Oral Answers to Questions
Jack Lopresti Excerpts(1 year, 10 months ago)
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Jack Lopresti (Filton and Bradley Stoke) (Con)
The Secretary of State for Health and Social Care (Steve Barclay)
We have introduced a range of contingency measures, such as the provision of military personnel, who are available to assist with the driving of ambulances, and community first responders, who can help before ambulances arrive on the scene.
Jack Lopresti
Will my right hon. Friend join me in thanking call handlers at the South Western Ambulance Service NHS Foundation Trust—and the public—for halving the number of 999 calls to the trust over the last month, and reducing average call answering times by 95%, to just three seconds? Will he also join me in expressing dismay at the approach taken by the Leader of the Opposition during the most recent session of Prime Minister’s Question Time in seeking to sow fear in the hearts of my constituents and others for his own narrow political gain?
Steve Barclay
I am happy to join my hon. Friend in paying tribute to the work of call handlers at the South Western Ambulance Service, and to the staff there as a whole. He is right to draw attention to the improved performance that we have seen in recent weeks, and also right to point out that all parts of the United Kingdom have faced considerable challenges, particularly over the Christmas period when we saw a significant spike in flu levels.
Winterbourne View Hospital and the Transforming Care Programme
Jack Lopresti Excerpts(3 years, 5 months ago)
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Jack Lopresti (Filton and Bradley Stoke) (Con) [V]
It is a pleasure to serve under your chairmanship, Ms McVey. I congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on securing this important debate.
Winterbourne View Hospital was in my constituency. The horrifying evidence of the systematic abuse of some of the most vulnerable people in my society, which happened in a place where they were meant to be safe and looked after, came to light just a year after I was first elected to serve as the Member of Parliament for Filton and Bradley Stoke. Immediately after the “Panorama” documentary was broadcast, I summoned to Westminster the chief executive of Castlebeck, which ran the hospital, and told him that the hospital had to close and that patients must be properly looked after in a sympathetic and caring manner.
Nobody who watched the documentary could be anything other than horrified by what they saw: a total and complete failure of humanity, a lack of any sort of care on the part of the staff responsible for those vulnerable adults, and the catastrophic failure of agencies and organisations to act sooner, which could have stopped the abuse before so many people fell victim to it.
In 2010, Terry Bryan, a former senior nurse at the hospital, brought forward concerns to the review. As the council states in its report on the hospital, his concerns
“made no difference in an unnoticing environment.”
The Care Quality Commission also acknowledged that it did not respond to Mr Bryan’s concerns. According to the report, it did not follow up because it thought Castlebeck and the council were doing so.
As I said in the House in September 2012, 40 safe- guarding alerts were sent to the council but not acted upon, because the council assumed that the hospital was being honest. Many of those terrible incidents could have been avoided had those alerts been dealt with. Twenty-nine contacts between the hospital and Avon and Somerset police were reported between January 2008 and May 2011. The police acknowledge that for staff-on-patients incidents, they relied far too heavily on the hospital’s information instead of listening to what patients were telling them or properly investigating concerns. Only one member of staff was ever prosecuted before the documentary was aired. Winterbourne View was a catastrophic failure of corporate responsibility and care for the most vulnerable.
In October 2012, I asked at Prime Minister’s questions whether care providers should be prosecuted for wilful corporate negligence if patients in their care had been abused. In 2013, I co-sponsored a private Members’ Bill to hold corporations criminally accountable for abuse and neglect in care settings. I am glad that since that dreadful incident, the Government have put in place some measures to improve the care of residents, and I welcome the steps that the Government have taken through national agencies such as the NHS, and local authorities, to ensure that care providers and givers are adequately resourced, and that patients are adequately protected and that their families can have confidence in the care system.
In December 2012, the Government published the “Transforming Care” report. It was of course vital to look at what lessons had to be learned and at what actions the Government must take to stop that abuse ever happening again. Some changes were made. The Government introduced a more rigorous registration, assessment and inspection process for learning disability services, and the Care Act 2014 set out a new basis for adult social care, which included the concept of wellbeing for individuals, including people being in control of their day-to-day lives, and residents having suitable accommodation and being able to contribute to society. The Act also reiterates the importance of good-quality, independent advocacy, and supports people, their families and carers, to help them raise concerns. It also requires local authorities to consider people’s views, wishes and beliefs, and focus on the end results that the people themselves want to achieve.
In January this year, the Government closed the consultation on reforming the Mental Health Act 1983. The changes that the Government are proposing are based on four patient-centred principles. Those principles are choice, autonomy—using the Act’s powers in the least restrictive way—ensuring that patients are supported to get better and, crucially, ensuring that patients are viewed and treated as individuals. The changes will allow people to make choices about their own care when they are well, and choose who might represent them should they become unwell. The Government have focused, as has been said earlier, on reducing levels of in-patient care for people with a learning disability and/or autism. Hospitals are not where people should live, and the Government have committed to move more people into community-based support. However, as we all know, that ambition has been postponed. The most recent target, as set out in the NHS long-term plan, is for a reduction in in-patient provision of 50%, compared with 2015 levels, by 2023-24.
As the commission recommended, the priority for the Government now must be to improve access to community-based mental health support, including crisis care, to prevent avoidable detentions under the Mental Health Act. I am pleased that this is already under way, backed by a ring-fenced fund of £2.3 billion a year as part of the NHS long-term plan.
We must continue to learn the lessons from the terrible events at Winterbourne View. Those who are entrusted to the care system, and their families, must be confident that their wellbeing is the highest priority for those responsible for their care, and of course we must all continue to ensure that such horrific abuse can never be repeated. It cannot be in any way justifiable that alerts are ignored by local authorities and the police, as they were with those terrible incidents, which could have been prevented and should never have happened.
