Public Health: Coronavirus Regulations
Craig Whittaker Excerpts(4 years, 1 month ago)
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Matt Hancock
Of course, the work on a vaccine continues. No vaccine technology is certain, but we have already bought six different vaccines and there are more than 100 in development around the world. That is what underpins the strategy, and the work on the leading vaccines, including the AstraZeneca Oxford vaccine, continues effectively. We have seen, both here and overseas, just how quickly the virus can take hold, and we have to act now to get it under control.
Craig Whittaker (Calder Valley) (Con)
At the beginning of August, Calderdale had just four people in hospital with covid, zero in intensive care units, and spikes in just two wards. This morning, we have 43 people in hospital with covid, six in ICUs, 12 deaths this month, and almost 800 positive cases coming through. Can my right hon. Friend say what steps he is taking to ensure that the NHS is not overwhelmed by the virus in the coming months?
Madam Deputy Speaker (Dame Eleanor Laing)
Order. I have just said that we must not have long interventions. These points are for the speeches that people are waiting to make later. If a Member wants to intervene on the Secretary of State about something that he has just said, that is all very well, but if they make points about their constituencies at this stage rather than waiting until later, it is simply dishonourable; it is just not right.
Daisy Cooper (St Albans) (LD)
If we are to have any hope of getting a grip on this virus, reopening our economy and restoring our freedoms, it all depends on fixing test, trace and isolate, and on giving control of that system to directors of public health. As I understand it, local directors of public health can make proposals on how to tackle the virus in their area only under tier 3. Can the Government confirm today that, if local authorities make proposals on how to use extra delegated powers and their local knowledge to keep the virus under control in their areas, they will work with them to enable this to happen, even when those areas are just in tiers 1 and 2?
We also need to see proper financial support for those businesses that are being asked to close, so that they can both survive and recover. This is no small threat. Almost 25% of hospitality businesses think they will fail in the next three months. We understand the need for public health measures, but they must come with a proper package of support. Many in hospitality are worried that the restrictions on households mixing in tiers 2 and 3, and on alcohol to be served only with a meal, might make businesses commercially unviable, and they will need to close even if they have not explicitly been told to do so. In those circumstances, will the Government make the extended job support scheme available to those companies? If local authorities decide to close all pubs in addition to tier 3 measures, do those who are forced to close have access to the Government’s central extended support scheme, and do suppliers to those businesses that have had to close, but are not technically forced to close themselves, have recourse to the extended job support scheme as well?
Then there is the curfew. We have seen crowds of people in close contact turfed out onto streets, onto public transport, into off-licences and into homes where they cannot be policed. The facts are well rehearsed. SAGE members were not consulted. The Government did no assessment of the cost to business. The Campaign for Real Ale and UKHospitality asked for the evidence, but got nothing. The curfew is now subject to a judicial review, because the Government have failed to provide any evidence. Yesterday evening, at a briefing for MPs, the Government’s medical advisers admitted that the curfew was a policy decision, not a scientific one. Overnight, SAGE’s minutes observed that the curfew would have a marginal impact.
Craig Whittaker
On that point, I used to be a landlord many years ago, in the days when we kicked people out at 10 o’clock on a Sunday and 11 o’clock the rest of the week. Is the reality not that it is up to people to take responsibility for their own safety and that this is not just about a policy?
Daisy Cooper
The idea that a Government can change a policy without having implications for public behaviour is absurd. That is why the behavioural science group exists to advise SAGE and has advised the Government on this point. What is worse is that we knew that the Government were advised to close everything down for two weeks and they did not, suggesting that the curfew was just a feeble attempt to look as though they were trying to do something. The Government are so desperate not to accept that they got it wrong, or to suffer a defeat, that even if the House votes down the curfew in the seventh vote tonight, it has already been incorporated into the package of measures in the first three votes, which will introduce the three tiers from tomorrow. The Government have provided no opportunity for Opposition MPs to amend them so that we can improve public health and outcomes for businesses. The Government had the opportunity to persuade the public and Opposition MPs with clear evidence, but they have squandered that, choosing instead coercion and control. It is outrageous that local government leaders, business leaders and Members of this House have had to fight tooth and nail for weeks to see the evidence behind Government measures that are threatening lives and livelihoods in our communities. It is an outrageous abuse of power and it must stop. There is a sickness of secrecy at the heart of this Government, and it can be cured only by some radical transparency.
Craig Whittaker (Calder Valley) (Con)
I will say at the start that, as a Conservative, imposing state control over people’s lives makes me feel incredibly uncomfortable and puts me well outside my personal comfort zone.
Back in August, when the whole of Calderdale was put under local restrictions, we got additional support from the Government in several forms. One form of support was an additional tier on the national track and trace system. That has been a valuable tool to give the local authority real evidence of where the spikes are coming from. As a result of that, we traced around 90% of contacts.
As I said, I have a problem with state control over people’s lives, but—and there is a “but”—what we have seen locally during local restrictions is that, although the majority of people adhere to the law and guidance, which is worth repeating, sadly, a significant number do not. Unfortunately, the actions of a significant few are putting everybody else at risk, and the current spike is staggering. It is the result of a significant minority who are taking the liberty of living their daily lives as they choose, and they are putting everybody else at risk. These are some of the things that are happening locally, some of which are evident from our track and trace system: people not self-isolating when they are unwell; people not self-isolating when they return from holiday; and people not self-isolating when they have been in contact with someone else who has tested positive. It is not advised to mix households in pubs and restaurants; however, because that has been guidance only, our local pubs and restaurants have been full of mixed households seated together. That is not evidence from track and trace, but from the local MP, in the pub for most of the weekend. Finally, households are still mixing, despite it being law that they cannot.
There are many reasons why people have not adhered to the law or guidance, but the reality is that when a significant few ignore Government advice and take decisions about the pandemic into their own hands, they put the majority at huge risk. This is by no means a criticism of our local police and local authority, but they have taken the decision to have a light-touch approach to enforcement of local restrictions. I have supported that, but we are again at a cliff edge with the virus locally, and that light-touch approach, where people are not penalised for taking their own decisions, is being abused by a significant number of people.
