Access to Migraine Treatment

Gavin Williamson Excerpts

Wednesday 20th March 2024 Westminster Hall

[Sir Gavin Williamson (South Staffordshire) (Con)]

It is a pleasure to serve under your chairmanship, Mr Mundell. I congratulate my hon. Friend the Member for Bishop Auckland (Dehenna Davison) on securing the debate. It is hard to imagine that this issue has not been discussed in Parliament for such a long time. That is especially true, as she so brilliantly articulated, given its impact on so many people in every one of our constituencies. One in seven people suffer from migraine, and over 1 million suffer from chronic migraine, so the impact on people’s lives and on families is widespread.

I am fortunate that I am not one of those one in seven people, but I have the experience of living with someone who suffers from chronic migraine. When we do not suffer from migraine, we do not understand how debilitating it can be. We cannot comprehend how it can take over someone’s life and stop them doing the things they most want to do—that they get pleasure from, that they live for. When that migraine seizes them, they just cannot do anything. They have to lie in a darkened room and cannot function in the way we expect and hope people can function.

Some of the statistics are concerning and saddening. My hon. Friend touched on the fact that 29% of respondents surveyed by the Migraine Trust had had to move from full-time to part-time work. That impacts not just what they do, but their whole family, what they can expect from life and their ambitions for the future. It can change the course of their lives. It is also concerning that 43% of those surveyed felt that their workplace did not believe them when they came in and said they had had a migraine. My hon. Friend touched on the sense of a migraine being just a bad headache. That is not what people have to live with and what they experience; this is something that seizes them totally and utterly.

We need to be more open about the wider impact that this is having on so many people. The fact that 34% feel discriminated against at work is just so wrong. I hope that by talking about this issue and highlighting its impact on so many people, we can improve understanding, not just among the Minister and those in his Department, but in workplaces right across the country, so that they can adapt and work with people who suffer. In that way, they can ensure that those people can give their best all the time while dealing with something we would not wish anyone to have to deal with.

The loss of days worked has a wider impact on businesses and individuals, so we have to start thinking differently, not just in our hospitals but, as has been touched on, in general practice and pharmacy as well. If people were suffering from a more visible disease or condition, the Government would be not just spending £150 million a year but looking at investing so much more in treatment and research so that they could deal with it. Sadly, migraine is one of those conditions where there is not one single answer that can be rolled out to deal with what every single person is suffering.

More and more people in this country are turning to A&E to be treated for migraine, but it is not the best place for them to be treated; it is not good for the hospitals or the individual. All of us in the room will know how important it is to get the right primary care and the right level of support for people, so that they can prevent migraine as much as possible, because when it has set in, it is so much more difficult to treat.

We also see understaffing. We have 1.1 neurologists per 100,000 people in the United Kingdom, compared with four per 100,000 in France and Germany. In addition, so few GPs have the true specialist knowledge they need to be able to sit down with their patients, talk through this issue and have a proper understanding of the type and range of treatments best suited to that individual. The Minister will talk about how all GPs cover neurological conditions, including migraine, in their basic training. However, with the prevalence of migraine in society, we need general practitioners to have not just a bit of general knowledge on it, but more specialist knowledge, certainly in the larger practices. We can then get those individuals who are unfortunate enough to suffer from migraine the specialist advice, treatment and knowledge they need. As we are so short of neurologists across the NHS, we must ensure that the burden is lifted away from our hospitals.

I would put in a particular plea in relation to pharmacies. It is not always that easy to see a doctor when a migraine is starting to emerge—when the indicators that it is about to hit start to show themselves. That is why it is important to ensure that support and help are widely available. I urge the Minister to go back to his Department and use his characteristic imaginative, thoughtful and revolutionary style to encourage it to be a little more bold and radical in its thinking—to be a little more “action this day”, as opposed to having another report. There are many things that can make a difference to people’s lives very quickly. One is ensuring that we make better use of our pharmacies, thereby lifting the pressure off the wider NHS. Another is ensuring that there is better training for GPs so that larger practices have that specialist knowledge.

I will finish with a final plea. My hon. Friend the Member for Bishop Auckland mentioned CGRP blockers. We are all aware that there is not a silver bullet to this problem, but they are one of those things that give so many sufferers a little hope that there is something that can actually help. It is awful that people in many parts of the country cannot access them; they are not in a position to get the help they desperately need. I urge the Minister to go back to his Department and to look at CGRP blockers closely, along with the other actions that have been suggested. He could do something transformative for the lives of hundreds of thousands of people, and lift the misery they have to live with far too often.

--- Later in debate ---

[The Minister for Health and Secondary Care (Andrew Stephenson)]

It is a pleasure to serve under your chairmanship, Mr Mundell.

I start by thanking my hon. Friend the Member for Bishop Auckland (Dehenna Davison) for securing this very important debate. I know that she has long been a champion for those living with migraine, and that her own ongoing struggle with chronic migraine, which she talked about, made it difficult, if not impossible, on some days to keep up with the demands of her ministerial role. Since leaving that role she has continued to shine a light on the impact of migraine at work and on what it means to live with migraine.

I also pay tribute to the outstanding charities that support the estimated 10 million people in the UK who live with migraine. For example, the Migraine Trust does fantastic work in empowering, informing and supporting patients, and in driving improvements in treatment and care.

I thank my right hon. Friends the Members for South Staffordshire (Sir Gavin Williamson) and for Romsey and Southampton North (Caroline Nokes), my hon. Friend the Member for Kettering (Mr Hollobone), and the hon. Members for South Antrim (Paul Girvan), for East Londonderry (Mr Campbell), for Midlothian (Owen Thompson), for Greenwich and Woolwich (Matthew Pennycook) and for Bristol South (Karin Smyth) for their contributions to the debate. In those contributions, almost all right hon. and hon. Members talked about the stigma around migraine, with many setting out their own personal experiences of it. We all know that awareness is key to addressing discrimination, so I very much welcome each and every contribution to this morning’s debate.

Migraine is one of the most common neurological conditions, affecting about 10 million people in the UK, yet in this House we very rarely speak about it and its impact. Many of us have first-hand experience of migraine, or at least some insight into the enormously debilitating effect that it can have on people living with it. Indeed, my own sister, Andrea Stephenson, who I know you know, Mr Mundell, and who many other Members may know, suffers from migraine and I have seen the impact that it has had on her over the years.

As we have heard this morning, migraine is a severe and painful long-term health condition and, as my hon. Friend the Member for Bishop Auckland so eloquently said, it is so much more than just a really bad headache. Anyone who lives with migraine knows that it can have a very significant and negative impact on quality of life. Perhaps the cruellest aspect of the condition is its ability to strike with little or no warning, disrupting people’s ability to perform even the most basic daily tasks. Migraine symptoms can last for days, affecting all aspects of life, including family and work life and the ability to engage in social activities. Even between attacks, migraine can impact on quality of life, especially when people try to limit daily activities to prevent another migraine.

Although the human cost is important—it is the most important factor—it is worth reflecting on the economic cost, which my hon. Friend the Member for Bishop Auckland and my right hon. Friend the Member for South Staffordshire set out so well in their speeches. That is why timely access to appropriate and effective care and treatment is so important. Accurate, timely diagnosis can ensure that people can access migraine treatments as early as possible, helping them to get the care that they need to treat attacks when they strike and prevent future ones. There is no specific test to diagnose migraines; for an accurate diagnosis, GPs must identify a pattern of recurring headaches along with the other associated symptoms. Migraines can be unpredictable, sometimes occurring without the other symptoms normally associated with the condition, so obtaining an accurate diagnosis can take some time.

The NICE guidelines on headaches and the diagnosis and management of headaches in young people and adults, last updated in December 2021, set out best practice for healthcare professionals in the care, treatment and support of people who suffer from headaches, including migraine. They aim to improve the recognition and management of headaches and migraine with more targeted treatments to improve the quality of life for people with headaches and reduce unnecessary investigations. NICE has also produced a clinical knowledge summary on migraine. Clinical knowledge summaries are concise, accessible summaries of the current evidence for primary care professionals, focusing on the most common and significant presentations in primary care. They give trusted information to support safe decision making and improve standards of patient care.

