Nurses and Midwives: Fees

Dai Havard Excerpts

Monday 23rd March 2015 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Havard. It is also a pleasure to follow my hon. Friend the Member for Foyle (Mark Durkan). We recently had the pleasure of serving for 13 hours that we will never get back on the Committee for the National Health Service (Amended Duties and Powers) Bill, which my hon. Friend the Member for Eltham (Clive Efford) promoted. It is quite a novelty to speak in a health debate in which hon. Members have actually spoken about health. It feels quite unique after the debates in that Committee.

As is customary, I place on the record my appreciation of and congratulations to the petitioners, who managed to achieve the number of signatures necessary for the debate, and my hon. Friend the Member for Blaydon (Mr Anderson) and the Backbench Business Committee on getting it on the Floor of Westminster Hall today. I also pay tribute to all who work in our national health service, not only the nurses and midwives in particular, but everyone who helps make the NHS the service that it is. We are now only five and a half weeks from the next general election and we are in the last full week of the 2010 to 2015 Parliament. Issues such as the one that we are debating show the direction in which our health service has been heading.

It is totally wrong to impose further charges on nurses and midwives, especially when many are facing a cost of living crisis caused by the Government. Wages are falling and prices rising; this is now set to be the first time in living memory when people will be worse off at the end of a Parliament than they were at the beginning. Yet the Nursing and Midwifery Council wants to increase the burden on the shoulders of registrants. What message does that send to the nurses, midwives and patients whose interests it is there to protect? I think a pretty poor one.

We have all had similar cases, but the hon. Member for Congleton (Fiona Bruce) put her constituent’s very eloquently. I am sure that other Members have such cases to pursue with Ministers, which highlight the issues surrounding the debate. We are talking about not only numbers, but real people, and it is right for such matters to be raised. Taken together with the 1% pay rise—for which, to put it bluntly, nurses had to fight tooth and nail after the Government initially indicated that they would not honour their pledge—the move we are discussing today shows what the Government think of public sector workers. When Labour gets into power, clearly we will have to look carefully at the books, but we absolutely will not do what this Government have done: break every single promise made to NHS staff.

As we have heard throughout the debate, in particular from my hon. Friends the Members for Blaydon, for Easington (Grahame M. Morris) and for Foyle, the Government should have introduced the Law Commission’s draft Bill on the regulation of health and social care professionals, which included some good measures. Had the Government introduced it, it would have enabled the NMC to increase efficiencies and decrease costs. Instead, the Government have been introducing a swathe of delegated legislation to form something of a patchwork quilt of reform. Indeed, I seem to remember, Mr Havard, that you chaired two statutory instrument Committees only last week—

[Mr Dai Havard (in the Chair)]

At the same time.

Obstructive Sleep Apnoea

Dai Havard Excerpts

Tuesday 2nd September 2014 Westminster Hall

[Julie Hilling (Bolton West) (Lab)]

I am very pleased to have secured this debate and to be—[Interruption.]

[Mr Dai Havard (in the Chair)]

Order. Could we have quiet, please, including in the Public Gallery?

[Julie Hilling]

Thank you, Mr Havard. I am very pleased to be serving under your chairmanship. You will not be surprised to learn that I first got interested in this subject from a road safety perspective. When a member of the Select Committee on Transport, I received an e-mail from the parents of a young woman who was killed by a lorry driver who fell asleep at the wheel, so I raised the issue on a number of occasions when we were doing different inquiries on things such as freight transportation and road safety. However, as soon as I started to talk about sleep apnoea, I discovered that it was far more common than I had thought—with a number of friends and acquaintances declaring that they had it—and that, in Bolton West, predicted rates of the condition are higher than the national average. I asked for the debate today to coincide with the launch of the British Lung Foundation’s obstructive sleep apnoea health economics report, because an estimated 1.5 million people have the condition in the UK, yet only 330,000 people are currently diagnosed and treated.

