Oral Answers to Questions

James Davies Excerpts

Tuesday 5th July 2016 Commons Chamber

[Jane Ellison]

I am not in a position to be specific about when we can make a statement, but I can give the hon. Lady and other interested Members the absolute assurance that we continue to look closely at the issue. We have read every single response that we have received. I was at a well-attended all-party group meeting on 25 May and gave people a sense of the direction of travel of our analysis. I hope to keep the House updated.

[Dr James Davies (Vale of Clwyd) (Con)]

Will the Minister confirm how he plans to implement the General Practice Forward View? Will he also confirm that sustainability and transformation plans will be returned to for further development if they fail to deliver the investment in general practice mandated by the forward view?

[The Minister for Community and Social Care (Alistair Burt)]

Yes indeed, we are developing detailed plans to implement the 80-plus commitments set out in the General Practice Forward View, which has been widely welcomed. The development of GP practices will be incorporated into sustainable plans.

Alcohol Consumption Guidelines

James Davies Excerpts

Tuesday 28th June 2016 Westminster Hall

[Byron Davies]

I am not quite clear on the hon. Lady’s point. I genuinely believe that this is a kind of social engineering, which I totally disagree with. A recent survey commissioned by the Campaign for Real Ale showed that a majority of GPs disagreed with the new advice and believes that drinking alcohol in moderation can be part of a healthy lifestyle.

[Dr James Davies (Vale of Clwyd) (Con)]

I congratulate my hon. Friend on securing this debate. As a GP, I can confirm the current lack of faith in the validity of the guidelines. Many feel, for instance, that the social benefits of moderate alcohol intake have not been given sufficient weight. Does he agree that, if they are to be observed, it is vital that guidelines are trusted?

[Byron Davies]

That is the crux of the matter—my hon. Friend makes a very valuable point, which I am delighted that he, as a practising GP, has made.

Lewy Body Dementia

James Davies Excerpts

Tuesday 26th April 2016 Westminster Hall

[Conor McGinn]

The hon. Gentleman, whom I would feel comfortable referring to as my hon. Friend, makes the point with his usual eloquence, and I could not agree more. I will say a little more later about some of the research being done.

Dementia is not just about memory. The supportive symptoms of DLB are fainting, falls, problems with swallowing and continence, delusions, depression and hallucinations, including hearing, smelling or feeling things. Some people have benign or pleasant hallucinations of, for example, children or animals. A sense of the presence of someone who is not there is common in many patients. Other sufferers see frightening and disturbing things and may react to them by displaying challenging behaviours that prove very difficult for the family to manage.

More than 700,000 people in the UK have dementia. That number is projected to rise to 1 million by 2021 unless significant advances are made; indeed, the figure is expected to double in the next 20 years. As the hon. Gentleman said, the issue now touches the lives of virtually every family in the United Kingdom. It is a big issue for the NHS, but also for all local authorities and, indeed, all public services. In the UK, approximately 100,000 people are thought to suffer from DLB. At least 5% of people aged 85 or older are thought to suffer from this little known, but not uncommon, and devastating disease.

It is important to note that diagnosis rates of dementia across the country are low and incredibly varied. In the UK, less than half of people living with dementia are diagnosed, let alone differentiations being made between the types of dementia.

[Dr James Davies (Vale of Clwyd) (Con)]

I thank the hon. Gentleman for bringing this important debate to the House today. He says that diagnosis rates across the country are patchy, but will he acknowledge that there has been good progress in general with dementia diagnosis, and that there is increasing awareness through dementia-friendly communities and so on? There is, however, a poor understanding of this type of dementia, and it is vital that we move ahead in informing the public and clinicians about not only dementia, but the various types of dementia.

[Conor McGinn]

I thank the hon. Gentleman for his intervention. I agree with him and will come later to some of the issues that he raises. I come to this debate in a spirit of co-operation, recognising the good work that has been done, and looking at how we can work effectively together to continue and develop it.

It surprised me that officially there are no data on the diagnosis of DLB. There is, however, an ongoing National Institute for Health Research-funded study examining diagnosis rates of DLB in the NHS. Current findings indicate that the rates are more than 50% lower than expected, with considerable variation, again, between services. I am sure that the Minister will agree that early and accurate diagnosis is of great importance and can allow more people to have as good a quality of life as possible for as long as possible.

