Care of the Dying

David Burrowes Excerpts

Tuesday 17th January 2012 Westminster Hall

[Mr David Burrowes (Enfield, Southgate) (Con)]

I welcome the opportunity to talk about care of the dying. It is marked that so many hon. Members are attending the debate on a subject that so many people in our constituencies would rather not talk about.

Last year, a ComRes poll found that 67% of people are scared of being told that they are dying. More significantly, 83% are scared of dying in pain. As a nation, we need to get better at talking about dying, death and bereavement, but Parliament can take a lead in breaking the cycle that can result in a lack of care. With the public reluctant to discuss end-of-life care, many professionals do not feel confident to deliver it. Services are not available to everyone who needs them. The aptly named Dying Matters coalition, across the public, voluntary and private sector, should be commended and supported when it has its annual awareness week in May.

Too often in health care, dying equals failure rather than a normal process. This attitude ignores those who will not respond to treatment, but who can still be cared for significantly. Although death may be a tragic inevitability, palliative and hospice care can ensure that the remainder of life is still worth living. We have an opportunity today to show the mark of a civilised society and care for the vulnerable and largely forgotten—the dying.

The growth of palliative care, not legalisation for assisted suicide, should form the central debate about care for the dying. As a country, we must do all that we can to allow the terminally ill to live a dignified life until death, to make the intolerable tolerable and to replace hopelessness with hope and desperation with serenity. Too often, this essential part of health care is forgotten, or simply shrouded by the more high-profile issue of assisted suicide. Reading media reports this year, one could be forgiven for thinking that that is the only option for those suffering with terminal illness. Rather than legislating for an abrupt end to life, we need to find better ways to help care for the dying.

The good practice of palliative care, which hon. Members will no doubt illustrate this morning with constituency examples, makes the point that we in this country believe that life should be treated with dignity at every stage through to death. Some 50 years ago, Dame Cicely Saunders, founder of the modern hospice movement, said:

“You matter because you are you, and you matter to the last moment of your life. We will do all we can not only to help you die peacefully, but also to live until you die.”

What a refreshing contrast from what we have heard recently from those advocating assisted suicide. Take the chilling words of Baroness Warnock, who said:

“If you’re demented, you’re wasting people’s lives—your family’s lives—and you’re wasting the resources of the National Health Service.”

Suggesting that we have a “duty to die”, she said:

“I think that’s the way the future will go, putting it rather brutally, you’d be licensing people to put others down.”

Well, that is not a future I want to be a part of, and I am sure many of those present today agree. [Hon. Members: “Hear, hear!”] If we adopted the law of Oregon, the trickle of people wanting to be killed in places such as Dignitas would become a flow—some estimate that more than 1,000 people a year would take that path.

[Andrew Selous (South West Bedfordshire) (Con)]

Does my hon. Friend agree that one of the most worrying things is that, if what he is talking about is introduced, many older people may feel that they are a burden and that they should bring an end to their lives?

[Mr Burrowes]

Indeed. We need to retain the present law, which continues to provide a strong deterrent to the exploitation of vulnerable people, while giving prosecutors discretion in hard cases. Parliament has agreed, through a detailed Select Committee inquiry and three votes in the past six years, to retain that protection. We have to recognise that it is easy, in the comfort of Parliament, to make fine-sounding points about terminal illness. I recognise that there are no easy answers for those who feel they are not valued and who may feel that they may be wasting resources or are a burden on their family or society. However, they are the very people who most need the protection of the law and the provision of good-quality palliative care. How do we best safeguard their dignity and autonomy?

When we talk about dignity in the context of a health debate, it can all too often be restricted to privacy and physical care, but palliative care recognises a wider, proper understanding of dignity. Good palliative care recognises the social, emotional, spiritual and psychological needs that put an embrace around a terminally ill patient, rather than the proposed arbitrary, so-called safeguards that put a straitjacket around patients and doctors. For example, the prognosis for a terminally ill patient is notoriously difficult to determine. The best safeguard is through specialist palliative care that helps a patient live with uncertainty. Take the case of a motor neurone disease sufferer who wants to end his life but, unknown to his GP, has developed fronto-temporal dementia and whose thinking has become distorted. Such a condition could only be noticeable if someone knew that patient very well before the illness. The best safeguard to help the patient live with those fluctuating moods and thoughts is specialist palliative care. The proper way to empower patients’ choice and protect the vulnerable is through driving up palliative care standards, not new legislation.

In 2010, the Economist Intelligence Unit ranked Britain, rightly, as top of the league of countries for the provision of end-of-life care. Much of the credit is no doubt due to the expansion of local charitable hospices that provide more than £700 million of care, the majority of which is donated by the communities that they serve. Additionally, more than 100,000 people donate their time to local hospices each year.

[Nicky Morgan (Loughborough) (Con)]

I congratulate my hon. Friend on securing the debate. The fact that there are so many hon. Members here at 9.30 on a Tuesday morning shows what an important subject this is. He talks about local hospices. The Rainbows children’s hospice, which is in my constituency, now looks after young adults with life-limiting conditions as well. In this debate, we will perhaps focus on older people, but we should not forget children with life-limiting conditions. One point that the hospice has made to me—I think that my hon. Friend is coming on to this—is the fact that we need to integrate both health care and social care. Rainbows children’s hospice would like to see more of that from the Minister.

[Mr Burrowes]

I am grateful for that point. Integration is needed, and we see that in the context of hospices and palliative care. We hope for that future in the reforms that are going through Parliament.

Although we should be proud, rightly, of individual examples in our constituencies, we should not rest on our laurels. We need to build on that solid foundation, because far more can be done. End-of-life care is not available to everyone who needs it. In fact, the palliative care funding review found that 92,000 people die in England every year without access to the services that they need. That figure equates to nearly 500,000 people during the term of this Parliament, and 700 people in each of our constituencies dying without the good palliative care services that they deserve.

