Oral Answers to Questions

Glyn Davies Excerpts

Tuesday 26th November 2013 Commons Chamber

[Norman Lamb]

Absolutely. I offer my condolences to the family of Sophie. The remarkable selfless fundraising done by such families does much to provide care for others and that will be a remarkable legacy for a fine young girl.

[Glyn Davies (Montgomeryshire) (Con)]

11. What discussions he has had with NHS hospital trusts on taking account of the interests of patients in Wales who depend on hospitals in England.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

As my hon. Friend knows, officials from NHS England frequently meet the Welsh Government to discuss the issue of health care provided in England for Welsh patients. He will know that NHS England has a duty to consider the likely impact of any commissioning decision it makes on people who reside in an area of Wales that is close to the border.

[Glyn Davies]

Does my hon. Friend agree that when commissioners for NHS hospital trusts in Shropshire are considering where to locate services, account must be taken of the needs of patients in Montgomeryshire, the vast majority of whom are dependent on Shropshire hospitals, particularly the Royal Shrewsbury hospital?

[Jane Ellison]

My hon. Friend is absolutely right to highlight the fact that cross-border health care is an area of great concern. There is a requirement to take note, as he says. The work is ongoing and I am happy to have those discussions with him.

Urgent and Emergency Care Review

Glyn Davies Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

Let me tell the hon. Gentleman that thanks to the reorganisation that he is so bitterly against, we have 5,500 more doctors on the front line and 8,000 fewer managers. We would not be managing to hit our A and E target today if we had not taken the difficult decisions that the Leader of the House took when he was doing my job.

[Glyn Davies (Montgomeryshire) (Con)]

Geography dictates that my Montgomeryshire constituents depend on A and E services in hospitals in England. Will my right hon. Friend reassure us that devolution will not be allowed to create a health care iron curtain between England and Wales, and will he ensure that decisions on A and E services in Shropshire take account of the interests of my constituents?

[Mr Hunt]

We will absolutely ensure that there is no iron curtain, but I must say that the increasing number of people coming from Labour-run Wales to seek treatment in England is an indication that people are voting with their feet because they know where the NHS is being better run.

Accident and Emergency Departments

Glyn Davies Excerpts

Tuesday 10th September 2013 Commons Chamber

[Glyn Davies (Montgomeryshire) (Con)]

My constituents depend on A and E services in Shropshire, which in many cases are already a long way distant. Does my right hon. Friend agree that when reorganisation takes place, which will happen in Shropshire, proper account should be taken of the distances that people living in rural areas will have to travel for emergency and urgent services?

[Mr Hunt]

I absolutely agree. It is really important that we recognise those challenges in rural areas, and indeed semi-rural areas such as my constituency, where we have had similar issues. I can assure my hon. Friend that when we make structural changes, we take those issues closely into account.

Managing Risk in the NHS

Glyn Davies Excerpts

Wednesday 17th July 2013 Commons Chamber

[Ann Clwyd]

Many people are afraid to complain. Some complain many years later, and some never do so at all. It must be made easier for people to complain.

[Glyn Davies (Montgomeryshire) (Con)]

I was reluctant to intervene when the right hon. Lady was giving all those examples, but this seems to be a natural break. I share her huge concern about end-of-life care in hospitals, and she may share my concern about the Government’s announcement this week that the Liverpool care pathway will end this year. I hope that the Government are clear about what will replace it, and that we do not end up with confusion about responsibilities in hospitals, which could lead to less dignity and care as people reach the end of their lives.

[Ann Clwyd]

I thank the hon. Gentleman for making that point. My next piece of testimony comes from a man who wrote this about his mother’s death in hospital:

“'My mother died under unspeakable conditions. The treatment she received, being deliberately dehydrated to death, on the so called ‘Pathway’, and total lack of sedation resulted in a death of anxiety, pain and total lack of dignity, which I personally witnessed.

The callous attitude of the staff beggared belief. My mother suffered incredible levels of neglect and abuse. We initiated a complaint, resulting in several distressing meetings. The whole procedure was to no avail as we only received platitudes of regret resulting in written statements of denial of any lack of patient care”.

