Hospice Funding and the NHS Pay Award

Derek Thomas Excerpts

Wednesday 31st October 2018 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I thank the hon. Member for Heywood and Middleton (Liz McInnes) for securing the debate. “Fantastic” is probably the wrong word to use, but this is an important opportunity for us to speak about the great work that hospices do, the part that they play in all our local communities and how they help people and their families at the most difficult times of their lives. It is an honour to take part in the debate. I want to talk about the role of hospices, how they contribute to the desire to integrate health and social care and, as a result, how they must be funded to deliver the great work that they do.

This may seem a strange thing to say, but I have spent my most special moments at the bedside of someone in a hospice. Over the years and even as an MP, I have taken the opportunity to sit alongside people and their families in our local hospice, St Julia’s, which is just on the edge of my constituency, and I always leave with an incredible sense of gratitude for the work that the hospice does and how it helps people at that difficult time. It helps people to live and die well, which is what I am sure we would all love to be able to do when the time comes.

Let me explain what I have learned in recent years. Even now, the word “hospice” assumes that that is where we will die if we have—dare I say it—the right kind of illness to justify that, but I am learning that hospices are actually far from just places to die. People can go into one when they are very sick and come out a week or two later, having had various things done to help them, to get their body working again and to identify the right medicine. Hospices can give people time to work out what medicine or drug is really the right one for them. My mum was ill for a very long time. She was given a few weeks to live, but actually lived for more than a year. She spent 10 days in a hospice when we really thought it was the end and then she went on for a good six or seven months after that, simply because the hospice was able to correct her medication and—well, “flush her out” is probably the way to put it. It was lovely to come together as a family and sit alongside her, and to give my dad a break; he had about 10 days of really important respite. The hospice movement across the country, in my constituency and across Cornwall is fantastic. When I go there, it is a different experience from when I go to sit beside the bed of someone in an urgent care setting who is also reaching the end of their life.

In Cornwall, we are learning that hospices are not just about taking people in the closing days or months of their lives, but about alleviating pressure on urgent care by taking people out of a ward where it is not really appropriate for them to be in their last few days, and on community care. In response to trying to get the money it needs, our hospice has done a great bit of work by going out to homes and supporting people there in their last few days and weeks.

The point is that, by properly funding hospices and all the work they do, I am convinced that we would create a saving for the wider NHS as well as the beds that are needed for other people. That is important in my constituency, because our main hospital is in special measures—“requires improvement” is where we are at the moment—and one area of that is about palliative care. The frustration is that there is a desperate need for beds in the hospital, but in the hospice, beds are available all the time. It is simply about a lack of commissioning joined-up thinking and working together, and not having enough money in the hospice system.

Hon. Members have given various quotes about how much NHS funding hospices receive. Some time ago, my first question in Prime Minister’s questions, when the then Chancellor was replying, was about how little Cornish hospice care was funded. At that time, about 11% of the money came from the NHS. That is in a part of the world where there is a lot of deprivation and average earnings are low, so the rest of that money was being found by people who were not awash with cash. I do not know that it has improved much since; we are still one of the areas that receives the least money for our hospice care.

That is frustrating, because people are dying in the urgent care centre who should be in a hospice. Three weeks ago, I spent time with a family who were desperate to get their mum out of my local hospital, which is part of the urgent care set-up. I do not want to be unfair to the hospital team, but unfortunately, they were so keen to get the lady home that they waited for care packages that did not arrive, and she died in the hospital when she could have been in the hospice.

[Melanie Onn]

I thank the hon. Gentleman for making that important point, which raises an issue that I have had with a constituent. His wife was sent home supposedly well after going into hospital for urgent treatment but sadly she died two days later. Going to the local hospice, St Andrews, would probably have been a much better option for her, but it had not been thought of in that process.

[Derek Thomas]

The hon. Lady is absolutely right, and I have heard several stories where that has been the case. Separate to the debate, there is an obsession—I use that word because it might get the Minister’s attention, although it may be the wrong one—with getting people home at every possible opportunity. When I sit with those people, some of whom are desperately lonely, I ask whether that is right for them or whether hospices, community hospitals and other settings would be more appropriate. I want us, as leaders and politicians, to be careful not to create an assumption that home is always the best place, because I do not believe that. It certainly was not for my mum in the last days and weeks of her life.