I have lots of stats about what is happening locally, but basically we have had 800 positive cases in the last two weeks. We now have 43 people in hospital and six people in ICUs, and we have had 12 deaths since 1 October. It is for that reason—that is, the evidence—that I support the Government 100% on implementing the tiered system, because we really need to get the virus back under control.
Covid-19 Response
Craig Whittaker Excerpts(4 years, 5 months ago)
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Matt Hancock
The drive-through centres are a classic example of the public and private sectors working in a team spirit. I just wish that people would not try to drive teams apart, because this is a combination of the private diagnostics companies that provide the tests; Boots and Deloitte, which have provided the logistics; the armed forces, without whom we could not have made this happen right across Great Britain; and, of course, the NHS, Public Health England and the relevant Scottish authorities—they have made it happen. I will look into the specific data point that the hon. Gentleman raises, but I want to congratulate all those involved, no matter their employment status, and I urge him and others to back the team.
Craig Whittaker (Calder Valley) (Con)
With couples sat together one minute and one of them taken away in an ambulance the next, with people not being able to see their partner in hospital or in the chapel of rest—those living in Calderdale could not even pay their last respects at the crematorium either—and with grandparents not seeing new-borns or their grandchildren for 10 weeks, on the whole, people have made huge sacrifices to maintain the lockdown and the Government’s public health message. Can my right hon. Friend advise whether an assessment has been made of what, if any, damage has been done to the Government’s public health message by the actions of the Prime Minister’s special adviser?
Matt Hancock
The critical thing is that, given the sacrifices that my hon. Friend lists and that are heartfelt, as a nation, we have the resolve to see this through. We can see that the number of cases is coming right down and the number of people dying is coming right down, and we have got to see the back of this disease. We are not there yet.
Coronavirus
Craig Whittaker Excerpts(4 years, 8 months ago)
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Matt Hancock
We are very concerned about this issue. We will address precisely the issue that the right hon. Member raises in the communication that I indicated we will publish soon to social care providers. This is an important and difficult consideration for what we do in a reasonable worst-case scenario. Of course, all the time, we are working to avoid that scenario. One area that has been highlighted in public is making it much easier to onboard volunteers, but they are not the only part of the answer to this problem.
Craig Whittaker (Calder Valley) (Con)
GAMA Healthcare in my constituency is playing a vital role in China as part of a bundled approach to infection control of covid-19. Adrian Fellows, a scientist from GAMA, says that washing hands is vital, but his concern is that every handwash is being promoted as an effective intervention, even those that are cosmetic-based, and supermarket sanitisers without a log 4 reduction are running the risk of giving a false sense of security. Will my right hon. Friend ensure that Government advice on hand washing is thorough, so that people do not run that risk of having a false sense of security?
Matt Hancock
I will look into our guidance on the nature of hand sanitisers and make sure that it takes into account the very best scientific advice. There is a broader point here, which is that although sanitising one’s hands with hand sanitiser is good, it is not nearly as good as washing one’s hands for 20 seconds with soap and, preferably, in hot water. That is the best thing to deal with the virus.
The National Health Service
Craig Whittaker Excerpts(5 years ago)
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Barry Gardiner (Brent North) (Lab)
At the opening of the London Olympics, Danny Boyle wanted to show the world what it meant to be British, and he chose the NHS because it illustrates all that is best in our country. Watching on TV, millions marvelled at our nurses, our doctors and our carers, and in the stadium, thousands cheered. That is how proud we are of our NHS. All the people who work in it—cleaners, consultants, nurses, night porters, radiographers and receptionists—play a vital role in caring for our society. They are our national symbol of community and our model of selfless service.
This debate has reflected that, with 34 speeches and 49 interventions. There have been some wonderful speeches, including personal testimonies from the right hon. Member for Old Bexley and Sidcup (James Brokenshire), the hon. Member for Dudley South (Mike Wood) and my hon. Friend the Member for North Tyneside (Mary Glindon)—my dear friend—who if she did not quite move herself to tears, certainly moved the rest of us.
However, millions now worry that the NHS could be up for grabs in a future free trade agreement. At the heart of those fears is the Health and Social Care Act 2012, passed by the Conservative and Liberal Democrat coalition. It puts costs before quality and commercial competition at the heart of health commissioning. Just after the Act was passed, our local 111 service in Brent North was outsourced to a private company, the majority of the directors of which sat on the local clinical commissioning group—the very group that had awarded them the contract.
The Health and Social Care Act has allowed perverse commissioning decisions like that up and down the country. Today, our local CCG in north-west London faces not the £51 million deficit at year-end set out in its operational plan, but £112 million—an additional £61 million overspend as a result of an increase in acute activity of 18% against a population increase of 5%. When Conservative Members and their Liberal Democrat partners told us that the NHS was not for sale, those assurances were worthless. People may not be able to buy it, but privatisation is tearing it apart. My CCG has announced the closure of the 24-hour service at the urgent care centre in Middlesex Hospital.
Barry Gardiner
I cannot give way because of time.
It is this legislation that now exposes our NHS to foreign competition and undermines our public healthcare system. It is Donald’s door into our NHS. Some 170,000 people already know this, and they have signed a parliamentary e-petition calling on this Government to introduce safeguards that will protect it from new trade deals. Trade agreements lock in privatisation, and open up access to foreign investors and speculators. That is why we need safeguards.
Hypermobility Syndromes: Healthwatch Calderdale’s Report
Craig Whittaker Excerpts(5 years, 1 month ago)
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Craig Whittaker (Calder Valley) (Con)
Healthwatch in Calderdale, like Healthwatch organisations across England, is the voice of people in its area on health and social care matters. It tells NHS service providers and commissioners about patients’ experience of care and holds them to account, and has a say in how local services are delivered and designed.
