Pulmonary Embolisms: Diagnosis

Helen Hayes Excerpts

Wednesday 30th November 2022 Commons Chamber

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

I am grateful for the opportunity to bring to the House the issue of the diagnosis of pulmonary embolism. Given the content of this debate, I put on the record that my husband is employed by the NHS.

I applied for the debate on behalf of my constituent Tim Edwards, who is watching the debate from the Public Gallery. Tim’s mother, Jenny, taught for 27 years in Lewes, East Sussex, before retiring in 2012. Jenny sadly lost her life to pulmonary embolism in February 2022. My speech is about the experience of Jenny and her family, and the research that Tim has undertaken in the aftermath of his mother’s death, which points to a significant issue with preventable deaths occurring as a consequence of misdiagnosed pulmonary embolism.

First, I want to put on the record my sincere condolences to Tim and his family on the loss of his beloved mother. I understand that in the weeks immediately prior to her death, Jenny had been enjoying time with her first grandchild. I am sure that, as Tim and his wife watch their daughter grow, they are constantly reminded of the relationship that she will now not be able to enjoy with her grandmother. Tim is motivated by his loss to seek to ensure that positive learning is derived from his mother’s case and many similar cases, so that diagnosis and the prompt treatment of pulmonary embolism is improved.

Globally, venous thromboembolism, which presents clinically as either deep vein thrombosis or pulmonary embolism, is the third most frequent acute cardiovascular syndrome behind heart attack and stroke. Pulmonary embolism is a blood clot in the vein passing to the lung and causing heart failure. The disease is serious but eminently survivable—if it is promptly diagnosed and treated, the death rate is 8%. Unfortunately, many pulmonary embolisms are misdiagnosed and attributed to other acute cardiovascular conditions because of the overlap of symptoms and the greater ease in identifying heart attacks and strokes.

My constituent has undertaken considerable research since his mother’s death, working with the charity Patient Safety Learning. He has estimated that there was a minimum of 400 excess pulmonary embolism deaths across England from April 2021 to March 2022, and that that excess figure is attributable to cases that were missed. He also looked at the age-adjusted mortality rates for pulmonary embolism across counties in England and Wales. There are some regions where the number of fatalities from the condition is almost three times the national average. The Minister may want to inquire as to what drives that discrepancy.

Let me give a sense of what can and does go wrong. In early February 2022, despite exhibiting risk factors and sudden symptoms, including fainting and collapse, my constituent’s mother, Jenny, was wrongly misdiagnosed in the care of an emergency department as having had a heart attack. She was then needlessly fitted with a stent. Upon her discharge from hospital, Jenny’s condition got worse again at home. She was dying. Yet she was reassured by a cardiac nurse who, over the phone, missed the clinical signs that indicate pulmonary embolism: shortness of breath, chest pain in the centre of the chest and fainting. The nurse advised that if these symptoms continued, Jenny should call her GP, and she did so, but she never made her GP appointment. My constituent does not want this to happen to other family’s loved ones, because it was entirely avoidable.

Jenny was waiting in accident and emergency for more than 12 hours, and there were nine independent decision-making points, at any one of which pulmonary embolism could and should have been diagnosed, but the condition was only discovered in an autopsy. My constituent has subsequently been motivated to write a report about what went wrong, given the mistakes that Jenny experienced and his sense that the NHS trust involved was unable to learn from what happened. His background is in the financial services sector, working in reinsurance, and he has a strong understanding of risk management. From a review of Jenny’s case and a report released by the Healthcare Safety Investigation Branch on this topic, part of the problem contributing to misdiagnosis appears to be that many emergency departments are frequently under-resourced and over-reliant on junior staff who may be ill-equipped to reliably suspect, assess and then treat pulmonary embolism, which is a relatively complex condition. That is supported by information provided by the Royal College of Radiologists, which commented on the lack of workforce sufficiency and a shortage of equipment.

Clinical staff in these settings have commented that either they do not have time or, astonishingly, do not feel that they need to follow clinical guidelines on how best to diagnose pulmonary embolism. On that last point, my constituent observes that there appears sometimes to be a culture of excessive leeway for clinicians to make their own decisions and a reluctance to follow clinical best practice. This is a source of concern.

My constituent has also discovered by interviewing a leading European professor in this area that the British clinical guidelines for diagnosing pulmonary embolism are out of step with those adopted across Europe and appear to exacerbate the risk of misdiagnosis, because the guidelines are thought of as subjective. He welcomes the news that these clinical guidelines are currently being reviewed. My constituent is also concerned that prior covid-19 infection has complicated the process of diagnosis in recent years, because some symptoms may be dismissed as linked to covid. However, this is inexcusable, as covid-19 was first established as an additional risk factor for pulmonary embolism by studies across Europe and the US in 2022. Prior covid-19 infection should give rise to greater, not lesser suspicion for patients presenting with symptoms.