Oral Answers to Questions
Jack Lopresti Excerpts(4 years, 2 months ago)
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Mary Robinson (Cheadle) (Con)
Jack Lopresti (Filton and Bradley Stoke) (Con)
Selaine Saxby (North Devon) (Con)
Matt Hancock
My hon. Friend has played a very important role, and I pay tribute to her and her community for playing a role in the success of the local action that we had to take in Stockport and other parts of Greater Manchester, which meant that we were able to release the measures last week. I am grateful for her work, the work of her council and other local leaders and, most importantly, the people of Stockport, who have worked hard and followed the rules, and the case rate is coming down. She is right that the integration of a national system that can move fast at scale and a local system, which can often reach more contacts because there are boots on the ground and people who know the communities inside out, is critical.
Jack Lopresti
In my right hon. Friend’s assessment, how does our track and trace programme compare with those of other countries, and what lessons are we learning from countries such as Germany and South Korea, which seem to be having some success with their systems?
Matt Hancock
Of course we learn the lessons, and I talk to my international counterparts, including those in Germany and South Korea. Compared with international systems, with the figures that I just read out, we are absolutely in the top tranche, and we are constantly looking all around the world to see how we can improve the operation of test and trace.
Oral Answers to Questions
Jack Lopresti Excerpts(5 years ago)
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James Cartlidge (South Suffolk) (Con)
Jack Lopresti (Filton and Bradley Stoke) (Con)
Ms Dorries
My hon. Friend works tirelessly on his constituents’ behalf. In fact, I think I am meeting some of his constituents tomorrow. I will look into the issues he raises, but the trust has been working since May 2018 on delivering the immediate improvements suggested by the Care Quality Commission, and leadership support has been provided by East London NHS Foundation Trust. I promise to look into the situation to see where the trust is at this point and what improvements have been made, and I may have that information to feed back to him tomorrow.
Jack Lopresti
I welcome the Minister’s recent announcement of greater support for people affected by the suicide of a loved one, but what form will that additional support actually take?
Ms Dorries
It goes without saying that anyone affected by a friend or family member taking their own life will be absolutely devastated. We made an announcement at the weekend of nearly £1 million of funding to target 10 areas to help to provide assistance and support to the bereaved. We will assess those 10 sites to see what is delivered and how it works, and we will hopefully be able to roll the scheme out across the UK in the future.
Infection Prevention and Control
Jack Lopresti Excerpts(6 years, 6 months ago)
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Jim Shannon
What my hon. Friend says is wise—we always hear very wise words from him, no matter what the debate. If we have best practice in Middlesex, Edinburgh, Cardiff, Newtonards, Bangor or Belfast—wherever it may be—let us replicate it everywhere else. My hon. Friend is absolutely right.
It is true that here in the UK we have made good progress in reducing the number of healthcare-associated infections over the past 10 to 15 years. The introduction of mandatory reporting of infections in the early 2000s has certainly helped to track the trends. When we look at some of the things we have done, there is good news. In 2003-04 the average quarterly count of MRSA bacteria was 1,925, but by 2008 it had reduced by 57% to 836—a significant reduction. Although that should be a cause for celebration, rates of healthcare-associated infections remain stubbornly high. Today’s debate is really about getting to the stubborn hard-core hygiene-related infections that do not seem to want to move.
The results of the most recent point-prevalence survey show that the number of patients contracting an infection in hospital is staggering. Every one of us knows how important the matter is. When my dad was in hospital for a time, he was always catching infections there. I am not saying that that was the fault of anyone, but I had thought that the possibility of infection would be greater at home—in hospital you expect it to be lower. Unfortunately, in the cases that I am aware of of people going into hospital with an illness, the rate of infection is high. People worry about that. My constituents worry about it, and I believe that everyone else’s do as well.
One in every 16 patients contract an infection in a UK hospital. That is only 6.4%, but it is 6.4% too many. There are 5,000 patient deaths every year from healthcare-associated infections. That is the thrust of the matter. If we are having deaths in hospital due to these infections we need to address the issue, and I look to the Minister for some thoughts on how we can do that. I am confident that he will come back with something that will help us in our debate.
The human cost of infection goes without saying. However, healthcare-associated infections also have a significant financial cost, which cannot be ignored. The health issues are one consideration, but the financial spin-off is also great. If we can address the infections early on, we can reduce the financial implications and also the deaths and infections. At a time when the health service is facing an unprecedented strain on services, reducing that financial burden is all the more pressing. It is estimated that hospital-acquired infections cost the NHS in excess of £l billion a year, which is 0.8% of the health service’s total budget. That is not an insignificant amount; £1 billion would change a lot of things for the health service and also, I believe, for people’s lives. That amount includes the immediate costs of treating patients in hospital, and also downstream costs due to bed-blocking—we all know the problems with bed-blocking. The costs are especially relevant, given the challenging winter that the NHS has just come through, with hospital capacity reaching 100% in some cases.
If I ask my constituents back home, where we unfortunately have a non-functioning Assembly, what the key issue is for them, they will say that it is health, and it will continue always to be health. If I may make a political statement, but not for any reason other than to illustrate the point: if Sinn Féin were to grasp what is important—and health is one of the things we can agree on—we could move forward together.
Jack Lopresti (Filton and Bradley Stoke) (Con)
I congratulate the hon. Gentleman on securing this important debate. I spent some time in hospital a few years ago and it was a positive experience with a happy outcome—and I escaped infection. Does the hon. Gentleman agree that it is important to get right locally the fundamentals of fighting the global threat of anti-resistance to so-called superbugs?
