Health and Social Care

Jackie Doyle-Price Excerpts

Monday 13th May 2013 Commons Chamber

[Andy Burnham]

We are going to have to get to the bottom of this—not just the Secretary of State, but all his Ministers and advisers and all the No. 10 advisers—because it looks to us as though this Government have raised the white flag on having any semblance of a progressive public health policy. I cannot believe that the Liberal Democrats put their name to such reactionary stuff. Where is minimum alcohol pricing? Where is public health in this Queen’s Speech? They are totally absent.

[Jackie Doyle-Price (Thurrock) (Con)]

I appreciate that the right hon. Gentleman has very clear convictions and a desire to tackle smoking as a public health issue. However, a third of cigarettes smoked in London are contraband. How would standardised packaging deal with that problem?

[Andy Burnham]

I agree that we need to do something about that, and we did bring forward measures in government, but standardised packaging is not plain packaging: it is about having designs on the pack that could be used to ensure there is no counterfeit tobacco. Surely some things are more important—the young smokers in the hon. Lady’s constituency and mine who are targeted by the tobacco industry. Surely we in this House can unite on issues such as this and take steps to improve the long-term health of the country. It seems to us that the Government have given up on the health of the nation.

I said I would set clearly out for the House what I would do had I been standing at the Government Dispatch Box today. For a start, I would have introduced a Bill to repeal the disastrous Health and Social Care Act 2012, which has placed our NHS on a fast track to fragmentation and privatisation. That Bill would have restored the powers and responsibilities that the Secretary of State’s predecessor gave away, and which he found out last week he no longer has. I would legislate for the full integration of health and social care as the only realistic answer to the challenges brought by the century of the ageing society.

People can see that increasingly it is the Opposition who have the courage and the answers to deal with the big challenges the country faces, not a failed coalition that is now playing out time. Its toxic medicine of cuts and reorganisation has laid the NHS low, and now it has no answers to the chaos it created. That is because the Secretary of State only discovered last week that his own reorganisation had stripped him of his powers to intervene, leaving him looking weak—in office, but not in power. Having done that, the Government’s answer is to try to scapegoat others for problems of their making. It will not work—we will remind people that it was a right-wing reorganisation that has left the NHS destabilised and demoralised. We will never tire of reminding the Prime Minister that the British people never gave him their permission to put the NHS up for sale, and we will restore the right values to the heart of our NHS—compassion before competition, integration over fragmentation, people before profits. The NHS and the country deserve better than a Government who are out of touch and out of ideas.

Oral Answers to Questions

Jackie Doyle-Price Excerpts

Tuesday 16th April 2013 Commons Chamber

[Anna Soubry]

As I have said, I am precluded from giving any personal opinion, but I am sure that we will all take on board what the right hon. Gentleman has said.

[Jackie Doyle-Price (Thurrock) (Con)]

Recent press reports have revealed that as many as a third of the number of cigarettes sold in the London area are contraband. Will the Minister discuss the matter with those in other Departments, in order to ensure that the objective that we are trying to achieve by standardising packaging will be achieved by that means?

[Anna Soubry]

I shall be meeting the relevant Home Office Minister today to discuss that very issue, but let me repeat that, far from being a counterfeiter’s dream, the packets produced in Australia would clearly be a nightmare here. A variety of colours, watermarks and holograms, and all manner of other things, can be attached to them, which is why they are described as “standardised” rather than “plain”.

Mid Staffordshire NHS Foundation Trust

Jackie Doyle-Price Excerpts

Tuesday 26th March 2013 Commons Chamber

[Mr Hunt]

The inspection regime will of course cover such issues as part of its inspection of whether basic standards of care are being met. Yes, of course such issues matter, but there are challenges beyond what an inspection regime can deliver which we will need to address to deal with these issues. In particular, a problem we are wrestling with at the moment is who will take responsibility for the frail elderly when they are discharged from hospital. One reason why they stay in hospital for a long time is because geriatricians are nervous about sending them back into the community. They do not think anyone will take responsibility for them and that is something we have to look at.

[Jackie Doyle-Price (Thurrock) (Con)]

On the respective roles of CQC and Monitor, can my right hon. Friend indicate that he expects Monitor to use the full regulatory tools at its disposal and give appropriate challenge to the boards of foundation trusts and hospitals where failure is indicated?

[Mr Hunt]

My hon. Friend is absolutely right. One of the changes we are announcing today is that, in the case of foundation trusts, CQC will be delegating its enforcement powers to Monitor so that it has more powers to insist on necessary changes and ensure that fundamental standards are not being breached.