Addressing some of the challenges requires an uplift in the funding available to hospices across the board, and we must pass on pay increases to nursing staff. I say again that when I go into my hospice, the working environment is very different from that in the urgent care centre, but I have already said that Cornwall is a low-wage area with a high cost of living due to the beautiful environment that we live in, which attracts people and pushes up the cost of housing. It is expensive to live in my part of the world, so nurses are not choosing to leave the hospice setting because they prefer urgent care—obviously, we need them there as well, so I am not trying to discourage that—but because they need the money to live. We should not be saying, at any stage, “It is okay, because hospices are a different environment to work in and they might prefer it there, so they will settle for lower wages.” I hope that we would never assume or expect that.

I met the chief executive of Cornwall Hospice Care soon after the pay award, and he expressed concern that the money being offered to NHS nurses and staff would have a negative impact on hospices and other parts of the system where people are not directly employed by the NHS. I agreed to raise that in the House at the first opportunity, which I have done, and I am grateful for this opportunity to do so as well.

I know that I am among friends when I say that the value of hospice care is not underestimated. The work that hospices do for children and adults is fantastic. They are an essential part of bringing health and social care together and ensuring that people are cared for in the right setting and as close to home as possible. We all know that it is better to be near our families, whatever our health situation, and certainly during the last moments of our life.

As I have said, people are dying in my urgent care centre, which has already been judged as poor for palliative care, when there are beds in the hospice not far away. That must be addressed, and I want the Minister to intervene to put pressure on the system—or systems, at the moment—on the question of why we cannot do more. There has been progress in the last three years towards working better together, but making the right decision is painfully slow for somebody who does not actually have the time for that decision to be made. There have been improvements in working together, and the managers in all the systems in Cornwall, including the hospices, have healthy relationships, but things seem to be getting stuck at ward level, so patients are potentially not getting the best care.

As I have said, hospices now do fantastic work in the community, which has been a response partly to funding but also to need. They are going out into people’s homes to help families and individuals to manage their care properly. I have made fairly clear the two things that are needed to help hospices to deliver that vital role. In the discussions around the NHS pay award, what engagement opportunities have the Minister and the Department had with hospices? Have they been included in discussions about how that can be addressed and passed on? I would love the Minister to look closely at the situation in Cornwall, which will be true elsewhere too, where the money available for hospices is not enough. That is a choice made at a local level by commissioners, not the Department.

We should also assess whether we are making full use of what is available in hospices. If there are 12 beds with people in who are being cared for in the right place, that care is far more cost-effective than if there are eight beds, as is the case in my local hospice. It is not just about throwing more money at hospices, but about making better use of resources. That will reduce the cost of care while ensuring that those people, who have such a challenge ahead of them in the days and weeks to come, are given the care, love and attention that they absolutely deserve and that we would expect in the great nation in which we live.

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Caroline Dinenage]

I am really pleased that the hon. Gentleman has raised this issue. Plymouth is indeed leading the way in creating hubs and showing how incredibly valuable they are in bringing together all the relevant services in one place, not only to tackle people’s current healthcare needs but to play a vital role in prevention.

[Derek Thomas (St Ives) (Con)]

Health and social care hubs provide a real opportunity to ensure that patients are cared for in the right place, and it is vital for that to be extended to those who need palliative care. Can the Minister confirm that the NHS 10-year plan will adequately address the need for equal and appropriate access to palliative care across the country?

[Caroline Dinenage]

My hon. Friend is absolutely right to mention this. Palliative care is crucial to the experience not only of patients but of their families and carers. He will be interested to know that we have a new indicator from 2018-19 to measure the proportion of people who have had three or more emergency admissions in their last 90 days of life, which will help us to assess how people can be better supported in the community, and to do that better.

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 24th July 2018 Commons Chamber

[Steve Brine]

Vaping and e-cigarettes were part of the Stoptober campaign that we ran last October through Public Health England. I am often criticised for not promoting vaping enough, and I am sometimes criticised for promoting it too much, which possibly gives me a steer. The advice is clear that the best thing to do, whether someone is pregnant or otherwise, is not to smoke.