Jim Shannon
The hon. Gentleman is absolutely right; we have got to get it right in our own hospitals and across the NHS and the whole United Kingdom of Great Britain and Northern Ireland, and then we can look further afield to other countries. He reminds me that last year I had occasion to be in hospital three times for various operations. I never had any infections. I had nothing but the best care. The surgeon’s knife went in the right direction and removed what had to removed. It was important to do that. The important thing is that we have hospitals and an NHS that are excellent. When the NHS works well, it is the best in the world, but sometimes we need to think about things.
The cost of infections to the NHS includes the immediate costs of treating patients in hospital, bed-blocking and so on. There are also issues with hospital capacity, which has reached 100% in some cases. The World Health Organisation estimates that 50% to 70% of hospital-acquired infections are transmitted by hands, so improving hand hygiene must play a central role in any strategy to reduce hospital infections. It would be remiss of me not to note the work carried out by the Secretary of State to improve patient safety in the NHS—let us give credit where credit is due. In November 2016, there was a commitment to halve gram-negative infections by 2020. The Secretary of State announced he would appoint a new national infection prevention lead, Dr Ruth May. Both are important steps in bringing down infection rates and show a commitment to do so.
Given that 50% to 70% of hospital infections are transmitted by hands, I was encouraged to see alongside those measures a commitment for the NHS to publish staff hand hygiene indicators for the first time. If hand hygiene is done—it should be, and perhaps there are indications of places where it has not been—then publishing hand hygiene indicators will allow benchmarking between hospitals and help drive up standards of hand hygiene. If we can have a system that can help drive hand hygiene, we should have it. Perhaps the Minister can respond to that point in his summing up.
The policy should not be implemented by weighing or counting cartridges used in hospital hand sanitiser dispensers. If it is done by the number of cartridges used, we might be under the impression that things are going the right way, but there has to be a wee bit more to it than that. Without factoring in patient bed numbers and staffing levels, the information is, I gently say, somewhat meaningless in showing hand hygiene compliance levels. The intention is right, but other factors need to be looked at.
The Secretary of State is a strong proponent of the use of reasonable technology in the NHS. Like me, he believes it has the power to radically change how we deliver care. Electronic monitoring technology can monitor hand hygiene to deliver real-time, accurate data to drive behavioural change. We want to see behavioural change where staff are not as active on hand hygiene as they should be.
Electronic monitoring is an innovative practice that is used internationally. Studies from a hospital in the US have shown that following the adoption of the technology, hand hygiene compliance improved by 30%. If we use that methodology, hopefully we can replicate what has happened in the US and reduce infections. That 30% increase corresponded with a 29% decrease in the number of MRSA infections, saving that one hospital more than $400,000. Here in the UK, electronic monitoring is being piloted at a number of hospital trusts in what the Care Quality Commission describes as “outstanding” and “innovative” practice. It goes back to what my hon. Friend the Member for Upper Bann (David Simpson) said in his intervention: where we see good things happening, we should be doing those things across the whole United Kingdom. My hon. Friend the Member for East Londonderry (Mr Campbell) also referred to that.
If the results from the US are replicated here in the UK—they can be—the national adoption of electronic monitoring technology could see 30,000 fewer infections, saving the NHS more than £93 million. More importantly, it would mean less infection, fewer people staying in hospital and fewer deaths. Dr Ruth May, the national infection prevention lead, said that,
“the collection, publication and intelligent use of data…will ensure organisations improve infection control and help…poor performers get the support they need”.
Those are very wise words. While I welcome the announcement of the hand hygiene indicator policy, it appears that progress on its implementation has stalled. I suppose that is the point I am coming to and the reason for this debate. The Department of Health and Social Care has missed its own deadline to publish the data by the end of 2017. Data is so important in drawing up a strategy, policy and vision of how we can address the issue.
We have been collecting mandatory data on the number of healthcare-associated infections, such as MRSA and Clostridium difficile, since 2004. When hand hygiene is so critical to reducing the number of healthcare-associated infections, it is difficult to see why it has taken more than 14 years to publish data on staff hand hygiene—data that we are yet to see. I find that incredible. I spoke to the Minister last night, so he knew I would raise this issue. The key issue for me is how we use the data we have to make a policy and a strategy from which we can all benefit. To mark World Hand Hygiene Day, the World Health Organisation is calling on Health Ministries worldwide to make hand hygiene a marker of care quality. If we do that right, we will be going in the right direction.
Will the Minister consider making hand hygiene a national marker of care quality? Will he, on behalf of the Secretary of State, outline who is responsible for the implementation of the policy? Will he set out a clear timeline for the collection and publication of this data, which is critical to driving up hand hygiene standards in hospitals? Someone walking through the door of any hospital will always first notice the smell. They will probably notice the warmth of the hospital, because it is there to care for patients and those who are ill. They will also see nurses running about with their gloves on. Hand hygiene is important for them, but we need to drive it a wee bit harder from the ministerial point of view and the local hospital point of view, to ensure that it happens.
Publishing data on hand hygiene compliance is a simple first step in improving hand hygiene, which is essential to raising standards of infection prevention and control in the NHS. It will save lives and money, and we cannot afford further delay. The UK and the NHS have been at the forefront of worldwide infection prevention and control strategies since the early 2000s. While a good deal of progress has been made since then—we welcome that progress, some of which has been significant—there is much work to be done to realise the Secretary of State’s ambition: that the NHS will be the safest health service in the world. We should strive to be the best. In many cases, we are the best, but we can certainly do better. The role of good hand hygiene in reducing hospital-acquired infections and improving patient safety cannot be overstated. We must also acknowledge that the current method of direct observation in monitoring hand hygiene in hospitals is no longer fit for purpose, and that technology can and should play a role in changing behaviours.
I look to the Minister for his response. I thank all Members for taking the time to come to Westminster Hall on a Tuesday morning to make a contribution. We look forward to those contributions.