Another man wrote:

“I left my wife with the assurance from nursing staff that she would be given a bath. I found her the next day some 15 hours later in her own excreta and vomit. Her face had been wiped clean. Nothing else. I was told the hoist was not working and that the bath was not plumbed in, and, in any event, nursing staff did not have the time to bathe her. Having found the equipment in perfect working order I bathed her.

I was caring for a fragile lady. I couldn’t make a complaint, I was frightened because my complaining would upset her and more uncomfortably, I had no trust in the nursing staff. Complain and how much worse could the callousness be? I took her home saying nothing. I'm still ashamed”.

Another man wrote this about his treatment for a punctured lung:

“My drip was not changed for six days, my chest hair that was shaved was left to fall under my bed and not cleaned up properly. I was never washed and in the end went by myself to the shower past the nurses station pulling my drip trolley—no one helped or worse enquired what I was doing. Water was taken away very early in the morning and not returned for at least two hours although there was obvious chatter coming from the nurses station”.

All the testimonies that I have read out come from Wales.

Cancer Care (England and Wales)

Glyn Davies Excerpts

Tuesday 12th February 2013 Westminster Hall

[Alun Cairns]

I am grateful to the hon. Lady for making an extremely valid point. The collection of data is exceptionally important, to identify which groups are potentially more vulnerable or which groups are not seeking the right sorts of treatment. Comparison between the home nations is important, but so is comparison between groups within the home nations, in order to bring the data together. It is exceptionally important if we are to reach the right conclusions.

I will focus on breast cancer to begin with. As I have already said, the mortality rate from breast cancer in England is 24.3 per 100,000 people, and in Wales it is 25.8 per 100,000 people. Clearly, those are worrying data, and it is worth considering the different approaches to treatment in the two nations.

In England, a patient concerned about the possibility of breast cancer can expect to see a consultant within 10 working days of the GP referral. In Wales, there is a different approach, which means that a GP differentiates between urgent and non-urgent cases. In cases that are deemed urgent, 95% of patients should expect treatment to start within 62 days, and in cases deemed non-urgent, the patient should expect treatment to start within 26 weeks. I want to underline this situation: a woman in England who is concerned about the risk of breast cancer will be reassured, or have her case elevated to the next level, within 10 days. In Wales, however, a patient has no such guarantee of consultant expertise until much, much later in the process.

We need to recognise that these are different measures and approaches. Breakthrough Breast Cancer has a helpful quote. It says that waiting for a referral is like being “left in the dark”.

[Glyn Davies (Montgomeryshire) (Con)]

The issue of waiting time for treatment and diagnosis is important to me. Does my hon. Friend agree that there should be an absolute focus on awareness, particularly regarding colon and rectal cancer, from which the chance of recovery is far greater if diagnosed early? There has to be a focus on early diagnosis, because it greatly increases the chances of recovery.

[Alun Cairns]

My hon. Friend makes a valid point about screening and awareness. Today I want to focus on treatment, but awareness and screening are exceptionally important and no doubt warrant another debate.

Social Care Funding

Glyn Davies Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

We will be happy to do that. I think that my hon. Friend’s constituents will value the fact that the horrifically low threshold of £23,000, beyond which they get no help at all, will be raised significantly to the £100,000 threshold, in 2010-11 prices, that Andrew Dilnot recommended. Under the draft Care and Support Bill, all local authorities will be obliged to give a care assessment and access to financial advice to everyone in their area in order to make sure that constituents such as those of my hon. Friend are given the information they need.

[Glyn Davies (Montgomeryshire) (Con)]

I, too, greatly welcome the framework for social care that the Secretary of State outlined in his statement. The Barnett consequentials should mean an extra £10 million for Wales if the proposal costs about £1 billion. What discussions has he had with the Welsh Government to encourage them at least to invest the Barnett consequentials in social care, given that it is as big a problem in Wales as it is in England?

[Mr Hunt]

I have had no discussions on that point. I will first establish what the Barnett consequentials of the announcement are. I would then be happy to talk to my hon. Friend.