Nationally, hospices receive about a third of their funding from the NHS, but that can vary substantially across the country. Indeed, in my constituency in Enfield, the NHS contributes less than 20% of what the hospice spends on care for Enfield patients. One of the biggest issues facing the terminally ill is where they will die. Currently, more than half the people who die in England do so in hospitals and just 20% die at home, although various studies have shown that two thirds of people would choose to die at home.

In Enfield, there are excellent palliative care services. I pay tribute to Nightingale Cancer Support Centre and North London hospice, which provides a community service providing care in people’s homes alongside an in-patient unit. In Enfield, the North London hospice community team are able to ensure that only 28% of people cared for by the hospice die in hospital.

According to the Minister, the Government should consider allocating national resources to continue to promote and extend palliative care. I look forward to hearing from the Minister about the progress in implementing the new per-patient funding system for hospice and palliative care providers, which will provide incentives to enhance services within community settings.

[Guy Opperman (Hexham) (Con)]

Will my hon. Friend give way?

[Mr Burrowes]

I will conclude in a moment, because a large number of colleagues want to contribute.

Jean Rostand, the French biologist, said:

“For my part I believe that there is no life so degraded, debased, deteriorated, or impoverished that it does not deserve respect and is not worth defending with zeal and conviction. I have the weakness to believe that it is an honour for our society to desire the expensive luxury of sustaining life for its useless, incompetent and incurably ill members. I would almost measure society’s degree of civilisation by the amount of effort and vigilance it imposes on itself out of pure respect for life.

I look forward to hearing hon. Members demonstrate that respect for life, for the dying, today.

Life Sciences

David Burrowes Excerpts

Monday 5th December 2011 Commons Chamber

[Mr David Burrowes (Enfield, Southgate) (Con)]

May I be the first warmly to welcome the Secretary of State’s statement and to make a bid for the catalyst fund for regenerative medicine, which not only offers great hope for the future but is providing life-saving treatment through umbilical cord blood? I refer him to the recommendation the UK stem cell strategic forum made last year for collaboration between universities, hospitals and farming industries to make greater use of the application of cord blood now and in future.

[Mr Lansley]

I am grateful to my hon. Friend and heartily welcome his support for the opportunities in regenerative medicine. I was fortunate enough to meet at the UK Stroke Forum last Thursday, among those exhibiting, a company that is based in England but undertaking trials and research activity in Scotland and is looking precisely at how it can use foetal-derived stem cells for regenerative purposes. The right hon. Member for Leigh (Andy Burnham) talked about Pfizer. In my constituency, it has been one of the companies leading the development of new regenerative medicine techniques. That is clearly one of the areas that this country has tremendous potential in developing. The technology innovation centre for regenerative medicine was announced in the “Plan for Growth” published alongside the Budget earlier this year, and I hope that it will be one of the areas in which we will see those developments.

Health and Social Care (Re-committed) Bill

David Burrowes Excerpts

Wednesday 7th September 2011 Commons Chamber

[Nadine Dorries]

I will not give way again to the hon. Gentleman, as I am sure that he will have an opportunity to make his point when he is called to speak later.

[Mr David Burrowes (Enfield, Southgate) (Con)]

My hon. Friend was right to introduce her remarks to the House and highlight the unacceptable personal attacks that have been made against her, which denigrate an issue of vital importance and interest to the whole House. The House needs to rise above that in today’s debate. With regard to evidence of change, could she indicate what research she has done on how much face-to-face counselling takes place in organisations such as the British Pregnancy Advisory Service, for example?

[Nadine Dorries]

I thank my hon. Friend, and in a moment I will come on to the difference between counselling and consultation, and what is available to women.

--- Later in debate ---

[Mr Burrowes]

It will not surprise the House to learn that I strongly support what my hon. Friend has said about the importance that should be attached to the life-saving cause of collecting cord blood and transplantation. As he has said, the Government are wholly committed to investing in and improving collections and to transplantation, but is it not important for us to consider whether that should form part of the duty of the Secretary of State? Is it not a priority, given that one in five members of black and ethnic minorities cannot obtain a match for the purposes of the transplantations that are sorely needed for life-saving operations?

[Nick de Bois]

My hon. Friend raises a key point. If we were to make prospective parents aware of the possibility of donation, we could address the major deficit in the BME community.

--- Later in debate ---

Collection of umbilical cord blood is a far less invasive procedure than extracting bone marrow, and the units can be collected, frozen and stored for years, which leads to fewer complications and makes transplants more readily available than for bone marrow. More importantly, it is easier to find matching stem cells from cord blood than from bone marrow. If we can develop a proper infrastructure for the collection and storage of cord blood, that will do much to alleviate the severe shortage of life-saving stem cells.

[Mr Burrowes]

Is it not also important to ensure, through the Bill or other means, that commissioners are able to make the right decisions? Evidence of some commissioners questioning the economic value of proceeding with stem cell transplants was brought before the all-party group on stem cell transplantation. It is important that we pursue commissioning excellence.

[Nick de Bois]

I understand that the UK Stem Cell Strategic Forum recommended to the Government that there should be a regional centre of excellence, and I hope Ministers will let us know by letter if that policy is indeed being pursued, as I think it might deal with the issue that my hon. Friend raises.

Cord blood is a natural, safe, ethical and sustainable resource, and it offers many advantages over using traditional bone marrow transplants. We in this country should be proud that the NHS was one of the first bodies to recognise the potential importance of cord blood and significant breakthroughs were made in Britain. In 1996 an NHS cord bank was established, which is now working alongside the Anthony Nolan trust. At a time when the health service is mindful of the need to inform patients fully about their health care, the issue of the collection of a mother-baby’s cord blood does not seem to get the same degree of attention. The principles of full information and consent do not seem to apply to cord blood, which is, in general, treated as a waste product, unbeknown to parents, apart from in exceptional circumstances. By agreeing to my amendments, we can change that situation and the Government can demonstrate that they are giving a lead in the dissemination of information to expectant parents.