Cancer Treatment: Patient Travel Times
Jack Lopresti Excerpts(6 years, 10 months ago)
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Tim Farron (Westmorland and Lonsdale) (LD)
I beg to move,
That this House has considered patient travel times for cancer treatment.
It is a great pleasure to serve under your chairmanship, Sir Christopher. I should also like to consider satellite radiotherapies at Westmorland General Hospital.
Almost every story that I have heard or read in recent times about the national health service has been negative. I understand why, given the debate in the main Chamber at this moment, but I sometimes wonder how much this further damages the morale of the thousands of professionals who work in the national health service. So I want to start by paying tribute and saying a massive thank you to those NHS professionals who work tirelessly up and down the country, day in and day out, to look after us and our loved ones when we need it most. I especially want to put on record my appreciation for those who work in cancer care. We have some of the best cancer care in the world. We should all take a moment to recognise the fantastically high standard of treatment that we have in this country, delivered by professionals whose competence and compassion are the hallmark of our NHS.
But here is the problem: yes, we have world-leading treatment, but it is not truly available equally. The availability of care depends hugely on people’s ability to access it. I welcome, and have done so on the record, the £130 million announced by NHS England that is to be invested in improving radiotherapy treatment, and the new service specification, which aims to improve standards across the country. Working in clinical networks and developing specialised services has a strong evidence base, but what is not addressed is the inequality in access to services that already exist. That inequality will only get worse if it is not addressed now by NHS England. I am grateful to the Government that the consultation on allocating that investment has been extended to 24 January, not least because it gives the Minister the chance to amend the criteria and the priorities for allocating services.
I passionately believe that one of the criteria in allocating improved radiotherapy services must be the shortening of the distances that people have to travel, especially for those with more common cancers. My position is backed up by evidence, including a publication in The BMJ in 2016 indicating that outcomes are worse for people who need to travel further. Let me be clear what “worse outcomes” actually means. Worse outcomes can mean patients actively deciding to forgo potentially life-saving or life-lengthening treatment because getting to hospital is just too much of a trauma for them owing to the length and difficulty of the journey that is required. Worse outcomes means choosing forms of treatment that may be less effective than radiotherapy because the nearest unit is too far away. Worse outcomes includes patients failing to complete a vital course of radiotherapy treatment because they simply cannot cope with the gruelling, wearying travelling every single day.
Action Radiotherapy estimates that one in six of us will need radiotherapy to treat cancer at some point in our lives, but easy access to this treatment can depend entirely on a postcode lottery. It is the sad reality that in rural areas of England travel times to cancer treatments can be unbearably long for too many people, and patients are often forced to cover these long distances on public transport. Not everyone has the option of travelling in the relative comfort of a personal car, and even if a person does, driving themselves or being driven, day in and day out for four to six weeks, is a massive challenge. I believe that it is frankly cruel, if we could do otherwise, to force people who are already very poorly to make a two or three-hour round trip every day, for weeks, in order to receive life-saving care.
Jack Lopresti (Filton and Bradley Stoke) (Con)
I congratulate the hon. Gentleman on securing this debate. I am a cancer survivor. I survived stage 4 cancer and I had a month of radiotherapy; I had to get the bus most days to get there, and caught a nasty infection because of the travel time, so I fully appreciate where he is coming from. I would like to highlight the cases of families with children with cancer. According to CLIC Sargent there are fewer than 20 treatment centres nationally, and that makes life extremely difficult for families who are having to travel for treatment. Will he pay tribute to CLIC Sargent for the respite care, finance and accommodation that it provides to families going through this terrible process and journey?
Tim Farron
I am grateful to the hon. Gentleman for raising those issues and his own personal experiences. As I will come to in a moment, the issues affecting children and young people are even greater. I am very happy to pay tribute to the work and provision of CLIC Sargent and, in particular, to recognise the impact on people with cancer who have young children themselves. Maintaining an income and maintaining family life is an immense challenge, and the distances involved can make it yet harder, so I thank him for that intervention.
In its 2007 report, the national radiotherapy advisory group recommended that cancer patients should have to travel no more than 45 minutes one way—an hour and a half both ways—to receive radiotherapy treatment. This was adopted in the service specification by NHS England, but has since disappeared. Experts in the field maintain that travelling any longer could have a hugely negative impact on treatment outcomes and patient wellbeing. If preventing unacceptable travelling times became a part of NHS England’s criteria for delivering radiotherapy, it would hugely increase our chances of bringing a radiotherapy satellite unit to Westmorland General Hospital in Kendal.
Oral Answers to Questions
Jack Lopresti Excerpts(7 years, 1 month ago)
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Jack Lopresti (Filton and Bradley Stoke) (Con)
The Minister of State, Department of Health (Mr Philip Dunne)
My hon. Friend is a doughty campaigner for Frenchay hospital and keeps it uppermost in our minds. The way in which we are looking at the pattern of health provision for the next period is through the STP process, and I encourage him to engage with the STP leadership in his area and make the case for Frenchay hospital.
Oral Answers to Questions
Jack Lopresti Excerpts(9 years ago)
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Jack Lopresti (Filton and Bradley Stoke) (Con)
1. What steps his Department is taking to improve care and support for people with learning disabilities and autism.
The Minister for Community and Social Care (Alistair Burt)
We are determined to ensure that people with learning disabilities live independent lives, with better care and improved outcomes. Taken together, the Government’s recent response to the “No Voice Unheard, No Right Ignored” consultation and the newly published “Transforming care” consultation set out the steps we will take to protect rights, strengthen choice, meet physical and mental health needs and end institutional care by default.
Jack Lopresti
I thank my right hon. Friend for his answer. South Gloucestershire and Stroud college, based in my constituency, is making an application to open a free school for autistic children. How does he feel that such schools can improve the support and education for children with autism?