The usual treatment approaches to migraine are designed to either stop or prevent attacks. Treatment for acute migraine includes medications such as analgesics, triptans and antiemetics. Treatments to stop or reduce the frequency of migraine attacks include medications such as beta blockers, tricyclic antidepressants and anti-epileptics. We are committed to supporting timely and consistent access to new, effective medicines for NHS patients, so I am pleased that in October 2023, NICE published technology appraisal guidance recommending Rimegepant for the acute treatment of migraine. Rimegepant is recommended where patients have tried at least two triptans but they did not work well enough; where patients cannot take triptans or where they were not tolerated; or where other medication has been tried but did not work well enough. In separate guidance, last year NICE also recommended Rimegepant as an option for preventing episodic migraine in adults where at least three previous preventive treatments have failed, opening a way for 145,000 people in England to choose that option.

[Sir Gavin Williamson]

I appreciate the Minister’s setting out all that has been done. A few hon. Members mentioned CGRP blockers. I am sure that an exciting announcement may be coming, but if not, can the Minister reassure us that they can be looked at, to ensure that something emerges and is done about them?

[Andrew Stephenson]

My right hon. Friend anticipated my next point. Several hon. Members mentioned the difficulties experienced by some patients in accessing CGRP blockers. That issue was raised by the hon. Member for East Londonderry in his intervention. I note my right hon. Friend’s concern, and the comments of my hon. Friend the Member for Bishop Auckland about the NICE guidelines being reviewed to allow specialist treatment such as CGRP blockers to be made available as a first-line therapy.

NICE develops its recommendations independently, based on an assessment of the available evidence of clinical effectiveness and cost-effectiveness and through extensive engagement with interested parties. It is right that those decisions are taken independently on the basis of the available evidence, so it would not be appropriate for me to intervene directly. However, NICE keeps its recommendations under active surveillance, and if significant new evidence emerged it would review its guidance. I very much hope that NICE has been listening to what has been said by hon. and right hon. Members in this debate and looks at the emerging evidence from charities, such as the Migraine Trust, which might prompt it to review the guidance.

The NHS in England is legally required to make funding available for treatments that have been recommended by NICE. If there are any concerns about the availability of a NICE-recommended treatment in a particular area, it is important that hon. and right hon. Members raise those with their local integrated care boards in the first instance. However, I would be more than happy to look into situations where Members still have concerns.

My hon. Friend the Member for Bishop Auckland raised the issue of CGRPs and prescribing rights in primary care. That is an interesting point. I have asked the Medicines and Healthcare products Regulatory Agency to look into this matter and I will write to my hon. Friend in the coming days.

Similarly, I will take away the point made by my right hon. Friend the Member for South Staffordshire about what more we can do to better utilise our local pharmacies. The Under-Secretary of State for Health and Social Care, my right hon. Friend the Member for South Northamptonshire (Dame Andrea Leadsom), is responsible for pharmacy policy. She has already overseen the roll-out of Pharmacy First, ensuring that more conditions than ever before can be addressed by pharmacists, rather than people having to wait to see a GP.

At the moment, we expect that patients suffering from migraine would normally be treated first by their GP. If this failed to resolve the problem, patients would be referred to a consultant neurologist for further investigations and tests. We recognise the challenges within secondary care, in terms of waiting list size and the length of wait, with patients waiting far too long to access the specialist care they need. Neurology is particularly challenging at the moment, with a need for more neurologists, specialist nurses and allied health professionals.

We are committed to reducing waiting lists. To this end, we commissioned NHS England to develop a long-term plan for the NHS workforce for the next 15 years, which was published in June 2023. This sets out how we would deliver the doctors, nurses and other professionals that will be needed, also taking into account improvements in retention and productivity. The plan looks at the mix and number of staff required and has set out the actions and reform across the NHS that are needed to reduce the supply gap and improve retention. The plan will help ensure that we have the right number of staff with the right skills to transform and deliver high-quality services for the future.

My hon. Friend the Member for Bishop Auckland, the hon. Member for Greenwich and Woolwich and my right hon. Friend the Member for South Staffordshire all raised the issue of awareness amongst GPs. UK medical schools determine the content of their own curricula. The delivery of these undergraduate curricula must meet standards set by the General Medical Council. The standards require the curriculum to be formed in a way that allows all medical students, by the time they complete their medical degree, to meet the GMC’s outcomes for graduates, which describe the knowledge, skills and behaviours they must show as newly registered doctors. Therefore, whilst not all curricula will necessarily highlight specific conditions, they all nevertheless emphasise the skills and approaches that a healthcare practitioner must develop to ensure accurate and timely diagnoses and treatment plans for patients, including for migraine.

All healthcare professionals, including GPs, are responsible for ensuring that their clinical knowledge remains up to date and for identifying learning needs as part of their continuing professional development. The Royal College of General Practitioners has developed e-learning resources to update primary care clinicians on the nature of migraine, the different diagnoses and how to approach a patient with headache.

Through NHS England’s getting it right first time—or GIRFT—programme, we are also offering practical solutions for managing the demand for services within secondary care. There have been major advances in treating neurological conditions, including migraine, but services often struggle to keep pace with innovation, which has a significant impact on outcomes for people living with those conditions. GIRFT is a national programme which is designed to improve the treatment and care of patients through in-depth, clinically led review of specialties to examine how they are currently being done and how they could be improved. The GIRFT national specialty report for neurology, published in September 2021, makes a number of recommendations applicable to migraine. For example, the report highlights that providing support and advice to GPs in diagnosing and managing patients with headache can improve management of patients without a patient necessarily having to be seen as an out-patient. GP access to CT and MRI imaging would also enhance GPs’ ability to manage headaches in the community using appropriate guidelines.

As several right hon. and hon. Members said, research is key. Investing in research is a key component of supporting people living with migraine. It plays a vital role in providing those working in the NHS with the evidence they need to better support patients and provide access to pioneering treatments, diagnostics and services. The Department of Health and Social Care funds research through the National Institute for Health Research, which has funded and supported a range of research projects on migraine over the past five years, including studies to assess the efficacy and cost-effectiveness of drugs to prevent and treat migraines, and resources and training on self-management. For example, a study that is close to completion is looking at the comparative clinical cost-effectiveness of pharmacological treatments for adults with chronic migraine.

I once again thank right hon. and hon. Members for their insightful points. I hope they and my hon. Friend the Member for Bishop Auckland are reassured by some of the measures I have outlined today. I recognise that we must go further, and I assure them that I will continue to support people living with migraine through system transformation, NIHR research and exploring and investing in new treatments to ensure we are delivering real results for patients on the ground.

Defibrillators

Gavin Williamson Excerpts

Wednesday 20th March 2024 Westminster Hall

[Jonathan Gullis (Stoke-on-Trent North) (Con)]

I beg to move,

That this House has considered public access to defibrillators.

It is a pleasure to serve with you in the Chair, Dame Maria.

Every year, 160,000 deaths—nearly a quarter of all deaths in the United Kingdom—occur as a result of heart and circulatory diseases. Of that figure, an estimated 100,000 people die each year from sudden cardiac arrest. Shockingly, the survival rate for out-of-hospital cardiac arrest has been persistently low, at around 8.5%. There is an urgent need for parliamentarians and the Government to improve the survival rate and radically change the way we approach cardiac arrest.

As chair of the all-party parliamentary group on defibrillators, I have heard some deeply moving stories that have led me to conclude that public access to defibrillators should be one of the Government’s foremost priorities. The APPG has undertaken a detailed inquiry into public access to defibrillators, which was published today. Its primary aim is to understand the impact of out-of-hospital sudden cardiac arrest and the need for improved public access to defibrillators. The plain reality is brutal: without defibrillation or cardiopulmonary resuscitation, someone’s chances of surviving cardiac arrest drop by 10% every minute. If a sudden cardiac arrest victim does not receive CPR or defibrillation within 10 minutes, they are unlikely to survive.

The quicker a defibrillator can be accessed, the more likely someone is to survive cardiac arrest. However, the APPG found that there are considerable regional disparities in access to defibrillators. The National Institute for Health and Care Research found that deprived areas had far more limited access: while 45% of the most affluent areas had at least one device, the figure was only 27% for the most deprived areas. Further, according to the journal Heart, people in England and Scotland’s most deprived areas are between 99 metres and 317 metres further away from their nearest 24/7 defibrillator than those in more affluent areas. Rural areas are also at a significant disadvantage: while 64% of urban areas have at least one device, the same can be said for only 36% of rural areas. Ambulance response times in rural areas are also considerably slower than in urban areas, heightening the risk of death by cardiac arrest. That should make access to defibrillators an imperative in those areas, but, much though I would like it to be, that is not currently the case.

Given the sad truth that socioeconomic factors, education, diet and stress can increase or decrease someone’s chances of cardiac arrest, that all goes to show that we need to improve public access to defibrillators significantly, especially in disadvantaged communities.