Last year academic research said that in order to have a truly effective operation we should strive to obtain 50,000 units of cord blood. I congratulate the Government, who have already committed £4 million to reach the first benchmark of 20,000 cord blood units. I commend the work of the Anthony Nolan trust and the NHS, which have also been sharing in building up to this target. Of course this is only the start, and I know that the Government have already expressed their commitment to helping to develop this very important work.

We have an opportunity for more lives to be saved, for valuable scientific research to be undertaken and for the UK to become a centre of excellence in cord blood. We can avoid the current situation whereby every day two people die waiting for a stem cell transplant, and 65,000 litres of cord blood are discarded every year. I welcome the Minister’s words of support and I appreciate the sentiments behind the Government’s thinking. I urge them to continue to get behind this valuable cause.

Oral Answers to Questions

David Burrowes Excerpts

Tuesday 12th July 2011 Commons Chamber

[Mr Burns]

My hon. Friend has hit on an important issue. The answer is clarity of purpose and vision on the part of my right hon. Friend the Secretary of State not only to talk the talk, but to walk the walk and achieve dignity for patients in the NHS in England.

[Mr David Burrowes (Enfield, Southgate) (Con)]

14. What progress he has made in reducing rates of hospital-acquired infections.

[The Parliamentary Under-Secretary of State for Health (Anne Milton)]

As the Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), has just said, clarity and vision are what is needed. The coalition agreement made it clear that the NHS should adopt a zero tolerance approach to all avoidable health care-associated infections, which have caused so many problems for the public over so many years. In 2010-11, there were just under 1,500 MRSA bloodstream infections. That is a decrease of 22% on the previous year. That means that infections are at their lowest level since mandatory surveillance was introduced. In the same period, there were just under 22,000 occurrences of C. difficile infections, which is a 15% decrease compared to the previous year. We will continue with our zero tolerance approach.

[Mr Burrowes]

I thank the Minister for that reply and the rapid progress made under this Government. I welcome the new C. difficile objective and the publication of weekly statistics, but does the Minister share my concern that it is the same hospitals that keep appearing with the highest number of C. diff cases? What is her Department doing to help those hospitals reduce such cases?

[Anne Milton]

My hon. Friend is absolutely right. Under the previous Administration there was a national target of reducing C. difficile infections by 30% by 2011, but that does not address the problem because, as he rightly says, there are hospitals that consistently had high rates of infections, so we changed that. Since April, every PCT and every acute trust has its own objective. The organisations with the highest rates of infection will have more ambitious objectives than those that are doing well.

Cheshunt Urgent Care Centre

David Burrowes Excerpts

Wednesday 23rd March 2011 Commons Chamber

[Mr Charles Walker (Broxbourne) (Con)]

It is a great honour to speak on the Adjournment this evening—we have had the Budget today, so the eyes of the nation are upon this place.

Two years ago, I was involved in a fantastic community campaign to bring an urgent care centre to Cheshunt. I was joined by more than 3,000 constituents in a letter-writing campaign to the primary care trust. We had a number of public meetings, with the car parks overflowing and many hundreds of constituents making their views known. The campaign culminated when I, along with the chief executive and the leader of the council, visited the then Secretary of State for Health, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), at the Department of Health. It was a true community campaign. If the big society means anything, that is its basis: people coming together from across a community and joining in one voice to bring a much-needed facility to the constituency.

Since the centre arrived in October 2009, it has been fabulously well received. It is estimated that 400 people a week would use it at most, but in some weeks we have had 700 people voting with their feet by coming to that GP-led urgent care centre. It really is at the heart of the community. The reason so many people choose to use the facility is that it is open 12 hours a day, seven days a week, from 8 in the morning to 8 at night. Unlike many GP surgeries, it does not close for lunch and is open on Saturdays and Sundays, when people can use a medical facility because they are not at work in London.

Despite that enormous success, I was horrified to learn a few months ago that the PCT was not happy with the centre’s performance. I do not need to tell you, Madam Deputy Speaker, that being a Member of Parliament over the past three years has been fairly challenging, but one of the bright spots of my career has been walking around my constituency and being stopped by people saying, “Charles, we are so pleased we have the urgent care centre. It was so much needed in this part of the borough. Thank you so much for the campaign you led.” It has been enormously gratifying and satisfying to get that level of feedback.

The PCT came to the House to meet Hertfordshire Members and I had my turn to chat with them about the issues relevant to Broxbourne. After 10 minutes of pleasantries I asked, almost off the cuff, “Of course, you’re not thinking of closing the urgent care centre, are you?” The reply was, “I’m afraid, Charles, that that is one of the options on the table.” I am normally a mild-mannered Member, but I am afraid that on that occasion I blew up. I think that I swore. Indeed, I know that I swore. I am ashamed of my behaviour, but it demonstrates how passionately I feel about the centre.

[Mr David Burrowes (Enfield, Southgate) (Con)]

I pay tribute to my hon. Friend for his passion and commitment to the urgent care centre and for the joint campaign run in Cheshunt and Enfield for the retention of a fully functioning accident and emergency department at Chase Farm hospital. Does what has happened to the urgent care centre not highlight the importance of the Secretary of State’s decision to encourage us all to think again about options other than the Barnet, Enfield and Haringey strategy, which would lead to the downgrading of not only Chase Farm hospital in Enfield, but, as predicated, an urgent care centre there?

[Mr Walker]

My hon. Friend makes an excellent point. He is at the forefront, along with my hon. Friend the Member for Enfield North (Nick de Bois), of the campaign to save Chase Farm hospital’s A and E, and I am always proud to join him outside those gates, making the argument for a fully functioning A and E service there.

The PCT has told me that it believes that the GP-led urgent care centre is treating inappropriate cases—whatever those are—and that people going there should be going to their GPs. It asks why it should have to pay for that treatment twice. Of course, they should not pay for it twice, but I always believed that the money should follow the patient, not the GP who does not deliver the service. My constituents use the urgent care centre so fully, because many—not all, but many—GP practices in my constituency do not deliver on their promise, or live up to their end of the deal, to provide a full GP service to them. So my constituents vote with their feet.