Accountability and Transparency in the NHS

Jackie Doyle-Price Excerpts

Thursday 14th March 2013 Commons Chamber

[Jackie Doyle-Price (Thurrock) (Con)]

It is a pleasure to follow my hon. Friend the Member for Harwich and North Essex (Mr Jenkin) and give a south Essex perspective on this issue by speaking about the Basildon and Thurrock Foundation Trust. It was found to have significant failings and high mortality rates in 2009, which led to regulatory intervention, on which the right hon. Member for Leigh (Andy Burnham) will recall delivering a statement to this House. At that time, the Care Quality Commission voiced its lack of confidence in the management at Basildon, but there was no change and no one was held to account.

As we all know—and as my hon. Friend has eloquently explained—institutions fail when they are poorly led. In the event of failure, senior management need to step up to the plate, either to take a grip of matters and force change or to take responsibility. The failure in accountability at that time has no doubt held Basildon back. Subsequent CQC inspections found Basildon failing in terms of care and welfare, safety of premises, safety and suitability of equipment, nutritional standards, dealing with serious incidents, record keeping and cleanliness. That is simply not good enough.

When I challenged the hospital management, the response was invariably, “We’re no worse than anyone else; we just get more scrutiny.” Indeed, in one letter the then chief executive criticised the sensational reporting of some unnecessary deaths at the trust and asked for my assistance in acquiring more positive media coverage, a clear example of the complacency to which the Prime Minister referred when he made his statement to the House on the Francis report. There simply has not been sufficient urgency in addressing weaknesses. That led me to conclude that the trust would not improve without a change in leadership—the same conclusion the CQC reached in 2009.

I also have some wider reflections on the systems of governance. At Basildon, the board clearly failed in its duty to provide effective challenge and to hold the management to account. I think that we need to give a clear indication to directors of foundation trusts that in the event of poor performance, the buck stops with the board. They are accountable and they need to accept that responsibility.

I must say that I found the CQC a very positive ally in seeking better performance at Basildon. I know that it has been criticised by some Members, but my feeling is that its powers were quite limited. It certainly had no power to hold senior management to account, a power that is reserved for Monitor. My right hon. Friend the Secretary of State has made his comments about the CQC, but I think that he really needs to look at Monitor. In my experience, the work of Monitor has been very disappointing. In Basildon it was not keen to take any enhanced action. Its view was that the trust was not doing as badly as it had been in 2009 and so the direction of travel was positive, even though it was failing to meet the basic standards of care that the public should be able to expect. I do not think that is good enough. It goes to the heart of what we are debating today: the collective failure of institutions in the NHS to hold people to account when things go wrong. I urge my right hon. Friend to look at whether Monitor is really fit for purpose.

Since I started challenging Basildon and Thurrock NHS Foundation Trust, I have been very heavily criticised, as if by holding the hospital to account for its performance I am attacking the NHS and its staff. The contrary is true. If we really believe in the NHS and in providing the best possible health services for our constituents, we must challenge it when things go wrong. We should have zero tolerance of failure. Do we not owe it to the staff who do their job well to ensure that those who do not are disciplined and held to account for poor conduct?

Thankfully, Basildon and Thurrock NHS Foundation Trust is now under new leadership. There are new non-executive directors who will provide a challenge. We have a new chairman, a new chief executive and a new medical director, and I am encouraged by the messages I have received from them. However, when senior management have been excusing poor practice for so long, there is a need for profound cultural change to get things fixed. An NHS with a stronger emphasis on accountability would have allowed us to start that process in Basildon so much sooner and to save many lives.

Backbench business

Jackie Doyle-Price Excerpts

Thursday 14th February 2013 Westminster Hall

[Caroline Nokes]

My hon. Friend makes an important point about the mortality rates, compared with those for other mental illnesses. In this place, we have made great strides in being far more open and willing to discuss mental illness. This illness is hidden, and has not received priority or generated the attention that it so desperately deserves. It is incumbent on all of us to ensure that the Minister, who I am sure is listening, gets that message loud and clear.

[Jackie Doyle-Price (Thurrock) (Con)]

Whenever we approach a public health concern such as this, one of the biggest things we have to do is educate the public. The media are an important partner in that. Does my hon. Friend agree that the media’s obsession with the cult of celebrity, and the focus on that, is holding us back on a significant public health issue?

--- Later in debate ---

[Caroline Nokes]

The hon. Lady makes exactly the point that I am coming on to: it is critical that when sufferers feel that they can reach out for help and acknowledge that they have a problem, the help is there for them. A delay of six to nine months can be dangerous—or, indeed, fatal.

[Jackie Doyle-Price]

Is my hon. Friend satisfied with the level of knowledge among medical professionals? Is there a job to be done in raising awareness of what they should be doing and of the signs that they should be looking for among sufferers of these disorders?