Dementia

Glyn Davies Excerpts

Thursday 10th January 2013 Commons Chamber

[Glyn Davies (Montgomeryshire) (Con)]

Like others, I pay tribute to those who secured today’s debate: the Backbench Business Committee, the right hon. Members for Sutton and Cheam (Paul Burstow) and for Salford and Eccles (Hazel Blears), and my hon. Friend Member for Chatham and Aylesford (Tracey Crouch). The debate is about a hugely important subject of which many Members will have personal experience.

Many of us are aware of the scale of the issue: dementia will affect 1.7 million people by the middle of the century, probably double the figure now. It is probably one of the biggest challenges that this Government—and future Governments—will have to face, and will be particularly important in Wales where the percentage of people aged over 65 is higher than anywhere else in the United Kingdom.

The right hon. Member for Salford and Eccles paid tribute to the commitment of the Prime Minister, who launched the dementia strategy last year, and there is a commitment to increased spending on research. That is not anywhere near enough, however, and I am certain that in future our commitment to tackling dementia will have to be greatly increased.

I want to make five or six brief points, some of which are from a Welsh perspective. As we know, the matter is devolved, but as the right hon. Member for Sutton and Cheam said, where there are differences between the parts of the United Kingdom, lessons can be learned from one Administration by another, and devolution can be a sort of test bed. Different attitudes are developing in Wales and we may be able to learn things from that.

The issue I will mention first because it is so important is early diagnosis. Levels of diagnosis in Wales are particularly low—only 37.5% of people with dementia are diagnosed, which is far lower than in other parts of the United Kingdom—and of course access to new drugs and treatments is simply not available to people who have not been diagnosed with dementia.

Many of us—probably most who will speak in this debate—have personal experience of the issue, and one thing that is common to most is that we do not realise when someone is suffering from dementia. We may think there is a degree of slowness but we do not realise what they are suffering from. The second time it happens in a family people respond much better because they know pretty much what to expect. Those suffering from dementia can be crafty because they are desperate to hide their condition; in some ways there is embarrassment about it and they do not want people to know. Without experience, dementia is difficult to identify, so early diagnosis must be an aim for anyone concerned with dealing with it.

The second issue, which was touched on earlier, is training for nurses. There is a general issue at the moment about basic care in the health service—that was touched on last Tuesday during the debate on the Liverpool care pathway, and the right hon. Member for Cynon Valley (Ann Clwyd) also mentioned it. To my mind, such training is particularly important for people in the acute health services, many of whom are elderly. Many people go into hospital because they have had a fall although they are also suffering from dementia. The level of disruption and disturbance caused when they go into hospital can completely disorientate sufferers, and the rapid onset of serious dementia is much quicker and more radical in such a situation. It is important that those working in acute health services are trained in identifying and dealing with the dementia aspect of illness, as well as with the actual condition such as a broken hip or bone.

My third point is about Parkinson’s disease. I am involved in my local Parkinson’s disease charity. I do not know whether the trauma of Parkinson’s disease brings on dementia or whether it is the other way round, but we know that people suffer from Parkinson’s disease for quite a long time before it becomes publicly apparent. Many people will go into hospital and seem to suffer from dementia without anyone realising that they are suffering from Parkinson’s. That disease may come on more quickly—the trauma may cause it—so it is vital that in hospitals and care situations patients’ conditions are regularly assessed to see whether they are suffering from Parkinson’s disease, and that they are not just dismissed as a dementia patient while another illness is completely ignored.

I touched earlier on the liaison between Governments in Wales and England but that may apply to other Administrations as well. Without making any negative political point, there is a difference in approach. The Welsh Government are much more suspicious of the private sector than the UK Government—that applies particularly to the provision of social care. The Welsh Government’s view is that social care is delivered far better by the public sector, but, generally speaking, social care is delivered by the private sector.

The relevant Committee has considered that, and there is a very good chance that there will be new, different approaches in Wales—they could be based on co-operatives or they could be community based. They might work in an urban situation, but it is important that the Government in Westminster and the Government in Wales are aware of what is happening, and that they learn about good practice and what might work.