As always, it is the human experience of the disease that expresses fully its awfulness and tragedy. My constituent Jacqui Cannon, who is chief executive of the Lewy Body Society, told me:

“In 2007 my darling dad was diagnosed with dementia with Lewy bodies. My father had been behaving increasingly strangely for a few months and I took him to the doctors. He was fortunate that he had a GP who was responsible for GP training in Greater Manchester and who made an immediate diagnosis. He was then referred to an old age consultant, he had an appointment almost immediately due to the ability to be able to pay as a private patient. The diagnosis was confirmed. The GP used him as a case study at a GP conference to put emphasis on the importance on patient centered care. My father had other underlying health issues and the consultant liaised very closely with his other doctors. This does not happen for everyone.

Knowing what I now know; my father had all the hallmark symptoms of DLB. He had hallucinations, he was totally muddled and could not distinguish between what was on the television and what was actually going on around...We struggled to care for my father at home. I was taking over from my mother when I finished working full time…for a major…company. He was very well cared for in a local EMI unit The caring doesn’t stop at this point and I visited every day after work and missed one day in 2 years, often only arriving home at 9:00pm each day. I did a google search and The Lewy Body Society appeared, I have been involved since that point.”

One of the charity’s founders, Ashley Bayston, said:

“In 2005 my precious mother was diagnosed with dementia with Lewy bodies. She had been behaving increasingly strangely for 5 years during which my father took her to dozens of doctors before, at my father’s suggestion, neurologist 26 made a diagnosis of DLB. I have heard this story so many times in the past decade. The carer, frustrated by the doctors’ prevarication and inability to admit they don’t know, does extensive search and ends up suggesting the diagnosis.”

Ashley also uses that phrase:

“Knowing what I now know, my mother had all the hallmark symptoms of DLB. She had terrifying hallucinations, she was totally muddled”,

and she says that her mother could not tell the difference between reality and illusion. She continues:

“One time she told me that she had seen me on the telly the night before and liked my outfit. She often thought that there was a cat in the house. Years before she had lost her sense of smell and at the start of her illness suffered from severe…hypotension and constipation. By the time my mother was diagnosed she was in the final stages of DLB. Totally bedridden and helpless and in and out of consciousness. Fortunately my father was able to keep her at home tended round the clock by angel nurses who treated her with the love and respect they would give their own mothers. This is very unscientific but I do believe that it was love that kept my mother alive after the doctors wrote her off. My parents had been married for 67 years when Mum died.”

There are, however, some grounds for optimism. It should be a source of pride that the United Kingdom has played a significant role in the recognition and management of the disorder. Newcastle University is a centre of excellence in the field and the UK is a major force in understanding the disorder. Indeed, Professor Ian McKeith from Newcastle, who is internationally recognised as the world’s leading expert in DLB, is the founding president of the Lewy Body Society. That is important because the society’s objective is to bring support and expertise over and above what is offered elsewhere. Additionally, the existence of an organisation dedicated solely to DLB validates those affected by the disease and gives them a sense of community. It is difficult for people to understand this complex and frightening disease unless they have experienced its effects.

Thirty years ago, the concept of DLB simply did not exist. People with the disorder were misdiagnosed and mismanaged to the severe detriment of all concerned. However, the situation has improved significantly. Many patients are now recognised as having the condition early and accurately, and receive appropriate treatment and care, but as always, and particularly in this case, much more needs to be done.

In the previous Parliament, the Prime Minister released “Prime Minister’s challenge on dementia 2020”, a five-year plan to improve dementia care and the understanding of dementia in England. The document set out the welcome ambition for England to be

“the best country in the world for dementia care and support and for people with dementia, their carers and families to live; and…the best place in the world to undertake research into dementia and other neurodegenerative diseases.”

The progress made is welcome; the £150 million Dementia Research Institute is set to be up and running by 2020. It is also welcome that more NHS and care staff have had specialist training in the development of dementia, but we are still a long way from getting to grips with the serious issue of DLB, which has often been neglected.

