NICE Appraisals: Rare Diseases Treatments

Emma Lewell-Buck Excerpts

Thursday 21st March 2019 Commons Chamber

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I would like to thank my hon. Friends and neighbours from the glorious north-east, the Members for Blaydon (Liz Twist) and for North Tyneside (Mary Glindon), for securing a debate on this important topic, and the Backbench Business Committee for granting it.

I want to focus my comments on phenylketonuria, which is classed as a rare disorder and has stark impacts for sufferers. If left untreated, PKU can result in brain and nerve damage, behavioural difficulties, vomiting, tremors and epilepsy, yet some of the impacts can be mitigated to a degree, if only the NHS would allow the drug Kuvan to be readily available.

PKU sufferers cannot metabolise protein and, as such, are kept on a strict diet and take a large number of supplements to ensure that they do not become deficient in anything that we would normally get from the foods they are unable to eat. Many sufferers also need to take an unbelievable number of tablets each day—tablets that are large and difficult to swallow. My constituent Harvey Parker has PKU. He is 15 years old and takes a staggering 65 of these tablets every single day. Although it is a distant memory for some of us, I am sure we all remember how difficult it is being a teenager, with that want to fit in and not stand out. Harvey told me that Kuvan would help him lead a more “normal” life.

Eating out and sharing food with others is an important part of socialising and something that most of us do without thinking, but many places do not cater for Harvey’s needs, and he ends up feeling “embarrassed”, “isolated”, “angry” and a “burden”. He said that when he has been out with his mates on a weekend, he tells his mam and dad that he has not eaten because he was not hungry, when really it was because he could not find anything that he could eat. Harvey told me:

“I don’t really talk to any of my friends about PKU as I get embarrassed and when I’m with my friends with no tablets to take, blood tests to endure or bland, unpalatable foods then I am just Harvey, one of the lads and not that boy with the rare invisible condition that no one has ever heard of.”

It is clear to see how access to Kuvan and the more relaxed diet that would follow could improve Harvey’s life. It has improved the lives of others who have taken it, so why is it being denied to so many sufferers?

Kuvan is used by more than 2,000 patients worldwide and is commonly used in 23 other European countries, but not England. Some sufferers have had access to the drug on the NHS after costly and lengthy court battles, but most are not that lucky. At an estimated annual cost of up to £50,000, the drug remains out of reach for so many sufferers. An adult with PKU’s protein-restricted diet costs the NHS £12,000 per year. Many sufferers get prescriptions for their food, which has a high price tag: a packet of pasta is £7.20, and a loaf of bread is £7.48. Our NHS was created on the principle that good-quality healthcare and medication should be accessible to all and free at the point of need, regardless of income, but time and again under this Government we are seeing the destruction of our NHS by stealth, with creeping privatisation and a rolling back of that principle.

Constant wrangling led to a situation where, four years ago, NHS guidance said that there was not enough evidence to prescribe Kuvan, and it then referred the issue to NICE to see whether Kuvan could be made readily available on the NHS. As we have heard, NICE has two methods of appraising medicine: the highly specialised technology appraisal for rare diseases, and the single technology appraisal route for common diseases. NICE decided to assess Kuvan using the same route as for common diseases, despite the fact that only one in 10,000 people has this illness—hardly “common”. Thanks to campaigning by the National Society for Phenylketonuria, NICE then suspended the appraisal and decided to reconsider, but the new process has yet to be started. However, as other Members have already noted, the HST route is not ideal for rare diseases, and a whole new different approach is needed.

The NHS also decided to prescribe Kuvan, then changed its mind due to costs. In short, it decided that it was too expensive. That is what happens when privatisation and outsourcing are prioritised over patients’ care and wellbeing. Harvey’s mam, Diane, said to me, “How can you put a price on my son’s health?” I sincerely hope the Minister will let Diane and Harvey know.

Appropriate ME Treatment

Emma Lewell-Buck Excerpts

Thursday 24th January 2019 Commons Chamber

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I thank all the hon. Members who secured this debate. In preparing to speak, I have become more and more angry about the injustice and pain heaped on those who suffer from ME. They live in a country where their illness is at best belittled and at worst ignored. Their illness is sneered at thanks to the development, in the medical field and in the press, of a culture of believing that it is just people being lazy or women being hysterical.

The effects of the condition can be totally debilitating. Any other illness with such life-limiting effects would not have psychological and behavioural treatments as the go-to options. This is not a psychosomatic or psychosocial issue, and a better response is needed. Graded exercise therapy must be suspended and CBT therapy should be an option, add-on or complement to other treatments, not the treatment.

