Maternity Safety Strategy

Graham Stringer Excerpts

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

I can absolutely confirm that. This follows a very interesting discussion on that topic we both had at lunch. My hon. Friend is right that the key is early intervention. Also, we know that continuity of carer makes a very big difference. If, well ahead of labour, people can meet the midwives who will be delivering their child, that can help reassure people and lead to safer births.

[Graham Stringer (Blackley and Broughton) (Lab)]

This is a very welcome statement. The Secretary of State will know of the very disturbing cases over the past few years in the Pennine health trust. Will he make space within the legislation for retrospective investigations where there have been a number of cases, as in the Pennine trust?

[Mr Hunt]

I will look into that very carefully. I am satisfied that there is strong new leadership at the Pennine trust and that it is being turned around, but it has told me about some of the cases to which the hon. Gentleman refers. They are of very great concern, and we absolutely must do everything we can to give answers to bereaved families.

Pennine Acute Hospitals NHS Trust

Graham Stringer Excerpts

Tuesday 17th January 2017 Westminster Hall

[Graham Stringer (Blackley and Broughton) (Lab)]

I beg to move,

That this House has considered the future of the Pennine Acute Hospitals NHS Trust.

It is a pleasure to serve under your chairmanship, Mr Streeter. We have a delicate path to tread in this debate. Over the past 10 years, there has undoubtedly been a scandalous failure of care within this NHS trust. It has been well documented; I will come to that in the middle of my comments. There has been a failure in the structure of the trust, a failure of management and, in individual cases, failure by clinicians, and people have suffered and died because of those failures.

That discussion and debate needs to be aired, while ensuring—this is the delicate balance—a solid and credible future for the hospitals in the trust, and particularly North Manchester general hospital in my constituency. The vast majority of clinicians, staff and employees in the trust are committed to the good care of patients, want the best for those patients and devote their careers and time to giving it to them. There is a delicate balance to be struck: I do not want any criticism of the trust to undermine morale further, but we have a responsibility to debate the issues. This is not about the present general debate on NHS cuts or the impact of the Health and Social Care Act 2012; it is specifically about the structures of the Pennine trust and some of its failures, and what we should do to secure its future.

Almost exactly 10 years ago, on 24 January 2006, I sponsored another debate on the Pennine Acute Hospitals NHS Trust; it can be found in Hansard at column 372WH. Shockingly, when I read that debate, I found that it covered almost exactly the same points that I believe we will discuss in this one. On the day of that debate, the front page of The Times highlighted misdiagnoses, with serious consequences, by the radiology teams at North Manchester general hospital, as well as at Trafford general hospital, which is not part of the Pennine trust. At the time, Professor George Alberti and Dr Joan Durose had written a report on the Pennine trust, which had been going for only three years, having been set up on 1 April 2002. The report found low staff morale, poor communications and poor administration, which is almost exactly what the Care Quality Commission’s current report found. The human resources director and medical director of the trust had already left, and after the 2006 debate, the chair and chief executive left.

We hoped for a better future and improvement through Professor Alberti’s 25 recommendations, but today we find that the chief executive of the trust has gone elsewhere and the current director of operations is on gardening leave. We are almost back where we were 10 years ago. In the meantime, there have been numerous warning signs that things have been going terribly wrong. One question on which I shall focus is why, even with all those red lights flashing all over the place for 10 years, with dire consequences for patients, the national organisation of the NHS and, more recently, the clinical commissioning groups did not notice them and sort out the situation.

The first strong warning sign that things were wrong came in a report from Channel 4’s “Dispatches” on 11 April 2011. “Dispatches” sent secret cameras into North Manchester and Royal Oldham hospitals in the Pennine trust, and found very poor care, amounting almost to low-level torture of some patients, who were shown not getting what they asked for. It was a terrible situation. At the time, I took up the case, and I am told that staff were disciplined.

[Liz McInnes (Heywood and Middleton) (Lab)]

Is my hon. Friend aware that the nurse who was dismissed as a result of “Dispatches” took her case to a tribunal, which instructed the trust to give her back her job?

[Graham Stringer]

I was not aware of that. There are obviously many technical details about the disciplinary situation of which I am not aware. However, I saw the programme, and the patients in that situation were undoubtedly treated appallingly. One cannot resile from what one sees directly.

[Liz McInnes]

I caution my hon. Friend against reading too much into the “Dispatches” programme. The tribunal overruled the trust. The reporters spent six months in the trust and managed to find two incidents, which they broadcast. When the case was heard by a tribunal, it ruled that the nurse in question should not have been dismissed.

[Graham Stringer]

As I just said to my hon. Friend, I will not go into the details, but I probably know more than she does about the situation from the patients’ side, because a relative was affected. I have no doubt that those patients were treated appallingly. I cannot comment on the details of personnel issues, but I can comment on the fact that patients have been badly treated. Given the technicalities of the situation and having watched the programme, I find it worrying that although one or two cases were found after six months, the nurses were re-employed.

After “Dispatches”, the CQC report found scandalous failings within the trust. It found that the safety and wellbeing of patients were inadequate, and that the trust’s responsiveness and effectiveness needed improving, but that the care of patients was good. That report was very worrying; the trust would have been put in special measures, if a new team had not already been put in place to deal with the situation.

As I say, the CQC report found that the care of patients was good, but within a very short time—and after excellent investigative work by Jennifer Williams of the Manchester Evening News and other journalists—an internal report on maternity care was made public, showing that the care provided by some individuals was very poor indeed.

It is worth reading out for the record an extract from that internal report, because we have now had a 13-year period of failure. It is also worth remarking that both that internal report and the CQC report relied on nothing but internal statements by the trust’s staff. A paragraph from the internal report really contradicts the CQC report, as it states:

“Staff attitude has been a feature of a significant number of incidents, from the most basic reports of staff relationship breakdowns, resulting in women and their families exposed to unacceptable situations, to an embedded culture of not responding to the needs of vulnerable women”.

The report went on to say of one woman that

“in one incident it is clear that the failure of the team to identify her increasing deterioration and hypoxia attributed her behaviour to mental health issues. Failure to respond to deterioration over a period of days resulted in her death from catastrophic haemorrhage.”

That means that, according to internal sources, the situation was actually worse than had been thought.

The report continued:

“A further example of staff attitude and culture has been experienced recently when a woman gave birth to her baby just before the legal age of viability (22 weeks and 6 days)…whilst no resuscitation would be offered to an infant of this gestation, compassionate care is essential. However, when the baby was born alive and went on to live for almost two hours, the staff members involved in the care did not find a quiet place to sit with her to nurse her as she died but instead placed her in a Moses basket and left her in the sluice room to die alone.”

That is inhuman treatment.

These failings are the failings of individuals, of management, who failed to sort things out, and of the structure of the Pennine trust itself. I could list a whole series of other cases. In fact, late last night I was contacted by constituents I know about another case. I do not know the details of that case, but my constituents wanted me to take it up, as they strongly believed that a misdiagnosis meant that proper therapeutic care had not been provided. So problems in the Pennine trust continue.

[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

My hon. Friend is making a very powerful speech and I share his absolute horror at some of the reports of the standard of care that some patients have received. Like me, he was at a meeting with staff last month, who also expressed their concerns about the quality of care being provided.

I am trying to understand something. Is my hon. Friend saying that this poor care, as set out in the CQC report and other reports, is endemic and is found right across the Pennine Acute Hospitals NHS Trust? Also, does he recognise that the new leadership is playing an important role and that the site leadership teams will have an important role in turning this situation around?

[Graham Stringer]

What I am saying is that there have been failures from the very beginning of this trust, in that it has four hospitals that were jealous of each other. That caused administrative problems, which means the trust has never worked well, and there is also a structural problem. Secondly, there have been failures of management to deal with those issues of individual failure to care.

I have enormous confidence in Sir David Dalton and the team who are taking over the Pennine trust. Sir David’s record of developing Salford Royal hospital is exemplary, and I hope that he can do the same with North Manchester general hospital and the other hospitals within Pennine.

As my hon. Friend the Member for Oldham East and Saddleworth (Debbie Abrahams) said, along with my hon. Friend the Member for Heywood and Middleton (Liz McInnes) we met the trade unions in Pennine just before Christmas and, like the vast majority of the staff, they were committed to improving healthcare in the trust. Like my hon. Friend the Member for Oldham East and Saddleworth, I made the point that one has to acknowledge failures to ensure that there is improvement. One cannot just say that, just because so many staff are committed, that is good enough for the future. One also has to recognise the failure of the local clinical commissioning groups to deal with the problems, the fact that the board of the trust seems to have been paralysed and the fact that NHS Improvement has not dealt with the trust’s problems.