The National Institute for Health Research has supported some DLB research, including the DIAMOND-Lewy study on diagnostic rates and management, run jointly by the University of Cambridge and Newcastle University. However, despite the increase in funding and commitments from the Government, funding for research into DLB has been limited, and although the National Institute for Health and Care Excellence issues guidance and guidelines about the management of dementia, and the Royal College of Nursing has done much to raise practitioner awareness, there are few specific provisions for DLB. The lack of funding available and the lack of guidance around DLB remains a concern.

The fact that DLB is not mentioned once in the entire 2020 dementia strategy means that there is a lack of funding available for the disease. The Lewy Body Society, for example, currently receives no funding from central Government. As a first step, will the Minister consider updating “Prime Minister’s challenge on dementia 2020” so that it specifically mentions DLB? Will he also incorporate plans to fund and help sufferers of DLB in the overall strategy? That would mean that the Department of Health could establish training programmes about DLB for GPs and other healthcare professionals. The NHS could then promote the message that, like cancer, dementia is a spectrum of diseases; that would make it easier to diagnose. It would also mean that research could be placed on a sustainable national footing and draw on existing expertise and experience. Recognition of DLB in the strategy will help awareness and lead to better treatment for those who suffer from it, because the more people who know, the fewer people who suffer.

The announcement that I was to become an ambassador for the Lewy Body Society received some media attention, and I received a phone call from my cousin, Patrick McGinn, whose father, my great-uncle Basil, had died some months previously. Like most of our extended family, I thought that Basil had Alzheimer’s or dementia, or was going senile or whatever particular euphemism we had occasion to use when we spoke about him. In fact, Basil had dementia with Lewy bodies. My own family has been touched by the awfulness and tragedy of the disease, and I did not know it. How many others are in a similar position, either suffering from DLB or caring for someone with it? For them and for my uncle Basil, I ask the Government for recognition to aid increased awareness of dementia with Lewy bodies, so that we can begin to help the many people affected by it.

End of Life Care

James Davies Excerpts

Wednesday 2nd March 2016 Commons Chamber

[Dr James Davies (Vale of Clwyd) (Con)]

I very much appreciate the opportunity to talk about this important topic today. As a GP, I have been involved in delivering palliative care—as has my wife, who is a district nurse. It was mentioned earlier that during the debates on the Assisted Dying (No. 2) Bill last year, end-of-life care was highlighted as an important topic that needed to be discussed. We have a world-class palliative care service in parts of this country. Indeed, many other countries look at our hospice movement and want to adopt it for themselves. My local hospice, St Kentigern, which I visited recently, provides excellent care as well as guidance to clinicians, as do so many hospices. However, there are variations in different areas of our country, between the care provided by different clinicians and between the palliative care available for differing conditions.

I have joined the Health Committee since the general election, so I was not part of the inquiry that led to the report. I do not intend to provide an exhaustive list of issues that I feel need addressing, but I thought it might be helpful to give the House a GP’s perspective on some issues that are important to me. The lack of prior planning and discussion for patients is a very real issue. There is certainly a need for more information for patients, carers and family members. It is worth noting, however, that health policy can influence patients’ awareness of developing conditions, and I would like to mention dementia in this context.

The Government have focused on dementia in recent times, and the Prime Minister’s challenge has been quite successful in increasing diagnosis rates. The rate has now gone up to about 67%. A diagnosis gives patients the opportunity to look to the future and decide how they see the end of their life. Sadly, the diagnosis rate in my area of Wales is only 43%, which shows how health policy can influence the debate in many ways.

Care homes are clearly critical to end-of-life care. My practice certainly felt that it was able to contribute to this domain through a local enhanced service that allowed oversight by one practice and continuity of care, which is extremely important. That service also helped to prevent unnecessary admissions to hospitals. It resulted in better opportunities for staff training.

Clearly, there is pressure on hospice beds and community hospital beds. There is also a need to address privacy in the acute secondary hospital setting, where hospital is the right place for end-of-life care. We know that so many patients wish to die at home, and out-of-hours services are crucial to that. We have heard a lot about a seven-day NHS in recent times and this is one crucial area where providing services at weekends and in the evenings is so important. If a patient is waiting for a delayed period for a syringe driver, for instance, that prolongs their discomfort. We also know that there are limited community services in some instances, particularly for children.