In Jenny’s case, well-documented symptoms of pulmonary embolism were discounted because of her prior covid-19 infection, although it had been asymptomatic and she had made a full recovery. My constituent reports that it seemed that clinicians were assuming that covid-19 had been beneficial to Jenny’s health. Upon my constituent’s complaint to the NHS trust responsible for Jenny’s care, a serious incident report was commissioned and an inquest took place. However, in my constituent’s opinion, the NHS trust appears to have exhibited what he describes as a “shrug of the shoulders, these things happen” conclusion, inhibiting sufficient learning.

My constituent demonstrates in his report that the clinicians who treated his mother are at odds with academic literature on the symptoms of pulmonary embolism when they discuss the rationale behind their decisions. That is deeply troubling, given the alarming rise in pulmonary embolism fatalities across the country. The trust used the lowest level of investigation to contribute to its serious incident report, meaning that the subject matter experts chosen to contribute to the report were all involved in Jenny’s original care. The report’s conclusion was that a pulmonary embolism could not have been detected, even though Jenny displayed symptoms consistent with 90% of pulmonary embolisms. My constituent disagrees with the report conclusions, and he is concerned that it lacks objectivity and that there is insufficient learning to prevent such misdiagnosis from happening again. A higher level of investigation would have ensured independent contributors to the report, and the lack of that gives rise to concern about how many other cases may have been inadequately reviewed.

The sadness and frustration that my constituent feels at the circumstances of his mother’s death have been compounded by the intransigence he has witnessed in the NHS trust responsible for her treatment and the discovery that Jenny’s case was not alone. My constituent has been working with the charity Patient Safety Learning and his report will be published in December. The report contains nine calls for action. I have read the report and I have also received a response from NHS England to the recommendations in the draft. I share my constituent’s concerns that the response falls back on existing guidelines and current practice. It does not acknowledge my constituent’s finding of around 400 potentially preventable deaths a year due to misdiagnosed pulmonary embolisms. It makes no commitment to any process of review or change.

The Royal College of Radiologists has also expressed concerns consistent with my constituent’s observation about resourcing issues in emergency departments, and workforce and equipment sufficiency to enable scans to be undertaken. It stated that clinicians do not always have the equipment necessary to provide optimum care. The current vacancy rate in clinical radiology consultants is 8%.

My constituent’s research on this issue following the tragedy that his family has suffered is commendable. It highlights serious problems with excess deaths and misdiagnosis, raises serious questions about a postcode lottery, workforce sufficiency and the availability of equipment, and raises concerns about the culture of learning in the context of misdiagnosis.

I ask the Minister to agree to work with NHS England to commission a review of the data set out in my constituent’s report and the concerns raised by the Royal College of Radiologists, with a view to ensuring that the rate of misdiagnosis of pulmonary embolism is greatly reduced, and fewer families have to suffer the loss that my constituent and his family have suffered.

Urgent and Emergency Care

Helen Hayes Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

That, I think, relates to the point that I just made about the need for flow in the system and an appropriate step-down capacity. Sometimes patients are not yet ready to be discharged to their homes, but some additional physio or other support may enable them then to go home, which is where they usually want to be. This is all part of taking a much more integrated approach, and part of that must be improving the quality of data in relation to the activity that takes place within community settings.

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

In July, the average wait time in London for an ambulance needed by someone describing the symptoms of a stroke was more than an hour—more than three times longer than the target time. Many of my constituents have told me that they are living with genuine anxiety and fear that if they or a loved one were stricken by illness or involved in a serious accident, the emergency help that they needed would not arrive in time. The Secretary of State has announced some measures today, but what my constituents want to know is when we can expect the time targets in London to be met once again, so that they can rest easy in the knowledge that if they need an ambulance, it will be there.

[Steve Barclay]

One of my reasons for going out with the London Ambulance Service—among others—over the summer was to answer the charge about what Ministers were doing, and to observe at first hand the challenges that the service had been facing. As the hon. Lady will know, performance has improved since the summer, but the service remains challenged. That is why we are considering a range of measures, such as boosting emergency departments, looking at pre and post-cohorting, looking at how we work with the taskforce, and looking at single points of access. One issue that paramedics emphasise to me is the need for, in particular, a better way for frail elderly patients to gain access to a single point for social care provision. We are working closely on that range of measures with colleagues in the London Ambulance Service.

Childhood Cancer Outcomes

Helen Hayes Excerpts

Tuesday 26th April 2022 Commons Chamber

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

I congratulate the hon. Member for Gosport (Dame Caroline Dinenage) on securing this very important debate. My constituent, Emma, contacted me about the experience of her family, when her 17-year-old daughter, Ruby, became ill with T-cell lymphoma, an aggressive form of blood cancer. Ruby passed away in May 2020 aged just 18. I am speaking today for Ruby; for my constituent, Helena, who is currently going through cancer treatment, whose mum Katherine has been in touch; and for every other family in Dulwich and West Norwood facing a diagnosis of childhood cancer.