I have listed some of the cases that have caused public concern. One cannot put a financial cost on those cases, but if one reads the internal report on maternity care, one sees that the amount of money spent on compensation in the year 2014-15 was £58 million. I repeat— £58 million. Nearly £20 million went on three cases, which means that just over £6 million was spent on each one. In those cases, the people involved took legal action and at the end of the process were awarded that sum to look after severely handicapped patients.

There is no question but that, as I just said to my hon. Friend the Member for Oldham East and Saddleworth, Sir David Dalton has put in place a team who are committed to taking North Manchester general hospital out of Pennine and putting right what was a structural mistake.

It is worth reflecting on another point that was made in the Westminster Hall debate about 10 years ago, which is about why the Pennine trust was created. It was not created for good medical reasons. There was a public reason, which was given at the time by Billy Egerton, the then chair of the North Manchester health trust—I think that was what it was called. He said that he thought that if North Manchester general hospital had remained separate from the trust, it would have been prey to the predatory instincts of Manchester Royal infirmary and the major central hospitals in Manchester. First, I do not think that was a good idea—there could have been co-operation—and secondly, there were a number of chief executives in the trust who were retiring, which meant that three chief executives could be paid off and one chief executive found. Those three chief executives who were paid off came back and did consultancy work for the NHS. Unfortunately, that is the way that the NHS has dealt with problems. It has spent money, and wasted money.

The proposals for devolution will help to deal with the problem. The national structures have not worked. Having the combined authority, encompassing the 10 local authorities, taking decisions and examining these issues, with North Manchester general hospital being within the Manchester hospital schemes, is not a guarantee of success, but I generally believe that when decisions are taken closer to what is happening on the ground, they are more likely to be correct decisions than if they are left to a national body, which has clearly failed in this situation.

[Mr Ivan Lewis (Bury South) (Lab)]

I congratulate my hon. Friend on securing this incredibly important debate and on his years of attempting to highlight the dreadful failure of leadership—not of frontline staff, who do a remarkable job—in the trust. We have to hope that the future is better, but being dependent on the leadership of one individual in the long term is not always the best way to turn around an organisation.

In the light of my hon. Friend’s comments about local decision making, does he believe that at a time when accident and emergency at North Manchester general is under such tremendous pressure, it makes sense for Bury CCG to press ahead with its proposal to close the Prestwich walk-in centre? At a time when patients are being told not to go to accident and emergency services, it seems absolutely bonkers to close a walk-in centre that is so well used.

[Mr Gary Streeter (in the Chair)]

Order. Interventions should be brief.

[Graham Stringer]

I agree with my hon. Friend about the closure of walk-in centres. There has always been a conflict of interest between GPs getting patients through their surgeries and walk-in centres. At a time when there is stress across the whole Greater Manchester NHS—indeed, across the NHS in the whole country—to increase that pressure by closing walk-in centres seems—my hon. Friend says “bonkers”, but I would use slightly tamer language—perverse.

I will finish with some questions for the Minister. Part of the plans that Sir David Dalton and his team have in place, which involve separate management teams for the three major hospitals—putting Rochdale in with Bury—will require investment in the short term in 24 new beds for intermediate care and hopefully, in the medium term, the demolition of more than half of North Manchester general, which is a 19th-century workhouse, to turn it into a completely modern hospital. What will help staff morale most is a commitment to the future of the hospital on that site, dealing with a community with some of the country’s worst mortality and morbidity statistics. The Minister might not be briefed on this because it happened relatively recently, but the paediatric audiology unit has failed its accreditation assessment. If he does not know about that—I would not necessarily expect him to—will he write to tell me what the response will be and whether paediatric audiology will continue on the site?

On 13 December 2016, in a statement on the NHS deaths review, the Secretary of State, while recognising the difficulty in doing so, committed to trying to understand which of the highlighted cases were avoidable deaths and which were not. It is important for both the families and the public to know which of them could have been avoided and which were, unfortunately, the kind of unavoidable hospital death that takes place when someone is very sick. Was it a mistake to remove 31 medical beds from the hospital just over 12 months ago? As a result, the number of people being admitted into North Manchester general is lower, because there simply are not enough beds. What is happening to the people who otherwise would have been admitted?

Those are the detailed questions. The real question for the future is whether the Minister will give a long-term commitment to the hospital and to its moving into the Manchester hospital system. Given the statistics showing that men from north Manchester are likely to have lives that are six years shorter than those of men in the rest of the country, and that women’s lives are likely to be about 4.4 years shorter, is there a commitment to quality care and investment in the hospital for the future, to ensure that those rather damning statistics are changed?

[Several hon. Members rose—]

--- Later in debate ---

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Streeter. I am an ex-employee of Pennine acute. I worked for Pennine acute and its predecessor trust from 1987 for 27 years before I was elected to this place. I come to this debate very much from the Pennine acute staff point of view and our experiences of working there.

We have always worked against a background of change. Ever since I started work in the NHS, I cannot remember a time when there was not a new scheme coming up. It was always couched in the same language and everything was going to be different under the latest proposals. That has been my experience of working for the NHS in a 33-year career. There was always a new scheme on the horizon that promised the earth. We would try to give it a go and work with the new system, but systems were never given time to bed in. Just as we were getting used to a different way of working, a new system would come along promising the earth and everything was going to be wonderful under the new system. We all wondered what was so wrong with the old system that we had been told would be so good and solve all our problems. That, in a nutshell, is my experience as a member of staff working in the NHS.

Listening to the views of my hon. Friend the Member for Blackley and Broughton (Graham Stringer) and the hon. Member for Bury North (Mr Nuttall) was very interesting. They have been MPs in the area for a long time. My hon. Friend the Member for Blackley and Broughton said that Pennine acute was formed from four trusts that were jealous of each other, but I feel that is a misinterpretation. He was partially right in quoting Bill Egerton: the trust was formed because North Manchester general was worried about being swallowed up by Central Manchester. That was a fear shared by the staff as well, because none of the four hospitals that form the Pennine Acute Hospitals NHS Trust are teaching hospitals. There was a real concern among the staff that North Manchester general, a local hospital, might be swallowed up by teaching hospitals in central Manchester and disappear. Patients were also concerned that their local hospital would disappear. The trust treats a disadvantaged area, as has already been highlighted. The fact that life expectancy is low in that region is more to do with the quality of life rather than the standard of hospital care there.

Pennine acute was formed in 2002 from a merger of four existing trusts that I think merged to support each other. It was very much a banding together of four non-teaching hospitals that wanted to work together and make a success of Pennine acute. Obviously, any change is difficult, and the merger was a major change, but when Pennine was formed there was a real spirit to make it work. It was one of the biggest trusts in the country with 10,000 staff.

[Graham Stringer]

I am glad my hon. Friend agrees with me about the reason for the formation. Does she recall that within three years of the formation of the trust the consultants and the unions had an unprecedented vote of no confidence in the management? All the different hospital sites believed they were going to be closed at the expense of another site. Within three years the formation was not working.

[Liz McInnes]

I was coming to that point because my hon. Friend referred to the chief executive leaving. I inferred from his speech that that was as a result of a debate my hon. Friend had held in Parliament, but the chief executive left because the doctors had a vote of no confidence. The trade unions similarly expressed concern about the way in which the trust was being managed, but, as I recall, the trade unions did not have a vote of no confidence. Unless my memory is not serving me well, I do not recall the trade unions voting on that. I was heavily involved in the trade unions and I have no recollection of our having a vote of no confidence. That came purely from the doctors, who were concerned about the direction the trust was going in. It was as a result of that vote that Chris Appleby resigned from the trust. I was heavily involved in trade union activities as I was a workplace rep for Unite the union while I worked at the trust.

I want to highlight the issues involved in constant reorganisation and relocation. With the single hospital service proposal and with Healthier Together, we have two proposals running concurrently now, both of which seem to have different aims with different groups of hospitals working together. Healthier Together relies on the four Pennine acute hospitals working together and the single hospital service review, commissioned last year, proposes that North Manchester general should now work with Central Manchester and South Manchester. To add to the background of the constant confusion of reorganisations, we now have two different schemes that do not seek the same outcomes. I am sure everybody can understand how confusing and worrying such uncertainty is for the staff.

