Hospice Funding

Edward Timpson Excerpts

Monday 22nd April 2024 Commons Chamber

[Edward Timpson (Eddisbury) (Con)]

Thank you very much, Mr Deputy Speaker, not least for enabling me to reassure myself that I can still get out of my seat, despite my London marathon legs from yesterday—I had to find a way to get that in!

May I start with some positives? I do not want to steal the Minister’s thunder, but there has been some really good support for hospices in recent times. We heard about the covid support. The Government gave around £400 million to increase capacity and to enable patients to be discharged from hospital. We saw hospices benefiting from the Government’s energy bill relief scheme until April last year and, since then, the discount scheme until March this year. As we heard earlier, there has been an increase in the NHS England children’s hospice grant from £12 million in 2019-20 to £25 million in 2023-24. I believe that that has, since July last year, been committed through to 2024-25, albeit it is now allocated through ICBs rather than directly.

So why are hospices struggling? I think that the answer is best encapsulated in a recent report from the Health and Social Care Committee, which stated that funding for specialist palliative and end of life care was “insufficient and unsustainable” and was creating

“inequality in access to and quality of care.”

What does that mean for hospices in my constituency and across Cheshire? Let us take the Hospice of the Good Shepherd in Chester, which is just outside my constituency but serves many of my constituents. As its chief executive, Rhian Edwards, informed me, last year it delivered more than 2,000 hours of direct care per week, supporting 476 patients and their families. To do so, it used £4 million of its own charitable funds, with the ICB contributing £1 million. Over three years the ICB contribution has fallen from 22% to 20%, and is expected to fall further to 16% in the next financial year.

This is against a backdrop of running costs—80% of which are staff costs—shooting up, mainly as a consequence of the requirement to match pay awards for medics and nursing staff, welcome as they are for those workers. The impact is a forecast operating loss of just under £1 million for 2024-25, and there is a similar scenario in nine out of 10 hospices in the country. Rhian told me:

“although we’ve always struggled to balance our books, this level of deficit is feeling very different.”

Another example is St Luke’s hospice in Winsford, which has been providing palliative care since 1988. It has 162 members of staff, and 95% of the workforce live and work in Cheshire. It has 700 volunteers and 10 charity shops. At the heart of this incredible organisation is a charitable purpose, and it does amazing work, but only 12% of its income is received through the NHS and the ICB, one of the lowest percentages in support packages of this kind across the country. It costs £5 million to run St Luke’s, so it has to raise—I have worked this out—£8 a minute to keep its services going. Within the Cheshire and Merseyside region, it receives about £1 million less grant funding than a hospice of a similar size in Merseyside dealing with the same end of life care.

Welcome though the extra funding was during covid, the fundamental financial issues facing hospices have not gone away; they have simply been postponed. This financial year, for example, will see a £350,000 black hole in the finances of St Luke’s, not helped by a staggering 60% increase in its utility costs. Neil Wright, its chief executive, explained to me:

“As a charity, we have a fiduciary duty to balance the books. This means that without progressive investment of sustainable funding, hospices will have to reduce and eventually stop services over the coming years. This will then place 100% of the financial burden of EoL”

—end of life—

“care back onto the already overstretched NHS”.

So what can be done? Hospices such as St Luke’s are not looking for, or expecting, 100% funding; they just want a sensible, sustainable funding formula. At present, however, ICB funding does not reflect the true cost of clinical care. When it comes to sustainability, as other Members have said, we need multi-year contracts to give hospices the confidence to deliver their services and invest, grow and develop to meet the needs of their communities. We have the NHS long-term workforce plan, which is hugely welcome and, I believe, provides a real opportunity to assess—fully and rigorously—and deliver the palliative and end of life care services that are necessary to meet the growing demand over the coming years and decades.

It is also worth remembering that some people face greater barriers in accessing palliative care, including those who live alone, in poverty or with dementia, as well as those with learning disabilities. In the end, if we do not secure the long-term future of hospices, we will have created a false economy and a false reality. If we do, we will not only reduce pressure on NHS services and have fewer unplanned and potentially avoidable hospital admissions, but will ensure that we can deliver compassionate care for those coming to the end of their lives and for their families and loved ones, thus demonstrating that we are a society that values both a good life and a good end of life.

Pharmacy First

Edward Timpson Excerpts

Wednesday 31st January 2024 Commons Chamber

[Dame Andrea Leadsom]

I am of course happy to read the letter, but I would say that Pharmacy First offers a significant new boost to community pharmacies.

[Edward Timpson (Eddisbury) (Con)]

My right hon. Friend will be pleased to hear that, across Cheshire and Merseyside, including my Eddisbury constituency, 535 community pharmacies will be starting the Pharmacy First initiative today. Particularly in rural areas, pharmacies are a lifeline for many people. Can she reassure patients of the clinical competence of pharmacists to make prescriptions, and can she reassure pharmacists on the issue of clinical liability?

[Dame Andrea Leadsom]

I can assure my hon. Friend that pharmacists are highly skilled and better trained than ever before in this country. They are fully equipped to meet the demands of their new prescribing role.

Lung Cancer Screening

Edward Timpson Excerpts

Monday 26th June 2023 Commons Chamber

[Steve Barclay]

I am sorry, but I missed the second part of the question. On the speed of treatment, that is why significant work is going into the faster diagnosis standard, which was hit for the first time in February. Part of the additional capacity going in—the extra 108 diagnostic centres—is to boost that capacity and speed up that treatment. There has been a surge in demand; a significant uptick in the nature of demand. That is the backlog we have been working through as a consequence of the pandemic, but the additional capacity is to address that exact point.