Ruby and her family really struggled to get a diagnosis after she became ill. She had six GP visits, while her family became increasingly concerned, before a GP referred her for the hospital tests that revealed that she had a 9 cm tumour in her chest. By the third GP visit, Emma had googled Ruby’s symptoms—a very swollen face, shoulder pain, tiredness and odd bruising to her abdomen—and she asked the GP whether Ruby could have a cancerous tumour obstructing her vena cava. She was told, “Not in one so young”, and was made to feel that she was an over-anxious parent, but that is exactly what Ruby had. It took three further GP appointments before she was referred for tests.

Ruby’s family now live with the additional pain of knowing that an earlier diagnosis might have saved her, and they are calling for better training for GPs in spotting cancer in children and young people and better practice in listening to and taking seriously parents’ concerns. Improvements in both those areas would increase early diagnosis, with life-saving consequences.

Ruby had 10 months of gruelling cancer treatment, and her mum highlights the lack of funding for research or progress in developing new treatments. The drugs used to treat Ruby’s cancer were approved in the 1950s, 1960s and 1980s. They have terrible side effects and long-lasting health consequences for children who survive their cancer.

Ruby’s family also highlight the impact that a childhood cancer diagnosis has on the wider family and the lack of support that is available. One parent often has to give up work and the average estimated additional costs associated with supporting cancer treatment are £600 a month.

Ruby was a remarkable young woman. She believed that the most important thing in the world was to be kind and to speak out against injustice and unkindness. Her motto was, “Live Kindly, Live Loudly”, and her family are seeking to keep Ruby’s memory alive by raising £500,000—roughly what the NHS spent on treating Ruby’s cancer—for the Children’s Cancer and Leukaemia Group. I recognise and encourage that vital and inspirational work. However, I also call on the Government to recognise the avoidable suffering that families such as Ruby’s face when a precious child or young person receives a cancer diagnosis, and to commit to the change that is needed—better training, more research and additional support for children and their families—to ease their suffering at this most difficult of times.

--- Later in debate ---

[Neale Hanvey (Kirkcaldy and Cowdenbeath) (Alba)]

I pay tribute to the hon. Member for Gosport (Dame Caroline Dinenage) for securing this enormously important debate, and to the right hon. Member for Alyn and Deeside (Mark Tami) for his very moving personal account.

My observations are based on a lifetime working in NHS cancer care and on having led the first Teenage Cancer Trust unit at the Middlesex Hospital for a period of time—this was the world in which I existed. I hope that the Minister will pay attention to some of my observations from that career, because I think they will be useful in informing policy.

I agree that there is a need for an overarching strategy, but some of the problems discussed today are perennial; they have been there forever, and there really needs to be a concerted effort to address them. Unfortunately, some of them cannot just be solved with money. In addressing diagnosis, treatment and ultimately outcomes and survivorship, we need to think about why diagnosis is delayed, about why diseases are considered to be rare and about the ultimate impact on outcomes for children and young people. The reason for many late diagnoses is that most GPs never see a case of childhood cancer, let alone cancer in an adolescent, so the effort that goes into raising awareness and training may seem misplaced, given how rare an occurrence it is.

The other challenge is that many of the symptoms with which children present are things that GPs see day in, day out. Fevers, lumps and bumps, lethargy, pains in the tummy—all those symptoms are standard fare, so it is very difficult to cut through to the truth and identify types of cancer. The essential thing is a greater emphasis on driving awareness. It has to be a core part of any differential diagnosis when examining a child that there is always a chance that they have something much more sinister than a cough, cold or fever. It is about making sure that that is built into standard practice.

Another point that I would like to make, although I may run out of time, is that these diseases are incredibly rare. Because the subsets are so rare, it is very difficult to do longitudinal studies.

[Helen Hayes]

The hon. Member speaks about the rarity of these diseases. Will he join me in recognising, as other hon. Members have done today, the work on brain cancer that is being done in the name of my predecessor Baroness Tessa Jowell? It provides a model for a children’s cancer mission to bring together expertise in the area.

[Neale Hanvey]

I thank the hon. Lady for that intervention. I agree: there has been an enormous amount of work across a range of disease profiles, and I want very swiftly to name some of the key people with whom I have had the great pleasure to work in my time. Professor Jeremy Whelan has done a huge amount of work on soft tissue sarcomas and bone tumours, and Professor Andy Pearson from the Royal Marsden Hospital has done a huge amount of work as well. I also want to mention all the members of the multidisciplinary teams who make that kind of research and progress viable.

Let me finally say something about the bigger picture. Cancer does not exist in a bubble; it exists in the social fabric of where we live, and people with cancer, particularly children, are not immune to challenges such as the cost of living crisis. If we want to do a robust piece of work in order to make progress, it must involve research and treatment, but it must also improve the life chances of children more generally.

Oral Answers to Questions

Helen Hayes Excerpts

Tuesday 19th April 2022 Commons Chamber

[Maria Caulfield]

I thank my hon. Friend for her question. I had an excellent visit to the surgery in East Leake, and I look forward to the submission of the business case so that we can look at it further. She is right that investing in primary care does a huge amount to support the health of the local community.