[Derek Thomas (St Ives) (Con)]

12. What steps his Department is taking to support families and patients affected by mistakes made in the healthcare system.

[The Minister for Care (Caroline Dinenage)]

Families and patients are at the heart of our work to improve patient safety, which is why all NHS organisations are subject to a statutory duty of candour and should be open and transparent with patients and families when things go wrong. Last week, the National Quality Board published new guidance for NHS trusts to help them better support, communicate and engage with bereaved families and carers.

[Derek Thomas]

I thank the Minister for that response, but since I was elected three years ago I have come across several examples of families who have lost loved ones who went to hospital for repeat interventions from the health service, yet died from undiagnosed conditions, many of which could have been avoided. The problem is that those families have found getting answers and finding anyone to accept responsibility fruitless, so what more can the Department do to help them?

[Caroline Dinenage]

My hon. Friend is right to raise that issue. Those who have lost loved ones in that way need answers when things go wrong. The recent bereavement guidance is clear that, when notified of a death, families and carers should be told that they can comment on the care of the person who has died and raise any concerns. From next year, medical examiners will offer greater scrutiny for the bereaved, increasing transparency and offering them the opportunity to raise concerns.

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 19th June 2018 Commons Chamber

[Steve Brine]

NICE has recommended the drug Translarna for use in the treatment of Duchenne muscular dystrophy; it is now routinely available on the NHS. It is a disease that I grew up with—the friends that I grew up with did not, and I did, and this is a timely reminder of how terrible this disease can be. I would be really pleased, therefore, to meet the hon. Lady and the charity that she mentioned.

[Derek Thomas (St Ives) (Con)]

Is the Minister aware of the recent NICE draft review regarding treatment of abdominal aortic aneurysms? Some 1,500 to 2,000 lives are saved yearly by NHS AAA screening. If the draft recommendations are adopted, a patient is likely to have an aneurysm erupt before treatment and 80% of patients are then likely to die. Will the Minister look carefully at this issue to avoid this unintended consequence?

[Steve Brine]

I am not the all-seeing eye, so all I can say is yes, I will look very carefully at the issue that my hon. Friend raises.

NHS Long-Term Plan

Derek Thomas Excerpts

Monday 18th June 2018 Commons Chamber

[Mr Hunt]

It is really extraordinary that on a day that we have announced a £20 billion annual rise in the NHS budget—you could not get a bigger commitment from a Government to state-funded healthcare—Labour is still running off down the rabbit hole of privatisation. If it is any reassurance to the hon. Lady, last year the proportion of NHS services contracted to the private sector went up by the enormous amount of zero.

[Derek Thomas (St Ives) (Con)]

This statement is very welcome, but I have raised in this place before how the money is distributed around the UK; it is well known that the south-west gets about 2% less a year of increased NHS funding. When the Secretary of State has a moment, will he look again at how funding is distributed, and ensure that as it increases, it is increased fairly?

[Mr Hunt]

I am happy to do that. My hon. Friend asks the same question as my hon. Friend the Member for Stafford (Jeremy Lefroy). These matters are now decided at arm’s length by NHS England because we think that the fairest way is to take the politics out of it, but I am happy to work with him to engage with NHS England on the Cornish questions.

Medicines and Medical Devices Safety Review

Derek Thomas Excerpts

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

We will certainly look at all those things, and the hon. Lady is absolutely right to draw attention to them. Licensing is one thing, but it is also important to ensure that proper information is available to clinicians and patients, because it appears from these cases that there are a number of drugs and devices that are safe but only in certain circumstances, and that knowledge might not have been properly disseminated. The database that the hon. Lady mentioned will help us to get that right.

[Derek Thomas (St Ives) (Con)]

I pay tribute to constituents of mine who have had surgical mesh implants—their campaign has been quite extraordinary and I am humbled by their work. The truth is that there is little prospect of any improvement in their condition. I welcome the statement and I recognise the issue around the ban and why that might not be possible, but will the Secretary of State assure this House and my constituents in west Cornwall that surgical mesh will be used only when there is absolutely no alternative?

