Contaminated Blood

George Howarth Excerpts

Thursday 15th January 2015 Commons Chamber

[Mr George Howarth (Knowsley) (Lab)]

I congratulate the right hon. Member for North East Bedfordshire (Alistair Burt) on the typically thoughtful and sensitive way in which he introduced and framed the debate. I think we are all grateful to him for that. I also thank the all-party group, co-chaired by my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), for its important work and for what I consider to be a very important report.

Once in every generation, a handful of issues arise that I tend to describe as debts of honour. The right hon. Gentleman mentioned Hillsborough, I could mention the thalidomide scandal, and I am sure that other examples have already been given or will be given during the debate. I shall give two examples from my constituency, which, I think, underline the fact that this is a debt of honour that needs to be addressed.

My first example concerns a lady called Mrs Phoenix. In 1980, Mrs Phoenix had an operation on her jaw at Broadgreen hospital in Liverpool, during which she received contaminated blood. In 1995—15 years later—she was diagnosed with hepatitis C, after which she began a course of interferon that lasted for approximately a year. That failed to eradicate the virus. In 2003-04, she began a further course of interferon, and, thankfully, this time the virus was eradicated.

In subsequent years, Mrs Phoenix was told repeatedly that she was not entitled to claim compensation for the hepatitis C that she had contracted from contaminated blood, because the medical professionals had not been aware at the time that the disease was being transmitted from person to person through blood transfusions. In 2011 her solicitor told her about the Skipton Fund, but when she tried to complete the relevant forms in order to submit a claim to the fund, she was told that the details of her NHS operation had gone missing. That is a not unfamiliar story. Luckily, she was able to carry out the necessary research and appeal against the decision, and her appeal was successful.

This is what Mrs Phoenix has asked me to tell the House:

“As far back as the 1950s some US doctors were raising concerns about paid blood donations from so called ‘skid row’ donors. I feel health officials here cannot cloud the issue by claiming ignorance of risks buying in blood from the USA. Personally I do not want to rely on charity, I don’t want tweaks to the current system, I would like a full and final settlement. This has been called the worst treatment disaster in the NHS; warnings were ignored and I feel gross maladministration is to blame.”

Mrs Phoenix has made three requests. First, she wants the Department of Health to acknowledge that purchasing blood products from the United States, including blood products from inside the US prison system, without testing them was negligent. Secondly, she seeks what many others have called for—an apology—and thirdly, she seeks adequate financial compensation.

[Mr Richard Bacon (South Norfolk) (Con)]

I have listened to many of these stories with growing anger. Constituents of mine have also been affected. Does the right hon. Gentleman agree that Governments of both parties have failed our constituents for many years, and that the House will have no patience with any Government of any party who do not produce a final resolution of these matters?

[Mr Howarth]

In a word, yes.

[Mark Durkan (Foyle) (SDLP)]

The right hon. Gentleman has said that the risks must have been known. Is he aware that the move to set up a compensation scheme in the Irish Republic was made before full state liability was recognised? That liability was recognised only when a second inquiry showed that the state had known there was a risk, but had continued to use contaminated blood products on the basis that, because the United Kingdom and others were using them, it could carry the risk.

[Mr Howarth]

The hon. Gentleman has made an important point, which I fully accept.

My second example comes from a constituent who wishes to remain anonymous. Her husband, who was a haemophiliac, died at the age of 59 after contracting hepatitis A, B and C through contaminated blood administered in the late 1970s and early 1980s. As a result of receiving that contaminated blood, he had developed cirrhosis of the liver, oesophageal varices, ascites, encephalopathy and liver cancer. Understandably, my constituent says, his quality of life deteriorated year by year and month by month until his eventual and sad death. His haemophilia had prevented him from accessing insurance products such as mortgage protection, and the early retirement necessitated by his ill health had decimated his pension, which had left both him and his wife struggling financially.

My constituent had close family members who also died as a result of receiving contaminated blood. The family has been hit hard by a terrible scandal. Twenty years after the death of her husband, my constituent is still campaigning for justice. The family has been given no explanation of why the scandal was allowed to happen, and why the medical records went missing at local hospitals and in the NHS.

My constituent is now 76 years old, and is herself in ill health. She is looking for answers to a number of questions that are still arising, and she hopes to receive those answers in her lifetime and as soon as possible. The family sent me the following statement, which they asked me to read out:

“My family holds that what has long been needed is for this tragedy, which has already directly claimed the lives of 2,000 haemophiliacs”

to be addressed and put into perspective, in terms of its “scale” and in terms of “financial support”. The statement continues:

“We believe that this disaster…is finally seen as one event…the ‘UK Contaminated Blood Scandal’….the scandal is already Britain and Ireland’s 15th biggest peacetime disaster in terms of death toll, since records began, yet very few people know about it…the UK Contaminated Blood Scandal claimed the third biggest collective peacetime death toll in the UK in the 20th Century. My family believes that until this tragedy is finally seen in the proper terms of its fatalities, and is recorded as such…very few people outside of those whose lives have been obliterated will ever be able to grasp the enormity of a scandal”.

The family make two specific requests. First, they call for the current support groups to be disbanded and a new, comprehensive method of support to be introduced to replace the support schemes that are currently available, which they consider to be confusing and unfit for purpose. Secondly, they call for substantial, regular financial support that will meet the care needs of those affected.

I began my speech by saying that this was a debt of honour. I end it by saying that it is a debt of honour that should now be redeemed in full.

Type 1 Diabetes (Young People)

George Howarth Excerpts

Wednesday 30th April 2014 Westminster Hall

[Mr George Howarth (Knowsley) (Lab)]

May I take the usual step of thanking you for chairing this sitting, Mr Havard? I know that that is something of a ritual, but on this occasion I am sincere. You may be aware that I was originally on the list to chair this sitting, so you have saved me the embarrassment of having to congratulate myself.

I begin with some acknowledgements. I am particularly grateful to the staff and patients at the diabetes centre at Aintree university hospital and the specialist diabetes services team at St Helens and Knowsley. I also thank the young people with diabetes who took the time to speak to me; the Juvenile Diabetes Research Foundation; Diabetes UK; Diabetics with Eating Disorders, known as DWED; Circle D; and Dr Mike Merriman in my constituency.

I sought this debate on behalf of children with type 1 diabetes in the UK, but I should point out that the condition does not affect children only. There are 400,000 people of all ages with type 1 diabetes in the UK and, currently, 35,000 children and young people have diabetes, 93% of whom have type 1 diabetes. It is important that we understand the difference between type 1 and type 2 diabetes, because, all too often, the two conditions are dealt with in the media as though they were one and the same thing. For example, a prominent businessman, Jim Ratcliffe, was recently quoted in The Sunday Times as saying:

“Childhood diabetes didn’t exist when I was growing up. It was an old man’s disease. But now lots of kids have diabetes. They are eating so much sugar that by the time they are 16, the pancreas is giving up the ghost”.

That is quite simply a misunderstanding of type 1 or childhood diabetes. Type 1 diabetes has absolutely no connection to dietary habits or a lack of exercise; it is an auto-immune condition and, as such, cannot be prevented. All people who suffer from type 1 diabetes have to deal with the consequences, which, for the most part, are inescapable and unremitting. A daily battle must be conducted to maintain blood glucose level within the medically safe range, balancing food and insulin intake, while taking into account physical activity, stress levels and temperature.

Young diabetics can take up to eight daily insulin injections and often have to perform invasive blood testing even more frequently. Yet according to research by JDRF, even those who stick rigidly to the prescribed regime will fall outside the medically safe range on more than three occasions in any 24-hour period.

Not staying within safe blood glucose levels has consequences. In the short term, high levels, which are known as hyperglycaemia, at the very least cause fatigue, and continued high levels can lead to diabetic ketoacidosis—known as DKA—which is a potentially fatal condition. Longer-term consequences include heart disease, kidney failure, neuropathy, blindness and amputations. Low blood glucose levels, known as hypoglycaemia, cause dizziness, incoherence and potential loss of consciousness and are often followed by severe headaches.

Blood glucose levels can alter dramatically, and apparently inexplicably, at any time of the day or night and require immediate attention. According to research undertaken by the National Paediatric Diabetes Audit, 85% of children and young people aged over 12 with diabetes have blood glucose levels higher than the recommended targets. That is perhaps unsurprising, because only 6% of those in that sample received the recommended care, services and support to which they were entitled.

Some children are diagnosed with diabetes in infancy, or when they are too young to take responsibility for managing their condition. Inevitably, the responsibility must be taken by family members, most commonly parents. For many families, having a child with type 1 diabetes affects them all and many adjustments have to be made to support that young person. As one young type 1 diabetes sufferer told me recently, until she was 18, she was almost entirely dependent on her mother monitoring her blood glucose and ensuring that she injected the right amount of insulin at the right time.

In advance of this debate, people contacted me about difficulties they have experienced with the Department for Work and Pensions and the disability living allowance system. Some of the problems raised arise from the fact that the DWP does not fully understand the complex needs of young people with type 1 diabetes. I would be grateful if the Minister raised that with the relevant Minister at the DWP to see whether that could be satisfactorily resolved.

Two young type 1 diabetics, Lauren and Nicole, both told me that they had experienced bullying at school as a result of their condition. Nicole, who is 16, states that she

“frequently experienced bullying because of my diabetes and because everyone thought it was because I was fat”.

Several young people have commented on the embarrassment that they feel at having to inject insulin in public. In some cases, they have been referred to as drug addicts, or been asked not to inject or test their blood, as others find it offensive.

I made two visits recently to the diabetes centre at Aintree university hospital and the specialist diabetes services team at St Helens and Knowsley Teaching Hospitals NHS Trust, both of which provide outstanding services for type 1 diabetics. They have a different range of specialisms to call on beyond the use of nurse specialists and diabetologists. For example, they can refer to psychological or, where appropriate, psychiatric services.

[Alison McGovern (Wirral South) (Lab)]

I pay tribute to the work that my right hon. Friend has done in this area. Before he moves off the stigma issue, does he agree that we need to think about how we can raise awareness among young people? Does he also agree that social media organisations need to be responsible but not afraid about stigma arising from the use of needles and so on? We need to talk frankly and honestly about type 1 diabetes and its consequences for young people, so that those with the condition do not feel in any sense as though they must hide away.

[Mr Howarth]

I am grateful to my hon. Friend for that intervention. She is quite right to say that social media has an important role to play. I will say more about that shortly, but one example was drawn to my attention where Facebook removed an image of someone injecting on the grounds that that was offensive. That is offensive, but not in the way that it thought. I will say something more positive about how social media can be used in a few moments, but it is important that more people understand exactly what we are saying.