During the formation of Pennine acute, as a union rep I dealt with many staff who struggled with suddenly being told that their job was moving to another site and that they would be expected to relocate. Very little attention seemed to be paid to staff’s caring responsibilities. I dealt with several staff with disabilities, who had real issues about suddenly being told their job at North Manchester general no longer existed and that they were now expected to get themselves to Oldham at the same time in the morning, even though they had an extra six or seven miles to travel. There were real issues in dealing with staff and relocation in a sensitive manner. Such issues lead to uncertainty for staff and also make Pennine acute look an unattractive place to work.

In the meeting that we had with staff, they were very concerned about the maternity report that had been reported in the Manchester Evening News and the detrimental effect that it would have on staff who wanted to work there. At the meeting we heard from a representative from the Royal College of Midwives that a scheme had been put in place for improvements. The scheme is ongoing and midwives are now being recruited. There was an anomaly with the grade on which midwives were employed. They were being employed one band lower than they should have been, but that has been remedied. So there is an improvement plan in place and we need to be careful about extrapolating from dreadful incidents and saying that the whole of the trust is failing. I caution against that.

I have spoken about Healthier Together and the single hospital service running simultaneously, but seemingly both requiring different outcomes. The staff at Pennine are concerned about the single hospital service and the proposal that Central Manchester, South Manchester and Pennine acute should begin working together. Unfortunately, a lot of staff have been through it all before. They have been through the assurances that their jobs will be safe and that they will not have to move, but they have seen those promises eroded over time. Many are concerned about the prospect of having to journey right across central Manchester to go to work at Wythenshawe. That will be a lot of commuting for staff and they are very concerned about the proposal. The single hospital service review makes a virtue of staff being transferable—that is quoted in the document—and yet, at the moment, staff are being assured that they will not have to move.

On maternity care, the hon. Member for Bury North said that it is not a funding issue, but the appalling report on maternity services highlighted the lack of funding. In the past, there was a proposal to improve maternity services, called “Making It Better.” That was based on an annual birth rate of 3,500. The trust is now dealing with 10,000 births per year on the amount of funding that was settled on 3,500 births, so the funding issue obviously needs to be addressed.

The building stock at North Manchester is a real issue, as my hon. Friend the Member for Blackley and Broughton already mentioned. In my understanding, it was never a workhouse and has always been a hospital, but it was built to serve the workhouse that was built next door. The state of the building stock was always the reason that Pennine acute could not get foundation trust status.

CQC: NHS Deaths Review

Graham Stringer Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

My hon. Friend makes a very good point. We are making sure that all A&Es have liaison psychiatry services by the end of this Parliament. The critical issue is that someone with a severe mental health problem or learning disability who turns up in an A&E has special needs, and has bigger needs than the other patients there, but unless that is recognised early in the process, they are unlikely to get the care they need. If a tragedy then happens and they go on to die—as sadly happens sometimes—but the illness or disability is not known about, people do not realise that there are other potential issues. That is why the report is very clear that all acute trusts are required to know when patients have learning disabilities or mental health problems and to pay particular attention in any mortality investigations that happen regarding those patients.

[Graham Stringer (Blackley and Broughton) (Lab)]

The CQC has produced a grim report, and there was an even grimmer internal report on maternity services operated by Pennine Acute NHS Trust. Mothers and babies have died. I have put in parliamentary questions to the right hon. Gentleman and talked to the chief executive to try to find out which of those deaths were avoidable. I welcome today’s statement, but is it possible to be retrospective, so that the families of those people who have died in the Pennine maternity service can find out whether those deaths were preventable?

[Mr Hunt]

When the new guidelines are published, we need to investigate, as far as we possibly can, deaths that have already happened. I totally recognise the hon. Gentleman’s picture of Pennine and share his real worry about the standard of care in that trust. The positive thing is that under the leadership of Sir David Dalton—the chief executive of Salford Royal, which is one of the safest trusts in the NHS and a CQC outstanding trust—things are beginning to turn around. I have spoken to him about the situation at Pennine on many occasions. The hon. Gentleman is right to say that there is a lot of work to do there.

Alcohol Consumption Guidelines

Graham Stringer Excerpts

Tuesday 28th June 2016 Westminster Hall

[Byron Davies]

I am grateful for that intervention. I accept that we have to be very careful on that issue.

We should not be complacent. It is essential that public health advice keeps pace with advances in scientific understanding. Crucially, the communication of any guidance from the state must be seen to be above reproach and carry the confidence of industry and the public alike. However, I felt this debate was needed because I and several other hon. Members are concerned that the process by which the chief medical officer reaches their conclusion is flawed and has, in some ways, been hijacked by a group of campaigners with a clear anti-alcohol, total abstinence agenda.

Views are strongly held on this subject, which divides scientific opinion and the medical community. I recognise that that puts the CMO in a difficult position in making judgments about risk and in communicating sensible guidelines to consumers. We are bombarded with health advice from all quarters in this 24-hour social media age, and it is vital that anything published in an official capacity as advice from the Government’s chief medical officer is properly scrutinised and beyond reproach. I argue that the process that has been adopted, the clear conflicts of interest of the panel of so-called experts deployed to deliberate on these matters and the biased presentation of the findings have left a crisis of confidence in the new CMO guidelines among consumers, the media and industry. The Minister needs to address that in her response to the public consultation.

Let me deal with those points in turn. First, on the process adopted to undertake this review, the Department of Health guidance for expert group members states clearly:

“It is important to avoid any impression that expert group members are being influenced or appearing to be influenced by their private interests in the exercise of their public duties. All members therefore must declare any personal or business interests relevant to the work of the expert groups which may or may not be perceived by a reasonable member of the public to influence their judgment.”

Members of the guidelines development group set up to advise the CMO have been active policy advocates during the time in which the guidelines have been developed. Thanks to the investigative journalism of Sean O’Neill, chief reporter at The Times, it has come to light that an academic who played a key role in drawing up the controversial new safe drinking limits, Professor Gerard Hastings, did not even declare his links to the Institute of Alcohol Studies, a registered charity that receives most of its income from the Alliance House Foundation, which states that its aim is spreading the principle of total abstinence from alcoholic drinks. That is not quite putting Dracula in charge of a blood bank, but it is not far off.

Policy advocates such as Professor Hastings have taken strident campaigning positions. Many have a temperance or total abstinence axe to grind. They are clearly not neutral or, I argue, objective in their assessment of the costs and benefits of alcohol consumption. Indeed, the chief medical officer for England, when giving evidence to the House of Commons Science and Technology Committee on the proposed new alcohol guidelines, admitted that the experts

“found remarkably little evidence about the impact of guidelines, but we did not do them to have direct impact so much as to inform people and provide the basis for those conversations and for any campaigns that, for instance, Public Health England and others might run in the future.”

One member of the behavioural expert group, Dr Theresa Marteau, writing in the British Medical Journal, went further and stated that the new guidelines are

“unlikely to have a direct impact on drinking…but they may shift public discourse on alcohol and the policies that can reduce our consumption.”

Minutes from the guidelines development group meeting of 8 April 2015 state:

“It would be important to bear in mind that, while guidelines might have limited influence on behaviour, they could be influential as a basis for Government policies”.

There we have it. Never mind what consumers think about being told by the chief medical officer to think of cancer every time they hold a glass of wine or pour a can of beer, or that, as someone drinking a pint of beer a day, they are drinking more than they should. The not so well hidden agenda of the temperance activists is to influence Government policy to drive down alcohol consumption across the board. Wales has a strong Methodist and temperance tradition, which I respect, but I take issue with organisations such as the Institute of Alcohol Studies, which is funded directly by the temperance movement, helping to produce biased reports that are then given undue influence over the Government’s alcohol policy.