OSA affects people of all ages, including up to 4% of middle-aged men, 2% of middle-aged women and 20% of those aged over 70. Although not everyone with OSA is overweight, many are, and with an increasingly overweight and ageing population, it is anticipated that the rates of OSA will increase in the coming years.

What is obstructive sleep apnoea? It is a condition whereby the muscles in the throat relax, causing an obstruction in the airway during sleep, meaning that a person stops breathing. Some people stop breathing hundreds of times a night, and others have periods during which their breathing is restricted. Untreated OSA can have a profound impact on the quality of life of those affected and it has been proven to cause high blood pressure, as well as being associated with a host of other health conditions such as heart disease, heart failure, stroke and diabetes. The life of someone whose OSA is not treated can be dramatically shortened. Correct treatment has been shown to increase the probability of survival of OSA patients by 25%.

There is a strong link between OSA and an increased risk of road traffic accidents, with individuals who have uncontrolled OSA three to seven times more likely than the general driving population to have an accident on the road.

--- Later in debate ---

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

I congratulate my hon. Friend the Member for Bolton West (Julie Hilling) on securing the debate and thank her for allowing me to make a very short contribution. The link between OSA and road traffic accidents is well established, and I was alerted to that fact when the nephew of one of my constituents was killed by a lorry driver with undiagnosed sleep apnoea. According to medical experts, 10% to 20% of lorry drivers—that could be as many as 40,000 drivers—may suffer from sleep apnoea. The Royal Society for the Prevention of Accidents estimates that one third of road accidents are caused by somebody at work. In 2012, the number of people killed in road accidents was 1,754, so we are talking about approximately 600 deaths involving people who drive for work. [Interruption.]

[Mr Dai Havard (in the Chair)]

Order. I am going to have to stop you, because we have a procedure issue here. The Minister did not understand that you were going to make a contribution.

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

I am happy for the hon. Lady to make a contribution, but it needs to be brief.

[Meg Munn]

I am coming to the end, Mr Havard. In fact, I would have finished—

[Mr Dai Havard (in the Chair)]

If I had not intervened.

Type 1 Diabetes (Young People)

Dai Havard Excerpts

Wednesday 30th April 2014 Westminster Hall

[Mr Howarth]

There are a number of problems to do with primary care. Sometimes, the lack of knowledge is appalling. The fact that on many occasions young people can go to a GP with what turn out to be classic diabetes symptoms without being diagnosed is a serious problem and needs to be addressed. The hon. Gentleman is right that education programmes for health professionals are important. It is equally important for people working in GP practices or other primary health care settings to be aware of the phenomenon that they are dealing with; otherwise they will make wrong decisions and give wrong advice, which in some cases can make things even worse.

We must prioritise access to education for self-management for children and young people. I am optimistic about the introduction under the best practice tariff of the requirement that children and young people will have access to education. There is, however, huge concern about the variety and standard of education. Considerable work is needed to ensure that what is offered is nationally standardised and tailored to meet the needs of children and young people, as well as their families. Unfortunately, there is no single best practice model throughout the NHS, although I am aware that the Government’s national clinical director for obesity and diabetes, Dr Jonathan Valabhji, understands that and is working with diabetes groups to find the best way forward. Today, I simply ask the Minister to take an active interest in Dr Valabhji’s work and to provide the support necessary to make progress.

I am told by those involved in diabetes that much research is focused on type 2 diabetes and that the principal source of funding is often pharmaceutical companies. That is of course welcome, but whereas with type 2 diabetes pharmaceutical companies can see long-term benefit in new and existing products, such a link is less clear with research into type 1 diabetes. There are some counter-examples, but it is an issue that needs addressing, so it is crucial for central Government to invest in type 1 diabetes research. Despite the UK having the fifth highest incidence of type 1 in the world, our contribution to type 1 research per capita is currently less than half that spent in the United States or Australia.

