Oral Answers to Questions
Debate between Edward Leigh and Cheryl Gillan(5 years ago)
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Dame Cheryl Gillan (Chesham and Amersham) (Con)
Sir Edward Leigh (Gainsborough)
Before I answer that question, Mr Speaker, I would like to thank you for your friendship over the years. I do not always agree with you, but in this place, John, friendship is more important than agreement, so thank you very much.
The NAO expects to publish its progress review of High Speed 2 in early 2020. The NAO expects to examine progress since its last value-for-money study in 2016, the reasons for cost and schedule increases, and the risk to value for money that remain.
Dame Cheryl Gillan
In his bombshell report, Allan Cook, the chairman of HS2, admitted publicly that HS2 was billions of pounds over budget and years behind schedule. Quite frankly, given HS2’s poor corporate governance and the rapid turnover of not only senior staff but Ministers, who are supposed to have oversight of this project, may I encourage the NAO to provide an in-depth report on the financial operations and probity of HS2, and can this report be made available to Douglas Oakervee, who is carrying out the Oakervee review of HS2? That review should not report until it has had the advantage of the NAO analysis, and I hope that this project will then be cancelled or radically changed.
Sir Edward Leigh
Of course the NAO will not get involved in the political argument about whether the programme is wise, but it has already reported three times on HS2. It found that the cost and benefit estimates underpinning the business case were uncertain, and addressed the weaknesses in the business case and in the estimate of the cost of land. I assure my right hon. Friend that the NAO will leave no stone unturned to ensure we get value for money from this project, if it proceeds.
Russia and the Council of Europe
Debate between Edward Leigh and Cheryl Gillan(6 years, 4 months ago)
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Dame Cheryl Gillan
That is one of the confusions that has arisen, because the rules and regulations about what happens to a country that is in Russia’s position are unclear. I think that Secretary-General Jagland has a great deal of work to do to clarify the position, because the Russians coming back to the ad hoc committee has caused a great deal of consternation among many of our colleagues and not least to myself, because we cannot understand why they still have the right to sit at the table when we are in this hiatus where the money has been withheld and they have removed the rest of their delegation from participation in any of our committees and activities.
It is widely agreed that the violation of the sovereignty of states arose from an illegal referendum. I want to dwell on that for a moment, because I serve as the vice-president of the committee on political affairs and democracy and am also the rapporteur for the new rules on referendums. We have just completed a large report in this country, under the auspices of the constitution unit at University College London, looking at the rules in the United Kingdom on referendums. The independent commission on which I have served for the past nine months has come up with a series of recommendations for changes to legislation in this country. I am working with Dr Alan Renwick, who is now the international adviser to the Council of Europe’s political affairs committee on this matter, and I am working with the Venice Commission as it updates its rules on referendums, which is badly needed after 10 years, to try to bring more clarity to the situation.
That we have Russia in the Council of Europe at all is one of the key achievements of the post-cold war period. When it ratified its membership of the European convention on human rights in 1998, there was a real welcome for its inclusion, but in December 2015 it passed a law to allow Russian courts to overrule the decisions of the European Court of Human Rights, because it disliked those decisions. Russia was particularly exercised, as my hon. Friend the Member for Henley mentioned, by being told to pay $2 billion to shareholders of Yukos, but there have been many judgments that have irked both President Putin and the ruling party, and some of their behaviour has resulted from that. More than one third of the cases that come before the European Court concern Russia. To put that in perspective, in 2017 the Court dealt with 8,042 applications concerning Russia. Even though 6,886 of those were declared inadmissible, it delivered 305 judgments concerning 1,156 applications, and in 293 of those there was a finding of at least one violation of the European convention on human rights. Before I arrived in the Chamber I looked up the figures for 2018, and already 5,975 applications have been allocated to a judicial formation, of which 579 have been decided by judgment. There are currently a further 9,191 applications pending a judicial formation. That is a heavy workload, and is a reflection of the human rights situation.