[Edward Timpson (Eddisbury) (Con)]

I welcome today’s announcement and acknowledge the important contribution made by many charities and organisations that work in the world of cancer, including Cancer Research UK and the Roy Castle Lung Cancer Foundation. The pilot has proved that a national screening programme will make a huge and significant difference to many lives, particularly in places that were not in the pilot areas, such as Eddisbury in Cheshire. One aspect of the pilot programme that enabled a diagnosis to be made more quickly was the screening trucks that went out into the community. Will that continue in the national programme, particularly in rural areas such as the one I represent, where there are health inequalities that need to be addressed?

[Steve Barclay]

My hon. and learned Friend is absolutely right. A key feature of the programme is the use of screening trucks to offer checks within the community. When I was talking to patients this morning, a theme that came through was that the prospect of going to hospital for such a check would have been seen as a more daunting experience. The fact that the check was available, using high-quality equipment, in a vehicle in a supermarket car park made it more accessible to people and, as a result, the uptake was higher than it might have been. He is absolutely right to highlight the proven importance of that in the pilot and that delivering checks through community schemes increases participation; that is a key feature of the programme.

Children’s Mental Health

Edward Timpson Excerpts

Tuesday 8th February 2022 Commons Chamber

[Dr Allin-Khan]

Do the right hon. Lady’s Government take any responsibility for the tens of thousands of children who are now bereaved as a result of losing their parents because of this Government’s shocking handling of the pandemic? We shall take no lectures from the right hon. Member and her party when it comes to protecting children’s mental health. I shall move on.

When children come to A&E—[Interruption.] Please feel free to intervene: I will take interventions.

[Edward Timpson (Eddisbury) (Con)]

The fact is that we are all in this debate this afternoon because we all care about the mental health of children right across the country. For me, this is an opportunity for us to use this precious time in the Chamber to try to find some common ground between us, so that we can move forward in a positive way and people watching can understand that there are things we can do to make their lives better. In that spirit, can I suggest to the hon. Lady that she look at my report on school exclusions, particularly at how we can ensure that teachers are better prepared at school, including with the mental health leads that the Government are bringing in, so that they understand issues such as trauma and insecure attachment and can enable children to get the support they need at the time they need it? That is the premise on which we should all move forward.

[Dr Allin-Khan]

The hon. Member highlights the point that mental health should not be a political football, which is why we hope that he will support the Opposition’s recommendations. I should be delighted if he sent me his report; I will read it with interest.

It is crucial that when a child comes to A&E or a hospital, doctors and nurses take the time to build trust with them as a patient so that they feel safe talking about their condition, but with waiting lists growing and the staffing crisis deepening, it is becoming all too difficult to find the time to build the trust and respect that every patient needs and deserves. That is the human cost of more than a decade of decline caused by under-resourcing and under-investment in our NHS and by the lack of a proper NHS workforce plan for the future.

The impact on entire families is crushing. Time out of school affects a child’s ability to learn and their later life choices and chances. Parents have to take time off work and sometimes leave their jobs as a result, and siblings are deeply affected. It should be a badge of shame for the Government that three quarters of children were not seen within four weeks of being referred to children’s mental health services.

Down Syndrome Bill

Edward Timpson Excerpts

3rd reading
Friday 4th February 2022 Commons Chamber

[Edward Timpson (Eddisbury) (Con)]

It is a real pleasure to follow my right hon. Friend the Member for North Somerset (Dr Fox), who, in a more modest way than I normally remember, has established an important part of what has made this Bill possible: his energy, enthusiasm and drive to get it to this stage in this shape and at such speed.

Many of us in this House will have different personal and professional reasons for supporting this Bill. For me, I must go all the way back to the early 1980s: believe it or not, I was alive and about seven or eight years of age. My parents had started fostering a few years before, and ended up doing so for about 30 years. During that period from the early ’80s to the mid-’80s, we as a family looked after Down syndrome babies, who came to live with us for weeks and sometimes months. We also offered respite care once a month for a long weekend for a Down syndrome boy in his early teens, to give his parents a much-needed break from an incessant and stressful time. Despite the love they had for their son, they needed a pressure valve in order to maintain their ability to look after him and keep their energy levels up.

We were as happy as could be to provide that respite care. I recall it vividly, because it captured some of the most enjoyable images of our time in fostering. I recall many occasions with that young teenager, who had a couple of obsessions that infiltrated our household. The first was with the recording artist Shakin’ Stevens, who I am sure is also a favourite of all those present. That young boy was a fanatic follower of Shakin’ Stevens, and whenever he came to join us for a weekend, the first thing he would do was to put on our Shakin’ Stevens tape, and we would all dance together in the kitchen with real abandon. I remember it as an extremely happy time.

That teenager was also fixated on the wrestling on “World of Sport” with Dickie Davies on a Saturday morning. He used to sit very close to the screen, because he did not have great eyesight, but he was transfixed by the bouts that were shown. Often, an hour or so would go by and he would not have moved.

There was one scarier moment when we took him to a local swimming pool, where he was very keen to put on a mask and snorkel, go underwater and have a go at swimming. Unfortunately, it became apparent very quickly that he could not swim, so someone who was on duty had to jump in, fully clothed, and rescue him. However, the fact that he wanted to do those things and that he was given the opportunity was important, because, as my right hon. Friend said, we must ensure that the rights people with Down syndrome have are the same as for everybody else. That includes all those opportunities that we come across in our lives.

That experience has led me to want to speak to the Bill—unfortunately, I was not on the Committee—as I am extremely supportive of what it seeks to achieve. There is clearly a lot of crossover between the reforms to the special educational needs and disabilities system, which I brought forward as children’s Minister, and this private Member’s Bill. As a learning disability, the estimated 47,000 people who have Down syndrome will potentially benefit from that system.