Having raised my concerns with the process adopted in undertaking the review, which I believe may have prejudiced the outcome and has certainly rendered the process lacking in credibility with consumers and the industry, I turn to the presentation of the review’s findings and, in particular, to the assertion that there is no safe level of alcohol consumption, the lowering of the recommended weekly levels for men in line with those for women, and the communication of risk. I believe that that assertion is at the heart of the flawed nature of the proposed guidelines and it is, in some respects, clearly deliberate on the part of campaigners. If the Government accept that there is no safe level of consumption, it becomes much easier to argue for more restrictions on alcohol availability,

[Graham Stringer (Blackley and Broughton) (Lab)]

I agree with the points the hon. Gentleman is making, specifically and generally. Does he agree that, not just on these guidelines but right across the board, Governments of all political colours have made a mistake in involving campaign groups and pretending that they are scientific experts? It is not just on alcohol, but in all sorts of other areas.

[Byron Davies]

I could not have put it better myself. I thank the hon. Gentleman for that intervention.

As I said, it becomes much easier to argue for more restrictions on alcohol availability, higher taxation of all alcohol regardless of strength, and more alarmist public health advertising to frighten people away from drinking. I am not a medic, but I have been around long enough to understand the old adages of “a little bit of what you fancy does you good” and “all things in moderation”—including international science. Indeed, looking into this further, I have discovered decades of evidence that shows the protective effects of low, moderate drinking.

Ealing Hospital

Graham Stringer Excerpts

Tuesday 3rd May 2016 Westminster Hall

[Several hon. Members rose—]

[Graham Stringer (in the Chair)]

Order. Before I call Dr Rupa Huq, I would like to explain the timetable for this hour-long debate. I would like to call the Opposition spokesperson at approximately 2.15 pm, and I expect him to take five minutes. Then the Minister can respond, leaving a minute or so for the proposer of the debate to reply. We seem to have plenty of time.

--- Later in debate ---

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Stringer. I congratulate my hon. Friend the Member for Ealing, Southall (Mr Sharma) on securing this extremely important debate and on the eloquent way he introduced it. He is widely known in this place for championing issues on behalf of his constituents; his contribution today will only further enhance that reputation. He presented a comprehensive picture of his constituency, rightly highlighting the scandal of health inequalities there and his concern about the implications for patient safety of the Government’s proposals. He cited staggering figures for the growth in elderly population in his area—not unique, but by no means to be ignored. He expressed his concern that the most vulnerable and those whose children have long-term conditions will have to travel further to access services, with possible negative implications for their economic situation. It is clear from what he said that he and his constituents have lost confidence in the process.

I draw attention to the contribution from my hon. Friend the Member for Ealing Central and Acton (Dr Huq). She is new to this place but is fast gaining a reputation as a Member who assiduously represents her constituents. She described the Government’s response as intransigent. If that is her experience, I am sure it is no reflection of the effort she has put in. She compared Ealing to the city of Leeds, and it is unthinkable that a city the size of Leeds would not have such fundamental health services as those being discussed today. She described what has been presented to us over the past few years as a bad deal all round. As an academic, she has based her comments on the evidence she has seen, not on opinion. She and my hon. Friend the Member for Ealing, Southall both expressed concern that Ealing hospital is on the way out. Those were not careless comments thrown about for political gain but genuine anxieties born out of what they see and hear.

My hon. Friend the Member for Hammersmith (Andy Slaughter) correctly said that the sooner the business plan for further implementation is available, the better. He identified the lack of information as a factor that has made the situation far more difficult than it could have been. As he says, where there is a vacuum, something will fill it. In this case, the vacuum has been filled by rumours—rumours so strong that two of my hon. Friends have felt compelled to raise them here today. He said that transparency will help; I certainly agree with that. I also agree that our concerns are no reflection on the hard work and valuable contribution that our NHS staff make each and every day.

More than 100,000 people have now signed the petition to express their concern about service downgrades and what they see as a real threat to the future of Ealing hospital. Their concerns relate to the “Shaping a healthier future” programme, which was launched in 2011 by a group of what were then 10 primary care trusts,

“to reshape hospital and out of hospital health and care services in North West London.”

Following the abolition of primary care trusts, the North West London Collaboration of Clinical Commissioning Groups has led the programme. It has proposed a number of extremely significant changes, including the downgrading of accident and emergency services at a number of hospitals.

In 2013, Ealing Council’s health overview and scrutiny committee referred the programme to the Secretary of State, who concluded that changes to NHS services in north-west London should proceed. In a statement, the Secretary of State said that five of the nine hospitals—Hillingdon, Northwick Park, West Middlesex, Chelsea and Westminster, and St Mary’s—would provide comprehensive, seven-day-a-week acute emergency care. He also stated that A&E departments at Ealing and Charing Cross hospitals would remain open, although with what—as my hon. Friend the Member for Ealing Central and Acton pointed out—he euphemistically called changes to the “shape or size” of services. Those changes have probably not turned out as people hoped. Changes were recommended to replace the A&E services of Hammersmith and Central Middlesex hospitals with urgent care centres, which were subsequently implemented in September 2014.

In 2013, it was decided that maternity services would be consolidated on to six hospital sites and maternity deliveries at Ealing hospital would cease. We have heard from my hon. Friends how significant that has been for their communities. The maternity unit at Ealing hospital was closed in July 2015. It has now been recommended that in-patient paediatric services should also be moved to maintain appropriate staffing levels. These changes have, understandably, caused great public concern, which in 2014 led to Brent, Ealing, Hounslow, and Hammersmith and Fulham Councils establishing an independent commission under Michael Mansfield QC to review the impact of the changes to the north-west London health economy and to assess the impact of planned changes.

On 2 December 2015, the commission published its final report, which was extremely critical of the “Shaping a healthier future” programme, finding that inadequate consultation had been undertaken and that departments had been shut without providing adequate alternative healthcare. Its recommendations included halting the SHF programme and that local authorities should consider a legal challenge. The Government’s response states that they are

“clear that reconfiguration of front line health services is a matter for the local NHS.”

It is clear from answers to parliamentary questions and a Westminster Hall debate on 24 March that both the CCGs and the Government do not accept the review’s findings.

The principle that decisions should be made locally by clinicians is sound, but there seems to be an issue about accountability in this case, as there is a clear feeling among the public and local politicians that their concerns are simply not being heard. Those who gave evidence to the commission were not fly-by-nights. Many were working on the front line of the services under discussion. Indeed, they are the local clinicians the Government say should be making the decisions. What recourse do clinicians, the public and patients have if they disagree so fundamentally with what is being done as we have seen here?

The most successful service reconfigurations are those where consultation is most effectively carried out and where support from clinicians at all levels, local politicians and, of course, members of the public is secured. It is no coincidence that when public concern is at its present level in Ealing and the surrounding communities, we tend not to see successful changes in provision.

Such was the frustration and concern about the changes that four local councils thought it necessary to use local taxpayers’ money to commission an independent report. As my hon. Friend the Member for Hammersmith said, the local authorities involved have behaved responsibly in commissioning this report. I do not believe there is any suggestion that they have behaved irresponsibly, so surely the Minister must acknowledge that taking this extraordinary step means that something must have happened that deserves further examination.

I turn to some of the recommendations in the independent report. Serious concerns have been raised about the consultation in 2012. There has been no significant further consultation since. Given that we are now four years on from that point and that the scheme has undergone considerable changes, as has the demographic make-up of the communities, it seems reasonable to consider a further period of consultation.

Concern was also expressed in the Mansfield commission’s report and here today about transparency, particularly in the business case on which the SHF scheme is based. I would welcome the Minister’s observations on both points, and if, like me, she is not satisfied that there has been sufficient public involvement, will she step in and ensure that that takes place before further downgrades or closures and that it is genuine consultation predicated on release of the full business case? Genuine consultation cannot take place if vital information is withheld. Transparency is the key to meaningful engagement.

The commission was asked to look at deteriorating standards in three local NHS trusts that were consistently failing to meet key targets, including that 95% of patients attending A&E must be seen, treated and admitted or discharged within four hours. The Minister will be aware that after six years of a Conservative Government, February’s figures are the worst on record for A&E waiting times. The most recent figures confirm that all three NHS trusts covering this area are failing to meet their targets.

In major A&E units, London North West Healthcare NHS Trust saw just 76% of patients within four hours and Imperial College Healthcare NHS Trust saw 69.1%. Does the Minister agree with the commission that the closures of Hammersmith and Central Middlesex A&E departments are responsible for these appalling figures, or is the Government’s overall record to blame?