GP surgeries close for lunch, early in the evening and at weekends. If people want an appointment, they have to call up on the morning that they want it, only to be told, “We haven’t got any today, but if you want to come and see us tomorrow try calling us tomorrow.” That is not acceptable, and my constituents are not going to sit at home and wait to be treated like that day after day; they are going to walk to the urgent care centre and get treated there. What really upsets me is that the beacon of success in our constituency—the one that sees up to 700 people a week—now faces closure, while the GPs are not facing the necessary censure for some of their practices in delivering services to my constituents.

I discovered in a PCT board paper that many GP practices in my constituency are in the NHS version of special measures, meaning that they are in the bottom 10% of GP practices in the country. That leads me to ask again, “Why does the urgent care centre, which delivers a high level of service, face closure?” while GPs, as I said earlier, are not delivering the service that they are paid to deliver.

The PCT says that there was a unanimous decision on behalf of a steering committee to change the use of the urgent care centre—at best to make it a minor injuries unit, or perhaps even to close it. It says that the decision came about as a result of a meeting with various stakeholders and some research—independent research, I was told—by an organisation called Opinion Research Services. Of course, it was not independent research, because it was commissioned by the PCT: it paid the bills of Opinion Research Service. I do not know what went on at that meeting, but I am fairly sure of what did not, which is that those there did not get a full picture of how successfully the urgent care centre meets the needs of local constituents.

What I did learn is that the GP services in the area leave a lot to be desired. On page 8, the board report states:

“A quarterly patient access survey carried out nationally has highlighted perceived problems with access and satisfaction with primary care in the area served by Cheshunt UCC.”

On page 8, it goes on to state:

“In addition, perceived poor access to primary care in and around the area served by Cheshunt must be addressed.”

Notice the emphasis on “perceived”. It is not perceived poor access, however; it is real poor access. If it was perceived, hundreds of my constituents would not go to the urgent care centre.

On pages 11 and 12, the report states:

“The need to improve access to primary care in the Cheshunt area has been recognised and steps are being taken in conjunction with the Clinical Executive Committee (CEC) to support and performance manage those practices”—

not a practice, but those practices—

“in the bottom 10% nationally in terms of patient’s perceived access.”

Quite frankly, that is not good enough.

I became even more concerned about the situation when I went on to read that it is local GP commissioners who are putting pressure on the PCT to close our successful GP-led urgent care centre.

On page 9, the report states:

“Local GP commissioners do not support the configuration and have confirmed that they would not wish to commission UCCs as currently configured at...Cheshunt in the future."

On page 12, it states:

“The view of the GP Practice-Based Commissioning leads in the localities is that these needs are best addressed directly with the practices rather than by way of additional services.”

But why are the practices not addressing those needs now?

The PCT has said, with great fanfare, that it is providing additional services and support to GPs to help them to improve. Of course, that is very welcome. However, given that it is providing new telephone systems, automated self-check-in screens, waiting room plasma screens, web-based online appointments systems and electronic document management systems, my constituents and I want to know what on earth has been going on in these practices for the past 10 years. One thing that GPs have not been short of is money, so how have they not placed these absolutely critical tools for managing patient load in their surgeries, with the PCT now having to fund them?

If services in my constituency are to improve, we need competition. We need the urgent care centre to set new standards of treatment. If the urgent care centre, which is driving ever-higher levels of patient care, is shut, what incentive will there be for GPs to improve their service levels? It is incumbent on my local GPs, who are falling behind, either to deliver or surpass that level of care, or perhaps to make way and allow practices to come into the borough that are willing to take up the challenge of opening 12 hours a day and providing weekend services. Until we reach that stage, the PCT has absolutely no excuse for closing down this urgent care centre.

Earlier today, the PCT had a meeting where it decided to downgrade the urgent care centre to a minor injuries unit; it thinks it will get away with that. However, that is not good enough and it will not satisfy my constituents, because closing down the urgent care centre and removing the GPs from it removes the incentive for practices in and around the centre that are not delivering to their patients to improve their services.

As you can see, Madam Deputy Speaker, I am really very annoyed about this. I thought that I would come here and manage to smile my way through it and be magnanimous, but I simply cannot. For my whole life, I have believed that good practice and success should be rewarded. I thought that that was just the way things were—that an organisation that saw an urgent care centre that was delivering not 400 patient outcomes a week, as envisaged, but 600 or 700, would feel that it was a success story that deserved to be built on. By accident or design, our PCT has stumbled on a formula that works and meets the needs of the local community, but instead of building on that, it is pulling the rug from underneath it, and I believe that it is being pressured by some GP practices in my constituency and future GP commissioners to do so.

I will conclude, after my 15 minutes, by saying that there is only one set of vested interests that I represent in this place. It is not the PCT’s interests or the GPs’ interests—it is the interests of my constituents, more than 520 of whom turned up, at about nine days’ notice, at a public meeting that I held last Thursday to say to the PCT: “No, we want to keep our urgent care centre.” The PCT has got it wrong, it needs to listen, and we need that urgent care centre in Cheshunt.

Umbilical Cord Blood

David Burrowes Excerpts

Monday 31st January 2011 Commons Chamber

[Mr David Burrowes (Enfield, Southgate) (Con)]

I am pleased to have secured this vital debate. At first sight, a debate about umbilical cord blood might seem highly specialised and marginal in terms of its interest and application, but I hope that the debate that I have initiated will highlight the importance of the issue, and its wide application to the saving of lives and money. We have just completed the Second Reading of the Health and Social Care Bill, and this debate chimes with the Government’s policy of creating a modern health service that is open to innovation and excellence, providing life-saving treatments.

I described this as a vital debate. “Vital” is a word used commonly in the Chamber. In fact, a quick search of Hansard will reveal that it was used 2,997 times in 2010—that is, an average of about 20 times each sitting day. It has been used in connection with banking reform, the G20, libraries and ladybirds. While all those are no doubt crucial subjects and worthy of parliamentary attention, my use of the word “vital” in this debate relates to the number of people who, sadly, die each year from blood disorders and cancers without the vital resource of umbilical cord blood.