The diagnosis will come extremely early in people’s lives, so there is no reason why an education, health and care plan cannot be put in place as early as possible. A focus on outcomes, whether educational, social or employment-related, can be built into those plans, which can go up to the age of 25. As we know, the life expectancy of those with Down syndrome has increased dramatically from the days when we were looking after Down syndrome children, so there is every reason to ensure that those outcomes are brought to fruition.

In publishing the guidance that the Bill brings in, there is an opportunity to ensure that the reforms to the special educational needs and disabilities system, particularly to the code of practice and the local offer that must be published in every local area to explain the services available for those with special educational needs and how to access them, marry up with what is already out there. That will ensure that there is a clear pathway for parents and carers to know what is available and how they can access it.

The level of support that those with Down syndrome need throughout their lives will vary considerably. It is important to remember that they are people with different individual needs, although there are certain services that they are more likely to need than others, such as speech and language therapy, physiotherapy or optician or hearing specialists. Therefore, the Bill is an opportunity to pull together the different routes to accessing key services.

It is vital, however, that those children, young people and adults with Down syndrome have a sense of agency and that they feel that those things are being done not to them but with them, so that they have a stake in their future. For example, with the increased life expectancy of those with Down syndrome and some outliving their parents, they are having to be cared for by other means. There are recent instances of people ending up in an elderly care setting that is not necessarily as appropriate for them as it could be, which may have stymied the possibility of them reaching out to a more individual lifestyle and having support in the community.

The Bill presents an opportunity to ensure that the guidance reflects the fact that those with Down syndrome need to be very much part of what they need for their future, so that the services that are built around them reflect that and ensure that the outcomes that they know they are capable of are reached. Although we have the Equality Act 2010 and the reasonable adjustments that go with it, they need more focus and definition through this Bill, for all the reasons that the Down’s Syndrome Association has illustrated so well in the case studies that it set out and that show the difference that will make.

I accept the point about other conditions, but doing all that will provide a blueprint for how each individual person, irrespective of their condition, can be provided with guidance, support and wraparound services. We need to use the Bill as a way to demonstrate our commitment not just to those with Down syndrome, but to all those living with a learning disability for whom we know we can do better by bringing together the services that already exist more effectively. With medicine and our understanding of conditions improving, we can ensure that the way that we build services reflects the needs of all those who require them.

I am hugely supportive of this Bill, for the personal and professional reasons I set out, and I very much hope and expect it will make a significant difference to many lives. It truly is the landmark that my right hon. Friend the Member for North Somerset suggests.

--- Later in debate ---

[Mr Mohindra]

Absolutely; my hon. Friend is on a roll with her interventions and I look forward to more of them.

When I was growing up—I am sure others will have had a similar experience—I always looked at the TV screen, the media or the newspapers and asked where the people of my ilk had got to and what they had achieved. It can only be a good thing for people to be able to see others who look or sound the same as them being world leaders or industry leaders or social activists—people who change others’ lives.

Locally to me, I want to give a shout out to DS Achieve and its teamwork across Hertfordshire. I did a bit of research—unfortunately for my right hon. Friend the Member for North Somerset I was unable to be involved in previous iterations of this Bill—and reading its website and understanding what it is doing is reassuring: it is about people achieving their potential and not being regarded as just having a disability. There is lots of work going on—my right hon. Friend commented earlier about the expected lifespan now associated with this condition, which is to be applauded—but we need to make sure that we consider not just living but quality of life. This Bill goes hand in glove with that aim, ensuring a safety net of local councils and communities so that additional support is in place if individuals feel they need it. Others have spoken about the fact that people’s needs are different: different individuals will need support at different times in their life, and not all the time, and being able to dip in and out knowing there is a named person they can go to as a one-stop shop for support is a smart idea, so I applaud my right hon. Friend for his foresight.

[Edward Timpson]

I am enjoying my hon. Friend’s speech and agree with his comments. Does he agree that in the past too often the default position for those with Down syndrome as they grew up was to envelop them in cotton wool and not give them a chance to grow and develop and demonstrate what they are capable of with the right support in place? The societal attitudinal change coupled with this Bill presents an opportunity for them to demonstrate, as we have seen on our TV screens and elsewhere in the media, that they can have a successful career and loving and meaningful relationships as long as we ensure, as we would for anybody else with a condition or difficulties in their lives, that they have the support and networks in place to be able to progress. In the past, those with Down syndrome have potentially been seen as simply to be managed, as my right hon. Friend the Member for North Somerset (Dr Fox) said in his opening speech.

--- Later in debate ---

[Siobhan Baillie]

Absolutely. That is so important. When I reel off this list, if I can get through it, Members will understand why it is so important.

I have seen my little sister battle for understanding about Down syndrome. I have seen her battle for the right to medical care for operations in a timely fashion. She has battled for education. She has battled for housing. She has battled to get landlords to take people with benefits. She has battled during the transition from Rhys being a child to an adult, and she is still doing that. She has battled to get the council to complete the required assessment. She has battled with the welfare system and disability living allowance appeals. She has battled with endless application forms and then had to re-do them because they have been lost by various authorities and had to start all over again. She has battled during covid. I know that a lot of families battled really fearing for their loved ones with Down syndrome, who are vulnerable, often with respiratory issues. Covid was thrown at all of us, but we found that parents were being ignored, or certainly felt they were being ignored, and not prioritised for vaccinations. The whole family was not being prioritised for vaccinations to protect the people with Down syndrome in their homes.

