Francis Report: Update and Response
Frank Dobson Excerpts(9 years, 3 months ago)
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Mr Hunt
As indeed we learn from you, Mr Speaker.
I welcome the question from my right hon. Friend, who is a former Secretary of State for Wales. People will want to know that these lessons will be learned in Wales. In the original Francis response, we set out clear plans for the way in which hospitals should make it clear, in every ward of every hospital, how one can complain not just directly to the trust, but to independent external organisations, such as the ombudsman, if necessary.
Frank Dobson (Holborn and St Pancras) (Lab)
May I warn the Secretary of State not to think that because he has decided something and because a circular has been issued, something has happened? In 1998, against a lot of opposition, I insisted that the whistleblowing law should apply to the NHS. I also issued a circular banning the use of gagging clauses. As I said in my discussion with Sir Robert Francis on this whole issue, it clearly did not work.
Mr Hunt
I thank the right hon. Gentleman for what he did when he was Health Secretary. I am well aware that in the world’s fifth-largest organisation, nothing happens just because someone issues a circular, which is why some of what we have announced goes beyond what Sir Robert precisely recommended. For example, by publishing avoidable death rates by hospital trust, we want to make the energy for change come from inside trusts, not from their being told to do things by Ministers. However, I welcome what he did as Secretary of State, and I hope we can do some other positive things.
Human Fertilisation and Embryology
Frank Dobson Excerpts(9 years, 3 months ago)
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Frank Dobson (Holborn and St Pancras) (Lab)
I have a sense of déjà vu, or perhaps déjà entendu. The objections that have been brought out today, and in previous discussions, about mitochondrial disease are identical to those that arose when Louise Brown was brought into this world at Oldham general hospital as a result of the risky work undertaken by Steptoe and Edwards and Jean Purdy. That was a risk that the scientists were willing to take and that Mr and Mrs Brown were willing to take.
Not long after I became a Member, Enoch Powell proposed a total ban on embryo research. I understand people’s ethical objections to embryo research, but if they object to something on principle, they do not need to add any other references to safety or effectiveness. If someone is opposed to it on principle, they are opposed to it, and I can respect that. When the Warnock report was published, this House had a creditable debate—to those who say that the House of Lords has a better quality of debate, I say that they should read its first debate on the Warnock report, and they might modify their views. All the things that are being said today were being said then, and all the things that were said in the debates about the establishment and development of the Human Fertilisation and Embryology Authority were the same.
In a previous speech, there were two novelties. One was that Robert Winston was being misquoted as opposing the proposal, which he cannot do any more as he actually wrote a full article in favour of it yesterday. The second was that US experts, some of the most distinguished experts who have written papers on the matter, were against it.
Frank Dobson
No, I will not give way, because I do not want to take up more than my allocated six minutes.
The question arises: will it be safe and will it work? The answer is that no one can make any guarantees, but that is the nature of scientific development. The thing to remember is that mitochondrial disease is horrible and that there is no treatment for it. I remind people that the team at Newcastle university did not start off with this riskier novel approach. It has been studying and trying to come up with treatments for mitochondrial disease for the best part of 20 years, and is still doing so now. Some 90% of its work is trying to come up with a treatment. The best that it has managed to come up with after all these years is helping parents cope with the horrible symptoms before their children fade away and die. As has already been said, the team has decided that if it cannot come up with a treatment—and it is still trying—it would be better to prevent the disease arising in the first place because prevention is better than cure. That is why I hope the regulations will be passed and handed over to the HFEA. Members should realise that it is a credit to this country and to this House that the HFEA was established. We must find a middle way between the free-for-all, which a few nutters want, and the total ban, which some others want because they are opposed to embryo research on principle.
The system that has been established is well regulated through the HFEA. Despite all the predictions to the contrary, there has not been a single scandal in all the time that the HFEA has been in existence. There has been no sign of a slippery slope. These people with great reputations at Newcastle think the time is right to take risks and to risk their reputations—
Frank Dobson
No, I shall not. Those people are taking risks, because if the treatment does not work, there will be those who will gloat—even, I am sad to say, Members in this Chamber. The parents are also willing to take the risks. Parents with children do not want this to happen again, and we have the opportunity to do something about it. The results are uncertain, but that is in the nature of both medicine and science. We cannot guarantee that it will work, but the people most involved in the matter and all the scientific advisory bodies in this country think that it will work, and we should take note of what they say.
Blood Safety (Variant Creutzfeldt-Jakob Disease)
Frank Dobson Excerpts(9 years, 3 months ago)
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Frank Dobson (Holborn and St Pancras) (Lab)
I start by declaring two peculiar interests. When I was Secretary of State for Health, I introduced the leucodepletion of the blood supply, which led to the establishment of the prion unit that now operates at the University college London institute of neurology in my constituency. I have therefore had a constituency interest, as well as a continuing interest, in the brilliant work of the large team run by Professor John Collinge.
The first time I saw the suggestion that variant CJD might be transmitted through blood or blood products was when I was reading a document produced by the Department that had been sent to me in a red box to keep me occupied during the Labour party conference in Brighton. The theme of the document was that Pasteur Merieux, the French pharmaceutical company, was being difficult by refusing to accept any blood or blood products from Britain because of the possibility of contamination by variant CJD. The document then stated that, as a result, we could of course no longer guarantee that variant CJD was not transmitted through blood or blood products. At that point, my eyes popped out and I telephoned the office in London to say, “Get the experts into my room. I am coming back from Brighton this instant.” The meeting included Sir John Pattison, the then head of the Spongiform Encephalopathy Advisory Committee and of the medical school at University college London, and Professor John Collinge, who was at that time at Imperial college. I was there as the representative of the ignorant layperson—I was adequately equipped for both words—but I was glad I was present.
