Care of the Dying

David Amess Excerpts

Tuesday 17th January 2012 Westminster Hall

[Mr David Amess (Southend West) (Con)]

I congratulate my hon. Friend the Member for Enfield, Southgate (Mr Burrowes) on the strength and spirit of his speech. I also congratulate the hon. Member for Hampstead and Kilburn (Glenda Jackson) and very much agree with what she said. I was privileged to be present at my father’s death. My mother will, hopefully, shortly celebrate her 100th birthday.

All hon. Members came into politics because we care about life. We did not come into it to legislate about death. This is a sensitive and serious issue. One of our former colleagues is not in great shape at the moment. If he were able to attend he would support what my hon. Friend the Member for Enfield, Southgate said.

When I was Member of Parliament for Basildon I was privileged to lay the foundation stone for St Luke’s hospice. My hon. Friend the Member for Loughborough (Nicky Morgan) mentioned hospices in her constituency. In the area that I represent there is Fair Havens hospice and Little Havens hospice for children. I agree with the views of my hon. Friend the Member for Enfield, Southgate on what Dame Cicely Saunders said.

Britain is the world’s leading provider of end-of-life care. We are the only nation to offer palliative care as a specialist, medical discipline in its own right.

[Mr Julian Brazier (Canterbury) (Con)]

Does my hon. Friend agree that, when Government budgets are under a great deal of stress and the amount of assistance received from the NHS by hospices such as his and the Pilgrims hospice in my constituency is being decided, it would send exactly the wrong message to those splendid hospices and to those making budgetary decisions in the NHS if the House decided to allow assisted suicide?

[Mr Amess]

I agree with my hon. Friend. His local hospice does splendid work.

Hospice workers require four years’ intensive training in order to practise. As a result, our hospitals and hospices are staffed by teams able to offer first rate end-of-life care when it is needed—all hon. Members will be familiar with the wonderful quality of care in our hospices—which puts Britain at the scientific forefront of palliative medicine, meaning that the care we can offer will only improve as advances are made. If we can offer this world-leading end-of-life care, why are we looking to euthanasia as an alternative solution?

We can do even more with end-of-life care than we are doing at the moment. We should seek to provide appropriate care to everyone who needs it, as the hon. Member for Hampstead and Kilburn said, no matter who they are or where they are. Figures suggest that 700 people in every constituency die without access to the appropriate services they need. Of course, this needs to change.

We need to help more with planning difficult situations. Understandably, thinking ahead can be traumatic for patients and families. None of us—I am the world’s biggest coward—wants to face the consequences of death. We must therefore do all we can to ensure that the end-of-life support received runs as smoothly as possible. We should focus on personalisation and integration.

Care needs to be developed throughout the community, so that the dying can spend those precious last moments in their local area, not in hospital.

We have already heard about the difficulties of legalisation in Oregon.

I could say much more, but I will not. I simply applaud the words of Dame Cicely, who said,

“Hospices are places where people come to live, not to die.”

Once again, I congratulate my hon. Friend the Member for Enfield, Southgate on providing the opportunity for us to debate this important issue.

Pregnancy Counselling

David Amess Excerpts

Monday 12th December 2011 Commons Chamber

[Anne Milton]

I thank the hon. Gentleman for his intervention, but there is no need for this to be dealt with in legislation. Before today, I have given my word at this Dispatch Box that we will carry out the consultation and bring forward the best options in finding the best way to make sure that women have an offer of counselling should they wish to take it up. It is important to remember that women who access services sometimes do so from a wide variety of directions—they may self-refer or come from their GP. What matters is that we get the offer in the right place. We need to consider whether the woman should have the one offer or whether the offer needs to be continually open because she might turn it down in the first instance, at the first appointment, but want to take it up, say, a week down the line. It is important that we get the detail right. We do not need to put it into primary legislation; in fact, it would arguably be inappropriate to do so. I repeat that I have said from this Dispatch Box, on more than one occasion, what we will do.

As the hon. Member for Luton South said, there is concern that there is a conflict of interest in that counsellors are paid for procedures and yet also expected to provide entirely impartial advice to women. Although there are no formal quality standards in place for counsellors and no minimum standards for training or qualifications, we have found that the majority of counsellors who work in independent sector abortion providers are registered with the British Association for Counselling and Psychotherapy. Underpinning membership of, and accreditation by, this organisation is a thorough ethical framework that counsellors must abide by. However, sufficient concern has been expressed, so we are looking at everything in the round to make sure that the sector is not only independent but has the confidence of the public that it is independent. It is important to say that independent sector abortion providers and organisations that refer women for an abortion are subject to the Secretary of State’s approval and monitoring by the Care Quality Commission. Marie Stopes International, which is one of the leading abortion providers, has reported that 20% of its clients decided not to go through with the termination following counselling. That is an interesting statistic.

