Oral Answers to Questions

Iain Stewart Excerpts

Tuesday 14th January 2014 Commons Chamber

[Norman Lamb]

The Government are getting on and implementing integrated, joined-up care. I remember talking about it constantly when the hon. Lady’s party was in government, and nothing ever happened. We are taking concrete steps to join up the system with the benefits of the £3.8 billion Better Care Fund.

[Iain Stewart (Milton Keynes South) (Con)]

T9. The Secretary of State is aware of the plans being developed by Milton Keynes hospital to expand its A and E capacity. In the interim, will he set out what assistance he can provide to ease short-term pressures?

[Jane Ellison]

I can confirm that the Department of Health is investing an additional £250 million over the next two years in A and E, with NHS England also allocating an additional £150 million for the current year. Milton Keynes has been allocated £2.8 million to support local initiatives to relieve pressures on A and E, and I know that, as a great champion for his local hospital, my hon. Friend will welcome that additional support.

Gay-to-straight Conversion Therapy

Iain Stewart Excerpts

Wednesday 20th November 2013 Westminster Hall

[Iain Stewart (Milton Keynes South) (Con)]

Does the hon. Lady agree that such courses are particularly dangerous for young people who are struggling with their sexuality? When I was a teenager, I had great difficulty reconciling who I was. The variability of those courses places an enormous burden on young people who are already frightened about the consequences of being open about who they are.

[Mr Jim Hood (in the Chair)]

Order. I remind hon. Members that this is a 30-minute debate, and interventions should be brief to allow the hon. Member whose debate it is to speak.

Accident and Emergency Departments

Iain Stewart Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

My right hon. Friend said to the House that he largely agreed with the changes that I wanted to make to the GP contract. I always listen very carefully to what the Select Committee says, but I point out to the hon. Lady what Professor Keith Willett, who is the person at NHS England who is in charge of all A and E departments, said. He said that between 15% and 30% of the people attending A and E departments could be looked after by primary care. If we ignore that—I am afraid that what Labour did in 2004 has made the problem a great deal worse—we will not solve the underlying problems with A and E.

[Iain Stewart (Milton Keynes South) (Con)]

I warmly welcome the additional £2.7 million for Milton Keynes hospital, which will help address short-term pressures this winter, but, looking at the longer term, I urge my right hon. Friend to look again at the case that I and my hon. Friend the Member for Milton Keynes North (Mark Lancaster) and the Milton Keynes Citizen have been making for an expanded A and E centre in Milton Keynes to meet the needs of a vastly increasing population.

[Mr Hunt]

I congratulate my hon. Friend and his Milton Keynes colleague on their assiduous and regular conversations with me on the pressures on their A and E. I recognise that it is operating way above its original planned capacity and hope that today’s announcement will make some difference, but we will continue to look at long-term solutions because we recognise that there are long-term pressures.

Brain Tumours in Children

Iain Stewart Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Mr Raab]

My hon. Friend is bang on. I was going to come on to exactly that point, and I could not agree more.

[Mark Pawsey (Rugby) (Con)]

Will my hon. Friend give way?

[Mr Raab]

I will make a bit more progress, because otherwise the Minister will not have a chance to respond at length, which I know she will want to do.

The HeadSmart campaign has developed an online education module to help health professionals to recognise the signs and symptoms of brain tumours in children and young people. There is now a network of clinical champions in each of the neuro-oncology centres around the UK giving presentations to fellow health professionals on the subject. There is also, critically, a network of local champions. David’s mum, Sacha, who is also here for the debate, is the first of those.

HeadSmart awareness packs have been distributed to more than 1,000 doctors’ surgeries around the country, and more than 625,000 symptom cards have been distributed across the UK. Only one year after the launch of the HeadSmart campaign, the diagnosis delay has fallen from an average of 9.3 weeks in 2011 to 7.5 weeks in 2012. This year, it is down further to 6.9 weeks. That is terrific progress, and we should welcome it.

Complex Regional Pain Syndrome

Iain Stewart Excerpts

Tuesday 9th July 2013 Westminster Hall

[Iain Stewart (Milton Keynes South) (Con)]

It is always a pleasure to serve under your chairmanship, Ms Dorries. I am grateful for the opportunity to highlight how regional sympathetic dystrophy, now known as complex regional pain syndrome, affects those who suffer from it and to press for more research into the condition, so that a greater number of people may be properly diagnosed and treated. If Members forgive me, I will use the acronym CRPS throughout the debate for brevity and ease of description.

