Breast Implants

Ian Swales Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Lansley]

As I hope the hon. Lady will appreciate from what I said to the right hon. Member for Leigh (Andy Burnham), the Health and Social Care Bill introduces for the first time a comprehensive continuity of service regime for the NHS, and it also creates, through the health sector regulator, the potential for us to consider whether such continuity of service needs to be extended beyond the NHS.

[Ian Swales (Redcar) (LD)]

If the NHS stands behind private providers in such cases, it is effectively providing free indemnity insurance. Will the Secretary of State look at the insurance position of providers of such services and ensure that the taxpayer does not face open-ended liabilities?

[Mr Lansley]

As my hon. Friend points out, to that extent the NHS has always stood behind the private sector provision of health care. If things go wrong, people have the right to access NHS treatment as they must be looked after on the basis of clinical need. Referring back to points I made earlier, the Health and Social Care Bill gives us an opportunity to look more systematically at continuity of care for patients both in the NHS and the private sector and at the responsibilities of providers under their licence.

Information Technology (NHS)

Ian Swales Excerpts

Tuesday 14th June 2011 Westminster Hall

[John Pugh (Southport) (LD)]

I congratulate the hon. Member for South Norfolk (Mr Bacon) on securing the debate. In this field, he is very expert, persistent and learned, and I believe that he is writing a book on the subject—I shall give him a plug because he is too modest to do it himself. We have both followed the debate for a fairly long time. We have had Commons debates and there have been PAC sessions on the subject. We have attended meetings with Mr Granger and been to numerous conferences. We have even sat in Richmond house and watched the Lorenzo system work—it proved to be a little more difficult to get it to work in a hospital in real time, but none the less it looked good when we saw it.

I do not want to sketch out the sorry history, as the hon. Member for South Norfolk has done so most lucidly. Everybody in the Chamber realises that it was a procurement disaster, and a project management disaster. It did all the things that are not supposed to be done, such as failing to shift risk to the private sector, failing to be clear about the actual benefits, failing to involve practitioners and stakeholders, and failing to control costs. It was a bright idea, but it was not realistically assessed and ultimately had to be scaled back.

Much of it, as the hon. Gentleman said, might have happened anyway. The good side of it, if I can so describe it—the PACS, e-prescriptions, improved broadband access, telemedicine and so on—might well have happened, and we ought to recognise the fact. However, the project would not have done well in front of Alan Sugar on “The Apprentice”, let alone the Public Accounts Committee. That is history, however, and to some extent we must now consider the present.

We are in unprecedented times of cash restraint, and we have to find £20 billion within the health service over the next few years. I doubt whether we will succeed, but we cannot abandon that target. Twenty or so hospitals will not achieve foundation trust status, and we cannot magic away their PFI debts or ignore the consequences that flow from dodging difficult reconfiguration issues. However, as we roll out Connecting for Health, the cost certainly matters. I believe that some of the costs, particularly those of the patient administration systems, are still being picked up by the ailing hospitals.

It is not easy to see how current health reforms will ease matters, as they will increase the diversity of providers and complicate somewhat the recording of data, as providers do it in different ways. That will add to the potential problems of data sharing and interoperability. Ultimately, we will require some merging of social care and medical records, and the changed landscape will necessitate appreciable changes in the choose and book system. I do not know whether we will be transferring or binning the existing IT programmes of PCTs, but it could be said that what we originally designed is now inappropriate—that NPfIT, an awful pun, no longer fits.

I believe that the Government have done all the sensible things in response to a difficult situation. They have allowed NHS trusts to adapt and develop existing systems. They have emphasised open standards and interoperability, and continue to do so, in order that we can have variety without undue chaos and do not end up being captive to a major supplier. That is the ultimate nightmare, and it was a big fear throughout the process. Indeed, although Granger tried to prevent it, it seems that he could not. The Government have sought to reduce and shave costs through negotiation or by cutting back on specifications. However, there appear to be a few problems with what is otherwise a sensible strategy.

First, I understand that, in these difficult circumstances, some of the key managers of the programme are to be the chief executives of strategic health authorities, but when they have gone I have no idea who will persist with the task and take up the burden. Secondly, savings within the NHS will lead to many of the much-maligned back-office staff going, and I presume that that will include NHS client-side IT people. The loss of client-side expertise will be a big worry, as it will make us even more dependent on the expensive consultants who got us into this mess. I note that McKinsey was pivotal in advising us to go ahead. I note also that, to this day, McKinsey has its feet well under the table in Richmond house, and is advising the Government on a number of problems.

The big problem, however, appears to be that we do not seem able easily to extricate ourselves or to revise contracts. Everyone agrees that that is necessary at the moment. Rather, I should say that we seem unable to do so without making matters worse. We seem doomed to spend another £4.3 billion, yet we need to save a further £20 billion. The fatal breakfast that Mr Blair had with the IT industry in February 2002 has come back to haunt us. Mr Blair might have been worried about his legacy, but it is now a worry for us.