Finally, the other key principle to which all service reconfigurations should adhere is that they should be based on clinical rather than financial need. They must represent what is in the best interests of the patients who access the services and not simply be a tool to balance budgets at any cost. In this case, because the Government have fundamentally lost control of NHS finances with 75% of trusts now in deficit, local people are understandably asking whether the serious financial hardship that the trusts face is forcing the CCGs to consider changes that they otherwise would not. Can the Minister assure us that no decision will be made in this case or any other on the basis of finance alone and that the interests of patients will remain the central focus at all times? It is clear that public confidence has been lost in this case, and it is simply not good enough for the Government to wash their hands of it. We urgently need an acknowledgement of those concerns and concrete plans to address them.

[Graham Stringer (in the Chair)]

To clarify, the debate, although it started early, will finish at 2.30 pm. Could the Minister leave a minute or two at the end for the proposer?

Dementia and Alzheimer’s Disease

Graham Stringer Excerpts

Tuesday 12th April 2016 Westminster Hall

[Graham Stringer (in the Chair)]

Order. Before I call Jim Shannon to move the motion, I must explain that we are having technical difficulties. The debate is hugely over-subscribed—many people want to speak—so it is likely that after Jim Shannon has spoken I will impose a time limit. However, there is no connection between my clock and the clock on the wall, which is going to be a difficulty for speakers. When Jim Shannon has spoken, I will explain what we are going to do.

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[Several hon. Members rose—]

[Graham Stringer (in the Chair)]

Order. Given the technical difficulties, the number of people who wish to speak and the fact that I intend to call the Front-Bench spokespeople at around 10.30 am, if my arithmetic is right, we are due to go over that time. I will put on a time limit of four minutes and not add time for interventions, because that gets too technically complicated. I hope that is clear. That will probably take us just over 10.30 am. The Clerk tells me that, to aid right hon. and hon. Members, a bell will be rung one minute before the end of their speech time limit.

--- Later in debate ---

[Neil Gray (Airdrie and Shotts) (SNP)]

I congratulate the hon. Member for Strangford (Jim Shannon) on securing this debate and pay tribute to him for his excellent speech, which will have touched many hon. Members here, as evidenced by the turnout today, and our constituents.

My father’s mother was diagnosed with Alzheimer’s years before I was born and my only memories of her, albeit fond, are of her diminished self. My father has told me about how kind, warm and generous his mum was, but Alzheimer’s changed her personality and made her short-tempered, intolerant and at times aggressive. She was nothing like the big-hearted and loving wife and mother her family knew so well. In her final months, she was unable to recognise my dad, and that was heart breaking for him and the rest of the family. I remember that distinctly.

As a young boy, it was difficult for me to understand why she kept asking if she was a pest and required an answer every time. She seemed remote and at the time I did not know why. On one visit to us in Orkney, when my grandfather was admitted to hospital for an operation, she insisted on going to the shops to buy sweets for my brother and me, but would not hear of anyone taking her. In the end, my parents had to compromise, so I went with her: a four-year-old guiding and making sure a 71-year-old found her way and got home again.

I cannot imagine how difficult it must have been for my grandfather, my dad and my auntie to watch that slow decline in someone who was once central to the whole family—a war-time wife and mother, and a proud, capable and clever woman. The way my grandfather cared for her well into his 70s was phenomenal and incredibly touching. When she was hospitalised, he visited her twice a day, his own health suffering after years of devoted care and worry.

It is difficult not to speak about the negative impact of Alzheimer’s because the results are real and devastating. It is also difficult to see beyond the illness, when for so many loved ones that is what dominates their daily lives for many years, but wonderful work going is going on to help people with different forms of dementia and their families. In my area, NHS Lanarkshire is working with Dementia Friends Scotland and Alzheimer Scotland to run a dementia friends programme at Wishaw general hospital that supports staff to recognise the signs of dementia and supports them in recognising that people with dementia can live fulfilling lives when given the care, support, respect and dignity they deserve.

It is important to put on the record the five key messages of the dementia friends programme: dementia is not a natural part of ageing; it is caused by brain disease; it is not just about losing your memory; it is possible to live well with dementia; and there is more to the person than dementia. It is important that we are all mindful of our language and actions. This debate is helpful in highlighting some of the issues that the dementia friends work so hard to bring to the fore. We all recognise the challenges faced by those with dementia and their families. We cannot hide away from them. They are faced from diagnosis through to end-of-life care.

If I had more time, I would have liked to touch on some of the Scottish Government’s excellent work. I am glad that my hon. Friend the Member for Argyll and Bute (Brendan O'Hara) mentioned it and I thank him. In February, they introduced the Carers (Scotland) Bill, which enshrines in law for the first time in Scotland the rights of carers, coupled with a commitment, if re-elected, to raise the level of carer’s allowance to match that of jobseeker’s allowance.

I am grateful for the opportunity to speak today and I thank the hon. Member for Strangford for raising the matter.

[Graham Stringer (in the Chair)]

I thank hon. Members for co-operating with the time limit on speeches, but if I am to get the last two speakers in, I must reduce it to three minutes.

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[Debbie Abrahams (Oldham East and Saddleworth) (Lab)]

I add my congratulations to the hon. Member for Strangford (Jim Shannon) on his exceptional speech and on securing the debate. It is a pleasure to speak, however briefly, in the debate as a co-chair of the all-party parliamentary group on dementia, as the only MP—I think that is still the case—who is a dementia friends champion, and as a former carer for my mum, who had Alzheimer’s disease. As we have heard today, if anyone’s life has not already been touched by someone who has dementia, it soon will be.

I commend the Government for their commitment and, in particular, the Prime Minister’s challenge and the investment in research funding that was announced last year at the World Health Organisation’s first ministerial conference on global action against dementia. It needs global action; we cannot act in isolation. It is estimated that by 2018 the global cost of dementia will be $1 trillion. I therefore ask the Minister to update us on the longer-term plans for building on that research investment and, specifically, what funding has been set aside to meet the challenges that make up the Prime Minister’s challenge on dementia and whether we are on track.

In addition to research, we need to ensure that hospital services take into account the specific needs of people with dementia. We know from the recent Alzheimer’s Society campaign, “Fix Dementia Care”—my hon. Friend the Member for South Shields (Mrs Lewell-Buck) mentioned some of the results—that 57% of carers, families and friends of people with dementia felt that the person they cared for was not treated with understanding or dignity in hospital; only 2% of hospital staff understood the specific needs of someone with dementia. We obviously need to address that. Could I put in a plug for the APPG report? Seven out of 10 of the people in hospital are not actually there for their dementia, but for something else. We have a report coming out next Wednesday on dementia and comorbidities, and I hope that people will be able to join us for that.

I am sure that my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) will mention this in her winding-up speech, but we cannot divorce the issues in relation to social care from dementia care. I called on someone, just in a regular door-knock, and she obviously had dementia. She was on her own. She greeted me with an empty medication bubble pack and just said, “I don’t know what to do.” Too many people are isolated in that way. So many demands are placed on family carers. I hope that the Minister can address some of those issues.

[Graham Stringer (in the Chair)]

We have gone slightly over time because of the unusual circumstances, so could the Front-Bench spokespeople bear that in mind? You have marginally over seven minutes, and that will leave just over a minute for Jim Shannon.

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

Seven minutes?

[Graham Stringer (in the Chair)]

Yes.

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[Barbara Keeley (Worsley and Eccles South) (Lab)]

It is a pleasure to speak in this debate with you in the Chair, Mr Stringer. I congratulate the hon. Member for Strangford (Jim Shannon) on securing this important debate. I recognise the remarkable amount of work that he does on social care and carers, and I thank him for that. We have had some excellent contributions from 14 hon. Members—almost too many to mention, so I will not mention them all. We are making some progress but we have a long way to go to improve care for people with dementia and support for their carers.

The Labour Government launched the first ever national dementia strategy, appointed the first national clinical director for dementia, and commissioned the National Institute for Health and Care Excellence to develop the quality standard for dementia. Together, those began the process of establishing memory clinics, providing better training for GPs and improving the quality of dementia care for people in hospital. I thank the hon. Member for Charnwood (Edward Argar) for mentioning that record. It is welcome that the Government are carrying on that work through the Prime Minister’s important challenge on dementia 2020. I am sure that hon. Members here today agree with the aims of that challenge but we have to accept that there is a long way to go before they become a reality.