A more positive story can also be told, however. Many young people now use insulin pumps. Last week, I met 23-year-old Alex, who told me how her pump had changed her life: “It’s a little like you don’t have to think about it anymore. I don’t have to get my needles out; I don’t have to offend anyone. I can have a biscuit, go to the gym. I can change it to temporary settings and go out with friends. I can do things now. Before I used to say, ‘I can’t be bothered having to plan around it.’ It only takes two seconds; it’s hidden.”

One of the research projects that holds the most hope for people with type 1 diabetes is the work to develop an artificial pancreas, which is known as an AP. The AP is in essence a combination of an insulin pump and a continuous glucose monitor. The clever part is that the two devices talk to each other via a complex algorithm. The monitor automatically checks blood glucose levels and then, in effect, tells the pump exactly the right amount of insulin needed by the body. Such technology holds great promise to help people to safely achieve the recommended blood glucose control, as well as alleviating an enormous amount of the burden associated with self-management. Recent trials of the device have been encouraging.

A consortium led by the type 1 diabetes charity JDRF is leading the development of the AP. JDRF’s artificial pancreas consortium encompasses 22 institutions worldwide participating in the study. It is a great credit to the UK’s life sciences sector that we can count Cambridge, Leeds and University college London among the contributors, alongside Harvard, Yale and Stanford. Another artificial pancreas, developed by Professor Joan Taylor of De Montfort university, could have its first human trials by 2016. It has a reservoir of insulin kept in place by a special gel barrier, which liquefies when glucose levels rise, releasing insulin to the liver, thus mimicking a normal pancreas. As the insulin lowers the glucose levels, the gel reacts by hardening again and preserving the reservoir. Such research is an important step towards developing a portable, usable and safe AP system.

To return to the point made by my hon. Friend the Member for Wirral South (Alison McGovern), social media are increasingly used to help and support young diabetics. Many young people with diabetes experience a sense of isolation and have no contact with others who share their condition. A good example of young diabetics helping themselves is the 18-to-30 support group Circle-D, which was founded by the inspirational Shelley Bennett and is celebrating its sixth birthday today—congratulations to Circle D. They have regular social activities and a rant room where people can have a rant and share experiences before going to the pub. Their motto is “you are not alone” and they now have a massive network of diabetics of all ages offering support online, via Facebook and in person. Another group, targeted at teenagers and young adults, is Hedgie Pricks. Information about both organisations can be found online, and I would certainly encourage young diabetics to get involved and to share their experiences with others in a similar position.

The debate today is an opportunity to praise the steps that are being taken to improve paediatric diabetes care and to pinpoint where we need to do more. With that in mind, I reiterate my support and optimism for the best practice tariff. Given that the tariff was only introduced recently, I hope that the Minister agrees that it would be sensible to return to the subject of type 1 diabetes in young people once we have had a chance to see how well that is working.

In the immediate future, however, the Government can and must do more. I would welcome the Minister commenting on extending the best practice tariff to 25, ensuring that children and young people with type 1 diabetes get the psychological support that they need and ensuring that educational standards for health care professionals and for children and young people with diabetes and their families are nationally standardised and accredited. I will be grateful to learn of any steps that the Minister can take to increase our contribution to type 1 research.

I have one final point to make. I feel strongly that the issue of type 1 diabetes needs a champion within the Government. I hope that the Minister will rise to the challenge and provide the political leadership that is so needed if we are to tackle this important matter.

[Mr Dai Havard (in the Chair)]

Six people wish to speak. I am looking at the time for planning purposes. We have just over an hour left, with 10 minutes each for the Front Benchers. I am trying to gauge the time, but you can do the mathematics for yourself. To be fair to one another, if you could plan for about seven minutes or something of that nature, that would be helpful.

--- Later in debate ---

[Mark Field]

That is a fair comment and I hope the Minister will comment on it.

I want to touch on an imaginative and innovative scheme in my constituency at St Mary’s hospital, Paddington, which is part of the Imperial College Healthcare NHS Trust and which I visited recently. I hope that it will not only raise awareness, but reduce the cost to which the hon. Gentleman referred. During my recent visit, I discussed the everyday realities for diabetes sufferers.