Alistair Burt
I thank my hon. Friend for the question. Autism is certainly a growing area of identified special educational need across the country that requires an increasing range of provision to meet the diverse needs of the population. Although it would be inappropriate for me to comment on a particular free school application, where it is needed, a special free school can add to the local continuum of provision, by providing specialist places and specialist expertise that can be shared more widely.
Health Provision (South Gloucestershire)
Jack Lopresti Excerpts(9 years, 4 months ago)
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Jack Lopresti (Filton and Bradley Stoke) (Con)
I beg to move,
That this House has considered health provision in South Gloucestershire.
It is a pleasure indeed to serve under your chairmanship, Mr Hollobone. My focus in this debate will be largely on the Frenchay hospital site and the lack of any health provision there, which affects healthcare provision across South Gloucestershire. I am pleased to see in the Chamber my neighbours and hon. Friends the Members for Kingswood (Chris Skidmore) and for Thornbury and Yate (Luke Hall). I look forward to their contributions.
I have a great sense of déjà vu, because this is the third time in just over five years that I have spoken in such a debate and sought to enlist help from the Government to address the question of the promised community hospital at Frenchay. The previous Labour Government made the highly controversial decision in 2005 to downgrade Frenchay hospital. As part of their overall plan, which included building a new acute hospital at Southmead, a commitment was made to provide a community hospital on the Frenchay site. Five years later, in 2010, in the “emerging themes” proposals for healthcare in the area, we were again promised a community hospital at Frenchay. We were told that acute care services would move to the new acute hospital at Southmead and that the community hospital at Frenchay would have “step down” and “step up” services.
The “step down” service would allow patients who receive surgery at the new Southmead hospital to be moved to their local community hospital before being discharged, to reduce the number of beds required at Southmead and enable family and friends to visit patients more easily during their convalescence and recovery. The “step up” patients are those who require hospitalisation but do not require the full services of an acute hospital. The bed numbers for the new Southmead hospital were planned on community hospitals such as Frenchay being available for more minor matters.
In total, 68 beds were recommended at Frenchay. There was also to be a range of out-patient services, diagnostics and an enhanced community health service for care to be provided at home. There was also to be space left on the site for a doctors’ surgery, extra-care housing and possibly even a nursing home. Fine—that was not what local people wanted, but it was a clear plan with clear objectives.
Then, in July 2012, the primary care trust and the clinical commissioning group began to change their minds once again. However, they did not fully update South Gloucestershire Council’s public health and health scrutiny committee until April 2013. At that point, they confirmed that there had been a “stock take” of out-patient and diagnostic capacity at Frenchay.
In September 2013, the council’s health committee received confirmation that there was no longer a proposal to have out-patients and diagnostics on the Frenchay site. In August 2013, the CCG met and decided that, only for the interim, rehabilitation beds at Frenchay would be moved to Southmead for two years. My Conservative colleagues on the council’s health committee came up with a plan and identified funds within the council’s budget to keep the in-patient rehabilitation beds at Frenchay for two years until the new Frenchay health and social care centre opens in 2016. They proposed the plans to the health committee in September 2013. However, Liberal and Labour councillors joined to vote down the proposal. The issue was then referred to the Independent Reconfiguration Panel by the Secretary of State for Health.
The IRP made scathing comments on the way that local healthcare providers handled Frenchay community hospital, and Frenchay hospital in general. The IRP said it is understandable that residents
“should feel exasperated by the years of delay”
and by the
“amendments to plans”.
The IRP concluded that the whole process had shown a
“marked lack of empathy”
by local healthcare providers
“for patients and public who have the right to expect better”.
My hon. Friend the Member for Kingswood secured a debate on healthcare in South Gloucester in March 2014. I sought assurance from the Minister, and she said:
“I am assured that the local NHS is committed to finding a long-term solution for the provision of in-patient beds at Frenchay. Although the CCG is commissioning 68 beds at Southmead for May 2014, that is a temporary measure while the Frenchay site is being improved to accommodate them after April 2016.”—[Official Report, 19 March 2014; Vol. 577, c. 888.]
Frenchay hospital closed in the early summer of 2014 with a commitment that it would be closed for only two years and would reopen in 2016 as a community hospital. However, that date has moved once again and is now mooted for August 2018 at the earliest and more probably November 2019. Is it any wonder that a large number of my constituents feel bitter and that many are extremely sceptical that there will ever be a community hospital at Frenchay? Will the Minister explain why there is a further delay? I should like her to address the timings to help me explain to my constituents why that continues to happen.
More than ever, there is a case for a community hospital in South Gloucestershire at the Frenchay site. There will be a large population expansion in my constituency over the next 10 years. There was nearly a 10% increase in population across South Gloucestershire between 2004 and 2014, and a big increase in housing is planned over the next 10 years. For example, in my constituency the Cribbs Patchway new neighbourhood plan will create at least an additional 5,500 new homes. As a country, we have an ever-increasing elderly population, and the number of people aged 65 and over in South Gloucestershire increased by more than 30% between 2004 and 2014, and obviously that growth is ongoing.
The Save Frenchay Community Hospital group has recently published a report highlighting that Southmead hospital is currently unable to achieve the necessary national performance targets due to a lack of intermediate care beds in the community, which has resulted in a high number of patients being discharged due to a lack of appropriate sub-acute care beds in the community. Opening Frenchay community hospital would alleviate that situation and was supposed to be part of the overall solution and plan. I ask the Minister to insist that the CCG publishes its definitive plans for the Frenchay site. If the 68 beds are no longer required, I should like the CCG to explain how the gap in provision of intermediate care beds for patients discharged from Southmead hospital will be filled.
I am writing to ask South Gloucestershire Council’s health scrutiny committee to ask the Secretary of State to refer the matter back to the IRP. It has been more than a year since the IRP criticised the CCG for the length of time it was taking to make a final decision. Finally, my constituents and I need clarity and confirmation that a community hospital at Frenchay will actually happen with a realistic, achievable timescale that is in the public domain. The uncertainty and continual moving of goalposts drives the cynicism that has gone on for far too long.