[Sir Gavin Williamson (South Staffordshire) (Con)]

I congratulate my hon. Friend on securing the debate. I know that he has done so much on this issue. In Stone in Staffordshire, we have the amazing charity AEDdonate, which does so much on installing defibrillators. One of the key points that it always hammers home is the importance of having defibrillators registered so the emergency services know where to direct people. Does my hon. Friend think that is critical to ensure that we get the best use out of them?

--- Later in debate ---

[Sir Gavin Williamson]

I congratulate the Department of Health and Social Care on that fund. My hon. Friend the Member for Stoke-on-Trent North (Jonathan Gullis) and I referred to the charity AED Donate. There is a lot of charitable work going on in this sector. I wondered whether it would be possible for the Minister to arrange for the charity to meet up with suitable officials, so that it can best understand how it can deliver the Department’s aims and so that the Department has an understanding of what it is delivering in communities across the country.

[Andrew Stephenson]

My right hon. Friend makes a very important point. I join him in paying tribute to that organisation. I would be happy to arrange a meeting with relevant officials in the Department.

Our partners on the programme of rolling out defibrillators are Smarter Society and the London Hearts charity. They have been assessing applications for delivering additional AEDs, working with a wide and diverse range of groups. The first hundred devices that Smarter Society distributed were fully funded, and our partners at the University of Warwick helped us to prioritise the areas of greater deprivation without an AED in situ.

I am delighted to update hon. Members and tell them that, as of 12 March, Smarter Society and London Hearts have now delivered 1,590 AEDs and are working to deliver more. I would also like to pay tribute to the work of my hon. Friends in the Department for Education, who are ensuring that every state school has access to a defibrillator. I am told more than 20,000 devices have been delivered to almost 18,000 schools. That will drastically increase the chances of surviving cardiac arrest for pupils and school staff across England.

The Department for Education has supported schools in making the defibrillators available to the community, having offered external heated defibrillator cabinets to primary, special and alternative provision schools in areas of deprivation, where access to defibrillators is typically lower. It has also provided internal cabinets to secondary schools with two or more defibrillators, so one device can be placed at a sports facility where cardiac arrest is more likely to happen.

All state-funded schools are required to teach first aid as part of the mandatory relationship, sex and health education curriculum—another positive change made by the Conservatives since 2010—since we have been in government. That involves children over 12 being taught CPR and the use of a defibrillator. The Department for Education has also provided awareness videos showing how simple the defibrillators are to use, and it is encouraging schools to share the videos in staff meetings and assemblies. That will ensure that as many people as possible are able to respond in an emergency.

I know that making defibrillators as affordable as possible is important to my hon. Friend the Member for Stoke-on-Trent North, as he set out in his speech. The Government and I agree, although we have to keep these matters under review. He will appreciate that matters relating to VAT are for my right hon. Friend the Chancellor of the Exchequer.

Although having access to defibrillators is important, just as important is knowing where they are, so that they can be used in a time of crisis. That is why the NHS is working in partnership with the British Heart Foundation, the Resuscitation Council UK and the Association of Ambulance Chief Executives to set up The Circuit, which my hon. Friend talked about. The Circuit is a national database that will make it easier for ambulance services quickly to identify the nearest defibrillator when assisting someone who is having an out of hospital cardiac arrest.

As of 1 March, there were 86,337 defibrillators in the UK—68,509 in England— registered on The Circuit. We encourage everyone with an AED to register it. I can assure the House that all defibrillators granted by the community automated external defibrillator fund must be registered on The Circuit. The registration is completed by what is known as a defibrillator guardian—someone nominated by the organisation hosting the device. That role involves registering it on The Circuit, regularly checking the defibrillator to ensure that it can be used, and keeping the record updated. As I hope my hon. Friend appreciates, that is both an effective and a pragmatic approach to ensuring that defibrillators are where we think they should be, and that they continue to be ready for use in times of crisis.

I reinforce the fact that defibrillators are designed for ease of use. If there is one message I want to land in today’s debate, it is that these simple devices are easy to use, yet life-saving. Anyone can use them without formal training. That said, training is actively helpful in increasing the confident use of defibrillators in a community setting. For that reason, the NHS has partnered with St John Ambulance to help people gain the skills they need. That includes a national network of community advocates championing the importance of first-aid training, and training up 60,000 people, which will save up to 4,000 lives a year by 2028.

I would like to take the opportunity to pay tribute to those organisations and others that work tirelessly to improve defibrillator access and first aid training in communities across the country. Their contributions are crucial in getting help for people in some of the toughest moments of their lives and I cannot thank them enough.

My hon. Friend the Member for Stoke-on-Trent North has raised the idea of requiring defibrillator training as part of driving tests. My hon. Friend the Member for Colchester (Will Quince) was a strong supporter of that as my immediate predecessor in this role. While this is primarily a matter for the Department for Transport, I know that my hon. Friend the Member for Stoke-on-Trent North will continue to make representations in this area. I assure him that the Government are always happy to engage in those discussions.

I am also aware of my hon. Friend’s interest in ensuring that all emergency vehicles carry AEDs as a matter of course. While the Government fully recognise that the equipment carried by emergency vehicles is an operational matter, I encourage all services to consider the benefits of carrying AEDs as a matter of routine.

On a personal note, I would like to pay tribute to David Brown, the incredible team leader of the Pendle, Padiham and Burnley community first responder team, of which I am part. I was backed up by David on the first ever cardiac arrest I attended as a community first responder almost 10 years ago. He does incredible work delivering CPR training across Pendle, as well as putting in thousands of hours as a volunteer with the North West Ambulance Service.

I would also like to pay tribute to my late constituent, Ruth Sutton. In 2016, Ruth saw a photo of me in the local newspaper unveiling a new community defibrillator in the Pendleside village of Blacko. She contacted me to see how we could get even more defibrillators across Pendle. Over the following months, she worked with me and the North West Ambulance Service, investigating possible locations to install new defibrillator cabinets. By 2018, Pendle had the best coverage for public access defibrillators in Lancashire, with 20 cabinets installed: a real, lasting legacy of a remarkable lady.

I hope that our prevention and treatment work, including the forthcoming major conditions strategy, which my Department is in the final stages of drawing up, will act as a guiding light for a faster, simpler and fairer NHS. In combination with our efforts to increase defibrillators and increase first aid training across the country, we will improve our ability to intervene in an emergency situation and to save lives.

I once again thank my hon. Friend the Member for Stoke-on-Trent North for securing this incredibly important debate. I look forward to working with him long into the future to make progress on this vital issue.

Question put and agreed to.

Oral Answers to Questions

Gavin Williamson Excerpts

Tuesday 5th May 2020 Commons Chamber

[James Cartlidge (South Suffolk) (Con)]

What steps he is taking to support children and young people to continue learning at home while nurseries, schools and colleges are partially closed as a result of the covid-19 outbreak.

[The Secretary of State for Education (Gavin Williamson)]

I am determined to help learning continue in these challenging times. We have committed over £100 million to provide devices and internet access to vulnerable children and published a list of high-quality online educational resources, and we continue to support parents and teachers in supporting children at home.

[Julian Sturdy [V]]

Headteachers in York have told me of their frustration that they will have to wait at least another month until they can provide students with laptops under the Government’s scheme. What assurances can my right hon. Friend give me that support will be available to schools in the meantime to help their most disadvantaged students learn from home?

[Gavin Williamson]

As I am sure my hon. Friend will understand, £100 million for computers and other support for schools is a major investment, and it takes a while for these resources to arrive at schools. We have already notified multi-academy trusts and local authorities of what resources they will be getting, and we continue to work to provide resources, with the BBC providing resources in the homes of children right across the country.

[Nigel Mills [V]]

Parents across Amber Valley have been doing a fantastic job of supporting their children to continue to learn while their schools are closed. Will my right hon. Friend join me in thanking them and set out what more we can do to support them to help their children continue to learn?

[Gavin Williamson]

I would very much like to join my hon. Friend in thanking the teachers and all the support staff who have done so much to support home learning and ensure that schools remain open for the children of critical workers and the most vulnerable children. We have seen the launch of the Oak National Academy, which is providing educational resources for children of all ages to support them in their learning, and we are looking at putting more and more resources online, to help schools and, most importantly, to help children continue to learn.

[Brendan Clarke-Smith [V]]

I very much welcome the funding for IT equipment, because there is nothing worse than when computer says no. Can my right hon. Friend confirm that the laptops and tablets provided to disadvantaged and vulnerable young people will not just benefit them while schools are closed, but will continue to be used by their schools to aid learning in the future?