[Caroline Nokes]

I have been struck by the number of times that relatives of sufferers have contacted me to make the point that their family member was slow to get a diagnosis, or to say that the GP dismissed the eating disorder as nothing more than a teenager being a bit fussy about their food. It is critical to raise awareness, not only among the wider community and the media, but among our general practitioners, because we need these disorders to be identified earlier so that damage to growing bodies, in the instance of young people, does not become permanent.

--- Later in debate ---

[Mr Howarth]

The hon. Lady is correct. I intend to address that issue when I bring my comments to a close, and I will make suggestions for what we need to do.

The consequence of people being treated either by a diabetologist who does not understand eating disorders, or by an eating disorder specialist who does not understand diabetes, is that they can be signposted to an unsuitable service altogether, or unforgivably, they will not be taken seriously when they have a serious problem.

An example I have been told about involved a young woman sufferer who was told that she was too heavy. That is not to say that she was heavy; she was very light, but she did not meet the criteria for being light enough to have an eating disorder, and was consequently told that she did not qualify for any support. The advice that she was given was that she needed to relax about food. Anybody who knows anything about diabetes knows that the relationship diabetics have with their carbohydrate intake is crucial to their well-being, so to say to a diabetic, “Go away and get more relaxed about eating”, could put them in a position where their life is threatened. Subsequently, the young woman concerned had to be admitted as an emergency case to hospital with ketoacidosis, which, had it not been treated quickly enough, would have been fatal. That was somebody who had presented themselves in the health system, looking for help, but was told to go away and get a better relationship with food.

DWED has some aims that I hope Ministers can address, and I shall go through those now. First, it wants to establish the principle, which I strongly support, that no diabetic with an eating disorder should be misdiagnosed or told, “There is nowhere to put you”, which is what is commonly said to them at the moment. That comes back to the point made by the hon. Member for Romsey and Southampton North.

Secondly, for type 1 diabetics with eating disorders—what I have termed as diabulimia—the condition needs to be properly recognised as a serious and complex mental health problem. I do not think that it is controversial for the hon. Lady to refer to it being a mental health problem, because although, in all the cases that she gave, there are serious physical consequences, the springboard often relates to mental health, relationship with body image, and so on.

Thirdly, those who seek treatment should receive the correct treatment with respect and compassion, on the basis of a multidisciplinary approach. In the example that I gave, there was not enough expertise in one specialism to be able to satisfactorily deal with the problem. Such an approach requires the Department actively to promote an understanding of the problem, so that health professionals catch on to what is happening. Protocols probably need to be in place, so that when somebody presents themselves with such a condition, health professionals know what to do.

The only people raising this problem, apart from me in today’s debate, are DWED, who work together with other bodies, such as Diabetes UK. DWED currently exists on an income, in the last financial year, of £9,000, which is not even enough to employ one full-time member of staff. DWED operates on the basis of having previous sufferers who are volunteers, under the co-ordination of Jacqueline Allan, who I mentioned earlier. I do not know whether it is more appropriate for support to come from foundations or the Government, or somebody else. I am not talking about needing hundreds of thousands of pounds, although I am sure that DWED would welcome that, but some way needs to be found to support the one organisation that is campaigning on, and raising and dealing with the problem. Given the importance of its unique role, I hope that the Government can find some support—not only for DWED, but for the issue as it exists across the health service.

Finally, just as it is vital that health professionals take a more multidisciplinary approach to this and other eating disorders, it is equally important that the Government take a more joined-up approach. I could have made the same criticism of the previous Government, and I realise how difficult it is to get a joined-up approach to eating disorders and many other things. However, on medical cases, there needs to be co-operation between different Departments, because a stronger push is required on the issue of body image and how that is dealt with. Perhaps it is not best dealt with by the Department of Health, but at the same time, some of the health issues involved need to be addressed.

[Jackie Doyle-Price]

Perhaps I can put an alternative view to the right hon. Gentleman. In my experience, people do not like being told what to do by the Government. If we acknowledge that the media are among the biggest perpetrators in pushing forward images that we should all aspire to, do we not need a good, populist campaign to educate the public that actually, curves are great?

[Mr Howarth]

The hon. Lady makes a good point. There is this idea of politicians wagging our fingers and saying, “This is what you should do”. For a couple of years in the previous Government, I had the responsibility in the Home Office for drugs policy, and one thing I know is that middle-aged men like me—perhaps I am flattering myself there—are probably the worst people to go into the media and say, “Actually, you should not be taking drugs.” A subtle, sophisticated approach is needed. A lesson from that, which applies equally here, is to provide information to young people so that they know the consequences of what they do. One problem we are dealing with is that people think there is an easy way to lose weight and to get to be the shape that they, or others, think they should be. Action has to be taken smartly, on the basis of real information about consequences, but it still has to be done.