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

T10. A survey by the charity stem4 has found that 95% of GPs believe that children and adolescent mental health services are in crisis, with children and young people waiting up to two years for treatment after referral. Will the Secretary of State stop treating children as an afterthought and act to provide open access mental health hubs for young people in every community, to put an end to these agonising waits?

[Gillian Keegan]

The hon. Lady raises a very important point. I know that children’s mental health services are treating more young people than ever. However, the demand has quadrupled since the pandemic and that is why we have invested £79 million in these services. By 2023-24, an extra 345,000 more young people will be accessing support. I mentioned the call for evidence. It is important that we work through our vision for our 10-year plan. We are also introducing mental health support teams in schools, which will help, plus access to community and mental health hubs, and more young people will have access to eating disorder services, but there is a lot of work ongoing.

Special Educational Needs and Children’s Mental Health Services

Helen Hayes Excerpts

Wednesday 9th February 2022 Westminster Hall

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

It is a pleasure to see you in the Chair, Ms Fovargue. I congratulate the hon. Member for Newbury (Laura Farris) on securing this very important debate during Children’s Mental Health Week. She has been a powerful advocate for her constituents who are struggling to access the support that they need for their children. I thank all the hon. Members who have spoken this morning. We have heard many powerful and distressing examples of the impact that the combination of the pandemic and the underlying gaps in support for disabled children is having on their mental health and the mental health of their families.

My hon. Friend the Member for Sheffield, Hallam (Olivia Blake) spoke movingly about her own experience and the impact that a lack of access to diagnosis can have, even into adulthood. The hon. Members for Newcastle-under-Lyme (Aaron Bell) and for Keighley (Robbie Moore) spoke about the battles that families in their constituencies face and about the need for a “tell it once” approach when dealing with services. My hon. Friend the Member for Bristol East (Kerry McCarthy) and the hon. Member for Cities of London and Westminster (Nickie Aiken) made a really important point about the lack of co-ordination among health, education and social care services, which leaves so many families being passed from pillar to post and without the support that they need.

My hon. Friend the Member for Vauxhall (Florence Eshalomi) paid tribute to the brilliant work of Lansdowne School, which is also attended by many children in my constituency, who progress to Lansdowne from Turney Primary School in my constituency. Both schools provide a brilliant education for their children.

It was very moving to hear the hon. Member for Bury North (James Daly) speak about his own experience and the battle that his family have faced and continue to face on behalf of his precious son. It is so important that the hon. Member has brought here today the insights into the system as a whole that that personal experience has provided. I do hope that his son is able to access the support that he needs in order to enable him to continue to flourish in the future.

The hon. Member for Winchester (Steve Brine) made a really important point—there is far too much distraction at the top of Government just now. The disgraceful reality of that is illustrated no more powerfully than by the plight of disabled children, up and down the country, who are struggling to access the support that they need.

From listening to those accounts and looking at the evidence on disabled children’s mental health, it is impossible not to draw the conclusion that the most vulnerable children are being profoundly failed by this Government. According to research by the Disabled Children’s Partnership, nine out of 10 disabled children have been socially isolated during the pandemic, with 72% of parents and carers reporting that their child was often unhappy, downhearted or tearful. The impact of the withdrawal of vital support services, both in and out of school, has been devastating. The situation is of course complex, because many disabled children have physical health vulnerabilities that increased their risk in relation to covid-19 and it was important that protections were put in place.

I pay tribute to the staff working in SEND education and support, who adapted their services very quickly to provide online learning and undertake home visits. I recently visited Cherry Garden School in Southwark, a brilliant primary school for children with special educational needs. I heard from staff about the rapid action they took to develop an online curriculum and the learning packs that were delivered to children via home visits. I know that those visits were a lifeline for many families.

Despite the undoubted commitment of professionals, there was no systematic approach. The necessary precautions that were taken to reduce the risk of covid infection were, all too often, not supplemented with any additional support. At the start of the pandemic, 76% of families surveyed by the Disabled Children’s Partnership said that the vital care and support they relied on had stopped altogether, leaving parents and siblings taking on all care responsibilities around the clock. The support has been very slow to come back. As late as June 2021, more than 70% of disabled children were still unable to access pre-pandemic levels of therapies and health services. The pandemic has been challenging for everyone. It has been particularly gruelling and exhausting for far too many families with disabled children.

However, we know that the challenges facing disabled children and their families are not only a consequence of the pandemic. Some 60% of families with disabled children have sought NHS mental health support due to the stresses of fighting for basic services. That is the story, again and again and again. Every Member of this House will know constituents who are battling with a system that simply does not work as it should, with thresholds for support that are getting higher and higher, and have been doing so for a decade. Parents battle for assessment and diagnosis, they battle for EHCPs, they battle for the right support or the right school place, and in many cases they battle for housing that is suitable for their children’s needs.

I have mentioned many times in this House my constituent Matthew Garnett. I am pleased to say that Matthew is now thriving as a young adult in supported housing, pursuing the things he loves, including his project to visit every football ground in the country. Matthew, who has autism and a learning disability, first came to my attention when he was, like far too many children, in a secure hospital, held under the Mental Health Act 1983.