I introduced the issue of umbilical cord blood to the House on 8 January 2008 through a private Member’s Bill on the subject. A number of hon. Members approached me afterwards, in a state of ignorance to which they openly confessed, to ask what it was all about. Since then the issue has been raised on a number of occasions—notably the debates on the Bill that became the Human Fertilisation and Embryology Act 2008—and great progress has been made in raising parliamentary awareness of the benefits that these life-saving cords can provide for people suffering from tragic illnesses. In 2008 an all-party parliamentary group was established, and I see that its chair, the hon. Member for Alyn and Deeside (Mark Tami), is present. I am sure that the House will wish to join me in paying tribute to the work of organisations such as the Anthony Nolan Trust, whose efforts have helped to keep the importance of cord blood at the forefront of the minds of many hon. Members, including Ministers.

I hope that tonight’s debate will remind Members of the value of this vital resource. Blood cancers are killers. According to Cancer Research UK, 4,000 new myeloma cases are diagnosed each year in Britain, and 2,500 myeloma sufferers die. There are 11,000 lymphoma diagnoses each year and 4,000 deaths; there are 7,000 leukaemia diagnoses each year and 4,000 deaths. For many sufferers, the only hope is a blood stem cell transplant. It may result from a bone marrow match, or from the taking of blood cells from the bloodstream of an adult donor or an umbilical cord donated by a mother after childbirth.

The procedure is complex, and there can be a range of complications that pose a threat to the patient. However, although it may seem awful that only 50% of blood transplant patients survive the treatment, almost none would survive without it. Blood stem cell transplants really are the last chance for people to whom no other treatment is available. For some of those people, a transplant is not just a treatment that saves their lives for a while, but an outright cure. At any given time, about 1,600 people in Britain are waiting for a matched donor for a transplant, hoping to survive long enough to get that chance.

Five-year-old Sorrel Mason was one such person. Three years ago Sorrel’s father noticed that she was looking pale, and she was eventually diagnosed with a rare strain of acute myeloid leukaemia. Her mother Samantha recalled the terrible fear and sense of helplessness that they felt at the time. She said:

“I remember the first time I saw her hooked up to all those machines. It broke my heart.”

After two doses of chemotherapy Sorrel was able to have a transplant, and received suitable stem cells from a mother’s umbilical cord from Tokyo—albeit an expensive imported cord; that is a point to which I shall return later. Thankfully, the procedure was a great success. In Samantha’s own words:

“Every day we waited for the daily blood counts. It was a miracle when eventually they came up okay.”

We are on relatively new ground here, because the first time a stem cell transplant took place using cells retrieved from a donated umbilical cord was in 1988. Since then, scientists have been discovering many advantages to the use of cord blood. You, Mr Speaker, will be relieved to know that I will refrain from reciting numerous tracts from the many academic papers on this subject. However, one especially noteworthy example of the great research work being carried out is the Cancer Research UK-funded trial being led by Dr Rachel Hough into the use of umbilical cord blood from unrelated donors for people who have cancer of the bone marrow or lymphatic system. Her team aims to investigate whether a transplant using cord blood cells can help cancer patients who cannot be matched to a bone marrow donor. This is an exciting and promising development that highlights the great potential for uncovering further benefits of cord blood.

The immediate benefit of a transplant from cord blood is that it achieves the same level of success for the patient at a significantly lesser degree of tissue matching. When I first raised this subject three years ago, we relied on speculation about the number of cord blood units needed for this country’s health needs. Now we know from evidence and with authority that a cord blood bank would have to maintain only 50,000 units to provide for the bulk of Britain’s unmet need for stem cells beyond the 770,000 registered adult donors. A great advantage of umbilical cords is the availability of the stem cells retrieved. They are collected, tissue-typed and frozen after the birth of the child, and then made available as soon as a patient requires them. That radically reduces the waiting time before a patient can access a transplant. Currently, the average time it takes for a patient to receive their transplant after the search for a match is started is some 160 days, during which time many patients become progressively weaker and the likely success of the transplant can thus be reduced.

Cord blood transplants save lives that other methods cannot, so it is no surprise that, globally, the proportion of transplants undertaken using cord blood is increasing every year. Great Ormond Street hospital, a leading transplant centre, will now use only cord blood where it is available. The pace of advance in this arena is excellent. Each year, the prognosis for patients treated is better than for those treated the year before, and that is because of the research taking place in the UK and around the world. Not only are blood cancers and similar disorders subject to increasingly effective treatments, but an active investigation is taking place into the use of cord blood in the treatment of sickle cell anaemia and HIV.

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

The hon. Gentleman will be aware that minority ethnic patients make up almost 20% of the unmet need for stem cell transplants, which is disproportionate to our 10% representation in the population. Does he agree that one of the important uses of this blood is in enabling ethnic minority patients, who find it more difficult to get a match, to have some hope?

[Mr Burrowes]

I am very grateful for that intervention. The hon. Lady and I share an interest in both sickle cell anaemia and the thalassaemia issue. The UK Thalassaemia Society, whose headquarters are in my constituency, has great interest in this area and, in particular, in the black and minority ethnic communities, who are not able to get matches through the bone marrow register and are acutely in need. That is particularly the case for mixed-race families, who struggle to find any match and are sometimes wholly reliant on a cord blood solution. That is why it is welcome that over the years the previous Government and this Government have increased the number of collection centres to make more of those units available.

However, more needs to be done because, sadly, where Britain once led, it is now falling behind the United States, France, Germany and Spain. All those countries now outstrip our cord blood collection, inhibiting our research capacity. There are 700,000 births each year in the UK and in almost every single instance the cord blood is discarded as medical waste. I am not proposing routine collection, but we must question the health and economic value of throwing all these potentially life-saving cords away. I welcome the fact that the Government are nudging people to agree voluntarily to donate their organs upon death, and I would encourage a similar nudge in encouraging mothers to consider donating umbilical cord blood.