The hon. Lady anticipated my next point, which is the responsibility of people in different industries. There is relentless media hype about what the perfect body shape should be, and the irresponsible attitudes often displayed by the fashion and entertainment industries need to be highlighted. Looking round the room, there might be one or two people who can remember what it was like to be a teenager—[Interruption.] I take that back. Several people around the room well remember what it is like to be a teenager, and one experience that we probably all share, and that every teenager in history has shared, is insecurity. They have not developed into who they are going to be, and they are insecure about everything, including their appearance—as is obvious, I have long since given up worrying about my appearance—the way they present themselves to the world, what it is to be cool, and all those things. A lot of that is dictated by what they read in magazines and see on cable channels—even on mainstream reality television shows.

It is wholly unrealistic for the industries that show those images to say, “Well, that’s a matter for the Government.” They have a responsibility to provide for young people role models that are realistic, that are just like the rest of the world, that show young people that they do not have to look like those images to be an acceptable, successful and attractive member of society. That responsibility is not just for Government or politicians, but for everyone who is in a position to influence how these things are presented to young people in particular, and to society in general. I hope that, as a result of this debate, we can at least move that agenda along a little further.

--- Later in debate ---

[Heather Wheeler (South Derbyshire) (Con)]

I appreciate being called to speak, Mrs Osborne, particularly because I am going to nip off later to the second debate in the main Chamber. I hope that my hon. Friend the Minister will forgive me. It is a pleasure to serve under your chairmanship, Mrs Osborne.

I begin by paying tribute to my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) for securing this very important debate during eating disorders awareness week 2013. She is respected by hon. Members on both sides of the House for her knowledge of this issue. I thank her for the tireless way she is championing an issue that is one of the most pressing and, if the medical profession’s statistics are to be believed, one of the most rapidly growing health issues that the nation faces. Indeed, male admissions to hospital are up by 68% in 10 years.

I also pay tribute to the all-party group on body image, of which my hon. Friend is the chair and which exists to inform the media, the fashion industry and wider society of the complex issues arising from poor body image. Body image is, as reported by the First Steps charity, which works in my constituency of South Derbyshire, one of the most significant causes of disordered eating behaviour. It is heartening that such groups exist and it is evidence that, in some small measure, awareness of the issue is starting to grow. Only a few years ago, the very idea of a group committed to improving body image would have been met with a roll of the eyes and a dismissive comment, yet the reality has always been that women, and now increasingly men, spend fruitless hours examining themselves critically in front of the mirror and obsessing over every lump and bump. They are often driven to self-loathing by what stares back at them.

Poor body image and a media full of unrealistic and unobtainable examples of body shapes that we are told to emulate are undoubted drivers in individuals who go on to develop eating disorders. Many who suffer low self-esteem and poor body image, especially men, go on to suffer serious mental health problems, often manifested in eating disorders and chaotic, dysfunctional and disordered lives, and suffer lifelong unhappiness. Therefore, the focus of the all-party body image group is more than welcome; it is essential and, indeed, it is a weather vane for how attitudes towards such real human issues are changing for the better as awareness of these issues improves.

Eating disorders are a complex issue to discuss in just a few minutes. It is a shame that this debate is not getting the priority that it deserves, perhaps by taking place in the main Chamber, but I am very grateful to the Backbench Business Committee for allowing the debate to be held in Westminster Hall. The number of MPs and, indeed, members of the public here today is testimony to the issue’s importance. Having the debate in the main Chamber would have gone a considerable way towards assuring sufferers that Parliament is at least serious about raising awareness of these issues and the problems that people face.

Of course, not all people with eating disorders come forward to get the help that they need. The most accurate figures of which we are aware are those from the National Institute for Health and Clinical Excellence. They suggest that 1.6 million people in the UK are affected by an eating disorder, of whom about 11% are male. Worryingly, the most vulnerable group are our young people, particularly those between the ages of 14 and 20.

[Jackie Doyle-Price]

Bearing in mind that we have heard from previous speakers in the debate that there is a critical window for intervention to support these people, and given that the incidence of these disorders tends to occur in the mid to late teens, does my hon. Friend think that there is a case for more education of our schools and teaching staff so that they know what signs to look for?

[Heather Wheeler]

Absolutely. I thank my hon. Friend for her intervention; she is absolutely right. We have been debating in the main Chamber what should go on the curriculum for personal, social, health and economic education. Perhaps the Minister can reflect on that in his speech. I apologise to him again for the fact that I will not be here at the end of the debate. I will read his speech in Hansard next week.

It is the case that 1% of the population between the ages of 15 and 30 suffers from anorexia. About 40% of those who suffer never fully recover and 30% suffer the illness in the long term. Official figures show that eating disorders rose by 16% in England from 2011 to 2012. The scale of the problem is therefore hard to ignore.