I was talking about psychiatric services. On a national scale, psychological support is not necessarily integrated into the diabetic service, and the practitioners are therefore unlikely to have sufficient understanding of diabetes. Psychiatric services are even more difficult to access, and I am told that patients can wait up to two years for an appointment. In some cases, that is a matter of life and death. The diabetes attitudes, wishes and needs survey, known as DAWN, published in Diabetic Medicine, interviewed 15,000 people in 17 countries and found that people with diabetes are more likely to suffer from depression. Those services are therefore very important.

I want to say a little about young people with type 1 diabetes who also have an eating disorder. According to the charity Diabetics with Eating Disorders, as many as 40% of young women between the ages of 15 and 30 admit taking insulin as a means of achieving weight reduction. The phenomenon sometimes referred to—although it is not a medical term—as diabulimia is increasing. Rapid weight loss is achieved when diabetes is left untreated, but the consequences can be catastrophic. DKA, a potentially fatal condition where the body turns on itself for energy, rapidly develops. Even if it does not prove fatal, it can result in serious health complications.

Diabulimia is difficult to diagnose and there are no current NHS guidelines on how to deal with the issue. Young people can be treated for their diabetes and for an eating disorder, but there is no integrated thinking to cover the two elements of care. Yet the treatment for a diabetic with an eating disorder is quite different from that for a person without diabetes. DWED has provided an example of a young woman who was admitted to a unit dealing with eating disorders, where no insulin needles were available and where the patient was fed via a tube without any insulin being administered. That exacerbated the problem that the unit was supposed to be treating.

There is a clear need for a more integrated service, with mental health professionals who have a knowledge of diabetes. A further and tragic example from DWED illustrates the point well. Jane, the mother of Rhys, a young man who was suffering from diabulimia, repeatedly requested that he be assessed psychiatrically. She did so every time her son was admitted to A and E suffering acute DKA, which happened on several occasions. She repeatedly raised it with the diabetes clinic and with the community mental health team. Unfortunately, her pleas were ignored, despite her saying that she was terrified that she would find her son “dead in bed”, and her son lost his battle with diabulimia on 25 July 2009. The ombudsman concluded that

“had a more coordinated and holistic care plan been put place it might have resulted in a different outcome.”

Jane has been fighting for recognition since 2009, and says that there was never an investigation into why her son died, which she attributed to his mental health problems. That was another complaint upheld by the ombudsman.

There is a serious need for a much more integrated service, so that all aspects of the treatment of type 1 diabetes can be dealt with together. There must be greater investment to ensure that emotional and psychological support becomes an accepted and routine part of management for all children with diabetes and that appropriate services are in place. Incorporating psychological services with routine clinic visits would avoid much of the stigma associated with treatment for mental health problems. In addition to regular clinic attendances, young diabetics require separate appointments for special eye checks and chiropody. Those should be available under one roof in an effort to improve the care achieved.

I am grateful that the urgent need to improve access to and integration of services is now being recognised with the introduction of the best practice tariff for paediatric diabetes. From April this year, the standards included in the best practice tariff are mandatory for all paediatric diabetes units, and the tariff has been extended to cover in-patient care, which will hopefully incentivise lower admission rates. However, I would argue that the best practice tariff should be extended to include all young patients up to the age of 25. Each young person is different, and transition from child to adult services must happen at a stage and time appropriate to them. The current cut-off for the tariff is 19, but the available data suggest that that is too soon, because 25% of all hospital admissions for diabetic ketoacidosis involve young people aged 16 to 25; the annual cost is £5.3 million. Extending the best practice tariff to 25 would provide an opportunity for better alignment of the service with the needs of young people.

[Steve Rotheram (Liverpool, Walton) (Lab)]

My right hon. Friend is making a powerful speech on an issue close to his heart. I hope that hon. Members will know his family circumstances. He is raising an important matter; there is a need to inform a much wider audience, not only so that everyone will be more aware of problems and issues to do with type 1 diabetes, but to inform people with the condition who believe they can manipulate their insulin intake for one reason or another. Does he believe that more should be done to highlight the problems that can arise when people do not stick rigidly to their insulin intake regime?

[Mr Howarth]

My hon. Friend makes his point well, in support of my argument, and I am grateful.

One in four children are diagnosed with type 1 diabetes when they are already in DKA, and the rate is even higher for children under the age of five. A number of clinicians I have met recently have advocated the removal of barriers between primary care and specialist teams, arguing that primary and secondary care teams should be sharing their expertise with one another in an attempt to close the skills and knowledge gap. In Merseyside, for example, specialist nurses have been working as mentors in practices to support primary care development and tackle deficits of knowledge, skills and confidence. Education is a major component of the improvement of care and outcomes. In many European countries, diabetes-specific training is mandatory for health care professionals who provide paediatric diabetes care. That is not the case in the UK. Although there has been a huge amount of work in the past five years to improve education for health care professionals, investment is needed to ensure that all paediatric units can access nationally standardised and accredited training.

[David Simpson (Upper Bann) (DUP)]

I congratulate the right hon. Gentleman on securing the debate. There are young teachers in schools in my constituency who are reluctant to inject children who are insulin-dependent. Surely, something more in the way of education and awareness needs to be done about that. Parents cannot come in to do that, so it needs to be done by someone such as a teacher or a nurse in school.

[Mr Howarth]

There are a number of problems to do with primary care. Sometimes, the lack of knowledge is appalling. The fact that on many occasions young people can go to a GP with what turn out to be classic diabetes symptoms without being diagnosed is a serious problem and needs to be addressed. The hon. Gentleman is right that education programmes for health professionals are important. It is equally important for people working in GP practices or other primary health care settings to be aware of the phenomenon that they are dealing with; otherwise they will make wrong decisions and give wrong advice, which in some cases can make things even worse.

We must prioritise access to education for self-management for children and young people. I am optimistic about the introduction under the best practice tariff of the requirement that children and young people will have access to education. There is, however, huge concern about the variety and standard of education. Considerable work is needed to ensure that what is offered is nationally standardised and tailored to meet the needs of children and young people, as well as their families. Unfortunately, there is no single best practice model throughout the NHS, although I am aware that the Government’s national clinical director for obesity and diabetes, Dr Jonathan Valabhji, understands that and is working with diabetes groups to find the best way forward. Today, I simply ask the Minister to take an active interest in Dr Valabhji’s work and to provide the support necessary to make progress.

I am told by those involved in diabetes that much research is focused on type 2 diabetes and that the principal source of funding is often pharmaceutical companies. That is of course welcome, but whereas with type 2 diabetes pharmaceutical companies can see long-term benefit in new and existing products, such a link is less clear with research into type 1 diabetes. There are some counter-examples, but it is an issue that needs addressing, so it is crucial for central Government to invest in type 1 diabetes research. Despite the UK having the fifth highest incidence of type 1 in the world, our contribution to type 1 research per capita is currently less than half that spent in the United States or Australia.

A more positive story can also be told, however. Many young people now use insulin pumps. Last week, I met 23-year-old Alex, who told me how her pump had changed her life: “It’s a little like you don’t have to think about it anymore. I don’t have to get my needles out; I don’t have to offend anyone. I can have a biscuit, go to the gym. I can change it to temporary settings and go out with friends. I can do things now. Before I used to say, ‘I can’t be bothered having to plan around it.’ It only takes two seconds; it’s hidden.”

One of the research projects that holds the most hope for people with type 1 diabetes is the work to develop an artificial pancreas, which is known as an AP. The AP is in essence a combination of an insulin pump and a continuous glucose monitor. The clever part is that the two devices talk to each other via a complex algorithm. The monitor automatically checks blood glucose levels and then, in effect, tells the pump exactly the right amount of insulin needed by the body. Such technology holds great promise to help people to safely achieve the recommended blood glucose control, as well as alleviating an enormous amount of the burden associated with self-management. Recent trials of the device have been encouraging.

A consortium led by the type 1 diabetes charity JDRF is leading the development of the AP. JDRF’s artificial pancreas consortium encompasses 22 institutions worldwide participating in the study. It is a great credit to the UK’s life sciences sector that we can count Cambridge, Leeds and University college London among the contributors, alongside Harvard, Yale and Stanford. Another artificial pancreas, developed by Professor Joan Taylor of De Montfort university, could have its first human trials by 2016. It has a reservoir of insulin kept in place by a special gel barrier, which liquefies when glucose levels rise, releasing insulin to the liver, thus mimicking a normal pancreas. As the insulin lowers the glucose levels, the gel reacts by hardening again and preserving the reservoir. Such research is an important step towards developing a portable, usable and safe AP system.

To return to the point made by my hon. Friend the Member for Wirral South (Alison McGovern), social media are increasingly used to help and support young diabetics. Many young people with diabetes experience a sense of isolation and have no contact with others who share their condition. A good example of young diabetics helping themselves is the 18-to-30 support group Circle-D, which was founded by the inspirational Shelley Bennett and is celebrating its sixth birthday today—congratulations to Circle D. They have regular social activities and a rant room where people can have a rant and share experiences before going to the pub. Their motto is “you are not alone” and they now have a massive network of diabetics of all ages offering support online, via Facebook and in person. Another group, targeted at teenagers and young adults, is Hedgie Pricks. Information about both organisations can be found online, and I would certainly encourage young diabetics to get involved and to share their experiences with others in a similar position.

The debate today is an opportunity to praise the steps that are being taken to improve paediatric diabetes care and to pinpoint where we need to do more. With that in mind, I reiterate my support and optimism for the best practice tariff. Given that the tariff was only introduced recently, I hope that the Minister agrees that it would be sensible to return to the subject of type 1 diabetes in young people once we have had a chance to see how well that is working.

In the immediate future, however, the Government can and must do more. I would welcome the Minister commenting on extending the best practice tariff to 25, ensuring that children and young people with type 1 diabetes get the psychological support that they need and ensuring that educational standards for health care professionals and for children and young people with diabetes and their families are nationally standardised and accredited. I will be grateful to learn of any steps that the Minister can take to increase our contribution to type 1 research.

I have one final point to make. I feel strongly that the issue of type 1 diabetes needs a champion within the Government. I hope that the Minister will rise to the challenge and provide the political leadership that is so needed if we are to tackle this important matter.

[Mr Dai Havard (in the Chair)]

Six people wish to speak. I am looking at the time for planning purposes. We have just over an hour left, with 10 minutes each for the Front Benchers. I am trying to gauge the time, but you can do the mathematics for yourself. To be fair to one another, if you could plan for about seven minutes or something of that nature, that would be helpful.