I supported Matthew’s parents in their battle to get him out of hospital. As part of that battle, the then Mental Health Minister commissioned a review of Matthew’s care. The review made devastating reading. It documented, year by year, his parents’ struggle, over more than a decade, to get their son the support he needed. The consequence of the system failure they encountered was that Matthew, like far too many autistic children and children with learning disabilities, ended up in a secure hospital, far away from his loved ones, with his health deteriorating week by week.

According to the Disabled Children’s Partnership, only 4% of parents and carers of disabled children feel they get the right support to care safely for their disabled children; 53% have had to give up work to care for their child; and 40% have experienced relationship breakdown since their child was diagnosed.

The Minister will, I am sure, mention the £30 million of funding for short breaks for families with disabled children. That is very welcome, but short breaks should be genuine respite. They should not be respite from a system of support that breaks people. It is not enough to substitute for a system that is failing in its entirety the promise of access to a short break every now and again.

The SEND review was originally promised in September 2019. It is now shamefully overdue. The pandemic is simply not an adequate excuse for the lack of urgency in that work, given the impact that the pandemic itself has had on disabled children. It sends its own message about the level of priority the Government place on families with disabled children. I hope the Minister will set out today a firm date for its publication. We need the review to set out clearly the gaps in current provision and in resourcing, so that the Government can set out a clear plan for ensuring that every disabled child in the country is able to access the support they need.

The current system is failing far too many families, and the impacts are being felt in devastating consequences for their mental health. This cannot go on, and I hope the Minister will set out a plan for change today.

Children’s Mental Health

Helen Hayes Excerpts

Tuesday 8th February 2022 Commons Chamber

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

I am grateful to all hon. Members who have spoken in this important debate. We have heard this afternoon many moving and devastating accounts of the ways in which children and young people who are struggling with their mental health are being let down by a system that simply cannot deliver the support they need, and by a Government who have no ambition for our children and young people and who refuse even to acknowledge the scale of the challenge.

There have been too many contributions this afternoon for me to mention everybody by name, but we heard from my hon. Friend the Member for Batley and Spen (Kim Leadbeater) about the shocking figures on suicide and self-harm in her constituency. My hon. Friends the Members for Ealing North (James Murray), for Streatham (Bell Ribeiro-Addy) and for Feltham and Heston (Seema Malhotra) highlighted the importance of mental health support being provided in our schools. My hon. Friends the Members for Bootle (Peter Dowd) and for Luton South (Rachel Hopkins) highlighted the vital importance of early intervention. The hon. Member for Twickenham (Munira Wilson) spoke movingly of some appalling cases in her constituency, including the suicide of a year 11 student.

My hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) highlighted CAMHS waiting times in his constituency, as did many other hon. Members. My hon. Friends the Members for Bristol East (Kerry McCarthy) and for Canterbury (Rosie Duffield) spoke about the terrible problems with out-of-area tier 4 placements, which are far too common. My hon. Friend the Member for Birmingham, Yardley (Jess Phillips) spoke powerfully, as she often does, of the impact of sexual violence and abuse on mental health.

Good mental health and wellbeing are vital for our young children, while poor mental health is a barrier to learning that prevents children from fulfilling their potential. It affects children’s sense of self and how positive they feel about the future. It can impact their whole lives and for some, poor mental health can, tragically, be fatal. For parents and carers, there are few experiences as devastating as watching their child’s mental health deteriorate, yet that is the experience of hundreds of thousands of families across the country. Parents are living with unbearable anxiety, having to stop work to keep their child safe and try to soothe their pain. No parent should be left in this position, without access to the support their child needs.

The covid-19 pandemic has taken a severe toll on children’s mental health, as children have been isolated from their peers, often unable to learn properly and at increased risk of online harms, with many suffering the trauma of bereavement or domestic abuse in lockdown. Before the pandemic, however, children’s mental health services were already in crisis, with waiting lists, acute admissions and out-of-area hospital placements far too high and with only around a quarter of children who needed mental health support able to access services.

We know what is needed to tackle the crisis in our children’s mental health. What is lacking is not the knowledge of what to do; what is lacking is the ambition of this Government for a country in which the mental wellbeing of our children is a priority and services are there for those who need them. We know that early support is key. While children languish on waiting lists, their mental health deteriorates and so does the length of their recovery and the impact that their illness will have throughout their lives. Delivering mental health support teams in just a fraction of communities is not a fit-for-purpose strategy. It is a half-baked plan that is worsening the postcode lottery of children’s mental health services.

Labour is pledging to end the postcode lottery. We will deliver specialist mental health support in every school, and open-access mental health hubs in every community. Hon. Members have asked about the detail of that service, and I would point them to one of my local authorities, Southwark, which has a service called the Nest. It provides open access to children who live in the borough and a really first-class standard of support for our children and young people, but we need such services to be available throughout the country to every single child who needs them.