This subject raises issues pertaining to public health, mental health, nutrition, education and the way in which families are supported in dealing with disordered eating behaviour at an early age. That final point is, for me, the most important one and the one on which I shall focus in the few seconds that I have left. I am referring to how we raise awareness of disordered eating behaviour in such a way and at an early enough stage that recognition and treatment are possible and at a time that predates the long-term physical health problems that eating disorders can cause.

So many who suffer from eating disorders start to experience their troubles as children and adolescents. Many suffer in silence, and in so doing curse their lives, not just with a disordered relationship with food, but by destroying both their physical and their mental health in the process. That will probably affect every aspect of their lives: their career, their relationships and even, sadly, in some cases, their ability to become parents themselves.

The underlying cause of much disordered eating behaviour is a person struggling to cope with anxiety, stress and poor mental health. The cause of that anxiety and stress may be bullying. It may be an escape from abuse or traumatic events. The cause may be a lack of control, bereavement, poor parenting or simply uncertainty over one’s place in the world. However, the cause is undoubtedly psychological. The illness therefore deserves genuine sympathy and understanding, not dismissive attitudes, which compound the problem. Perhaps over time, the disordered eating behaviour may be modified through self-discipline or self-awareness. The sooner someone gets the treatment they need, the more likely they are to make a full recovery.

For the reasons that I have set out, this issue deserves at least equal priority with other physical and mental health problems. We cannot ignore or be indifferent to the obvious consequences of eating disorders. We have only to look at those who so bravely suffer them to see why we as a society must do more to tackle them, and we must start by raising awareness of their existence, their causes and their cures.

Selective Dorsal Rhizotomy

Jackie Doyle-Price Excerpts

Wednesday 18th April 2012 Commons Chamber

[Chris Heaton-Harris]

I thank my hon. Friend for that intervention. I will come to that, but I entirely concur. The earlier the problem can be tackled, the better, in general terms.

As I mentioned previously, the global medical community gradually became aware of Dr Park’s superb work in St Louis. Here in the UK, on 3 May last year, the very first UK micro-neurosurgical SDR was performed in Frenchay hospital in Bristol. Kristian Aquilina, the consultant neurosurgeon, and his team carried out this operation. Towards the end of last year, I took Mr Aquilina and some parents whose children have benefited from SDR, including my constituent Jo Davies into the Department of Health for a very helpful meeting with a couple of the Minister’s officials, in a bid to encourage the NHS to offer SDR here in the UK. The hope is that there would be three or four centres of excellence that could offer the operation to those patients who had been evaluated as able to benefit massively from the procedure.

From speaking to Mr Aquilina, I know that he has now set up a multidisciplinary team at Frenchay hospital to evaluate and select children for SDR. This team consists of a number of people—a paediatric physiotherapist with special expertise in cerebral palsy, a paediatric neurosurgeon, a paediatric orthopaedic surgeon and a paediatric neurologist. Mr Aquilina tells me:

“Children over four years of age, with a diagnosis of spastic diplegia following premature birth, should be considered for SDR. Children with typical spastic diplegia, whether born prematurely or at term, should also be considered. These children tend to have delayed motor development and spasticity interferes with their progress.”

I am also aware that another surgeon, Mr John Godden, from Leeds has been out to St Louis to learn about the procedure and is ready to undertake his first operation.

One of the common causes of cerebral palsy is premature birth and there is now extensive evidence, recognised by NICE, that demonstrates the value of SDR for these children. The NICE guidelines for SDR were issued in December 2010 and concluded:

“The evidence on efficacy is adequate. Therefore this procedure may be used provided that normal arrangements are in place for clinical governance and audit.”

But a more recent guideline focused on the lack of long-term studies of outcome and changed the first NICE guidelines, recommending that SDR be done in the context of clinical research. The problem with that is that a long-term study for, say, 10 or 20 years after surgery, costs an awful lot of money, and because no long-term study has been done on any of the non-surgical and surgical treatments currently employed here in the UK, following that rationale to its logical conclusion would mean that this successful proven treatment for cerebral palsy cannot be covered by the NHS for years.

[Jackie Doyle-Price (Thurrock) (Con)]

I commend my hon. Friend for the eloquent way he is making the case for the procedure. I have two cases in my constituency where the local community has come together to raise £40,000 each time to fund the treatment. On the point that my hon. Friend is making about the need for long-term trials, surely all NICE needs to do is to look at those children and how their lives have been transformed by that procedure.