I understand through the grapevine that this was a matter of heated debate at the last meeting of the PAC, which was a rather rumbustious affair. I saw Mr Nicholson shortly after that meeting, and I have to say that his account of events differed slightly from that of some hon. Members, in terms of how satisfactory an occasion he thought it was and how far they had got in their Socratic examination of the flaws. However, it seems that he and we are trapped between a rock and a hard place, and that there is not an easy way out.

The dilemma is not only ours; it is one also for the IT industry. The industry can help us to meet the Nicholson challenge, or it can compound it. It can work ever more closely in areas such as telemedicine and so on, and on how to produce genuine cost savings, including on the implementation of IT; or it can simply go on as before, selling us more kit that we do not need and software that we cannot use. If that is the industry’s choice—it is the industry’s choice as much as ours; we have to throw down the challenge to suppliers—it will face years of adversarial attrition as we try to cut costs, presumably followed by bad feeling and empty order books, and endless fulmination from the hon. Member for South Norfolk, who becomes increasingly frustrated as the drama continues. However, the industry could accept that it is a collective problem.

It is a very big collective problem, because at some point in time it will throw into stark relief what we do with the summary care record, which has less utility than we ever imagined and more complexity than we ever realised.

[Ian Swales (Redcar) (LD)]

As a member of the PAC who was present at the rumbustious meeting to which my hon. Friend referred, I gained the impression that the suppliers were completely unprepared to consider the correct option of considering things differently and trying to be positive. It seemed that they were prepared to protect their positions to the hilt, which is partly why it was a rumbustious sitting. Does my hon. Friend have any advice on how to change the attitude of the suppliers?

[John Pugh]

Given that, uniquely in the UK, many suppliers are dependent on Government contracts in the long term, they have a stark choice between pleasing their shareholders and pleasing their long-term customers. They must recognise that. However, I am not sure how to achieve that while doing anything useful with the summary care record. I suspect that that may be a matter for another debate—and possibly a longer one.

Oral Answers to Questions

Ian Swales Excerpts

Tuesday 8th March 2011 Commons Chamber

[Ian Swales (Redcar) (LD)]

T5. A new primary care hospital opened in Redcar at the end of 2009. So far, the endoscopy unit and the two operating theatres are completely unused, and a state-of-the-art hydrotherapy pool has hardly been used. Will the Minister meet me to discuss that commissioning failure and to see how we can bring those facilities into use for the local community?

[Mr Burns]

I understand that the PCT will continue to work with health care providers to develop existing and future services at Redcar primary care hospital, and to promote the availability of services, but I would be more than delighted to meet the hon. Gentleman to discuss that issue.

Myalgic Encephalomyelitis

Ian Swales Excerpts

Wednesday 2nd February 2011 Westminster Hall

[Ian Swales (Redcar) (LD)]

I begin by reading what a constituent of mine, Jan Laverick, who suffers from myalgic encephalomyelitis, wrote to describe her condition:

“ME is sudden and extreme muscle weakness to the point of not being able to lift a glass. It is collapsing with exhaustion and not being able to move for hours. It is struggling to sit up long enough to eat a meal that has been placed in your lap. It is tachycardia, seizures, paralysis and black outs. It is sensitivity to light, sound and touch. It is extreme abdominal bloating, nausea, loss of appetite, excruciating stomach cramps…It is daily fevers and sweats. It is inflammation and horrendous joint, nerve and muscle pain. Imagine suffering from these symptoms only to find there is little research into the cause or cure, that you might not be taken seriously by your GP or the benefits system. Your condition might even have been dismissed as ‘yuppie flu’.”

I welcome the fact that the Department of Health now accepts ME as a genuine medical condition. However, it is clear from speaking to sufferers and medical professionals that diagnosis can still pose a problem because ME symptoms are similar to those present in several other medical conditions. I recognise that one of the main obstacles to the adequate treatment of ME is the lack of knowledge and consensus about the disease, and I will argue that funding and research must be focused on the biomedical factors involved, and not simply on managing the psychological symptoms.

[James Wharton (Stockton South) (Con)]

I congratulate my hon. Friend on securing this important debate on a subject that I know is close to his heart. It has been raised with me, as it has with him, by a number of constituents who are concerned about it. I echo his comments and point out that, at present, no funding is available for biomedical research into the causation of ME. Does he agree—I believe he just said that he does—that this is an area we want the Government to look at again, and that we should encourage them to take seriously?

[Ian Swales]

I thank the hon. Gentleman; indeed, that is right. I am not sure whether no funding is available, but it certainly is the minority of funding, and that seriously needs addressing.