My final point—perhaps I will be the only hon. Member to make it in the debate—is on the Welsh language. Many who are elderly and frail in Wales spoke only Welsh until they were seven, eight or nine years old—in those days, people became involved in education at that age. Today, people often go to monolingual, Welsh language schools. Up until the ages of seven or eight, that is the only language they speak, and we know that people suffering advanced dementia revert to their childhood language.

I visited an esteemed former Member of the House and House of Lords who suffers from dementia. Towards the end of his life, he was able to speak only Welsh. Previously, he had been able to speak English, but at that stage, he could speak only Welsh. I acted as an interpreter. That is important in care homes in Wales. Such people are suddenly completely isolated. Very often, they cannot speak even to their spouse.

[Mrs Moon]

I rise only to confirm exactly what the hon. Gentleman says. I worked in specialist rehabilitation in Gorseinon, which is part of Swansea where the Welsh language is much more prevalent. Families would come in, and often, I would say to them, “Speak to your family member,” which was usually a mum or a dad, “in Welsh, and tell me what you want.” It is true that going back to the language of childhood often makes communication continue for much longer than speaking the adoptive language. However, that has implications in our multicultural society across our ethnic communities, and we must bear it in mind. No matter where a person comes from or whatever their culture, we must be able to provide communication in their language of childhood.

[Glyn Davies]

I thank the hon. Lady. I was going to expand my point on the Welsh language into the impact on people who speak other languages, as so many do. People’s reversion to the language they spoke as children came as a huge shock to me. I found that the great parliamentarian I went to see was unable to communicate with his wife because she did not speak that language—it was the only one he could speak. It was a strange experience. In that home, nobody could speak Welsh, which was a tragedy. Hon. Members often discuss and debate where the Welsh language should be available, but it should be available in care homes in Wales, and particularly in ones that have a dementia wing. Having somebody who can speak Welsh is important.

A spin-off point from that is on people who have moved away from Wales—the diaspora. They could fall ill in another part of the country. Traditionally, they would come home to where they are originally from and continue to see family and friends, but they could finish up not being able to communicate with people where they live. There is a case for work between the Governments in England and Wales—the availability of the language of youth applies to other parts of the UK—on helping to repatriate people to deal with the problem. Not being able to communicate with anybody, including family, must be incredibly difficult.

Dementia is a huge issue and there are many aspects to it. I hope I have touched on one—language—and one or two others that have not been covered by other hon. Members.

Antibiotics (Intensive Farms)

Glyn Davies Excerpts

Wednesday 9th January 2013 Westminster Hall

[Zac Goldsmith]

I thank my hon. Friend for his intervention. I will come to that point in about 20 seconds if he does not mind, because I want to demonstrate the vigour with which the industry has in the past resisted and will continue to resist any change such as I have described. Indeed, I had a briefing yesterday from the British Poultry Council that included some fascinating statements. In it, the BPC says:

“There is no scientific evidence that intensive farming systems contribute more to the overall risk of antibiotic resistance than extensive farming systems.”

On the contrary, two DEFRA-funded reports find that antibiotic resistance is roughly 10 times lower in organic chickens and pigs than in conventional equivalents. The BPC says in the same report:

“The industry is not aware of any recent evidence that ESBLs”—

extended-spectrum beta-lactamases—

“(E.COLI) are increasing in chicken farms across the UK.”

[Glyn Davies (Montgomeryshire) (Con)]

I would like to pursue this point a little further. The reference made then was to organic farming. I was an extensive farmer and I have always had the view that the sloppy use of antibiotics was every bit as bad in extensive farming as in intensive units. I can understand the point in relation to organic farming, but not to extensive farming.

[Zac Goldsmith]

The difficulty is that it is very hard to measure antibiotic use in extensive farming of the sort that my hon. Friend describes, whereas in organic farming there is quite clear regulation—self-regulation, in effect—which enables that comparison to be made. He is probably right, but I cannot authenticate what he says, because the data simply do not exist.

The second BPC quote that I read out cannot be true. The BPC must be aware of DEFRA’s statement last year that as many ESBLs were found in chickens in the first half of last year than in the entire previous year, so what it has said to me in its briefing simply is not true.