Pregnancy counselling is about providing women with a non-directional and non-threatening service in which they can explore the issues. Some will immediately decide on their course of action, and others will still be unsure about what to do at their first appointment with a health professional. This can sometimes make it very difficult to provide the uniform standard of care that is so important. What is right for one woman will not necessarily be right for another, and so a flexible service that can respond as far as possible to individual women’s needs is essential. Moreover, we do not want to create barriers or to instil delays in the service. Counselling can help a woman to recognise conflicting emotions and feelings and allow her to accept that there may be no perfect, straightforward answer to this crisis in her life. Most importantly, it allows her time and space to reach an informed decision. There is evidence that counselling can help women, particularly vulnerable women, to make a decision with which they are comfortable. We have also heard anecdotal evidence from women who feel that they could have been helped by counselling before making their decision to have an abortion.

Counselling must be balanced. Effective counselling must be confidential, non-directive, non-judgmental, supportive and understood by the person to be independent of any assessment for legal approval for abortion. It needs to happen away from the influence of family or friends. The hon. Member for Luton South highlighted the case of a woman who felt pressurised by her boyfriend and I know that some women feel pressurised by their families.

Contraception has been free on the NHS since 1974. It has helped millions of people to avoid unintended pregnancy and to plan their families as they wish. There are 15 methods of contraception and we have seen a recent increase in the number of women choosing highly effective methods of long-acting contraception.

Although abortion rates for all ages have remained stable, between 2007 and 2010 the abortion rate fell for those aged 24 and under, and the number of abortions overall fell. In 2007 there were just shy of 200,000 abortions, whereas in 2010 there were 189,574, which is a decrease of nearly 10,000 in the space of three years. That is good, but we clearly have a great deal of work to do. Ideally, we do not want to face anything near those numbers. We must ensure that young people have good relationships and sex education so that they can make good choices for their lives.

In conclusion, this work is about ensuring that all women considering an abortion get the best possible service, which they not only need, but deserve. We are looking to build on the recent early successes of the increasing access to psychological therapies programme and to use that model to develop options for pregnancy counselling. We have had discussions with the officials leading that team in the Department and there is a lot of opportunity. I have no doubt that when we offer young women counselling, it will be an opportunity for some women to unearth all sorts of other issues in their lives, such as domestic violence and sexual abuse. I hope that all Members agree with the principle behind this, as I think they do, even though we sometimes disagree about the small print. I hope that the hon. Member for Luton South and all hon. Members will continue to work with us to get this right.

[Mr David Amess (Southend West) (Con)]

I congratulate my hon. Friend on the stand that she is taking, even though some of her statistics have slightly mystified me. Before she completes her speech, will she tell the House roughly when, after the consultation next January or February, she believes we will come to a new arrangement for abortion counselling?

[Anne Milton]

As I have said, I am working with Members on all sides of the debate to get the consultation document right, with the right options and the right offer. The consultation will last for 12 weeks and I then hope to bring forward the arrangements. There are issues with the number of counsellors who are available and with the pathways. These things never happen as quickly as I would like. I always wish that things could happen yesterday, but sadly they cannot.

Oral Answers to Questions

David Amess Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Lansley]

I do not have a figure for that. If the hon. Lady and others want to discuss it, I would be glad to see evidence of it—and so should NHS employers, because as part of the implementation of “Agenda for Change”, staff should be banded in grades according to independent criteria.

[Mr David Amess (Southend West) (Con)]

T9. Last year in Westminster Hall, the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton) rightly praised the work of midwives and the Royal College of Midwives. Does she share my concern that locally, there could be a downgrading of community midwives, leading to an overall reduction in the number of midwives in our area?

[Anne Milton]

I thank my hon. Friend, and I will take this opportunity to praise again the work of midwives and the Royal College of Midwives. It was a pleasure to be at its conference only last week. I would point out that there are now more than 20,000 full-time equivalent midwives. That is an increase of 2.4% on last year. We have record numbers of midwives in training, with 2,493 this year and an increase on that next year. What matters is that we get the right services for women who are pregnant, ensure that they can exercise the choices that they need, and get the right skills mix.