[Chris Heaton-Harris]

I absolutely agree. In the United States, SDR has been practised since late 1986. Dr Park has been performing the operation since May 1987. SDR is currently performed in many medical centres across the US and has undergone unprecedented scientific and clinical scrutiny by orthopaedic surgeons, neurologists, rehabilitation medicine practitioners, therapists—the lot. At this time, medical evidence shows that SDR is more robust than any other treatment for cerebral palsy. It is the only treatment that can reduce spasticity permanently and that enables patients to move better and thus allows them to exercise as they grow, which anyone with spasticity cannot do. SDR at an early age reduces the rate of orthopaedic surgery and there are many other proven benefits.

SDR is safe. Of Dr Park’s 2,300-plus patients, only two have developed spine problems and three have had spinal fluid leaks that needed surgical repair. None has developed neurological complications such as paralysis or loss of bladder control. Some of Dr Park’s patients who had SDR 20 or 25 years ago are now in their mid-40s and not one patient has returned to him with late complications.

The purpose of the debate is to ask the Minister, his Department, NICE and the commissioners of procedures in the future to look at the success of SDR elsewhere in the world and help those practising it in the UK to overcome any of the remaining hurdles so that it can be performed on the NHS without problems or charge.

Children suffering from cerebral palsy in the UK are invariably given a frame for the first four or five years of their life and are then given a wheelchair when it becomes too difficult for them to walk with the frame. SDR can enable many of those wheelchair-bound children to walk independently, sometimes for the first time. An excellent example of this is a constituent of my right hon. Friend the Member for Carshalton and Wallington (Tom Brake), Dana Johnston, whom I had the pleasure of meeting very recently and who used a wheelchair 90% of the time before she had the SDR operation. Now, eight months after that operation, Dana does not use her wheelchair at all and is looking forward to a future of walking everywhere and living as close to a normal life as possible.

SDR would not be a very common operation, but it would change those who undergo the procedure from being recipients of taxpayers’ money via the NHS over a protracted period—in fact, for their lifetimes—to being active, tax-paying members of society in the future.

In Chichester, a friend of a friend is trying to raise £24,000 so that his grandchild, Finlay Fair, can be operated on by Mr Aquilina in Bristol. Indeed, Finlay’s financial target has nearly been reached and if all is well he will be operated on later this month. As I mentioned earlier, in the past three years or so 145 parents have raised the £40,000 and more required to get their children SDR in St Louis. I completely understand that the NHS, the Department of Health, NICE and any future commissioning body will all have procedures and processes that need to be followed, but surely it is now time for us to say that this life-changing, well-researched operation should be funded across the country by the NHS. We have surgeons with the expertise, an operation with a long-track record of success and children who could be walking and running independently, rather than being consigned to a life in a wheelchair.

I ask the Minister for whatever support he can give to ensure that SDR is offered by our excellent national health service so that in the future the parents of remarkable children such as Holly Davies, Dana Johnston and Finlay Fair as well as those given as examples by my colleagues do not have the burden of having to raise large sums of money to pay for their children to have this amazing, life-changing operation.

Information Technology (NHS)

Jackie Doyle-Price Excerpts

Tuesday 14th June 2011 Westminster Hall

[Jackie Doyle-Price (Thurrock) (Con)]

I congratulate my hon. Friend the Member for South Norfolk (Mr Bacon) on securing this debate. I pay tribute to his tenacity in pursuing the subject. I know that he has a long-standing interest in it, and rightly so given the amount of money being spent on the project. I cannot compete with the way in which he articulated his case, or with his forensic and almost anorak-like knowledge of the subject, but I associate myself with the conclusions that he draws.

The project has always been over-ambitious. We would all agree that it has been poorly led and ineffectively delivered. As with many procurement projects in the public sector, the cost has escalated considerably. We have seen it happen too many times, and it is always entirely predictable. Indeed, senior leaders in the NHS were warned about that from the start.

The intention to ensure that health data should be made available at any time and anywhere was laudable, but delivering it has to be offset against the cost and whether it offers good value for money. Clinicians, practitioners and IT specialists throughout the NHS said that it would not work. Ultimately, clinicians will find their own way of doing things, and a top-down system will not work unless it is executed from the bottom up. As my hon. Friend explained, the decision to involve clinicians in the design of the system was not taken until late in the day and probably beyond the point when they could have had a useful input to ensure that the programme was fit for purpose.

Let me underline what my hon. Friend said. If we look at the initial programme of delivery and what we have achieved, we can see that we have not progressed far. Of the 4,500 sites that were contracted to receive the system, some two thirds have yet to receive anything. If we examine the progress made by Computer Sciences Corporation—my hon. Friend has outlined the history of its involvement with this case—we will see that it is contracted to deliver its systems to 97 hospitals, but so far it has delivered only four and none has been able to confirm that the system has been installed satisfactorily. Put simply, CSC has not delivered the goods against its obligations on the contract.