As a very rough rule and guide at Healthwatch Calderdale, a trigger to indicate that there is a particular issue in an area of health or social care is when it receives about three complaints on the same issue at the same time. Hon. Members can therefore imagine the concern when Healthwatch Calderdale began to hear of difficult NHS experiences from a large number of adults with hypermobility syndromes, both at events and via its telephone advice service. The level of concern was so great that, for the first time since its inception, a joint piece of work was undertaken between all local Healthwatch areas across Yorkshire and Humber, with Healthwatch Calderdale taking the lead. Approximately 250 adults with hypermobility syndromes took part in the project—all relating stories of difficult NHS care. I will speak more about the findings of the report shortly, but first I want to give the House an outline of what hypermobility syndromes are.
Hypermobility is the term used to describe the ability to move joints beyond the normal range of movement—something that I have not been able to do for many, many years. Joint hypermobility is common in the general population, especially in childhood and adolescence, in females, and in people of Asian and African-Caribbean descent. In many people, joint hypermobility is not problematic at all. It can even be a bonus, especially for sportsmen or sportswomen. However, this debate is neither about athletics, nor is it about party tricks. It is about problematic hypermobility linked to chronic ill health. It is about people who experience symptomatic hypermobility that not only affects the joints, but also causes very challenging symptoms in many other body systems including the digestive system, the nervous system, the skin, the bladder, the cardiovascular system, the teeth and the immune system. It is these people who are described as having a hypermobility syndrome.
The most common of these syndromes is hypermobility spectrum disorder. Other conditions include heritable disorders of connective tissue such as Ehlers-Danlos syndrome, Marfan syndrome, osteogenesis imperfecta and Stickler syndrome. Although these are all conditions in their own rights, they are all complex, chronic conditions that are frequently associated with co-morbidities that require multi-disciplinary healthcare teams to diagnose, treat and manage.
Jim Shannon (Strangford) (DUP)
I thank the hon. Gentleman for giving way and for bringing this matter to the House for consideration. People suffering from hypermobility syndrome feel that they have to fight to be believed, fight to be seen, fight to be diagnosed and fight to receive treatment—they are tired of simply fighting. Does he agree that the NHS in Calderdale and further afield must do better and must believe and treat these people?
Craig Whittaker
The hon. Gentleman is right in a lot of what he says, but the thing about hypermobility syndromes is that they are incredibly complex. As I said earlier, things like the digestive system, the immune system and teeth can all be factors. It is not like when someone goes to hospital with a broken leg, and we know what the problem is. There are multiple complexities around this disorder, so it is difficult from a professional point of view, which I will speak about later, but he is right in much of what he says.
From the Healthwatch work on the subject, it is clear that many people—specifically those with hypermobile Ehlers-Danlos syndrome or hypermobility spectrum disorder—are not receiving the appropriate NHS care, as the hon. Member for Strangford (Jim Shannon) indicated. It is not clear how many people in the United Kingdom are affected by hypermobility syndromes. Hypermobility is often misdiagnosed as fibromyalgia, osteoarthritis, seronegative arthropathy, psychogenic rheumatism, depression or chronic fatigue syndrome. I do not know about you, Madam Deputy Speaker, but after that description, I need to lie down in a darkened room. So imagine how patients with hypermobility-related problems feel when they have to battle alone with immense health problems, often for years before obtaining a diagnosis, only then to face immense difficulties in accessing appropriate NHS healthcare to manage their complex and multi-system disorders and conditions. These patients describe feelings of being let down by the system, as well as huge frustration at both the widespread lack of understanding about their condition from medical professionals and the lack of appropriate care for their condition.
Holly Lynch
I am grateful to my neighbour for giving way. I thank him for securing the debate and congratulate him on articulating a number of those medical conditions incredibly well. I have two constituents I am aware of who have a diagnosis of Ehlers-Danlos syndrome. I was incredibly disappointed earlier this year when the clinical commissioning group informed me that Manchester Royal Infirmary, which had been delivering a degree of care for those with hypermobility, was going to have to stop accepting tertiary referrals for that support. Not only are people struggling to get a diagnosis after years, but regional specialist care is then not available once they have received a diagnosis. We really need to address that.
Craig Whittaker
My hon. Friend and neighbour is right. Because there is a lack of understanding about this syndrome and because, not only at GP level but in some specialist areas, areas that do particularly well on this issue are now having to close the list to outsiders because they are becoming over-subscribed. She is absolutely right; that is one of the issues. When I get to the end of my speech, one of my recommendations, which the Minister can hopefully address, is having a regional centre for this condition.
Healthwatch’s report was published in July this year, and it focuses primarily on patient experiences. It presents the overwhelming negative NHS experiences of adults with hypermobility syndromes, and it makes for challenging reading. It is 70-odd pages, and it is not a pleasant read at all. The report took evidence from 252 people via focus groups and a questionnaire. Approximately 86% of the participants had a diagnosis of hypermobile Ehlers-Danlos syndrome, or what would now be termed hypermobility spectrum disorder. A further 13% had other diagnoses linked to hypermobility syndromes. It is precisely those people who are presently excluded from NHS specialised rheumatology services, and it is those people on whom I would like to focus this evening.
The report identifies problems with NHS care in many different areas. It highlights that people are experiencing difficulties obtaining a diagnosis: 76% of respondents indicated that obtaining a diagnosis had been challenging; 22% described the process as difficult; and a staggering 54% stated that it had been very difficult. Frequently, people described the diagnostic process as leaving them feeling depressed, alone and isolated as a consequence of the lack of understanding that appeared to be the norm among professionals. This and the level of disbelief by professionals, as the hon. Member for Strangford pointed out, have led to people doubting themselves, despite their symptoms and, of course, their experiences.
Common terms used to describe how the diagnostic process made people feel included being angry, belittled, desperate, and feeling like a liar or a fraud, and some even said they were feeling as though they were going a little crazy. By contrast, obtaining a diagnosis generated feelings of hope and reassurance, and the feeling that they had been vindicated or were relieved at having an explanation of their difficulties.
On the road to diagnosis, many tests and procedures were commonly performed—sometimes repeatedly, sometimes in isolation and sometimes in conjunction with others. Many people reported that they had had many blood tests, scans and X-rays. A number of respondents spoke of being tested exhaustively over many years. For some people, this extensive testing was a route to an eventual diagnosis and, in some cases, supported interventions, but for others, this resulted in delaying the diagnosis, misdiagnosis and delayed support. A pathway would not only be beneficial to patients, but would also reduce the costs and associated wastage to the NHS of all the unnecessary tests, which are often carried out on a repetitive basis, as they are not giving the anticipated results at the time.
