Leaving the EU: NHS

Graham Stringer Excerpts

Thursday 22nd March 2018 Westminster Hall

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I thank my right hon. Friend for bringing this debate to the Chamber today. As many Members will know, my predecessor Baroness Tessa Jowell is campaigning, in the face of the cancer that she is dealing with, for greater international research and access to dynamic trials and new treatments for patients suffering from brain tumours. Does my right hon. Friend agree that Brexit puts at risk exactly that kind of international collaboration—that access to data sharing and to international scientific research—that patients suffering from brain tumours and many other conditions need to see move forward, not backwards? This is a grave threat from Brexit.

[Graham Stringer (in the Chair)]

Before I call Ben Bradshaw, let me say that we have sufficient time, given the number of people who want to speak, but may I please ask that interventions are to the point and brief?

[Mr Bradshaw]

I absolutely agree with my hon. Friend the Member for Dulwich and West Norwood (Helen Hayes). I will develop that argument in more detail in a moment.

Our Committee also recognised that the Government have ruled out, so far, continued membership of the customs union and the single market. In the absence of a change of mind from the Government, the Committee concluded that the least damaging Brexit for our NHS will be for us to keep the closest possible regulatory alignment with the rest of the EU in the long term. A majority of the Committee would probably have liked our recommendations to be stronger on that and to include keeping open the option of an European economic area-type relationship in the long term. However, as Committee members we recognised that it is much more powerful for a Select Committee to agree a unanimous report, which ours is, rather than to disagree on a contested one.

--- Later in debate ---

[David Tredinnick (Bosworth) (Con)]

It is a pleasure to serve under your chairmanship, Mr Stringer. It is also a pleasure to see the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston). When my right honourable Friend, then the Member for Charnwood, Stephen Dorrell, stood down, I had the pleasure to chair that Committee, which I served on during the 2015 Parliament, and it was a great disappointment when I stood against my hon. Friend and she won. I will not tell hon. Members about how close the contest was, other than that she won handsomely and has chaired the Committee very well.

This is a sombre day: the anniversary of the death of members of the public and of PC Keith Palmer not very far from here. On that day I was too close for comfort; I will not forget it. I reflected then, and I reflect now, that luck plays a part in life. We are all lucky to be here today.

I want to focus on a section of this important report and on the Government’s response. I see the Minister in his place. He took over from my hon. Friend the Member for Ludlow (Mr Dunne), who was my Whip for a while. I want to focus on the future staffing requirements and on delays and cost.

The report states:

“The Government’s plan for our post-Brexit should…ensure that health and social care providers can retain and recruit the brightest and best from all part of the globe”.

On healthcare, we have to think beyond the European Union when we address Brexit, and I congratulate the right hon. Member for Exeter (Mr Bradshaw) on securing the debate and on his introductory speech.

The Committee reported:

“The Government must acknowledge the need for the system for recruiting staff to the NHS, social care and research post-Brexit to be streamlined to reduce both delays and cost.”

The Government’s response states:

“We are also boosting the domestic supply of staff through expanding training places and nursing and other areas.”

We have to focus on other areas. The thrust of my remarks is that if we are going to solve the ever-increasing problems of demand in the health service generally and have a better service post-Brexit, we have to broaden the base of practitioners; we have to look beyond doctors and nurses.

As part of that, we have to pay attention to regulation. The Committee addressed that under recommendation 10, which states:

“Attention needs to be paid to the balance between patient safety as served by regulatory rules which may restrict access to the profession... Regulation should not evolve into unnecessary bureaucratic barriers that inhibit the flow of skilled clinicians into the NHS.”

What we need to do post-Brexit is get more skilled people—health practitioners other than doctors and nurses—who adhere to properly regulated registers, into the health service, to reduce the demand on the doctors, nurses and other hard-pressed professionals who work there.

I refer my hon. Friend the Minister to the recent report by the Professional Standards Authority and the Royal Society for Public Health. The PSA regulates 31 occupations, including acupuncturists, holistic therapists, hypnotherapists and clinical technologists, as well as the Society of Homeopaths, the UK Council for Psychotherapy and many others. One of its key recommendations was that its 80,000 regulated practitioners should have the authority to make direct NHS referrals in appropriate cases, thereby reducing the administrative burden on GP surgeries.

I have tabled questions about whether Ministers have considered the report, and to date I have not had a positive response. I am sure that that is an oversight. However, I want to point out to my hon. Friend, and perhaps to the Chair of the Health Committee, my hon. Friend the Member for Totnes, that Harry Cayton, who chairs the PSA, is not happy that the report has effectively been ignored. For years we have been told that better regulation is necessary before additional practitioners can be given the opportunity to practise in the health service. As soon as better regulation appears, that seems to be of no consequence. The report was produced by not just the PSA but the RSPH. Where else do we go? The work has been done, and I should like to hear from the Minister about the important work on regulation done by the PSA.

I want to refer to two parliamentary reports. In 2000 the House of Lords produced a report on complementary and alternative medicine and set out to categorise a wide diaspora of services that were available in that field. It came up with a classification, and it is important that I run through it. In the top rank were five categories of what were known then as complementary and alternative medical practitioners. The report said they had to be considered independently in relation to the question whether they should be included in mainstream healthcare. The five were osteopaths, chiropractors, acupuncturists, herbal medicine practitioners and homeopaths. I shall run briefly through those in relation to their appropriateness for use in the health service.

I had the honour to serve in the 1987 Parliament, and at that time the mantra was, “The osteopaths are out of control.” It was all about one or two miscreants and why they needed regulation. Some of us organised a private Member’s Bill, and I served on the Committee that resulted, in the 1992 Parliament, when John Major was Prime Minister, in the Act of Parliament that regulates osteopathy—the Osteopaths Act 1993. Osteopaths are now regulated by Act of Parliament. Not only that, but they have brought the different colleges of osteopathy together so that they are regulated by one body.