The Council of Europe is no stranger to the practice of bringing together representatives of countries that have political and diplomatic tensions, and it acts as an important partner in the soft diplomacy required to bring resolution to intractable problems. What we are discussing is probably one such problem. We need to seek a remedy for the situation because at the moment 140 million Russians will be denied access to the European Court of Human Rights, and that is not something to be taken lightly. We should not capitulate and accept an unconditional deal, as that would set a precedent for those countries that are often accused of backsliding on democracy. It is important that the founding principles of the Council of Europe should not be held to ransom as it faces complicated financial issues.
Sir Edward Leigh
My right hon. Friend makes a good point. However imperfect the Russian Government’s attitude towards the Court, at least there is a chance that the 144 million Russians will continue to have access to a genuinely independent human rights court. That is why Russia must maintain its place on the Committee of Ministers—so that at least there is a chance of ordinary Russians getting access to the Court.
Dame Cheryl Gillan
The unilateral withdrawal of the funds that are important for running the Council of Europe and the Court is to be deprecated, and I should like those funds to come back, but I do not believe we should give in to the current blackmail. We need to stiffen the resolve of the Council of Europe and of Secretary-General Jagland. Money should not be more important than the democratic principles by which we all want to live. I hope for a resolution to the problem that does not involve rolling over and giving in to the Russians.
Out-of-school Education Settings
Debate between Edward Leigh and Cheryl Gillan(8 years, 10 months ago)
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Mrs Gillan
I am most grateful to my hon. Friend for giving way and congratulate him on securing the debate. This issue has caused great concern among my constituents, particularly Rev. Simon Cansdale, who leads our churches in Chesham. He makes the point that surely we should be the Government who are responsible for wiping away red tape and disincentives for voluntary organisations to carry out this sort of work, but we appear to be putting more red tape in the way and creating more disincentives for them. As far as I am concerned, the proposals could even apply to, for example, teaching children music for recitals or outdoor skills, or to any sort of activity such as singing songs or reading out stories to young children. Surely it is verging on the ridiculous and should be swept away.
Sir Edward Leigh
That sums it up very well. All the tools are there, and I will list them in a moment. They are based on risk.
The DFE’s real target, as we all know, is religious teaching; let us be honest about that. The major problem is that many religious groups do not have confidence in Ofsted. I led a debate last year on the treatment of certain Church and Jewish schools. I will not repeat all I said on that occasion. I mentioned the particular problems that Orthodox Jewish schools are having; I read out letters from pupils at a Christian school; I mentioned St Benedict’s Catholic School in leafy Bury St Edmunds, which was accused of not doing enough to tackle radicalisation; I mentioned Middle Rasen School in my constituency, which, according to Ofsted, is not British enough. I will not repeat those points, but they are on the record.
The Catholic Education Service does not oppose the plans, but it has a number of concerns, including the risk of
“Vexatious complaints and the use of the system as a means of pursuing critical objectives”.
Ofsted told Trinity Christian School in Reading to invite leaders of other faiths to lead collective worship and actively to promote other faiths. Ofsted denies it, but why would the school make it up? I am afraid that Ofsted has a reputation for being unfair to some Christian and Jewish schools. When inspectors went into the Birmingham non-faith schools that were part of the Trojan horse Islamist plot, they first rated them as “outstanding”. One of the key figures in the scandal was an Ofsted inspector, so it hardly has a stellar record of spotting extremism. Yesterday, I talked to Sir Michael Wilshaw, who is a very reasonable, able man and is clearly doing his best. I have no doubt that he has worked hard in the past year with his resources to root out radical jihadism, but because he has to look even-handed, he has to take part in this activity of controlling thousands of other group.
Are British values the answer? One only has to say the phrase now and people roll their eyes. The consultation paper says that British values include
“democracy, the rule of law, individual liberty and the mutual respect and tolerance of different faiths and beliefs.”
That is too vague to provide a basis for state inspection of churches and scout groups. It is also sloppy. We cannot show respect and tolerance for all beliefs. Jihadism is a belief, and we certainly do not respect that.
The Government admit that their out-of-school plans will create a new burden on providers—the understatement of the year—but I do not think they have any idea of how big the bureaucratic monster they are creating is. The National Council for Voluntary Organisations—hardly an extremist group—says that there are more than 160,000 voluntary organisations in the UK. Many of them work with children and young people. For 37,000 of them, it is their core work. The NCVO counts only registered charities, but a vast amount of voluntary work is done without the formality of setting up a charity, so there are many thousands more groups not included in the NCVO figures.