[Gavin Williamson]

My hon. Friend is right in his analysis. It is not just about helping children during this crisis; it is about helping and supporting children for many months and years to come, ensuring that schools continue to have that resource and helping many children through that resource over a long period. We recognise that a lot of work needs to be done to support children as they catch up on what they have missed, because there is no substitute for a child being in a classroom, learning directly from a teacher.

[Lee Anderson [V]]

School closures will, of course, affect children of all ages and backgrounds in different ways. Children from more disadvantaged backgrounds are much less likely to have access to the internet via a mobile or tablet. Will the Secretary of State confirm that devices with internet access are being sent to disadvantaged children, so that they can learn online more easily? That would certainly help to ensure that the disadvantaged children in my constituency of Ashfield and Eastwood, which the Minister visited recently, are not further disadvantaged by this crisis.

[Gavin Williamson]

I had the great privilege of joining my hon. Friend on a visit to Leamington primary school in his constituency, to see the amazing work being done there. We have made substantial investment in not just laptops but 4G routers, to ensure that families have better access to the internet and that children can benefit from the brilliant resources, many of which have been made available for free by people, companies and organisations, to allow children to continue to learn.

[Mrs Drummond [V]]

Will my right hon. Friend join me in congratulating schools in Hampshire on their success in ensuring that 31% of vulnerable children are attending school, and in thanking all the teachers, school staff and children, particularly those in Meon Valley, for their hard work both in school and at home? Has he assessed the impact on the mental health of children and young people during the coronavirus crisis?

[Gavin Williamson]

I do indeed join my hon. Friend in thanking the teachers, the support staff, the social workers, Hampshire County Council and all those who have been involved in making sure that schools stay open and available for vulnerable children. They have done amazing work. The attendance rate she highlights is truly outstanding. Since the Easter holidays, we have seen a doubling of the number of vulnerable children who are attending school, and that is down to the work of teachers, school staff and social workers, reaching out and encouraging them to come into school. Mental health, which my hon. Friend also raised, is an important issue. That is why we have committed £5 million of funding to support charities to help children with mental health concerns and issues while they are at home.

[James Cartlidge [V]]

While schools are closed, the issues of home-school transport affecting my constituents have effectively been paused, but they will come back eventually and potentially result, for example, in siblings having to go to separate schools. Although this is a county council matter, the Government issued a consultation on home-school transport last October, and five Suffolk MPs, including me, wrote to the Government asking them to consider changing the guidelines to state that siblings should not be separated by changes in school transport policy. Has my right hon. Friend had time to consider that consultation, and will he publish the response soon?

[Gavin Williamson]

The consultation closed in October last year. We were hit by twin issues of purdah being imposed and now, obviously, our principal focus being on dealing with the coronavirus. We hope to respond to the consultation in the near future, but I am not currently in a position to give my hon. Friend an exact date.

[Rebecca Long Bailey (Salford and Eccles) (Lab)]

Constant speculation on when schools will reopen and whether it is safe to do so is leaving many parents, pupils and staff anxious. Last week, it was reported that the Government were looking at best practice in other countries; this weekend, it was reported that the Government would reopen schools for year 6 pupils on 1 June; and last night, it was reported that there were discussions in Government about giving schools and multi-academy trusts the flexibility to decide for themselves, amid concerns that Ministers were coming under pressure to help to kick-start the economy. I am sure the Secretary of State will want to reassure parents, pupils and staff that their safety is the Government’s No. 1 priority, so will he clarify the basis on which the Government are making decisions on school and college opening, and when will he make the scientific advice supporting his strategy publicly available?

[Gavin Williamson]

First, let me take this opportunity to congratulate the hon. Lady on her new appointment. I appreciate the time she has made available to speak with me, and I hope the regular briefings from officials that we are providing are of considerable assistance to her, as I think they were to her predecessor.

All SAGE advice is made public, and we will certainly do that. On the return of schools, I am sure the hon. Lady shares my desire for children to be given the opportunity to return to school when it is the right time to do so. The decision will be based on the scientific and medical advice that we receive. I assure her that we will take a phased approach to reopening schools, and we will always aim to give schools, parents and, critically, children maximum notice of when that will happen.

[Rebecca Long Bailey]

I thank the Secretary of State for his kind comments. He must understand that faith that children and staff are safe will be necessary to parents having the confidence to send their children to school, but nearly 1 million pupils in English schools are in classes of 31 or more—an increase of 28% since 2010—so there is understandable concern that social distancing will be difficult in schools. Everyone wants a return to vital education to support pupils and to stop the ever-widening attainment gap, but does the Secretary of State agree that first we need a national plan for social distancing and personal protective equipment, evidence of a sustained downward trend in cases, comprehensive access to testing for staff and pupils, a whole-school strategy for when cases emerge, and protection for the vulnerable? In the words of the National Education Union:

“Anything else will be a dereliction of duty from government”.

[Gavin Williamson]

I think the hon. Lady would very much appreciate the fact that I take my responsibilities for the safety and the health of children who attend school as the absolute principal motivation for everything I do, as is the case for those who work in schools. I always welcome constructive dialogue with her, which is why we have made every effort to do so, about how best we can support children to be in schools. Let us not forget that the overwhelming majority of schools—over three quarters of them—are currently operating in a safe, considered and proper way, supporting the children of critical workers as well as those children who are most vulnerable in society. Every step we take is about making sure that we look after those who are the most important part of our society, and that is our children, but also about supporting those who work in educational settings.

[Henry Smith (Crawley) (Con)]

What steps his Department is taking to ensure that vulnerable children are identified and supported during the covid-19 outbreak.

[The Secretary of State for Education (Gavin Williamson)]

Schools remain open to children in care, and local authority virtual school heads are actively tailoring their expert offer of advice and support to all children on what they are learning in schools. For those not attending, we have made it clear to local authorities and schools that they should be doing everything they can to maintain contact with and support for children not attending school.

[Henry Smith [V]]

What specific support during the covid-19 pandemic is being provided for children in care and children with special educational needs, such as dyslexia?

[Gavin Williamson]

We have been working right across the sector to make it absolutely clear that we understand the need for very specific, tailor-made guidance for a lot of children in special educational needs settings. We have been working with special schools to be able to provide that. We have also been providing tailored advice, support and resources online for children with a whole spectrum and range of special educational needs, as well as on how we support families to give education at home.

[Mr Speaker]

I welcome Tulip Siddiq to the Front Bench. I call the shadow Minister.

[Tulip Siddiq (Hampstead and Kilburn) (Lab)]

Thank you, Mr Speaker. Last week, the Children’s Commissioner for England, Anne Longfield, said that the Government’s latest reduction in legal protections for children in care without proper scrutiny or an opportunity to scrutinise was not justified, given that the staffing in social care is “holding up”. The Labour party agrees with the Children’s Commissioner for England. Does the Secretary of State also agree with the Children’s Commissioner for England?

[Gavin Williamson]

On the regulations we have laid, we worked very closely with the ADCS—the Association of Directors of Children’s Services—on how we make sure we do everything we can to maintain the very best support for all children when they are in care. It and the sector have specifically asked us to make sure that some flexibilities are made available to them. This is a temporary measure that we have taken in response to concerns that people have raised about making sure they are able to provide the best care for the most vulnerable children. It is certainly not something that is going to be continued once we are through this crisis.

[Robert Halfon (Harlow) (Con) [V]]

First, will my right hon. Friend thank the teachers and support staff of Harlow, who have been doing everything possible to teach children of critical workers and vulnerable children over the past few weeks? Given that only 5% of vulnerable children are being educated in schools, nearly 50% of under-16s are potentially being exposed to online harms and possibly two thirds are not accessing online education, does my right hon. Friend agree that a catch-up premium, with tuition, mentoring and wellbeing, will be necessary for these vulnerable children as schools begin to reopen once again?

[Gavin Williamson]

I certainly will join my right hon. Friend in paying tribute to the teachers and all those who work in schools not only in Harlow but right throughout the country for the amazing work that they are currently undertaking.

We are working closely on how we ensure that every child in this country has the ability to catch up, and I was interested to hear my right hon. Friend’s ideas. We are looking into how we can take forward some of those concepts, including the enormous good will among the British public, to help to support children to make sure that they do not miss out as a result of this crisis. We need to make sure that that is not just an idea but actually becomes a reality.

