(9 years, 9 months ago)
Commons ChamberThe House has a lot of business to attend to today. That said, this Bill deserves consideration in some detail. It clearly has widespread support across the House, including on the Opposition Benches, and from medical professionals across the NHS. Some groups have raised a number of concerns. I know that the hon. Member for Stafford (Jeremy Lefroy) will want to address them.
The Bill is made up of three key areas. Part one relates to provision of care that avoids harm. It requires the Secretary of State to bring forward regulations setting out the requirements on providers registered with the Care Quality Commission to ensure that the services they provide do not cause avoidable harm. Clearly, that is a principle we all support. All of us have learnt the lessons of what happened in the hon. Gentleman’s constituency and none of us wants to see that repeated in any part of our health economy or anywhere in our country. We want the very best care for our family and friends. Harm-free care should be something we all strive for at all times. We know that our doctors, nurses and other medical staff work incredibly hard, as Government Members have said, often in exceptionally trying circumstances. The Government—any Government—must do everything within their power at all times to support those professionals. That is surely beyond question.
The second part of the Bill relates to the continuity of information and how it is shared between providers of care. For effective health care to be provided in the 21st century, data must be utilised as effectively as possible. I am sure the Minister shares that viewpoint. Macmillan Cancer Support has shown in north Trent that local data, when used effectively, can be used to redesign the follow-up care that colorectal cancer patients receive. On analysing the data, it discovered that more than a third of people who survived for more than five years had an additional, non-cancer complication such as type 2 diabetes or heart problems. By using these data—and, by extension, knowledge—it could better plan the future care of those patients. The principle of using complete data to identify patients’ needs must be applied more often to ensure that patients get the care they require. There are some tremendous examples of GPs in Salford deploying this care model. I urge Members to take a look at the innovative techniques being developed there.
I ask the House to indulge me for a moment. Like everyone, I understand how such data can lead to better patient outcomes. Two weeks before the last general election, as an undiagnosed type 1 diabetic, I was rushed to hospital—once again, I place on the record my gratitude to the West Cumberland hospital for saving my life—and now every day my life is governed by data: blood glucose readings, insulin ratios and so on. I want such data to be easily available to me: I want them on my smartphone, and I want them provided to pharmacists and GPs, to help me and others in my situation better to control the condition. Incidentally, such a huge innovation would also save the NHS a lot of money and improve outcomes for patients with a variety of long-term conditions. In that regard, the Bill is doing exactly the right thing.
I would be grateful if the hon. Gentleman could set out again how the Bill would make data sharing more consistent across the whole health service, because this is a challenge. Where individuals’ personal data are concerned, there are clearly issues of privacy to address. That debate rages across many sectors and is routinely discussed on and offline and in the House. I have been here almost a decade now—it is hard to believe—and issues of individual personal data have been discussed throughout that time. Nowhere is that felt more sharply than with medical data.
It was regrettable—and avoidable—that the Government failed with the care.data scheme, as it severely eroded public trust in how data protection matters are dealt with. I do not think that anybody would take issue with the principle that medical confidentiality should always be respected and protected. I hope the hon. Gentleman will outline what safeguards are in the Bill to ensure that only relevant patient data are shared. Sharing unnecessary information could undermine patient trust, particularly regarding the use of personal data, and, critically, could slow down treatment, which we do not want.
I am grateful to the hon. Gentleman for setting out from personal experience how important this matter is. I can assure him that the aim of these provisions is to ensure that data are shared only for the care of individual patients. This is not about data collection, but about patient care and safety, for which, as he rightly says, data are often so important.
I thank the hon. Gentleman for that response. We will drill down into this in Committee because it is important that we get the details absolutely right.
This is about the efficacy of the care provided, and if we do not get it right, we will be storing up trouble for the future. The sharing of relevant health information is already governed by professional obligation, as the hon. Gentleman will know from his marital circumstances, and the British Medical Association has said it would be unnecessary to replace that with a statutory framework without clear justification. I hope to hear some justification for a new framework. One of the lessons of my party’s time in office, and one of the lessons that should be learned by this Government, is that we need to take medical professionals with us. If we do not, we will put ourselves and patients in a difficult position. We can devise all the statutory and regulatory frameworks we want, but if we do not take medical professionals with us when we apply those strategies, we will be in difficulty.