[Edward Timpson]

I think all of us are very moved by what my hon. Friend has had to say. Does she agree that her point about the battles she described demonstrates how important it is that, as the Government develop the guidance—I know my hon. Friend the Minister will very much have regard to this point—they involve the experiences, views, opinions and, I suspect, recommendations of those who have Down syndrome, or their parents, carers and supporters, so that they form the best possible guidance to deliver the right type of support at the right time and in the right way? That might then mean that those battles are much reduced and hopefully eradicated in future?

[Siobhan Baillie]

I thank my hon. Friend for his contribution not just in that intervention, but in his speech. I loved the Shakin’ Stevens stories. I defer to his expertise as a former children’s Minister. That is why the Bill will do so much good. Even the fact that we are having this long debate today with so many colleagues is incredibly moving. I am pleased to see that the Minister is as equally moved as me and that it is not just me with the tissues on these Benches.

These problems have existed under multiple Governments, so parties of all political colours should hang our heads but also want to see improvements. We all know, from our surgeries and inboxes, that parents of disabled children who have to come to see their MP are often completely exhausted. They are exhausted by the fights to get things for their children that they know they should already have or have seen other children have. They also know that they have no choice but to continue fighting. I know that MPs of all political colours try to help, but we have to get better at getting the legislation and the policy right so they do not get to that stage.

The Government are trying really hard to make improvements to legislation and to the system and the practicalities for people with disabilities. The Minister with responsibility for disability, the Minister of State, Department for Work and Pensions, my hon. Friend the Member for Norwich North (Chloe Smith), is absolutely excellent and I have real confidence in her ability and commitment to secure change.

As part of my small role in trying to push through those changes, I sit on the Work and Pensions Committee, and we have been doing an inquiry into things such as personal independence payments. During the inquiry, we heard from an excellent representative from the Down’s Syndrome Association. She gave a few examples of things we can change that directly impact people with Down syndrome. She explained that it is usually the parents making welfare and disability applications.

We have heard today from a number of hon. Members that, thankfully, those with Down syndrome are living much longer. Their life expectancy is no longer 30 years, but 60 years. That means that their parents are also significantly older, and we must bear that in mind. The constant drive for digital-only application is welcome in many respects and will mean there is a record, so hopefully we will not have the constant losing of paperwork that many families have to deal with. However, there are many elderly families and elderly parents who cannot cope with that, and we must build that into our systems.

Separately, there is a new in-person assessment approach to PIP, which can throw up some interesting results—unintended, in some cases. Where previously a family could sit down and do a written submission about what they needed and what they wanted changed in their PIP, doing an in-person assessment is very reliant on the person with Down syndrome.

My nephew Rhys’s favourite word is yes, because he gets a positive response to it. If someone says to him, “Do you play for Reading Royals?”, he will say yes. “Do you run for a bus?” He will say yes. One thing that my sister said made her nearly jump up and down was something like, “Do you have your own life partner or girlfriend?” He was saying, “Oh yes, oh yes.” She said, “No, no, no! He absolutely doesn’t.” We must bear that in mind when we create those policies and programmes, because it will not always work for everybody.

I welcome all the focus on and learning about people with Down syndrome today. I am still learning—I think we all still need to learn from people with Down syndrome and listen to them.

--- Later in debate ---

[Jo Gideon]

My hon. Friend is absolutely right. All the statutory authorities need to understand that the statutory duty in this Bill will require them to provide guidance and a level playing field for people with Down syndrome.

[Edward Timpson]

As a fellow member of the Health and Care Bill Committee that looked at the new integrated care systems that are being introduced, my hon. Friend will know that they have been delayed slightly until April this year. Does not that present an opportunity for the Minister to write to all the chairmen and chief executives of the interim boards, or those who have been appointed to the new interim care boards about the Bill; and, hopefully, for them to act in due course so that they are prepared for the guidance that is coming and can inform the wider board about that at the earliest opportunity?

[Jo Gideon]

I thank my hon. Friend. It is absolutely right that the integrated care boards and the Health and Care Bill need to accommodate what is suggested in this private Member’s Bill. The integrated care boards, as I have said, will have a huge breadth of responsibility. Unless we are quite specific on certain duties, they may get lost and that cannot be allowed to happen.

Covid-19 Update

Edward Timpson Excerpts

Monday 15th November 2021 Commons Chamber

[Sajid Javid]

I am fully aware of the pressure on the ambulance service, A&E departments and the other emergency work done in our fantastic hospitals. It will not surprise the hon. Gentleman that my Department and the NHS discuss this on a very regular basis and take action wherever needed. He will know there is a lot of pressure on hospitals and ambulance trusts, but the funding support and other measures we have taken are undoubtedly helping.

[Edward Timpson (Eddisbury) (Con)]

I also welcome today’s statement, which is another important step forward. I will be booking my booster as soon as I can.

It is encouraging news that we have now vaccinated more than 1 million 12 to 15-year-olds against covid-19. As those figures continue to rise, will my right hon. Friend speak to his ministerial colleagues in the Department for Education to review the current regime of asymptomatic testing in our schools, which is extremely burdensome, expensive and intrusive, to make sure it does not last longer than needed?

[Sajid Javid]

My hon. Friend will not be surprised to hear that we work very closely with our colleagues in the Department for Education, especially with regard to that particular age group. The issue on asymptomatic testing is something we keep under review and, as soon as we can remove that, we will.

Hospital Building Programme

Edward Timpson Excerpts

Wednesday 3rd November 2021 Westminster Hall

[Dr Kieran Mullan (Crewe and Nantwich) (Con)]

I beg to move,

That this House has considered the hospital building programme.

It is a pleasure to serve under your chairmanship, Mr Sharma. I welcome the chance to discuss the Government’s £3.7 billion hospital building programme, and particularly welcome the opportunity to make the case to the Minister for my local hospital, Leighton, to be included as one of the final eight sites chosen by the Government.