There is a growing consensus about the use of pacing for managing ME. Sadly, current NICE guidelines state that there is insufficient research evidence about the benefits or harm of pacing. That is why more funding for research is vital. We need a commitment from the Minister to increase the sparse funding for ME research, which at present stands at a paltry £1 for every sufferer.

The now widely discredited PACE trial had far-reaching implications. Not only did it add to the existing myths around ME, but it led to alterations in the application of benefits and eligibility for social care.

For someone who knows how unwell they are, there must be nothing worse than being told that it is all in their head and being sneered at by the very professions and organisations that should be supporting them. The constant quest to be believed and the desperation of just wanting some answers was summed up powerfully by my constituent, Barbara Kell. She described the endless rolling of eyes by some GPs and the frustration of others who wanted to help her but knew they would be hauled up in front of the General Medical Council if they did. Barbara told me that she is living “half a life”, and that she grieves for her past. She said she is missing out on so much, including time with her grandchildren—I can testify to the House that they are gorgeous little girls. Like thousands of others, Barbara wants and deserves to live in a country where the Government properly fund research; where treatment helps and does not hinder; where support from the state does not come at the cost of dignity; and where people actually listen to her. Right now, that is not the case.

Barbara told me that every time she went for blood tests, which were of course the wrong ones, and the results came back, she was actually hoping it was something like cancer, just so that she could put a name to the intense pain that she was feeling, get the right treatment, and know whether she was going to live or die. For the sake of my constituent Barbara and the 250,000 others affected, I hope that the Minister is really listening to what is being said today and is ready to give some justice and comfort to those who have been ignored for decades.

Oral Answers to Questions

Emma Lewell-Buck Excerpts

Tuesday 27th November 2018 Commons Chamber

[Mr Speaker]

I do slightly worry about the staying power of some colleagues. I will not say who, because it would be unkind, but there was a Member I was about to call who has beetled out of the Chamber. People have got to be a bit patient.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

South Tyneside District Hospital recently surpassed targets for waiting times, yet this Government’s forced cuts under the guise of sustainability and transformation plans have left my constituents fundraising to fight the downgrading of key services in court next month. Why is the Secretary of State presiding over this destruction by stealth of our high-performing hospital and the NHS?

[Matt Hancock]

Of course, the STP proposals have to be clinically led and consulted on and discussed with local people. It is right that the allocation of services and exactly how they are configured locally is led locally, so that we can get the best services to people in Tyneside and across the country.

South Tyneside Hospital

Emma Lewell-Buck Excerpts

Thursday 14th December 2017 Commons Chamber

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I am grateful for having been granted this timely and important Adjournment debate.

I know that this Government, despite all their warm words and platitudes, do not really care for our NHS. The very principle and essence of it simply does not sit well with their ideologically driven privatisation agenda. We should judge this Government’s commitment to our NHS by their actions. The shambolic top-down reorganisation that began in 2012 has been followed by increasing competition, increased privatisation, and now the introduction of sustainability and transformation plans and accountable care organisations that are heralding the end of our NHS.

Here is how it works. The Government starve the NHS of the finances it needs and refuse to implement collaborative working structures inside and outside Parliament to come up with a long-term sustainable plan for properly financing our NHS. They then force local areas in England to come up with plans to make £22 billion of efficiency savings to compensate for the Government’s own neglectful incompetence. As local areas grapple with these cuts, services are inevitably transferred from one hospital to another. The receiving hospital cannot cope. It buckles under the strain, it closes, and private healthcare takes over.

In South Shields, the sustainability and transformation plans have been brought in under the guise of a path to excellence, and we have been placed in an arbitrarily created boundary footprint area of Northumberland-Tyne and Wear. By 2021, the health and social care system in that footprint area is projected to be £960 million short of the funds it needs to balance its books while maintaining the same levels of care for patients. Make no mistake: these plans are about cuts. They are nothing to do with transforming our NHS for the better. The NHS has been set an impossible task by the Government, and the endgame is to see it in private hands.

Over a year ago, the management teams of South Tyneside NHS Foundation Trust and City Hospitals Sunderland NHS Foundation Trust merged, and work began in earnest on formulating these Government-led plans by local clinical commissioning groups that look after all the health services in our area, as well as the hospital trusts. The plans are scrutinised by a joint scrutiny committee of South Tyneside Council and Sunderland City Council, and the clinical commissioning group is accountable to the respective local authorities’ health and wellbeing boards.

The plans are officially supposed to be targeted at improving health and care, but people in Shields and right across England are discovering that they are actually about the biggest-ever programme from any Government to shut down our NHS once and for all. Alongside supposedly improving health and care, the Health Secretary has endorsed plans for cuts of up to £5 billion in our NHS. This is the man who has written about how to achieve full privatisation of the NHS, and who got the Chancellor, in the last Budget, to give £2.6 billion to help to embed these sustainability and transformation plans—in other words, using Government and taxpayers’ money to close down local hospitals.