[Steve Double (St Austell and Newquay) (Con)]

What assessment he has made of the potential effect of the introduction of T-levels on the (a) quality and (b) recognition of technical education.

Mid Staffordshire NHS Foundation Trust

Gavin Williamson Excerpts

Tuesday 7th January 2014 Westminster Hall

[Gavin Williamson (South Staffordshire) (Con)]

Most of my constituents and, I am sure, many of my hon. Friend’s, would find it deplorable if Stafford hospital did not have a consultant-led maternity unit. The pressure that that will place on so many hospitals—Walsall, Manor, New Cross, Queen’s or the University hospital of North Staffordshire—will be unsustainable. I urge Ministers to look at the issue again.

[Jeremy Lefroy]

I am most grateful to my hon. Friend. I will come to that important point.

I pay tribute to the work of Support Stafford Hospital, because the impact of its campaign has shown just how much the community values the services at Stafford and Cannock. I also pay tribute to the working group, which I set up, and all those who have worked with me on that to provide us with the detail on alternative proposals, some of which I shall outline.

There is no doubt that the administrators listened carefully to what was said in the consultation and made a number of changes in their final proposals. However, the proposals as they stand are insufficient. What I am setting out requires not a re-doing of all the work of the trust special administrator—given what I have said about the urgency of the situation, that would not be sensible—but a modification of the detail.

I do not believe that such a modification would necessarily require more money than is currently proposed, although that remains to be seen, but it would be of huge benefit to many thousands of my constituents, and those of hon. Friends and other hon. Members. It will also ensure that both Monitor and the Secretary of State can fully comply with their legal obligations under the Health and Social Care Act 2012, in respect of health inequalities, as I will show later.

My proposal is that rather than cutting three areas of service in Stafford, those continue in a more cost-effective form, at least for two or three years. I, and the clinicians at Mid Staffs, consider that it will be quite possible to show how these services can be run across the two sites in Stoke and Stafford on a networked basis. The areas concerned are paediatrics, obstetrics and maternity and critical care.

First, the report proposes a reduction of the critical care unit to four beds. It says that the possibility of the highest level of critical care—level 3—should be maintained, but it is not clear how this will be possible without a rota for specialists in critical care. The critical care department at Stafford made its own submission to the consultation, which suggested a reduction in beds and a networked specialist rota. That seemed eminently sensible. Given that the CCU at Stafford is a net contributor and supports several other activities, I urge Monitor and the Secretary of State to determine that this model is tried for a period, during which it will, hopefully, be proven to operate well, clinically, operationally and financially.

The TSA’s final report also proposes, as my hon. Friend the Member for South Staffordshire (Gavin Williamson) mentioned, removing the consultant-led obstetrics and maternity service and replacing it with a midwife-led unit dealing with approximately 350 to 400 births a year. That is a step forward from the draft report, which proposed no childbirth at all at Stafford. However, my constituents and I do not believe that it is sufficient.

Currently, Stafford sees more than 2,000 births a year and that is likely to rise, with extensive house building, various new business parks being built and the doubling of the size of MOD Stafford, to mention but some developments, resulting, in the coming years—even with a MLU—probably in some 2,000-plus babies being born in other maternity units, mainly at Stoke and Wolverhampton. UHNS in Stoke already sees some 6,000 a year and its population is also growing. With at least 1,000 births, and probably more from Stafford, UHNS will probably approach 8,000, which is the number currently born at the largest unit in the country, in Liverpool.

The NHS rightly promotes choice for women about where to have their babies and the Prime Minister has spoken out against the trend towards ever larger units. Yet that is precisely what is being proposed here for women who are unable to use a MLU, due to the possibility of complications in childbirth. There would also be an impact on those who currently use UHNS and the Royal Wolverhampton, as their local units will become even busier—probably including Walsall as well—taking in women from a much wider area.

My proposal, and that of clinicians at Stafford, is to continue with the current service, fully networked with UHNS, while the impact of the current rise in both the population and birth rate is assessed. That would also enable the special care baby unit at Stafford to continue to support the regional intensive care network for babies, as it currently does. An added benefit would be that women will continue to have a local obstetric and gynaecology service, which I am sure the Minister will appreciate as he comes from that specialty. Again, that would relieve pressure on the larger University hospital of North Staffordshire and the Royal Wolverhampton hospital.

Thirdly, the TSAs propose to reduce the paediatric assessment unit to 14 hours a day from 24 hours a day and to do away with in-patient paediatric beds. There will be no paediatric rota, although A and E doctors will receive extra paediatric training and paediatric out-patient services will continue. The principal reason given by the TSAs is the national standards of the Royal College of Paediatrics and Child Health, which state that such services should be provided by a full consultant rota, which is usually between eight and 10 consultants, whereas at Stafford it is between five and six.

Let me be clear about the consequences: if the proposal is allowed to happen, the clear logic is that dozens of other paediatric units across the country that have similar numbers of consultants, or indeed fewer consultants, must be closed or have their activities drastically curtailed. Monitor cannot use the argument that that must happen at Stafford but not at other foundation or NHS trusts for which Monitor or the NHS Trust Development Authority are responsible, and neither can the Government.

The argument that all in-patient paediatric care should take place in the largest hospitals is not accepted by the general public. They fully understand why very sick children should go to specialist units; they do not understand why their local general hospital cannot receive sick children at night or for short stays, and neither do I. If experts at the Royal College insist on making that argument, however, let it be open, let it be consistent across the land and let it be agreed by all political parties. The proposal should not be implemented by stealth through a trust special administration that in no way arose because of the performance of the paediatrics department at Stafford.

I have one final point.

Stafford Hospital

Gavin Williamson Excerpts

Thursday 4th July 2013 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

Thank you, Madam Deputy Speaker, for this opportunity for a debate on Stafford hospital.

On 31 July, the administrators of the Mid Staffordshire NHS Foundation Trust will present their proposals for the future of health services at Stafford and Cannock hospitals. They, as well as Monitor, to which they report, and the Government, have a tremendous opportunity to show the way forward for the NHS as a whole, which celebrates 65 years this week. This trust special administration is the first under the Health and Social Care Act 2012 and is a chance to show how emergency, acute and maternity services can continue to be provided affordably, locally, safely and to the highest standards. We are also talking about the administration of a trust that has been the subject of intense scrutiny since the revelation of appalling standards of care in some parts of Stafford hospital in the period to 2009. Since then the improvement has been marked, as the Care Quality Commission has evidenced, although there is no complacency about that on our part.

When tens of thousands of people marched through Stafford on 20 April this year to a rally that I had the honour to address, along with the Bishop of Stafford, we were showing just how much we value the services provided at Stafford and Cannock. We were also expressing our concerns about the future—a future that the contingency planning team’s report, which came out earlier this year, said was unlikely to include the provision of most acute, emergency and maternity services in Stafford, even though our maternity services have some of the best outcomes in the country. When the trust special administrators produce their report, I hope they will provide us with complete access to the data on which they worked, as well as the assumptions made—something that did not happen with the contingency planning team.

We were also making it clear that we cannot see how other, neighbouring hospital trusts, which are already under so much pressure, could cope with substantial numbers of additional patients who would have to come for treatment, travelling considerable distances on routes that are not well served by public transport.

[Gavin Williamson (South Staffordshire) (Con)]

Does my hon. Friend agree that if we do not keep a strong core of services in Stafford and at Cannock, the consequence for other trusts could be a deterioration in the care they can give patients, which would be highly detrimental for patient care right across Staffordshire?

[Jeremy Lefroy]

I entirely agree with my hon. Friend. Many people, including those with more experience of these matters than I have, have said the same.

The coincidence of the publication of the Francis report—which was commissioned by my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), whom I am glad to see in his place—and Monitor’s contingency planning team report into the future of services at Stafford and Cannock was, I have to say, unfortunate. Both organisations were running to independent timetables, but the coincidence gave rise to the incorrect impression that the proposed downgrading of services at Stafford was somehow the direct consequence of the failures in care until 2009. Let us be absolutely clear: it is not. In fact, the financial problems of the trust are long standing. It should never have been granted foundation trust status by Monitor back in 2008.

However, the impression that exposing poor care somehow resulted in threats to services had a double effect. First, blame was completely unjustifiably put on those who spoke out. Secondly, the impression was given that if people speak out in future anywhere else, local services might be at risk. The result is that Stafford has experienced ups and downs in the last few months. They include the wonderful coming together of a community of all ages and a group supporting the services at the hospital working across the political divide. Sadly, however, we have also seen cases of threatening behaviour against Julie Bailey and members of Cure the NHS, who courageously brought the serious problems at Stafford to light. I will not mince my words: it has been heartbreaking to hear people—good people, with the welfare of the community at heart—on opposite sides of an argument that should never have happened.

