NHS Specialised Services

David Amess Excerpts

Thursday 15th January 2015 Westminster Hall

Motion made, and Question proposed, That the sitting be now adjourned.—(Damian Hinds.)

[Sir David Amess (in the Chair)]

Our subject for debate is the national commissioning of NHS specialised services. There is clearly great interest in the debate and I am sure colleagues can work out how much time is at our disposal. Obviously, I want to call everyone who would like to speak.

--- Later in debate ---

[Kelvin Hopkins (Luton North) (Lab)]

I, too, congratulate you on your knighthood, Sir David, which is well deserved. It is a pleasure to serve under your chairmanship. I also congratulate the hon. Member for St Austell and Newquay (Stephen Gilbert) on launching and promoting this very important debate.

I want to speak up for robot-assisted surgery, which should be the subject of national commissioning and should not be localised. The case for it is very powerful indeed. Some 500,000 robot-assisted surgical procedures took place in the world in 2013, and 5,000 of those were in Britain—but 5,000 is quite a small number when compared with the total number of operations across the whole field of health during a year. These operations are very specialised; a small number of very specialised surgeons do them. Clearly, such surgery is wholly inappropriate for local decision making, local funding and local commissioning. My hon. Friend the Member for Bristol East (Kerry McCarthy) made the point very strongly: these operations should be part of a national service, where we can get economies of scale and a focus on centres of quality and expertise.

The operations are used, among other things, to treat patients with prostate cancer, kidney cancer and bladder cancer and, to a lesser extent, in the areas of colorectal surgery and gynaecology. Having seen some of the operations on film, I know how incredibly precise and difficult they are and what miracles can be worked by robotic surgery. It cannot be done by human beings: however brilliant a surgeon is and however delicate their hands are, they cannot be as precise as a robot. Robots will increasingly become part of the way we operate on human beings more broadly.

My reason for being so interested in this issue is personal. Over the last four years, I have been invited to speak, briefly, at an international symposium on surgical robotics at the Royal Geographical Society. It has been led by my noble Friend Lord Darzi, of another place. As we all know, he is a gifted and brilliant surgeon himself. I make a brief address at the beginning—not because I am a medic myself or know anything about these things, but because my late father was Professor Harold Hopkins FRS. He was a gifted scientist who designed the first successful optical endoscopes. Flexible fibre optics were his, as were rod lens cystoscopes and all the endoscopes that followed from them.

If anyone has ever had a colonoscopy or a gastroscopy—or, indeed, had their bladder inspected through the urethra—they will have had one of those instruments poked inside them. I have experienced more than one of them, but fortunately I was in perfect health, so I was pleased about that. I also had the unusual experience of seeing the first ever clear picture of bladder cancer; my father showed it to me when the first endoscope was used to take it. It was an historic moment.

The point I want to make is how important it is that these procedures are promoted within the national health service, because Britain must be at the forefront of this technology. We have brilliant surgeons and brilliant designers and scientists designing these things, but when my father first invented his cystoscopes, his endoscopes, he could not get them produced in Britain. Eventually, he met a man called Storz in Germany, who manufactured the endoscopes and made millions of pounds from them.

The Deutsches Museum in Bonn has a case devoted to those instruments in a part of the museum for foreigners who have made a contribution to the German economy. It could all have been done in Britain, but it was not. I fear that if we do not keep funding this cutting-edge technology—“cutting” is perhaps an unfortunate word—we will lose our position in the world at the head of all these developments. It is so important for Britain, as an economy, that we sustain these things, but they will not be sustained if we have penny-pinching local commissioning, which will undermine the procedures and their availability.

These are very serious concerns. Sadly, my father died of prostate cancer himself some 20 years ago. There is a hereditary component in prostate cancer, so I have a personal interest in making sure that all these operations are available and that we have the best possible technologies to deal with the disease.

A recent front-page report in The Guardian or The Independent—I forget which—showed that prostate cancer treatment varies enormously from area to area, and death rates are higher in some areas than in others because some treatments are not available nationally. Some treatments, such as implanting into the prostate small radiation-generating components that kill off cancer cells, are not available to all sufferers, and they should be.

There are all sorts of reasons for national commissioning to ensure consistency of provision across the country and that people do not die unnecessarily of dreadful diseases. There is a powerful case in many other fields for national rather than local commissioning. We are talking not about hip replacements and tonsillectomies, but about very specialised operations, sometimes for rare diseases and conditions, using technology that is not available in every area. There should be national centres for such things.

That is my case, although I could speak at much greater length. I want to finish on the question of funding for the health service. There has been a lot of press comment and alarm about the state of the health service, and quite rightly so. I do not speak for my Front-Bench team—I only wish I did, and from time to time I try to persuade them that I should—but I believe that NHS spending must be increased. We spend at least 2% less of GDP on health than do the French or the Germans, and 2% of GDP is the equivalent of approximately £60 million per constituency. I would like to see an extra £60 million spent on health in Luton North, as I would in Luton South and in every other constituency. That would simply match the current situation in Germany and France.

The NHS does a wonderful job and is incredibly efficient, despite what people say. It has a high level of productivity, although that is being damaged by fragmentation and creeping privatisation. It is a remarkable organisation, envied across the world. It is still, in many ways, the best health provision in the world, but it is in danger from underfunding. I want us at least to match what the French and Germans do, especially as our economy is now evidently stronger than theirs.

There is a possibility of spending more. The population regularly indicate in polls that for certain areas, particularly health, they would be prepared to pay a little more tax to make sure that they are safe. I look forward to the next Labour Government, who should be in office in the next few weeks. We will then be able to move forward and properly fund the NHS.

[Sir David Amess (in the Chair)]

I call Mr Mark Tami, who, as it turns out, has plenty of time at his disposal.