The International Centre for Circulatory Health is based on the St Mary’s hospital campus of the Imperial College Healthcare NHS Trust, just behind Paddington station. Imperial college has published some of the lowest amputation rates in the world from its diabetic foot service, led by Dr Jonathan Valabhji. It has a large diabetes technology centre that is closely linked with a research programme developing closed-loop insulin delivery for type 1 diabetics and novel continuous glucose sensor devices. Its clinical technology research is led by Dr Nick Oliver, who talked me through the pioneering work he is doing to develop the artificial pancreas system for everyone with type 1 diabetes. I hope that that will also reduce the costs to which reference was made earlier.

That ground-breaking research aims to offer the next best thing to a cure for type 1 diabetes patients in the future. I saw for myself how a small, discreet device, connected to the blood stream via micro-needles, can monitor glucose levels. When paired with insulin and glucagon pumps, the artificial pancreas should be able to give diabetics an approximate response to blood sugar levels close to what a body would normally produce. With consistent levels of insulin delivered, sufferers are liberated from the constant monitoring and worrying that comes with the daily management of the disease. The St Mary’s site is just one research centre forming part of a global effort that could help to change the lives of many of the 400,000 people who are living with type 1 diabetes, and save the NHS a significant proportion of the money that is currently spent on treatment.

The artificial pancreas system has three components. Two, the insulin pump and continuous glucose monitor, are available. However people with type 1 diabetes face difficulties trying to access insulin pumps despite a supportive technology appraisal from the National Institute for Health and Care Excellence. Indeed the national uptake of insulin pump therapy stands at just under half the NICE benchmark, set as long ago as 2008, which is extremely low and means the UK is lagging behind many western countries. There seems to be consensus among those working in diabetes research that greater investment from the Government is vital to drive developments in this area. At present, our Government invest less per capita than the US, Australia and Canada in type 1 diabetes research.

I am aware that there is some joined-up thinking, not least by my right hon. Friend the Minister for Universities and Science, but I would be grateful if the Minister here told us how the Government will work to ensure that the sort of treatment for type 1 diabetes sufferers will be matched up to the level of other western nations, what more can be done to fund pioneering research, and how we can roll out the level of service received by patients at Imperial college to patients throughout the country.

I am pleased that so many hon. Members are here today. We all have our contribution to make and I look forward to hearing what they have to say. The 400,000 sufferers and their many millions of relatives and carers will be cheered that we are treating the issue seriously.

[Mr Dai Havard (in the Chair)]

Thank you, Mr Field, for managing your time well with an intervention.

Mobile Technology (Health Care)

Dai Havard Excerpts

Wednesday 21st November 2012 Westminster Hall

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

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

It is also a pleasure to respond to this debate, and I congratulate the hon. Member for West Lancashire (Rosie Cooper) on securing it and on highlighting an important focus of future health care policy. She is right to highlight the Nicholson challenge: for the NHS just to stand still and to continue performing at the same level so that patients continue to receive the high-quality care that we all believe and know they deserve, it needs to make £20 billion-worth of efficiency savings and to put that money back into front-line patient care. A key part of the debate is that better IT will improve the way we communicate with patients and keep people well and better supported in their own home and community, on the basis that preventive health care is much better than curative health care, both for the patient and, financially, for the NHS. Of course, I would be delighted to meet the hon. Lady and people involved in the IT industry at a later date to discuss things further.

Although we know that simple things such as in-ear thermometers, improved hoists in hospitals and better-quality equipment in operating theatres has improved the quality of patient care over many years and driven down the cost of providing health care, the hon. Lady is right to highlight the fact that we need to harness and better utilise more modern types of technology such as telehealth and mobile technology to support people better in their own homes and to drive down the cost of care.