Secondly, there are the chiropractors, who are also back manipulators. We got another private Member’s Bill through the House. That became the Chiropractic Act 1994. The chiropractors came together—the McTimoney chiropractors and the others—and were bound together under one regulatory body. They are regulated by Act of Parliament.

Before I go on to the third discipline, my hon. Friend the Minister should be aware that the number of people taking hours off work for lower back pain is the highest for all complaints. He would do well to make better use of chiropractors and osteopaths in the new landscape post-Brexit. That is something we have ignored, and now we are freed from the European connection, or will be—although we will obviously have links—we should look at it.

The third discipline that the noble Lords referred to was acupuncture, which is regulated by the PSA, and the fourth is herbal medicines, which has different forms of self-regulation. In the 2010 to 2015 Parliament, I was asked by my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), then Under-Secretary of State at the Department of Health, to work with Professor David Walker on a report on herbal medicine. We met as a Select Committee meets, for the best part of a year, to produce a report that recommended further improvement in regulation. That is something we need to return to.

The last discipline referred to was homeopathic medicine. Homeopathy is the most controversial of all the treatments I have described, but has had huge support in the House. In the 2006-07 Session, Rudi Vis, a former Labour MP, whose constituency I forget, put down an early-day motion in support of six NHS homeopathic hospitals. That was remarkable for two reasons. First, it attracted over 200 signatures, or one third of the House. Secondly, it was signed by the Secretary of State—not the former Secretary of State, but my hon. Friend the Minister’s boss. He signed it—here is his name on the motion. He is sympathetic to homeopathy. His problem is that he has been sandbagged by people such as the chief medical officer, who knows nothing about it. That is a major problem.

The early-day motion said:

“That this House welcomes the positive contribution made to the health of the nation by the NHS homeopathic hospitals; notes that some six million people use complementary treatments each year; believes that complementary medicine has the potential to offer clinically-effective and cost-effective solutions to common health problems faced by NHS patients”.

In subsequent Parliaments, other motions were tabled, and there was a change in approach—not by members of the public, but by a tiny, vociferous anti group outside the House, which launched attacks on Members who signed the motion. I took that to the Speaker as a breach of privilege. There was a motion backing homeopathy in—

[Graham Stringer (in the Chair)]

Order. I have been listening carefully to the hon. Gentleman; he has referred his remarks back to the impact on the NHS of leaving the EU, but I think he is drifting a little. Does he think he could bring those remarks back to the subject before us?

[David Tredinnick]

I certainly can, Mr Stringer. I would be glad to. We served together on the Science and Technology Committee in the 2010 to 2015 Parliament, and you know my interest in this.

I will draw this all together with what is now a very important report. I have referred to the Lords report and said that there has been some doubt about complementary medicine. The reason the Government need to look at this post Brexit is the publication last week in The BMJ of a report entitled “Do NHS GP surgeries employing GPs additionally trained in integrative or complementary medicine have lower antibiotic prescribing rates?” More than 7,000 practices were surveyed—I will end on this point, Mr Stringer—and the report shows that there are statistically significant differences between the patient populations of surgeries employing integrated medicine and those of conventional GP surgeries. It is a properly formed report, and I suggest to the Minister that such treatments can reduce the cost and prescribing not only of antibiotics—we know that Dame Sally Davies published a book called “The Drugs Don’t Work”—but of other drugs.

In the post-Brexit landscape, the Minister has to look at a wider field. To ensure I stay in order, Mr Stringer, I turn to a question I asked the Secretary of State this week:

“Does my right hon. Friend agree that leaving the EU will be a good opportunity to build links with other countries’ medical systems, particularly those of the Chinese, who have, for instance, integrated Chinese medicine and western medicine to reduce the demand for antibiotics?”

The Secretary of State replied:

“My hon. Friend is right to draw attention to antimicrobial resistance because China is one of the big countries that can make a difference on that, and yes, we have had lots of discussion with Chinese Health Ministers about how we can work together on that.”—[Official Report, 20 March 2018; Vol. 368, c. 149.]

As a representative of Leicestershire, I found that significant, because Leicester’s hospitals have signed a memorandum of understanding with China—with a Nantong University-affiliated hospital—which expands a deal they already have to ensure greater research and training collaboration across the international medical community.

I have used Chinese medicine for years. I have no doubt that, post Brexit, when we have a better opportunity to strike deals and are no longer being hampered by the European Union’s restriction, we can bring those practices here. It would be good to set up a trial. Also, the Minister should look at the Indian Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy—AYUSH—which I will be visiting in September, to see how that wider base reduces healthcare costs in India.

When I was Chair of the Health Committee for a short time, I managed to get out a report on long-term care and conditions. About 15 million people in the UK have long-term conditions, which involve polypharmacy, or lots of drugs, and polymorbidity, or lots of problems. Many complementary therapies are effective in that context. That is another reason the Minister should look at them.

On Monday, the Secretary of State announced five new medical schools. Is the Minister aware of the time medical schools spend teaching the disciplines I have been discussing? In a five-year course, it is one hour. No wonder many doctors are reticent about such referrals, given that they do not understand the subject. Let us have a wider base of learning in the new medical schools so we have a better service in the future.

I have spent a long time in this House—30 years—and I have pretty much stuck to this subject right the way through. I think we are at a turning point with the report I have referred to, published in The BMJ, in which 7,000 practices are analysed. It blows out of the water the argument that there is no evidence. There jolly well is evidence, and if the Minister will only look at it, he can improve the quality of the post-Brexit health service, get better value for money, and bring people who have studied for years and who are out in the cold into the service. If he does that, we will have a much better situation than we have now.