I have seen discharge liaison services in hospitals moving heaven and earth to meet patients’ wishes and allow a death at home. Those need to be focused upon to ensure that, wherever possible, that can take place, with adequate support for carers once the patient is discharged home. Finally, clinicians need the confidence to identify what constitutes an end-of-life situation and to manage it appropriately, and so clearly there is a need for education. One in five of those who die is not receiving the end of life care that it is felt they should receive, so clearly there is still much work to be done, despite the best efforts of so many in this country.

Junior Doctors’ Contracts

James Davies Excerpts

Wednesday 28th October 2015 Commons Chamber

[Dr James Davies (Vale of Clwyd) (Con)]

As a doctor and BMA member, and having been a junior doctor until 2008, I have listened over recent weeks and months to medical colleagues who have articulated loud and clear their fears about what a new contract might bring. Of course, this is a contract for England and I am a Welsh MP, but some of my constituents work in the north-west of England, and we also know that the contract adopted in England is often reflected in the contracts adopted elsewhere in the UK.

I have been concerned by the breakdown in the relationship between junior doctors and the Government, particularly as there is widespread agreement that a new contract is necessary. I have met the Secretary of State and the chair of the BMA’s junior doctors committee, Johann Malawana, and I am grateful to them for conducting sensible and reasonable discussions.

Junior doctors and other NHS staff want to feel valued, because they work extremely hard, have large workloads and, like the rest of the public sector, have been subject to pay restraint. There have been multiple attacks from the media in recent years, and indeed from politicians, which frankly have been unreasonable. Some doctors and NHS staff have been voting with their feet and moving abroad. We cannot afford that.

The Government have a duty to improve safety for patients at weekends and ensure that the NHS is affordable in challenging financial circumstances. It is evident to me that there has been some misinformation and unfounded fears about what is proposed in the new contract. The real difficulty with the current situation is that unless and until talks resume, there are in some respects no precise proposals to discuss, so it is very much a fear of the unknown. I believe that the main issue of concern is the threat to impose a contract. I understand how that threat came about, because two and a half years of negotiations led nowhere. I believe that that threat is now impeding the opportunity to resolve the current impasse.

Let me look at the rationale behind a new contract. It includes: an attempt to increase rostering of doctors at weekend; pay scale flexibility, with premiums to support shortage specialties or geographical areas; a change from time served in annual increments to pay progression based on training grades; a reduction of the total number of hours worked by doctors each week; and better consultant cover at weekends.

Of course, concerns have also been raised by the BMA. They include: the removal of financial penalties for hospitals that allow doctors to work excessive hours; and recognition of unsocial hours as premium time. We now know that no junior doctors are at risk of a pay cut. The BMA acknowledges that, in reality, compromise through discussion is required, but some of its current demands would effectively limit the ability for any new contract to be formed along the lines originally envisaged.

Health and Social Care

James Davies Excerpts

Tuesday 2nd June 2015 Commons Chamber

[James Davies (Vale of Clwyd) (Con)]

Thank you, Mr Speaker, for the opportunity to deliver my maiden speech as the new Conservative Member of Parliament for Vale of Clwyd. It is a privilege to follow the right hon. Member for Exeter (Mr Bradshaw).

Vale of Clwyd was a newly created seat in 1997, and for 18 years it was represented by Mr Chris Ruane, a former primary school teacher at Ysgol Mair in Rhyl. An assiduous Member, Mr Ruane spent four years as Parliamentary Private Secretary to the then Secretary of State for Wales, the right hon. Peter Hain, but he will be best remembered as a popular and hard-working local MP. I pay tribute to his commitment to the area during all those years.

It is a great honour for me to represent in Parliament the area where I was born and brought up. I sincerely thank all those who put their trust in me, as well as my family, particularly my wife Nina and 19-month-old son Wilfred, who is already a veteran campaigner. My constituency is in an area which has been true blue for most of the past 100 years. It has been represented by such well known and somewhat controversial figures as Nigel Birch, later Baron Rhyl, and Sir Anthony Meyer, both of whom played a part in the overthrow of a Prime Minister. I assure the leadership that I have no plans to emulate them in every respect!