East of England Ambulance Service

George Howarth Excerpts

Tuesday 25th June 2013 Westminster Hall

[Mr Henry Bellingham (North West Norfolk) (Con)]

I congratulate my hon. Friend the Member for Witham (Priti Patel) on her characteristically candid and very well-crafted speech. She speaks for many of us in expressing those strong arguments.

Like my hon. Friend, I pay tribute to the paramedics, drivers and engineers—the people at the sharp end—because they have done a consistently good and professional job, despite poor leadership; they have not had the backing that they deserve. I also join her in paying tribute to the Minister’s ministerial colleague, Earl Howe, who has been very attentive to our concerns throughout.

Dr Marsh’s report is well researched and impressive. If the report has one compelling conclusion, it is that the crisis in the ambulance service trust is the consequence not of a lack of resources, but of a lack of leadership, vision and strategic direction. The comparisons that he draws with West Midlands Ambulance Service NHS Foundation Trust are pertinent, because it is a trust with a similar population base—the population is obviously more urban—that faces similar challenges, but it has met those challenges through strong direction and leadership throughout. That is why the West Midlands Ambulance Service NHS Foundation Trust is at the top of the pile. Unfortunately, our trust is down at the bottom.

I agree with my hon. Friend the Member for Broadland (Mr Simpson), who said in his important intervention that recently, over a number of years, a management culture has emerged in the East of England Ambulance Service NHS Trust that basically deems second best to be acceptable, and consequently action that should have been taken has not been taken.

If the trust was an alternative investment market-listed company that had gone into crisis mode, the non-executive directors would have resigned on principle; if the trust was a company listed on the main stock exchange, the directors would have had to resign. It is staggering that they have somehow decided that it is okay to cling on to their jobs and stay, despite the complete lack of oversight of corporate governance and the failure to adhere to the combined code. As I understand it—the Minister will correct me if I am wrong—the non-executive directors are responsible under the combined code in the same way as directors of public companies. The trust is obviously not a public company, but it has the same corporate governance rules. Notwithstanding the fact that it is a different organisation, the non-executive directors have that responsibility. If they had any integrity, they would offer their resignations.

I hope the Minister is able to tell us that she will advise the non-executive directors, with the approval of the Secretary of State, to resign before tomorrow’s board meeting. It is no good for the interim chairman, Dr Harris—there is a whole lot of management speak here—to review the board members’ benchmarking against leadership criteria, etc. What the hell does that mean? Basically, the board needs reconstituting, and it needs reconstituting very soon. Will the Minister give us some insight into what her Department is doing to try to bring new blood—people with real ability, not jobsworths who simply get recycled around one public board after another—on to such boards?

Just as the trust has fallen way down to the bottom of the league, King’s Lynn and west Norfolk is unfortunately lagging behind the rest of East Anglia. I find that very worrying. Obviously, I accept that, in remote rural areas, there are some hamlets and remote communities where it is physically impossible for an ambulance to reach a patient within the targets. We know that. There are some places in my constituency, and in the constituencies of many of my colleagues here today, where that is absolutely impossible, even with the best will in the world. There might be a coincidence in which, for example, an ambulance is going along a main road at a particular juncture, but achieving the target may well be impossible, so it is even more important that the targets are met in the towns and bigger communities, where it might be thought perfectly reasonable to expect ambulances to get to a call within the target time in 95%-plus of cases. Unfortunately, the targets are not even being met in the towns in my constituency.

I have been given permission by my constituent Mrs Delna Barrett to refer to her case. Her husband, Chris, had been suffering from Parkinson’s disease for some 20 years. He stopped breathing in a restaurant in Hunstanton, which is the second-largest town in my constituency, and it took the ambulance more than 20 minutes to arrive. Despite numerous resuscitation attempts, he died in hospital two days later. We do not know whether, if the ambulance had arrived within the target time, he would have had a better chance of surviving. The family are not criticising the paramedics or the staff, but the bottom line is that the ambulance did not arrive within a reasonable time.

We know that many difficulties are caused by the problems at A and E, to which my hon. Friend the Member for Witham alluded in her excellent speech, and we know that those problems have been around for quite a long time. There certainly are problems at the Queen Elizabeth hospital in my constituency, and there are problems at the Norfolk and Norwich hospital, where at one stage back in March all 17 of the trust’s ambulances were tied up waiting outside. All that is well documented, and it is not entirely within the purview of this debate, but we cannot consider the problem of the ambulance trust in complete isolation; we must consider out-of-hours services and out-of-hours cover.

Very often, individual family events bring home to us the different parts of the health service that are perhaps in need of improvement or are examples of best practice. Some 20 years ago, I was staying with my mother near King’s Lynn, and at about four in the morning she banged on my door and said that she was dying. She was in the most appalling pain—absolute agony. My mother is a war veteran who was in the Women’s Royal Naval Service. She is a very tough person, and she never complains about anything. She told me that she was in complete agony and could not move. I rang the local doctor, who came out within 20 minutes. He said, “You have kidney stones, and I am going to give you an injection that will put you asleep until tomorrow afternoon. I will then come back and we will take stock of the situation.” He gave her some more injections the following afternoon. The stones were broken down, and she did not even have to go to hospital.

If my mother knocked on my door now, what would I do? Obviously, I would dial 111 or 999, but so risk-averse are all those call centres that she would undoubtedly have gone into A and E. I would not have been happy with any advice from someone who did not know her medical records. The key to her treatment by the local doctor was that he knew her medical records and understood that she might be prone to that problem.

We must sort out the out-of-hours cover. We cannot go back to what we had before, when each doctor’s surgery provided out-of-hours cover, but the idea of co-operatives and mergers between GP practices to provide cover and ensure that the people who deal with patients out of hours understand their medical records and are prepared to provide service is key to sorting out the problem. Otherwise, given that the population in some parts of the country is growing, that people are living longer and that many more people have challenging illnesses and a multiplicity of problems, more and more people will have out-of-hours difficulties. Unless we sort out the out-of-hours service, we will have more and more problems.

[Mr George Howarth (in the Chair)]

Order. The hon. Gentleman is straying somewhat from the theme. I realise that it is a related matter, but he should return the discussion to the ambulance service.

[Mr Bellingham]

I shall do so immediately, Mr Howarth, as that is the topic of the debate. However, I wanted to put it into that context, because we cannot consider the ambulance service in isolation.

In conclusion, there is a great deal of concern throughout the region, but we take the view that the problem can be solved through new leadership if management get a grip, put common sense first and, above all, bring out the best in the people at the sharp end, who serve our constituents and take great pride in doing so. Those people set high professional standards. Given the right management, they will do the job to a high standard and give our constituents the ambulance service that they deserve. This is a turn-around situation. I wish the interim chairman and chief executive all the best in sorting out the problem. However, they require the Minister’s assistance and support, and her first step must be to grip the decision of the non-executive directors. She must then work closely with the management team to ensure that the trust is turned around for the benefit of our constituents, who deserve better.

[Several hon. Members rose—]

[Mr George Howarth (in the Chair)]

Order. We have four further speakers. If Members take about six minutes each, we ought to be able to get everybody in, which is my aim.

--- Later in debate ---

[Robert Halfon (Harlow) (Con)]

It is a pleasure to serve under your chairmanship, Mr Howarth. I give my sincerest congratulations to my near neighbour and hon. Friend the Member for Witham (Priti Patel), who has led the campaign against the shocking performance of the East of England Ambulance Service NHS Trust.

The East of England ambulance service continues to give my constituents and me huge concern. As my hon. Friend said, however, I want to make it clear that those worries are not aimed at front-line staff, for whom I have nothing but admiration, especially the senior staff and the paramedics in Harlow. They do a tough job and give 100% to their work; I am proud that we have such extraordinary people living in Harlow and throughout the east of England. The staff, however, are lions being led by donkeys—that is the truth of the matter, as so brilliantly highlighted by my hon. Friend.

At the end of 2012-13, the East of England ambulance service had failed to reach its targets, whether for category A response times for calls to do with life-threatening situations, the less serious green calls or even the ability to pick up the phone on time. Not only is the trust failing to hit demanding targets, but my post bag is regularly filled with letters from local residents complaining about the service that they have received. I have also had staff contact me to complain that they feel they are offering an inadequate service because of the shocking performance of senior managers.

It is outrageous that when I have raised constituents’ problems with the ambulance service, it has taken an unacceptably long time to respond. For example, I wrote to the trust about a serious case in which one person had, tragically, died. The trust did get back to me and acknowledged that its response was unacceptable, contributing to the man’s death, but it had taken nearly five months to respond to my letter on behalf of the family—that is a disgrace.

We have to see change in three areas: we need better resources, targeted at delivering better patient outcomes; the management system urgently needs restructuring; and we need to show staff that they are valued, increasing their skills, so that they continue to make progress. Only by doing those things can people in Harlow and throughout Essex and the east of England get the treatment that they deserve.

For far too long, I have had residents contacting me about the poor level of service. Nearly all the concerns are focused on delays that their family or friends have suffered when waiting for an ambulance or during the handover time in hospital. A tragic case is that of cyclist Robert Tyler, who died by the roadside in my constituency after waiting 45 minutes for an ambulance, despite being only three minutes away from A and E. Sadly, such anecdotes are borne out by the statistics and, as I said, the trust failed to meet its operational targets last year.

I was glad to receive a letter from Dr Geoffrey Harris that claimed he is starting to see signs of improvement. I hope that is so, but on speaking to a worker from the ambulance service yesterday, it was troubling to hear that they felt that little had improved. The worker made the important point that we need more ambulances on the road, telling me that the rapid response vehicles were only being used to ensure that targets were hit. To deliver the best patient care, according to the worker, rapid response vehicles should be in addition to ambulances, not a replacement for them. That view is held across the trust, with more than 300 staff supporting a move calling on the management to claim the A19 target only when an ambulance arrives.

I was disturbed when a constituent told me about her 97-year-old mother who had fallen, hurt her leg and was unable to stand. The first responder arrived quickly and provided good care, but because no ambulances were available, my constituent was left waiting in pain for eight hours. That is absolutely unacceptable, and the new chairman must look at providing more ambulances, so that we can minimise patient suffering and provide a more efficient service.

When I speak to local staff, time and time again they bring up problems with the management structure and their dissatisfaction with it. Some have pointed to directors whom they hold accountable for the problems in the trust; those directors have not resigned, despite the strong pressure to do so. Dr Marsh’s report, as has been highlighted, is no different: he has made it clear that some trust non-executive directors need to resign. He points to an inability of the board to claim responsibility, a lack of clear vision, too much management and no tangible recruitment plan.