The earliest descriptions of CRPS apparently date back to the American civil war, but I became aware of it only through my constituent, Kevin Scardifield, who suffers from the condition. He contacted me because his experience of CRPS and the quality of care that he received led him to believe that there is neither an adequate understanding of the condition by NHS clinicians, nor good-quality care for sufferers such as him on the NHS.

Before I proceed, it might be helpful if I explain CRPS and its symptoms. The NHS Choices website describes CRPS as

“a poorly understood condition in which a person develops a persistent (chronic) burning pain in one of their limbs.”

It continues:

“The pain usually develops after an injury—which in most cases is a minor injury—but the pain experienced is out of all proportion to what you would normally expect.”

It is through an injury that my constituent developed the condition in 2009. He was undergoing carpal tunnel release surgery when the local anaesthetic failed to work and he broke his hand against the clamp when he jerked so hard because of the pain.

To give a full account of the symptoms experienced by sufferers of CRPS, I will quote directly from a letter that Mr Scardifield sent to me:

“The pain of this condition is so great that there are recorded cases of sufferers self-amputating in a desperate attempt to escape the excruciating agony. Others have had their circulation so badly damaged that they have developed gangrene and have had to have amputations to save their lives. In either case it has caused the condition to spread further into their bodies.

According to the…McGill Pain Index, it is the world’s most painful incurable condition; it is almost impossible for us to understand exactly how painful that is. Try and imagine a 3 bar electric fire with a metal grill—how long do you think you could hold your hand against the grill with one bar on? Now try and imagine that fire is inside your hand, one bar is a good day for a sufferer, three bars is a bad day and there is no off switch.

Try and imagine a pain so great and a grip so weak that you cannot pull open a packet of crisps yourself, a sneeze that turns into a scream of agony. Knowing that you will never be able to pick up and hold or play with your newly born child or grandchild because one hand is useless and they could cause your condition to spread or start somewhere new.”

My constituent recounts that his injury was missed, not only by the surgeon in subsequent visits but by the hand therapists in approximately 50 visits. Eventually, he was diagnosed as having CRPS following a referral to the hand therapy unit of Milton Keynes hospital.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this matter to the House for consideration. I have a great many constituents who have the problem, which concerns me. Does he believe there is now a greater need for doctors to be trained to tell the difference between fibromyalgia, which some people think CRPS is, and the actual disease itself? If so, does he think the NHS should initiate training among doctors and surgeons to ensure that that happens? Should there be more research on how the pain starts and where it comes from?

[Iain Stewart]

I have much sympathy with what the hon. Gentleman says, and if he bears with me, I will address training and research funding a little later.

The NHS Choices website sets out the quality of care and treatment that CRPS sufferers should receive due to the complex nature of the condition. My constituent should have been provided with a care team comprising a physiotherapist, an occupational therapist, a neurologist, a psychologist, a social worker and a pain relief specialist. He informed me that he has not received such care, as most health professionals whom he has encountered do not even know the condition’s acronym.

That leads me to my principal argument. If NHS clinicians do not sufficiently understand the condition, how will they be able to diagnose it properly and ensure that patients are adequately treated and cared for? The NHS Choices website says that it is hard to estimate exactly how common CRPS is because many cases go undiagnosed or misdiagnosed. I think the hon. Gentleman was referring to that point.

My constituent contends that possibly 250,000 people in England have not been properly diagnosed. He is understandably impassioned about the issue and has been carrying out his own research using American sources—it appears more research is being conducted into the condition in America.

From my own research, I learned from one study that as many as one in 3,800 people in England may be affected by CRPS. Therefore, going by the 2011 census estimates, 14,000 people could either have been misdiagnosed or remain undiagnosed. Although that might appear to be a small number by comparison with my constituent’s estimate, it does not diminish the issue’s importance.

The core principles of the NHS state that good health care should meet the needs of everyone and should be based on clinical need. Kevin Scardifield is unable to do the everyday things that other people take for granted. He was a police officer before the onset of the condition—a profession he greatly loved but had to give up. So debilitating is the condition that, by the middle of last year, he had been able to leave the house only six times, which was just for a few yards to the GP.