The experts said that it was not certain that CJD could be transmitted through blood or blood products, but that it was a possibility. Some of the people at the meeting, and some of those involved in advising me afterwards, were strongly of the opinion that that was not possible. As the Committee’s excellent report states, however, it was a “prescient” decision to introduce leucodepletion
“at a time when the prevailing scientific view was that blood transfusion would not prove to be a source of prion transmission.”
The balance of opinion at the time was therefore against doing anything. Nevertheless, the next thing I wanted to know, even if nothing was certain, was whether and how CJD was being transmitted. The experts said, “If it is being transmitted, it is probably being transmitted in the white corpuscles, but not necessarily.” I asked, “What can we do about it?” They said that in some cases we already leucodeplete—take the white corpuscles out of the blood—and that we could do that for the whole of the blood stock. I asked how much that would cost—not at that meeting, admittedly, but a week or two later—to which the answer was, “Probably somewhere approaching £100 million.” Having looked at the conflicting evidence, I said, “Right, do it.” I then went over to talk to the Prime Minister about several things. At the end of our little get together, I said, “By the way, I have just authorised spending £100 million on a project in the hope that it’s a waste of money.” I will not report his response to hon. Members because the language was more vulgar than even I use.
I freely admit that I acted as I did because I had observed the BSE crisis, when officialdom had kept punting things to all sorts of special advisory committees and God knows what, with the various Departments involved being what might be described as a decision-free zone. Nothing had been done and disaster had resulted. One of the questions that arose was, “If the disease is being spread in this way, how many people are likely to be affected?” Things that were ludicrously described as computer projections were produced, and figures ranged from about 200 people to some 2.5 million to 3 million, if I remember rightly. Again, officialdom and the expert bodies did not know much more than I did, frankly.
I nevertheless gave the go-ahead, and that has proved to be useful, according to the people who are now giving scientific evidence to the Committee and Ministers. However, the process has been very costly, and one of my few criticisms of the report is that it gives the impression that protecting the blood supply from vCJD costs between £4 million and £4.5 million a year. Leucodepletion costs about £4 million to £4.5 million a year, but a year or two ago, which was the last time I asked a parliamentary question about this, the total cost incurred in protecting the blood supply from vCJD—I think that this was for 2011-12—was £540 million. That is because, for example, we now import plasma, whereas we used to export it. There is a substantial loss of income from our not being able to export plasma and other blood products because of people’s fear of vCJD. These days, fending off vCJD certainly costs more than £600 million, in addition to, as the hon. Member for Mole Valley (Sir Paul Beresford) said, about £200 million a year on synthetic clotting factor for haemophiliacs. The interest in sorting out this matter is therefore not just clinical, not just about public decency, not just ethical and not just patient-centred, because there is a huge financial interest in sorting it out. That money could otherwise be spent on other areas of the national health service, so we need clarification and an end to the uncertainty.
The prion unit at the institute of neurology, led by Professor Collinge, has proved to be invaluable. The people there have done magnificent work. They are the people who came up with the blood test, although that test has been denied the opportunity of full-scale retesting here to try to match and outdo the testing that was arranged in the United States. If we are spending millions of pounds, quite rightly, on that first-class fundamental research at the institute of neurology, why are we indulging in that famous British lunacy of then not getting on with applying that research? That has happened in the case of the blood test.
As the hon. Member for Mole Valley said, there is also the question of the contamination of instruments. Again, it was the people in the institute of neurology—Professor Collinge’s team—who came up with the initial ideas to make use of the fact that the prions cleave to metal. That was then taken further by DuPont, but it was not taken further by the national health service. If there is a threat—it is still an “if”—that would be one way of countering it, and it would not be wildly expensive.
The blood test and the instruments were, in a way, sideshows. They were about trying to do something practical and effective to help as people got on with the fundamental work of trying to come up with a treatment for vCJD, which they have now done. I have a great deal of time for the current chief medical officer, as I have had for all her predecessors—they were all people of great distinction—but she sort of said, “Well, you know, they’ve been given a lot of money, particularly Professor Collinge,” as though he stuffed it in his back pocket and went boozing of an evening. The money has been spent. The unit invested that money—more than £90 million—in fundamental research. It has now come up with what it thinks is a treatment, but it needs £2 million, £3 million or £4 million to proceed with the pre-clinical trials. Having invested that £90 million, however, the researchers are being told, “We can’t come up with the £2 million, £3 million or £4 million to see whether it works.” That seems to be yet another example of British scientific lunacy: doing the fundamental research, but not getting on with applying it.
We therefore have the situation that the institute of neurology has come up with a blood test, instrument cleaning and treatment, none of which has been properly and effectively pursued. I am not vilifying the Minister or any of her predecessors, but quite frankly—the Committee’s report says this—if I had fallen for people saying, “Oh, we have to get 43 different scientific advisory committees to look into leucodepletion,” leucodepletion would not have been introduced, and we would all now be in a much worse situation.