Leighton Hospital was built in the 1970s, and officially opened by the Queen in 1972. I have looked back at the pictures of her visit, and it made me think about just how long Her Majesty has been serving our nation in this way—visiting, before I was even born, the hospital that serves my constituents today. At that time, Leighton Hospital represented a huge change in how healthcare was provided in the area, going on to pick up the role of several smaller hospitals spread across the patch. Its importance and role have only grown since then, serving a population that has increased significantly and now stands at more than 300,000 people.

Whether it is the hip and knee replacements it carries out, the babies it helps deliver, the thousands of cancer screening tests and treatments it undertakes, the cataracts it repairs, or the urgent GP and accident and emergency care it provides, Leighton is at the heart of our local health services. In an ordinary year, Leighton provides around a quarter of a million out-patient appointments, carries out more than 30,000 operations and more than 200,000 diagnostic imaging tests, and has more than 90,000 visits to its emergency department. Of course, none of that would be possible without its fantastic staff: Leighton employs more than 4,500 staff, and that fantastic team of cleaners, porters, cooks, receptionists, healthcare assistants, physiotherapists, occupational therapists, nurses, doctors, volunteers and many others is what turns a building into a hospital.

Those staff can be proud of their achievements in the battle against covid. Not only have they cared for covid patients, but they have also vaccinated 47,000 people under the leadership of their director of pharmacy, Karen Thomas. I had the absolute pleasure of volunteering alongside the staff during the first lockdown. I was quite uncomfortable with the media attention on me for doing this for only a short period of time, when those staff do it day in, day out without any fuss or attention.

As I have seen again and again during my time working in the NHS, its staff have an enormous amount of dedication, often going above and beyond, and are perhaps too accustomed to working in departments and environments that make doing a really good job more difficult than it should be. That is why, although we are talking about buildings today, it is important to highlight that—as others have said—we will only be able to make the most of new facilities if we are able to carry on with the success we have had so far in recruiting more staff.

[Edward Timpson (Eddisbury) (Con)]

My hon. Friend is making a strong case for Leighton, and he will know that, as a former Member for his constituency, I was able to work with that hospital very closely. All four of my children were born at Leighton Hospital, which sits in my constituency, and I also spent a week working in that hospital and cannot praise its staff highly enough. I hope that this building programme will give those staff the environment they deserve in order to provide the healthcare we know they can deliver, which is world class.

[Dr Mullan]

My hon. Friend is absolutely right, and what he has said is typical of people who live in the area, who have also experienced their children being born at that hospital and receiving excellent care there.

--- Later in debate ---

[Dr Mullan]

It is great to get cross-party support to demonstrate to the Minister how important it is to all our local communities. I thank the hon. Gentleman for his support.

As I was saying, the building was not designed to last this long or to serve the size of population that it serves. My view is clear that we can be more efficient and do more in the community, but an aging population will have an ever-increasing demand for healthcare. We can delay the need for the most specialist hospital care in a population, but we can almost never remove it and stop the demand increasing overall.

How has Leighton managed this challenge over recent years? Rightly, it has benefited from major investment, as mentioned by my hon. Friend the Member for Eddisbury (Edward Timpson) who is working closely with me on this campaign alongside my hon. Friend the Member for Congleton (Fiona Bruce). I remember his excellent work in helping to secure funding for brand new theatres and a brand new ITU.

My first campaign after becoming the candidate for Crewe and Nantwich was to reverse the decision to turn down a request for an emergency department extension, which was ultimately funded in 2019. More recently, Leighton received £15 million to build a brand-new emergency department. As the Government understand the necessity, Leighton has had funding to tackle the parts of the original building that are simply not fit for use in the short term. However, there comes a point where the costs of one-off investments, accumulated maintenance and the need to replace the original building structures become a cost that cannot be borne by the ordinary capital spending, and when a whole new building becomes the best option financially and for patient care. That is where Leighton is at.

The life span of the original building is coming to an end. I suggest to the Department of Health and Social Care and the Treasury that they view the funding committed to the hospital building programme as a unique opportunity to look at estates that are winding down towards the end of their life span and address that now.

Under the leadership of the chief executive officer, James Sumner, Leighton has done an enormous amount of work for many months to develop its plans for a new hospital. The team sought expert advice on the life span of the current estate and, importantly, the cost of maintaining it and to keep the existing original buildings in use. I know the Minister will scrutinise the figures and see for himself the financial sense in the case that has been made. Independent analysis demonstrates that the ongoing refurbishment of the present failing infrastructure over the next 15 years will cost substantially more than projected new build costs.

Importantly, the plans are ambitious in ensuring better healthcare is delivered in a better environment for patients and staff. As well as providing the mentioned much-needed bed capacity to meet the projected demand later in the decade, the new facilities will deliver single rooms to improve privacy, dignity and infection control. The new layout will incorporate the latest design advice for supporting patients with conditions such as dementia.

The site as a whole will be reorganised some of the long journeys from key locations, such as the emergency department, to other parts of the hospital that have grown as a result of sporadic development to date. They will future proof the hospital with the most up-to-date digital infrastructure which is becoming increasingly important for delivering the best possible care and doing so efficiently. A new site will enable Leighton to play its part in the race to net zero with more energy efficient buildings and solar power and even, potentially, a geothermal heat source, which is a technology I am campaigning for the Government to support to get off the ground across the country.

The team at Leighton have a track record of delivering improved and innovative care to back up their pledges. For example, the trust recently received an award for its same-day emergency care programme, led by surgeons David Corless and Ali Kazem. I am sure that, with improved facilities, they will continue to find new and better ways to care for their patients.