[Mr Hunt]

This is a complex procedure that can go wrong, so it would only ever be used if it was absolutely the right thing for patients. We have looked at this very carefully. Other countries have introduced restrictions on the use of mesh, but we have concluded that that would be disadvantageous to women in certain circumstances. However, that means that we have to take much more care in when it is used so that we avoid those truly horrific complications.

Junk Food Advertising and Childhood Obesity

Derek Thomas Excerpts

Tuesday 16th January 2018 Westminster Hall

[Andrew Selous]

Thank you, Ms Dorries. Lord Patel told the Commons Health Committee on 24 October last year that the United Kingdom had the second worst obesity problem in the world, after the United States of America. I want to see action on a range of issues. Credit where credit is due—the sugary drinks levy has been successful, but the Government are now measuring nine types of food. We look forward eagerly to the release of that data in March this year. If we have established the principle with sugary drinks, there is no reason why we should not extend that approach to other foods, so that it will lead in the main part to reformulation, as the hon. Member for Sheffield Central (Paul Blomfield) said earlier.

I had a good meeting with Kellogg’s a couple of weeks ago. It is making serious efforts to make their breakfast cereals have much less sugar, so there is movement in the right direction, and by extending the framework of the sugary drinks levy to other foods, we could encourage that process further, which would be helpful.

If the Government are worried that there will be devastation in the food and drinks industry, they should take heart from what happened in Thailand. We know from a recent study by the University of Bangkok what happened when Popeye was featured a lot on television in Thailand. Of course, Popeye—as we all know from our own childhoods—ate lots of spinach and one particular television programme showed children developing fantastic muscles through eating lots of spinach. Those children who watched lots of Popeye programmes doubled their intake of spinach and other green vegetables. So, if some food and drinks manufacturers end up making less harmful foods, perhaps we will see an increase in the healthy and nutritious part of our food industry, which we all want to encourage and we all want to see have a great future in this country.

Like my hon. Friend the Member for Erewash, I do not think that only one measure is the solution to this problem. I welcome the specific focus of this debate on ramping down advertising to children, but there is a whole range of measures we can take, including clear food and drink labelling. The traffic light system labels should be on all food in our supermarkets. They are clear and easy to understand; the public can understand them. Also, when we go into a restaurant, why not make the number of calories in what we are ordering available? That would give people information.

We could do so much more in planning. I would like to see health as an objective in planning policy, and to see local authorities having the ability to turn down planning permission for unhealthy fast food outlets right next to schools. We cannot beat the food industry over the head and then allow a proliferation of shops selling unhealthy food right next to our schools. We need to be measured, we need to be fair and we need to have a policy that applies across government.

I would like the Minister to get on an aeroplane and go over to Amsterdam. I am extremely grateful to the Centre for Social Justice for drawing our attention to the Amsterdam healthy weight programme. The Minister looks as if he has not had that much foreign travel, so perhaps we can get him on a plane to Amsterdam before too long. It would not be a jolly; it would be a very serious piece of work. We do not need a pilot or to try a few things here or there, to see what works. We have four years of hard data from the Netherlands, showing that if there is a city-wide approach, led by political leaders, progress can be made. In Amsterdam between 2013 and today there has been a 12% reduction in the number of obese children across the board and an 18% reduction in obesity among the most deprived children. Mayor Eric van der Burg has shown that with political will, a ban on advertisements of fast and junk food in every metro station in Amsterdam, consideration of the built environment, and consideration of health in every policy, progress can be made.

I have raised the matter with Simon Stevens in the Health Committee, and I raise it now in the presence of the Minister: let us see action. We do not need to reinvent the wheel; a model just the other side of the channel has delivered results and we need to replicate that here.

We need to support our health professionals as well. There is an initiative called “make every contact count”, in which every clinician—at the GP surgery or in hospital—is supposed to talk about healthy lifestyles and weight at every opportunity but, in reality, it rarely happens, as they are overworked and time-pressured. Nevertheless, we need to hold firm to that, and to help GPs have sensible and sensitive conversations, recognising that people may find it a difficult and sensitive subject. It is not about embarrassing or upsetting anyone. I am lucky to be able to eat like a horse and look like a rake, but I recognise that not everyone is like that. This is a challenge; many environmental factors make it difficult for many families.