We need some boldness from Ministers. If the Treasury says that we cannot find the money, I suggest that the people at the Department of Health and those with responsibility for science pick a couple of lunatic things that the Treasury is spending money on—it always has some lunatic projects of its own—and say, “We think we deserve a bit more, so you could stop doing x, y and z.” At the moment, we are in danger of, to use the old phrase, spoiling the ship for a ha’p’orth of tar. I cannot think of any rational organisation that would invest in deploying immense expertise over a long period of time, spending £90 million, but then say, “We can’t find £3 million or £4 million to test out the effectiveness of what has been produced.” I hope that Ministers will accept that they are looking stupid, and the worst thing that anybody can do is look stupid. I am an advocate of non-stupidity, if we can possibly have it.
Jane Ellison
Marvellous. My mistake. In that case, I have plenty of time.
In case there is anything I cannot cover in my remarks, I should point out that we have already committed to write to the Committee with a further update before the end of the Session. There are issues where we will have more to report, and I will focus on a couple of specifics today.
Let me start by thanking the Committee for the opportunity to look at the issue again. May I also apologise for the fact that I am holding my notes so far away from me? I have left my glasses at home.
Jane Ellison
Let’s see how I get on, although I thank the right hon. Gentleman for that kind offer.
First, let me reiterate—I said this in the evidence sessions, but perhaps we did not stress it enough in responding to the Committee—that there is no hint of complacency over the issue on the part of the Government, the Department of Health, me, the chief medical officer or anyone else, although I understand why that question mark is in the title. I would hate for my optimism about our perhaps being in a better place than we were to be characterised in any sense as complacency or as not wanting to keep this area under careful review.
In that respect, I want, like other contributors to the debate, to mention the number of cases. We have had one UK case of vCJD since 2010. The UK’s annual mortality rate per million for all forms of CJD from 1993 to 2012 was 1.1, which, I am pleased to say, is lower than that in France, Spain, Germany and Italy. On secondary transmissions, there is no evidence of any person-to-person transmissions via blood since 1999, as was said in the debate. There is also no evidence of any person-to-person transmissions via surgery or dentistry. However, I accept that the fact that there is no evidence does not mean there is no challenge.
On Government funding, the shadow Minister, the hon. Member for Liverpool, Wavertree (Luciana Berger), referred to the ring-fenced budget. The Department of Health has provided more than £95 million for CJD studies since 2001. It is funding 18 CJD-related research projects with total investment of about £45.5 million. In 2011, it was estimated that about £500 million had been spent on prion-related research.
Professor Collinge has been mentioned. His advocates are here in the form of hon. and right hon. Members who are familiar with the work done by him and his unit. The Department of Health has provided more than £16 million of research funding to the National Prion Clinic, led by Professor Collinge, since 1996. The Medical Research Council continues to provide £6 million annually to fund the MRC prion unit, which is led, again, by Professor Collinge. Members have said that that has been said before, but it is important to stress that it is the context in which the Committee’s report was written.
There was perhaps a slight lack of generosity in the way some contributions to the debate characterised the attitude of the Department and the Government, and I want, therefore, to make two general points about science. I rather disagree with the point made by the right hon. Member for Holborn and St Pancras (Frank Dobson) that if we have spent an awful lot on theoretical research, it follows that we must always seek to apply it. It would be slightly dangerous always to adopt that principle, because that would make the funders of research far more risk-averse. If there was an obligation to put into practice every piece of research one had backed, there would be an inclination to back away from the more risky pieces of research and to back only the winners. That is just a comment on the principle; it does not necessarily relate to this issue.
The second point I hope colleagues would concede is that there is surely a difference between having one set of scientists look at something and then another set of scientists look at it and reach different conclusions and recommendations, and being in any sense complacent. A lot of different people with great scientific knowledge have advised Ministers over the years and have sometimes come to different conclusions or made different recommendations. It is important to stress that in all the ways in which we have responded to the report we have been guided by some very senior scientists. I want to put that on the record.
Frank Dobson
Will the Minister confirm that none of the scientific advisers has advised her or any other Minister that the John Collinge treatment proposals would not work or ought not to be tested?
Jane Ellison
I will say a few words about some aspects of the Collinge work later, but I want to focus on giving an update on some of the work on the assays.
National Health Service
Frank Dobson Excerpts(9 years, 3 months ago)
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Mr Hunt
I am going to make progress, but I will give way later.
I want to look at the pressures that the NHS is facing, because the right hon. Member for Leigh asked about the direct causes. There are more than 1 million more over-65s than there were four years ago. Many older people become particularly vulnerable when it is cold, which is why winters are always difficult for the NHS. The truth is that over successive decades, we have made older people more dependent on emergency care by under-investing in primary and community care, reducing the responsibility of GPs for out-of-hours care, removing the personal responsibility for patients from GPs, and failing to integrate health and social care.
The right hon. Gentleman spoke as if that was nothing to do with Labour. However, he knows what damage was caused by the GP contract changes in 2004, he knows that his Government failed to integrate health and social care for 13 years, and he knows that where Labour runs the NHS today—in Wales—the performance is even worse. Instead of debating constructively, he chose to start this year by putting up a scaremongering poster that implied that the NHS would cease to exist if this Government were re-elected. That is not good enough. The whole country can see that, for him, it is not about the ward, but the weapon; it is not about the patients, but the politics. For this Government, it is about the patients.