[Edward Timpson]

My hon. Friend has been extremely generous with his time. Will he also confirm that this project, if delivered, would save more than £400 million in backlog maintenance, as well as helping to free up a lot of the community care, which at the moment is under extreme pressure because of the lack of beds available at Leighton and in the surrounding area?

[Dr Mullan]

My hon. Friend makes an excellent point. This is actually about saving money in the long term given the unavoidable costs at the existing site.

Of course, building the hospital will provide jobs and opportunities for local people, with apprentices at South Cheshire College and others well placed to take advantage in the parts of Crewe where employment and salaries are still not where we would want them to be. I know that the plans have the full support of my hon. Friends for Congleton and for Eddisbury. Leighton’s bid is also supported by both Cheshire West and Cheshire East, as our local authorities, and the Cheshire clinical commissioning group. There is also cross-party support with the hon. Member for Weaver Vale (Mike Amesbury).

The chair of our newly formed Crewe Town Board, Doug Kinsman, has been keen that the whole board support the proposal, and the rest of the board have seen how important Leighton is to Crewe, both economically and in improving the health and wellbeing of Crewe residents. Importantly, we have the support of those residents. So far, more than 1,000 people have signed our petition supporting the hospital in its efforts to make it into the final eight. The residents include Betty Church, whose daughter was born in the hospital the year it opened, 1972, and Steve Burnham, who explained that not only were three members of his family born there, but his mum worked there for 40 years.

I asked residents to tell me about their experiences and share why they were supporting the campaign. Janice Butler wrote:

“My husband, elderly mother-in-law and father-in-law have all received fantastic help and treatment here. The hospital serves a huge population now and help to improve and upgrade its facilities is desperately needed and has been for many years. Despite the huge pressures, we have experienced excellent help here.”

Susan Marsh wrote:

“I started work at Leighton in 1972 and worked there for 35 years. Since retiring I have been a patient there numerous times. It has changed in the care it delivers since my day, both numbers and treatments. With a new build it will be able to continue to grow along with the population in the area, which will be badly needed.”

I will finish with what a current staff member said about Leighton, both as somewhere to work and as somewhere their family received treatment. Sophie Morris has shared her perspective from what must have been a difficult time in her life, which makes her words even more powerful. She wrote:

“I have worked at Leighton A&E for 6 years now and over that time the demand on the hospital has increased massively. Our last few summers have been busier than most winters. Shortly after starting as a nurse in A&E, my husband became ill. We found out he had terminal throat cancer when I was 7 months pregnant. From beginning to end we had fantastic support and care from all over the hospital.

I think it says a lot about the place and the fabric that is the staff who work there, that I could carry on working in a place that holds so many raw memories. As a body of staff we work so hard to look after the people who come to us for help, now we need some help so that we can provide the care that is demanded of us. Now we need some help so that we can provide the care that is demanded of us.”

I could not have put it better myself.

I know that the Minister will hear the case for investment in many other sites. He will need to consider all the applications carefully. I will work with residents to campaign for this much-needed investment, whatever the outcome of this opportunity, but I hope that I have left him in no doubt today that the case for Leighton to be included is a strong one and there is a whole community of people who want to see it succeed.

Health and Care Bill (Seventeenth sitting)

Edward Timpson Excerpts

Committee stage
Tuesday 26th October 2021 Public Bill Committees

[Edward Argar]

We tabled the amendments following the publication of recommendations by the Health and Social Care Committee on the Bill. The Committee recommended that the Care Quality Commission be given a role in assessing integrated care systems—the umbrella term, of course, for integrated care boards, local authorities and their system partners working collectively. We agree entirely; indeed, I thank the Committee for championing that agenda. The intention is for those reviews to provide the public and the system with independent assurance of how their ICS area is performing, and in particular the effectiveness of joined-up working and integration. Those reviews will be a valuable way to improve the services provided and encourage the effective joint working that the Bill enables.

[Edward Timpson (Eddisbury) (Con)]

I welcome the involvement of the CQC in reviewing the work and impact of the new integrated care systems, but other parts of public service provision, particularly children’s services, are regulated by other bodies—Ofsted, in the case of children’s social care. Can the Minister reassure me, either now or at a later stage, that those bodies will be involved in the initial discussions about what the reviews will look like, and how Ofsted may be able to provide input to ensure that the review encompasses all aspects of regulation and inspection that will touch on the ICSs.

[Edward Argar]

I am grateful to my hon. Friend for his comments. He is right that we must not at any point forget the interest of children and families in the context of the services being provided. I hope that I can give him the reassurance that he seeks. I certainly envisage that, as we draw up the system, and as what we are proposing becomes designed and operationalised, the process would encompass close co-operation with Ofsted and other relevant bodies to ensure that it does the job that it is intended to, and that no one falls through the cracks—for want of a better way of putting it—in that regime.

Our approach builds on the existing role of the CQC as the independent regulator of health and adult social care in England. Under the Health and Social Care Act 2008, it already reviews individual providers of health and social care. This Bill expands its role, as under clause 121 it will also have a duty to review and assess the performance of local authorities in delivering their adult social care functions under part 1 of the Care Act 2014.

--- Later in debate ---

[Alex Norris]

It is a pleasure to speak to this important clause, which sets out restrictions on advertising less healthy food and drink. I echo what the hon. Member for Central Ayrshire said about its importance and the general commitment to it across the House. Importantly, it also gives me an opportunity to put on the record a message of thanks to the hon. Member for Bury St Edmunds (Jo Churchill) for all the work she did in this area while a Health Minister. She has moved to a new post during the Bill’s consideration, but she championed this provision for a long time and fought very hard for it, so I have no doubt that she will be glad to see it included in the Bill.