Participants reported that between one and six health professionals were involved in the diagnosis. One significant theme of the responses generally was the failure of medical professionals to link together the variety of symptoms and health issues being reported and a focus on the presenting symptom only. Perhaps unsurprisingly, many participants said that they had received other diagnoses, rather than a diagnosis of hypermobility syndrome. Altogether, a staggering 62 other conditions were named during the process.
The complex and diverse symptoms resulting from hypermobility syndromes have led to many people being misdiagnosed. They were told, for example, that their symptoms were related to mental health issues or mental illness, such as depression, anxiety or stress, and this resulted in subsequent referrals to mental health services, as health professionals could not find a physical cause of the symptoms. People also reported that health professionals had ascribed the symptoms to excess weight, clumsiness or lack of physical exercise. Misdiagnosis, partial diagnosis or stereotyping left people feeling upset and patronised by health officials and led to feelings of anger, frustration, rejection and defeat.
Inadequate knowledge among health professionals was another key theme of the report, and that also emerged from the data. The majority of the respondents referred to health professionals as not aware of, not knowing about or not believing in the wide-ranging symptoms and the health and life impact of hypermobility syndromes on the patients. GPs were specifically mentioned in this regard, and rheumatologists and physiotherapists also received mixed feedback about their knowledge. Some people who had a diagnosis also talked of medical professionals disbelieving the conditions, with some being told, “It’s all in your head,” or assuming that people were just after drugs, rather than genuinely being in pain, despite the diagnosis.
Another key theme that emerges from the data is poor communication between health professionals, both between departments in the same service and between one medical facility and another. Communication between professionals is by no means consistent. Communication failures occur frequently and conversations are repeated at consultation. Again, this experience is described as exhausting and demoralising. A number of participants also reported difficulties in persuading GPs to refer them to consultants. Most people who responded to the survey said that they had either no NHS care or inadequate NHS care. The life impact of these difficult NHS experiences is significant, with people having to give up work, experiencing difficulties in education, having problems with social relationships, the breakdown of families and financial problems, too.
Jim Shannon
I thank the hon. Gentleman for giving way again. He outlines the case for people physically, emotionally and mentally, but it is also about the follow-on. If people cannot work, they need benefits and help. If doctors do not understand the intricacies of the health condition, how can they back up constituents’ claims for benefits? Does the hon. Gentleman sometimes become bewildered with the system?
Craig Whittaker
It is not I who become bewildered with the system, but the patients who are incredibly frustrated at the whole process. As the hon. Gentleman says, not just with pre-diagnosis but post-diagnosis, there is a lack of professional understanding. Unless someone has a good consultant or GP who understands the system, the things we have talked about—the frustration, pain, stress and anxiety—go on for years. The hon. Gentleman is, again, absolutely right.
Ironically, people feel that they have to manage their own cases entirely without medical support and sometimes without fully understanding it themselves, researching the condition so that they can then ask for what they think they might need. This was often stressful for the respondents, with the stress causing further problems. Some people spoke of having some NHS care, but for some people the only care they received was pain management, often without review. There are several examples of respondents being prescribed opium or strong medications, but they said it was without adequate medical support or review. In the few cases where people reported having good experiences of NHS care—there were some—this appeared to be generally after moving around the country, changing GPs or hospital specialists. This usually occurred over a long period.
It should be noted that not many people commented on social care experiences and this in itself may—there is no evidence—reflect the lack of involvement and awareness of the issues among social care staff. A few people have received some care or support via social care. The most frequently reported were aids and adaptations for the home. Some people have also been given additional support for personal care and social support.
The report details exactly what actions all the local Healthwatch organisations in Yorkshire and the Humber will take to raise the issues with local NHS service providers and commissioners. What is it that those who have experienced this poor level of care are asking for from the Government, NHS England and our strategic health authorities? I have gone through the common asks, but I have come up with five that I and the authors of the report think are probably the most important.
First, we are asking for improved knowledge and awareness of hypermobility syndromes and the related conditions among health professionals across the whole of the NHS. Secondly, we are asking for a dedicated care pathway with faster referrals and a specialist service of some form, such as a specific regional specialist centre. People felt that that would help to address the current fragmented care that many are receiving. Thirdly, we are asking for the ability to access medical support where needed for services such as physiotherapy, without the need for a new referral. Each time a course of physiotherapy is required, people currently have to go back through the process to be referred for it. Fourthly, we would like to see the use of technology, such as video or telephone appointments, to access medical professionals. This would help people to better manage fatigue by removing the requirement to be physically present at the appointment. Finally, we would like improved communication, co-ordination and information sharing between health and social care, either as part of a specialist service, as we have discussed, or simply just as good practice.
Some of those suggestions regarding better care, such as digitalisation and integrated care, fit very well with the NHS long-term plan. It is very clear, however, that other additional actions are required to improve NHS care for this group of patients. It is important to remember that the vast majority of people who responded to the Healthwatch hypermobility syndromes survey are not those who are referred to the specialised rheumatology services, which are commissioned by NHS England. They have hypermobile Ehlers-Danlos syndrome or what is known as hypermobility spectrum disorder. They are specifically excluded from the Ehlers-Danlos national diagnostic service and, at present, have very poor experiences of that NHS care, which, they report, impacts incredibly negatively on their lives.
Thank you, Madam Deputy Speaker, for your time this evening, and I look forward to hearing my hon. Friend the Minister’s response.
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
I congratulate my hon. Friend the Member for Calder Valley (Craig Whittaker) on securing this debate on such an important issue, and for taking the first step to bring the broader element of education and communication to the Chamber tonight by outlining the report from Healthwatch Calderdale on hypermobility syndromes. I join him in commending the work of local Healthwatches in championing the patient voice and in doing all that they do.