It is good news that the new chairman of the trust has stated that he will be making changes to the board, but I join my hon. Friends in calling for five board members to resign and, if possible, for them to be taken to court to be sued for legal negligence—I wish that could be the case. It is shocking that they have been allowed to continue when their failings have been made so apparent. They have put their people’s lives at risk and they have treated my local residents of Harlow shoddily. The board must be refreshed, replacing those members with people who have a proven track record of driving up standards.

I have heard of other problems from workers and residents. Staff are always praised, but staff morale is the worst of all the ambulance trusts in England—it is chronically low. Staff are embarrassed by how long an ambulance can take to reach patients. Sickness levels are high, with an 8.8% sickness rate—almost double the national average for ambulance trusts in England. Also, there is lack of training, with staff telling me that they feel unsupported; records show that the level of completed training days is abysmally low and last year only 45% of appraisals actually took place.

I am pleased that Dr Harris is making some changes, but action needs to be far quicker. At previous meetings with the trust, it seemed to be suggesting that Government funding was partly to blame, but Dr Marsh’s review blows that excuse out of the water. As my hon. Friend the Member for Witham says, the review found that the trust is funded above the average for ambulance trusts, possibly by several million pounds.

The board must take full responsibility for the problems that have plagued the service over the past few years. Action should be taken, including provision of a proper training programme for existing staff, a coherent recruitment plan to rebalance the staff ratio and direction of resources so that more ambulances are on the roads. I favour the ambulance service being broken up, so that there is an Essex ambulance service, because the East of England service is far too big. Genuinely, with the right management and the right resources, we can deliver some of the best care to my constituents in Harlow, to Essex and throughout the east of England.

[Mr George Howarth (in the Chair)]

I will call Peter Aldous in a moment and the Opposition spokesman at 10.40 am. If the two remaining speakers before the Front-Bencher take five minutes each, that should just about cover the time.

Mental Health

George Howarth Excerpts

Thursday 16th May 2013 Commons Chamber

[Caroline Nokes (Romsey and Southampton North) (Con)]

I add to those of other Members my congratulations to the right hon. Member for Sutton and Cheam (Paul Burstow) on securing this debate, and indeed to the Backbench Business Committee on having agreed the time for it.

I fear I shall stray into what some Members might regard as rather a niche area of mental illness. Some will recall that I led a Westminster Hall debate several months ago on the topic of eating disorders, raising the connection between eating disorders of whatever type and other mental illnesses.

One of the sadnesses I encountered in the run-up to that debate was the trivialisation of eating disorders even by some fellow Members, who made the point that they were not serious conditions but just the afflictions of silly teenage girls who needed to get a grip on their eating patterns. Far from it: in fact, eating disorders are one of the most prevalent mental illnesses. There are thought to be some 1.6 million sufferers in the UK. Anorexia nervosa is the most lethal mental illness: 20% of sufferers eventually die from it and a further 20% never recover.

It is important to recognise that the symptoms of a wide variety of mental illnesses such as low self-esteem, physical abuse and alienation from peers are common traits in a wide range of mental health problems, and are often particularly manifested in eating disorders. As I have said previously, the route map to an eating disorder is not identical for everybody, but similar traits and commons themes can be found. The same route map and traits can be found in schizophrenia and serious personality disorders such as bipolar disorder, for example.

I want to pick up and draw on as a point of contrast the issue of borderline personality disorder. I want to make the point, hopefully as succinctly as I can, that eating disorders are not the poor relation of more serious personality disorders and mental health problems; they are a serious condition of the psyche that should command far greater public awareness and, indeed, greater public spending.

To demonstrate the significant threat posed by eating disorders, one need only make a comparison with a more well-known and recognised mental health problem such as borderline personality disorder. BPD has a higher incidence of occurrence than schizophrenia or bipolar disorder and is thought to be present in about 2% of the general population. It has a phenomenally high rate of suicide and self-harm: 10% of BPD sufferers eventually commit suicide. Those mortality rates are augmented by disorder-related deaths from drug or drink abuse. One of the most well-known cases of undiagnosed BPD was that of the singer Amy Winehouse, who eventually died from alcohol poisoning.

However, anorexia nervosa—like BPD, it is thought to affect roughly 2% of the population—has a 20% mortality rate, which is nearly twice that for BPD. Yet awareness of this shocking statistic is not high; people simply do not know about it. That could be because, unlike BPD, those deaths do not predominantly come from suicide—although that is not uncommon—but happen many years later after the physical effects of anorexia have taken their toll. Many of the deaths occur from multiple organ failure or heart attacks, in addition to the straightforward and more well-known effects of the sufferer having too low a body weight for them to survive.

[Mr George Howarth (Knowsley) (Lab)]

I congratulate the hon. Lady on the persistence with which she has raised this issue and the trenchant way she argues her case. She will be aware that one of my concerns is type 1 diabetics who, by manipulating their insulin intake, can achieve rapid weight loss, which is in itself a form of eating disorder. Does she agree that the major problem confronting these people is falling between two stools? On the one hand they get physical treatment for the physical consequences of their rapid weight loss—organ damage and so forth—while on the other they have difficulty getting access to proper psychological or psychiatric services. Does she agree that the two need to be more integrated?

[Caroline Nokes]

I thank the right hon. Gentleman for that timely intervention. That is one of the key problems. Far too often in eating disorders, the treatment is focused on body-mass index and ensuring that the sufferers are physically well, but without necessarily addressing the underlying cause through therapies and treatments that deal with what triggered the condition. The right hon. Gentleman’s example of diabetics who manipulate their insulin intake is a particularly stark one. Anyone who has done work with diabetics knows that incorrect levels of insulin can lead to horrendous physical complications. Across the whole spectrum of eating disorders, there is far too much focus on physical and too little on mental well-being.

Sudden Adult Death Syndrome

George Howarth Excerpts

Monday 25th March 2013 Westminster Hall

[Mr George Howarth (Knowsley) (Lab)]

I am pleased to be serving under your wise chairmanship, Mr Amess. It is a pleasure to follow the hon. Member for Brigg and Goole (Andrew Percy) who brought to this debate some very particular knowledge, the scope of which, I suspect, none of the rest of us has. It was really interesting to listen to what he had to say.

I congratulate my hon. Friend the Member for Liverpool, Walton (Steve Rotheram) on introducing the debate, which he did not only with his usual thoroughness but in a very accessible way. That will be much appreciated by those involved in campaigning. Finally, I thank the Oliver King Foundation for keeping the issue alive and for raising awareness of it. My hon. Friend the Member for Liverpool, West Derby (Stephen Twigg), who has left the Chamber, spoke about the print media. Although I accept that they can have a positive role to play in promoting such issues, it is a double-edged sword, because their coverage of bereavement is often both intrusive and inaccurate, so we should not indulge in an orgy of congratulation. If the Press Complaints Commission had had any teeth, the print media would often have been condemned for the way they have covered bereavement.

I shall cover some of the same ground as my hon. Friend the Member for Liverpool, Walton, but with perhaps a slightly different perspective. He was right to say that as much knowledge as possible needs to be disseminated about how to keep blood pumping, which is basically what we are talking about, and about the use of defibrillators. If we talk to people about being trained so that they will be able to act if a defibrillator is available—this issue was brought out well by the hon. Member for Brigg and Goole and by my hon. Friend—the thing they are concerned about is not necessarily being taught how to use the modern device, but whether they will be able to recognise accurately what they are confronted with. That is often a barrier for many people, but I say rather brutally that the alternative to making a mistake is taking no action at all, which can be fatal. In many cases, that is the choice that people are confronted with.

My second point is about the availability of defibrillators and training in how to use them. Yes, we need them in schools and in public buildings, but there is also an argument, which should be debated, that they should be available in every workplace of significant size. At the end of the day, the powerful case that was set out by my hon. Friend to address the situation hinges on having both defibrillators available and people able to use them. Indeed, the more defibrillators that are available in more diverse places, the more lives will be saved.

My hon. Friend mentioned the availability of fire extinguishers, which is a really good comparison; another is smoke alarms. The impact that smoke alarms have had on detecting fires has been phenomenal. We are now at a point where almost every household has, or should have, a smoke alarm installed. I am not saying that every household should have a defibrillator, but the more widespread these safety and intervention measures are, the more effective they can be.

Finally, there is an overpowering case for screening. For several years now, I have been involved in the all-party group for cardiac arrest in the young, which does an excellent job in campaigning for widespread screening. Personally, I would like every young person to have the opportunity to be screened, because regardless of whether they believe that they might have a problem, the availability of screening would mean that they would, wherever possible, know what happens—in other words, we are talking about screening age groups that might be vulnerable to this sort of problem. However, screening is not easy to access at the moment. Also, where there has been a fatality or where someone has been diagnosed as being vulnerable, there is often a genetic component, so it is possible that other members of the family might be vulnerable as well, but in one case in my constituency, siblings wanted to be screened after they had tragically lost their brother, but they had to go to great extremes and be extremely persistent to access the screening service. That is clearly a problem that needs to be addressed.

Let me finish on a helpful note. Earlier, the hon. Member for Portsmouth North (Penny Mordaunt) said that the campaign needed a bit of “oomph” behind it. That is a good way of describing what we would all like to see as a result of today’s debate. If the Minister can address the problem, she might perhaps be known as the Minister for “oomph”.

--- Later in debate ---

[Andy Burnham]

My hon. Friend is right. Let schools decide, but let us make it a clear legal requirement that they teach those skills. That is how to make a difference: by having a population that is much more educated in emergency first aid and CPR. The difference that it can make is huge. The Department for Education appears to be highly resistant; I do not know why. Surely we could link it to science or biology. Surely there are ways to deliver that teaching that are not irrelevant to the rest of the curriculum. That is our first request. Can we have a clear requirement?

Secondly, as my hon. Friend the Member for Liverpool, Walton asked, is there not a case for a screening programme, particularly for at-risk young people, such as those who play lots of sport? I know that the UK National Screening Committee has considered the issue, partly because I asked it to, but still no firm recommendations have been made. Will the Minister consider it? It could be delivered for incredibly small amounts of resource in NHS terms; a screening test costs about £30 pounds. It should be available to any parent who wants to make use of it, particularly for young people who play sport every week. My son plays a lot of sport, and I watch him play every week. I have still not had him tested. It crosses my mind all the time that perhaps I should. It should be an easy thing to do; it should not be hard to find. The time has come to provide more screening.