Despite many people denouncing me and other campaigners for scaremongering, I have remained firm in my view that from the day the two management teams merged, the plan was to downgrade South Tyneside Hospital and move all our services to Sunderland. But I take no pleasure in being right about this. When the first phase of the consultation was launched, we were advised that the clinical teams’ preferred option was to move stroke services to Sunderland. Not only does having a preferred option fly in the face of the Gunning principles, but all our suspicions were confirmed when in October last year, without any public consultation, our stroke unit was closed and moved to Sunderland, with the promise that the measure was temporary and a response to staffing challenges. There is currently no option on the table that would allow the unit to come back to South Tyneside.

In relation to maternity services, gynaecological services, and children and young people’s urgent and emergency paediatrics, all the options presented lead to a drastic reduction in provision of acute services, in particular, for South Tyneside. Yet in October our A&E, inclusive of paediatrics, was found to be the second best in the country, and South Tyneside is one of the very few hospitals that has achieved the four-hour waiting time target.

I have been consistent in rejecting this consultation. I refuse to accept that a consultation that is predicated on a massive cuts agenda, against a backdrop of additional cuts to social care and other services, will do anything at all to improve the health and care that people in South Tyneside receive; in fact, it will do quite the opposite. I am not alone in that view. The trust and the clinical commissioning group state that the proposals before us were formulated by, and are supported by, clinicians and staff at our hospital, but many of those clinicians and staff have contacted me and provided me with evidence to show that they have, in fact, been actively blocked out of the formulation of these proposals. How on earth can the public be expected to trust a consultation that raises such serious questions about transparency and due process and that has lacked integrity from the outset?

I have been trying to get my local authority to refer the whole shambolic consultation to the Secretary of State, so that the smokescreen can be lifted and matters conducted properly, with due process. So far, to my abject disappointment and that of my constituents, that has not happened. Constituents have also raised with me their concerns about the potential conflicts of interest. Our council leader is a paid non-executive director of the trust and chairs the health and wellbeing board. The chair of the CCG is the vice-chair of the health and wellbeing board and a practising local GP.

On 30 November, a press release was issued, advising that the special care baby unit was closing with immediate effect. The reason given for the closure was staffing issues. That closure, coincidently, sits neatly with all the proposed options put forward by the CCG and trust. The safety and wellbeing of babies and parents should, of course, always be a priority, but subsequent events indicate that this is yet another development in the managed decline of South Tyneside Hospital. On 3 December, after the local media had been advised, staff from the maternity unit were invited to a meeting to be told that from 8 am the following morning, the maternity unit would be closing as a result of staffing issues. That happened after the trust had discussed matters with regional groups—not local ones, and not staff.

We have now reached the stage at which no more babies are being born in South Tyneside, but the maternity unit has the full complement of staff present, as it did when it was fully and safely operational. The staff presented the trust with a workable rota system to keep the unit delivering, so there is no reason for the closure to continue. Right now, instead of delivering babies, these trained, professional and dedicated midwives are doing admin and transferring mams to neighbouring hospitals.

I have been advised that expectant mams are having to find, on average, £40 for each round-trip journey to another hospital in the region when they thought they were due to deliver. One woman was sent home after being told she was not in labour by a neighbouring hospital. Once home, and very much in labour, she ended up having a home birth because she simply could not afford another taxi, and ambulance waiting times were too long. The situation is dangerous and completely unsustainable for my constituents, and it takes away a woman’s right to choose where she gives birth.

From day one of this process, the trust and clinical commissioning group have given us one version of events, but the evidenced facts from the clinicians and other staff at the hospital tell a different story. The dedicated hard work and professionalism of clinicians and staff is being denigrated, their morale reduced as they work under the veiled threat that if they speak with me they will be risking their jobs.

There remains a multitude of unanswered questions—questions critical to the whole process that have been asked repeatedly. What capacity does Sunderland Royal Hospital have to take the extra patients from South Tyneside? What will happen to the staff at South Tyneside? What transport arrangements will be put in place, bearing in mind that car ownership in the area is among the lowest in the entire country? Does the North East Ambulance Service have the capacity for the increased emergency demand that will be created by the options?