Last week, my right hon. Friend the Secretary of State for Health outlined the NHS mandate, in which he set out the vision for the NHS and addressed some of the key challenges that we face. In her speech, the hon. Lady rightly highlighted that we have an ageing population with many people living a lot longer with long-term medical conditions such as diabetes, cancer, heart disease and dementia. The challenge for the NHS is ensuring that we deliver care in a better way that meets people’s care needs while ensuring that, where we can, at the same time as producing high-quality care, we reduce costs so that there is more money to go around to look after more people.

My right hon. Friend the Secretary of State announced in the publication of the mandate that a real priority for the NHS is to improve the management of long-term conditions by helping people to better understand their conditions and to take control by supporting them to self-care, thereby realising the massive potential benefits offered by information technology both in supporting people to better understand and look after their conditions in the community, and in their own homes, and in supporting, better educating and better looking after the people who look after patients—the carers. That is an important part of providing high-quality health care.

We already know that there are 15 million people with long-term conditions, accounting for some 70% of all in-patient beds. We also know that many such hospital stays could be avoided through better management, including the better use of mobile technologies to prevent people from becoming so unwell in the first place that they need to be admitted to hospital. That would also help to prevent the revolving door of hospital admissions that sometimes happens when people do not necessarily have the support that they need and deserve when they are discharged from hospital, perhaps after a hip operation or similar stay.

Improving access and the quality of health care available to all patients is a key aim for the NHS, not just in meeting the Nicholson challenge but in improving day-to-day quality of care. Increasingly, technology will play a part in that: not just breakthroughs in simple day-to-day medical devices but changes in how we reach people in remote rural settings and in their homes and communities through the use of telemedicine, telehealth and mobile devices. We can and should take advantage of the deeply interconnected nature of modern society to improve people’s experience of health care and significantly increase our efficiency in delivering it.

There are infinite ways in which technology can transform how people access health and social care services. “Digital First”, a report published in July by the Department of Health, estimates that the NHS could save up to £2.9 billion by implementing just 10 simple actions to transform how people access health care. Those savings could be made almost immediately and with minimal investment by making use of existing technologies to reduce inappropriate face-to-face contacts.

There are many examples of simple things that can be done, such as having a doctor or nurse talk to a patient on the phone when they call to book an appointment or as an initial assessment. About one third of patients do not necessarily need a face-to-face GP appointment. Such conversations can reassure callers that they are okay and not that unwell, and that perhaps they should see how things go overnight or later in the day and call back if they need further help. They also help the patient access health care in the most appropriate way, as the GP triages the patient remotely.

Texting and e-mailing people to remind them of appointments has already been shown throughout the NHS to reduce the number of people who fail to turn up to their medical appointments. One big challenge in health care is getting patients to attend and comply with treatment, particularly those with longer-term conditions who must make multiple trips to a hospital or care setting. E-mails and texts are an effective way to remind people about their appointments and help educate them, removing the burden from the acute setting by ensuring that they understand how better to manage their conditions.

Those are simple changes, using the technologies that people use every day and are already familiar with, that can free hundreds of millions of pounds and provide more convenient access to NHS services, particularly for patients who live in more remote and rural parts of the country.

Technology can also improve the working lives of professionals. The funds that we are making available to nursing staff will enable them to access information faster so that they can spend more face-to-face time with patients, an important point that the hon. Lady made in her speech. Doctors, nurses and all health care professionals want to spend time looking after their patients. They do not want to be bogged down in paperwork. Technology, whether used on the ward or to access and look after patients remotely via telehealth or mobile technology, is a good way to ensure that front-line health care professionals have more time to do what they want to do and what they are trained to do: care for and look after the sick and patients.

I have seen at first hand the potential of telehealth and telemedicine to transform and save people’s lives. Earlier this month, I visited the telehealth hub at Airedale NHS Foundation Trust, which I know is on the other side of the Pennines from the hon. Lady’s constituency, but I am sure she will not mind my using it as an example. The hub is staffed 24 hours a day, seven days a week, by skilled nurses specialising in acute care. A consultant is also on hand if needed.