My goal is to see the Government-funded Medical Research Council work with ME sufferers and biomedical researchers to achieve a proper understanding of the condition’s challenges and to change the unjust perceptions of it.

[Annette Brooke (Mid Dorset and North Poole) (LD)]

I congratulate my hon. Friend on securing this debate. It is almost a year since I had a similar debate, but I am not sure that we have moved on since then. Recently, the MRC announced £1.5 million for research, but does he agree that there appears not to be an overall strategy to deal with research into ME, and that there still seems to be concentration on the symptoms and not enough attention given to the causes?

[Ian Swales]

I thank my hon. Friend. Yes, the lack of a strategy focused on the latest information is one of the problems.

I was delighted that two days after this debate was announced, the MRC announced £1.5 million for further research into ME—I am sure that it was just a coincidence. That important step shows that leading medical researchers and the Government are finally admitting that current thinking on ME is inadequate.

The condition affects an estimated 250,000 people in the UK. It is not a disease of the elderly: onset commonly occurs during the 20s to 40s in adults, and between 11 and 14 in children, wrecking the lives of so many young people. Studies show that the vast majority of patients never return to their pre-illness level of functioning, and relapses can occur several years after remission. ME is an extremely complex disease for which there is no scientifically proven cause or cure. The main symptom is severe fatigue following almost any mental or physical activity which does not go away with sleep or rest. That often leads to its being defined under the term “chronic fatigue syndrome”. However, an important step in changing the misleading perceptions of ME is to recognise that CFS is a loose umbrella classification covering a wide range of illnesses of which fatigue is a prominent symptom, and that those illnesses may be neurological, malignant, infective, toxic, genetic or psychiatric in nature. Fatigue is a loosely defined symptom which can occur to some degree in a wide range of conditions.

Using that umbrella term has further compounded the already significant obstacles to the diagnosis and treatment of ME, which is now identified on the basis of at least nine different definitions. A major problem lies in the fact that different types of illness are also contained under the CFS umbrella. That makes sound scientific research difficult to conduct, as different illnesses have different biomarkers. A research group that consists of people with completely different physical and psychological causes of their fatigue or tiredness can have only limited use, and certainly cannot lead to the development of any sound findings on the causes of ME.

ME, on the other hand, has a clear definition. The term “myalgic” means muscle pain, while “encephalomyelitis” means inflammation of the brain and spinal cord and represents a clearly defined disease process which has been included in the World Health Organisation’s “International Classification of Diseases” since 1969. That poses the obvious question of why research has been mainly focused on psychological symptoms, when the very definition of the disease refers to a physiological condition. “Fatigue” is also a clumsy way of describing a complex range of extremely debilitating symptoms. It is not the kind of fatigue that non-sufferers would recognise. ME, as we heard from my constituent, can involve sudden and extreme muscle weakness to the point of not being able to lift a glass. What recognition is there in the Department that ME is distinct and different from the much broader term CFS? Equally, in the light of the recent MRC funding announcement, I urge the Minister to encourage the Department to focus its research, as treating ME/CFS as a single homogeneous condition will only encounter the problems I have just outlined.

That blurring can also lead to a uniform approach to treatment, which is unreasonable and even dangerous. An indiscriminate, blanket approach to treatment was advised by the National Institute for Health and Clinical Excellence in 2007, no matter what the disease process, infectious agent or psychological condition. Again, the symptom of fatigue gets flagged up and treated in the same way in nearly all cases. That can be ineffective for many, and positively dangerous for others. That lack of recognition of ME specifically happens at every level; yet I believe it essential that GPs have the ability to spot ME early and to prescribe appropriate, tailored advice. I would like the Government to recognise the many differences between and subtleties of ME and CFS, and urge the Minister to do the same, as the current treatment guidelines are completely unacceptable.

I decided to call for this debate because the issue has been under-researched. The lack of understanding and stigma surrounding ME have meant that sufferers have had to live with the condition without recourse to the treatments and research they deserve. I initially tabled early-day motion 778 to gauge support, and I am delighted to report that, as of yesterday, 100 colleagues from all parties have put their names to it. That shows the strong feeling in Parliament that significant changes need to be made. There has been a distinct lack of funding into ME research in the past decade. Between 2000 and 2003, not a single penny was spent by the MRC on researching the condition. Things did improve, peaking with just over £1.3 million allocated in 2007-08, but that dropped to just £109,000 in 2009-10.

I welcome the recent funding announcement. However, more than 80% of the MRC’s expenditure on ME research so far has been allocated to psycho-social therapies, instead of biomedical studies to prove the existence of a physical cause. That research has continued to pursue a well-trodden path and ignored a vast landscape of other, potentially more rewarding areas. I am concerned to see whether the new MRC funding will focus on that biomedical work. Not only has there been a palpable lack of funding for research; a past study commissioned by the Department of Health found that the quality of research was poor. For a long-term condition that affects 250,000 people in this country, with no known cause or cure and huge costs to the NHS, the amount of research funding dedicated to it, even with the recent announcement, is pitiful.