At the same time, hundreds of people in the community have put in a huge amount of time and effort to support Stafford hospital. I want to mention some by name. They include Sue Hawkins, Cheryl Porter, Karen Howell, Brian Henderson, Diana Smith, James Cantrill, Chris Thomas, James Nixon, Councillors Mike Heenan, Rowan Draper and Ann Edgeller, and Ken Lownds—who has put in a huge amount of expert work—together with my hon. Friends the Members for Stone (Mr Cash), for Cannock Chase (Mr Burley) and for South Staffordshire (Gavin Williamson).

But I wish to focus on the future, and I am going to concentrate on Stafford hospital although Cannock, too, is vital. Stafford is one of the many small district general hospitals up and down the country that play a vital part in our emergency and acute infrastructure. The number of acute beds has fallen substantially in the past 20 years, including in Staffordshire. The new PFI-funded hospital that opened recently in Stoke has 250 fewer beds than its predecessor, although it is none the less a wonderful hospital. We all welcome the fact that the length of hospital stays has fallen sharply, to an average of less than four days, but a report from the Royal College of Physicians published last year pointed out that there is little room for further reduction. Indeed, as the population begins to age, the average length of stay might start to creep up again.

The only way to manage acute beds, even at the current capacity, is to ensure that people do not have to be admitted in the first place. I am sure that we all want to see that happen, but it will depend on expanded community provision and the better integration of health and social care. That will happen, but it is not happening yet. Even when it does, my firm belief is that although it might halt the increase in demand for acute services, it will not reduce it at this time of a rising and ageing population. The Government are listening to experts who say that we need substantially increased rail capacity by 2035, so I am sure that they will also listen to the experts who say that we cannot cut any further the local and regional capacity for emergency, acute and maternity care. I say to Monitor and to the Government that Stafford is ready to be a national leader in such integration, with patients and the provision of the highest quality of care put first. However, that demands time and co-operation.

The first element of co-operation involves a larger acute trust. In the case of Stafford, the obvious partner is the University Hospital of North Staffordshire in Stoke. Working with UHNS as one team will bring advantages to both hospitals and both communities. For Stafford, the chance to become part of a university hospital will be an exciting prospect. We already welcome third, fourth and fifth-year medical students from Keele university medical school, and they report that they value the experience of working in a busy district general hospital. For the clinical staff at Stafford and at Stoke, the chance to work as a much bigger team across two sites would bring greater opportunities for them to develop their skills and experience. Frankly, for Stafford, it would also ensure that there was much less chance of a return to the complacent culture of the past that the Francis report identified as a major problem in parts of the hospital. For Stoke, which is already under considerable pressure as a result of the reduction in beds and has had to reopen up to 100 old ones, coming together with Stafford would offer welcome additional capacity. It would also create a larger catchment area, which would make some specialties that are currently marginal at Stoke much more viable.

But this would not be easy, as UHNS also has a substantial deficit and a PFI cost that is frankly unsustainable. I urge the Government to do everything within their power to cut the cost of UHNS’s PFI so that the 750,000 and more people who would rely on a combined major acute trust—whether in Stoke, Newcastle-under-Lyme, Leek Stafford, Cannock or further afield—can continue to have access to services delivered as locally as possible.

health

Gavin Williamson Excerpts

Tuesday 18th September 2012 Commons Chamber

[Jeremy Lefroy (Stafford) (Con)]

May I, too, welcome the Minister to his place? Last week, two decisions were taken affecting the Mid Staffordshire NHS Foundation Trust, which covers the Stafford and Cannock hospitals. The first was the decision by Monitor to undertake a review of the trust’s finances. The second was the decision of the commissioners not to reopen the accident and emergency department at night, although the trust had said that it was in a position to do so. What is common to both decisions is that there has been no consultation so far with my constituents or those of my hon. Friends the Members for Cannock Chase (Mr Burley), for Stone (Mr Cash) and for South Staffordshire (Gavin Williamson). These are their health services, which is why I have established a working group specifically to look at Stafford hospital, so that my constituents can make their proposals and views clear, both to Monitor and to the commissioners.

As hon. Members will know, there has been a public inquiry into the failings of Stafford hospital, especially those in the period 2005 to 2009, although the failings go back much further. The Francis report in 2010 exposed shocking care, particularly of the elderly and vulnerable. The public inquiry, which looks at why the NHS and others failed to pick up these problems, is due to report later this year, so I will not comment on that. The time of publication will be the time for very careful and mature reflection on what happened and how the NHS must change in response. As a senior member of the Royal College of Physicians said to me, it is the most important inquiry into the NHS in two or three decades.

Standards at Stafford hospital have improved considerably in the past three years, although there is no room for complacency. The Care Quality Commission recently lifted all its remaining areas of concern and the accident and emergency waiting time target has been met for the first time in a long time. There remains a substantial financial deficit, however, with an operating deficit of some £16.5 million last year and one of £15 million predicted for this year. At this point, I thank the previous Secretary of State for Health, my right hon. Friend the Member for South Cambridgeshire (Mr Lansley), who is in his place as Leader of the House, and the former Minister of State, my right hon. Friend the Member for Chelmsford (Mr Burns), for their steadfast support for the trust as it sought to recover, as well as the staff of the hospital and those from the Ministry of Defence who helped out at A and E for a few weeks.

The financial problems facing the Mid Staffordshire trust that Monitor wishes to tackle arise, in my analysis, from three sources. The first is underuse of the estate in Stafford and Cannock. It is essential in my view, and that of my hon. Friend the Member for Cannock Chase, that both hospitals remain open, but the estate must be used efficiently as money that is needed for services is being spent on empty property.

Secondly, the consequences of the events at Stafford mean that patients who would normally attend Stafford no longer do so. Confidence in the hospital needs to return, and that confidence must be based on real progress. There are welcome signs that that is happening, but it will take time.

Thirdly, and most importantly by far, endemic problems face medium-sized acute trusts across the country. Mid Staffordshire is far from unique and that is where the Monitor review is vital as it has the chance to establish a sustainable model for district general hospitals around the country. There seems to be a view gaining currency that all medical care in the future will either be highly specialised or general, based in community hospitals, which will squeeze out the medium-sized acute hospitals. Not only does that not accord with the evidence, it goes against the wishes of the public.

I do not dispute the need to concentrate highly specialised care in larger hospitals where consultants in each specialty are available around the clock. That has happened for some time. However, there is an increasing and substantial need for emergency and acute care, particularly for the elderly, which is much better given as locally as possible and in close co-ordination with social care services. District general hospitals such as Stafford remain the best place for that.

Monitor therefore has an excellent opportunity to work together with the people of Stafford and Cannock to show how a medium-sized acute trust can flourish in the tough financial climate we face. Indeed, Monitor has a duty to do so under section 62 of the Health and Social Care Act 2012, which states that its main duty

“in exercising its functions is to protect and promote the interests of people who use health care services by promoting provision of health care services which…is economic, efficient and effective, and…maintains or improves the quality of the services.”

It also states that:

“In carrying out its main duty, Monitor must have regard to the likely future demand for health care services.”

The last paragraph is very important as not only is the population of the area predicted to rise substantially in the coming years, but there will be a greater demand for acute care.

It may be argued that none of Monitor’s duties requires that services be provided locally. I reject that. To provide services locally is economic, efficient, effective and an intrinsic part of their quality, so Monitor has a duty to promote health care services that are as local as possible. We also need to be very careful in the definition of the word “services”. In the debate in Committee on what was then clause 69, I said that

“it is extremely important to have clarity on what constitutes a service. Services can be salami-sliced down to very small items or, as others have said, they can be an agglomeration. One could say that, in an acute hospital, a service is not only the accident and emergency, but some—not necessarily all—of the other wards associated with it. That might constitute a block of service or, under other definitions, several services. How will Monitor interpret that word?”––[Official Report, Health and Social Care Public Bill Committee, 22 March 2011; c. 943.]

[Gavin Williamson (South Staffordshire) (Con)]

Everyone in Staffordshire knows how hard my hon. Friend has fought on behalf of Stafford hospital. Does he agree that the closure of Stafford A and E at night will put an increasing burden on many other local hospitals, including New Cross hospital in Wolverhampton and the University hospital of North Staffordshire?