The third part of the Bill relates to objectives for the regulation of health and social care professions. This part, and the draft order on the objective of the General Medical Council, amends the objectives of health and social care regulators and the Professional Standards Authority. Professional bodies such as the GMC and the BMA have differing views on the impact this will have in practice. The GMC states that while this Bill will not impact on the GMC per se,
“The newly worded statutory objectives in the draft order address the aim of protecting the public and set out clearly the importance of public confidence issues when deciding on appropriate action in the public interest.”
The GMC also believes that the Bill will align other regulators’ statutory purpose with their own. The BMA, however, believes that the now separate role of protecting the public while maintaining public confidence in the professions could lead to regulatory committees and panels punishing professionals who do not pose any threat to the public.
The details of this part will be subject to further scrutiny in Committee, but I would be grateful if either the hon. Member for Stafford or the Minister explained how this scenario articulated by the BMA could be avoided. Let me repeat that it is essential to take the medical professions with us on this, in view of the lack of appetite for the application of the Francis recommendations with regard to the individual duty of candour. I think this has been dropped because the medical profession did not believe it to be enforceable. The Government listened, but we should explore those concerns in greater detail.
It was disappointing that the Government did not bring forward in the Queen’s Speech a Bill to deal with the wider reform and regulation of health care professionals. An opportunity was missed, and I hope the Minister will explain why. Wider reform is clearly needed. The Nursing and Midwifery Council was disappointed not to see such a Bill in the Queen’s Speech and still says that wider legislative reform is needed. We must remember that this Bill is an essential component of the implementation of the Francis recommendations and that, without it, some of the important changes recommended by Robert Francis simply cannot take place. We support the superb efforts of the hon. Member for Stafford principally in that context. This is an issue that many in the professions wanted to see addressed by the Government in the Queen’s Speech. They should have brought forward a Bill, and it clearly cannot be through a lack of parliamentary time or because of a packed legislative agenda that no Bill has been introduced. I hope an explanation for that will be forthcoming.
Other issues need to be addressed. The principle of the Bill is one that we support and we will not divide the House on it. The details will be scrutinised further in Committee, and I hope that both the Minister and the hon. Member for Stafford will be able to deal with some of the issues I have raised.
Finally, although the Bill is an important step, cultural change in any organisation or profession is difficult and takes a long time to achieve. There is no magic bullet, as has been said, and we should always recognise that. I was grateful to the hon. Member for Stafford for mentioning the regulation of the nuclear industry, of which I have a lot of experience. I think I was the first person to introduce this regulatory example into this whole debate, and it is a very important comparison.
What is the point of the comparison? Effective regulation is an iterative process that relies on an effective partnership between the regulator and the regulated. Too often, regulatory bodies in a number of sectors can play cat and mouse or hide and seek with respect to those they regulate, which can have a serious, damaging and counter-productive effect. We are beginning to see that with Ofsted—the comparator often used nowadays for the Care Quality Commission. Of course we want to see education standards driven up; of course we want to see pupils receiving the best education in the world; and of course the pursuit of excellence must be constant and consistent. We must, however, consider what happens when regulators begin to damage the cause they exist to support. None of us wants to see the medical profession becoming as beleaguered as those other essential public servants in the teaching profession.
That said, public services exist first and foremost for the benefit of the public, not for the public servants—an essential principle. Iterative regulation is undoubtedly the way forward, as is demonstrated by the safety and performance improvements that have taken place in the nuclear industry over the past decade and a half. Those changes accompanied a major regulatory recalibration in the early part of this century. Cat-and-mouse, hide-and-seek regulations were actually making performance in the industry worse. Regulators should not wait for failure to occur and then seek to punish; they should work to prevent failure from occurring in the first place, and that requires a partnership between the regulator and the regulated.
There is a great deal in the principle of the Bill that unites the House. I am exceptionally grateful to the hon. Member for Stafford for all the work that he has done, and his Bill has the Opposition’s support.