I have several questions that I hope the Minister will reply to. How will those tens of thousands of bodies be notified of the new obligation to register, given that some of them do not even have a permanent address? Whose responsibly will it be in the setting, especially if the group is informal and has no structure? What about venues with different groups operating on the same premises? How will ad hoc groups calculate whether they breach the six-hour threshold? How many will be forced to register just in case? How will they know what Ofsted is looking for if they ever get a visit? How will they prepare for a visit? Can football be played in a non-British values compliant way? Can a conservation club be intolerant? Should martial arts clubs be worried?
The whole thing is a ridiculous mess that will severely damage the big society—our big idea. Some groups will cut their provision to less than six hours to avoid having to register, and some will close down altogether. Groups that rely on teachers as volunteers will be especially vulnerable because teachers will not want to risk their career by being involved in an amateur outfit that might slip up with Ofsted. It is the children who will suffer, not us, Ofsted or the Government. There will be less provision, which means that in future there will be fewer footballers, swimmers, linguists, artists and other high-flyers, all because of this bizarre, unfocused, ill-thought-out, politically correct imposition on our freedom.
Mrs Gillan
I am also greatly worried about the cost and burden that the scheme will place on our already squeezed local authorities and on the Government. More taxpayers’ money will be spent on the scheme, and I think it would be unreasonable to expect local government to meet the cost.
Sir Edward Leigh
From talking to our local councillors, we know that the last thing we should do is impose more burdens on them.
To top it all, the scheme will not make children any safer from extremism; it will just tie up thousands of non-jihadi groups in red tape. The idea that jihadists will take the time to register is incredibly naive. Islamist extremists regard our laws as a total irrelevance. If they have no conscience about teaching children that Jews and Christians are worse than dogs, does anyone seriously think they will have a conscience about registering with the local authority? Are they really going to put themselves on the radar for an inspection? If they beat up children for not memorising the Koran, do we really think they are going to put their hands up and say, “Here we are—come and inspect us”? If Ofsted turns up to assess them, does anybody think that they would use the occasion to show their ghastly videos?
If we want to find extremists groups that put children at risk, we have to use good old-fashioned intelligence. We spend a huge amount of money on the intelligence services. We have to rely on intelligence, surveillance, common sense and the bravery of members of the public who blow the whistle on such groups, including the many good Muslims who are fed up with this, frankly, and the good Muslim mothers who do not want their children to go to such places.
We should use existing laws, of which there are plenty. If these groups urge children to do things that break the law, we should prosecute them for encouraging the commission of a criminal offence under section 44 of the Serious Crime Act 2007. If the children are at risk of significant harm, we should get a prohibited steps order or a supervision order under the Children Act 1989. If the premises are dangerous, we should invoke health and safety law to close them down. If it is really an unregistered school, we should use the Education and Skills Act 2008 to close it down, as the DFE did last week to a school in Stamford Hill. We have the powers, and we should use them to deal with the genuine cases.
This out-of-school setting scheme is a total and utter distraction. We will end up with a list of tens of thousands of law-abiding, non-extremist groups, and Ofsted inspectors will try to justify their existence by picking on the occasional conservative religious group and brand them non-compliant with British values. It is a typical case of politicians and civil servants wanting to look as if they are doing something, rather than actually doing something. If they actually want to do something, they need to knock together the heads of the police, social services departments, Ofsted and all those with existing powers to make them use those powers properly.
This scheme is fundamentally illiberal. It is big government at its worst. It would do little or no discernible good, and an awful lot of harm, leading to false allegations. Ofsted knows that false allegations against teachers are a massive problem in the profession. A system based on “British values” and “undesirable” teaching is ripe for subjective, exaggerated and politically-motivated complaints, especially against religious groups. This will generate false flags and waste time. Finding extremists is already like finding a needle in a haystack. This system will just make the haystack much bigger.