We need to encourage our schools to do the right thing. I pay tribute to Ardley Hill Academy and Linslade School in my constituency. They both have a fantastic graphic on the wall of different types of drink, showing the number of sugar lumps in each. The bottle of water at the end has, of course, none. What an amazing graphic.

[Derek Thomas (St Ives) (Con)]

My hon. Friend has made some excellent points. Will he give credit to the many schools across the country, including in west Cornwall, that do the daily mile? Every child does 15 minutes’ exercise or walks a mile every day. He is right to encourage schools, but it must be soul-destroying for teachers to go home and see TV advertising undoing their good work.

[Andrew Selous]

I could not be more grateful to my hon. Friend. He is absolutely right. The daily mile started at St Ninians School in Stirling in Scotland, and it is a fantastic initiative. If children cannot run, they can walk it. They do not have to bring in special gear. The teachers do it as well, and the health benefits have been phenomenal. The headteacher has said that pupils all look like rosy-cheeked children from the 1950s. Colds and sniffles have disappeared from the school, virtually no one sees the school nurse, and obesity and weight problems have come right down. My hon. Friend has mentioned another fantastic example of a whole-community approach, and that is the approach I encourage the Government to take when they come up with their new plans in March.

Social Care

Derek Thomas Excerpts

Wednesday 25th October 2017 Commons Chamber

[Derek Thomas (St Ives) (Con)]

I concur with pretty much everything said this afternoon. As an MP who recently fought a marginal seat, I fully felt the pain and discomfort over how we handled the proposals for social care. Since then, however, several constituents have come to me having lost family homes because they needed to pay for a family member in care. As we know, the money people have can dwindle down to £23,000 before the local authority steps in.

Our manifesto plan to protect people with up to £100,000 and to ensure that their properties were sold only after they had passed away has been welcomed by those who have come to see me. People often do not realise—I am surprised that the Labour party has not picked this up—that that policy supports our poorest families rather than those who may have greater assets.

I am a Cornish Member of Parliament. Two weeks ago, the Care Quality Commission put our urgent care hospitals into special measures. The CQC’s report, which also looked at social care and the role of the local authority in Cornwall, states that 82 people in the county are in beds in those urgent care hospitals owing to delayed transfers of care, as against 42 in comparable local authority areas. The report makes it clear that Cornwall Council, which has been run by the Liberal Democrats since 2013, has chosen to give half as much funding to social care as comparable authorities do. That has put enormous pressure on Cornwall’s NHS budget, which is currently funding those gaps in social care support. In April, the Government gave a further £12 million to Cornwall council to address the delayed transfers of care, and a further £12 million is promised for 2018-19 and 2019-20.

Our health system is under enormous pressure, largely owing to delayed transfers of care, but we know that our care and support workers need and deserve proper pay that reflects the work that they do and is similar to that of NHS assistants. They deserve that extra money, and they deserve the training that would help them to do their job more easily and safely. My plea to the Government is to do what they can to help Cornwall Council to prioritise social care and help it to address the challenges that it faces in deciding how to allocate funds and how to reward those who provide social care services on the frontline.

It is very easy for people always to blame the Government, and that has been a habit of our local authority—every time a decision is made, it says that it is because of Government cuts—but sometimes the responsibility must be shared by local managers. I welcome the Government’s intention to review social care, but I agree with other Members that their review must look at how we can integrate health and social care, because a weakness in one currently has dramatic impacts on the other.

People in Cornwall and the Scilly Isles deserve the very best care, and there are those on the ground who want to provide it, but all sorts of barriers hinder them from doing so. I ask the Government to work urgently to help our local authorities to address that crisis.

Surgical Mesh Implants

Derek Thomas Excerpts

Wednesday 18th October 2017 Westminster Hall

[Derek Thomas (St Ives) (Con)]

I commend the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) for securing this vital debate.