The BPC also says:

“Antibiotics may only be used on a farm if they have been prescribed by a veterinary surgeon”.

But it knows that producers often go straight to the feed mill, which will write out the prescription, send it to the vet’s at the eleventh hour and put pressure on them to sign it immediately. We know that because a number of vets have complained to the Veterinary Medicines Directorate about just that.

Finally, the BPC says:

“Scientific evidence increasingly recognises that the problem of antibiotic resistance in humans comes largely from the use of antibiotics in human medicine.”

That is true, as I have already acknowledged, but for certain bacteria—salmonella, campylobacter and E. coli—the farm use probably accounts for more than half the problem. It certainly accounts for a very significant chunk of the problem. With MRSA, it is probably accounting at the moment for only a few per cent. of cases, but if it is allowed to get established in UK livestock, that situation could very easily change, and dramatically.

The briefing adds, approvingly, that the use of growth-promoting antibiotics was banned 10 years ago in this country. It is probably worth pointing out that that ban came into force only in 2006 and was vigorously opposed by the BPC at the time. Perhaps for that reason, the British Government of the time, initially at least, was the only EU member state Government to oppose the ban. That is another example, I would suggest, of the industry calling the shots on this issue.

I must acknowledge that, 12 months ago, the BPC agreed to introduce a voluntary ban on the use of cephalosporins in poultry production and to stop giving fluoroquinolones to day-old chicks. That does not go nearly far enough, but it is an important step forward and demonstrates an acknowledgment by the BPC, albeit a reluctant one, of the problem.

There is no excuse to delay. The warning has been there since 1945, when, on accepting his part of the Nobel prize in medicine for the discovery and isolation of penicillin, Alexander Fleming said that

“there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.”

If we continue to ignore this risk for fear of upsetting vested interests, we will be complicit in robbing future generations of one of the great discoveries of our species and propelling us—apologies for repeating myself—into a truly frightening, post-antibiotic age. It is surely time for the Government to act.

Liverpool Care Pathway

Glyn Davies Excerpts

Tuesday 8th January 2013 Westminster Hall

[Glyn Davies (Montgomeryshire) (Con)]

Mr Weir, I would like to say how much of a pleasure it is to serve under the chairmanship of a fellow Celt. I declare an interest as a board member of Living and Dying Well, which specialises in research into and opposition to the legalisation of assisted suicide.

I shall begin with a summary of the current position. The “Liverpool Care Pathway for the Dying Patient” was developed by the Marie Curie Palliative Care Institute Liverpool as a framework for health professionals to use to ensure that people who are dying have as comfortable and dignified a death as possible. The pathway was developed and has been in use since the 1990s. Today, about 130,000 of the 450,000 patients who die in hospital care every year die while being cared for on the pathway. It has also been exported and is now in use in more than 20 other countries.

However, during the past few months, the Liverpool care pathway has been the subject of some very serious criticisms and allegations in the media, which has led to questions about whether it is indeed a worthy process. I shall explain why I sought this debate and the outcomes that I would like to achieve before considering in greater detail the criticisms that have been made of the pathway.

By any measure, the Liverpool care pathway plays a very significant role in how the end of life is managed in our country. Its role is much greater than most of us realise: 30% of patients who die in hospital care die while on the pathway. The sheer scale of this is why I believe that debate about it is too important to be led by national newspapers, although I certainly do not criticise those newspapers for reporting stories in the way they have done. Indeed, they have served a valuable purpose by raising public awareness of such an important issue. However, there is, almost inevitably, a tendency for newspapers to couch the debate in sensationalist terms. It is up to us as parliamentarians to ensure that this complex and potentially controversial issue is subject to balanced and thorough debate in the House of Commons.

The outcome that I seek today is calm reflection by parliamentarians, including those on the Front Benches, on this most sensitive of issues—calm reflection on the issues without encouraging the spread of alarm and despondency among those entering care, which can result from sensationalist allegations. I also seek a response from Government—from the Minister—that they will ensure that the review on which they have already embarked includes careful and thorough investigation of the allegations that have been made of bad practice. It is important to know whether the allegations are accurate and, if they are, where the weaknesses lie and what needs to be done to put those matters right.