NHS (Essex)

David Amess Excerpts

Tuesday 15th March 2011 Westminster Hall

[Mr David Amess (Southend West) (Con)]

I congratulate my hon. Friend the Member for Witham (Priti Patel) on securing this debate, and particularly on how she has raised concerns on behalf of her constituents. Witham is very fortunate to have her as its representative.

I served on the Health Committee for a decade; in fact, I was on it for so long that towards the end of that time we were repeating inquiries. We travelled to a number of countries and when we returned home, we always concluded that our health service was the best in the world. We did wonder, however, how on earth we would fund the service if we were starting it from scratch.

Since I first became involved in health matters, the needs and demands of the health service have changed dramatically. I am in a very good position to comment on such matters because when Ann Widdecombe was shadow Secretary of State for Health I was one of her troops, serving on the Committee on the Bill that brought into force primary care groups and primary care trusts. Although the right hon. Member for one of the Southampton constituencies got slightly irritated with my endless questioning and long speeches, if anyone is very sad and wants to read Hansard I recommend the speeches that I made then because everything that I forecast would happen, sadly, has happened. It has taken the present Government to reverse what happened 13 years ago.

I am very familiar with four hospitals: Newham General, the King George in Ilford, Basildon and Southend. I will not share my views of my experiences at those hospitals, because I was there not just as a politician but as a user, along with my family. I shall simply say that the experiences were very different from one another, and they are ongoing.

Let there be no doubt that I agree with everything that my hon. Friend the Member for Witham said. I have to be slightly partisan; I have to tell my hon. Friends who were elected last year that I feel very strongly that during the 13 years of Labour Government the word “deprivation” was not on the register at all for the south of England. There is no doubt that resources shifted from the south to the north. All I say to the Minister, who has a wonderful background, is that I hope we will now be treated fairly. I am confident that that will happen.

I am more concerned now about management generally, particularly that of our hospitals. Why is a school considered good? Because it has leadership from an excellent head. Why are transport facilities good? Again, because there is good leadership. Why is a country successful? It is because of a great Prime Minister. I am challenged on a number of fronts by leadership in our hospitals. I will not go on about matrons, but when people are anxious and have health problems, with which they need to go to A and E for example, they want to know who is in charge. It is not rocket science. Nor is cleanliness and all the rest of it. Leadership is so important, and I do not care if a leader is seen as a bossy boots, like Hattie Jacques. I am fed up with managers who have endless meetings. What are they meeting about? As MPs, we have to take full responsibility for how we represent our constituencies, and if something is not right it is down to a hospital’s chief executive—it is no good their blaming the troops.

My hon. Friend the Member for Witham touched on some matters concerning Essex, for example the demographic pressures and shifts. The council and the NHS have developed, and are continuing to develop, joint commissioning arrangements there. That is very good. In Essex, we are working hard to implement the White Paper, and are progressing well with putting into practice the Government’s flagship reforms. The Secretary of State has been criticised in some areas for rushing the reforms, but in my time in the House I cannot remember a shadow Secretary of State who was in post for as long as my right hon. Friend was, so he had a lot of time to think about the reforms. This is the only job that he wanted, so the idea that he is rushing is wrong.

In Essex, commissioning with the independent voluntary and community sectors is going extremely well, as is the scrutiny of health functions. As the changes—some of which are controversial and challenging—go through, will the Minister reflect on how our hospitals are managed? That is so important. In my previous constituency the fullest age profile was for young people and in my present one we have the most centenarians in the country, so the challenges are very different in different places.

I want to raise a number of quick points. I will not cause the Minister angst, but she will be aware that there is an issue locally with the Essex Cancer Network and the proposal for an increase from seven to 10 linear accelerators. I hope that any increase is in Southend, and that we do not look further afield. The Minister would expect me to say that, and I do not want to put her in a difficult position.

For the past nine months, all health and social care partners and representatives of patients, carers and care homes have been working in a formally governed partnership to deliver an innovative and integrated model of care for the elderly locally. Will my hon. Friend the Minister look at how we are dealing with that? Over the past year, partners have worked together to open a new “step up” intermediate care facility on the Southend hospital site. I wish that many years ago, managers had considered more carefully when deciding to close Rochford hospital. Unlike Basildon hospital, which has plenty of land around it, Southend hospital is landlocked and has nowhere to expand, and we are paying the price.