These measures form part of the Government’s obesity strategy, which is coming through the system bit by bit. The strategy has largely come through in secondary measures, so I welcome the fact that this provision has been included in the Bill, because it gives us an opportunity to propose improving amendments. Is the Minister able to explain why other provisions in the strategy have not been brought forward in this way? For example, we have considered a statutory instrument on showing calories on menus, which I dare say all Members will have received something about in their mailbags, because it is a contentious and emotive topic, with many shades of grey. That provision would have been improved if we had had a chance to amend it, so I am sad that we instead got a “take it or leave it” measure. I do wonder why the entire obesity strategy was not put through in this way.

Turning to what is before us, ensuring that we do not see the aggressive promotion of products high in fat, sugar and salt, particularly to our nation’s children, is an important step in reducing the obesogenic environment we live in. We know that one in three of our children leave primary school overweight and one in five are obese, and we know the lifelong impact that that has on physical and mental health, such as the links to diabetes, musculoskeletal ailments and depression. We also know the impact on children’s education, as they go to secondary school and beyond, and on their prospects in the world of work.

It is a well-established and long-standing precedent in this country that we try to protect children from exposure via the television by using a watershed, so it makes sense to consider these products within that scope. Of course, the nature of the content we all consume—children are no exception—has changed beyond all recognition in my lifetime. The explosion of the internet and its pre-eminence in our lives has provided new advertising space for traditional means—banner ads, pop-up ads and similar—but there is also a much broader platform. Today is probably not the day, certainly not in the witching hour of this Committee, to get into the influence of culture and how the entertainment landscape is changing—not least because I feel woefully underqualified to talk about it—but the point is that there are extraordinarily novel ways of connecting with people, especially young people. It is therefore right that we in Parliament enter this space to try to create the safest possible environment.

I will say, alongside this, that I am surprised that we have not yet seen the online harms legislation—it seems to have been coming through the system for a very long time indeed—because it would sit very neatly with this. I hope there will be a sense of trying to weave this in with that in due course.

The Government’s answer here goes beyond a watershed and into full prohibition. I hope that the Minister will take us through how that decision was reached. I understand from my conversations with industry, particularly those working in digital media, that they have offered a solution that would act as a de facto ban for children without being an outright ban. Given that we genuinely lay claim to being world leading in advertising in general, and in digital media in particular, we ought to listen if there are more elegant ways of doing that. I hope the Minister can cover the conversations being had with the sector and why this approach was chosen, not a slightly more nuanced one. Perhaps it was considered too complicated, but we need to know that.

As the hon. Member for Central Ayrshire says, clause 125 inserts schedule 16 into the Bill. As that is where the meat is, I want to probe the Minister on a couple of points. First, on the fines regime, what are the sanctions in the Government’s mind? Secondly, the schedule provides for regulations to follow. I suspect we will see a full regime, but when are we likely to see it? How far along are we, and what sort of consultation will there be? Thirdly—again, this will be a matter for regulations, but I hope the Minister might be drawn on it now as a concept—who does the burden fall on? Is it the advertiser or the platform? It might be both, and obviously it could not be neither. That will be a very important point going forwards.

Adding to the case the hon. Member made about small and medium-sized enterprises, we supported that conceptually in the statutory instrument on calories on menus because there was agreement that it was reasonable to say that these things would be a significant burden for a small operator, which might have only one or two members of staff. I do not think that applies in the advertising space. Again, we would be keen to understand how the Minister and his colleagues reached the conclusion they did.

Amendments 139 and 141 deal with alcohol. One of the few parts of the obesity strategy where we have departed from the Government’s view is the curious decision to remove alcohol, particularly with regard to calories and labels. We all know that alcohol is a less healthy product—I may well be the billboard for that, certainly when it comes to weight—so why has it been left out? Our amendments are more probing than an attempt to actually change the Bill, because I hope that alcohol has already been covered. However, in the obesity strategy in general, it seems to have disappeared, which seems very odd. I hope that the Minister can explain his thinking on that.

New clause 55 seeks to protect the nutrient profiling model. According to gov.uk, the NPM

“was developed by the Food Standards Agency in 2004-2005 as a tool to help Ofcom differentiate foods and improve the balance of television advertising to children. Ofcom introduced controls which restricted the advertising of HFSS foods in order to encourage the promotion of healthier alternatives.”

So far, so good. We would say that that principle is sound today and will be sound going forward; that is why we are keen to see it in the Bill. It is crucial that we continue to uphold those standards, but we know that foods change. We know that our understanding of what different nutrients mean for us or our children changes over time. We know that the biggest prize in this space is about reformulation, as much as it is about anything else, which would put more stresses on the NPM. I am keen to hear a full commitment from the Minister today that before meaningful changes are made to the NPM, they will be put out to proper consultation and that industry and consumer groups will be properly engaged, along with anyone else who may have an interest.

I will finish with amendment 113, in the name of the hon. Member for Central Ayrshire. I have made the arguments around engagement through consent, mutual good faith and co-operation from Ministers multiple times, and I hope to hear that in closing.

Clause 125 is very important, and we would like to know a bit more about schedule 16. I would be keen to hear that the issues raised in our amendments are covered elsewhere or at least to have a commitment to that. Finally, I would like to hear a bit about the nutrient profiling model.

[Edward Timpson]

Briefly, on clause 125 and schedule 16 in particular, I want to pick up where the hon. Member for Nottingham North left us, on the issue of obesity. I think we all share concerns that a rising number of children continue to leave primary school either overweight or obese. Much of the answer to tackling that lies in making physical education and sport part of the core curriculum in schools, but we need to look at all measures, including on what children look at and are exposed to in the changing and more digital age in which we live. I welcome measures to tackle that head on, particularly in primary legislation, although I recognise that regulation will flow from that.