Sir Michael Wilshaw tried to justify the new plans on LBC Radio last week by citing cases of unregistered schools where children were
“living in appalling conditions in a filthy environment where there was homophobic literature, anti-Semitic literature and misogynistic literature”.
That summarises the difficulty. On the one hand, it identifies real problems such as educating children in filthy conditions, but talks about those problems as if we cannot tackle them without a new law. That is not true. We do not need a new scheme to do that. On the other hand, Sir Michael Wilshaw raises issues that involve highly subjective judgments, such as what constitutes “homophobia” and “misogyny”. People routinely use words such as homophobic and misogynistic to describe the contents of holy books of all religions. One can bet there are Ofsted inspectors who take that approach. I half wonder whether the homophobic, misogynistic and anti-Semitic literature found at unregistered schools was just some religion’s holy book. There is some pretty blood-curdling stuff in the holy books of all religions.
I absolutely accept that no religious person has the right to impose any violent language on anybody else, but we are talking about religious people. It does not matter whether they are Hindu, Sikh, Muslim or Christian —they believe their holy book. I am not saying that anyone has the right to enforce their holy book on others, but they do have a right to say that they believe that their religion is right and that others are wrong. That is why they are religious. That is real diversity and pluralism—not this ridiculous situation in which we all have to pretend that we believe the same thing.
The Minister may tell us that the Government have no intention of registering Sunday schools, chiefly because they do not like the sound of the headline, but Sir Michael Wilshaw told the LBC Radio audience last week that Sunday schools would have to register. He is right because Sunday school provision is just one aspect of a church’s work with young people. If a child spends two hours at Sunday school, another two hours at a youth group on Wednesday, and another two hours in choir practice on Friday, they have spent six hours receiving tuition and training from the church. It may have involved three different groups with three different sets of volunteers but it is all in one setting, so that church will have to register. Its Sunday school workers, youth group leaders and choir masters are all liable to British values inspections.
In 1787, it was estimated that a quarter of a million children were enrolled in Sunday schools. They were mainly non-conformist. Frightened by the French revolution, the then Archbishop of Canterbury denounced Sunday schools as “nurseries of fanaticism”. Prime Minister William Pitt almost introduced a Bill prohibiting the dangerous innovation—plus ça change. In conclusion, the Department must think again before it unleashes a whirlwind of destructive over-regulation on the voluntary sector.
High Speed 2
Debate between Edward Leigh and Cheryl Gillan(10 years, 10 months ago)
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Sir Edward Leigh (in the Chair)
Order. We are in danger of going round in circles now, so perhaps the right hon. Lady could get on with her speech. Perhaps if she gives way to the Minister, we can get on and hear from other people.
Mrs Gillan
I am not digging up anything. The project has not got the final stamp of approval. There is still the option of pursuing other ways in which we could improve our economy.
Let me get back to my local picture, because I think that it is only fair to my constituents that some of their grievances are aired. The agricultural holdings in Chesham and Amersham will be severely impacted. Several farms will be badly affected by the construction, to such an extent that they will probably be put out of business. People cannot run an equestrian business next to a major construction site; nor can they use ground that has been submerged in 50 feet of soil. Will the Minister, although he is rightly going to defend his position, as he must, let me know what detailed work he had done on the losses that will be sustained by the businesses and particularly the farming and agricultural holdings in my neck of the woods? HS2 Ltd estimates that, across the whole route between Birmingham and London, about 300 existing businesses will be required to relocate to new premises, but people cannot relocate a farm and people cannot relocate a family business, when its land has been divided into two or part of its land has been appropriated.
I referred briefly to roads that will have to be closed, realigned or diverted during the construction phase. The impact on communities and local facilities will alter people’s travelling patterns and shopping habits, perhaps even for life. That is a great threat to the local economy. If people start to read through the detail of the environmental assessment, they can see some of the estimates of traffic congestion at the junctions of School lane and the A413, the Amersham bypass and the A404, and Chesham road and Bottrells lane—I could go on, but people will have got the idea. But I want to know what estimates the Department has made of the losses to our local economy from the delays, traffic congestion and disruption that years of construction will bring to Chesham and Amersham.