I am sure that Members can appreciate why this is such an important issue and why Kevin Scardifield has been campaigning hard for proper diagnosis and treatment. Since he made me aware of the condition, I have made a number of representations to the Department of Health, the local hospital, the primary care trust—now the clinical commissioning groups—and even the Department for Work and Pensions.

I am grateful to the Minister and his predecessor, the right hon. Member for Sutton and Cheam (Paul Burstow), for their replies to my constituent’s concerns when I brought them to their attention. Had my constituent felt that his concerns had been fully addressed, however, we would not be having this debate, so if the Minister will forgive me, I will raise a number of specific issues. First, as I have mentioned, people are either being misdiagnosed or remain undiagnosed because NHS clinicians do not appear to have sufficient awareness of the condition.

[Stuart Andrew (Pudsey) (Con)]

I congratulate my hon. Friend on raising the issue. Although I take an interest in health issues, CRPS is new to my attention. Only today, I was contacted by a lady from Leeds who is a sufferer, and listening to her story was very harrowing. Is my hon. Friend surprised, as I am, that there is only one specialist centre in the UK? That centre is in Bath, which is a long way from many places. If CRPS is diagnosed early, there is a high chance of it going into remission, which would be great for the NHS and, more importantly, for the patients involved.

[Iain Stewart]

My hon. Friend makes an important point, and I suspect that if we spoke to all our colleagues we would find that they, too, have been contacted by constituents with this condition. One of the points that I will make in a few moments is on the need for greater research and specialist services, so that the types of benefit that he rightly describes can be identified and delivered.

Secondly, the number of people diagnosed with the condition is unknown. Indeed, the Department of Health has informed me that it does not hold such records. My constituent informs me that, in 2010, he was told by NHS Direct that just over 11,000 people had been diagnosed in the United Kingdom. In 2012, he came across some information in the CRPS guidelines prepared by the Royal College of Physicians that quoted research suggesting a higher incidence of CRPS in Europe. On the back of that, he again contacted NHS Direct, and this time he was informed that it had been ordered to stop keeping records and to delete existing ones, as that responsibility would be undertaken by the Office for National Statistics. The ONS, however, replied that no such responsibility had been passed to it. Will the Minister clarify that issue and assure me that there is a strategy in place adequately to capture the number of people being diagnosed with CRPS? Will he also look into claims that specialists are failing to highlight the seriousness of the condition, particularly its potentially degenerative nature?

Thirdly, there does not seem to be an agreed pathway within the NHS for the treatment and care of those diagnosed with the condition. If there is, it was not reflected in the care that my constituent received. Will the Minister ensure that all NHS trusts and clinical commissioning groups follow the guidelines?

Fourthly, compared with the United States and other European countries, we are not doing enough to research the condition with a view to finding a cure and ensuring an improved quality of life for CRPS sufferers. While preparing for this debate, I observed that there was more information on the condition on US-based websites than on UK-based ones. I have also been unable to find UK charities or support groups for CRPS. Everyone can be proud of the fact that since the start of modern clinical trials, 39,179 trials have been made or are in progress to find a cure for cancer. The UK has carried out about 2,299 of them. The UK Charity Commission has 976 cancer charities on record, and the NHS spent more than £375 million between 2008 and 2012 on researching a cure for cancer. Clearly, that is a wonderful amount of research, but during the same period, only 76 trials on CRPS have been conducted worldwide. Holland, with a population of just over 16.5 million, has carried out three trials, and Switzerland, with a population of 8 million, has carried out two. The UK has a population of more than 60 million, yet I have been unable to locate a record of our carrying out any trials.

In addition, the NHS does not appear to have invested much in researching CRPS. I understand that one project was carried out last year in Bath, to which my hon. Friend the Member for Pudsey (Stuart Andrew) referred, but it was not aimed specifically at finding a cure, and it was funded by an American charity. Will the Minister look into funding for more UK research into the condition? Specifically, will he consider my constituent’s suggestion that a post be created within the Department of Health for a CRPS officer to liaise with specialist clinics around the world to collect, collate and disseminate papers and studies on the condition? My constituent explains that it would prove useful, as it was not until 19 years after the US first stated that guanethidine blocks were ineffective on RSD sufferers that our own specialists came to the same conclusion.