My third and main point is to ask the Minister to give serious consideration to setting a minimum legal requirement for the number of defibrillators in public places. The time has come for that to be required by law. Hon. Members have referred to fire extinguishers and smoke alarms. There comes a point when technology allows something to be made much more widely available in public places and buildings, and I believe that we have reached that point with defibrillators.

[Mr George Howarth]

My right hon. Friend is making a powerful case. Does he agree that workplaces could be added to the list?

[Andy Burnham]

I am sure they could. That is my appeal to the Government. I am not being prescriptive and saying that I want this, that or the other. A compelling case has been made for schools because of the loss of young lives. Shopping centres are also a possibility because of the footfall, as are train stations, airports and so on, and workplaces, particularly where people are under the extra pressure of carrying out intense physical activity.

The Government can advise on what the minimum requirement might be, but it is important to have one. Then we would have national clarity on where the public can expect to find a defibrillator. They would know where to locate one, because defibrillators would be required by law. Communities are crying out for it, and we do not have clarity at the moment. Earlier in the debate, someone asked where we would find a defibrillator in Parliament. I would not know. We need to start thinking about clarity and signage. If we did so, we might be able to have a national open register of defibrillators. It is not beyond the wit of man to ensure through an app on a phone that people in a situation where somebody had fallen could find out in real time, via modern technology, where the nearest defibrillator was. An effort could then be made to locate it as soon as possible.

Such things could be done. Lives could be saved. There is no excuse for complacency. We are not talking about huge amounts of money. This House could apply its mind to the issue, bring a little more focus to it and make proportionate and sensible requirements for where defibrillators must be located. Those locations could be publicised, and the public could be educated about how to use them. Why are we not doing it? We should be. I am not making a political point; I am being as critical of our time in government as I am of the current Government. We should be doing it. The case for action is unanswerable.

My hon. Friend the Member for Liverpool, Walton has done us all a huge service by requesting this debate, which is long overdue. Other countries are way ahead of us in putting a proper, thought-through policy in place at every level: education, screening, prevention, and response through public access to defibrillators. My three requests can be given fair consideration by the Minister; if she were to act, we would secure something momentous for the people who have campaigned so vigorously on the issue over recent years. They know and people outside know that it is right to make a change, and some communities are just getting on and doing so; they are not even waiting for Parliament to do something, and that alone should be enough to make us think and act. If we made a commitment now, I am certain that in a matter of years we would see those statistics improve and more lives being saved which, at the end of the day, is the best memorial we can give to Oliver King, Ciaron Geddes, Daniel Young and all the young people who have tragically lost their lives.

--- Later in debate ---

[Anna Soubry]

The hon. Gentleman’s point is good and is well made.

[Mr George Howarth]

In some respects I share the Minister’s scepticism that legislation is always the answer; it can, on occasions, be a blunt instrument. The problem, however, is that whenever we look at what the alternative is, it is not straightforward. My hon. Friend the Member for Bassetlaw (John Mann) talked about parish councils, but not everywhere is covered by parish councils.

[Anna Soubry]

That, again, is a good point. Clearly, one size does not fit all. Every area has different needs.

Backbench business

George Howarth Excerpts

Thursday 14th February 2013 Westminster Hall

[Mr George Howarth (Knowsley) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Osborne.

I congratulate the hon. Member for Romsey and Southampton North (Caroline Nokes) on raising this issue and in particular on her comprehensive survey of some of the problems experienced mainly by young people but, as she said, not exclusively so. She presented her case clearly and did a very good job.

It is important for us to send a message from this place today: quite naturally, human beings come in all shapes and sizes. There is no perfect body or shape, each one of us is different; we are genetically predisposed to look a certain way. It is important for us to say that as loudly and as often as we can, to counteract the loud noises often experienced in the media by young people about what they should look like.

Before I move on to the specific area that I want to cover, it might be worth giving an example not of a constituent but of someone I know through my family friendships: a young woman who is now in her 20s and has been studying violin since the age of five. She is a talented and well trained young musician and was offered a contract to play at an international festival in, as it happened, the south of France. The contract specified what body size she should aim to be—that says so much about where we have gone with the issue—by the time of the event. That was outrageous, and agents who become involved in such contracts should be ashamed of themselves.

I want to speak about an eating disorder that affects young people with type 1 diabetes. It is informally known as diabulimia, but the medical profession does not recognise that title and, to be fair, it is not an accepted name. In so far as I use it, I do so as shorthand to describe a quite complex phenomenon. I pay tribute to Diabetics with Eating Disorders—DWED—and particularly Jacqueline Allan who provided me with briefing to enable me to take part in this debate. Diabulimia is a condition, although not officially recognised as such, that affects mainly but not exclusively young diabetics. For clarity, I emphasise that I am talking about type 1 diabetes, which people are born with a predisposition to, and which has nothing to do with lifestyle. Some people are born with something that is likely to trigger diabetes at some stage, and too often we confuse type 1 with type 2 diabetes when they are absolutely not the same.

Sufferers of type 1 diabetes are exclusively prone to suffer diabulimia. If a young diabetic does not take their insulin, their level of blood sugar—glucose—increases, as medical science has known for a long time. However, young people have discovered that when that happens, the glucose cannot be converted into energy, and in turn the glucose is removed through the natural process of urination. Consequently, necessary calories are also lost, so manipulating their insulin intake may lead to rapid weight loss. If the intake of insulin, which is needed to stay alive, is manipulated, diabetics can achieve rapid weight loss. That information is circulated all the time in the social media on Facebook and Twitter, and young diabetics who want to lose weight are learning from other young diabetics how to lose weight rapidly. I will move on shortly to the consequences for those young people.

First, it is important to give some context for diabetes and associated problems. Young female diabetics aged 15 to 30 have a nine times higher death rate than their non-diabetic counterparts, which is an alarming statistic. According to a BBC report last year, of the 26,000 avoidable deaths from diabetes, the highest increase is among young women in that age range, which bears out the point made by the hon. Member for Romsey and Southampton North. According to the Joslin Diabetes Center and DWED, having type 1 diabetes increases the chances of developing an eating disorder twofold, and 40% in that age range regularly manipulate or omit taking their insulin, which they need to survive, in order to lose weight.

At first glance from the perspective of young people who want to lose weight, that seems like a way of using their condition as a means of doing so easily. However, the problem for people with type 1 diabetes is that deliberately increasing their blood sugar levels may have serious consequences and lead to early death. In the long term, as the hon. Lady said, there is a risk of fertility problems, which are common in relation to other eating disorders, but for diabetics there is also a risk of loss of limbs, kidney damage, blindness, heart damage and many other serious complications.

There may also be serious short-term consequences. When a type 1 diabetic stops taking sufficient insulin to balance their blood sugar levels, the body produces ketones, which are highly acidic and dangerous, and above a certain point might lead to diabetic ketoacidosis or DKA, which is always fatal if not treated quickly.

The health system is very poor at dealing with this problem because it is not officially diagnosable and the reaction of health professionals is often confused, at best, which might lead to courses of action that can have serious consequences, including death. Sufferers report being told that diabulimia does not exist—it does not exist as an official medical term—and consequently they have been discharged with no treatment. Sometimes they have been designated as non-compliant. If the health professional does not recognise what they are looking at, they assume that there is a problem with lack of co-operation from the patient and simply discharge them, which may have dangerous consequences. I will give an example in a moment.

In other cases, such people have been diagnosed as anorexic or bulimic, and treated for a condition that they do not have, often with fatal consequences. DWED reports that sufferers have sometimes been treated by eating disorder specialists who have little or no knowledge or understanding of diabetes, or by diabetes specialists who have little or no understanding of eating disorders.

[Caroline Nokes]

I welcome the right hon. Gentleman raising diabulimia, about which I knew absolutely nothing prior to calling this debate. A constituent of my right hon. Friend the Secretary of State for Communities and Local Government contacted me to inform me that treatment of the condition is incredibly rare, and they were aware of only one hospital in south London that specialises in it. Can the right hon. Gentleman confirm whether that is correct?

[Mr Howarth]

The hon. Lady is correct. I intend to address that issue when I bring my comments to a close, and I will make suggestions for what we need to do.

The consequence of people being treated either by a diabetologist who does not understand eating disorders, or by an eating disorder specialist who does not understand diabetes, is that they can be signposted to an unsuitable service altogether, or unforgivably, they will not be taken seriously when they have a serious problem.

An example I have been told about involved a young woman sufferer who was told that she was too heavy. That is not to say that she was heavy; she was very light, but she did not meet the criteria for being light enough to have an eating disorder, and was consequently told that she did not qualify for any support. The advice that she was given was that she needed to relax about food. Anybody who knows anything about diabetes knows that the relationship diabetics have with their carbohydrate intake is crucial to their well-being, so to say to a diabetic, “Go away and get more relaxed about eating”, could put them in a position where their life is threatened. Subsequently, the young woman concerned had to be admitted as an emergency case to hospital with ketoacidosis, which, had it not been treated quickly enough, would have been fatal. That was somebody who had presented themselves in the health system, looking for help, but was told to go away and get a better relationship with food.

DWED has some aims that I hope Ministers can address, and I shall go through those now. First, it wants to establish the principle, which I strongly support, that no diabetic with an eating disorder should be misdiagnosed or told, “There is nowhere to put you”, which is what is commonly said to them at the moment. That comes back to the point made by the hon. Member for Romsey and Southampton North.

Secondly, for type 1 diabetics with eating disorders—what I have termed as diabulimia—the condition needs to be properly recognised as a serious and complex mental health problem. I do not think that it is controversial for the hon. Lady to refer to it being a mental health problem, because although, in all the cases that she gave, there are serious physical consequences, the springboard often relates to mental health, relationship with body image, and so on.

Thirdly, those who seek treatment should receive the correct treatment with respect and compassion, on the basis of a multidisciplinary approach. In the example that I gave, there was not enough expertise in one specialism to be able to satisfactorily deal with the problem. Such an approach requires the Department actively to promote an understanding of the problem, so that health professionals catch on to what is happening. Protocols probably need to be in place, so that when somebody presents themselves with such a condition, health professionals know what to do.

The only people raising this problem, apart from me in today’s debate, are DWED, who work together with other bodies, such as Diabetes UK. DWED currently exists on an income, in the last financial year, of £9,000, which is not even enough to employ one full-time member of staff. DWED operates on the basis of having previous sufferers who are volunteers, under the co-ordination of Jacqueline Allan, who I mentioned earlier. I do not know whether it is more appropriate for support to come from foundations or the Government, or somebody else. I am not talking about needing hundreds of thousands of pounds, although I am sure that DWED would welcome that, but some way needs to be found to support the one organisation that is campaigning on, and raising and dealing with the problem. Given the importance of its unique role, I hope that the Government can find some support—not only for DWED, but for the issue as it exists across the health service.