Demand for care of the elderly is increasing, and I am not entirely convinced that we have a solution at the moment. Children’s services in south-east Essex are doing well. We have been recognised as baby-friendly by UNICEF and have received a certificate of commitment. We are launching a new service for children and young people with disabilities and we are opening a new diabetes rehabilitation suite. Southend hospital has secured a patient safety award. Many good things are happening.

GPs are being asked to deliver health care reforms. When Bernard Ribeiro, who has now been made a peer of the realm, was the lead consultant at Basildon, it was clear where the leadership of consultants was. I am puzzled to know who leads groups now. Endless meetings are held, but we need ownership and someone to take responsibility for what happens when a patient arrives at hospital. Who sees them first? When they go to accident and emergency, are they seen quickly by triage? Who deals with their case afterwards?

We have many wonderful GPs in Southend— Dr Husselbee, Dr Pelta, Dr Lawrence Singer, the Zaidis; the list is endless—and they are all working hard to deliver what the Government want. I believe that my constituency has the only GP pathfinder consortium in south-east Essex, and it has one of only seven partnerships in the east of England announced during the first wave. The group covers a population of nearly 80,000 patients, mainly in the west of Southend.

The practices have been working well together for the past three years and have managed to set up out-of-hospital ear, nose and throat, gynaecology and urology services, which give rapid access to specialist care at less cost to the NHS than at present. The group has implemented a clinical gateway that enhances GP referrals, reduces waste and ensures that patients get to the right specialist first time, which is critical to reducing the amount of money spent and the stress caused to patients waiting for referrals. Practices co-operate closely, with patients attending other surgeries for minor surgical procedures.

As a result of such close working for the past three years, the group is moving forward and seeking to become a sub-committee of the primary care trust, which will not exist within 18 months, and to take greater control of the budgets delegated to it by the PCT. The group has ambitious plans to improve care for the elderly, which I salute, as well as the health of patients with long-term conditions.

When local authority work begins, close working relationships will be vital to align the health and social care budgets to enable—colleagues might be puzzled by this phrase—more integrated working. That will be better for patients and lead to greater efficiencies. Similar joint working is happening between community and mental health programmes. The Health and Social Care Bill clearly puts patients at the centre of the NHS. This is controversial, but when budgets are stretched it is vital that the public are part of the process for deciding how the commissioning budget will be spent. We must take people with us if they are to accept that resources are scarce.

I am delighted to say that our local group has a grant from the Department of Health to define what public involvement should look like. A successful meeting was held recently involving a wide range of stakeholders—that awful word—including patient voluntary organisations, special interest groups and representatives from the local involvement network, Southend and Essex hospitals and the community. It is expected from the initial meeting that an agreement will be reached on how the public can best be involved, both at strategic level and in making decisions about specific projects. One possible outcome involves forming a group of health champions who have received training on commissioned health services.

I will not take up any more of the House’s time, as it is not fair to the colleagues who are waiting to catch your eye, Mr Dobbin, but I say to my hon. Friend the Minister that it would be good for the Department of Health to take seriously any representations made by hon. Members for the great county of Essex.

Maternity Services

David Amess Excerpts

Tuesday 26th October 2010 Commons Chamber

[Mr David Amess (Southend West) (Con)]

When I applied for this Adjournment debate, I did not anticipate quite the level of interest that there appears to be from colleagues, because I did not want to talk about specific constituency matters; I wanted just to draw to the House’s attention to one or two general midwifery matters. So all I would say, Mr Speaker, is that I hope that colleagues will be fortunate enough to catch your eye.

There can be no more personal, emotional or exhilarating experience than watching a baby being successfully delivered. I had the privilege of watching each of my five children being brought into this world, and the sense of wonder and excitement is very personal and unique to everyone, but I am much more comfortable observing babies being born than having to deliver one. It is extraordinary how some members of the animal world seem to have babies so much more easily than human beings do.

However, the point that I really want to make is that from a woman’s perspective, there can be nothing more personal than the relationship that a lady having a baby has with the midwife. Indeed, when our five children were born, I represented Basildon, and so strong was our relationship with the midwife, a wonderful lady called Ladze, that she ended up being godmother to all our children.