[Jeremy Lefroy]

I entirely agree. Of course, the hon. Member for Walsall South (Valerie Vaz) has the Manor hospital in her constituency, too, and I pay tribute to the work done by her hospital, by my hon. Friend’s hospital in New Cross and by Stoke and Burton hospitals.

So, how will Monitor interpret the word “services”? To date, as far as I am aware, we do not know the answer to that question. I want to make a very clear case that Monitor must, in the case of emergency and acute services, view the matter in the round and not engage in accountancy-based salami slicing. One cannot separate an A and E from a medical admissions unit, a surgical admissions unit, a paediatric admissions unit, an intensive care unit and the related diagnostic and therapeutic services. They must be considered as a service block. Of course, there will be a difference between the block in a district general hospital and that in a major specialist hospital, as the latter will cover emergency and acute events that a district general hospital cannot.

That brings me to the question of the accident and emergency department at Stafford, which has been closed between 10pm and 8am since 1 December last year. Today a petition is being presented in Downing street to urge the reopening of the department at night. Up until Sunday 16 September, 4,381 patients who would have been treated at Stafford at night have gone to other hospitals. To put that in perspective, the A and E department treated 51,000 people in 2011-2012. That is more than 4,000 patients who could not use their local acute hospital in an emergency when previously they could. We need to see them back at Stafford.

The reason given for closing the A and E department at night was that it was not safe for 24/7 reopening. Subsequent events have proved that to be the right decision as the department was close to breaking point. However, a set of criteria were given for reopening and the trust considers that, after much hard work, they have now been met, although there are concerns about sustainability. The commissioners have decided not to go ahead with night-time reopening but instead to pursue what they call a model of 24/7 emergency and urgent care. My constituents and I were very disappointed with that, because, nearly 10 months after night-time closure, we still do not have an A and E 24/7 but also because we do not have details of what that emergency and urgent care model might be. What are the similarities and differences between emergency and urgent care and A and E as traditionally understood? That needs to be made clear, not just in Stafford and Cannock but everywhere such a model is proposed.

The commissioners’ statement made it clear that even while A and E was closed, children, maternity and GP cases continued to be received at Stafford at night. They are also working on how to bring back to Stafford the 15 or so patients who currently have to go elsewhere each night. That is welcome and sounds similar to the service prior to closure. So what is different? Can we not return to an open-door 24/7 service with effective triaging to filter out the unnecessary attendances that place a strain on emergency departments everywhere?

Mid Staffordshire trust may be exceptional in the long hard road it has to travel to regain the confidence of local people—and it has come a long way down that road—but it is not exceptional in the pressures it faces as a district general hospital. The Government have a chance to show how district general hospitals can thrive, providing emergency, acute and elective services to their people, working closely with social care and with the specialist hospitals in their neighbourhood.

Stafford Hospital

Gavin Williamson Excerpts

Tuesday 20th December 2011 Westminster Hall

[Gavin Williamson (South Staffordshire) (Con)]

I congratulate my hon. Friend on securing this debate. He touches on an important point, especially at this time of peak demand for hospitals. New Cross hospital and hospitals in Walsall and Stoke-on-Trent are under a lot of pressure. It is vital that we ensure that this closure is only temporary and that we resume full-time, 24-hour accident and emergency services.

[Jeremy Lefroy]

I am most grateful to my hon. Friend for making that point. I reiterate my thanks to those hospitals for taking on the extra patients in the night-time hours during this difficult time in the winter. Stafford accounts for 14% of the entire number of A and E admissions for the whole region, which includes Staffordshire, Wolverhampton and Walsall.

Fourthly, with Stafford being shut at night, most patients have to travel considerably further for emergency care. The University hospital of North Staffordshire in Stoke is 19 miles away, New Cross in Wolverhampton is 18 miles away, Manor hospital in Walsall is 19 miles away and the hospital in Burton is 27 miles away. The absence of Stafford, even for 10 hours at night, leaves a very large hole in accident and emergency provision for the region. It is a matter not only of distance, but of the amount of traffic on the roads. Night-time travel is usually reasonable in the area, but congestion can be substantial during the day, particularly when the M6 is closed between junctions 12 and 14 and all motorway traffic is diverted through the middle of Stafford.

It has only been possible to cope with the temporary night-time closure with the use of several additional ambulances and increasing staff cover. Such facilities are expensive. Indeed, they are more expensive than keeping the A and E department open 24/7, which emphasises the fact that the decision was taken for reasons not of cost but of patient safety.

It is essential that Stafford hospital has a full-time accident and emergency service, but not every emergency can be treated there. Given the advances in medical science and treatment, it makes sense for some of the most serious emergencies to be treated by top specialists who will only be in the largest hospitals. Patients with major trauma, severe strokes or major heart attacks already go to regional centres such as UHNS. That is understood and generally accepted. However, a district general hospital should be able to respond safely to a number of emergency conditions and provide a minimum set of services, such as acute medical, including rheumatology and geriatric; acute surgical and orthopaedic; paediatric; maternity; and mental health, particularly for overdoses. In some cases, hospitals may have to stabilise a patient before they can be transferred to a specialist centre.

Retaining a core set of emergency services in district general hospitals is important to protect their viability. As John Donne said:

“No man is an island.”

That can equally be said of many acute services. It is not possible to retain acute medicine, which provides the lion’s share of the income of an acute hospital, without having access to surgical opinion on the spot. Any emergency service also needs the full-time support of critical care units and radiology, to name but two. That is not to say that there can be no change—there must be changes to make district general hospitals financially sustainable in a difficult climate—but we must not put so much pressure on them that their only option is to close their doors to emergencies from the communities that they serve, forcing people to travel considerable distances for all but minor injuries.

Changes must be thought through and discussed openly with those communities. There should be no sudden changes and nothing hidden in the small print. The NHS is paid for by the British people and is a service that gives us great reassurance, even if we are fortunate enough rarely to need it.

I have set out clearly why Stafford hospital needs a full-time accident and emergency service. I am making the argument from the point of view not of the hospital itself, the bricks and mortar, but of the patients—my constituents and those of my hon. Friends the Members for Cannock Chase (Mr Burley), for Stone (Mr Cash) and for South Staffordshire (Gavin Williamson), many of whom rely on its services.

Stafford hospital provides a first-class service to many people in our area. The management, the staff, my parliamentary colleagues and I are not complacent; we recognise that there is more to be done. None of us will be satisfied until our hospital is known nationally, as I believe it will be, for its high-quality treatment and care and it has the confidence of all those whom it serves.

Manufacturing

Gavin Williamson Excerpts

Thursday 24th November 2011 Commons Chamber

[Graham Evans]

I am grateful for the hon. Gentleman’s intervention. At the beginning of my speech, I made the point that all Governments of all political persuasions have contributed to the overall decline. I take on board the closures in his constituency. All Governments need to learn the lessons of the past, but that does not mean that we should underestimate the problem.

Let us consider energy-intensive manufacturing sectors, which include the chemical, steel, glass and paper production industries among others. The chemical industry is of particular importance in my constituency, where Tata and INEOS Chlor are still major employers in Northwich and Runcorn. According to Waters Wye Consulting, policies such as the EU’s emissions trading scheme and the unilateral carbon price floor mean that the average energy-intensive company’s energy bill will rise from £3 million now to £17 million in 2020—an untenable level for the majority of these firms, which simply cannot afford to continue production in the UK. Proponents of these policies argue that energy-intensive sectors account for only 1% of GDP and so do not matter. If we quantify that figure, it equates to a potential loss to the UK economy of £15 billion and 290,000 jobs. More widely, the Royal Society of Chemistry claims that £220 billion of GDP and 5.1 million jobs are partly reliant on UK chemical research alone. Clearly, the visible threat to UK manufacturing is only the tip of the iceberg, but the problem is that most people do not realise that.

British industrial decline, relatively speaking, is in sharp contrast to the experiences of our neighbours—in particular, Germany. German long-term support for manufacturing means that it now possesses the economic clout to dominate Europe. Given the UK’s and Germany’s widely different starting positions 60 years ago, it is clear that it has done something that we have not, and that something is valuing industry. From post-war restructuring to reunification, Germany has always recognised that manufacturing was the backbone of its economy and therefore never enacted policies that would endanger it. Indeed, political infrastructures were set up to nurture industry, especially mittelstand—or, as we refer to them, small and medium-sized companies or SMEs. Foremost among those tools stands KfW, the state-backed bank that ensures that mittelstand can access funding even when the commercial banks are unwilling to lend. The value of such an institution was seen in the financial crisis. According to its accounts, in 2010 KfW financed a record €28.5 billion for SMEs, amounting to approximately 94% of all its commitments for the year. Without KfW, the potential for many extra jobs and exports would have never been realised for Germany.