I am a supporter of the Liverpool care pathway, but my aim today is not to defend or to attack the pathway, those who have made allegations of shocking bad practice, or the media, which have given the allegations such great publicity. It is to promote open and genuine debate in Parliament. In any case, I am not in a position to judge how much substance there is to the various criticisms that have been made, but I do know that we cannot avoid death and I also believe that most people do not fear death so much as they fear the process of death. The aim of the Liverpool care pathway is to ensure that the process is as compassionate, dignified and free from pain and discomfort as possible and, importantly, consistent with public safety. Our aim should be that the pathway is used in a way that retains public confidence—that it is being used in accordance with the principles on which the Marie Curie Palliative Care Institute developed it.

I hope that the Minister will agree that we must ensure that the pathway is subject to the very highest levels of scrutiny and that the framework can be allowed to be implemented only against a background of total transparency. There must be discussion with patients or with patients’ families or carers and there must be clearly available avenues through which complaints and concerns can be channelled. I hope that the Minister will assure us that the very serious allegations reported in the media will be thoroughly investigated and that, if any examples of bad practice are found, action will be taken to expose those responsible, to hold them to account and to do everything possible to prevent it from happening again. The experiences at Winterbourne View and hospitals in Worcestershire and the appalling and chilling events that took place in Stafford are too raw in the memory to allow anything else. It is only through audit and disciplinary measures, if and when appropriate, that the Liverpool care pathway will retain the integrity needed for it to be acceptable and the confidence of those who might use it.

Two years ago, I had never heard of the Liverpool care pathway. I first took an interest in it as a consequence of my concerns about and opposition to the legalisation of assisted dying. I was hugely surprised by how widely the pathway was in use. I had no idea that 130,000 patients in hospital care died while on the pathway every year and I do not think that many people realise that today.

[Jonathan Evans (Cardiff North) (Con)]

I am grateful to my hon. Friend for giving way to a fellow Celt. I congratulate him not just on securing the debate, but on the tone in which he has introduced it. He referred to the number of people who are on the Liverpool care pathway, but to help the debate has he done any work on the expansion in numbers since the 1990s? Did we swiftly move to 130,000? Is that a consistent number, or has there been a gradual increase over time? I ask that because of course it is the rolling out of the pathway that may lead to some people having less expertise—less skill—and then, as a result of that, some of the instances that my hon. Friend refers to some poor reporting of?

[Glyn Davies]

My hon. Friend makes a very important point about the need for training and expertise for all those who are responsible for putting people on the pathway and for looking after them when they are on it. I want to come to that later in my comments.

The negative coverage in our national media has probably increased awareness of the Liverpool care pathway. To that extent, I think that it has been a very good thing, but because I do not believe that the scale of the pathway is widely known, I think that it is right to say something about what the Liverpool care pathway is and what it is not in order to set out the context of the debate,. It is certainly not and must never be any form of “euthanasia by the back door”—a phrase that I have heard—nor is it a form of clinical treatment or even any specific type of care. It does not instruct doctors or nurses to provide this or that treatment. What it does is prompt them to consider whether certain treatments are appropriate in individual circumstances. It supports—it does not replace—clinical care. It is no more than a framework of good practice, backed up by training and education, to guide doctors, nurses and other health professionals towards delivering the high levels of palliative care that have been available in hospices for many years. It enables them to be transferred to hospitals, care homes and patients’ homes. It is about the appropriate way to look after a patient who is clearly dying through the last few days and hours of life.

Some other points should be made in this debate. The Liverpool care pathway does not recommend, as some have suggested, that dying patients should be deprived of food and water, although food and water may be withdrawn in individual cases if clinicians believe that that is the right step to take. The Liverpool care pathway does recommend to doctors and nurses that they explain to dying patients, or more often their next of kin, exactly what is happening and why. Secrecy forms no part of the Liverpool care pathway whatever.

It is also important to emphasise that there is nothing irreversible about being placed on the Liverpool care pathway.

[Andrew Bridgen (North West Leicestershire) (Con)]

Will my hon. Friend give way on that point?