Despite some improvements in the national health service’s maternity provision in recent years, much more must be done to ensure that women throughout the United Kingdom receive the best care possible. For those and many other reasons, I want the House tonight to consider how best we can value and support the work of our wonderful midwives.

Let me say immediately that Southend’s maternity services are absolutely splendid. Indeed, their quality was recognised in the Healthcare Commission’s report into maternity services in the UK, in which Southend University hospital was rated one of the very best in the country. Indeed, I have just heard that I have become a member of the Royal College of Midwives parliamentary panel. It is unpaid and voluntary, but I declare it as an interest. As I am sure that all colleagues will agree, midwives throughout the country provide an absolutely invaluable service.

Recently, when I was privileged enough to undertake voluntary service overseas in the Philippines in order to support Filipino nurses, I went to a village in Ifugao, and there at first hand I witnessed just how difficult it is for some ladies to deliver babies. Our services in the UK are somewhat better than those in the Philippines, bearing in mind the challenges that are faced there, but we could still do much better.

Relations between midwives and consultants must be strengthened, and I say to my hon. Friend the Minister that more training should be available to midwives. Although the previous Government claimed some success in introducing consultant midwives in 1999, by 2009 there were only 59 throughout the United Kingdom—just not enough.

Midwives throughout the country are anxious about the outcome of the review of their pensions. The NHS pension scheme hands billions of pounds over to the taxpayer. Indeed, more is paid into the fund than is paid out to pensioners. In the past five financial years, the scheme has handed over £11.3 billion in surplus to the taxpayer, thereby helping, not hurting, public funds.

I congratulate my hon. Friend Baroness Cumberlege on the work that she did when she was a Health Minister in 1993. The report that she produced, “Changing Childbirth”, is as relevant today as it was back then. Furthermore, the work of the Royal College of Midwives, under its very capable general secretary, Cathy Warwick, must be acknowledged. This organisation, which represents 95% of all practising midwives in the UK, does wonderful work that helps women and newborns across the country. The NCT has also given me an excellent briefing on this subject and I know that it supports the points that I wish to raise this evening.

There has been a decade-long baby boom, with 100,000 more babies born last year than in 2001. Rises in the number of midwives have gone some of the way towards catching up with this extra demand. Indeed, there has been an increase of 2,000 in the number of midwives in the last three years and more than 600 more places for student midwives than there were four years ago. However, those extra midwives have largely been swallowed up by the need to provide valuable one-to-one care in labour. This means post-natal care remains woefully inadequate. Extra demand has also come from growing complexity. Mothers are increasingly younger or older than before, and some mothers have serious weight problems. The conception rate for women aged 40 to 44 has doubled since 1991, while the teenage pregnancy rate in the UK remains the highest in western Europe. There have also been significant increases in multiple pregnancies and pregnancies to women with medical conditions that would previously have precluded childbirth. The caesarean section rate is also at a historically high level—just shy of one in every four births. More midwives would help to provide women with the level of antenatal care that would prepare them properly for labour and birth.

Currently we are almost 4,800 full-time equivalent midwives short, based on calculations using established midwifery work force planning tools. For too long, maternity services were not a priority within the NHS: spending on maternity care as a proportion of the NHS budget fell from more than 3% in 1997 to below 2% in 2006, and the share of the NHS work force made up of midwives fell throughout the Labour years. Indeed, while in 1997 there were more midwives in the NHS than there were managers, after 12 years of a Labour Government, by 2009 there were 18,000 more managers than there were midwives—a ridiculous situation. The contrast in what has happened to the two work force groups illustrates how focus may have slipped away from clinical care on to performance monitoring and the dreaded targets. It is the task of the new Government to ensure that midwives do not continue to be sidelined, that their work is valued and that focus returns to good quality patient care.

Aside from resources, however, is the question of policy. The recent White Paper promises that the Government will extend maternity choice but there are questions about how it will be achieved. Although the Labour Government often said the right things and made many promises in relation to choice, they failed to deliver. Progress in implementing choice for women throughout pregnancy, childbirth and the post-natal period was impeded by a lack of sustained investment in maternity services; insufficient recruitment of midwives; and a lack of prioritisation on the part of many commissioners and providers of maternity services. It is easy to assume that it saves money to consolidate, but I do not believe that in the medium to long term that is true.

The main issue with choice is location—the options being birth in a consultant-led unit in a hospital; birth in a midwife-led unit, which may or may not be on a hospital site; and birth at home. A midwife can handle more births in a year in a midwife-led unit or at home than in a hospital, so it is an issue of efficiency as well as choice. Capital investment to provide more midwife-led units is vital, but sadly the total number of such units has dropped significantly in the last two years.