(9 years, 10 months ago)
Commons ChamberThis affects my constituents too, as I am also a London MP and therefore take a very close interest in it. I think it is unfair to say that the trust is in chaos. It is taking urgent steps to address the situation, including recruiting extra paramedics, increasing overtime, and reducing the number of multiple vehicles attending each call. We are working with Health Education England to increase the pool of paramedics, with 240 being trained in 2014, going up to 700 in 2018. Urgent measures are being taken to address the problem right now. I have had those assurances directly from managers in the trust whom I met very recently.
It is a fact that ambulances are taking longer to reach patients in the most critical condition. Today we are publishing figures regarding the increasing use of private ambulances. Nobody expects a private company to respond when they dial 999. Private ambulance usage has grown by 82% in the past two years nationally and by over 1,000% in London over the same period. Will the Secretary of State now admit that he sees no limit to the role of private companies in the national health service?
That is complete nonsense. The previous Government occasionally deployed private ambulances, which trusts use occasionally when they need to do so. This is another part of Labour’s myth of creeping privatisation, which is not true—it is absolute nonsense. It is important, however, in the interests of patient safety and as a short-term measure, that if that is what it takes, trusts must do it, as happened under the previous Government, because patient safety comes first.
(9 years, 10 months ago)
Commons ChamberI would like to thank your office, Madam Deputy Speaker, and the office of Mr Speaker, for the advice with which they have provided me in the lead-up to today’s debate. That a Member of Parliament could have been prevented from speaking on an issue that relates directly to his constituency and constituents owing to the decision of an individual Minister, is too absurd to contemplate. That would have made a mockery of our democratic process at a time when there is a growing dislocation between the public and Parliament. This Chamber exists precisely for the purpose of holding power to account and if any Minister in any Government believes they can be exempted from that then they are badly wrong. That said, I am exceptionally grateful to the Minister for granting me permission to speak. I would also like to extend my thanks to my hon. Friend the Member for Workington (Sir Tony Cunningham) for securing this debate and congratulate him on his richly deserved knighthood over 12 months ago now—this is the first chance I have had to do so in public.
My hon. Friend and I have campaigned consistently on behalf of West Cumberland hospital in a fight that will continue for as long as it is necessary. The Government must not try to shut down the debate, especially given that patients, the public and medical professionals across west Cumbria require clear and open discussion and genuine public engagement regarding the future of our hospital—the first new hospital built after the establishment of the national health service.
We need the support of the Government in ensuring that such engagement takes place. The Government’s health reforms, of which I am a long-standing critic, were billed as devolving decisions about local health services to the communities relying on them, but in Cumbria, which the previous Health Secretary said should be the template for the whole of the country—consider that for a minute—engagement could not be any worse. In my constituency and that of my hon. Friend, the Minister will find tens of thousands of people willing to engage with the Government—and with the trust, for that matter—on the future of their services, but their voices are being deliberately ignored.
Before I continue, I must declare my interest in this topic. I was born at West Cumberland hospital; my four children were born there; my wife was born there; and over the past few years, it has saved my life not once, but twice—which I appreciate sounds careless. I am indebted to its staff for all they have done for me and countless others from my part of the world. The hospital has been one of the main focuses of my efforts since I was elected to this place, and it will remain so for as long as I am here.
I do not wish to repeat what my hon. Friend said, but I want to echo my support for the We Need West Cumberland Hospital campaign group. These are local people exercised by what is happening to their national health service. They have created a group with passion and purpose, and it is time for decision makers to sit up and take notice of them—that means the Government as well as the trusts in question. The group exists only because the local health economy is in turmoil and because its members, like everyone else, are being purposely shut out of decisions relating to their hospital, as service decisions are made and increasingly removed by stealth.
As my hon. Friend pointed out, just a few weeks ago this group of concerned people organised a public meeting to discuss the future of services at West Cumberland hospital. About 4,000 people attended on a dark Monday evening at the recreation ground in Whitehaven. Had we held it on a summer weekend, only a few weeks earlier, more than 10,000 people—easily—would have attended.
My constituents are deeply concerned. The lack of engagement from the North Cumbria trust and other decision makers has fostered a feeling of toxic distrust. This simply is not conducive to establishing faith or trust, or to building the local services my constituents, the people of west Cumbria and the whole of the Cumbrian health economy need. I implore the Minister to intervene to stop this behaviour and ensure that an effective framework of meaningful public engagement is put in place before it is too late. I hope he can write to the North Cumbria trust to ensure this takes place.