It is hard to understand how far the value of German industry goes. Youngsters are encouraged from an early age to appreciate the importance of making things.

[Gavin Williamson (South Staffordshire) (Con)]

Does my hon. Friend agree that one of the key elements of Germany’s success is its investment in research and development? We need to be encouraging that. Jaguar Land Rover is building a new factory in my constituency and investing in R and D, and the Government could go a long way towards helping that by reviewing R and D tax credits, which the Treasury is considering at the moment.

Oral Answers to Questions

Gavin Williamson Excerpts

Tuesday 12th July 2011 Commons Chamber

[Gavin Williamson (South Staffordshire) (Con)]

Does my right hon. Friend agree that although there is a cost in making these changes, it will have been paid back within two years, and that £5 billion a year will be available to be invested in front-line services and making sure that people in South Staffordshire get the best possible from their health service?

[Mr Burns]

My hon. Friend makes an extremely important point, because not only are his figures correct, but thereafter until the end of the decade there will be savings of £1.7 billion a year, on current projections. Every single penny of that will be reinvested in front-line services for patients.

Hospital Car Parking Charges (Hereford)

Gavin Williamson Excerpts

Monday 26th July 2010 Commons Chamber

[The Minister of State, Department of Health (Mr Simon Burns)]

I begin by congratulating my hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) on securing his first Adjournment debate—on the effect of NHS PFI costs on hospital car parking charges in Hereford.

Let me provide a little background on the trust before discussing my hon. Friend’s specific points about car parking. As he will know, Hereford Hospitals NHS Trust is the main provider of acute services across Herefordshire and for parts of Wales. The trust offers a wide range of services, including a dedicated cancer unit, which forms part of the three counties cancer network. I understand that funding has now been secured in partnership with Macmillan Cancer Support to develop a new cancer unit.

The most recent Care Quality Commission outpatient survey, released in April this year, showed that 19 out of 20 patients—95%—attending the Hereford hospital out-patient department rated the care they received as either “good”, “very good” or “excellent”. It also found that 89% of those asked stated that they were treated with dignity and respect at all times. This is very much to the hospital’s credit, and I pay tribute to the hard-working staff at Hereford hospital. It is through their dedication and expertise that my hon. Friend’s constituents benefit from such a high quality of care.

My hon. Friend has raised the important issue of parking costs at Hereford hospital. The quality of care inside the hospital is excellent. However, the service provided outside the hospital presents a real and pressing concern for patients, visitors and members of staff.

The Hereford county hospital development was, as my hon. Friend mentioned, part of the previous Government’s first wave of private finance initiatives. The County hospital PFI contract lasts for 30 years, from 2002 until 2032. In some respects, the Hereford contract differs from later PFIs, which utilised a standard form developed following the experience of earlier agreements.

In 2005, car parking charges for the period 2006-15 were agreed between the trust and Mercia Healthcare and incorporated in the main PFI contract through a legally binding variation, as my hon. Friend mentioned. Although Mercia owns the car parks, CP Plus operates them on a day-to-day basis via a subcontract with Sodexo, which runs all food and facilities management services on the site. I am told, unfortunately, that the cost to the trust of buying back the car parking element of the contract to 2032 has been calculated at some £7 million, a sum that my hon. Friend will agree is deemed prohibitive by the Hereford Hospitals NHS Trust.

The contract also switched car parking charges from pay and display to pay on exit. That change was introduced to discourage people using the hospital car park when shopping in Hereford city centre, cutting the number of spaces available for patients and visitors to the hospital. The hospital offers concessionary parking for different types of user. For example, a range of discounts is available to those who use the car park frequently, to the disabled and to a wide range of people on benefits or low incomes. In addition, when the length of stay exceeds certain local waiting targets, the cost of parking is reduced to the target wait. For example, if initial treatment is not given within four hours at accident and emergency, the cost of parking is reduced so that a patient pays only for four hours. Also, parents of children staying overnight in the hospital have their parking costs discounted to the two-hour rate of £3.

However, there is a real issue about people not knowing that those concessions exist. Although they are clearly displayed on the trust’s website, the internet, as my hon. Friend will probably appreciate, is not usually the first place to look for information when one drives into a car park. The clear and prominent display of the discounts and concessions available is a common complaint of patient groups throughout the country and one with which I have a considerable sympathy. I am told that the current car parking charges are in fact a little lower than those originally agreed with Mercia and reflect the trust board’s decision to subsidise the tariff by 50p an hour over the past two years. The annual cost of that subsidy is £88,502.

The strategic health authority has informed me that the trust board has taken a number of measures to ensure that car parking charges are reasonable. It has committed to reducing progressively the costs of on-site parking for patients and, eventually, to eliminating those costs all together. To pay for the reduction, charges for visitors and other users will be increased in line with the existing 10-year tariff plan. The trust is also investigating alternative transport initiatives to encourage staff and patients to use public transport.

The strategic health authority informs me that Hereford Hospitals NHS Trust is reviewing its car park policy. The aim is to develop proposals for charges and concessions for patients’ parking at the hospital, covering the hourly rates charged to patients and the availability of revenue to develop alternative arrangements. The review will also consider the range and appropriateness of current concessions. The trust hopes to complete its review of car parking charges by the end of this month, and the next increase to car parking charges, now due, is on hold pending the outcome of it. I also understand that the trust has already agreed a package of measures to improve car parking arrangements for patients receiving chemotherapy. These include the allocation of further free car parking spaces and better advertising of concessions.

Individual patients and advocate groups such as Macmillan Cancer Support and the Patients Association regularly raise the issue of car parking charges. Macmillan has highlighted how a lack of awareness among users and the poor promotion of concessions by some trusts lead to low take-up among long-term patients. We are giving those concerns serious thought. The Department of Health recently conducted a consultation on car parking charges, and I can assure my hon. Friend that we aim to publish a response to that consultation in September.

Unfortunately, though, whatever one’s views might be on the subject of NHS car parking charges, given the dire state of the public finances it is simply not possible to abolish them. Within a very difficult economic climate, this Government are committed to delivering health care outcomes that are among the best in the world. As part of this, power is being devolved to the front line like never before. As my hon. Friend will appreciate, when we came into government in May we inherited a deficit of £155 billion. Some tough decisions are having to be taken because my right hon. Friend the Chancellor of the Exchequer rightly makes it a priority to reduce the huge debt that we inherited, which is causing so many problems for our general economic well-being.

I am sure that my hon. Friend will appreciate that, as I said, it is simply not possible to abolish car parking fees at the moment, because the ethos of our policy towards better provision of health care, as outlined by my right hon. Friend the Secretary of State for Health in his White Paper last week, is that we believe that it is crucial to put patients at the forefront and the centre of health care. We must have bottom-up provision of health care that meets local needs to improve services and ensures the finest quality health care that the health service can provide in such a way that we do not have politicians and bureaucrats dictating a top-down approach.

[Gavin Williamson (South Staffordshire) (Con)]

Does my hon. Friend agree that many of the problems that we face in Hereford and in many other towns across the country are down to poorly negotiated private finance initiatives agreed by the last Labour Government?

[Mr Burns]

I am grateful to my hon. Friend for making that cogent and powerful point. As we have all found out since we came into office, the economy was left in a dire state, and we are now having to pick up the pieces, as we did in 1979, to sort out the mess that the previous Government left us. That is the challenge that we are facing, and that is why we are having to take some tough decisions for the general better welfare of the economy as a whole and the people of this country, as tends to be traditional when we come to power after a Labour Government.

Where car parking charges make it difficult for staff to do their jobs properly, where they damage patients’ access to services, or where they prevent family and friends from visiting, hospital trusts have a responsibility to look again at their charges and policies. As my hon. Friend knows, a review is currently under way at Hereford hospital. I trust that he and all his constituents who are concerned about the level of car parking charges at the hospital are contributing to that review and ensuring that their views and concerns are known as regards the impact that those charges may be having on them. I also believe that it is crucial, not only in Hereford but throughout the country, that greater publicity and prominence be given to the fact that some people may qualify for a reduction in car parking charges due to their individual circumstances. That must be drawn to the attention of the client group that might benefit, because one suspects that too often, there is too little publicity and awareness of those discounts, which would provide genuine help to those who find car parking charges genuinely onerous to pay for.