Improving Cancer Outcomes
Jack Lopresti Excerpts(9 years, 9 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Baron
That is a very good point, and I will touch on it briefly later; I know that my hon. Friend will do so as well. I agree that there is a danger of that. We need to raise our one-year figures significantly—not by just a few percentage points; if we want to be among the best in Europe, then it has to be by 10 percentage points—and that means that we cannot exclude a lot of the rarer cancers, because there is only so much low-hanging fruit. I hope that this sends out a general message that there must be initiatives across the whole spectrum of all 200 cancers. The rarer cancers are the poor cousin at the moment, and we need to address that specifically. I look forward to hearing what my hon. Friend says later.
Let me explain why it was important to get the one-year figures into the delivery dashboard. We were told that it was all very well to get them into the outcomes indicator set, but they also needed to get into the top tier of NHS accountability—namely, the delivery dashboard. Chief executives of CCGs have told us that they felt they were monitored on that delivery dashboard, or—shall I put it this way—that that was their first port of call.
It is great to be able to inform the House that cancer is now the only disease-specific outcome indicator on the delivery dashboard. I say “great” in the sense that I am delighted that cancer is included, although I wish the delivery dashboard had more outcome indicators, not just process indicators. Processes are fine, but they do not necessarily lead to better outcomes. In my view, if we are serious about improving outcomes, the more outcome indicators we can get on to the delivery dashboard across a range of diseases, the better.
Getting the one-year figures on to the delivery dashboard will be transformational only if we use the tools in the toolbox and ensure that CCGs are held to account effectively. That means not only addressing poor performance, but encouraging those with the highest survival rates in the UK to continue to strive for improvement. There is no point having such figures if we do not use them. Will the Minister clarify how CCGs are being made aware of the upcoming changes to accountability? More importantly, what measures will NHS England take to address underperformance in one-year cancer survival rates by CCGs?
On survival rates, I want to touch on another issue that the all-party group has campaigned on—inequalities. Our recent report, “Cancer across the Domains: A vision for 2020”, particularly highlighted the poorer outcomes for older people. We are not the only ones to have drawn attention to the issue. A recent report from the National Cancer Intelligence Network noted that
“over half of all cancer deaths occur in people aged 75 and over”.
A National Audit Office report on cancer services, published last month, found that
“cancer patients aged 55-64 are 20% more likely to survive for at least 1 year after diagnosis than those aged 75-99.”
Such variation is completely unacceptable. Evidence suggests that the under-treatment of older people happens because some clinicians base their prescriptions on chronological age, not necessarily on their fitness to receive treatment. There is general recognition that older people suffer worse outcomes. The NAO report accepted that
“survival rates for older people are expected to be lower”,
but stated that
“this is unlikely to explain fully the significant variation between age groups.”
I suggest that we need to look at that issue. The all-party group on cancer welcomes the increased focus on it. However, we must ensure that such focus results in action and, as with early diagnosis, that the right accountability levers are in place to deliver real change.
Our recent report highlights our concerns about the fact that all the cancer mortality indicators in the NHS outcomes framework are for under-75s. It is almost as though the NHS has made a decision that the lives of those over 75 are worth just a little bit less than those under 75. That impression has been created in certain quarters, and we need to address that perception. We believe that it sends the wrong message about the importance of older people with cancer. Will the Minister outline what steps the Department is taking to tackle the inequalities faced by older people with cancer?
To move on to patient experience, we tend to think of outcomes simply as survival rates, but it is essential for the NHS to deliver good outcomes for patients at every stage of the cancer pathway. Members will be aware that tomorrow marks two years since the report of the Francis inquiry into the Mid Staffordshire scandal. It therefore feels like an appropriate moment to highlight the importance of the patient experience not as an add-on or a facility that is nice to have, but as an integral part of how we deliver cancer care.
The cancer patient experience survey has given us valuable insight into the experience of cancer patients in the UK. The findings continue to reveal widespread variation in the experience of care that people receive. For example, people with rarer cancers, which were mentioned by my hon. Friend the Member for Castle Point (Rebecca Harris), continue to report poorer experiences than those with more common cancers. The same is true of people with long-term conditions, younger patients, older patients, some ethnic minority patients and patients treated in London hospitals. That widespread variation is unacceptable.
Such an insight is worth very little if we do not ensure that it is used to drive real change. I suggest to the Minister that the mechanisms for doing so simply do not exist at the moment, or if they do, they are disparate and unco-ordinated. The all-party group has real concerns. We know that some trusts develop action plans based on CPES results, but there is no requirement for them to do so. NHS England does not require trusts to report on results. CCGs and NHS England do not seem actively to measure NHS trusts’ progress against their action plans to improve their scores. All that leads to a gap in accountability on the cancer patient experience. There are still concerns about the accessibility of the data from trusts and other local bodies for patients. For example, trust-level reports do not seem to be available on official NHS websites.
The all-party group was pleased that the Minister, in her response to “Cancer across the Domains”, confirmed there were no plans to discontinue the CPES. However, we were concerned to hear that, due to procurement issues, the CPES may not report in 2015. Will she provide an update on whether it will report results in 2015? Perhaps more importantly, will she clarify how NHS England will ensure that the CPES is used to drive improvements in the cancer patient experience, and to hold trusts and CCGs to account?
Jack Lopresti (Filton and Bradley Stoke) (Con)
Aside from my hon. Friend’s points about the strategic level of decision making and accountability, does he agree that at an individual level it is crucial to have complete clarity, understanding and credibility from the point of view of the consultant and the patient, and that there should not be any room for ambiguity or confusion?
