commissioning groups. After that point there are no guidelines on what constitutes a suitable late effects service for patients and no guarantees of appropriate funding for transplant centres to deliver the care that stem cell recipients will continue to require. As such, the result is geographical variations.

Delivering the long-term care that patients need at a consistent standard across the country requires a clear and fully funded patient pathway. It is my belief, and that of Anthony Nolan, the blood cancer charity, that that pathway should cater for each patient for at least five years after transplant and look much further beyond the arbitrary 100-day figure. I hope the Minister will touch on what can be done to ensure that every patient has access to the same standard of care and support. Will he agree to meet with representatives of Anthony Nolan to discuss how best to deliver a comprehensive post-transplant pathway?

Just as consistency around post-transplant care is essential, so too is the need for consistency in the NHS’s policy on second transplants for blood cancer patients. This is not a plea—I hope my husband will not need a second transplant: he is currently well, but living with the after-effects of the drugs needed to see him through this period—but unfortunately NHS England currently has no clear or consistent policy on whether it will fund second stem cell transplants for the small number of patients each year who relapse, even though there are many people alive today because of a second transplant.

Will the Minister offer his assurances that if a patient’s doctor recommends a second transplant, NHS funding will be allocated to ensure that that patient has a second chance of a cure? After all, is that not why we are here today: to ensure that all blood cancer patients have access to the best treatments available for their condition—treatments that offer the best chance of a cure—whether it be a stem cell transplant, a course of radiotherapy or chemotherapy or access to medicines approved by NICE or those available through the CDF?

NHS Bursaries

Colleen Fletcher Excerpts

Wednesday 4th May 2016 Commons Chamber

[Colleen Fletcher (Coventry North East) (Lab)]

I am grateful for the opportunity to contribute to today’s important debate. This is the second time I have raised concerns about the Government’s plans to scrap NHS bursaries in favour of a loans-based system for nursing, midwifery and allied health profession students, and it follows my contribution to a Westminster Hall debate on the same subject in January. I do not propose to reiterate in their entirety the arguments I put forward; instead, I intend to make just a few brief observations on the Government’s proposals, which have been roundly condemned by students, trade unions and professional bodies alike. They have been described by one of those bodies—the Royal College of Nursing—as “high risk”. The proposals are high risk because they take a significant gamble with the future sustainability of the NHS workforce. There are several reasons for that.

First, the proposals have the potential to deter many committed and talented prospective students from pursuing nursing, midwifery and allied health profession degrees altogether. That is due primarily to concerns over the huge level of debt associated with the change to a loans-based system. That is particularly true for more debt-averse mature students, who may have young families, caring responsibilities and a mortgage to pay, and for those for whom healthcare is a second degree.

There is a considerable problem with recruitment and retention of staff in the NHS, and the Government’s plans are likely to exacerbate that problem, so impacting adversely on the future security of the NHS workforce. This is at a time when we have an ageing and increasing population, which will require more, not fewer, front-line healthcare professionals.

Secondly, the proposals do not take into consideration the fact that nursing, midwifery and allied health profession courses are very different from most arts and science degrees. These courses are much longer, with shorter holidays, and they offer fewer opportunities for students to supplement their incomes, as people are required to spend a significant amount of time working with patients in clinical practice, with a requirement to work irregular and long evening and weekend shifts as standard. Effectively, the Government’s proposals will mean that these students—the individuals who keep our wards running and who are involved in life-and-death decisions on a daily basis—are forced to pay for the privilege of undertaking often physically and emotionally demanding work in the NHS.

Thirdly, the proposals seek to replace the bursary system, which has, for some considerable time now, fostered strong and enduring links between healthcare students and the NHS right from the start of their course. The Government propose severing that link, which risks reducing students’ loyalty to, and the attractiveness of, the NHS as a potential employer.

Those are just a few of the reasons why the Government’s plans are so high risk. There are, of course, many more, some of which have been eloquently articulated by others in the House today. I conclude by urging Ministers to drop their proposals and instead work with trade unions, professional bodies and, most importantly, the dedicated individuals who work in the NHS—the nurses, midwives, physiotherapists, speech and language therapists, occupational therapists, dieticians, radiographers, chiropodists and podiatrists—to find a fairer, more sustainable and effective funding solution.

Brain Tumours

Colleen Fletcher Excerpts

Monday 18th April 2016 Westminster Hall

[Colleen Fletcher (Coventry North East) (Lab)]

It is a pleasure to serve under your chairmanship, Ms Buck. I pay tribute to my hon. Friend the Member for Warrington North (Helen Jones) for securing the debate and for producing, along with the other members of her Committee, an excellent report arising from the e-petition on funding for research into brain tumours. I also commend those who created the e-petition and those who signed it. Their laudable campaign has afforded us a substantive opportunity to discuss the unmet need for and chronic underfunding of research into brain tumours, the biggest cancer killer of children and adults under 40.

In the days and weeks leading up to the debate, I received a number of emails and letters from constituents outlining the shocking human cost of what is a devastating disease. Each of those missives included a personal account of the distressing experiences of the correspondent whose life had been affected by this terrible disease. We have heard many such stories today. It was striking how many of them had common themes and how the experiences of one individual and their family were echoed in the experiences of another. The Petitions Committee’s report remarked on the similarities among the stories they heard and set out those common themes, which included

“difficulties and delays in getting a diagnosis; lack of treatment options; poor survival rates and the huge burden of the disease on patients and their families.”

There was unanimity from patients and their families that those problems were exacerbated and perpetuated by chronic underfunding of research into the cancer, and that those problems could be fundamentally addressed only through a significant increase in resources. They argued that there is a clear correlation between the funding for research on a specific cancer and improved survival rates and reduced incidence. Yet despite brain tumours being the most fatal of all cancers in the number of life years lost, they have for too long been the poor relation in cancer research. That is why improvements in outcomes for brain tumour patients continue to lag so far behind results in better-resourced areas of cancer treatment.

I readily admit that preparing for today’s debate was an eye-opening experience, in large part because of the profoundly tragic and painful stories I received from constituents, but also because I learned that research into such a deadly disease received just 1.5%, or £7.7 million, of the £498 million national spend for cancer in 2014, and just 1% of the overall national spend since 2002. The charity Brain Tumour Research estimates that, at the current rate of national spending, it could take another 100 years to find a cure. How many more lives will be tragically cut short and how many more families bereaved during that period? The answer is not one we should countenance, so I have no hesitation in joining the e-petition signatories in calling for the Government to show leadership and ensure that brain tumours are treated as seriously as other cancers and that more resources are provided.

Through improved funding we can raise awareness of brain tumours and increase the number of early diagnoses. That in turn could increase the opportunities for research, allowing us better to understand the causes of this devastating disease and potentially to develop urgently needed treatments, which could improve survival rates and patients’ quality of life.