Mr Hunt
What the last Government did, that was right, was to say that—[Interruption.] I am just saying what the last Government did right. The hon. Member for Worsley and Eccles South (Barbara Keeley) might want to hear this, because I do not usually compliment the last Government.
To bring waiting times down to 18 weeks, the last Government said that they would support the NHS by allowing the private sector to do some operations. We have continued that policy, not changed it. The result, the hon. Lady will be pleased to know, is that 6,000 more operations are happening every year in her constituency under this Government than in 2010.
For this Government, it is about the patients. That is why we increased the NHS budget; why we hired 9,000 more doctors and 6,000 more hospital nurses; why we are doing nearly 1 million more operations a year than four years ago, with fewer long waits than ever; why we have increased cancer referrals by half, saving an estimated 1,000 lives every single month; and why we have learned the lessons of Mid Staffs by putting in place safe staffing, having independent inspections and turning around six failing hospitals.
Patients say—[Interruption.] The right hon. Member for Leigh should listen to what patients say, because he did not do that when he was Secretary of State. Patients say that their care is safer and more compassionate than ever, with the independent Commonwealth Fund saying that under this Government, the NHS has become the best health care system in the world.
Frank Dobson
Will the Secretary of State confirm that the only reason why he has been able to recruit British doctors is that the previous Government increased recruitment into medical schools by 35%?
Mr Hunt
I welcome the fact that the previous Government increased training places, but as the right hon. Gentleman will know, having been Secretary of State, those doctors have to be paid for. The NHS budget has not been cut, as the shadow Secretary of State wanted, so we can afford to pay for those doctors. There are 219 more doctors serving the constituents of the right hon. Gentleman because of the decision that this Government took to protect the NHS budget.
Even more important than what we have done for patients in this Parliament is the fact that, under this Government, the NHS has developed its own plan for the next five years, the “Five Year Forward View”. Because we have a strong economy, we can back that forward view with a record £2 billion extra for the NHS front line next year alone.
Part of our commitment to the NHS—this is a real difference between the Government and the Opposition—is that we face up to difficult decisions, including on pay. No one wants to be more generous to staff who work long hours than I do, but the official advice that I received as Secretary of State was clear: the cost of accepting the pay review body’s recommendation would be £450 million, which would mean that hospitals might lay off between 6,000 and 14,000 nurses.
It is easy for Labour to support a pay strike, but it is deeply cynical if it cannot pay for its promises, as it knows it cannot. Labour claims to stand up for staff, but will it today stand up for patients by condemning the strike right in the middle of winter, which was supported by only 4% of NHS workers, or do the votes and financial support of the unions matter more? The test of a party that aspires to govern is not the easy decisions that it makes, but the tough ones. We have seen nothing brave or principled from Labour today.
Frank Dobson (Holborn and St Pancras) (Lab)
Whatever people like or dislike about the language, I do not think anyone could deny that the NHS at the moment is struggling to care for patients in the way that the hard-working staff in the NHS would like to be able to care for them and to deal with them as promptly as they would like. Everyone recognises that the NHS is managing to cope only because of its amazingly dedicated staff doing amounts of work and quality of work far above the call of duty. I have to say that a nurse from one of the two great hospitals in my constituency, to which the Secretary of State referred, said to me, “If he says how wonderful we are and then defends us not getting a pay increase, I will throw up.” I do not think she intended doing it in front of patients, but the hypocrisy of the approach she describes seems to me to be indefensible.
This situation is not entirely novel. A and E has been facing difficulties and has been overstretched in many parts of the country, even during the summer. That is largely because too many people are having to go to A and E or are being taken to A and E because they cannot be looked after properly at home. That is one of the main reasons. If people are kept in, there are not enough beds. I noticed that the Secretary of State quoted the King’s Fund. Having been interested in health care in London for 40-odd years, all I can say is that the main contribution of the King’s Fund has always been to demand reductions in the number of hospital beds; then, where there are not enough of them, it comes up with a million reasons why there are not enough—none of them being that there are too few beds; it is always some other factor rather than the shortage of beds itself that it manages to blame.
The reason why people, particularly the elderly and the physically and mentally disabled, have to go into hospital is that they cannot be safely looked after at home. Once they are in hospital and occupying a bed, they cannot safely be discharged home. So, they are brought in because there is no adequate care at home, and they cannot go back out of a hospital bed because there is no adequate care at home. The Government simply cannot get away from the fact that there have been massive reductions in care at home, particularly for the elderly. Logic suggests that if there are more elderly people who are chronically ill, there should be an expansion of the service to meet the increased need. In fact, however, services have been contracting.
The excellent work done by my hon. Friend the Member for Leicester West (Liz Kendall) a fortnight ago—just a small aspect of it—demonstrated that there had been almost 200,000 fewer people getting meals on wheels. I do not know whether the Government ever deigned to consider the impact of that, but if old people who previously relied on meals on wheels were not getting them, they were probably no longer being properly fed, and if they were not being properly fed, they were more likely to need nursing care. If no additional care was available, they were more likely to go to A and E and, once they had gone into a hospital bed, they were less likely to be safely discharged simply because they were no longer getting meals on wheels.
The meals on wheels service does not have the function only of providing food. On every day that a person gets meals on wheels, somebody is checking how they are doing, and it gives those who are lonely some human contact. The disappearance of all those meals on wheels will undoubtedly have led to more elderly people having to go to A and E, and fewer elderly people being able to be treated safely at home.