Mr Baron
My hon. Friend makes an excellent point. Good communication and indeed consultation is terribly important, and it is one of the key issues that the cancer patient experience survey addresses in trying to gauge patients’ experiences. The NHS can sometimes forget that patients with cancer, like those with long-term conditions generally, are often very knowledgeable about their condition. They need to be consulted, and there must be better communication. That is why we should formulate the cancer patient experience survey better, and ensure we draw out the lessons to be learned so that we can take action to improve experience. I completely agree with my hon. Friend, and I look forward to hearing his speech.
Finally, may I touch briefly on data access? The effective use of data is the foundation for improving cancer outcomes. Good data are at the epicentre of how we are going to improve outcomes. However, I suggest to the Minister that there are problems. Health charities play a crucial role in driving improvements in the health service, including in cancer services. For example, Macmillan’s research has provided invaluable new insight into patient clinical outcomes and the accuracy of GP cancer referrals, which has helped to improve services. However, charities and others are finding it increasingly difficult to access routinely collected data, leaving vital projects stranded for months. In some cases, they do not get the data at all.
There are a number of reasons for that. First, information governance rules are being applied inconsistently. Changes to the legal status of bodies under the NHS reforms have led to confusion about who data can be shared with and, in some cases, have reduced the capacity for analysis. Secondly, different parts of the system are failing to work together. Both nationally and locally, organisations are adopting an increasingly fragmented approach. Furthermore, organisations that are responsible for releasing data do not appear to have the capacity to do so. In a recent Public Accounts Committee hearing, Cancer Research UK indicated that the research group had been waiting 16 months to access data on cancer waiting times.
As the Minister will know, the recent National Audit Office report on cancer services made recommendations on that issue. First, it recommended that the Health and Social Care Information Centre should be
“held to account for how effectively it is discharging its responsibility to disseminate data to help drive improvements”.
Secondly, it recommended:
“As a minimum, it should seek, and publish the results of, regular feedback from NHS data users.”
The cancer community was concerned to hear Sean Duffy call for greater pressure to release and use data at our Britain against cancer conference. To me, that sent a clear signal that further leadership from the Government was needed on this issue. When she responds, will the Minister outline what plans the Department has to clarify the data access rules and to ensure that they are applied consistently, so that we can plan and make proper use of them? That is the essential point.
In conclusion, I thank the Minister for being here and for being prepared to respond to the debate. I have not had a chance to cover a great number of areas, including inequalities more generally, cancer commissioning and survivorship to name a few. However, I hope and expect that other Members will touch on those important issues. I will end where I began: by focusing not only on the scale of the challenge facing us, with the news that 3 million people will be living with cancer by the end of the next Parliament, but on the opportunity. Because of many of our campaigns over the past few years, the NHS now has the tools that it needs to accelerate the improvements in cancer survival rates. The challenge that I set for the Minister today is to ensure that NHS England uses those tools to full effect to deliver the best outcomes in Europe and, quite literally, to save tens of thousands of lives.
Jack Lopresti (Filton and Bradley Stoke) (Con)
I was not entirely sure whether it was a good idea to apply to speak in the debate. It is the first time I have properly put anything on the record about my own experience. I am a cancer survivor. A year ago virtually to the day, I finished about 30 sessions of daily radiotherapy, with oral chemotherapy. It is like awakening from a bad dream. I wanted to get on with my life and not look back. Looking back and putting it all together has been quite difficult this week, but the thing that convinced me that I should say a few words was that, apart from support from family, friends and colleagues once I had my initial diagnosis, the most valuable thing for me in getting through the whole thing, keeping my spirits up and being positive was reading, as an inspiration, about people who had been through the journey.
I ordered tonnes of books from Amazon. I read Bob Champion’s story and re-read the chapter in Rudy Giuliani’s memoirs on beating cancer to give myself as much information as I could about happy endings and going through the process. So I will tell my story, with the message that anyone who is facing the journey, which is very daunting and can be a lonely process, despite the best efforts of friends and family, will get through it. All things end and I am pleased to say that, after I finished my treatment, I was back here within a week or two.
Within a few months of listening to my friends telling me not to overdo it, I managed to run the Bristol half-marathon and the Stroud half-marathon before Christmas. [Hon. Members: “Hear, hear.”] Thank you. I have just applied to run the first Bristol to Bath marathon in October. That points to a surprising thing. I was always incredibly fit and healthy. I had run my first full marathon nearly a year before my diagnosis. So this can come out of left-field. That is not an excuse for not looking after ourselves, however, because the fact that I had looked after myself and was fit and healthy meant I coped with my treatment better and got through it more easily than I might have done.
Two years ago in January I had what I thought was the normal annual virus or bug. I thought perhaps I had overdone it a bit at Christmas, so I carried on with the usual paracetamol and got on with things, but eventually, after a couple of weeks, I succumbed and went to see my GP. She was very good and very calm and said, “We’re not quite sure what it is,” but she did refer me quite quickly to my local hospital as an out-patient.
The staff there said they were worried about me and the fact that I kept flinching when they pressed on my appendix area. They did not let me go home even to get some books and my pyjamas, but my family helped me out. I stayed in for a few days, and the prognosis when the consultant let me go on the Monday morning was that they were pretty certain it was appendicitis but I had an abscess and it could well have hit a cancer. That was the first time I had heard that word. He quickly reassured me that I was far too healthy-looking and it was not very likely, but it was a possibility. They gave me intravenous antibiotics while I was there and sent me home to recover saying, “We don’t normally like to operate on appendixes straight away these days because it is a tricky operation and can be treated with antibiotics.”