We are also pledging an end to agonising waiting lists, with a new national commitment to mental health treatment within a month for every child who needs it. To those hon. Members who have questioned the value of targets I say this: if we do not measure it, it does not get done. Targets are not the whole solution, but they are a vital tool in ensuring that services are delivered to children who need them.

Today’s motion is for every child and young person who needs support for their mental health and for every parent and carer living with devastating worry for their child. It is a statement of Labour’s ambition for a country in which every child can thrive. I commend it to the House.

King's College Hospital: Covid-19 Recovery

Helen Hayes Excerpts

Friday 3rd December 2021 Commons Chamber

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

I am grateful for the opportunity to hold this debate on King’s College Hospital and the post-covid recovery, in which I will make the case for the sustained investment that our local hospital needs to keep delivering for our communities and beyond. Let me start, however, by placing on record the immense gratitude of so many of my constituents to all the staff at King’s College Hospital for their incredible work during the covid-19 pandemic.

King’s College Hospital is on Denmark Hill in my constituency. The King’s College Hospital NHS Foundation Trust also includes the Princess Royal University Hospital in Bromley and Orpington Hospital. I will refer to some issues that impact the trust as a whole, and some that are specific to the Denmark Hill site in my constituency.

King’s College Hospital holds a very special place in the hearts of families across my constituency, who are grateful for the live-saving, life-enhancing treatment and care that it provides. My family is no exception: both my children were born at King’s; my mum worked at the hospital for a decade; I have been a surgical patient there; and paediatric A&E has been there to patch up our children on several occasions. The team at King’s is a proud expression of the diversity of our wider communities in south London, including significant numbers of staff from the Caribbean, the Philippines, India and west Africa in particular. As a local community, we are grateful to those who have travelled to the UK to serve in our NHS, and for whom the pandemic has created the added pain of long separation from their loved ones.

King’s is a centre of excellence in many different disciplines, including trauma care, neurosurgery, maxillofacial surgery, hepatology, neonatal care and many others. At the start of the pandemic, the trust’s finances were in a very precarious financial state. Absorbing the Princess Royal University Hospital and Orpington Hospital into the trust in 2014, following the closure of the South London Healthcare NHS Trust, without an adequate funding settlement, had resulted in the trust having the highest levels of debt of any hospital trust in the country. This was completely impossible for the trust to address, despite punishing control targets bearing down on every single department.

I had been making the case to Ministers for many years prior to the pandemic that the only viable solution to King’s finances was for the debt to be written off, and I was enormously relieved when the Government finally announced this at the start of the pandemic. It made all the difference, allowing the staff team at King’s to focus fully on doing what was necessary to get through the pandemic. And that work really was extraordinary.

Between the start of the pandemic and the end of November, King’s treated and discharged 6,871 patients who tested positive for covid-19. Sadly, during the same period 1,285 patients who had a positive covid-19 test passed away at King’s. The second covid-19 wave hit King’s particularly hard. For example, on 18 December 2020, the trust was treating 90 covid-19 positive patients in its hospitals, yet by 11 January 2021, this had risen to 776 patients—a nearly ninefold increase in just over three weeks. Despite the intense pressures, the care and commitment of the staff at King’s ensured some of the best covid-19 patient outcomes anywhere in the country. Between February 2020 and June 2021, 17.6% of patients admitted to our hospitals with covid-19 sadly died, compared to the national average of 21.5%.

The specialist care and treatment provided by King’s also improved as the pandemic progressed, as expertise and knowledge grew. At the start of the pandemic, 27.2% of covid-19 positive patients admitted to King’s hospitals sadly died. That figure reduced to 16% by the second wave and fewer than 5% now. King’s also continues to help support the wider national covid-19 response, including through research, with teams currently running more than 55 covid-19 active research studies, placing King’s in the top five sites in the UK for the number of research studies undertaken. More than 5,000 patients have participated in covid-19 research at King’s, and its teams have published 169 covid-19 research papers.

Amid all this work, there have been some particularly moving human examples. In April 2020, King’s staff celebrated patient Jose-Luis Fernandez, aged 80, who was discharged from King’s after recovering from covid-19. Jose-Luis, a grandfather of five from Sidcup, was admitted to hospital on 15 March 2020 and then tested positive for covid-19. Jose-Luis’s daughter Natasha said:

“Dad’s recovery has been nothing short of miraculous. At one point, we didn’t know if he’d be able to walk or talk again, yet he’s back on his feet. So many people at King’s were instrumental in my Dad’s recovery. We can never thank them enough”.

Emmanuel Boateng had an extraordinary start to life. Born three months premature, Emmanuel fought off life-threatening infection before becoming King’s youngest survivor of covid-19. Emmanuel was due on 27 April 2020 but arrived unexpectedly on 30 January, at King’s, after his mother Evelyn went into premature labour. He spent time in the neonatal intensive care unit before being discharged, but just a week later Emmanuel was back in King’s with covid-19, fighting for his life. Emmanuel is King’s youngest survivor of covid-19, so when it was time for him to finally go home on 27 April 2020 —his original due date—he received a round of applause from staff as he left the ward.