Finally, just as it is vital that health professionals take a more multidisciplinary approach to this and other eating disorders, it is equally important that the Government take a more joined-up approach. I could have made the same criticism of the previous Government, and I realise how difficult it is to get a joined-up approach to eating disorders and many other things. However, on medical cases, there needs to be co-operation between different Departments, because a stronger push is required on the issue of body image and how that is dealt with. Perhaps it is not best dealt with by the Department of Health, but at the same time, some of the health issues involved need to be addressed.

[Jackie Doyle-Price]

Perhaps I can put an alternative view to the right hon. Gentleman. In my experience, people do not like being told what to do by the Government. If we acknowledge that the media are among the biggest perpetrators in pushing forward images that we should all aspire to, do we not need a good, populist campaign to educate the public that actually, curves are great?

[Mr Howarth]

The hon. Lady makes a good point. There is this idea of politicians wagging our fingers and saying, “This is what you should do”. For a couple of years in the previous Government, I had the responsibility in the Home Office for drugs policy, and one thing I know is that middle-aged men like me—perhaps I am flattering myself there—are probably the worst people to go into the media and say, “Actually, you should not be taking drugs.” A subtle, sophisticated approach is needed. A lesson from that, which applies equally here, is to provide information to young people so that they know the consequences of what they do. One problem we are dealing with is that people think there is an easy way to lose weight and to get to be the shape that they, or others, think they should be. Action has to be taken smartly, on the basis of real information about consequences, but it still has to be done.

The hon. Lady anticipated my next point, which is the responsibility of people in different industries. There is relentless media hype about what the perfect body shape should be, and the irresponsible attitudes often displayed by the fashion and entertainment industries need to be highlighted. Looking round the room, there might be one or two people who can remember what it was like to be a teenager—[Interruption.] I take that back. Several people around the room well remember what it is like to be a teenager, and one experience that we probably all share, and that every teenager in history has shared, is insecurity. They have not developed into who they are going to be, and they are insecure about everything, including their appearance—as is obvious, I have long since given up worrying about my appearance—the way they present themselves to the world, what it is to be cool, and all those things. A lot of that is dictated by what they read in magazines and see on cable channels—even on mainstream reality television shows.

It is wholly unrealistic for the industries that show those images to say, “Well, that’s a matter for the Government.” They have a responsibility to provide for young people role models that are realistic, that are just like the rest of the world, that show young people that they do not have to look like those images to be an acceptable, successful and attractive member of society. That responsibility is not just for Government or politicians, but for everyone who is in a position to influence how these things are presented to young people in particular, and to society in general. I hope that, as a result of this debate, we can at least move that agenda along a little further.

[Sandra Osborne (in the Chair)]

I call Heather Wheeler.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

It is a pleasure to serve under your chairmanship, Mr Walker. You are an appropriate Chair for this debate because of your interest in mental health and your willingness to speak out about your own experience, which meant an enormous amount to those who are fighting the stigma of mental health problems. Indeed, my hon. Friend the Member for Braintree (Mr Newmark) has done the same today. Such moments, when people are willing to speak out, are incredibly important in challenging and addressing the stigma of mental health problems in society.

I am deeply grateful to the members of the Backbench Business Committee for convening this important debate. It is good that Parliament has recently been willing to debate a number of different mental health issues in a way that perhaps has not happened in the past. Mr Walker, before Christmas you raised the issue of schizophrenia, on which we had a useful debate. The great value of such debates is that they force people to think about an issue, just as my hon. Friend the Member for South Basildon and East Thurrock (Stephen Metcalfe) has today. His experience of recognising the problem, perhaps for the first time, and talking about it with his children demonstrates the great value of such occasions, because they force all of us to think about an issue. Indeed, they force officials in my Department to think about the issue, too. I am grateful.

I do not want to detain everybody unnecessarily, but I will devote a little time to responding to the specific issues that hon. Members have raised. If the hon. Member for Romsey and Southampton North (Caroline Nokes) does not mind, I will refer first to the speech by my hon. Friend the Member for Braintree. I am so grateful that she persuaded him to come speak in this debate, because he made an incredibly valuable contribution. I was struck by his remarks about the huge stress experienced by teenagers. As the father of two boys who have been through the teenage years, I am acutely aware of the pressure on teenagers and the impact that it can have on their mental and physical health. He discussed huge stress, fear of failure and anger. I was struck by what he said: unless the mind is healed, the body cannot heal. We must look at the problem holistically.

One problem with health care is that we have institutionalised fragmentation. We have managed to separate mental health from physical health, which is ultimately not a good thing. We must consider the whole person. I know that the Opposition have been talking about that. It should not be an issue for political disagreement; it is such an obvious thing to recognise.

My hon. Friend the Member for Braintree discussed the need for education and raising awareness, including among parents. The strain, stress and anxiety that parents go through must not be underestimated. Improved awareness is needed in society of this range of conditions. He said that mental health care was the orphan within the NHS, which is absolutely true. There is an institutional bias against mental health. The way that money flows within the NHS disadvantages mental health. There is an 18-week target for physical health care and a tariff, meaning that every patient takes money with them into acute hospitals. Money is sucked through into acute hospitals, and there is great political pressure from every side to maintain the 18-week target. There is no equivalent in mental health. There is no right of access. Waiting nine months to access care and treatment is completely unacceptable. We must challenge that, and he was absolutely right to raise it. He ended on a positive note. There can be life after anorexia, however tough it is to get through it. Some, terribly sadly, do not. I will return to that point in a moment.

The hon. Member for Romsey and Southampton North made some incredibly important points. She mentioned her local organisation, April House in Southampton, and the fantastic work that it does, and she spoke about the absolute importance of raising awareness in primary care. Some people are lucky enough to find a GP who understands mental health and is passionate about it, but some are not. Families with a GP who just does not get it can be desperate; they have nowhere to turn. There is a need to raise awareness.

In the first mandate, a set of priorities published by the Government for the new NHS Commissioning Board, mental health has been given a higher priority than it has ever had in the NHS. The mandate makes it clear that the NHS is under a legal obligation to deliver demonstrable progress towards parity of esteem by 2015. That means treating mental health on a par with physical health. By placing the commissioning board under that obligation and disseminating the message to clinical commissioning groups, we will start to make progress on forcing the system to recognise the importance of treating mental health and physical health equally. It will not happen overnight, but it is a journey that we must take to improve the condition of many people. The hon. Lady discussed the impact on families and the unfair sense of guilt that many experience. She also mentioned waiting times, which in many cases are simply unacceptable.

I am grateful to the right hon. Member for Knowsley (Mr Howarth) for his contribution informing me and others about diabulimia. He discussed the rapid weight loss that can occur with diabetes, and how some people use the condition to lose weight in a dangerous way. He also said that in too many cases, a wrong diagnosis is made and the wrong treatment given as a result, and urged me to ensure that the condition was recognised better at a national level and the knowledge disseminated through the system. I urge him to engage with the commissioning board. I am happy to work with him on that, and for him to write to me on the issue.

[Mr George Howarth]

I am grateful to the Minister for the helpful way that he is addressing the problem. I have written to one of his ministerial colleagues on the matter. I arranged a meeting with her that she had to cancel owing to diary commitments, but I would be more than happy to meet him and anybody else he wants, including Diabetes UK and Diabetics with Eating Disorders. I am sure they would be happy to accompany me.

[Norman Lamb]

I am nervous about treading on other ministerial toes, but I am sure that in one way or another we can get the issue addressed properly. I am grateful to the right hon. Gentleman for informing me so well.

The hon. Member for South Derbyshire (Heather Wheeler) made a helpful contribution and discussed the need to raise awareness of eating disorders. She mentioned personal, social, health and economic education in schools. All schools are encouraged to provide young people with good, age-appropriate education about sex and relationships, but we are reviewing PSHE to establish how teaching can be improved. There is clearly a need to improve the teaching in many schools.

The hon. Member for North Tyneside (Mrs Glindon) mentioned her local service, NIWE, and the important work that it is doing. She spoke about the number of people who are not diagnosed but who none the less suffer from eating disorders, and about the fact that they have the highest mortality rate of any mental illness. She said that early intervention was important.

I was struck by what the hon. Lady said about recovery groups. This morning I spoke at a conference on mental health. I spoke specifically about recovery and a new way of looking at mental health. We must move from trying simply to treat the condition to working collaboratively with professionals and people experiencing the condition, and we must focus on recovery. Fantastic results are being demonstrated from that shift in approach. It is frustrating that in some parts of the country, great things are happening, but it is patchy, as many hon. Members have said, and improvement is needed. She also made the point that mental health is the poor relation, as I have acknowledged. That must change.

I pay tribute to the hon. Member for Enfield, Southgate (Mr Burrowes), who has had to leave, for the work that he has done on addictions, focusing on treatment and recovery. He has been committed to improving the experience of people suffering from a range of addictions. He, like other Members, discussed the growing prevalence of the condition among teenage boys, which should worry us all. My hon. Friend the Member for Wells (Tessa Munt) spoke movingly. She mentioned the cult of celebrity, pressure on youngsters, variability of services around the country and access to those, the quality of care being variable and the need for much improved training and for multidisciplinary teams.

Interestingly, my hon. Friend mentioned issues of consent, a difficult area about which there are strong views on both sides. I am acutely aware of the horrible position of a parent wanting to help, but being unable to because of the legal constraints that prevent them from making an effective intervention. We need to think more about that, and the Children’s Minister is also involved in the discussion.

My hon. Friend the Member for South Basildon and East Thurrock got it right. Fascinatingly, he talked about his discussion with his children last night. I am so pleased that his television is broken, because it has led to our being given a valuable insight that we might otherwise not have had. He mentioned the increasing prevalence among males, including among gay men, which is a real concern. He also talked about the need for help for parents in understanding the condition much better.

The shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), was right to talk about holistic care and the need to look at the whole individual. I will mention other things that he said as I go through my speech. I wish his son a happy birthday today, as he enters his teenage years.

The hon. Gentleman asked a couple of questions. On collating national statistics, we have a long way to go on the collection and interpretation of data relating to mental health. I have a fortnightly meeting on mental health in my office, so that we maintain an absolute focus on achieving tangible improvements. We talked specifically about data yesterday. The Health and Social Care Information Centre is getting more data but is not yet able, with the resources available, to interpret those. I want the same resources applied to mental health as to physical health. That is a challenge that I have made to the system.