Diana Johnson
I am listening carefully to what my right hon. Friend is saying. He has the perspective of a London MP. In Hull over the Christmas period, we had the longest wait for A and E in the country—and this at the same time as we have seen a quarter of the local authority budget being cut, which impacts on social care. It seems to me that the two are very closely related. Does my right hon. Friend agree?
Frank Dobson
I entirely agree with that. The fact is that the services that can be provided at home need a higher priority than they have had in the past—under any Government. They need more staff with more time, because many of the people attempting to provide a service are given a quarter of an hour to dash in, help somebody wash or cook and then dash out again to rush along to somewhere else. If one person takes up more than a quarter of an hour, they will be late for the next person they are supposed to be looking after. What is more, all these people get lousy pay. In fact, the level of pay that such people get is a disgrace.
We also need a massive improvement in the co-ordination of services between hospitals, GPs, health visitors, nurses and the people providing those practical cleaning services and so forth. This will cost more. Anyone who pretends that we will not have to pay some more to get a service that works to replace one that does not is either just misleading themselves or—in the worst version—misleading other people.
Previous Governments have not expanded the services in line with the need, but the recent response of this Government has been to contract the service available, which is indefensible. Proposals under the new regime—if that is the right term, Madam Deputy Speaker—have brought about fragmentation, competition and binding legal contracts between various providers of these services. If anybody thinks that will improve co-ordination, they are again either deceiving themselves or attempting to deceive the rest of us.
In this country and in this House, we have to wake up to the fact that if we want a first-class service, we are going to have to pay a first-class fare. That was something I wrote in a long and entirely personal memorandum to the Prime Minister, not long before I foolishly resigned as Health Secretary. I pointed out that a massive increase in investment was needed. I am quite proud of some of the things I did when I was Health Secretary. That might have been the most important thing I did, because about two years later, the Government put an extra £40 billion into the health service. To be fair to the Prime Minister, I received a note from him saying, “Your long personal note triggered what we did.” I felt pretty glad about that.
When we talk about these issues, we need to bear in mind that our NHS is easily the most cost-effective system in the developed world. The total we spend on health care is 9.4% of gross domestic product: the Germans spend 11.3%, the French 11.6% and the United States, which has an insurance system like the one the leader of UKIP wants to introduce here, spends 16.9% of their GDP on health, and life expectation there is lower than ours.
The other really startling point, when we get people such as the King’s Fund and others demanding reductions in the number of hospital beds, is that for every 1,000 people we have three hospital beds, while the French have more than six and the Germans eight and a half. So far as I know, there is no daft consensus in either of those countries to get down to the British level.
Paul Burstow (Sutton and Cheam) (LD)
It was a pleasure to listen to the right hon. Member for Holborn and St Pancras (Frank Dobson). I was particularly struck by the point he made about the important case for investing in our health and care system. I dare say that the note that he mentioned will in due course be published under the 30-year rule, and that we shall then have a chance to read the full text. It must be said, however, that it took nearly four years for the argument he was advancing to be understood and acted on, and that those were lost years during the a 13-year Labour Administration.
Frank Dobson
I should point out that, partly as a result of earlier negotiations, we had secured an increase of £20 billion.
Paul Burstow
I may return to that point later, but first I want to talk about my own experiences of my local national health service, and in particular about a visit that I paid to my local trust, Epsom and St Helier University Hospitals NHS Trust, at the beginning of the month. During the visit I had a chance to meet staff, including A and E staff. I pay tribute to the hard work that is done in the trust, and especially to the work that is done in the A and E department. Last week Epsom and St Helier was placed sixth among all the London trusts in terms of the time for which people were having to wait in A and E, when measured against the standard, and, according to figures that were published yesterday, 99% of people are seen within the standard four hours. That is an example of great performance. The trust is facing great pressure, but it is doing a fantastic job none the less, and that side of the story ought to be told. We ought not to focus only on hospitals that may not have learnt some of the lessons that have been learnt by my local trust.
The A and E staff members whom I met made it clear that there was no single cause of the pressures in their department. In fact, the precise mix of factors varies from one hospital to another, and from one area to another. St Helier, however, has made excellent use of the winter funding it has received. It has added capacity to A and E, and has introduced examples of good practice. For instance, there are daily reviews of patients to ensure they are being given the right treatment in the right place; patients who are ready to be discharged are identified on the previous day so that arrangements can be made in good time; and there is a system of “ward buddies”, enabling corporate staff to provide additional administration support at times of extreme pressure—such as the present time—in order to assist safe discharge. A further welcome boost is the news that an extra £325,000 has been provided to assist people’s safe discharge to their own homes or to step-down care.
A piece of work examining the position in the Sandwell and west Birmingham area revealed huge variations between attendance rates by practice. Its authors found that some people considered A and E attendance to be the norm, and that a fifth of attenders made a conscious decision to go to A and E on the previous day. They also found that many A and E attenders believed that it was not even worth trying to access primary care in the first place. There are issues relating to communication, understanding of the system, and how we explain it. That cannot be dealt with in a universal, national way; it must be tailored to patients’ preferences and their expectations of the system at local level. That piece of work has already helped those in Sandwell to think about how to target messages more effectively in order to ensure that people have access to the support they need at the time they need it.