Once the contract is in place, everyone signs up even though it is quite clear that the company is not delivering what it promised. To be fair, in this case, the NHS started to renegotiate the contract in December 2009. None the less, more than 18 months later, no new contract or renegotiated contract is in place. CSC is still working on the same terms that it initially agreed to and we still do not have adequate delivery.

The NHS was quite clear when it said that it would not sign a new contract until it could see that Lorenzo was working. It is clear that we have to take some tough decisions because it simply is not working. As it is taking so long, we have to decide whether we are managing the project efficiently. Just how poorly does a contractor have to perform before a serious charge is made as to whether that contract should be maintained?

The NHS is an extremely powerful client. I know that suppliers have duties and obligations to their shareholders, but surely maintaining a good relationship with a customer that is as big as the national health service or even as the Government is important. We would expect suppliers to be slightly more conscious about what they are obliged to deliver.

[Duncan Hames (Chippenham) (LD)]

I listened very carefully to the initial speeches in this debate. The story that I heard was that there are suppliers and contractors who have fallen by the wayside and who have been shot and had their business fed to the others. That leaves us with the dilemma of what happens if we are left with only one supplier. Where does that leave the bargaining position of the NHS? My hon. Friend will find that there have been contractors who have found that they were not going to get paid because of their inability to deliver on their contracts.

[Jackie Doyle-Price]

My hon. Friend makes an extremely good point. To be fair, those suppliers have acted extremely honourably with regard to their obligations under the contract. When it became clear that they could not deliver the software under Lorenzo because it was not fit for purpose, they took the honourable action and negotiated their way out. Such behaviour shows a lot about those suppliers. It is increasingly worrying that CSC in particular is finding itself in a monopoly position because it has acquired and strengthened its shareholding in iSOFT. Who we negotiate with in the future is a long-term worry.

I associate myself with the conclusions of my hon. Friend the Member for South Norfolk about when we should take a decision on this project. Is it time for an emperor’s new clothes moment, or are we going to continue throwing good money after bad in a project that is clearly not going to deliver?

[John Pugh]

Is it not enormously hard for parliamentarians to form a judgment on that when we are not party to the actual contractual details? We do not know what cancellation involves for the firm or for the development of the project.

[Jackie Doyle-Price]

That is a good point. I was coming on to say to the Minister that he must examine this matter with considerable rigour before deciding on the right course. The message that we got from the Department was that such contracts are complex, although it was rather unclear just how complex this one was. I urge the Minister to achieve maximum value for money because ultimately this is a lot of money that could have been spent on patient care rather than on delivering this programme.

My final point relates to how these big procurement projects should be managed. We have examined a number of them on the Public Accounts Committee. Too often we find examples of poor project management. Poor leadership is assigned to these projects, which then go on to spend incredibly large amounts of taxpayers’ money.

When Sir David Nicholson appeared before the Committee, he was unable to answer a number of questions that my hon. Friend the Member for South Norfolk put to him even though he has been the senior responsible owner of the project since 2006. Until the machinery of government can put in place good project management disciplines to deliver effective leadership, we will continue to spend a lot of money and to fail to deliver on the intended project. I hope that this is a lesson not just for the Department of Health but for the Government as a whole and especially the Cabinet Office as it looks at how it delivers these projects and puts in place good disciplines, so that this unhappy experience is not repeated.

NHS (Essex)

Jackie Doyle-Price Excerpts

Tuesday 15th March 2011 Westminster Hall

[Jackie Doyle-Price (Thurrock) (Con)]

Thank you, Mr Dobbin. Like my hon. Friends, I should like to congratulate my hon. Friend the Member for Witham (Priti Patel) on securing this debate and on giving an articulate exposition of the inherent tension between process and outcomes. I think that one thing that we are all looking forward to from the Government’s health reforms is a greater focus on achieving outcomes and rather less on the processes that she has outlined.

This issue is of great importance to my constituents in Thurrock. Frankly, considering recent years in particular, the performance of our local health services needs to be better. I pay tribute to the staff involved in the care and treatment of patients—they discharge their efforts with the best of intentions and commitment—but, as my hon. Friend the Member for Southend West (Mr Amess) has pointed out, what is often lacking in the health service is leadership. In south-west Essex in particular, poor management at a number of levels has resulted in too many people being failed and in local people’s confidence in the local health provision being too low. We all need to work hard to improve that and give people the health services they deserve.

I shall give some clear examples. My constituents rely on services provided by Basildon hospital, and the primary care trust responsible for delivering them is South West Essex PCT, which is currently implementing a severe programme of cuts, following a significant overspend. I shall deal with the hospital first, but as hon. Members will realise from my remarks, the ongoing issues at Basildon are interlinked with the overspend in the PCT. Dealing with that overspend will have implications for the hospital, too, so there is a great deal of uncertainty among my constituents, and a serious lack of confidence in local health services at present.