[Glyn Davies]

On that point, I will, yes.

[Andrew Bridgen]

I thank my hon. Friend for calling this very important debate. I, too, share some of his concerns about the consistency with which the Liverpool care pathway is implemented across the country. I made some inquiries in the hospitals that serve my constituents, but information seemed to be lacking on the implementation of the care pathway. I am particularly concerned that patients placed on the pathway may have no opportunity to be taken off it if they improve. There are no figures on the number of patients for whom care has been reintroduced after being placed on the pathway. One of the hospitals told me, anecdotally, that no one there could remember anyone being taken off the pathway. I find that worrying.

[Glyn Davies]

My hon. Friend makes a very good point. Patients on the pathway should be monitored regularly, and if the patient shows signs of rallying, as does happen in a minority of cases, the treatment should be modified to support recovery. If that is not happening, the pathway is not being implemented properly. The Liverpool care pathway is not a pathway to death —a phrase I have seen used often, but which I think is unbelievably awful. It is a travesty of the truth to describe it as a form of euthanasia.

Why have we reached the point of huge public controversy, which has caused so much angst and fear? It has arisen from allegations—serious allegations, some of them from doctors and nurses—that the pattern of end-of-life care I have described has not been followed in some cases. There have been stories of dying patients being deprived of the food and water they needed and others being kept continuously sedated until they died; and of patients being placed on the pathway without consultation with them or their families, or to meet targets. The fear of that is especially shocking, and I hope the Minister will comment specifically on the issue of targets.

Let me look at some of the allegations in more detail. According to the Daily Mail in June last year,

“NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds”.

The report is based on a presentation to the Royal Society of Medicine by Professor Patrick Pullicino, a consultant neurologist. He stated:

“The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway.”

That is the debate being led by the Daily Mail. Professor Pullicino continued:

“Very likely many elderly patients who could live substantially longer are being killed by the LCP.”

Imagine how a frail elderly person entering hospital a few weeks after reading that would feel. Professor Pullicino added:

“Patients are frequently put on the pathway without a proper analysis of their condition.”

According to the Daily Telegraph, in September, a group of experts stated in a letter that

“dying patients…can…have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.”

The letter—again according to the Daily Telegraph—spoke of a “national crisis” in patient care, and

“a national wave of discontent…building up, as family and friends witness the denial of fluids and food to patients.”

According to the newspaper, some patients were wrongly being put on the pathway, which created a “self-fulfilling prophecy” that they would die. The report continued:

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway”,

and,

“many doctors were not checking the progress of patients enough to notice improvement in their condition.”

Those are shockingly serious allegations. If they are true, urgent corrective action is needed.

There is another side to the equation, however. More than 20 respected organisations, including the Department of Health, Age UK, the Alzheimer’s Society, Macmillan Cancer Support, and the Royal Colleges of Physicians, General Practitioners and Nursing, have signed a declaration that

“Since the late 1990s, the Liverpool Care Pathway has been helping to spread elements of the hospice model of care into other healthcare settings”.

It mentions:

“Published misconceptions and often inaccurate information”—

referring, I think, to the stories in national newspapers I have quoted. Our task and the Minister’s is to reconcile the support of all those organisations for the Liverpool care pathway with the allegations made—in good faith, I am sure—by people who believe that the pathway is what they call a pathway to death.

Any tool is only as good as the workman who uses it. The declaration states clearly that the Liverpool care pathway

“Relies on staff being trained to have a thorough understanding of how to care for people who are in their last days or hours of life.”

We have to face the fact that, in most professions, there are instances of excellence and malpractice, and health care is no exception. It would be surprising if, when 130,000 people a year are dying on the Liverpool care pathway, there were no cases in which the pathway had been misapplied. That applies to every branch of medicine and, indeed, every occupation. There are good and less good doctors and nurses; there are well run and less well run hospitals; but to lay the blame at the door of the Liverpool care pathway is like tearing up “The Highway Code” because there are some bad drivers. Where there is bad practice and poor care, it should be rooted out and replaced with good care.