To cut a long story short, this went on for two or three months. I kept finishing the antibiotics, and within about 10 days I would start to feel really ill again. My hon. Friend the Member for Basildon and Billericay (Mr Baron) said to me, “For goodness sake, go back to your constituency and get whatever’s in your body removed because you’re obviously very ill.” I even went to the nurse here at Parliament who said almost the same thing: “I’m very worried. I’m not happy. Get back and get it removed.” But the hospital said, “Oh, it’s a grumbling appendix” and kept me in for another week on intravenous antibiotics. Within a week or two of that not working three months had passed, so the initial stages of quick referral and reasonable expectation of what it could be had dragged on for a long time.
I again recovered quite quickly after the operation, but within a week was due to go back for a referral. I had a phone call in the morning: “You’re coming in to see the consultant tonight?” “Yes, I am. Is that still okay?” “Yes, it’s fine. Bring somebody with you.” That was the first indication that things perhaps were not going to work out. I took my mother, and they gave me the good news. I was being very cheerful because my mother was with me and I said, “The only thing I really want to know is can you sort it?” “Yes,” was the answer, so I was fine. “And can we get on with it?” I asked right away, and they did, in fairness. I started six cycles of chemotherapy over three months, which I got through relatively easily because of my health and my natural optimism.
I remember doing gardening for the first time in my life and planting a fig tree in my garden, and thought things were progressing quite well. Colleagues sent me books. My hon. Friend the Member for Bristol North West (Charlotte Leslie) sent me some poetry which was really nice of her and I will always be grateful. So that period passed well, and I had cracked it in my own mind: I was in that place, and I was moving forward.
Then, on 17 September, after a sort of debriefing appointment to ask me how I felt and how I was getting on with things, I had a letter which said: “I saw Mr Lopresti today in clinic. He has chosen to stop his chemotherapy after three months and so has completed treatment.” I thought to myself, “That conversation never took place,” and started to question myself and wonder whether I had heard correctly. Fortunately, I then had a consultation with the oncologist who said, “You will have six rounds of treatment over three months.” For the first time in my life I did not question instructions: I did as I was told. Actually, I am very impatient, and I just wanted to get on with it and get on with the next stage of my life, but I had started to question whether I had heard that correctly.
I thought about what had happened and spoke to my mother and my wife who had been there. They said, “Yes, they said, ‘It hasn’t spread, we’re going to cure it, and we’re going to give you six rounds.’” So I made a complaint. I said, “This has knocked me back probably almost as much as the original diagnosis,” because it shatters confidence in getting straightforward, reasonable, objective analysis and projections of treatment. I also thought, “What would have happened if I was an older person on my own and feeling quite vulnerable?” The apology I received explained that it was because a randomised control was being carried out and they were trying to work out whether giving somebody six rounds in three months was as good as 12 lots in six months. That is fine, and as it turned out my next scan was clear—as have been all my scans, so I am in good order. If they had told me, “You are relatively young and fit. You don’t need 12 lots because it can damage the nerves and there are long-term consequences”, I would have been okay with that, but in fact a conversation that did not take place was recorded and they wrote to me about it. I started to think, “If they can make a mistake on this, what else have I discovered?”
So I had the apology, and I went back to see my consultant. He said to me, “I have really good news. Your scan is clear. You are fine. We can just keep an eye on you or you can have some radiotherapy.” I said, “Look, given what has gone on, I want everything you’ve got. Whatever you’ve got, let’s do it once, get it done. I do not care if you have to carry me out of here, let’s try to get it first time.” In fairness, they did that. I had daily radiotherapy, which surprisingly was more debilitating and took more of my energy than my long course of chemotherapy. I think that was because it was daily and because of the way radiation reacts on the body.
As hon. Members have said, early intervention is, obviously, key. The referral to the hospital was done quickly in my case and was great. The problem was that three-month delay, when a tumour about the size of a fist was in my body. Fortunately, the cancer had not gone anywhere else, but I had a very lucky escape. It could have moved and gone elsewhere, and we could be having a different conversation. I agree that early intervention is key and people should get off to the hospitals quickly, but if there is any suspicion that something is cancer, people have an obligation to get on with dealing with it as quickly as possible, for all the obvious reasons.
I received great medical support and care from the nurses—the people at the sharp end, the people in the wards, the people who did my PICC line—but I felt slightly detached from the consultants. As I say, the experience of a letter completely misrepresenting an interview that took place was shattering and it shredded my nerves for quite a time. I am pleased that the Government have been working to achieve earlier diagnosis of cancer and to set up a strategy to save 5,000 lives by 2015. The latest projections are that, as a result, the NHS is on track to save an extra 12,000 lives each year. That is all fantastic.
What I wish to say in conclusion—I apologise for my emotion—is that when someone gets the diagnosis, they have to stay focused and stay as positive as they can. There are lots of help groups, such as Macmillan.
Mr Baron
I commend my hon. Friend for the bravery he has shown, not just in how he dealt with his complaint, but in sharing his journey with the House, because nothing is more powerful than hearing personal testimony. He illustrates better than anybody in the Chamber will do today the importance of good communication and consultation between patients and the NHS and the consultants. For me, at least, that is the key message he is portraying. It is terribly important, and I hope all of us and, in particular, the NHS learn from it.
Jack Lopresti
I thank my hon. Friend for his kind remarks, which I shall not dwell on. You do become, if not an expert, certainly quite knowledgeable, and are introduced to the cancer world. There is a lot of information out there. I was told by some consultants not to spend too much time on the internet, as you can go down different avenues and worry yourself to death, but there are lots of good books. I would recommend talking to Macmillan and other cancer groups, reading others’ stories, being inspired and being motivated. You should never lose heart.
Bob Stewart
I will finish for my hon. Friend. This is a very brave man, because he wants to join the Royal Air Force. He is fully fit, he does marathons—he is a lunatic of course—and he wants to join the Royal Auxiliary Air Force, whose tie I am wearing in support of his bid.