What are the proposals for the next phases of the consultation? This is only the first phase of a consultation that has another two phases to go. We cannot continue with a situation in which those tasked with providing the very best healthcare scenarios for my constituents are acting outwith that remit and not promoting good, safe, equitable healthcare. Choice has been removed from my constituents: their health needs—in fact, their lives—are deemed secondary to those of others in the region. I am asking the Minister to support the taking of some serious steps. NHS England must step in, investigate and, if necessary, remove the clinical commissioning group’s powers, and NHS Improvement must take investigative action against the trust.

Things have become very nefarious in Shields; people have misunderstood my representing and relaying of my constituents’ views and laying out of the facts as personal attacks. I remind those who have tried to silence me, and who have stated publicly that I am a liar and tried to bully me into toeing their line, that I put myself forward for public office not to cosy up to others or bow to those in power or vested interests, but to represent the people of Shields no matter how uncomfortable for some that may be. No amount of threats or bullying will stop me from doing the job I was elected and entrusted to do.

I end by paying tribute to all the amazing staff in our hospital and those in South Tyneside who have wholeheartedly joined the fight to save it—especially Roger Nettleship and Gemma Taylor, who have worked tirelessly leading the Save South Tyneside Hospital campaign and are currently crowdfunding to raise money for a potential judicial review. Please, if anyone is listening, donate and help us—this process does not begin and end with our hospital. The Government are coming for our entire NHS.

[The Minister of State, Department of Health (Mr Philip Dunne)]

I congratulate the hon. Member for South Shields (Mrs Lewell-Buck) on securing this debate about the future of South Tyneside Hospital. I pay tribute to the emotion she showed in standing up for her constituents, but I have to say that I was disappointed by the tone she adopted, particularly at the start of her remarks. Frankly, her allegation of conspiracy—trying to paint the issue as some kind of dastardly plot to privatise the health service, for which there is not a shred of evidence—is scaremongering that will undoubtedly alarm residents in her area. That rather undermined the force of her quite proper concern for her constituents, so I am sorry that she chose to characterise her position in that way.

I welcome, however, the hon. Lady’s support for the staff at her hospital and join her in congratulating them on their work. Despite significant pressures, South Tyneside NHS Foundation Trust is performing very well for the vast majority of patients under its care. She pointed out the performance in A&E. The trust is one of the few in the country to be performing at and above the four-hour waiting target, but that is not the only area in which it is performing well. It is also one of the few trusts across the country to be meeting all of the eight cancer targets, as well as the referral to treatment waiting time targets—again, that is unusual at present—and all the diagnostic targets. It is therefore one of the best-performing trusts in the country, and I think the hon. Lady and I will be on the same page on that.

The trust and its neighbour, the City Hospitals Sunderland NHS Foundation Trust, recently formed an alliance known as South Tyneside and Sunderland Healthcare Group. That is why the group is looking at a reconfiguration of services across the two trusts to remove unnecessary duplication and improve the sustainability of services to ensure that the local population’s healthcare needs are well looked after across the range of activities.

Ultimately, as the hon. Lady knows, any service changes at South Tyneside Hospital will be a matter for local health authorities. All proposed service changes should be based on clear evidence that they will deliver better outcomes for patients. The changes should also meet the four tests for service change: they have support from GP commissioners; they are based on clinical evidence; they demonstrate public and patient engagement; and they consider patient choice. In addition, NHS England introduced this year a test on the future use of beds that requires commissioners to assure it that any proposed reduction will be sustainable over the longer term and that key risks such as staff levels are addressed.

[Mrs Lewell-Buck]

The Minister says that both hospitals are working together to create safe healthcare for both populations. However, how does shutting down a maternity unit and a special care baby unit with hardly any notice at all help to create that environment? Surely they are failing the task they have been handed.

[Mr Dunne]

I am coming on to explain precisely why there was an emergency shutdown of that facility because the hon. Lady’s characterisation does not quite represent what happened. I will go into that in some detail to try to reassure her and her constituents about the reasons behind this sudden—and, we hope, temporary—closure.

On 30 November, as the hon. Lady pointed out, the delivery of high-risk births at South Tyneside District Hospital was suspended due to staffing pressures. A number of urgent safety protocols were put in place to accommodate a very small number of low-risk deliveries over the weekend of 2 and 3 December. Since 4 December, all maternity services have been temporarily suspended at South Tyneside Hospital on patient safety grounds. The trust did not take this decision on its own initiative. It sought advice from the Northern Neonatal Network and the heads of midwifery services for the north-east of England. Their unanimous clinical view, based on all the evidence available at that time, was that births should be temporarily suspended in the interests of the safety of mothers and babies.

The trust has about 70 hospital-based staff who are directly affected, who have all been asked to report for duty as normal. The staff are working with the trust to contact the 165 women currently affected to ensure that safe alternative arrangements are made. The trust has been in close contact with neighbouring units and has had overwhelming support from NHS partners across the system. Women have been choosing to deliver in Sunderland, Gateshead and Newcastle, with a number of women opting for a home birth.