I believe that some of the claims made by consultants are not correct. There will be a lot of substitution in the economy. Yes, businesses will be attracted to the high-speed rail line and may move, as they did when the BBC, which the hon. Member for Edinburgh East referred to, went to Salford. That move has attracted many production companies and media companies to that area. However, that is substitution, because the businesses have been drawn from other parts; hence one of the very important things that was highlighted in the KPMG report was the disinvestment and the permanent loss to GDP of other regions as businesses are attracted falsely to the line.
This will be a distorting project. Many MPs around the country do not realise that there will be an effect on their constituency, which will suffer disinvestment as businesses move closer to new conurbations, for example into buildings created with Chinese investment, as we have heard, for the Manchester airport area and in other centres where they intend to build buildings that will accommodate businesses or shops.
Sir Edward Leigh (in the Chair)
Order. The right hon. Lady has been speaking for 20 minutes, so I think she might bring her remarks to a close now.
Mrs Gillan
That is exactly what I intend to do, Sir Edward, and I am grateful for your latitude. I think everybody understands how badly Chesham and Amersham will be affected and how strongly people feel about the matter.
I do not believe that HS2 will deliver all the benefits that have been laid out, but I can see at first hand the terrible effect that it will have on my locality and the businesses there. Many commentators, including the Institute of Directors, the New Economics Foundation and the Institute of Economic Affairs, have said that the project is not the answer to economic growth. I urge the Minister to be sympathetic to my constituents and what they are going through, and to question hard whether the project is the right one. It is still not too late to look at the alternatives.
Several hon. Members
Dermatology Funding
Debate between Edward Leigh and Cheryl Gillan(10 years, 11 months ago)
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Sir Edward Leigh (Gainsborough) (Con)
It is a pleasure to serve under your chairmanship, Mr Turner. I am grateful for this opportunity to debate issues relating to the provision of dermatology in the NHS. This area has received little parliamentary attention over the years, given the considerable morbidity and mortality for which skin disease is responsible. Indeed, I think I am right in saying that this is the first debate in the House of Commons in several years on dermatology and how it is treated in the NHS.
I should declare an interest, because we are always supposed to. I have a skin condition called rosacea. It is not that serious; I take antibiotics every day and it is controllable, but it has, of course, led me to take an interest in this subject.
In preparing for this debate, I consulted widely among the different interests in skin disease, and I am grateful for the insights that I was given. It is noteworthy that the same themes emerged from all quarters. Skin disease is extensive and has a great impact. It results in profound psychological consequences for many, especially for those with severe variants of conditions. It is under-treated in the NHS, and there are commissioning issues that relate partly to dermatology’s continuing to be something of a Cinderella disease. Talking to people, I heard the expression “Cinderella disease” time and again.
Most crucially, there is wholly inadequate training, notably among general practitioners, to enable doctors to handle the dermatology cases that will come their way in day-to-day practice. Why is this? There is a view that dermatology does not matter and that it does not kill. This is both complacent and wrong. Many skin diseases have horrendous effects, even when they are not fatal. Skin cancer is a major killer, and there would be benefits from renewed focus on this disease, both to help people avoid it in the first place and to identify and treat it quickly where it occurs.
The statistics on the burden of skin disease are eye-popping. Some 54% of the United Kingdom population experience a skin condition in any 12-month period. Of those, 14% seek medical advice, usually from a doctor or nurse in the community. Some skin conditions will be trivial, but many are not. Skin conditions are the most frequent reason for people to consult their GP with a new problem. Some 24% of the population visit their GP with a skin problem each year.
Mrs Cheryl Gillan (Chesham and Amersham) (Con)
I congratulate my hon. Friend on obtaining a debate on a subject that has not been discussed for a long time. I have looked at facts and figures on dermatology services in my constituency. Would it surprise him to hear that, in the first six months of the year, the trust’s dermatology department had 501 day cases, 4,160 new out-patient appointments and 7,951 follow-up out-patient appointments, and undertook more than 3,292 out-patient procedures? Does not that show the demand in the system for dermatological services?
Sir Edward Leigh
In a moment, I will address the fact that skin diseases can have fatal consequences. As GPs often do not have adequate training, they are not able to spot conditions that can be very dangerous.