--- Later in debate ---

[Alex Norris]

The Minister and I have had these Brexit-type statutory instruments time and time again, so I am not going to get too involved in the conversations that we have had. As we said in the discussion on clause 146, we would like to see greater safeguards. We are glad about the use of the affirmative procedure but we do not think that there is a strong mandate for Ministers to march across the statute book. I hope to hear that this power will be used to the minimum extent necessary to implement the decisions that we have taken.

[Edward Timpson]

I want to put on record my support for the clause and for the opportunity that it presents for our domestic market and the promotion of locally grown produce, the high standards of animal welfare across the UK and our eco credentials. We do not want to make labelling too complicated for people––we want to make it accessible and simple to decipher––but this power is a chance to put that to the forefront so that consumers get produce that is good for them but also good for the UK market.

[Edward Argar]

I just want to give the shadow Minister the assurance he seeks that I believe that the powers under this clause would be used sparingly and proportionately.

Question put and agreed to.

Clause 127 accordingly ordered to stand part of the Bill.

Clause 128

Fluoridation of water supplies

Health Incentives Scheme

Edward Timpson Excerpts

Friday 22nd October 2021 Commons Chamber

[Maggie Throup]

My hon. Friend is exactly right. This is not stigmatising anybody. It is not about weight loss; it is about healthy choices and empowering individuals.

[Edward Timpson (Eddisbury) (Con)]

In welcoming today’s announcement, may I concur with my right hon. Friend the Chairman of the Health and Social Care Committee about the importance of ensuring that we start as early as possible in tackling obesity? In doing so, may I encourage the Minister to continue to support, through her Department, the funding of the primary PE and sport premium, which is worth around £320 million a year, as well to consider the core recommendation of a report by the Association for Physical Education, for which I chaired a taskforce, which looked at how we can ensure that PE is at the heart of school life and that every child leaves primary school able to swim and has PE as a habit for life, so that we tackle this as early as possible?

[Maggie Throup]

I thank my hon. Friend for his question and his work on the taskforce. This is something I believe in and have been working on across my Department and the Department for Education, too.

Health and Care Bill (Fourteenth sitting)

Edward Timpson Excerpts

Committee stage
Tuesday 19th October 2021 Public Bill Committees

[Edward Argar]

During our debate on amendments 101 and 122, we discussed a number of the key themes that run through clause 95. This clause sets out that, as an independent body, HSSIB will be able to decide its own priorities and determine which qualifying incidents it investigates. We would expect this to be the result of referrals it receives, but also its own intelligence. The clause also gives the Secretary of State powers to direct HSSIB to carry out an investigation when, for example, there has been an incident that has caused a particular concern, and it allows the Secretary of State to request a report to be produced by a specified date.

I appreciate that, as we have heard today, some could argue that the clause could be perceived to encroach on the independence of HSSIB. I hope I set out in my earlier remarks why I do not take that view, and why I believe it is right that the Secretary of State, who has responsibility for the health of the nation, has such a power and is able to respond to emerging, ongoing safety priorities or issues of concern. I believe that this measure strikes the right balance, providing the Secretary of State with that flexibility while ensuring effective and proportionate accountability. HSSIB is not bound to follow the instruction, but it is bound to explain why it deems it unnecessary, or why it has determined it should not pursue a particular investigation request.

[Edward Timpson (Eddisbury) (Con)]

As a point of clarification, I notice that clause 95(2) gives the Secretary of State the power to direct both an individual investigation and

“qualifying incidents that have occurred and are of a particular description”,

but I wonder whether HSSIB, off its own bat and as part of its independent investigation, is able—as we were when I chaired the national Child Safeguarding Practice Review Panel—to look at a number of incidents in which there is a theme that it would want to investigate. For example, we looked at a number of cases of co-sleeping with babies, which gave us an opportunity to look at that issue in the round, rather than individual cases. Is that something that HSSIB will also be able to do?

[Edward Argar]

I am very grateful to my hon. Friend for making that point, and I put on record my gratitude—our gratitude—to him for his work, which he alluded to. He is right: one of the key things we would hope HSSIB would seek to do, where it was supported by the evidence, is to join the dots where there is a systemic issue—not just in an individual trust, for example, but an underlying issue for the Department or the NHS as a whole—and be able to reflect that in its decisions on what to work on and how to broaden the scope if it deemed that to be necessary.

Clause 95 provides that whenever HSSIB decides to undertake an investigation, it is required to make a public announcement, setting out briefly what it will be investigating and what it expects to consider during the investigation. I take the point made by the hon. Member for Central Ayrshire: that announcement should give the public an indication of the fact that something is being looked at, but it should not limit which leads—for want of a better way of putting it—HSSIB decides are worthy of investigation and of following. HSSIB will also be able to get in contact in advance with anyone who it thinks may be affected by the investigation. This may, for example, include patients, families or any individual who has referred the incidents to HSSIB, a trust or other healthcare provider.

Finally, there may be occasions when HSSIB decides not to investigate an issue or to discontinue with an investigation. Clause 95 covers those scenarios. If HSSIB decides to discontinue the investigation of an issue, we have set out that it should make a public statement explaining the reasons for doing so. If HSSIB decides not to investigate a qualifying incident, it will be able to give notice of the decision to those who it considers might be affected by it and to explain the reasons to those who have an interest in it.

I hope colleagues on the Committee will agree that the provisions are necessary for HSSIB to be in control of the qualifying incidents and to investigate and to ensure transparency about what investigations are being carried out or discontinued by the agency. We expect that the Secretary of State’s power of direction will be exercised extremely sparingly but it can ensure that crucial patient safety issues can always be focused on where appropriate. I therefore commend the clause to the Committee.