My hon. Friend has rightly highlighted how critical it is for those living with hypermobility syndromes to be able to obtain the right diagnosis and sometimes how challenging that is, because of the nature of all the different elements of the syndrome involved. This is also about people having their symptoms taken seriously by healthcare professionals. As he and the hon. Members for Strangford (Jim Shannon) and for Halifax (Holly Lynch) outlined, sometimes just being taken seriously is the first step on the path to accessing the relevant treatment that they need. Those professionals need to be aware of the spectrum of the condition. All those things are incredibly important so that patients can access the right care at the right time. For example, someone may access physiotherapy if they feel particularly unwell, but if they then feel like they have to go back down the snake, it can often seem like more of a fight, as the hon. Member for Strangford alluded to, so making sure that pathways are streamlined is exceedingly important.
As my hon. Friend the Member for Calder Valley will be aware, the NHS England specialised commissioning team in Yorkshire and the Humber responded to the report only last month. I gather that the specialised commissioning team and the clinical commissioning group continue to engage with Healthwatch Calderdale on the report’s findings. Ensuring that that engagement is beneficial and delivers what patients want, and that it is as broad as possible, is important. I urge both him and the hon. Member for Halifax to make sure that they are engaged with the process and with holding the CCG and Healthwatch Calderdale to account in understanding whether objectives are being met and a better service is being delivered.
We have heard from my hon. Friend that hypermobility syndromes can have devastating effects on quality of life but often go undiagnosed or misdiagnosed for many years, which also adds to the stress. This situation must improve. As he pointed out, good communication and information sharing could make a big difference to how an individual feels their journey is progressing, and I assure him that we are committed to improving the diagnosis of rare diseases and to assisting patients so that their diagnosis feels less like a fight, as the hon. Member for Strangford put it.
Craig Whittaker
One of the key problems is that the hypermobility syndromes are treated by NHS England as rare diseases. As we have heard, Healthwatch Calderdale has 11 complaints on the books, but if we times that across Yorkshire and the Humber, it means there are several hundred complaints, and that is only people who have complained, not people who have been diagnosed. My challenge back to the Minister is this: we keep calling it a rare disease, but is it really a rare disease?
Jo Churchill
The challenge with rare diseases is that they are collectively common but rare in and among themselves. As my hon. Friend articulated, there are many different elements to this syndrome that may be diagnosed as Ehlers-Danlos or a plethora of other things. That makes treating them more of a challenge and is why there has to be communication and information sharing to make it a proper pathway for an individual. Although for each life it is really challenging, 11 is not a large patient cohort. That is one of the challenges when dealing with diseases and syndromes such as Ehlers-Danlos and hypermobility syndromes more broadly.
Improving the diagnosis using cutting-edge technology is key. The genomic medicine service, which was announced last October, aims to provide consistent and equitable access to the most up-to-date genomic testing in England, which may help, and I am pleased that hypermobility syndromes are included in the national genomic test directory, which underpins this service. That may provide more of the cohesion that my hon. Friend is looking for.
As my hon. Friend points out, improving awareness of hypermobility syndromes among healthcare professionals, particularly general practitioners, is key. It is critical to ensuring better diagnosis and treatment of these conditions and is vital if we are to build trust and confidence in the system and actually help those with rare diseases. As I say, they are collectively common—3.5 million people across the UK are affected—but there is a significant gap in our understanding of their diagnosis because of the number of different ways they can present.
On raising awareness, there is always more that can be done, and we must learn from areas of good practice. For example, Ehlers-Danlos Support UK has developed a toolkit in collaboration with the Royal College of General Practitioners. I am pleased to hear that my hon. Friend’s clinical commissioning group, NHS Calderdale, has issued the links to the EDS toolkit to its GP member practices and encouraged clinicians to consider adding this topic to their learning needs, because building awareness is very much part of the answer.
Recently, a clinical update on Ehlers-Danlos syndromes was published in The BMJ. That is another excellent example of how the clinical community is working to improve knowledge and awareness and help provide positive NHS care for patients by transferring that knowledge into better diagnosis.
NHS England commissions specialised diagnostic services for hypermobility syndromes, including Ehlers-Danlos syndrome, osteogenesis imperfecta and Stickler syndrome. It is currently implementing a new “rare disease insert”, which aims to improve the patient experience through provision of a single person responsible for the co-ordination of care for hypermobility patients; I think that that was one of my hon. Friend’s constituents’ main asks. It also aims to improve the transition pathway from child to adult rare diseases services, including services for those with hypermobility syndromes.
Several centres in England deliver services for hypermobility, although, as we heard from the hon. Member for Halifax, not all of them are always accessible to everyone. They include two centres delivering complex EDS services, four delivering osteogenesis imperfecta and childhood osteogenesis imperfecta services, and a specialist centre for Stickler syndrome. Those centres help to co-ordinate specialist regional care and manage the transition to non-specialist NHS care. I did very much hear my hon. Friend’s request for a more co-ordinated service for his constituents. I encourage him to engage with his clinical commissioning group, as the idea has much merit. It could potentially secure better diagnosis and provide a better pathway for patients through discussion of the single point of contact, giving them much-needed continuity and a timeline for provision in Calder Valley and for patients more broadly.
My hon. Friend said that he thought virtual GP services would help people with hypermobility syndromes, because they would no longer have to travel all the time. He will be pleased to hear that virtual GP services are beginning to be rolled out in general practice. That means that patients will have the right to web and video consultations by April 2021, which I hope will also be of benefit.
As was announced by my colleague Baroness Blackwood this summer, we need a national conversation on rare diseases to help to inform and communicate. We will be engaging with patients, researchers and clinicians, gathering evidence, and identifying the major challenges faced in the field. We welcome the input from the hypermobility syndromes patient cohort and from healthcare professionals, and the work that they have done on the report.
Let me end by thanking my hon. Friend, who has spoken so passionately and so knowledgeably about this issue. I am grateful for the opportunity to discuss such an important report in the Chamber. We are dedicated to trying to improve the lives of all patients living with hypermobility, and, as my hon. Friend said, that is laid down in the NHS long-term plan and our implementation of the UK strategy. I hope that I have given a little reassurance to patients who are struggling for diagnosis that we are here to try to make the pathways stronger and diagnosis easier, and to improve the lives of all those affected by hypermobility syndromes and other rare diseases.