I knew nothing about surgical mesh until I was elected in 2015. Since then, women who have written to me or sat opposite me in my surgery have introduced me to their experience: a world of untold suffering, misery, distress and anxiety, which could and should have been avoided. I can add little to the debate other than to describe the experience of ladies in west Cornwall. A constituent in Helston writes:

“Before mesh, I was a vibrant and active woman, positively contributing to my community and society. Mesh has ruined my life with devastating life-altering consequences. Life is now marked by overwhelming daily challenges to my physical, psychological, social, occupational, and financial health and wellbeing. I am unable to work which adds to the financial stress. I am primarily housebound and not able to participate in the lives of family and friends, which I find most heartbreaking. I have three beautiful granddaughters…who live in…Germany. It has been a year since I have been able to visit and look into their curiously beautiful eyes.

I have a Masters Degree in Psychology which has helped me to cope with the devastating life-altering limitations and overwhelming daily challenges of living with significant mesh complications. The pain, discouragement, depression and anxiety is overwhelming every day, and excruciating on others, which is why I have also sought the support of occupational therapists, health psychologists and mental health professionals.”

Another constituent of mine states that the Food and Drug Administration in the USA has issued strict guidelines for mesh use and that in the USA a warning is given to patients about the potential dangers. She had a mesh implant to correct a pelvic prolapse and was told by her doctor that her quality of life would be significantly better, but it has not been. Her retirement has been ruined. She used to walk miles every day with her dogs but now struggles to walk due to pain and feels she might have to go into a wheelchair, as even the shortest walk around the house causes excruciating pain.

More recently, a lady came to see me in my surgery and talked about her experience. She had undergone an operation where a surgical mesh was used. After complications, she underwent a second procedure, during which the mesh was accidentally compromised, and she now suffers recurrent uterine prolapse. The surgeon has written to her, explaining the damage caused during the surgery, and has stressed the need for urgent further intervention, but she has been told that she cannot have surgery until May 2018. Until my intervention, she did not expect to hear back from the hospital until December at the earliest.

Further stories have emerged, including that of a constituent whose mesh eroded through her bladder and vagina. The mesh had been inserted in 2008 for stress urinary incontinence. At the time her complications emerged, there were only two surgeons in England who specialised in removing such mesh. One was in Oxford and one in London, both of which are a long way from west Cornwall.

Finally, another constituent of mine had transobturator tape, or TVTO, inserted five years ago to treat stress urinary incontinence. The device immediately caused her pelvic pain. Within six months, she suffered complete saddle anaesthesia with associated bladder, bowel and sexual dysfunction. The mesh was removed after two years but my constituent’s chronic pain continues, due to nerve damage.

For those ladies, little can be done to put right years of discomfort, distress and indignity. What they want is for the Department of Health to allow the use of mesh only in the most serious of cases, where no other option is available. A husband of a patient whose suffering continues following her surgical mesh implant writes:

“Our ultimate desire and goal is to see a complete ban on surgical mesh procedures so other women need not suffer the same appalling life-altering complications.”

I pay tribute to my constituents who have lived with this harm and who are willing to face up to the indignity of talking about their experiences, so that others do not suffer a repeat.

Oral Answers to Questions

Derek Thomas Excerpts

Tuesday 10th October 2017 Commons Chamber

[Jackie Doyle-Price]

I do not recognise Age UK’s assessment of unmet need. As I said, the requirements are enshrined in statute and local authorities should be held to that. In response to the hon. Lady’s final point, let me say that we are getting on with it, but we need a real cultural change in how we tackle these issues. There is a long-term issue to address in the fact that we are all living longer. This is not just going to need a sticking plaster; we will need to take the public with us. So this is not just another consultation; it is a vehicle for making sure that we as a society tackle this issue once and for all.

[Derek Thomas (St Ives) (Con)]

The Royal Cornwall Hospitals NHS Trust was put into special measures last week, but delayed discharge caused by unmet social care needs contributes to the pressure in the trust. I welcome the £12 million that was awarded to the council this April to address that, but what more can the Minister do to help to relieve the pressure? Will he meet me and my Cornish colleagues to discuss the healthcare challenges faced in Cornwall and on Scilly?

[Jackie Doyle-Price]

My right hon. Friend the Secretary of State has visited twice in the past year, and the Minister of State, Department of Health, my hon. Friend the Member for Ludlow (Mr Dunne) is more than willing to meet my hon. Friend next week, with other colleagues.