In December 2020, King’s became one of the first 50 hubs to begin vaccinating people against covid-19, at the start of the biggest immunisation programme in history. Initially, people aged 80 and over, as well as care home workers, were the first to receive the jab, alongside NHS workers. It was then rolled out more widely to the general population. Collectively, the vaccination hub at King’s and its sister site, the Princess Royal University Hospital, will have administered a quarter of a million vaccines by the end of 2021.

We know that for far too many people the covid-19 infection leaves long-lasting health impacts known as long covid. Members of the occupational health team at King’s have worked with other NHS colleagues on training materials for people impacted by long covid-19. Alongside colleagues from NHS England, NHS Improvement and St George’s Hospital, members of the therapies team, who have experience of caring for patients with long covid, came together and led on the development of training materials and guidelines for staff who work with patients suffering from the condition. The team developed a package of materials, with contributions from GPs, frontline staff and individuals with lived experience of long covid. The rehabilitation guidance will roll out nationally to benefit patients throughout the country.

The work I have described represents the extraordinary commitment of our NHS staff to the communities they serve, and I want to say a heartfelt thank you to everyone who works at King’s—the nurses, doctors, porters, cleaners, reception staff, allied healthcare professionals, management and maintenance staff and all who have done so much to give hope to those afflicted by covid-19 and their families, and to offer comfort to those who have tragically lost loved ones by doing everything they possibly could to save them.

The staff are continuing to work under incredible pressure, so I also want to take this opportunity to urge all my constituents to get the booster jab as soon as possible, not only to protect themselves but to help to reduce the pressure on staff at our local hospital. Shockingly, staff at King’s are being subjected to increasing levels of abuse from patients and family members, so I want to state very clearly that however stressful someone’s situation, there is no excuse at all for violence or aggression or for the verbal abuse of our hard-working NHS staff.

Just writing off King’s College Hospital’s debt is not remotely sufficient to put the hospital on a sustainable long-term footing for the future, because prior to the pandemic King’s had been strapped for cash for far too long. The hospital sits on a comparatively small site for a large hospital in the middle of a densely populated urban area, with a mixture of ageing buildings, the newest of which was opened 18 years ago. Much of the work of the staff at King’s is all the more extraordinary because it is undertaken in facilities that are badly in need of upgrading. When people talk about the need for efficiencies in the NHS, it is often interpreted to be about the rate of work for individual staff, and it is often forgotten that a huge part of NHS efficiency is staff having access to the equipment they need, close to their patients.

In common with NHS staff throughout the country, the team at King’s are exhausted and burnt out by the pandemic. I have spoken to staff who are full of praise for the support they received during the pandemic from the hospital, their trade unions and members of the public—the hospital established a health and wellbeing hub, and local residents and businesses donated hot meals, snacks and care packages—but many are traumatised by what they have witnessed and in need of longer-term support.

Recruitment into NHS roles remains hard, even for one of the best and most popular hospitals in London. King’s urgently needs to be able to plan for and commit to a sustained programme of capital investment to renew out-of-date facilities and ensure that the hospital is fit for purpose for the 21st century. This is vital for sustaining good patient care, for dealing with the backlogs left by the pandemic and, importantly, for the retention of staff. Specialist clinicians at King’s are among the best in the world. They are committed to the NHS, but they are also committed to scientific advancement within their areas of specialism, and they can work anywhere in the world. To retain the best clinicians and scientists at King’s, they must be provided with the equipment, facilities and working environment to do their work to the best of their ability.

I know that the trust is grateful for the capital investment that it has received in the past two years, as well as for the announcement today of funding for the emergency department at Orpington Hospital and to bring the long-awaited and already built critical care unit fully into use. However, a decade of under-investment has left the trust with an £80 million maintenance backlog that the funding allocation is inadequate to address. The current funding will not enable the trust to invest in IT and digital infrastructure to match the excellent clinical care that staff provide, or to address the wider investment needs of the Denmark Hill site in my constituency in particular. Capital investment in King’s, including in diagnostic equipment such as scanners, would directly help to address the backlog caused by the pandemic and support the emergency department, which remains under immense pressure.

Will the Minister join me in thanking the staff across the King’s College Hospital NHS Foundation Trust for all that they have done during the pandemic and all that they continue to do for our communities while working under intense and sustained pressure? Will she commit to the sustained capital investment that King’s urgently needs to support its staff in continuing to deliver the best possible care and in working through the backlog created by the pandemic? What comfort can she offer the hard-pressed staff at King’s and every other NHS hospital across the country that the Government have a plan to address the staffing crisis and alleviate the pressures they will face this winter and beyond? We are immensely proud of our local hospital in south-east London, and I will keep speaking up for the resources that it needs.

Adult Social Care

Helen Hayes Excerpts

Wednesday 1st December 2021 Commons Chamber

[Gillian Keegan]

We will commit a further £573 million per year to the disabled facilities grant between 2022-23 and 2024-25. We are also taking steps to ensure that the disabled facilities grant can benefit more people in need. We will consult on some of those steps in 2022.