The aim of the service is to care for patients closer to home and keep them there whenever it is safe to do so. In other words, it ensures that people are properly supported and well advised in their own homes and other care settings, such as residential homes, so they do not become as unwell as they might otherwise. They are given appropriate health care advice, guidance and support in their homes and care settings, which helps reduce the burden on acute services in the area. It is particularly important in more rural areas, where the distances that professionals must travel to look after patients are so great that the only effective way to get around to as many patients as possible, in both financial and human care terms, is to use the benefits that telehealth brings to Airedale and the surrounding areas.

Evidence suggests that many patients are admitted into hospital when, as we have discussed, that is not always the best environment or the most appropriate place for them. Using telemedicine allows patients to manage their conditions with the hospital’s support. It can prevent time-consuming, costly trips to hospital for outpatient appointments. The patient’s GP is instantly informed and kept up-to-date about any consultations that occur via the telehealth care hub.

Importantly, the Government do not want such initiatives to take place in isolation. We believe, as I know the hon. Lady does, that we must ensure that they become day-to-day occurrences in the NHS as the years go on. Technology and the better use of information provide immense opportunities for improving the quality and accessibility of NHS care, not just in remote rural settings but in every care setting that we can think of.

The Government’s information strategy for health and social care, “The Power of Information”, is another example that highlights the importance of harnessing innovative new technology and delivering better health for patients. The strategy, of which I know the hon. Lady will be aware, was published in May, setting out ambitions for people to be offered online and mobile access to records, electronic communication with professional teams, online health and care transactions and the ability to rate services and provide feedback about how effective and convenient they were for the patient.

A small number of actions will need to be led nationally, such as setting common standards to allow information to flow effectively around the system. More detailed implementation planning will be led by organisations including the NHS Commissioning Board to ensure that current good localised initiatives in different parts of the country are rolled out nationally. We learn from areas such as Airedale, where looking after people in their own homes through the better use of technology is going well. Those examples should be rolled out to become the norm in the NHS. I know that the NHS Commissioning Board will be central to driving that through, which is why improving information technology was at the heart of the NHS mandate launched last week.

Mainstreaming assistive technology across the NHS is particularly important. As we have discussed, it is not good enough to have high-quality localised initiatives; we need a systematic, NHS-wide approach that embraces technology. My right hon. Friend the Secretary of State for Health announced at the Age UK conference last week that plans have been agreed that will ensure a further 100,000 people will be supported by telehealth in 2013, a sixteenfold increase in the number of people being helped by telehealth and telecare. It will make Britain the largest market in the world behind the USA, which is something that we can all be proud of.

The recently published results from the whole system demonstrator programme are potentially game-changing. We now have robust academic and scientific evidence that such technology can drive improvements not only in quality and value in the NHS but in patient satisfaction levels and outcomes. We all know that the most important people in all these discussions are the patients whom the clinician looks after and the telehealth provider wants to look after. Importantly, when we are designing telehealth services, like all other NHS services, we need feedback from patients in order to ensure that where services are working well, they can be rolled out elsewhere in the NHS, and that where improvements could be made and things are not going so well for patients, the NHS can learn from that and adapt technology to improve care in future.

At the Age UK conference last week, my right hon. Friend the Secretary of State announced some significant steps on the road to supporting the 3 million people who stand to benefit from telehealth and telecare by 2017. As the hon. Lady said, the key is improving care for older people. They are the biggest users of NHS services, so they will see the most immediate changes and feel the most immediate benefits from telehealth. We have a growing elderly population and growing numbers of people with multiple long-term conditions. In order to meet the challenge of looking after them properly and providing dignity in elderly care, we must ensure that we keep them well at home and in their communities. One significant part of the answer is doing more for telehealth. The Government are well on the road to doing so. I welcome further discussions with the hon. Lady about what more we can do to look after people, particularly the frail elderly, in their own homes.

[Mr Dai Havard (in the Chair)]

Thank you, Minister. I am sure that you will have interesting discussions with your colleagues in the devolved Administrations about interconnectivity as well.

Question put and agreed to.