Dementia is a distressing condition. In the long term we should be aiming for a cure, but while working to find a cure we must put equal emphasis on the care provided to people with dementia and the support provided to their families and carers. Carers UK reminds us that the symptoms of dementia can make providing care particularly difficult. People with dementia—we have heard about this in the debate—can grow agitated and violent, and night-time wandering and shouting can disrupt carers’ sleep.

Families report challenges in finding services that have the expertise to provide the right care and support. Of course, that means that it is more difficult for carers to get practical help or to take essential respite breaks as they do not have, or they lose confidence in, the quality and appropriateness of the care available. I welcome the strong case made by my hon. Friend the Member for Burnley (Julie Cooper) for better support for carers.

The care sector has a turnover rate of 25% so even when a care package at home is arranged, high staff turnover makes it harder to build familiarity and trust. For people with dementia, receiving care each day from someone they see as a stranger can be upsetting and confusing, and can make them more likely to refuse support, putting further pressure on their family carers. It is clear that improvement is needed, so can the Minister say whether the carers of people with dementia will be a key strand of the upcoming carers strategy?

I applaud the Alzheimer’s Society “Fix Dementia Care” campaign, which wants to ensure that people with dementia receive the highest standards of care in hospital, in care homes and in the home. It is of great concern that a survey of carers of people with dementia found that only 2% believed that hospital staff understood the specific needs of people with dementia, more than half felt that the person they cared for was not treated with understanding and dignity in hospital, and nine out of 10 felt that the person with dementia became more confused while in hospital.

The Alzheimer’s Society is calling for all hospitals to publish an annual statement of dementia care. In my area, it was pleasing that Salford Royal recorded information for patients with dementia and that the records showed that Salford Royal’s performance on a number of elements of care was better than national averages. However, other local hospitals did not record that information so there is much to do to bring that up to standard.

As part of improving hospital care for dementia patients, listening to carers would be a step forward. Nicci Gerrard is leading John’s Campaign for the right for family carers to stay with people with dementia in hospital, as we heard earlier. Nicci’s father John suffered a significant decline when he was in hospital for five weeks. Although the family felt that individual nurses and doctors were kind, conscientious and respectful, restrictions on waiting times meant that the family could not sit and talk to John, read to him, make sure he ate or keep him attached to the world.

John’s Campaign calls for the families and carers of people with dementia to have the same rights as the parents of sick children. They should be allowed to remain with them in hospital for as many hours as they are needed or are able to give. I understand that 272 hospitals across the UK have pledged their support to John’s Campaign. Will the Minister outline what is being done to improve hospital care for dementia patients and whether she supports John’s Campaign?

As well as improving hospital care, there are real concerns about the state of social care. The Association of Directors of Adult Social Services reports that £4.6 billion has been cut from adult social care budgets and that 300,000 fewer people are receiving publicly funded services than in 2009-10. Social care has been an easy target for cuts. I am concerned now that the Chancellor’s aim to find a further £3.5 billion in savings by 2019-20 will hit council and social care budgets even further.

The Government have stated that, by 2020, they want to see an increase in the number of people with dementia being able to live at home with more personalised support available to them and their families. That is a laudable aim, but the Channel 4 “Dispatches” programme last week showed just how poor home care can be, with time clipped from care visits, careworkers working very long days and not being paid for travel time, care needs neglected, and no time for the careworker to talk and listen to the person receiving care.

This year and next year are tough years for social care funding because home care and residential care providers bringing in the so-called national living wage have estimated they will face costs of £330 million in 2016-17 with no additional funding for this Government policy. The better care fund only provides £100 million extra next year, so this year is a problem. It is not surprising that careworkers say that issues with their pay and conditions prevent them from delivering good quality care. Unison found that three quarters of domiciliary careworkers do not have enough time to provide dignified care and that 84% of service users not getting enough time for care are people with dementia.

Caring for someone with dementia is not just about aspects of physical care. It is about conversations—knowing the person and knowing what is a comfort to them. Across hospitals, primary care and home care, we need to improve staff training and understanding of how to support people living with dementia and how to support and work with their family carers.

Carers UK reminds us that carers are the experts in the care needs of the person they care for, so it is heartening that today, Dr Julie Wray of the School of Nursing, Midwifery, Social Work and Social Sciences at the University of Salford is launching her book, “Supporting families and carers: a nursing perspective”. I hope that her nurse colleagues use the book to develop their knowledge of how to work with carers of people with dementia. They are the people who make such a vital contribution to the care of all those people.

[Graham Stringer (in the Chair)]

I call the Minister. Would you leave a couple of minutes for Jim Shannon to sum up?

Cities and Local Government Devolution Bill [Lords]

Graham Stringer Excerpts

Monday 7th December 2015 Commons Chamber

[Mr Betts]

That is an added complication. At present, three separate police and crime commissioners cover the Sheffield city region: one for south Yorkshire, one for Derbyshire and one for Nottinghamshire. Those issues might be considered at some point way down the line, but the leaders of the Sheffield combined authority have— sensibly, in my view—decided not to incorporate the police and crime commissioners’ powers in their devolution deal, probably because that would lead to exactly the sort of further complications to which the hon. Gentleman has referred. They have confined their deal to economic, transport, skills and growth issues, which are precisely the issues to which the Secretary of State will have to give particular consideration if there is a decision to be made about which combined authority the districts are to go into.

[Graham Stringer (Blackley and Broughton) (Lab)]

I am sure my hon. Friend agrees that we live in an extremely complicated country both culturally and economically, and one of the things that has bedevilled attempts to devolve powers to local authorities has been searching for the perfect boundaries. The perfect boundaries do not exist. Does my hon. Friend agree that it is better to devolve than to spend for ever looking for those perfect boundaries?

Cities and Local Government Devolution [Lords] Bill

Graham Stringer Excerpts

Wednesday 21st October 2015 Commons Chamber

[Mr Brady]

I absolutely agree with my hon. Friend. In my Greater Manchester constituency, the level of knowledge of what is being proposed on changes in governance is still remarkably low. Certainly, it was not a significant feature of the general election campaign or the last local election campaign. We need to try to create a better level of knowledge and engagement.

[Graham Stringer (Blackley and Broughton) (Lab)]

It is correct that no political party has so far campaigned on a metro mayor, but can the hon. Gentleman tell me of any political party, in Greater Manchester or elsewhere, that has ever campaigned on more power for central Government? In fact, the opposite has always been true. Having written Labour party manifestos several times, I know that political parties have always asked for more decentralised power.

[Mr Brady]

The hon. Gentleman and I agree in a distressingly large number of circumstances, and I absolutely agree with what he says now. Most of us are very firmly in favour of the devolution of powers from central Government to a level closer to the people, but we are discussing the mechanism for governance and whether people should have the right to consent to changes in that mechanism.

My hon. Friend the Minister says that this is a necessary package. Clearly, the position that the Government are seeking to establish is one where we can have these levels of devolution only with the particular type of accountability that comes through a directly elected mayor. In that case, does he not believe that that can be put to the people of Greater Manchester as a package? If the benefits of the devolution package are sufficiently good to make it an attractive proposition—if enough of the powers that the hon. Member for Blackley and Broughton (Graham Stringer) and I would like to come closer to the people are being devolved—perhaps even those who are sceptical about the elected mayor model might accept it as a whole. I hope that the Minister, in looking at how the Government might more effectively take on board the views of local people, will consider that possibility as well as the one we have put before the Committee in amendment 51.

--- Later in debate ---

[Mr Allen]

The nuance that I would add to my hon. Friend’s excellent point is that local taxation need not necessarily always be collected locally. Income tax is a very good example. Provided that it is distributed fairly from the centre, it makes a lot of sense for collection to be a central function, with Her Majesty’s Revenue and Customs simply continuing to do what it does, openly and transparently. Other things—he mentioned a hotel tax, business rates and so on—are much more amenable to local decision making, but we are long way from that.

[Graham Stringer]

Will my hon. Friend give way?

[Mr Allen]

I will, but if I may, I will make that the last intervention, otherwise you will start to twitch, Mrs Main.

[Graham Stringer]

My hon. Friend is committed to and searching for radical localist solutions. He mentioned the efficiency of decisions taken locally. My experience is that local government is much more efficient than central Government. Would not the most radical constitutional change be to make central Government responsible to local government, not the other way round?