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

It has been two and a half years since the Prime Minister stood on the steps of Downing Street and promised to

“fix the crisis in social care once and for all with a clear plan we have prepared”.

I think we can all be forgiven for asking what on earth the Government have been doing during that two and a half years—a time when the social care crisis has got worse. Right now, more than 100,000 vacancies exist in adult social care. Care homes are refusing new admissions because of staff shortages. Providers are haemorrhaging staff to better-paid roles in hospitality, retail and distribution. The sector is on its knees as we head into the harshest winter in living memory.

The Minister’s statement today was completely tone-deaf on the scale of the crisis. Can she say, because it was not clear from the statement, how she expects the sector to get through the winter? What does she have to say to the families who are waiting right now for a care home place that simply does not exist under her Government’s failing social care system?

[Gillian Keegan]

The hon. Lady seems to be the only person in the whole world who has missed the global pandemic, but it occurred during the same period. To answer her specific question, she is absolutely right that there are pressures right now. There are pressures continually in the system, because there is always a need for growth every year, but right now the winter pressures are challenging. As we bounce back from the pandemic, everything is opening again and there is a lot of competition for labour—there are 1.2 million vacancies in the country.

We have invested £162.5 million, which is on its way—it has probably just landed in most councils’ bank accounts. That investment is there for short-term fixes, similarly to what we put in place for January to March this year, which was very successful; it brought forward 7.3 million extra hours and 39,000 new recruits. We have invested in that funding for the workforce, and we keep it under review—we get data every month through a capacity tracker system. We work closely with the sector and will continue to monitor its needs.

Oral Answers to Questions

Helen Hayes Excerpts

Tuesday 23rd November 2021 Commons Chamber

[Bill Esterson (Sefton Central) (Lab)]

10. What steps he is taking to tackle the high job vacancy rates in social care.

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

16. What steps he is taking to tackle the high job vacancy rates in social care.

[Chris Grayling (Epsom and Ewell) (Con)]

20. What steps he is taking to tackle staff shortages in the social care sector.

--- Later in debate ---

[Gillian Keegan]

As I mentioned earlier, we have sent out £162.5 million, which has not yet been put into effect. For example, Sefton received £1,032,474. That money has only just gone into the bank account, and has not yet been utilised to retain staff, or to recruit agency or other staff. As the hon. Gentleman says, adult social care providers can recruit key adult social carers from overseas from the shortage occupation list. That provides lower fees and a reduced salary threshold of £20,480 for someone to be eligible for the skilled worker visa.

[Helen Hayes]

The adult social care sector faces the worst staff shortages in living memory. A recent survey by the National Care Forum found that one third of managers of registered care homes are limiting or stopping admissions from hospital, due to staff shortages, with direct consequences for both the NHS and for vulnerable people who cannot access the care they need. The care sector needs action now, not warm words and job adverts. Will the Minister commit to paying a retention bonus to frontline care staff, to help stem the tide of those exiting the care sector this winter? Will she commit to a fully funded, permanent pay increase, to bring the minimum level of pay for care workers up to £10 an hour—the minimum rate at which Amazon is recruiting in many areas where the care shortage is at its most acute?

[Gillian Keegan]

We have committed to bring forth new measures in the White Paper, and to spend at least £500 million on recruiting that workforce. To address the emergency now, as I mentioned, there is £162 million. In addition, we have put around £500 million particularly to address discharge processes, and to ensure a discharge to assess process, which means it can be much quicker. We must ensure that those teams work together to shorten the discharge process. There is no doubt that our NHS and our whole system is under extreme pressure this winter, and we thank it for all the work it is doing.

Oral Answers to Questions

Helen Hayes Excerpts

Tuesday 13th July 2021 Commons Chamber

[The Minister for Care (Helen Whately)]

I thank my hon. Friend for raising this question and the situation of her constituent. What I can say is that we expect clinical commissioning groups to commission fertility services in line with National Institute for Health and Care Excellence guidelines, so that there is equitable access across England. We are aware of some variations in access, and we are looking at how we can address that. Very specifically, CCGs should not be using criteria outside that NICE fertility guidance.

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

  Many of my constituents who are extremely clinically vulnerable due to conditions such as blood cancer are terrified that, from 19 July, the Government are effectively abdicating responsibility for keeping them safe in public. There is evidence that more than two thirds of people do not understand that vaccines are not always effective for people who are immuno-compromised or the importance of wearing a mask to protect others and to alleviate anxiety. Can the Secretary of State not see why it would send a much clearer message to keep masks on public transport mandatory, rather than leaving the safety of clinically vulnerable residents to chance?

[Sajid Javid]

The hon. Lady is right to raise this issue. As she has rightly explained, there will be a number of people who, understandably, will be concerned about the move away from regulations to guidance. None the less, there must come a point when we start to remove the restrictions slowly, in a measured way, as we are doing—not least because we want to be able to start dealing much more with all the non-covid health problems that have been created as well. We have provided very clear guidance on masks and it was published yesterday. I hope that the hon. Lady can share that with people who are concerned.