I chose in 2004 to return to the constituency from university to begin my junior doctor training at Glan Clwyd Hospital in Bodelwyddan. At the same time, I was elected to represent my home town of Prestatyn on the town council and on Denbighshire county council. I subsequently became a general practitioner in the NHS, more recently with a special interest in dementia. I look forward to using my experiences as a GP and as a councillor in my new role as Member of Parliament.

The topic of debate today is health and social care, and the House will be only too aware of the concern about the performance of the NHS in Wales, particularly on my patch. Although health is devolved to the Welsh Assembly, it was perhaps the principal issue brought up on doorsteps during my campaigning. We await the outcome of a judicial review of a threatened downgrade of maternity and gynaecology services at Glan Clwyd hospital, and my support for the campaign against these dangerous and short-sighted proposals is resolute. Last week saw the release of a report on allegations of neglect on the Tawel Fan mental health ward in my constituency. That disturbing report confirmed significant failings in the function of the local health board, but ultimate responsibility must lie with the Labour Assembly Government.

Having worked in the NHS in both north Wales and north-west England, I have seen an increasingly obvious divide develop between NHS performance in Wales and in England, with Wales facing soaring waiting times for A&E, out-patient appointments and surgery, as well as cancelled surgery, queuing ambulances and abysmal hospital-acquired infection rates. Ongoing concern has also been expressed about mortality rates, with evidence coming from those on both sides of the political divide—indeed, the right hon. Member for Cynon Valley (Ann Clwyd) has shown much interest in that important issue—yet the Assembly Government continue to refuse to consider a Keogh-style inquiry.

Many people have felt a deep sense of inequality, as their relatives have been unable in Wales to access cancer drugs that are available to people in England. All that has come on top of the closure of community hospitals and other services, often in a seemingly haphazard manner. It is no wonder that many patients are seeking healthcare arrangements in England, but of course this is not only inconvenient but impossible for many patients, and places unfunded burdens on services in border areas.

Many of those who supported me on 7 May did so in the expectation that I could positively influence problems affecting local health services. I should add that the support I received came from dedicated staff as well as patients. I have heard and understood a loud call for Parliament to address the issue of consistently failing devolved services in Wales, and this is something we must find a way of doing.

As a new MP, there could be no better area to fight for than the area I truly care about. I look forward to assisting with and helping to drive the regeneration of the seaside resort of Rhyl which, perhaps even more than some of the other great Victorian resorts, has struggled in recent times but still retains so much potential. Within days of my election I had the good fortune to speak to the Prime Minister on two occasions. On the first, I stressed my intention to make a difference in the town and he very kindly pledged his commitment to assist with this. On the second, he advised me that he had just referred to the town live on national television, so I and my constituents very much look forward to the progress our third meeting will bring!

I also relish helping to lead the continued revival of neighbouring Prestatyn and Meliden. In fact, much of the reason behind my standing for Parliament relates to the immense satisfaction I have gained through helping to turn around this, my home town, whether by supporting it in winning the coastal category in Britain in Bloom or by supporting and pushing forward many projects such as the new town centre shopping park, the Scala cinema and arts centre and the Nova centre redevelopment. Inland, the constituency includes the village of Dyserth, whose waterfall, as some hon. Members will no doubt recall, featured in the mystery tour in the 1973 comedy film “Holiday on the Buses”. A short distance away is the town of Rhuddlan, featuring an impressive castle, constructed by Edward I in 1277, and also St Asaph, the town of my birth, the site of Great Britain’s smallest ancient cathedral and home to a thriving optics sector. St Asaph was awarded city status by Her Majesty the Queen in 2012 to celebrate her diamond jubilee. At the southern end of the constituency is the historic market town of Denbigh and the nearby village of Henllan.

Linking many picturesque villages such as Cwm, Tremeirchion and Bodfari is the Offa’s Dyke national trail, which starts at our blue flag beach in Prestatyn. Tourism, whether coastal or rural, is a very important feature of the constituency. So too is farming, particularly in the fertile land around villages such as Trefnant, Rhewl and Llandyrnog, where there is a creamery—the fourth biggest cheese factory in the UK. One of its many customers is the Snowdonia Cheese Company in seaside Rhyl. I can certainly vouch for the quality of its Black Bomber! I encourage hon. Members to try it. There I will conclude my whistlestop tour of a very special constituency, which I look forward to serving to the very best of my ability.