[Mr Allen]

I would not ever wish to do to central Government what they have done to local government. I will therefore resist the temptation that my hon. Friend puts in my way. Sometimes, however, when we are being lectured about fiscal prudence, I ask myself: who has the triple A rating in this country? It is local government, rather than central Government. Who goes cap in hand to international lenders? Central Government. Who runs tight and balanced budgets? Local government. A central Government of any political colour who lectures local government should look in the mirror first.

I just want to mention one last new clause, new clause 16. It relates to having an institution, created by local government, as one of the What Works institutions that, thankfully, are now springing up across and outside government. They take the best possible practice out there and spread it around. A national-level inspectorate can tell local government what to do, but I am saying that there is a different model. We should draw up from the localities to national level something selected by the localities to spread best practice. We all want to do better and to hear who is doing the good stuff.

I will boast about the fact that the city of Nottingham has just come with the idea of an energy broker. Anybody can phone up and get the best deal—done. It will save people several hundred pounds a year. It is a not-for-profit service. As a Nottingham patriot, I could go on about our trams and many other innovations that we are introducing with two hands tied behind our back.

If we release people in the way I am describing, we can show them best practice and we can see what they are doing. I ask the Minister to consider that point very seriously. The Government have very generously created What Works institutions in policing and early intervention —I played a small part in creating the Early Intervention Foundation—and there are about 10 of them across the board. We need an organisation created by local government and that local government will respect—based in the LGA, the Department for Communities and Local Government or wherever—to give advice, offer evidence and fight local government’s corner. That is something for the Minister to take away and consider, and I hope it will reappear in the next of the two other devolution Bills I anticipate before 2020.

Hospital Services (South Manchester)

Graham Stringer Excerpts

Tuesday 8th September 2015 Westminster Hall

[Mike Kane]

May I say a couple of things? On a personal level, I am delighted that my hon. Friend won her seat of Ashton-under-Lyne. She worked at the coalface of integrated care services in east Manchester and she brings all that experience to the House. I, too, was involved in public life in Tameside, for six years, so I am delighted that the hospital has been taken out of special measures today. I pay tribute to everyone who has helped that to happen, from those in the Ministry to local leaders and the consultants at Wythenshawe hospital who over the past few years have advised on bringing Tameside general hospital out of special measures.

Almost £2 billion has been taken out of the budget for adult social care, with more cuts to come. We need to do things differently to meet the challenges of the time. Better integration of local authority services and the NHS will be a key part of that change and will be realised under the new powers being devolved to Greater Manchester. My hon. Friend the Member for Stretford and Urmston (Kate Green), the hon. Member for Altrincham and Sale West (Mr Brady) and I have serious concerns about the outcome of Healthier Together and believe that the decision-making process is flawed.

Reorganising our tertiary services before resolving the huge challenges that we face to integrate our health and social care in the region feels like putting the cart before the horse. The benefits to be gained from our devolved powers in this area are yet to be realised, so we are redesigning our tertiary services in the dark. My constituency is home to the University Hospital of South Manchester Trust, which delivers services costing £450 million, employs 6,500 people and has 530 volunteers who give up their free time to help patients and visitors. The UHSM hospital has several fields of specialist expertise, including cardiology and cardiothoracic surgery, heart and lung transplantation, respiratory conditions, burns and plastics, and cancer and breast care services. Indeed, the trust is home to Europe’s first purpose-built breast cancer prevention centre. Its hospital not only serves the people of south Manchester and Trafford, but helps patients from across the north-west and beyond.

Healthier Together has decided that UHSM will partner the Central Manchester University Hospitals NHS Foundation Trust, or CMFT, in a single service for Trafford and Manchester. UHSM and CMFT have agreed to work together to improve collaboration between the trusts. There is clearly a great opportunity for two of Greater Manchester’s leading university teaching hospitals to work together to improve services, to increase integration at all levels, including with social care, and to improve research and education.

The Wythenshawe hospital, however, provides an extensive portfolio of secondary and tertiary services that rely on support from general surgery to maintain their quality and safety. In fact, UHSM provides all 18 of the services identified by Healthier Together as needing support from general surgery, including secondary services such as maternity, gynaecology, gastroenterology, urology and acute medicine, as well as tertiary services such as heart and lung transplant, burns care, cystic fibrosis and extracorporeal membrane oxygenation, which are provided only by UHSM for patients from across Greater Manchester and the north-west.

UHSM regularly accepts elective and emergency surgical patients from Greater Manchester and beyond who require the specialist support of its tertiary services —for example, patients requiring emergency or complex elective general surgery with complex cardiac disease. There is genuine concern that those secondary and tertiary services, which are outside the scope of Healthier Together, could be destabilised or downgraded through the implementation of the proposals.

UHSM also provides all the services, as identified by Healthier Together, on which emergency, high-risk general surgery is absolutely dependent, such as interventional gastrointestinal radiology and interventional vascular radiology. The latter is only provided at three hospitals in Greater Manchester that also provide vascular surgery, one of which is UHSM’s Wythenshawe hospital. Wythenshawe hospital must continue to deliver high-risk, emergency general surgery procedures for in-patients and for surgical emergencies in its secondary and tertiary services. UHSM will need to retain its existing level of general surgery support at Wythenshawe hospital in order to undertake surgical assessment, perform emergency surgery and manage the elective workload from a highly complex group of patients.

We were pleased that, in order to support UHSM’s tertiary services, Healthier Together recognised at a public meeting on 15 July that Wythenshawe hospital would need a higher level of general surgery service than that described in the Healthier Together service model for a local hospital. Much greater clarity, however, is required on how secondary care services, such as maternity, gynaecology, gastroenterology, urology and acute medicine, will continue to be supported, as the service model for general surgery could have significant implications for many services outside the scope of Healthier Together.

UHSM believes that the key features of a service that would maintain the quality and safety of its secondary and tertiary services are that Wythenshawe hospital should meet the Healthier Together quality and safety standards; should remain a receiving site for emergency general patients, including those with co-morbidities in its tertiary specialties and those who self-present; should have 24/7 senior general surgical assessment and opinion rapidly available to A&E; should remain able to admit and manage general surgery patients of all types; and should continue to deliver all emergency general surgery procedures, both major and minor, for in-house emergencies—for example, in-patients in urology—as well as for emergency general surgery patients with co-morbidities in its tertiary specialties. I am thinking, for example, of a patient with a bowel obstruction who is also being treated by the hospital for cystic fibrosis. As a minimum, the existing level of general surgery capacity must be retained in order to deliver and maintain that level of service in support of UHSM’s secondary and tertiary services.

Wythenshawe currently has a high-capability team of 10 consultant general surgeons with experience in all specialities of managing high-risk surgical emergencies in-patients, supported by a team of trainee surgeons. Although Healthier Together analysed implications for the consultant workforce, it is not clear what analysis there has been of the implications for other staff, including the effects on medical training posts and the support those posts provide to consultants.

Healthier Together has recognised that the service model required at UHSM must be more than that described by the programme for a local general hospital, and UHSM’s surgeons have been invited to discuss potential service models with the Healthier Together team. However, serious questions have been raised with both me and Members whose constituencies border mine about patient safety and quality in what can only be described as a fudged model for UHSM, which would be neither a specialist hospital nor a local one.

Throughout the Healthier Together process, we have been told that the dominant driving force of the proposed changes is to save more lives, yet in the end the final part of the decision to allocate the fourth specialist site was taken based on one factor only: travel and access. It is clear that for the Greater Manchester-wide—indeed, north-west-wide—specialist services provided at UHSM to continue safely, a robust and high-quality general surgery service must be maintained at Wythenshawe hospital. That is essential to ensure the quality and safety of the secondary and tertiary services that our constituents and patients from across Greater Manchester, and beyond, rely on.

[Graham Stringer (Blackley and Broughton) (Lab)]

I congratulate my hon. Friend on securing this debate. He is making an excellent and detailed technical case on behalf of Wythenshawe hospital. Does he agree that the downgrading of the status of Wythenshawe—that is what this is—will make it much more difficult to recruit the necessary specialist staff and is another example of how flawed the whole process has been?

[Mike Kane]

My hon. Friend knows more than anyone in this place about the principle of subsidiarity. He was fighting for devolved services for Manchester in the ’80s. We are beginning to catch up with his vision for devolved services across Greater Manchester that he argued for when he was ably leading Manchester through the depression of the ’80s and its economic regeneration in the ’90s. I agree that this fudged proposal could lead to a death by 1,000 cuts. It will undermine confidence, and we are passionate about avoiding that.