Progress has been made, but more needs to be done. There are 1,600 people waiting for a stem cell transplant, but the unmet need in annual terms is only 440 transplants per year. A bank of just 50,000 umbilical cords would provide the bulk of that need. Sadly, simply increasing the size of the adult register is not an alternative to having cord blood. We already have access to more than 16 million donors on registers worldwide. The work of the Anthony Nolan Trust and others helps us to access that adult register, but we would need a UK adult register of a similar size to approach the effectiveness of a 50,000-unit cord blood bank.

[Mark Tami (Alyn and Deeside) (Lab)]

I thank the hon. Gentleman for his earlier comments. It is difficult to talk in financial terms about such issues, but with patients who do not get a transplant, there is a huge ongoing medical cost for their treatment, whereas a transplant could save that money, which could then be reinvested in the health service.

[Mr Burrowes]

We often talk about investing to save, but this is an area in which investment would save both money and lives. I shall go into that in more detail.

A report on transplantation by the UK Stem Cell Strategic Forum, ably chaired by Professor Charles Craddock, was published in December 2010 by NHS Blood and Transplant. The Minister discussed the report, which makes important recommendations, with the all-party group on the day of its publication. The report recommended, first, investing in expanding Britain’s cord blood bank capacity to 50,000 units. Those proposals have been properly costed and the costs have been balanced against effectiveness by NHS Blood and Transplant. For an investment of £50 million, spread over five years, Britain could have that 50,000-unit cord blood bank.

[Nadine Dorries (Mid Bedfordshire) (Con)]

I thank my hon. Friend for giving way. I want to congratulate him on the work that he has consistently put into this issue over the past three years, which is to be commended. Would he endorse the proposal that certain hospitals or regions could be piloted or allocated as regions to collect and donate the necessary 50,000 units? Rather than having routine testing across the country, it could be just in specific regions or units.

[Mr Burrowes]

I am grateful to my hon. Friend for making that point. There has been some progress on the areas that could retrieve unit cords, particularly from members of BME communities who lack those matches, but we also need to look further at matching that up with regional centres of excellence. I shall return to that point.

First, let me deal with the money issue, which we cannot ignore in this area of health. For an investment of £50 million over five years, we could get that 50,000-unit blood bank. Although it would be difficult to find £10 million a year for five years in these austere times, the financial benefits make sense. The blood bank would provide economies of scale that would reduce the cost to the NHS of every treatment and would radically reduce the need to import expensive stem cell units from abroad, which is, sadly, too common a practice today. The saving that would bring to the NHS has been calculated at £6 million a year in perpetuity. Within 10 years, the entire investment would have been repaid and the programme would save the NHS money for the foreseeable future—and then there are the 200 lives we can choose to save each year by taking that step. So, it would save £6 million and 200 lives a year, and those figures are with currently available treatments at success rates that are currently being achieved.

[Thomas Docherty (Dunfermline and West Fife) (Lab)]

I am very grateful to the hon. Gentleman for giving way. He has mentioned money several times. Is he aware of the work of the Round Table around Britain and Ireland, of which I am a member? It has consistently raised large sums for the Anthony Nolan Trust. Will he place on record his thanks to the Round Table movement for its support for the trust and this matter?

[Mr Burrowes]

I am grateful to that movement and other groups and charities that support this important work.

We need to ensure that we do well what we can do well by adopting the report’s second recommendation to establish regional centres of excellence in cord blood transplants. That would reduce the number of UK centres from 30 to 12, leading to a £12 million saving over 10 years. The report makes the point that that would, crucially, ensure that we had specialised, life-saving therapies in safe, publicly accountable environments. That is fully in line with the Government’s commissioning policy for specialised procedures and would provide great benefit.

The third, really exciting recommendation is about providing an opportunity to build on Britain’s unique strategic advantages, encouraging world-class research and private and voluntary sector growth that will provide new jobs and save further lives. The proposal to create a national trial programme in stem cell transplantation would take advantage of world-class centres of scientific research and the easy and sustained access to patients that the NHS provides. The proposal offers the potential for inward investment, private sector job creation and third sector involvement, as is well demonstrated by the success of the Centre for Clinical Haematology at the Queen Elizabeth hospital in Birmingham. To quote Professor Craddock:

“The unique international trials network will be highly attractive to pharmaceutical and biotechnology companies who wish to rapidly evaluate new drug therapies and can be anticipated to make a major contribution to the growth of private sector jobs in this sector.”

The Government, as we know, are encouraging growth. Where better than in the field of cord blood stem cell transplantation? The Minister has been kind enough to keep me informed of the progress that her Department is making in the development of a response to the proposals in the report. I hope the time is nearing when she will be able to make a statement on her plans in this area. I trust that in the complexities and scientific details of that report, her Department will be clear about the central message that 200 lives and £6 million can be saved each year.

In conclusion, I draw upon the story of Sorrel Mason. Prior to her life-saving procedure, her parents had never heard of the importance of cord blood donation and its benefits for stem cell transplant patients. No one could put it better than they did when they said:

“It’s quite hard in this country to donate your umbilical cord. Hopefully as time goes by there’ll be more places that offer this lifesaving opportunity.”

In a Parliament that will be characterised by the difficult decisions that it makes, this is one decision that we cannot afford not to take, and yes, I will say it again: it is vital to do so.

Public Health White Paper

David Burrowes Excerpts

Tuesday 30th November 2010 Commons Chamber

[Mr Lansley]

Yes, I entirely agree. The extent to which charities and the voluntary sector can initiate new ideas is woefully underestimated. This is not just about local authorities, and still less about central Government saying, “Here is a programme, would charities like to bid to run it?” Even more importantly, we must be clear that charities should now come forward to anticipate the resources needed to improve public health, and to suggest their own innovations to deliver better health for their communities.

[Mr David Burrowes (Enfield, Southgate) (Con)]

My right hon. Friend will recognise the description of alcohol treatment as a Cinderella service, which is sadly not just a seasonal description but often the soft target of cuts by PCTs. I therefore welcome the opportunity in the White Paper for pooled budgets and for co-ordination between public health service directors and children’s services directors to prevent and tackle alcohol misuse.