Basildon hospital has had a difficult recent history. In November 2009, the then Secretary of State, the right hon. Member for Leigh (Andy Burnham), made a statement in respect of Basildon hospital, following concerns about excessively high mortality rates there, which my hon. Friend the Member for Southend West will remember extremely well. The then Secretary of State said:

“There is still considerable variation in standards throughout the NHS, from one hospital to another, and in some cases the variation is unacceptably wide. That is the case in respect of Basildon and Thurrock University Hospitals NHS Foundation Trust.”—[Official Report, 30 November 2009; Vol. 501, c. 855.]

[Hywel Williams in the Chair]

Since that time and despite various programmes to tackle poor performance at the hospital, my constituents and I are concerned that such variation is unacceptably wide. The hospital management tell me that things are improving, but my postbag tells a very different story. Although many constituents report excellent treatment at the hands of the hospital, simply too many do not. As I say, week in and week out, there are reports in the local press of new things that have gone wrong. The impact on my constituents is that they simply do not have confidence in the hospital and they do not want to be treated there.

It is true to say that there has been some improvement since 2009 but, returning to the then Secretary of State’s statement, that has happened from a very low base. The Care Quality Commission continues to find that there are serious deficiencies in patient care. Most recently, the CQC’s February 2011 report states that of 16 measures taken into account, four needed action and six received suggestions for improvement. Criticisms include a lack of consistent nursing care, a failure to check that equipment is safe, the need for improvements to care for patients with dementia, and issues with poor nutrition and weight loss going unreported.

The hospital’s management are taking rather too much satisfaction from the improvements reported by the CQC. It does no one any good that the reputation of Basildon hospital remains so low. However, there is an opportunity to achieve real change. The current chairman is due to depart and I hope that the Minister will take steps to ensure that the opportunity is taken to provide some decisive leadership to the board, so that the real challenge to improve performance can be dealt with.

On the state of NHS South West Essex, many treatments have recently been cut by the PCT—including in vitro fertilisation—and restrictions have been put on cataract operations. As a Government, we have promised to protect the NHS budget from cuts and we have held to our promise. However, in south-west Essex, people just do not believe us because they are faced with a cost-cutting programme to fix a black hole of some £50 million. How did the PCT get into such a mess? In the past two years, it has taken on 100 extra backroom staff. Those people were not involved in front-line delivery; they were working in the PCT headquarters. The PCT also spent money building a community hospital in Brentwood that is far bigger than required. When I visited that hospital, I went around switching on lights in redundant facilities. That service was commissioned under the private finance initiative, so it will be an enduring cost to the NHS budget. It is a classic example of complete incompetence in managing the commissioning of a service.

A further reason for the overspend brings me back to what has happened with Basildon hospital and the impact that that is having on the wider health provision in south Essex. As confidence in Basildon fell, patients were desperate to be treated elsewhere, which meant that the PCT had to buy services from other hospitals in Essex, London and Kent. The hospital was faced with a loss to its income because of the decline in demand, and it dealt with that by routinely booking additional out-patient appointments in the knowledge that the PCT would pick up the bill. Such a situation added to the financial pressure.

No one has been held to account for the PCT’s overspend. Patients therefore perceive what has happened to be a direct result of the Government’s programme. I cannot emphasis enough that that is not the case. The responsibility for that overspend rests firmly with the PCT’s management. It is disappointing and bad for public confidence that no one has taken responsibility. Unless someone is held accountable, how can we ensure that our constituents regain confidence in the system and trust what we say? When we say that we are ring-fencing the NHS budget, that sounds pretty hollow to my constituents. I pay tribute to Andrew Pike, the newly appointed chief executive of the PCT. He has grasped the nettle and is making the necessary painful decisions to turn the situation around. The price of that is an accelerated programme of redundancies and carefully managed demand for services. That means patients are not getting seen as quickly as they would have done, and my constituents are not getting the same standard of service they would if they lived elsewhere. It also means that the new hospital planned for Grays is likely to be delayed as we fill the black hole, which will lead to much disappointment locally.

I look forward to hearing the Minister’s comments on those issues. Too often, poor performance in the NHS goes unchallenged. While ever-senior NHS managers continue to draw hefty salaries, the least we can expect is that when things go wrong, someone steps up to the plate and takes responsibility. It is galling for members of staff to receive redundancy notices when the people who are responsible for that overspend remain on the NHS payroll. I hope that the Minister will take action to improve accountability among senior management because that will go a long way towards rebuilding confidence.