The trust is working closely to make sure there is an individual plan for each patient and that there is clear communication between the healthcare professionals involved with their care. The trust aims to reopen the special care baby unit for low-risk births when a safe staffing level has been established.

I now want to dwell on the specific staffing challenges that have precipitated this action. South Tyneside NHS Foundation Trust has been contending with the challenge of safely staffing the special care baby unit over many years, so this situation has not just crept up on it. When the Care Quality Commission visited in May 2015 and rated the trust overall as requiring improvement, inspectors raised serious concerns about its special care baby unit staffing arrangements. Since 2015, the trust management has made relentless efforts to mitigate these staffing issues. Regular recruitment has taken place for permanent vacancies in the special care baby unit and paediatric emergency care over the past two years, with the latest round taking place only this month.

Contrary to the hon. Lady’s allegations of a long-standing conspiracy to compel the unit to close, I want to give her the facts about that unit as I understand them. In recent months, chronic staff sickness has reduced the six full-time equivalent specialist neonatal nurse workforce in the special care baby unit to just four full-time equivalent staff. That has resulted in an unsustainable situation, with the remaining nurses working many extra hours each week to ensure safe staffing on the unit. One of the four remaining nurses then became ill, exacerbated by work pressures, and that led to unsustainable staffing levels to keep the unit open. It has not been possible for the trust, however hard it has tried over the past two and a half years, to fill the rota. It has not been possible most recently to use bank and agency staff to do so, given the very specialised skills required by neonatal nurses in the special care baby unit. This decision, although difficult, was driven by very clear clinical advice that put the safety of mothers and babies first and foremost, and also took account of the health and wellbeing of hospital staff, to whom the trust also owes a duty of care.

The hon. Lady referred to the consultation that has taken place in recent months over the path to excellence.

[Mrs Lewell-Buck]

I thank the Minister for giving way again, but I am really disappointed. I can see that he has the official lines from the trust and the CCG, but did he not listen to what I said? Regional groups made this decision, not local groups. The unit is now at the full staff complement at which it has been historically. In short, there is no staffing problem there right now. Midwives are sitting doing admin work when they could be delivering babies.

[Mr Dunne]

I was referring to the special care baby unit. My understanding is that the staffing levels at the neonatal unit are as I have just described to the hon. Lady. If she has other information, I will happily go back to the trust tomorrow to ask whether it has managed to fill those slots. There is no intention of keeping the maternity unit for normal births suspended for any longer than is necessary.

I will touch on an area that the hon. Lady did not mention specifically, because a similar situation occurred in relation to stroke services in the region. I want to put that into context to help her to understand why the decision was taken.

Since December 2016, any patient requiring acute care for a stroke has been taken to Sunderland. This decision was taken to ensure patient safety because South Tyneside also had a significant staffing challenge in its stroke unit. In fact, it had only one part-time physician, who was single-handedly assessing and treating incoming stroke patients. The stroke unit faced significant pressures in maintaining a sufficiently staffed nursing rota to support that clinician to maintain the patient safety required for stroke patients.

The benefits of centralising high acuity stroke care have been shown in Manchester, London and other parts of the country where reduced mortality and a more efficient use of resources have resulted in better care for patients. Most other parts of the country have either implemented similar changes or have plans to do so. Centralising stroke care into a smaller number of larger units provides the opportunity to ensure that there are specialist nurses and doctors available to manage patients at all times, and to provide access to imaging and other investigatory facilities immediately as they are required. I will illustrate what that means to patients, who are at the heart of these changes.

Across the NHS in England, 84% of stroke patients now spend the majority of their hospital stay in a specialist stoke unit, compared with 60% in 2010. This has led to excellent progress in the treatment of stroke over recent years. More than 93% of stroke patients across England now receive a brain scan within 12 hours of their arrival at hospital, with more than 50% screened within one hour. That is a huge improvement since 2010, when 70% of patients waited up to 24 hours for a scan. The concentration of stroke services and specialist units has helped to save lives.

The workforce challenges experienced by South Tyneside Hospital are being proactively addressed in the long term through the path to excellence programme that the hon. Lady mentioned. This is a five-year transformation programme for healthcare services in South Tyneside and Sunderland, and a localised response to the Northumberland, Tyne and Wear and North Durham STP of which she was so critical. The public consultation for the path to excellence programme ran from 5 July to 15 October. The areas of service under consultation were maternity and women’s healthcare services, including the special care baby unit; stroke care services; and children and young people’s urgent and emergency services. Before the CCGs make their decision, they will consider all the feedback gathered during the consultation from all stakeholders, including the hon. Lady and other hon. Members. The CCGs are also holding a number of public engagement sessions between now and February, in which I strongly encourage her to participate. An extraordinary meeting of the CCG’s governing bodies will be held in February 2018, in public, for the two CCGs to make their final decisions.