[Mr Lansley]

I am grateful to my hon. Friend, because I think that through these measures we will help to integrate drug, alcohol and sexual health services, rather than see them in silos. Even in primary care trusts, those services have often been treated as completely discrete activities, because they have been related to specific targets that central Government have set, rather than part of an holistic community view of how we improve health.

Inside the NHS we are shifting public health to that degree of protection, because back in 2005 when the Labour party was in charge, the Chief Medical Officer said:

“There is strong anecdotal information from within the NHS which tells a…story for public health of poor morale, declining numbers and inadequate recruitment, and budgets being raided to solve financial deficits in the acute sector.”

Under Labour, public health was raided and denigrated; under this Government, public health will be given the place it deserves.

Clostridium Difficile

David Burrowes Excerpts

Tuesday 9th November 2010 Commons Chamber

[Mr David Burrowes (Enfield, Southgate) (Con)]

It was in January 2007 that I last secured a debate on clostridium difficile, or C. diff as it is commonly known. It was the first time that the House had debated the subject, and I recall how at the time Mr Speaker’s office questioned what C. diff was. Indeed, many hon. Members had never heard of it. Since that time, however, sadly the impact of this cruel and often unremitting infection has demanded the public’s and, indeed, the Government’s attention. All hon. Members will probably know of someone in their constituency or family who has suffered from C. diff. Indeed, in that regard I welcome the attendance of Mr Deputy Speaker, who has a deep and personal interest in the issue, following the loss of his mother as a result of C. diff.

I gladly acknowledge that there has been much progress in the three or so years since I last raised this subject. However, C. diff still leaves thousands of people each year suffering great discomfort, loss of dignity and, sadly, loss of life. The media spotlight comes on to the subject when there is an inquiry into a hospital trust and then moves on but, away from its glare, the terrible and often tragic effects of this infection have not gone away.

I know that the Minister will provide me with an answer, which is the primary purpose of this debate—namely, an assurance that the Government take C. diff very seriously and are working hard not only to reduce it but to eradicate it. Much has changed since 2007, not least with the Government’s plans to revolutionise the national health service and empower patients and general practitioners. I hope that this debate will help to identify the challenges and opportunities to tackle C. diff, not only in the hospital setting but in the community.

Some things, or rather someone, have not changed since the previous Adjournment debate in 2007. I refer to the active involvement and national leadership on the issue of C. diff of my constituent Graziella Kontkowski, who has attended the debate this evening, as she did back in January 2007. Tragically, Graziella’s grandmother died as a result of the C. diff infection. Graziella describes being

“helpless, watching my grandmother die a slow and painful death without being able to do anything to help her—it was the worst thing I've ever experienced.”

Since then, she has used her experience and remarkable passion and energy to ensure that other families are able to face and fight C. diff and its terrible effects. Alongside her brother Mark, Graziella set up the online C. diff support group, which can be found at www.cdiff-support.co.uk, to make it possible for people who have been infected by C. diff, or whose loved ones have suffered from its effects, to share their experiences and advice with one another. The C. diff support group has about 1,500 members and continues to make a valuable contribution to the public debate on C. diff and to the lives of many who are struggling in similar circumstances to those that Graziella and her family went through.

Graziella also helps to support the work of the Centre for Healthcare Associated Infections, which is based at the university of Nottingham. With the danger of bacteria mutating to become more resistant to antibiotics, its efforts towards the development of new vaccines and rapid diagnostic tests for the detection of the infection are to be commended. Its research can truly be described as life saving, and I encourage members of this House, and members of the public, to consider supporting its work.

[Richard Harrington (Watford) (Con)]

I congratulate my hon. Friend on the work that he has done on this very difficult subject. I would like him and his constituent to know that there is a device in America called Zimek, which I have observed. It is the most fantastic system that disperses disinfectant and has eradicated C. difficile in hospital wards. It is undergoing clinical tests in Northwick Park hospital, which is just next to my constituency and where many of my constituents are being treated. I urge the Minister to take note of this. I would be delighted to send him details showing the fantastic effects that the device has had in America, very cheaply and in a way that I believe could save millions of lives in this country.

[Mr Burrowes]

I am grateful to my hon. Friend. He makes the case for that proposal very well. Indeed, there are several innovative developments, not only in the hospital setting but in trying to look at prevention. Prebiotics is another area that is worth considering. I ask the Minister to look at supporting the centre I mentioned and at how we can support research in this field.

A C. diff infection exacts a great cost from the patient who suffers from it and the family who witness it. It is also financially expensive. In 2008, the Department of Health released a report called “Clean, safe care: reducing infections and saving lives”, which noted that treating one patient with a C. diff infection cost the NHS more than £4,000 per patient. By this estimation, and considering the number of infections reported last year, C. diff cost taxpayers close to £1 billion in the past 12 months.

It is true that C. diff has received a far more coherent and concerted response from the NHS in the past three years than it had previously. It is equally clear that this focus has had a positive effect on the quality of care and on survival rates in our hospitals. Last year the infection was noted on fewer than 4,000 death certificates and was considered to be responsible for deaths in 1,712 cases. That is less than half the rate in 2007, when more people died as a result of C. diff than as a result of road accidents. However, as the Secretary of State for Health has said:

“There is no tolerable level of preventable infections.”

I am grateful to his Department for making it clear that a zero-tolerance approach to health care-associated infections is a priority for the Government. During the week beginning 26 September, 190 new cases of infection were reported by hospitals in England and Wales—an average of 27 cases a day, or more than one every hour. There is no room at all for complacency.

One problem of which we need to be aware is the number of incidents of recurring C. diff symptoms in patients. I am greatly concerned that hospitals are releasing those who have suffered with the symptoms of the infection too early, which leads to many having to return to hospital with the same problem. I am glad that the Department has recently made it clear that hospitals are responsible for the care of a patient for up to 30 days after they have been discharged.

[The Minister of State, Department of Health (Mr Simon Burns)]

indicated assent.