Misinformation, widespread confusion and ignorance about ME and CFS have resulted in people with entirely different illnesses receiving the same diagnosis. A London sufferer, David Eden, drew my attention to some interesting research that has been taking place in the United States. Recent studies by the Whittemore Peterson Institute, the National Cancer Institute and the Cleveland Clinic have linked ME with the presence of a newly discovered retrovirus. Blood from 68 of 101 ME patients was found to contain a human gammaretrovirus, xenotropic murine leukaemia virus—XMRV—while only eight of 218 healthy patients were found to have the same retrovirus. While that result grabbed headlines, most subsequent studies have been less clear, although one other study did support the original findings. It remains uncertain as to whether XMRV is linked to ME and is involved in causation. I would like to encourage the Minister, therefore, to explore other areas of research, such as retroviruses, in order to ascertain once and for all whether they play a part in ME. To judge by the contact I have had with sufferers, there is constant frustration that the Government are failing to fund research into key areas.

Another, more practical consideration is the recognition of ME by the benefits system. Currently, disability living allowance is assessed by severity of condition, and ME is treated like the vast majority of other conditions. Due to the lack of overt clinical findings, much of the assessment rests on anecdotal evidence and whether the person’s description of their disability is consistent with their daily activities. However, despite the guidance on conducting these interviews, an ME sufferer will only be able to attend such a session on a good day. It is therefore impossible to judge accurately the severity of the condition at the assessment interview. I would argue that a more flexible approach to ME is needed. The effects of the condition can wax and wane unpredictably, meaning that often, a person’s DLA is withdrawn because of a short-term respite of the symptoms. There needs to be more consultation with and input from GPs and other medical professionals who are in contact with the individual over a prolonged period. Obviously, I understand that this issue is not directly the Minister’s responsibility. However, I strongly urge him to make representations, and to make this case, to the Department for Work and Pensions.

I thank hon. Members and the Minister for listening. To end the plight of ME sufferers, appropriate and correctly targeted biomedical research into the causes of the disease must be funded. GPs must be properly apprised of the specifics of ME; sufferers’ disability must be recognised in the benefits system, with the support of GPs; ME and CFS must be properly classified; and fatigue must no longer be used as a catch-all symptom. The current situation, which has endured for decades, cannot be allowed to continue. As things stand, 250,000 men, women and children, their families and carers, face terrible injustice and neglect. I call on the Government to put that right.

Oral Answers to Questions

Ian Swales Excerpts

Tuesday 7th December 2010 Commons Chamber

[Mr Lansley]

We have been very clear that we are asking the whole of the NHS administration—we are applying the same discipline inside the Department, to arm’s length bodies and across the whole of government—to secure a reduction by a third of real-terms administration costs over four years. In the NHS in particular, I am looking for a reduction in management costs of 45% in cash terms. By that, I mean specifically the costs of managers and senior managers. By definition, that does not include clinical staffing.

[Ian Swales (Redcar) (LD)]

T3. In the light of the recent damning report by the Care Quality Commission into Redcar and Cleveland council’s adult social care services, what steps is the Secretary of State taking to improve adult social care and will he meet me to address the issues raised in the report?

[The Minister of State, Department of Health (Paul Burstow)]

I am grateful to my hon. Friend for his question. I know of his concerns, which he has raised for some time. I understand that an improvement plan has been developed by Redcar and Cleveland and that it has been shared and agreed with the Care Quality Commission. The plan has a strong focus around ensuring a rigorous approach to improving the safeguarding of vulnerable people, and a peer review process is being established with the Local Government Group and the Association of Directors of Adult Social Services. I would, of course, be happy to meet my hon. Friend to discuss the matter further.

Oral Answers to Questions

Ian Swales Excerpts

Tuesday 2nd November 2010 Commons Chamber

The Secretary of State was asked—

[Ian Swales (Redcar) (LD)]

1. What recent discussions he has had on the likely effects on mental health patients of changes to health care provision arising from the comprehensive spending review.

[The Minister of State, Department of Health (Paul Burstow)]

The Government confirmed their determination to protect the most vulnerable in our society by protecting both the NHS and social care in the recent spending review. The Chancellor also announced funding to expand access to talking therapies.

[Ian Swales]

Can the Minister give assurances that the Department of Health is having full discussions with the Department for Work and Pensions about the problems that those with mental health problems experience in returning to work?

[Paul Burstow]

I thank my hon. Friend for that question. I can certainly assure him that those discussions are ongoing and regular, and that we work very closely with colleagues, both ministerial and official, in the DWP. Indeed, we are evaluating two of the Department’s collaborative projects on employment advisers working with people recovering from depression and anxiety disorders.