Training is important. In a 2008 survey of final-year medical students, only 52% of 449 respondents said that they felt they had the necessary skills to manage skin conditions. A lack of education and training may lead to fatal errors, and I stress that point because skin disease is not only about psychological damage. Skin lesions mistakenly taken to be benign can lead to cancer. Conversely, inappropriate referrals to secondary care can be costly and are blocking up big parts of secondary care. As awareness of litigation increases in the NHS, GPs are, unsurprisingly, less and less willing to take risks, so they refer more and more patients to secondary care. I understand that the general hospital in Lincolnshire—this echoes the point raised by my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan)—has seen a 26% rise in dermatology referrals for secondary care in the past year, and it is not alone.
The exploding incidence of skin cancer, an ageing population and side effects from new potent drugs are all driving referral rates. It has been guesstimated that there are 100,000 cases of skin cancer a year in the UK, but the number is not known for sure because the NHS does not collect figures for cancers that are not melanomas. Work this year suggests that the number may be nearer to 700,000; that is what dermatologists tell me, because they are dealing with such a volume of cases, day by day.
Studies show that the skill of GPs in diagnosing skin lesions needs improvement, and other studies raise concerns about the standard of skin surgery offered in primary care. In 2012, the Royal College of General Practitioners updated its curriculum statement on the care of people with skin problems. The statement goes a long way towards recognising dermatology as a key component of a GP’s training. The statement sets out a number of expected key competences within the field, but crucially, dermatology remains an optional component. For undergraduates, the British Association of Dermatologists recommends a two-week full-time attachment to a dermatology unit, with a realistic assessment at the end of the course. The association thinks that dermatology should also be taught when undergraduates work with general practitioners in the community. When trainee GPs are undertaking their two-year hospital placement, a six-month post in dermatology alone, in a combined post such as dermatology and general medicine, or in a combined minor specialty rotation would go a long way towards helping trainee GPs to take a special interest in dermatology, which is what we need.
The GP training period is likely to be lengthened by 12 months. I urge all interested parties—Health Education England, the royal colleges, the General Medical Council and the ultimate employer, NHS England—to use half or all of that extra time on a proper dermatology rotation, which would ensure that the GPs of the future are properly equipped to address their future work load. If that is to happen, funding must be made available to ensure that there is adequate consultant time to train budding GPs and to pay their salary while they undergo the hospital training.
Mrs Gillan
My hon. Friend is making a powerful argument. Does he agree that there is a worrying lack of provision for the psychosocial aspects of skin conditions? Is he familiar with Changing Faces, which, among other things, provides skin camouflage clinics? It sent me an e-mail when I was preparing for this debate saying that the King’s Fund has stated that there are only 3.7 posts across the country providing support for the psychosocial aspects of skin conditions, and the funding for those posts is under threat. Does he propose that funding should be found to try to support that vital work?
Sir Edward Leigh
I entirely agree. I talked to a doctor recently who said that one of his patients had not dared to go out for 20 years without wearing enormous amounts of special make-up because she was so worried about her condition. We should take that very seriously, because it affects hundreds of thousands of our fellow citizens and their feeling of self-worth.
The lack of dermatology education applies not only to GPs but to nurses and pharmacists, who also play a key role in the management of patients with skin disease. High and ever increasing sales of over-the-counter skin products suggest that people buy many products from pharmacies, yet training of pharmacists in the management of skin problems is limited, and evidence that they are providing appropriate advice is lacking.
There is considerable potential for improving self-care through the provision of high-quality patient information and the development of the knowledge and skills of community pharmacists in skin diseases. That would save the NHS money, as well as improve patient care, and it is a nettle waiting to be grasped.
The General Medical Council, working with the Royal College of General Practitioners, the British Association of Dermatologists, the Royal College of Nursing and the Royal Pharmaceutical Society, plus Health Education England and NHS England, has a duty to ensure that urgent priority is given to the provision of proper dermatological training for all GPs, nurses and pharmacists. That training should surely emphasise that most inflammatory skin diseases are long-term conditions and are likely to need ongoing care, often throughout a patient’s life. Similarly, the psychological effects of skin disease should be considered an integral part of any dermatological training course; I echo my right hon. Friend’s important point on that issue. There is good evidence for the effectiveness of general practitioners with a special interest in dermatology working within appropriate accreditation frameworks. More needs to be done to expand that group of clinicians, which is still all too small.