Paul Burstow
I must make some progress if others are to have a chance to speak.
The NHS has grappled with a productivity challenge during the current Parliament, but it should be noted that it was first set up and signed off by the last Administration. The target was £20 billion, and it was to be delivered within a shorter period than the coalition Government set in their 2010 spending review. The Labour productivity programme was set in 2009, and it was clear then that the NHS was on notice that it faced a very tough settlement regardless of which party was in government after the 2010 general election. Reducing management overheads has been a key part of our efforts to balance the books during this Parliament. Focusing on the management overhead costs of the commissioning side of the NHS in the legislation that went through the House at the beginning of the Parliament was sensible, and increasing clinical involvement in commissioning was another important move.
Paul Burstow
I will not, because I want others to have a chance to make their speeches. I hope that the right hon. Gentleman will forgive me.
In fact, that legislation did not change the configuration and organisation of hospitals, although that is how it is routinely portrayed by Opposition Members. As a result of the change to commissioning, £1 billion a year is now being saved, and there are 13,000 more front-line staff in the NHS. Having laid the blame for the pressures on A and E on a reorganisation of the NHS, which is the central proposition advanced by him today, the shadow Secretary of State then tells us that the solution is another comprehensive reorganisation. Is he now suggesting that that is not the case?
A and E (Major Incidents)
Frank Dobson Excerpts(9 years, 4 months ago)
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Mr Hunt
My hon. Friend is absolutely right about that, and it is very important. Targets matter, but not targets at any cost. It is worth remembering that, over the four years we were seeing the tragedy unfold in Mid Staffs, it was meeting its A and E target the majority of the time. So it is very important that patient safety is the priority. That is why we have to support NHS trusts when they have major incidents and why we have to make it clear that, although targets matter, trusts need to be sensible and proportionate in their efforts to meet those standards.
Frank Dobson (Holborn and St Pancras) (Lab)
Does the Secretary of State accept the truth of the assertions by A and E doctors and nurses that the call handlers working for the 111 service are referring far more patients to A and E than happened when NHS Direct was staffed by nurses, who exercised professional discretion?
Mr Hunt
It is always important to keep the algorithms used by call handlers—111—under review. I say to the right hon. Gentleman that 111 is part of the way we have been able to relieve pressure on A and E departments. Calls to 111 doubled this Christmas, and 27% of the people who called it said that they had been planning to go to an A and E department but did not do so following the call. That is a very important way of relieving pressure on our A and E departments.
UK Ebola Preparedness
Frank Dobson Excerpts(9 years, 4 months ago)
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Mr Hunt
Yes, I am. I join the hon. Gentleman in commending the actions of the Nigerian authorities. What has happened in Nigeria in respect of Ebola shows a great deal of hope for what is changing in Africa more generally. There was a perception that all African countries would find it as challenging to deal with Ebola as Sierra Leone, Liberia and Guinea have found it, but it is clear that a generation of African countries have developed substantially and are able to respond in a much more effective way. That is a very encouraging change from what might have been the case 10 or 20 years ago.
Frank Dobson (Holborn and St Pancras) (Lab)
I thank the Secretary of State for his statement. I am in no position whatever to comment on the effectiveness of the screening and suspect that no one else in the Chamber is. On long-term preparedness, it is several decades since Peter Piot, now director of the London School of Hygiene and Tropical Medicine, first identified Ebola. Worldwide, not enough has been done to address the problems. We should not be looking for a vaccine now; it should have been looked for years ago. I hope the Secretary of State gives full support to the rare disease consortium that has been established by the London School of Hygiene and Tropical Medicine, Imperial college and the Royal Veterinary College to look at infectious diseases that are capable of crossing from one species to another, and in particular this species.
Mr Hunt
The right hon. Gentleman is absolutely right. Peter Piot is a remarkable man who came to Downing street to advise the Prime Minister and me early in the development of the Ebola crisis. He is well worth listening to on this subject.
The right hon. Gentleman also makes a good point in that the global response to Ebola was far from adequate. The World Health Organisation has some important lessons to learn, and tomorrow my right hon. Friend the Secretary of State for International Development and I will meet Margaret Chan, when we will no doubt talk about those lessons. In an era of globalised travel, it is important that we have a much faster and more effective response when we have outbreaks of deadly viruses.
NHS (Five Year Forward View)
Frank Dobson Excerpts(9 years, 5 months ago)
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Mr Hunt
The commitment to a paperless NHS is not a commitment to the creation of paperless hospitals by 2018; it is a commitment to the creation of a paperless NHS so that, with patients’ consent, information can flow seamlessly between different parts of the system. The interface between primary care and secondary care, and social care, is a very important part of that process.
Frank Dobson (Holborn and St Pancras) (Lab)
Will the Secretary of State tell the House how much money is now being diverted from patient care to the negotiation of legally binding contracts between commissioners and suppliers of services, or will he confirm that he cannot do so because he does not bother to collect the information?
Mr Hunt
What I will confirm to the right hon. Gentleman is that the rules on the contracting out of services are the rules that we inherited from the Labour Government, although he personally might not have introduced them had he remained Health Secretary throughout those 13 years.