I hope that the Minister will address those matters when he replies, and I hope that this debate will help draw attention to this important issue, so that more people are properly diagnosed and adequately treated. I also hope that I have been able to do justice to the needs of sufferers such as my constituent. May I suggest that the Minister find time at some point in future to meet them, so that he can properly understand the sheer pain and agony that they face?

Oral Answers to Questions

Iain Stewart Excerpts

Tuesday 15th January 2013 Commons Chamber

[Mr Hunt]

It is our intention to roll it out nationally as soon as possible, and I will make sure that the hon. Lady gets the exact details.

[Iain Stewart (Milton Keynes South) (Con)]

T9. Many of my constituents are concerned by the Care Quality Commission’s recent findings at Milton Keynes hospital, which came despite an increase in nursing staff since 2010. What reassurances can my right hon. Friend give my constituents that the problems are being rectified and that they will be able to enjoy high-quality care?

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

First, let me say that substandard care simply will not be tolerated and it has to be taken extremely seriously. I understand that the trust involved is reviewing its staffing levels so that the necessary improvements can be made. It has also started two-hourly checks, during which nursing staff check that patients have everything they need to be both safe and comfortable. There is clearly a big challenge and the trust has to meet it.

Mental Health Act 1983

Iain Stewart Excerpts

Monday 29th October 2012 Commons Chamber

[Mr Hunt]

My hon. Friend makes a very important point. All the patients’ rights to challenge their detention are preserved, with the exception of their rights relating to the technical irregularity over the authorisation of doctors under section 12. If they are challenging any other clinical or legal due-process decision, they are free to continue to do so: that will be completely unaffected by the retrospective legislation.

[Iain Stewart (Milton Keynes South) (Con)]

Can my right hon. Friend explain the position of trusts such as Milton Keynes PCT, which was part of South Central strategic health authority but is now part of East Midlands SHA? I understand that that is one of the SHAs that were affected. Will my right hon. Friend look into whether any issues have arisen from that transfer?

[Mr Hunt]

I can reassure my hon. Friend that if any issues have arisen from the technical irregularity involving the authorisation of doctors under section 12, they will be dealt by the retrospective legislation.

health

Iain Stewart Excerpts

Tuesday 18th September 2012 Commons Chamber

[Iain Stewart (Milton Keynes South) (Con)]

I am grateful for the opportunity to speak about community health services in Milton Keynes. Before I outline the issue that is causing concern locally, I will set out the background.

Milton Keynes council, the primary care trust and Milton Keynes Community Health Services have a 12-year history of working collaboratively to deliver jointly commissioned and provided services to the citizens of Milton Keynes. That has been possible because the three organisations share a common vision and common values, and are committed to the principle of local services for local people. The collaboration has supported a transformational approach, which has delivered financial efficiencies and good quality outcomes for people. There is a single joint management structure, which manages combined budgets and resources, and works to a single operational policy.

The collaboration covers mental health and learning disability services, intermediate care services for older people and community equipment. Additionally, there is an integrated pathway involving adult community nursing, end-of-life care, community matrons and social workers. I put on the record my deep appreciation of the invaluable role that those dedicated professionals play in our communities. They often go unsung, so I would like to take this opportunity to record my gratitude.

To achieve such a locally tailored, integrated model is one of the admirable aims of the Government’s health and social care reforms yet, oddly, our successful local model may be at risk because of administrative factors. I hope that common sense can prevail.

Last year, it was hoped that there would be a managed transfer of the community health services to Milton Keynes Hospital NHS Foundation Trust. However, that was not achievable within the required timetable and the PCT enacted a temporary divestment to Bedford Hospital NHS Trust, in full agreement with the strategic health authority and in full knowledge of the anticipated later divestment to the foundation trust. That is an acceptable hosting arrangement that will allow the integrated model to continue.

On 14 December last year, the PCT wrote to the foundation trust, inviting it to submit a proposal for the managed transfer of the community health services, which was to be considered by the PCT board at the end of February this year. However, on 22 February, the cluster PCT received e-mail communication from the head of provider development at NHS East Midlands, which advised that it should follow an open tendering process.

On 11 April, following strong representations from the council and local health partners, a positive meeting was held with Bob Ricketts at the Department of Health, where it was indicated that a managed transfer of the community health services to the hospital would be possible, subject to SHA assurance. However—the situation gets more complicated—a letter from Sir Neil McKay, of NHS Midlands and East, advised that the transfer was no longer possible and that the PCT should proceed towards a competitive tendering process for NHS providers only.