Question put and agreed to.
Defibrillators in Public Areas
Craig Whittaker Excerpts(7 years, 10 months ago)
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Maria Eagle (Garston and Halewood) (Lab)
Defibrillators save lives. That is the truth that drives the work of the Oliver King Foundation, a charity that campaigns to ensure that defibrillators are available in public places and that people are trained to use them. Every year, ambulance services in the UK treat about 30,000 people for a non-hospital cardiac arrest, but fewer than 10% of them survive—fewer than one in 10. Of the average 82 people who suffer cardiac arrest outside hospital every day in the UK, just eight live.
Cardio pulmonary resuscitation is often championed as the best way to treat cardiac arrest before the emergency services arrive. Indeed, in some cases it can double the likelihood of survival. But even then the chances of resuscitation are still as low as 20%, and that is only in some cases. Clearly CPR alone is not enough.
Craig Whittaker (Calder Valley) (Con)
A little over a year ago, on 7 December 2015, my 28-year-old son had a cardiac arrest. He is one of the few lucky ones who got to hospital in time and survived. He has his own defibrillator, but does the hon. Lady agree that, in conjunction with defibrillator training, it is incredibly important that people are trained in CPR? In my son’s case, his girlfriend was trained in CPR and saw him through the process until the paramedics arrived.
Maria Eagle
The hon. Gentleman has had a frightening experience in his family, and also learnt the incredible importance of not only having defibrillators available, but having people who know how to use them. I could hardly better his family’s example of how important that is.
A study by the British Heart Foundation found that for every single minute without defibrillation, chances of survival fall by between 7% and 10%. The Care Quality Commission sets a response target of eight minutes for emergency ambulance services, but we know that ambulances cannot possibly arrive within that time in every case. Even if they did, the chances of survival without immediate defibrillation and CPR will have already plummeted to 20% or lower. Access to a defibrillator can therefore make a huge difference. If cardiac arrest is recognised, basic first aid is given, 999 is called and CPR is applied, in combination with rapid and effective defibrillation, the chances of survival can exceed 50%. In fact, in some cases it can be as high as 80%. However, immediate action is vital. A defibrillator must be at hand for those survival rates to be realised.
Three people who know that better than most are my constituents Mark, Joanne and Ben King. In 2011, Mark and Joanne King lost their son Oliver, and Ben lost his brother. Oliver tragically died following a sudden cardiac arrest while racing in, and winning, a school swimming competition. He was just 12 years old. He had a hidden heart condition, and without access to a defibrillator at school his chances of survival on that day were dramatically reduced. Had he lived, this Saturday would have been his 18th birthday.
I never met Oliver, but I have been struck by talking to those who knew him well. He was clearly a very happy and popular boy, judging by the tributes that poured in from those who knew him following the shock of that terrible day. He was known as a big character at King David High School. His teachers recall his “uncompromising zest for life” and how he was loved and respected by boys and girls and teachers alike. His best friend David recalls Oliver’s charm and how it was deployed on more than one occasion to get them out of a tricky situation. This year is particularly difficult for David, as he will be celebrating the milestone of turning 18 without his best friend.
Everyone mentions Oliver’s love of football—he was a staunch Evertonian. His family and friends all recall his great talent and potential on the pitch. One of his teachers describes him as
“a sportsman at heart and a natural at whatever he turned his hand to”.
Above all, Oliver was caring, loving and incredibly close to his family:
“family was everything to Oliver.”
It goes without saying that Oliver’s death left many who knew and loved him with a great sense of loss. His family and friends are sadly not alone in going through this terrible ordeal. As well as the thousands of people who die every year following sudden cardiac arrest, there are thousands more who are now faced with the agonising reality of living without their loved one.
CQC: NHS Deaths Review
Craig Whittaker Excerpts(7 years, 11 months ago)
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Mr Hunt
When the new guidelines are published, we need to investigate, as far as we possibly can, deaths that have already happened. I totally recognise the hon. Gentleman’s picture of Pennine and share his real worry about the standard of care in that trust. The positive thing is that under the leadership of Sir David Dalton—the chief executive of Salford Royal, which is one of the safest trusts in the NHS and a CQC outstanding trust—things are beginning to turn around. I have spoken to him about the situation at Pennine on many occasions. The hon. Gentleman is right to say that there is a lot of work to do there.
Craig Whittaker (Calder Valley) (Con)
Many people will be shocked to hear that some trusts do not even know how many in-patients have died in their care. Will my right hon. Friend say more about what action should be taken against boards and leaders who are negligent in that way?
National Health Service Funding
Craig Whittaker Excerpts(8 years ago)
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Craig Whittaker (Calder Valley) (Con)
Our national health service is, and always has been, valued and cherished by my constituents who rightly expect an excellent standard of care to be provided free at the point of use when they need treatment. We are all deeply committed to the future of the NHS, but to ensure that it can continue to provide the quality of care that our constituents expect, it cannot stand still. It needs to continue to transform the way in which it delivers services so that more resources lead directly to better care for patients.
Both the total NHS budget and the amount of NHS spending as a proportion of total Government spending have increased in every single year since 2010. Spending is now 10.1% higher per head in real terms than in 2010, and that increase has brought our health spending as a proportion of GDP broadly in line with that of our western European neighbours. In order to achieve best value from its resources and to deliver £22 billion of efficiency savings—those are savings that the NHS identified as achievable in its five year forward view—it is necessary to reconfigure the way in which health and social care services are delivered at a local level. That is a huge issue, and until we amalgamate social care budgets with health budgets to deliver a truly health-driven service with proper health-led care in the community, we will struggle with this for many years. I mention that not to cause controversy, but to highlight the difficult decisions ahead. Too often those decisions and the long-term sustainability of our local services are hindered by ideology, local politics and empire protections over budgets.