In addition to poor training at primary care level, there is also an issue with the number of consultant dermatologists. I pay tribute to my consultant, Professor Chris Bunker, who is well known in the field and is president of the British Association of Dermatologists. Compared with mainland Europe, the ratio of consultant dermatologists to the general population remains low in the UK, at 1:130,000. It is estimated that there is a 20% shortfall in consultant numbers in the UK.
Furthermore, there are significant issues related to vacancies in dermatology consultant posts—there were some 180 consultant vacancies at the last count. That is due both to an inability to attract people to posts in remote areas and to the widespread problem of funding being available for a post but the relevant deanery refusing to provide a training number that allows the post to be filled by a trainee.
As well as being unpleasant and demoralising for patients, some skin conditions kill; that must be emphasised. Skin conditions are not just a psychological problem. There were nearly 4,000 deaths due to skin disease in 2005, of which 1,817 were due to malignant melanoma, which is now the UK’s most common cancer. That is against a background of 13,000 malignant melanomas each year, a level that has increased 50% in little more than a decade. Those figures continue to rise, driven by the wide availability of cheap holidays in the sun, the continued fashion for using sunbeds and the inadequate resourcing of awareness campaigns. We must do more about that; improved public funding for awareness campaigns, better training and stronger regulation of the use of sunbeds are some of the most obvious answers to the problem, yet very little, if anything, ever happens. Despite skin disease being very common, the direct cost to the NHS of providing skin care is relatively modest. The overall direct cost to the NHS in England and Wales was some £1.82 billion at the last estimate, in 2006.
As of October 2013, there is no policy lead for dermatology in the Department of Health or NHS England; I put that point directly to the Minister. The majority of dermatology services are commissioned by clinical commissioning groups, but national oversight is necessary to co-ordinate care across the country and to drive the agenda. Prior to the April 2013 switchover, primary care trusts were responsible for commissioning dermatology services, but the Department did at least have a policy lead on overseeing service provision. No similar post now exists in NHS England, so no one—I hope the Minister can reassure us on this—champions this area, spots good practice, or drives change.
Earl Howe recently stated in the other place that dermatology would be spread across the five domains of NHS England, and that it would not, as was previously thought, sit primarily under long-term conditions in domain 2. That surely only heightens the need for a director to co-ordinate policy across the five domains. Even if only a junior post were to be created, patients and health professionals would be given a clear line of accountability and a person to whom they could appeal who was above their local CCG lead for commissioning. Given the prevalence of skin disease, a national clinical director for dermatology, which is what I am calling for, would not look out of place among the long list of such posts at NHS England. I urge it to consider such an appointment.
There is a lack of sources of peer-group, independent advice for people with skin conditions. Patient support organisations are mainly charitable institutions that rely, for the most part, on donations from individuals and pharmaceutical companies. People with skin disease place great value on the information and help provided by dermatology patient support groups. Skin disease is not a well-resourced area, and such groups struggle to make ends meet. There is no group at all, for example, to provide support to people with acne, the previous group having run out of funds some years ago. Given that such charities are almost certainly a cost-effective way to provide what might be life-saving support to patients, perhaps the NHS should consider being a little more generous in its funding.
I thank all those who have helped me to prepare this speech, particularly the British Association of Dermatologists. It is clear that a small number of important steps would make the greatest difference in this area of disease, including the appointment of a national clinical director to co-ordinate learning around the NHS and to drive uptake of new ideas and change. More important, however, is persuading the relevant bodies that I have mentioned to ensure that undergraduates emerge from medical school with a reasonable grasp of dermatology and that newly appointed GPs can recognise a malignant melanoma, which is probably the most important point of all. Those changes alone would have far-reaching, positive consequences for dermatology and for those with skin disease, and I urge the Minister to consider what can be done to make them a reality. I hope that this debate will make some difference.