The hon. Lady mentioned the Save South Tyneside Hospital group. I am aware that the group is active in campaigning against any reconfiguration of healthcare services between the two hospitals. I hope that I have helped to clarify to her that no decisions will be made on reconfiguration until the responses to the path to excellence consultation have been thoroughly analysed.

[Mrs Lewell-Buck]

The Minister’s analysis of the Save South Tyneside Hospital campaign is incorrect. We want safe, decent healthcare for people in South Tyneside. We are campaigning for equitable, safe healthcare.

[Mr Dunne]

I am sure that that is the objective. It is also the objective of the trust to ensure that sustainable, high-quality services are available to the populations of the areas served by both hospitals.

The South Tyneside NHS Foundation Trust now faces a challenging task in ensuring that the two hospital trusts, through the path to excellence process, remove any unnecessary duplication and improve sustainability. It is important that the trusts work well together, with the local community and with their commissioning groups, to ensure that any plans that they have are communicated clearly to local populations. [Interruption.] The hon. Lady says that that is not happening. It is incumbent on the trusts to engage properly with their local communities. I am sure that they will be watching this debate and taking note of the comments that she and I are making. There should be full public engagement, and as I have identified, that will continue right up until the decision of the CCGs in February.

I conclude by simply saying that it is incumbent on all of us who represent our local communities to get engaged —the hon. Lady is doing this with her campaign group—with the people who are responsible for making decisions. That is the local NHS in her area. [Interruption.] She indicates that she is engaged with her local NHS. I am pleased to hear that, and I ask her to encourage all other MPs to get engaged in a constructive way, to find the best solution for their local residents that will put patient safety at the top of the list.

Question put and agreed to.

Oral Answers to Questions

Emma Lewell-Buck Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Speaker]

The other doughty champion of the hospital is of course the right hon. Member for Chorley (Mr Hoyle), who regularly deputises for me in this Chair. I am sure the House will want to acknowledge that important fact.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

I heard the Minister’s response earlier. He was of course right that sustainability and transformation plans are led locally, but he failed to acknowledge that the Government have given a mandate to make cuts attached to STPs. Without consultation, my local hospital has been downgraded. What on earth will the Secretary of State say to my constituents who may lose loved ones because they have had to travel miles further to another hospital?

[David Mowat]

If I may, I will give a quote:

“To reshape services over the next 10 years, the NHS will need the freedom to collaborate, integrate and merge across organisational divides.”

That comes from the 2015 Labour manifesto. The STP process is designed to bring about better care and health, and better productivity. We should be critical friends of the process because we all want a better national health service.

NHS Sustainability and Transformation Plans

Emma Lewell-Buck Excerpts

Wednesday 14th September 2016 Commons Chamber

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

We have all become accustomed to the Conservative party’s disdain for our NHS since the shambles of the top-down reorganisation that began in 2012. Now we have the stealth introduction of sustainability and transformation plans—secret plans that would bring yet more unjustifiable and drastic reforms to cash-starved hospitals. Instead of being given the funding they so desperately need, hospitals are being asked to make £22 billion of efficiencies to compensate for this Government’s total mismanagement of our NHS. The audacity of making hospitals themselves pay the price for that by threatening them with closure or the reduction of acute services is the final act of treachery in a tragic and deliberate play to decimate our NHS.

South Shields is part of the footprint area of Northumberland, Tyne and Wear, an arbitrarily created boundary. By 2021, the health and social care system in that footprint area is projected to be £960 million short of the funds it needs to balance its books while maintaining the same level of care for patients. Make no mistake: these plans are about cuts. They are nothing to do with transforming our NHS for the better. The NHS has been set an impossible task by the Government; the endgame is to see it in private hands.

The Government have said that the initial STP submissions to NHS England are

“for local use, and there are no plans to publish them centrally”—

a nice touch to put the onus once on to our hospitals again, so that the Government themselves do not have to deal with the flak.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

Will my hon. Friend give way?

[Mrs Lewell-Buck]

I would rather not, because a lot of people are waiting to speak.

I was born in South Tyneside hospital. I am the local MP for the area, and I have not seen a single plan—not even the governors at my local hospital have, let alone the people of Shields, whose vital acute and emergency services could be devastated by these changes.