It seems to me that the review the Government recently launched provides an excellent opportunity to consider thoroughly all those issues. It is urgently needed. The review should call for any evidence of poor end-of-life care. We need the Minister to assure us this afternoon that the stories I have quoted will not simply be taken at face value, but will be investigated in detail, so that we can establish the scale of poor end-of-life care, and understand the causes and correct them.

[Lilian Greenwood (Nottingham South) (Lab)]

I am listening carefully to the important points the hon. Gentleman is making. My constituents John and Mary Roche lost their mother five years ago. They came to see me because, having seen the media reports, they were concerned about her care toward the end of her life—she had been admitted to hospital and subsequently had her food and nutrition withdrawn. Does he think my constituents and others like them should be encouraged to share their stories, so that they can be taken into account in the Government’s review of the Liverpool care pathway and its appropriate use?

[Glyn Davies]

I thank the hon. Lady for making that point, because I most certainly do agree. I hope that, as a result of today’s debate, more people will come forward to put their experiences, especially of bad practice, in front of the Minister and the review.

We must not forget that it is necessary not to allow the shortcomings of some end-of-life care providers to undermine the outstanding work that the majority of doctors and nurses perform. It is easy to forget that, for those caring for people in the last days and hours of their life, alarmist stories cause real problems, misleading vulnerable people and their relatives into thinking that the unhappy experiences reported so prominently are typical of end-of-life care as a whole, making them reluctant to accept care that is genuinely beneficial, and generating fear of going into any sort of care setting. My sense is that the high profile given to these serious allegations, unaccompanied by supporting evidence, is analogous to shouting “Fire!” in a crowded theatre. We need to know that the Minister will consider all the allegations that are made, including those that have been reported, look at the evidence, and institute whatever changes are needed to ensure safety and thereby confidence in the integrity of the Liverpool care pathway.

I end with a general observation. I was appalled, as I am sure everyone in the Chamber was, by the recent revelations of poor care in a Worcestershire hospital, in Winterbourne View and in Stafford hospital. I was moved, as many of us will have been, by the observations made in the main Chamber before the Christmas recess by the right hon. Member for Cynon Valley (Ann Clwyd) regarding the inadequate and cruel care given to her late husband. We are reading about too many such cases. Considerable advances have been made in medical science, but we must ensure that, at the same time, we do not lose commitment in the NHS to basic care. I cannot help wondering whether the examples of poor end-of-life care that some relatives believe was given to their loved ones stem from the wider malaise of forgetting how to care for the sick, rather than from any specific clinical protocols such as the Liverpool care pathway.

[Several hon. Members]

rose—

Winterbourne View

Glyn Davies Excerpts

Monday 10th December 2012 Commons Chamber

[Norman Lamb]

I thank the right hon. Lady for that. She is absolutely right in what she says about institutional care. I keep mentioning Tower Hamlets, as it was rather inspirational to visit and see how things are done there. I was told that Tower Hamlets has one of the lowest rates of children going into care because of the support for families that it provides, preventing that from ever being necessary.

As for the right hon. Lady’s second point, she is absolutely right: this is moment that demands a change of culture, not just in the health and care system but in society as a whole. There must be a change in all our attitudes. We will make progress only if we understand the fundamental point that someone with learning disabilities has exactly the same rights as anyone else, and should be treated with dignity and respect.

[Glyn Davies (Montgomeryshire) (Con)]

We are for ever reading in reports such as this about poor behaviour in social care. In the last year or so, we have had Southern Cross and then Winterbourne View, which is probably the most shocking example of all. We greatly welcome the measures that the Minister has announced, but can he tell us what arrangements exist to enable us to share the knowledge that we have gained and the lessons that we are learning with the Welsh Government? I am sure that there are very good examples that we can pass over Offa’s Dyke, and that Wales has very good examples from which we can learn.

[Norman Lamb]

I know that some people from Wales were placed in Winterbourne View. This issue is important and relevant to Wales, Scotland, England and Northern Ireland. I would encourage officials of the devolved Administrations and the United Kingdom Government to liaise closely in order to ensure that the lessons that we are learning here can be applied elsewhere, and that good lessons from Wales and elsewhere can be learned in England.