The hon. Gentleman mentioned National Institute for Health and Clinical Excellence guidance. NICE is independent. I do not know whether there is a need for a review—a renewal—of the advice. I am happy to talk further to him about that.

This is an occasion on which we should not just raise awareness of the issue as part of eating disorders awareness week, but send a clear message to people with eating disorders, their loved ones and families: we hear you when you talk about your concerns. I am determined, as the Minister responsible for mental health, to do what I can to help.

I pay tribute to the work of Beat, based in Norwich in my county of Norfolk, which does brilliant work. Hon. Members have also mentioned Anorexia and Bulimia Care and the fantastic work that it does.

Eating disorders can be tremendously dangerous and damaging conditions. The UK has the highest rates of eating disorders in Europe. But it is a disease that is often hidden, as hon. Members have said. Sufferers are often unwilling to seek help or to recognise they have a problem. Reported cases are the tip of the iceberg. It is a disease that often strikes at the young. In 2009, the adult psychiatric morbidity survey showed that 20% of 16 to 25-year-olds admitted to having “a problem with food”. That is a significant percentage.

According to the Health and Social Care Information Centre, in 2011-12 the biggest increase in hospital admissions for eating disorders was among girls aged 10 to 15. The shadow Minister, the hon. Member for Denton and Reddish, mentioned admissions of those under 10, as well—shockingly, more than 50 children under 10 were also admitted.

University Hospitals of Morecambe Bay NHS Foundation Trust

George Howarth Excerpts

Tuesday 5th February 2013 Westminster Hall

[John Woodcock]

The hon. Gentleman makes an interesting point, for which I am grateful. I am sure that Ministers will want to consider that, but I think it must not come at the expense of local MPs’ taking our eye off the ball in the forthcoming consultation.

The Minister was good enough to write to me about James Titcombe and other grieving families. In the first letter, he said that he would keep the issue under review. I hope that, when he has time to look at the matter further, the Minister will agree that the trust’s commitment to an independently chaired but internally managed inquiry, although it is a welcome step forward, will not be sufficient to give confidence and ensure that lessons are learned, not only in this individual hospital, but in the entire NHS. Most of all, I hope that he will join me today in sending a message, loud and clear, that the need to be accountable for past mistakes must never be used by the trust as an excuse to remove services that our community clearly needs.

The final part of my speech relates to the crisis caused by the trust’s shock decision to transfer, apparently temporarily, the special care baby unit and consultant maternity services out of Furness general to Royal Lancaster infirmary due to increased sickness absence levels at the trust.

Let me deal first with the shambolic process that has left expectant women unsure about where they can give birth—even now, as we speak, two hours after the transfer was due to take place—because of genuine fears about a lack of ambulance cover. The decision was taken unilaterally by the trust, with no consultation or warning given to the public, the obstetric consultants who work at Furness general, or the GPs responsible for commissioning the services. The option of transferring staff from the Royal Lancaster infirmary was not put to the board. Although there can be no doubt that staffing levels are low at Furness general, there was no detailed risk assessment of the dangers of transferring mums in labour by ambulance. Most alarmingly, no attempt was made to engage the North West ambulance service—this was confirmed to me by the service last night—until last Wednesday evening, leaving that organisation unable to find the extra unit that it estimates will be necessary to cope with the increased demand on an already stretched operation. This is an appalling and potentially dangerous shambles that has greatly increased the anxiety of pregnant women in my constituency, on top of the worry they already felt at the news, during what is naturally one of the most worrying times in their life anyway.

Will the Minister intervene personally to impose order on the chaos? Will he confirm that the regional health authority’s gold command is meeting today to escalate the situation? Will he meet me to ensure that we have the best chance of getting the services we need back as soon as possible? Let me be clear: families in my constituency and beyond will be devastated if we lose consultant-led maternity services permanently. The Minister is a practising obstetrician and will know better than I that the removal of the clinician-led special care baby unit will result in women who expect complicated deliveries or who experience complications during birth facing a transfer to Lancaster, involving a journey time of about one hour along a road that, less than a fortnight ago, became almost impassable due to heavy snow—in fact, journeys between Barrow and Lancaster were taking up to 10 hours. Trying to transfer a mother who needs consultant care in such conditions is hard to imagine.

It has been suggested that air ambulances could be used to speed up transfer times in the event of Furness general hospital’s maternity unit being downgraded, but serious questions need to be answered about the practicality of that proposal. The Great North air ambulance service is a fantastic organisation that helps to save many lives each year, but it has just three helicopters to cover not only Cumbria, but the whole of north-east England and North Yorkshire. We cannot simply assume that the answer lies in the air.

I am immensely proud to be backing the “Thousand Voices” campaign in my constituency, which comprises mums who got together to make themselves heard when they saw the crisis coming. I know that I cannot use props, Mr Howarth, so I will not, but I urge all hon. Members to go to www.YouTube.com/saveFGHmaternity to hear the stories being shared. People are going out and using camera phones to get video clips from mums and dads, wherever they can find them. Let me read just one such story on the site, which reflects the views of hundreds. Mum of three, Christina Pickering, said:

“Due to extreme circumstances in my third pregnancy, I was sent to the Royal Preston hospital to deliver my daughter and that’s got to be one of the most terrifying experiences of my life, being in an unknown hospital, on my own, to deliver my baby. I don’t want this to happen to any mums—it doesn’t have to. Downgrading our maternity services at Furness general would not only be detrimental to mums and babies, but to the whole community. We’ve got to stop this happening.”

Let me end with the Minister’s own words from before he was promoted, which I wholeheartedly endorse. In a Westminster Hall debate in September 2010, he said that,

“generally speaking, if we consider the example of”

other hospitals,

“we see that the push has been to have a low-risk, midwifery-led unit alongside a higher-risk unit. We in obstetrics know that a greater number of women—rising to about 30%—are giving birth by Caesarean section, and that number is going up year on year. Many births that we initially think uncomplicated end up being much more complicated.”—[Official Report, 14 September 2010; Vol. 515, c. 230WH.]

The Minister summed it up perfectly. Families in Furness want the security of knowing that they can have their babies in Barrow with specialist help on hand. They pay for their health services with their taxes and they are speaking with one voice. They need the Government to listen.

[Mr George Howarth (in the Chair)]

I call David Morris, but for two minutes only, as the Minister needs time to respond to the debate.

[David Morris (Morecambe and Lunesdale) (Con)]

I thank you for calling me in this debate, Mr Howarth, as it is one that will be closely watched in my constituency. For some weeks, the local press has been awash with allegations about both maternity and accident and emergency services at our NHS trust. I am concerned not about services changing but about the scare stories surrounding the matter. I have a letter from the chief executive of the trust that confirms that it will not shut the A and E at Royal Lancaster infirmary. The Minister also has this letter, but I will quote from it:

“The A and E at the Royal Lancaster Infirmary serves the population of Lancaster and surrounding areas and treats in the region of 50,000 people each year. Whilst it would be wrong of me to second guess the future, I personally find it hard to imagine Lancaster not having emergency services. Let me be clear, we do not have any plans to shut the Accident and Emergency department in Lancaster. We are deeply concerned that these continual rumours are undermining confidence and frightening the public. We will continue to work with the public, staff and stakeholders to better understand the review of services to help allay these concerns.”

Jackie Daniel, the CEO of the trust, is saying there that not only does she have no plans to close the A and E, but she cannot even imagine a scenario in which anyone would close it, not least because it serves 50,000 people a year.

However, a concerted Labour campaign has been mounted by local party members who actually work in the NHS to make people believe that the A and E is likely to close. The campaign involves press briefings, an online petition, a Facebook group and even people walking round the centre of Morecambe with clipboards inviting people to join. I want the e-petition removed from Directgov and have written to the Cabinet Secretary to ask for him to intervene. We cannot have this dishonest campaign fought through the Directgov e-petition platform. If the A and E is not under threat, it must be concluded that Labour is frightening people for its own political advantage, which is morally wrong.

It is perhaps time to admit the truth: the trust is getting better under this Government. A new and better management was brought in by the previous Secretary of State for Health. A new minor injuries unit was opened in my constituency by the Minister only a few weeks ago. A new health centre in Heysham, costing £20 million, was opened last year. We have four new wards just opened. All of that was paid for by the 2.8% increase in funding for the NHS.

[Mr George Howarth (in the Chair)]

Order. I call the Minister.

National Health Service

George Howarth Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham]

No, it does not. This is what Government Members do not understand. It is not about the organisations, but about the services that they provide. The existing organisations can be asked to work differently, and I would ask them to work differently. I do not want NHS organisations to be in outright competition, hospital versus hospital; I want them to work collaboratively. So yes, we will repeal the Act, but no, there will not be a pointless top-down reorganisation of the kind that we have seen the Secretary of State inflict on the NHS.

This complacency is dangerous, and it cannot be allowed to continue. We had two clear purposes in initiating today’s debate. First, although we cannot stop the Government’s reorganisation, we can hold them to account for promises that they made to get their Bill through. I shall shortly identify five such promises in respect of which we are asking Ministers to live up to their words. Secondly, we wanted to give the House a chance to help the NHS by voting to hold the Government to account and enforcing the coalition agreement’s commitments on NHS spending.

Let me first deal with Ministers’ claim that there is no evidence of rationing of treatments by cost. They have promised to act if any evidence is presented. In fact the evidence is plentiful, and it is simply not credible for Ministers to deny it. The postcode lottery of which we warned is now running riot through the NHS. We have identified 125 separate treatments that have been stopped or restricted in the past two years, in some cases in direct contradiction of guidance from the National Institute for Health and Clinical Excellence.

[Mr George Howarth (Knowsley) (Lab)]

Last week I was at Whiston hospital, which, as my right hon. Friend will know, covers Knowsley and St Helens. The net effect of all the changes is that its staff, particularly the nursing staff, are thoroughly demoralised. Does my right hon. Friend accept that any commitment that he makes to changing the system will be welcomed by NHS staff?

[Andy Burnham]

I have heard the same from staff throughout the system. Morale has never been lower. People have been badly let down by a Government who promised them no top-down reorganisation, a moratorium on hospital changes, and real-terms increases. None of those things has been delivered. During the run-up to the general election the Conservatives cynically used the NHS to try to gain votes, and they will pay a heavy price for breaking the promises that they made then.

--- Later in debate ---

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

The motion that we are debating today is typical of the Opposition. Rather than praising the NHS in a year of change, they seek to denigrate it. Rather than commending the hard work and dedication of NHS staff, they undermine their efforts and belittle their results. Rather than supporting the parts of the NHS that are dealing with long-term financial challenges—challenges that were partly of the own making of the right hon. Member for Leigh (Andy Burnham)—they attempt to scaremonger.