I am told that the timetable for implementing these unseen plans begins this autumn, yet the first we will see of them in my area is at the end of this month—that is, in the autumn. I am extremely alarmed at the lack of accountability and transparency with which the plans are being pushed through. There is simply no time at all for consultation. I make a plea to all NHS leaders not to be complicit but to stand up for their hospitals and the communities that they serve. The Government have no mandate for such a radical reconfiguration of our NHS, one that could involve the closure of accident and emergency and acute services up and down the country.

Last week, the Prime Minister called in NHS leaders to order them to stop any hospital mergers or closures that risk causing local protests. There is already a protest in my constituency.

Dementia and Alzheimer’s Disease

Emma Lewell-Buck Excerpts

Tuesday 12th April 2016 Westminster Hall

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate the hon. Member for Strangford (Jim Shannon) on his excellent speech and on securing the debate.

In the north-east, there are an estimated 25,841 people living with dementia. In coastal constituencies such as mine, South Shields, the figures are higher than average due to large elderly populations. Over the coming years the figure is projected to rise locally and nationally, with more than a million people forecast to be living with dementia in the UK by 2021. I am sure the absence of any mention of the NHS or social care in the recent Budget was of little comfort to those who have loved ones living with dementia.

As the numbers of people in need of care and support rise, real action from the Government is lacking. Yes, we have the Prime Minister’s commitment to making England

“the best country in the World for dementia care,”

and we are told that research investment has doubled and policies for improving diagnosis rates are in place, and that there are a million dementia friends, but commitment, research and reliance on charities are no substitutes for the care and support that thousands of people with dementia need right now.

Anyone who has ever had to make the heart-wrenching, emotional decision to have a member of their family placed in a residential or care home, even for a short while, will know that good care, dignity and respect are the cornerstones of providing loved ones with the safety and security they once enjoyed in their own homes. I know about that from my own gran, who was one of the strongest and bravest people I ever knew. As she got older, this strong woman became physically frail and, worse still, her mental health deteriorated too. Gran had dementia and, after many stays in hospital and some painful discussions, our family decided that she needed to be admitted into a care home. She escaped from the first home and was found alone, shivering in a field. At the second home she seemed happy enough, but she suffered an injury through carelessness of staff. If my gran had had carers at home, she would probably have had only one or two visits a day, with all of her getting up, getting dressed, meal times and bed times dictated by the times her care company could come, not when was best for her.

The thing is, though, gran’s story is not unusual; because in an age of increased need and reducing budgets, respect, dignity and choice are always the first to go. They cost nothing on the balance sheet in the first place, yet they mean so much to the people receiving care. This view is supported by the Alzheimer’s Society, which has reported that more than half of carers felt that their loves ones were not treated with understanding and dignity in hospital.

At present, we have a crisis in adult social care and in the NHS. Local authorities predict a £4.3 billion gap in adult social care by 2020, and NHS England and the Nuffield Trust estimate that by 2021 the NHS funding gap could have grown to £30 billion a year. Residential and care home providers and organizations that provide home care say openly that they do not know how much longer they will manage, because they have realized what we all know: there is no real profit to be made in good quality care.

The average cost of a year’s dementia care is £32,250 per person. I have always known that if we are really going to care for people living with dementia and support their families, we need to formulate policy starting with them and their needs. That is the approach that I took when I was a local councillor, and I am proud today that building has actually begun on South Shields’s £9 million centre of excellence for older people, an integrated care services hub with a focus on dementia, which I worked tirelessly on before coming to this place. I know that I do not have all the answers, but I know that the Government need to be more inventive and creative, and to address the crisis right now.

Oral Answers to Questions

Emma Lewell-Buck Excerpts

Tuesday 9th February 2016 Commons Chamber

[Alistair Burt]

Yes, indeed. We strongly support the initiative. Our work to look after children who need extra care, particularly in relation to their health and emotional needs, has been helped by the transforming care package, which is going through local authorities at the moment. Their vulnerabilities are certainly a matter of great concern, and that will be followed up by the Government.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Over 1 million elderly people are able to maintain independence and remain in their own homes due to the attendance allowance. What discussions has the Minister had with his colleagues about ensuring, when the fund is transferred from the Department for Work and Pensions to the Department for Communities and Local Government, that the allowance will remain at the same level?

[Alistair Burt]

The consultation is ongoing between Departments. A unit has been set up by the Department of Health and the DWP to look at a range of issues that concern us both. The actual detail of the future attendance allowance has not been finalised yet, but it is a matter of concern and discussion between Departments.

Post Office Horizon System

Emma Lewell-Buck Excerpts

Monday 29th June 2015 Commons Chamber

[Mr Kevan Jones (North Durham) (Lab)]

I congratulate the hon. Member for North West Leicestershire (Andrew Bridgen) on securing this debate.