[Mr Burrowes]

I am glad that the Minister fully shares my concern. It is good to know that hospitals cannot expect any additional payment for treating those who have suffered a recurrence during those 30 days. However, I ask him whether there could be any sanctions on trusts that sadly fail to reduce the rate of infection.

Along with the Department of Health, my constituent Graziella has produced a leaflet, which my hon. Friend the Minister helpfully distributed just before the debate. It is called “C. difficile—now you are going home”, and it sets out the best ways for patients to protect against the infection spreading. It is intended to be given to patients so that they can be aware of the risks and know how to prevent other vulnerable people from catching the infection. However, although both Graziella and I would like to see this leaflet distributed by every hospital and GP, there is no requirement that that happen. Many patients return home without the information in that fantastic leaflet about how best to protect themselves and others. Will the Minister consider requiring—or, in the more localising language that Conservative Members prefer, incentivising—hospitals to provide the leaflet or similar information to all patients leaving their charge who have had the infection?

Although improvements have been made in acute trust hospitals such as my local North Middlesex university hospital, it is important that we do not lose sight of the need to pay attention to what is happening in our primary care trusts. In fact, in every month of last year, PCTs reported far more cases of C. diff than acute trusts. Enfield PCT, which is by no means extraordinary in this regard, reported 144 cases in patients aged over two in just the past year.

[Nick de Bois (Enfield North) (Con)]

To pick up on my hon. Friend’s point about Enfield, as he knows, at our local hospital, Chase Farm, there has been an extraordinary improvement in recent months, particularly since August. That is essentially down to a massive concentration of effort on this one problem, and there, in part, lies the solution.

[Mr Burrowes]

I am grateful to my hon. Friend, and I support the work that has happened. It has very much been prompted by Graziella, who has been going from ward to ward to ensure that what people say is being done is, in fact, reflected in their actions.

We also need to get to grips with the problem of C. diff in the community. In the past, there has been too little interest in what happens to a patient once they leave the hospital walls, and too little attention to the problem of infection being spread between hospital and home, or worse, between hospital and care home. Sadly, many of my hon. Friends will have witnessed that situation. That two-way corridor of infection must be addressed, as must the associated lack of care that care home residents can sometimes receive, as they are sadly away from the public eye.

Given the clear danger of allowing infections to spread within an enclosed community of elderly and vulnerable people, I would be interested to know what the Department is doing to monitor cases within the care home setting, and specifically to monitor whether cases are being reported consistently and dealt with promptly and according to the most recent hygiene code.

As we move boldly to a health care system that puts the patient and their recovery at the heart of every decision, it is essential that health care-associated infections such as C. diff are on GPs’ radars, especially as they take on responsibility for commissioning in their area. There needs to be an assumption in favour of testing for the infection when patients are suffering from diarrhoea. GPs must also be properly aware of the need to check up on patients, and avoid prescribing them certain drugs that are known to increase the risk of infection and the likelihood of patients suffering from severe symptoms. The C. diff support group has identified a number of worrying cases of GPs prescribing antibiotics. I also ask colleagues to look on its website and check out Imodium, which is known negatively to affect patients suffering from C. diff.

In December 2008, the Department of Health’s report on C. diff strongly recommended that

“all cases of diarrhoea among people in the community aged two years and above should be investigated for C. diff unless there are good clinical reasons not to.”

Such good practice needs to be extended to all GPs. Does the Minister know what more the Government can do to ensure that GPs are fully briefed on C. diff and that they are responding to this knowledge efficiently and consistently?

Perhaps the Minister would consider enabling the NHS computer systems in both hospitals and GP surgeries to tag an alert to Imodium and other drugs that are known to increase the risk of C. diff in vulnerable patients. Doctors intending to prescribe such drugs would be reminded to consider whether the patient might have the infection before doing so.

As for the careful monitoring of patients in the community, I would be interested to know what, if any, guidelines GPs follow with regard to the treatment of patients with C. diff. Perhaps the Department would be willing to provide such advice to doctors. Doctors could perform a simple blood test on elderly patients in the community to provide an early warning against the possibility of renal failure.

I very much welcome the Health Secretary’s attendance today and his commitment to comprehensive, trustworthy and easy-to-understand information on how to look after patients’ health. The data on C. diff infection rates already exist and can be found online, but they are often inaccessible in their format. They can be sketchy and incomplete at best.

Yesterday, NHS Choices listed 12 hospitals within five miles of one of the postcode areas in my constituency. Of those 12 hospitals, data on the prevalence of C. diff cases within the last 12 weeks were available for only two of those hospitals—North Middlesex University hospital and St Ann’s hospital. On the same day, the Department published business plans with a focus on transparency. To ensure that we see even more marked improvements in the next three years, will the Minister tell us what he intends to do to ensure that “easy to understand” information is available, especially on those websites that patients are most likely to use and at those locations that they are most likely to frequent?

Finally, I look forward to the time when the Minister can declare to the House that preventable healthcare-associated infections such as C. diff can be eradicated. However, I am conscious, as the Minister will be, of George Bush’s regret when he prematurely declared “mission accomplished” and there is much to be done before we can get near to such a declaration. I hope that this debate, which supports the great work of campaigners such as my constituent Graziella Kontkowski, can move us closer to a time when we have no need to raise this important issue in the House again.

Oral Answers to Questions

David Burrowes Excerpts

Tuesday 2nd November 2010 Commons Chamber

[Mr Speaker]

Order. I do not want to be unkind to the Secretary of State, but I am thirsting to hear the question from Mr David Burrowes.

[Mr David Burrowes (Enfield, Southgate) (Con)]

T7. My right hon. Friend has shown great interest in the reconfiguration plans for Enfield hospitals, culminating in the moratorium announcement outside Chase Farm hospital in May. Would he expect the outcome of the clinical review to be simply an endorsement of the present clinical strategy, which is based on previous models of care for emergency and maternity services, or should it embrace future health care choices, opening up to GPs, patients and the public?

[Mr Speaker]

We have got it.