In truth, this has been a year that has tested the NHS, which has dealt with significant financial pressures as well as the transition to the new system, but it is also a year in which the NHS has proven its mettle. Far from the meltdown that some gleefully predicted, we have seen a robust and resilient NHS delivering better care for patients.

[Mr George Howarth]

Will the Minister give way?

[Mr Burns]

In a minute.

I know that waiting times mean a great deal to the right hon. Member for Leigh, so let us have a look at the numbers. Despite what he peddles around the country, waiting times remain low and stable—in fact, below where they were at the last general election. In May 2010 more than 18,000 people waited more than a year for treatment. Today that figure is just 4,317. Today 55,335 people wait more than six months for treatment—almost half the figure of 100,979 at the last general election. There are 149,912 people now waiting more than 18 weeks, compared with 209,411 in May 2010. The median wait for admitted patients has fallen in that time from 8.4 weeks to 8 weeks, and for non-admitted patients from 4.3 weeks to 4 weeks. Across the country, all NHS waiting time standards for diagnostic tests and cancer treatment have been met.

--- Later in debate ---

[Mr Burns]

Yes; 96% of patients wait for fewer than four hours in A and E, and as the right hon. Gentleman knows, the percentile is 95%.

[Mr George Howarth]

rose—

[Valerie Vaz (Walsall South) (Lab)]

rose—

--- Later in debate ---

[Mr Burns]

The hon. Lady will know that GP referrals have gone down slightly, but the referrals to A and E have risen slightly.

[Mr George Howarth]

The Minister said in his opening remarks that Opposition Members are denigrating NHS staff and their achievements. Does he accept that if he has any conversations with NHS staff, he will find the reverse—they feel that they are being denigrated by this Government and their reforms?

[Mr Burns]

I do not like to contradict the right hon. Gentleman, but I will. What I said was slightly different from what he accused me of saying. What I said was that rather than praising the NHS in a year of change, the Opposition denigrate it. That is slightly different.

To pick up on a point that the right hon. Member for Leigh mentioned from a sedentary position, GP referrals for 2011-12 were 1% lower than in the previous year, but outpatient referrals were, as I said, slightly higher.

EU Working Time Directive (NHS)

George Howarth Excerpts

Thursday 26th April 2012 Westminster Hall

[Mr Nuttall]

But not obviously for the NHS.

[Mr George Howarth (in the Chair)]

Order. If the hon. Gentleman wishes to make an intervention, he should stand up and do so in the approved manner and not mumble from a sedentary position.

[Andrea Leadsom]

Thank you, Mr Howarth. Occasionally it is difficult to remember that we are not having a conversation.

The point about the opt-out is that, under the working time directive, individuals can opt out of the maximum 48 hours per week if they choose to do so—they cannot be compelled to do so.

--- Later in debate ---

[Mr Burns]

I will not, if my hon. Friend will forgive me, simply because I have only seven more minutes. I was hoping to address some of the points raised by my hon. Friend the Member for Bristol North West.

We have to abide by the legalities. Otherwise, chaos will ensue and we will not in the longer term achieve what we are hoping to, even if we might on that narrow issue. Until the negotiations in Europe come to a successful end we are obliged to comply with the European Court of Justice and we cannot unilaterally go against it. The Department of Health and the Department for Business, Innovation and Skills are working very closely together on how the WTD will apply to the UK health care sector. Both Departments agree that we need to keep the opt-out and it would be a grave error to surrender it or to abandon it for other concessions. That is a red line for us. We have to keep the opt-out.

We also want to solve the issue of flexible on-call time and compensatory rest that allows the NHS to work within the current constraints of the working time directive. Those are both very important issues to the Government and to the NHS, but as I said, the bottom line is that the opt-out must stay. European social partners have opened negotiations to amend the WTD. At this stage, as hon. Members will know, it is not national Governments directly who are conducting these negotiations; they are being done through what is known as the social partners. In our case, it is NHS Employers and the Local Government Association with regard to local government and the knock-on effect for social care; that is an important part of the delivery of NHS services and social care.

That process is autonomous, and operates independently of the Commission and Council. The social partners have nine months at most to reach an agreement. That takes us up to September 2012. If an agreement is reached, it would be submitted to the Council for approval. But if an agreement cannot be reached, it will be up to the Commission to issue a proposal to change the directive. The Government have made it patently clear to everyone that long-term, sustainable growth must be the EU’s key priority. Every decision the EU makes must be geared towards that. So we will carry on working with our partners to make sure that EU measures support labour market flexibility and do not impose unfair costs on member states or businesses, or services like the NHS, that could hold back our economy and the delivery of services.

For the NHS specifically we are keen to ensure that an amended directive provides more flexibility, particularly in the areas of on-call time and compensatory rest, provided that a workable opt-out can be maintained. Responding to concerns about how the directive is being applied, particularly with regard to medical training—an issue raised by a number of hon. Members—Medical Education England, the Government’s independent advisory body on medical education, commissioned an independent review chaired by Professor Sir John Temple. My right hon. Friend the Secretary of State for Health has asked Medical Education England to help improve our training practices in line with Sir John’s recommendations.

In response, Medical Education England has set up a programme known as Better Training Better Care, which will improve patient care by increasing the presence of consultants and by ensuring that service delivery supports training. It includes two important components: identifying, piloting, evaluating and sharing good education and training practice; and improving the curriculum so that training leads directly to safe, effective patient care. From an education and training perspective, handovers present an excellent opportunity for training. The Better Training Better Care programme includes pilots that will hopefully show how education and training practice can improve in that area and take advantage of those opportunities.

NHS trusts in England have responded very positively to this programme: 96 trusts applied for part of the £1 million available for NHS pilots in 2012-13. Following that competitive process, last month 16 projects with 16 NHS trusts were awarded funding for those pilots. I look forward to seeing what developments they come up with.

As I am running out of time, I say to my hon. Friend the Member for Bristol North West, who wants to make a contribution to end the debate, that I will write to her with answers to a number of important issues that she raised. However, I will deal briefly with two issues now.

First, my hon. Friend asked what will happen in emergency situations such as a flu pandemic. I hope I can give some reassurance on that point. In such circumstances, as long as health and safety are protected in the round and the employer has correctly judged that the circumstances are exceptional, the rest requirements of the directive can be suspended.

Secondly, my hon. Friend the Member for Kingswood and other Members raised the vital issue of locums, including the cost of locums and their number. I share the concern of my hon. Friends about the use of locums. They play an important role when there are short-term staff shortages, or when there is illness or holidays, and there may be a limited impact of the EWTD that means that trusts will be employing locums when they might not otherwise do so. However, the evidence about the extent of that practice is not as extensive and meaningful as we would like it to be; we would like to get a fuller picture. Nevertheless, whatever the reason for the use of locums, we are concerned across the board about their extensive use and the add-on costs that brings to the NHS. That is why we are working through our training programmes and through the Quality, Innovation, Productivity and Prevention programme to seek to minimise unnecessary use of locums and to bring down the number employed, thereby reducing costs. As I said to my hon. Friend the Member for Kingswood, there has been an 11% reduction in the employment of locums, and at the same time there has been an increase in doctors.

In conclusion, I also hope I can give some reassurance to my hon. Friends about staffing levels, particularly in specialised areas, because the situation is slightly more encouraging than they may have feared. For example, if we take the current year and general surgery—

[Mr George Howarth (in the Chair)]

Order. I call Charlotte Leslie.

Health and Social Care Bill

George Howarth Excerpts

Tuesday 13th March 2012 Commons Chamber

[Andy Burnham]

I think that Government Members are misjudging the mood of the country, and particularly of health professionals, who have not given a knee-jerk political response to the Bill but have given it careful consideration since it began as a White Paper and then proceeded on its tortuous path through Parliament. They have come to the conclusion that it is better, even now, to abandon it and work back through the existing legal structures of the NHS rather than proceed with the new legal structure and all the upheaval that that entails.

[Mr George Howarth (Knowsley) (Lab)]

Yesterday I was at a meeting with people with diabetes who expressed grave concern that they do not know what services would be available if the Bill were to go ahead. Is not that another good reason to take a pause and decide to drop the Bill until all these problems can be resolved?

[Andy Burnham]

I am aware of the concerns expressed by Diabetes UK and, indeed, by many other organisations representing people with long-term conditions, who have not been given the clarity that they need in order to give their support to these changes. [Interruption.] The Secretary of State says “Rubbish”, but I am afraid that those questions have not been answered, and that is not good enough.

--- Later in debate ---

[The Secretary of State for Health (Mr Andrew Lansley)]

As a learned man, Mr Deputy Speaker, you will recall that Plato said that

“empty vessels make the loudest sound”.

The right hon. Member for Leigh (Andy Burnham) has been a study in this: as his arguments have diminished, so his tone has become more strident. By the end of his speech, he was simply shouting slogans. I listened carefully to his speech, but in vain, for evidence of an argument, still less of an Opposition policy.

I ask the House to reject the motion, which is a desperate ploy from a desperate party. The House scrutinised and approved the Bill, with amendments. following a substantial and highly constructive engagement right across health and care services and with the independent NHS Future Forum. We accepted all their recommendations. The chairman of the British Medical Association Council said at the time that the recommendations

“address many of the BMA’s key concerns”.

Dr Clare Gerada, the chair of the Royal College of General Practitioners, said that

“we are reassured that things are moving in the right direction”.

Yes, things have moved in the right direction, including, apparently, Dr Gerada, encouraged by her council.

In the other place, things have moved in the right direction, too. We have had hours of constructive debate leading to further positive amendments, including amendments to put beyond doubt the Secretary of State’s responsibility and accountability with respect to a comprehensive health service, and a duty on the Secretary of State to have regard to the NHS constitution; amendments to make it clear that Monitor will have the power to require health care providers to promote integration of NHS services, enabling Monitor to use its powers to support integration and co-operation in the interests of patients; and amendments conferring new responsibilities on the NHS Commissioning Board and clinical commissioning groups to play an active role in supporting education and training, and requiring providers to co-operate with the Secretary of State when exercising his duty to secure an effective education and training system. All those amendments were positively accepted in the Lords.

[Mr George Howarth]

The Secretary of State quoted Plato earlier. Does he recall the advice that Cromwell gave to Members of the Long Parliament—that they had stayed in their place for too long and to no useful purpose? Is that not advice that he might take?

[Mr Lansley]

I do not think the right hon. Gentleman should quote Cromwell to a Cambridgeshire MP; I think I know more about Cromwell than he does. [Hon. Members: “Ooh!”] I might also tell him—