On 12 June, my hon. Friend the Member for Milton Keynes North (Mark Lancaster) and I raised questions in the House on this issue. In response, the then Secretary of State for Health urged the PCT and the SHA to ensure that any decision was in the best clinical interests of patients. He stated that it must meet the views of clinical commissioners of the future and those of the public, not least as expressed through the local authority.

Following that, NHS Midlands and East met Milton Keynes council and its partners to discuss the position adopted by the SHA. It was agreed that a meeting should be convened to assess the case for an integrated care organisation. However, it was also agreed that the cluster PCT should continue with a twin-track approach, including an expressions-of-interest process.

Finally, on 11 September, NHS Milton Keynes and Northamptonshire cluster PCT received advice from the NHS Midlands and East SHA to progress with an NHS-only competitive procurement for the services currently provided by Milton Keynes Community Health Services. There has, therefore, been a sequence of contradictory advice from different parts of the NHS, which has thwarted the ambitions of the council, local health partners and patients’ representatives to achieve the best local solution for our citizens—an integrated care organisation in Milton Keynes.

All that is happening at a time when the NHS landscape is changing. The SHA and PCT will be wound up next year, and there is an acute services review that may change the configuration of the local hospitals. My call, and that of my hon. Friend the Member for Milton Keynes North and many local people, is quite simple: the temporary hosting arrangement should continue for the time being, until the new NHS landscape is settled and a sensible permanent arrangement can be found. My hon. Friend and I have raised this matter with the Secretary of State. In welcoming the Minister to his new role, I hope that he will ask the Department to intervene in any way that it can to achieve the common-sense solution, for which there is much local appetite.

Oral Answers to Questions

Iain Stewart Excerpts

Tuesday 12th June 2012 Commons Chamber

[Anne Milton]

As I am sure the hon. Lady is aware, we have proposed in the alcohol strategy to make sure that public health and other health considerations can be used in making decisions about licensing applications. This is what we have achieved from having a cross-government strategy and approach, moving public health responsibilities back into local government.

[Iain Stewart (Milton Keynes South) (Con)]

May I emphasise to my right hon. Friend the strength of local feeling in Milton Keynes that we should retain our integrated community health service, which has worked incredibly well and provides a good role model for elsewhere in the country?

[Mr Lansley]

I am grateful to my hon. Friend. The four tests for service change that we have set out—I think rightly—are not just about the tests that must be met before changes can be introduced; they also involve the same considerations that should drive the design of services. If local commissioners, the local authority and local people are supportive of a particular form of organisation, including community services, I would hope that that would provide the basis on which the design of services would proceed.

Oral Answers to Questions

Iain Stewart Excerpts

Tuesday 21st February 2012 Commons Chamber

[Paul Burstow]

That was a pretty limp attempt. One of the most striking things about this Question Time is how many Opposition Members are yet again suffering from another health problem—memory lapses. When it comes to the Labour party’s record in government, £12 billion was wasted on a computer system that did not work, with which 60,000 nurses could have been recruited and employed for a decade.

[Iain Stewart (Milton Keynes South) (Con)]

8. What progress he has made in improving outcomes for NHS patients.

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

Last December, we published data against 30 indicators in the new NHS outcomes framework, which has been supported enthusiastically by patients, by professionals and internationally. The data show that for 25 of the new measures, the NHS improved or maintained performance, including MRSA infections being down by half and C. difficile infections being down by 40% since 2008-09. I expect continuing improvement over the coming years, as the focus on outcomes drives change and improvement.

[Iain Stewart]

Campaigns such as “Be Clear on Cancer” are invaluable in ensuring the early detection and treatment of serious conditions. Will the Secretary of State do what he can to ensure that there is proper co-operation between charities and local hospitals about the timing of such campaigns, to ensure that the spike in referrals that follows is dealt with as efficiently as possible?

[Mr Lansley]

I will indeed ensure that that happens. We work closely with the cancer charities. We are working with them as we roll out the campaign that was piloted in the east of England to encourage the awareness of symptoms and the earlier diagnosis of bowel cancer. I hope that we will ensure that the services, such as endoscopy services, are available to support that.