Mitochondrial Replacement (Public Safety)
Frank Dobson Excerpts(9 years, 8 months ago)
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Frank Dobson (Holborn and St Pancras) (Lab)
Mitochondrial disease is horrible. It has dreadful effects on children and shortens their lives and there is no cure. The scientists at Newcastle university have been trying to improve the inadequate treatment services that are presently available and one of the reasons why they got involved in this research is that they do not see very much progress there. The replacement technique does not provide a cure; it prevents the condition from arising in the first place, and generally speaking we all believe prevention is better than cure.
There is no other option for these families and children. What is proposed would not be permitted under the law passed in 1990 and there has been consultation since 2003 about changes to the law, which led to the law being revised in 2008. That permitted progress to be made on this issue by regulation when the House decides that that should happen.
Some people have fixed views and are totally against any embryo research and any changes to human fertility, and some other people want a total free-for-all. By and large, most of us do not want either of those things. The practical measures that were put in place through the HFEA have worked very well. They provide protection against the unprincipled and dangerous use of genetic science, and everything is subject to strict regulation. People are rightly concerned about the idea of designer babies and super-babies and the creation of a master race, but mitochondrial DNA replacement does not do that. All it does is eliminate one horrible life-threatening defect. It does not change personalities, and the baby we hope will be born will have a usual father and a usual mother—one mother and one father—and the idea that they will have three parents is ridiculous.
Will it work? We do not know. There is a risk that it will not work. That is in the nature of science. In the earth-shattering paper produced by Crick and Watson in 1953, they were tentative and were not very sure about DNA, but they pressed on.
Will it be safe? We cannot say for certain that it will be safe. There is always risk, but the risk will be taken only with the informed consent of the parents, and if people had always avoided risk in this sphere and if in 1968 at Oldham general hospital Robert Edwards, Patrick Steptoe and Jean Purdy had not taken risks with the agreement of Mr and Mrs Brown, the first test-tube baby in the world would not have been born and the whole world would be worse off as a result. If the scientists are willing to take the risks and keep them to a minimum and the parents are willing to take the risks and take the advice, we should put the HFEA in a position to regulate and permit this technique so that it can be used when it and it alone, is convinced that it is safe. That is why I oppose tonight’s motion.
Robert Flello (Stoke-on-Trent South) (Lab)
I thank the hon. Member for Congleton (Fiona Bruce) for securing this important debate. Some in this House are in favour of the treatment and oppose the motion, whereas others, like me, support the motion and oppose the procedure. The important thing is to have the debate and to put down a marker, and I hope that the Government do not try to rush these things through, as I believe they originally intended.
Frank Dobson
Consultation on this started in 2003. If this is a rush, how would my hon. Friend describe something that was slow?
Robert Flello
I am grateful to my right hon. Friend for that. I have been in this House since 2005 and this is the first debate I have had here on this matter, even though the consultation may have started in 2003. I will return to the issue of the consultation shortly, if I am able to do so in the four minutes and 10 seconds remaining to me.
There is no doubt that this disease affects many children—I believe the figure is one in 6,500—and has some horrendous and devastating consequences. However, the chief medical officer seems to believe that perhaps 10 lives a year might be changed as a result of this treatment. That is absolutely important for the 10 people involved and their families, but my understanding of the science is that it is very hard for the researchers to know who those 10 people might be and how to decide which children might benefit and which might not.
I agree with a number of speakers who say that two issues are involved. I have grave concerns about this from not only a moral, ethical point of view, but a public safety point of view. Whatever someone’s position on mitochondrial transfer, I am sure we must all agree that we cannot authorise new research techniques that are unsafe or might be unsafe. In this context “unsafe” does not only mean that procedures may not work; it means that they may result in disabilities and illnesses. To put it crudely, there is every possibility that we could be legislating to allow techniques that could cause damaged embryos, resulting in further damaged children. That is not spin; it is a reasonable assumption based on the available data. Newcastle university’s own paper concluded that, compared with control experiments, 50% fewer eggs fertilised through pronuclear transfer reached the blastocyst stage—in other words, pronuclear transfer is twice as likely to cause the embryos to fail. No further work was conducted on why so many of these embryos developed abnormally, despite consistent calls from concerned scientists.
Based on the available data, therefore, we cannot rule out the possibility that these techniques could cause the people born as a result to have illnesses or disabilities. The Government have a responsibility, as we all do, to avoid such eventualities, and we cannot take that lightly. We might not know the result for many generations. We might not know whether some damaged has been caused until three, four or five generations later. We simply cannot know that. Indeed, in a conversation I had with an hon. Friend in this House not a few hours ago there was talk of how science is about probabilities and risk; it is not fact but about what may or may not happen.
Care Bill [Lords]
Frank Dobson Excerpts(10 years, 2 months ago)
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Andy Burnham
Government Members would do well to listen to my right hon. Friend because she followed that whole process in detail. If people listen carefully, she is saying that clinical evidence took second place, and the process was driven by management consultants, not by clinicians. Government Members told the House that doctors would be in charge from now on, but that was not the experience of my right hon. Friend or the hon. Member for Stafford. That is why this proposal should not be accepted by any Member of the House.
Frank Dobson (Holborn and St Pancras) (Lab)
My right hon. Friend says that the propositions were made by management consultants. He will be aware that those consultants were from PricewaterhouseCoopers, which was Northern Rock’s auditor and did not notice that it went broke, and KPMG, which was the auditor for Halifax Bank of Scotland and Bradford and Bingley, and did not know that they went broke. They are probably giving bad financial advice as well as clinical advice.