My constituent Tom Brown, a postmaster for 30 years, had a post office in Newcastle. In 2008, he informed the Post Office that there was a problem with his Horizon system, and it took away one of his base units to change it. He was told by the helpline—a euphemism because it has not been very helpful to many sub-postmistresses and sub-postmasters and has actually got them into more trouble—that the system would rectify itself. It did not. The next audit said that his figures were down by £85,000. He was arrested by Northumbria police, and his car and home were searched. Subsequently, the police dropped all charges as there was no evidence against him. Then, for some unknown reason, the Post Office took out a prosecution against him to take him to court for false accounting. That process took until July 2013, when he finally appeared in court for the third time. No evidence was put forward to the court, and after that the case was dropped.

This man has lost his home, his livelihood and his good reputation. He is one of the individuals who have gone through the mediation system, even though, as the hon. Gentleman outlined, the system is a sham. He was given four different dates that were all delayed. He described this to me as six hours of wasted time. The Post Office employed top lawyers from Newcastle to represent it. It again went through what it said was the evidence, and made no offer at all. The system is a sham. As the hon. Gentleman outlined, it has been a way of delaying decisions on these cases.

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

Does my hon. Friend agree that the Post Office has failed to be transparent about this process? My constituent, Mrs Carter, a sub-postmistress, asked the Post Office to audit her branch to get to the bottom of the problem, but it refused to do so.

[Mr Jones]

I will go further than that. It has not only not been transparent; it has gone out of its way to delay cases and hide evidence.

My concern about the work done by Second Sight is that it suggests that if information is returned to the Post Office, evidence will go missing. That is why I totally agree with the hon. Member for North West Leicestershire that there needs to be an independent judicial inquiry into this—as he described it—national scandal. I am pleased that my hon. Friend the Member for Hartlepool (Mr Wright), the new Chair of the Business, Innovation and Skills Committee, is present for this debate. I urge him and his Committee to look at this as a matter of urgency.

The fundamental point is this: who controls the Post Office? This organisation is out of control. It has led to people’s lives being ruined and, as we have heard, in some cases to people being given prison sentences when clearly they are innocent. It is important that we get to the bottom of this. Without a judicial inquiry, I fear that this national scandal will continue and these people’s reputations will continue to be blackened.

Oral Answers to Questions

Emma Lewell-Buck Excerpts

Tuesday 2nd June 2015 Commons Chamber

The Secretary of State was asked—

[Mrs Emma Lewell-Buck (South Shields) (Lab)]

1. What assessment he has made of recent trends in ambulance waiting times.

[The Secretary of State for Health (Mr Jeremy Hunt)]

As you said, Mr Speaker, we shall have those tributes tomorrow, but I should like very briefly to echo your comments, because I know that the whole House is shocked and deeply saddened by the umtimely passing of Charles Kennedy. He was a giant of his generation, loved and respected in all parts of the House. Our thoughts are particularly with Liberal Democrat Members who knew him well, and to whom he was a very good friend over many years. We shall all miss him as a brave and principled man who had the common touch, and who proved that it is possible to be passionate and committed without ever being bitter or bearing grudges. Our thoughts are with his whole family.

I can tell the hon. Member for South Shields (Mrs Lewell-Buck) that the ambulance service is performing well under a great deal of pressure. Although a number of national targets are not being met, the service is responding to a record number of calls, and is making a record number of journeys involving all categories of patients.

[Mrs Lewell-Buck]

I echo the comments made about the late Member for Ross, Skye and Lochaber. He was one of the kindest Members of the House, and he will be greatly missed by many of us.

As for the Secretary of State’s response to my question, I think that his assessment was a bit off. When my constituent Malcolm Hodgson’s son-in-law broke his leg in a local park, he waited in agony for 50 minutes for an ambulance, and then waited a further five days for an operation. Can the Secretary of State explain how our ambulance and health services were allowed to fall into such a dire state over the past five years, and will he apologise to that young man for the delay and the pain that he suffered on the right hon. Gentleman’s watch?

[Mr Hunt]

I take responsibility for everything that happens on my watch. [Interruption.] I think it is a little early to ask the Secretary of State to resign—but maybe not. The ambulance service is under great pressure, but across the country we have 2,000 more paramedics than five years ago, we are recruiting an additional 1,700 over the next few years, and from March this year, compared with March the previous year, the most urgent calls—the category A red 1 calls—went up by 24% and the ambulance service answered nearly 2,000 more calls within the eight-minute period. There is a lot of pressure, we have a plan to deal with it, but we need to give credit to the ambulance service for its hard work.