A few weeks ago, the West Yorkshire and Harrogate STP was published, setting out the vision, ambitions and priorities for the future of health and care in the region. This built on the significant work that was completed locally by both the Calderdale and the Greater Huddersfield clinical commissioning groups, which have been working together to address the significant challenges facing the health economy across our whole area. The decision to proceed with the development of a full business case was met with considerable concern from some members of the public who have been vociferous in their opposition to what they perceive to be a complete withdrawal of urgent care treatment at Huddersfield royal infirmary. Although the process has been challenging, to say the least, I would argue that it has been absolutely essential. What is certain is that the current model through which health services in Calderdale and Huddersfield are delivered is not sustainable in the long term, and that changes are needed to ensure that we have a local health service that continues to provide excellent care.
Amid some of the sensational media headlines from the local press and the comments of some of my opponents at the last general election, it can be easy to forget that these proposals are being put forward not by politicians or by the Government, but by our senior local clinicians and doctors—the very people who understand how our local health services can best be delivered in the long term. They have taken an independent view about how the additional resources that the Government are making available can directly lead to better care for patients locally, and we have to trust their judgment. However, if we are to receive the support of our constituents for transforming the way in which we deliver their care, we must vastly improve the way in which we communicate any proposed changes and not keep scaremongering about cuts and reduced services, especially when the annual NHS budget spend is increasing in real terms.
Craig Whittaker
Does my hon. Friend agree that one lever for discouraging bed-blocking would be to join up some of the budgets around health and social care?
John Howell
I do, and that is precisely what the organisations in Oxfordshire have been trying to achieve.
The second point I would make relates to how we produce better-serving hospitals. In my own area, the Townlands Memorial Hospital, which is in Henley but which serves the whole of south Oxfordshire, has recently gone through a major reprovision. It now has an increased number of facilities serving the population of the area, but the beds are not in the hospital. Although limited in number, they are in an adjoining care home, whose opening I happened to attend with the Duke of Gloucester only the other day. It is good to see the issues at the hospital finally resolved.
That is the way forward for local hospitals: better treatment for people in their home through a system of what has come to be called ambulatory care. Such a system prevents the problems I mentioned, with patients suffering when they stay in hospital for a long time. This view comes not from politicians but from clinicians both local and national. The national clinicians I would point to are those in the Royal College of Physicians, who are fully behind this process. This method costs more in the first instance but provides better value for money and increases better patient outcomes.
The third area I want to discuss is what can happen when we integrate the staff providing care who are employed by the county council and those who are employed by the NHS. This allows us to ensure that the pay and service requirements of both groups of people, who are doing exactly the same job, can be harmonised in a much more positive way. That sets out a good scope for efficiency in the operation of social care within the NHS model. I agree with my hon. Friend the Member for Calder Valley (Craig Whittaker), in that I would like to see them fully integrated, but until then I have set out a very good method of being able to operate in those circumstances and to co-operate in order to achieve the outcomes that I have mentioned.
Sustainability and transformation plans focus on organisations working together and are the best hope of improving health and social care services in the long term. That is not my view but that expressed by the King’s Fund when it looked at the plans. I fully agree with its assessment of the situation and of these plans, which are working towards achieving the same outcomes.
Katie Road NHS Walk-in Centre
Craig Whittaker Excerpts(8 years, 9 months ago)
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Steve McCabe (Birmingham, Selly Oak) (Lab)
Tonight I am seeking an opportunity to shed some light on the continuing saga of the Katie Road NHS walk-in centre in my constituency. Its future status has been in doubt ever since its fate was placed in the hands of one of the new clinical commissioning groups. My constituents have had to live with rumours, on-off consultations and continuing threats to the long-term future of an immensely popular and highly valued service that sees about 70,000 patients a year. The origins of the service lie in concerns that the large number of students in the area, as well as vulnerable individuals—often with mental health conditions and in unstable accommodation—were placing a demand on GP services that could not be met by existing provision, which was in turn placing intolerable strains on the local accident and emergency services.
My own fairly extensive consultations with constituents have established that the centre is regularly used by those who cannot easily secure quick appointments with their own GP. That is often a problem for those in work—especially those who work unsocial hours—and for families with elderly relatives or young children who cannot easily gain access to GPs at weekends or in the evenings. The Katie Road centre sees about 300 to 400 patients during an average weekend.
There is now fairly widespread recognition of the value of walk-in centres. The 2014 Monitor review reported rising demand for the service year on year. About 70% of the centres that were surveyed reported that they were seeing an average of 20,000 to 45,000 patients a year, as opposed to anticipated attendances of between 12,000 and 24,000. Yet despite the demand and support for walk-in centres, local commissioners have closed more than 50 since the start of 2010, reduced services at 23 others and reduced overall capacity by about 20%. I am not aware that, other than the Monitor report, there has been any substantial review into the impact of that loss of provision. I wonder whether the Minister is in a position to enlighten me, and whether he might take this opportunity to say what the Government’s position is on urgent care generally and walk-in centres in particular. I noticed that the Department of Health consultation “Refreshing the Mandate” says that
“we want to improve people’s access to primary care through new forms of provision including rapid walk-in access.”
In early 2013, Birmingham CrossCity clinical commissioning group announced plans to consult on the future of the Katie Road walk-in centre. That was apparently based on a report commissioned by the former South Birmingham primary care trust, a report that remains secret to this day. I first asked to see a copy of it in March 2013. In June 2013, the CCG called off its plans for walk-in centres and it was announced that they had been saved, only for the chair of the clinical commissioning group to reveal later that it planned to renew the contract temporarily and that Katie Road had been saved for 12 to 18 months. Later, the CCG announced that it planned a two-stage consultation, with a pre-consultation phase and then a main consultation with the public.
Naturally, I wanted to ensure that my constituents had their say on the matter. When I consulted them, I discovered that more than 72% had experience of using the centre and were firmly opposed to any plans to close it.
Craig Whittaker (Calder Valley) (Con)
I agree that walk-in centres have the ability to take pressure off overworked A&Es, but does the hon. Gentleman agree that the best way to take pressure not just off A&Es but walk-in centres is to have GP surgeries open seven days a week, so that people can access services overall?
Steve McCabe
I might agree with that, but one of the problems in my area is that GP surgeries have been cut as well, so that is not the answer.