The price of getting maternity care wrong is extremely high, as the cost of litigation shows, and in a time of austerity these are costs that the country simply cannot afford. Of the 100 biggest damages payouts made under the clinical negligence scheme for trusts, 79 derived from obstetric care, and of the total £3 billion paid out in damages under the CNST, almost £1.4 billion was down to claims deriving from obstetrics. Cutting corners in maternity care carries a heavy human and financial cost.

In conclusion, the Prime Minister has admitted that the profession is “stretched to breaking point”, “overworked” and “demoralised”. During the election, all three parties agreed that more midwives were needed to cope with the continuing shortfall. Rightly, the NHS was shielded from cuts in the comprehensive spending review, and this protection should mean that the Government can provide enough midwives to deliver the level of maternity care that women and newborns expect and thoroughly deserve.

[Several hon. Members]

rose—

Epilepsy Services

David Amess Excerpts

Tuesday 12th October 2010 Westminster Hall

[Mr David Amess (Southend West) (Con)]

It is always compelling when colleagues speak from personal experience. That has certainly been the case today. I congratulate my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) on the way in which he introduced the debate. Indeed, his speech was so comprehensive that he has left little for other hon. Members to say. But being a Member of Parliament I will try to find something to add to this debate. I congratulate my hon. Friend on sharing his experience with us this morning. I am certain that he is still reflecting on what the history of this country would have been like if he had been elected as MP for Twickenham.

Colleagues have spoken about their personal experiences, so perhaps I could share some of mine. A number of my family members have suffered with epilepsy, although I will not name any of them because they do not want to be the subject of any intrusion whatsoever. All I will say is that it is scary when people are not prepared for what happens when someone has a fit. When a baby suddenly stops breathing it is stressful for parents who have not been warned about such a situation.

My hon. Friend mentioned people suffering from epilepsy perhaps being thought to have had a bit too much to drink. I am ashamed to say that I am guilty of having made that misdiagnosis myself and coming to the wrong conclusion. I am glad that he mentioned that.

The Minister and I were colleagues on the Health Committee. Throughout that time it occurred to me that, although it would have been a new contribution to the debate, we never had an inquiry into epilepsy. Now that my right hon. Friend the Member for Charnwood (Mr Dorrell) is chairman of that Committee, perhaps the Minister might like to consider that matter, together with my hon. Friend the Member for South Thanet (Laura Sandys), who is chair of the all-party group on epilepsy. That would be a good subject for a Health Committee inquiry.

Sudden unexpected death in epilepsy accounts for more than half of all epilepsy-related deaths in the United Kingdom. We know that with a clear understanding of epilepsy and good management of seizures, the risk can be minimised, as hon. Members have already said. The National Institute for Health and Clinical Excellence guidelines recommend that information about the problem should be provided to patients following a diagnosis of epilepsy. There is clear evidence that that does not appear to be happening. Perhaps all colleagues would be diligent about this situation and inquire about what exactly is happening. People who are diagnosed with diabetes or heart problems, for example, are made aware of the risk of death if their condition is not well managed. Epilepsy should be in that category and dealt with in the same way.

There is no national monitoring of epilepsy deaths. However, the Coroners and Justice Act 2009 highlighted epilepsy as one area in which standards could be developed. There continues to be an urgent need for research into the cause and prevention of the problem. Eight years on from the national sentinel audit that established the level of avoidable deaths, our understanding of sudden death in epilepsy is greater, but we still need to reduce the number of such deaths, as my hon. Friend the hon. Member for Blackpool North and Cleveleys said. We need more research into this neglected medical syndrome.

The White Paper reforms may offer a significant opportunity for some of the more neglected conditions in health care. It has been acknowledged that national targets, which I have deplored, ignored some conditions. Now the White Paper promises a relaxation in the use of targets and puts patient safety at the heart of the NHS.

In conclusion, if primary care practitioners are to be responsible for commissioning epilepsy services, they will need to be well informed on these issues, as my hon. Friend has made clear. They will need to move beyond the dreadful tick-box exercise for epilepsy in the GP contract and look seriously at the potential for achieving more positive outcomes for patients and a more cost-effective health service.

I ask the Minister to bring these issues to the forefront as we build on our excellent national health service.