I hope the Minister will work with us to ensure that patient safety across Greater Manchester is the primary factor in the decision-making process. Very few Members of Parliament are fortunate enough to represent the hospital that they were born in. There is nothing I would not do for patients—not just in my constituency, but throughout Greater Manchester. We were told that Healthier Together was a clinician-led consultation; unfortunately, our clinicians are now telling us that they have serious concerns. Local MPs must listen and act. We have reached an unfortunate situation in which those clinicians have applied for judicial review, and we are at the stage of the letter before action in that process.

I urge all sides to negotiate to see whether an equitable solution can be found. If it cannot, the proposals are so flawed that any judicial review would probably be successful. That would not please me in any way whatever; I am the last person who wants to see a long and protracted legal process. I believe that, fundamentally, we should move towards a devolved set-up in Greater Manchester and that that process will be put back by this situation. However, I cannot stand by and be told that patient safety may be at risk without raising the issue in Parliament.

--- Later in debate ---

[Mr Brady]

Yes, absolutely; that is an important point. Without venturing too far into the realms of legal opinion and the judicial review that we could face, what makes the decision so demonstrably unreasonable is the failure to take account of a known factor that will materially change the travel times on which that decision is purported to have been based.

Furthermore, it is questionable policy to proceed with such profound changes to services at the same time as another review was going on. It may be sensible to proceed with some of the shared service propositions for UHSM and Central Manchester—that may be the way forward and may lead to better outcomes for patients in both trusts, and it should certainly be explored—but seeking to arrive at agreement on that while the Healthier Together process was still to conclude was deeply questionable and is a source of serious concern for us all.

I will not rehearse the long list of outstanding tertiary services offered by Wythenshawe not only to Greater Manchester, north Cheshire and north Wales but far beyond. We are debating hospital services in south Manchester, but as the hon. Gentleman reminded us, we are also talking about a hospital that provides the most complex tertiary services for a much wider area. Clearly, therefore, the issue is more significant, and it is more important to get it right, than would be the case were the hospital providing important tertiary services merely for a local population.

The consultants who have spoken to me—I am sure that they have also spoken to my friends on the Opposition Benches—have been very clear. There is no question that they are trying to defend their own patch or their own empire; some are constituents whom I have known for many years, and many of them are at a point in their careers when they really do not need to be concerned about those things. Some are very eminent in their fields, and when they tell me that their concerns are purely about patient safety—they say that they are entirely open to sensible proposals for reorganisation, shared service agreements and so on, but that they are worried that the work being done at UHSM could be threatened and could, in the hon. Gentleman’s words, suffer death by a thousand cuts—I am inclined to take those concerns seriously.

To boil the consultants’ concerns down to the simplest level, their analysis is that the high level of complex tertiary services at Wythenshawe can continue into the long term only if it benefits from an equally high level of general surgical support to ensure that different, co-dependent services and procedures can always be provided in the safest way. The hon. Gentleman said very clearly and correctly that, in the consultants’ view, the provision of general surgery would remain at an appropriate level only if Wythenshawe remained a receiving centre for complex general surgery. If the same level of support is not present—we have all seen how this works—it will be only a matter of time before we find ourselves here again, with a new review suggesting that it really is not safe to perform heart and lung transplants at Wythenshawe, because it lacks the necessary general surgical support when complications arise.

The consultants make a powerful and plausible case. First, there is the procedural case that Healthier Together has been flawed and that the process and decision were unreasonable. I also find it compelling when they say that having a certain level of general surgical support is the only way to protect the complex services that are provided at the moment.

[Graham Stringer]

I agree with the case that the hon. Gentleman makes about the importance of general surgery to the highly specialised tertiary services at Wythenshawe. Just over 30 years ago 55 people died on the runway at Manchester airport. I hope that such a thing will not happen again, but with the downgrading of Wythenshawe hospital is it not likely that, if people were to need services following an accident at the airport, those services would be of a lower quality? That is not acceptable.

[Mr Brady]

I am grateful to the hon. Gentleman, who makes a critical point. Most other airports probably envy the level of support that Manchester has almost on site—given the trauma centre and the combination of capabilities that Wythenshawe enjoys, so close to Britain’s third busiest airport, which is a major international airport. That is where someone planning with a clean sheet of paper would want a major trauma centre. Added to that, Wythenshawe even has its own helipad to receive emergency cases and get them into the operating theatres as quickly as possible. It is a lifesaving centre for many reasons.

I want to conclude with some thoughts about the way forward. As has been said, correctly, if judicial review proceeds there must be a good chance of success. Unlike most branches of the law, judicial review rather relies on reasonableness, which is viewed through the prism of a reasonable lay person’s views. It is pretty clear that the Healthier Together process fails on those grounds. However, if we get a successful judicial review the price will be at the very least a protracted delay in the reorganisation of services, which should bring benefits to patients across Greater Manchester and beyond. Potentially the price may be much worse, if it is to inhibit the move to the new world of integration of health and social care, for which we all have such high hopes.

The least that we need now is a sensible pause for reflection. We need the parties to draw back from the brink and get back to the table—not to the kind of negotiation in which the decision is restated and people are told they are being silly not to accept it, but to a genuine consultation and discussion with senior clinicians, who have previously felt excluded from the process and unable to make the input that they should have been able to make in the interest of patients. I do not think that any of us cares whether the pause is effected by Ministers at the Department of Health, commissioning groups or the interim Mayor of Greater Manchester.

We need people to be brought around the table, with the genuine good will that I think still exists on all sides. We need a genuine willingness to reopen the question, and an understanding that unless Wythenshawe either becomes an additional specialist centre in the terms of Healthier Together or, at the very least, is guaranteed a status as a receiving centre for acute general surgery, we will not arrive at a state of affairs that is good for Wythenshawe, for Greater Manchester or for the thousands of patients from north Wales and the north-west of England who depend on the complex tertiary services currently offered there.

Human Fertilisation and Embryology

Graham Stringer Excerpts

Tuesday 3rd February 2015 Commons Chamber

[Steve Baker (Wycombe) (Con)]

I approach this subject with a considerable degree of humility, for two reasons. First, I will never forget meeting a family in my constituency whose child suffers from mitochondrial disease; there was both a haunting sorrow in that family and the hope that if these regulations are passed they will be able to have a child without this problem. Secondly, I am very aware of my own shortcomings in relation to biological science. As a chartered engineer, I am perhaps more competent in the physical sciences, and I do not mind admitting that I had to look up at least a few of the words in the regulations in order to understand them.

As I have listened to this debate, not only today but previously, I have wondered whether we have really reflected on how science proceeds, because scientific truth is not established by authority or by democratic vote; it is established, as Karl Popper put it, through “conjecture and refutation”—trial and error. Someone who reads Thomas Kuhn’s “The Structure of Scientific Revolutions” will discover that it is possible for quite large bodies of knowledge to be developed with errors in them. When those errors are corrected, the paradigm shifts—that is a term we have all heard. That is how science proceeds, through trial and error. The reality is that there will always be uncertainty in any scientific procedure.

When the Commons Library summarised the Nuffield Council on Bioethics’ review, the second point mentioned was this:

“The knowledge about these techniques is uncertain and could remain so for several generations—their use could potentially harm future persons.”

The hon. Member for Liverpool, Wavertree (Luciana Berger), speaking from the Front Bench, made the point that, broadly, the question before us was whether there was a reason to withhold these techniques from people. If there is a reason, it is that they may do harm to future persons. I will not support the measure because this is inherently uncertain. That uncertainty is an inherent part of science, and it is no good appealing to authority to try to resolve the question, because different authorities will disagree and there is no way to resolve those disagreements apart from through empirical evidence, which we can obtain only by experimenting on humans.

[Graham Stringer (Blackley and Broughton) (Lab)]

The hon. Gentleman is making a typically thoughtful contribution to this important debate. Does he not have to balance that uncertainty, which he points out fairly, with the 100% certainty that the children of mothers with mitochondrial disease will suffer?

[Steve Baker]

The hon. Gentleman is absolutely right, which is why I began by expressing the humility I feel on this subject as a result of meeting and having had a lengthy conversation with a family who face just that issue. I remind myself, however, that we are dealing here not with a cure for those who have already been born, but with ensuring that those who are subsequently born do not suffer from that disease. If we were discussing a cure for those already living, perhaps the circumstances might be different.