As I said, more than 72% of the people I consulted had experience of using the centre and were firmly opposed to any plans to close it. I also found that 56% of people had used the centre for out-of-hours emergency treatment, and 55% expressed serious concern about any plans to move the service to or near the A&E unit. My findings are consistent with that of the survey conducted on behalf of the NHS central midlands commissioning support unit in 2012, which found that more than two thirds of patients surveyed at eight walk-in centres and urgent care centres across Birmingham and Solihull indicated that they had attended because of an access-related issue—for example, they could not get an appointment with their GP or had to wait a considerable time to be seen.
There were major objections from my constituents to relocating their walk-in centre to the main hospital. They referred, for example, to the distance, waiting times, parking and accessibility. During a visit to Katie Road, I witnessed an ambulance crew bring into the walk-in centre an elderly lady in need of stitches to a leg injury. They did that rather than take her to the A&E unit because of their concerns over the likely delays. The CCG’s own figures suggest that an average visit to the walk-in centre costs around £45, as opposed to £75 to £100 for an A&E visit.
I am aware that there are many examples of walk-in centres being co-located with other health or social care services, and that some have a pharmacy on site or are co-located with diagnostic services such as X-ray services, dental facilities or family planning, but I should like to ask the Minister whether there is any evidence that shows an obvious advantage in co-locating an urgent care or walk-in centre alongside an A&E unit, especially evidence that would outweigh such negatives as distance, waiting times, parking and accessibility. In fact, is it not the case that most walk-in centres have a limited ability to refer patients on to secondary care services, as patients needing a referral to secondary care are normally referred by GPs, who are the traditional gatekeepers—a role that has, if anything, been strengthened as a result of the reorganisation of the NHS?
In autumn 2013 the CCG commenced its pre-consultation. The chair of the CCG met with a number of my constituents in February 2014, when he heard clearly their desire to retain Katie Road and their objections to a plan being pushed by the CCG to relocate the walk-in centre to a site at the University Hospitals Birmingham NHS Trust site, adjacent to the hospital’s A&E unit. In July 2014 I invited the chair of the CCG and a number of his staff to take part in a second meeting attended by more than 80 constituents—we were limited by the size of the room, or it would have been many more. At that meeting they heard clearly once again that there was total opposition to the closure of the walk-in centre and the plans to relocate to the hospital. That review or consultation eventually fizzled out, with the promise of a bigger and better consultation later in 2014.
NHS (Charitable Trusts Etc) Bill
Craig Whittaker Excerpts(8 years, 10 months ago)
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Kit Malthouse
That may be so, but—I hesitate to stress this point again—in my view these charities are different. They trade off the advantage of being associated with the national health service. People see them as part and parcel of the health service; they are not viewed as separate in the way that Oxfam or the Guide Dogs for the Blind might be. If something is called the Great Ormond Street hospital charity, people see it as a wing of the national health service.
Craig Whittaker (Calder Valley) (Con)
My hon. Friend raises a point about charities going off and lobbying. Does he feel that enough safeguards were included in the Transparency of Lobbying, Non-party Campaigning and Trade Union Administration Act 2014, which was designed specifically to prevent charities from taking non-transparent action?
Kit Malthouse
This is a difficult area. Some charities are composed in such a way that their entire purpose is a social mission. For War On Want or the Child Poverty Action Group, for example, decisions made by politicians are intrinsic to their objectives. Other charities, including some in the health sector, are more about providing funds and ancillary support to hospitals, and that kind of political campaigning is not intrinsic. I am not knowledgeable about the 2014 Act, but since my hon. Friend has raised it I will go and have a look. He may well be right to suggest that it contains enough protections, but I maintain my point that the special status of these charities, and the fact that they raise their money because of their association with the NHS, means that the Secretary of State must maintain some kind of toe-hold. To set those charities completely free is asking for political disaster at some point in the future.
The second part of amendment 2 would mean that if all trustee positions were vacant for three months, the Secretary of State could—and indeed should—appoint some new trustees to kick-start the organisation. That obviously will not happen often, but much of the business of this House involves planning for the unexpected. If a charity were for some awful reason to lose all its trustees at once—perhaps they are all off on a fact-finding mission together and there is a horrible accident; who knows what may happen, but let us pray to God that it does not—the Secretary of State will have the power to appoint people.
Craig Whittaker
I need to challenge my hon. Friend on the assumption of “Who else better than the Secretary of State?” Of course, our current Secretary of State is a very highly esteemed colleague of great standing—I do not question that at all. What I question is the previous string of people who have appointed politically biased appointees to various quangos around the country. Surely he can see that a Secretary of State would have the potential to be not the best person to make the decision.
Kit Malthouse
My hon. Friend will make a great diplomat when the time comes. I agree there is the possibility of misbehaviour by politicians, but we politicians come with a great advantage. We have had a few thousand people vote for us and those few thousand people can vote us out if they think we have behaved badly. There are not many other people in public life who come with that brake on their behaviour.
Wendy Morton
I agree wholeheartedly, and I am grateful to my hon. Friend for sharing with us the example of a hospital charity in her constituency and the fantastic work it does.
I thank my hon. Friend the Member for Mid Dorset and North Poole (Michael Tomlinson) for his amendment that would oblige the Secretary of State to carry out public consultation before making regulations consequential to the removal of his power to appoint trustees to NHS bodies. I understand where he is coming from. In my time as a councillor, many were the days when we discussed the pros and cons of public consultation. On the one hand, we often want more public consultation, but there are times when, as my hon. Friend the Member for North West Hampshire (Kit Malthouse) said, we feel it leads nowhere. It is an interesting point, though, and one that has provoked some lively debate. We, as elected representatives, often ask these questions about public consultation.
Craig Whittaker
I am reminded of my family’s frequent trips to Disneyland Paris when my three children were much younger. Their favourite ride was the Peter Pan ride. They played a game to see who could first spot Wendy quivering on the end of the gangplank as Captain Hook chased her into the sea. Does my hon. Friend think that Wendy might be quivering that little bit harder at the thought of yet more public consultation?