Andy Burnham
I am not sure there is much I can add to that. Why are management consultants better placed—my right hon. Friend makes the point that they are not—to make sweeping changes to hospitals in our constituencies than experts and clinicians?
Dr Poulter
I must make progress. I want to address the points made by my right hon. Friend the Member for Sutton and Cheam (Paul Burstow). I will not give way until I have made better progress. On the point made by the right hon. Gentleman—and this is important—when he put forward the legislation on the TSA, he envisaged potentially turning it into a hospital closure clause. In 2009, on Second Reading of the Health Bill, he said:
“We believe these measures will provide protection against the possibility of NHS providers continuing indefinitely.”—[Official Report, 8 June 2009; Vol. 493, c. 544.]
That would suggest that the right hon. Gentleman thought that whole organisations might be shut down or closed as a result of the TSA regime. We do not believe that that is the case. We recognise that trusts, when they severely fail, may have to change the services they deliver. We want to protect trusts from the closure that the right hon. Gentleman envisaged in his remarks. His own words indicate that Labour had a hospital closure clause in the TSA regime. The Government, however, are making it clear that this is about service change in the interest of patients when all other avenues have been exhausted, which is a good thing.
Let me turn now to new clause 16, tabled by my right hon. Friend the Member for Sutton and Cheam, my hon. Friend the Member for St Ives (Andrew George) and other hon. Members.
Dr Poulter
I will give way to the former Secretary of State in one moment, but I would like to make some progress. I have been very generous in giving way.
The Government are grateful to Members for raising these important issues, but, regretfully, we cannot accept the amendment. The amendment makes two key changes. First, it gives commissioners of other trusts affected by the recommendations of an administrator at a foundation trust the power to define essential services at those trusts. That would be cumbersome and impractical and draw the focus away from the trust in administration and undermine the need for recommendations affecting other providers to be “necessary and consequential”, which is something that my right hon. Friend the Member for Sutton and Cheam believes in and raised in Committee.
Secondly, protecting essential services gives the administrator their focus for the trust in administration; it is a critical part of the process. Asking commissioners at other trusts to define their essential services would incorrectly indicate an equivalence in the administrator’s role between the failed trust and other successful providers.
Clause 119 recognises the need to give other commissioners a clear role and a proper say. It already extends the existing requirement on an administrator at a foundation trust to obtain the consent for their recommendations from each commissioner of the failing trust, and also from each commissioner of any affected trust. NHS England support must be sought in cases where not all commissioners agree.
Let me be absolutely clear. Under subsections (3), (4) and (6), the commissioners who are asked to agree and draft the final TSA report already include commissioners from affected trusts. It may be hard to spot that in the clause, as it amends existing legislation.
Clause 119 also requires the administrator to consult other affected commissioners. He or she must publish a summary of the consultation responses and take them properly into account when making final recommendations. The Secretary of State or Monitor will need to be satisfied that the administrator has carried out their administration duties properly, including showing proper regard for the statutory guidance.
Commissioners of other affected trusts will therefore have every opportunity to make their views known. However, I would like to thank my right hon. Friend the Member for Sutton and Cheam for bringing the matter to our attention. The Government agree that it is important for other local commissioners to be able to protect their essential services. We will update the guidance to make it clear that the agreement of commissioners to the TSA report should include their agreement that essential services have been protected at other trusts, as well as at the failing trust, so that all local commissioners have an equal say, with NHS England arbitrating in the event of disagreement. Furthermore, I would like to invite my right hon. Friend to chair a committee of MPs and peers to consider the draft guidance and ensure that his concerns are properly addressed before the regime is used.
Mid Staffordshire NHS Foundation Trust
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Mr Hunt
I did not hear Deb Hazeldine this morning, but I have met her on a number of occasions, and she is an extraordinary, powerful advocate for the changes that we need to make in the NHS. I have had discussions with my right hon. Friend the Leader of the House about the possibility of debating this on the Floor of the House, and I would very much welcome the opportunity to do so. My right hon. Friend deserves great credit for the fact that he was one of the earliest people to push for a full inquiry. I hope that the shadow Secretary of State will now accept that it was wrong not to have a public inquiry—it was blocked so many times by the Labour party—because we have learned so much from what Robert Francis has been able to say, and the NHS will be the better for it. Great credit should go to my predecessor, who is sitting here now, who took the decision to have that public inquiry.
Frank Dobson (Holborn and St Pancras) (Lab)
Does the Secretary of State not agree that the horrors of Mid Staffs were taking place at the same time that wonderful first-class care, from both a clinical and compassionate point of view, was available in many hospitals throughout the country? Is he confident that the measures that he is putting forward now will ensure that the worst performing hospitals will raise their standards to those of the best?
Mr Hunt
We have to wait and see, but we have put in place a radical, tough new Ofsted-style inspection regime. The point of that regime is not just to identify hospitals where care is unsafe, but to identify outstanding hospitals, so that hospitals in difficulty have hospitals from which they can learn, and we create a culture, just as we have in schools, where failing schools learn from outstanding schools and have a pathway to improvement. That will make a big difference. As the right hon. Gentleman knows, we now have 13 hospitals in special measures, and I am sure there will be more as the inspection process gets under way. But we will also have the great hospitals that we can learn from, which will mean that this can be a positive process for the NHS.