Consultation is one thing, but meaningful engagement is another thing altogether. Rather than simply being consulted on a plan designed by the trust behind closed doors, it would be much more beneficial to have public involvement in what the plan should look like before it is consulted on. Surely that would make for a much easier, expedited consultation and a much easier, effective implementation. We did that locally prior to 2010 and we should do so again. I hope the Minister will address that point directly.
I want to address the concerns expressed about the services provided by West Cumberland hospital. The vacuum left by the lack of engagement from the trust means that local people are understandably worried about what their services will look like in the coming years, and the ability of the trust to engage with local people has been clearly and demonstrably worsened by the recent reorganisation of the NHS. However, the acquisition of North Cumbria by the Northumbria trust is also proving to be a significant problem. I hope the Minister will pay careful attention to this point. The acquisition cannot proceed unless both Monitor and the Care Quality Commission are satisfied that the trust is both financially and clinically sustainable.
The acquisition was meant to provide certainty and stability, yet years later the process has provided neither. In fact, the uncertainty is only worsening matters. There are justifiable fears that financial sustainability will be achieved by reducing, and only by reducing, the amount of services provided at the West Cumberland hospital, under the guise of “clinical sustainability”. Will the Minister agree today to stop any further progress of the acquisition of North Cumbria by Northumbria unless a comprehensive public consultation on the future of services provided by the West Cumberland hospital is undertaken prior to an acquisition? The people of west and north Cumbria need the Government’s help with that, which is the least the Government could do.
We have already seen some services move from the West Cumberland hospital to the Cumberland infirmary at Carlisle, itself a hospital in serious difficulty. People are worried that more services will follow and they are especially worried about consultant-led maternity services being transferred from West Cumberland to Carlisle.
The journey between West Cumberland and Carlisle is 40 miles, but some people have to go to Newcastle—for example, for chemotherapy. Just think of the anguish when children have to have chemotherapy as far away as Newcastle, which is almost 100 miles away.
My hon. Friend makes an absolutely pivotal point. This is about not just the effectiveness and efficacy of the clinical solutions provided by the NHS; it is about the patient experience and the best outcomes for patients, and not just those 40 miles from Carlisle and further afield. The 40-mile point is Whitehaven, but it is actually much further south than that: it is Egremont, Cleator Moor, Seascale, Wasdale, Eskdale and so on. It is the people there who, perhaps more than others, are disadvantaged by these moves.
Childbirth is one of the biggest moments in any parent’s life, but the elation and happiness that surrounds a new family at this time can all too often turn to stress, worry and fear. Any complications can have a catastrophic effect—I have seen this recently with close friends. If there are complications during a labour, it is just not feasible for an expectant mother—particularly one in difficulty—to be transferred 40 miles from Whitehaven and further afield south, on a journey that, as my hon. Friend said, takes well over an hour at the best of times and considerably longer in heavy traffic. On occasion, the roads will become impassable in bad weather. In fact, only this year, after a visit to my constituency, a Minister wrote to one of his colleagues, a Minister in the Department for Transport, pointing out the inadequacy of the A595, bemoaning the state of the road infrastructure. If the roads are not good enough for visiting Ministers, they are certainly not good enough to be transporting patients at the time of their greatest need.
The truth is that a one-hour journey for a mother in labour means more than 90 minutes, bed to bed. That is indefensible. Also, studies have shown that an increase in straight-line ambulance journey distances is associated with an increased risk of death and that an increase of 10 km in straight-line distance is associated with an absolute increase of around 1% in mortality. Consider that for a moment. The centralisation of some services from the West Cumberland hospital in Whitehaven to Carlisle will increase the mortality risk for west Cumbrians much further afield than Whitehaven.
Between 2007 and 2008, the local primary care trust, as it then was, undertook a consultation on local services, to which it received 140,000 responses. As a result, the people of west Cumbria were told that they would receive a new hospital, built on the site of the West Cumberland hospital. The new hospital would retain services, including consultant-led maternity services, and also develop specialisms not catered for at Carlisle. The deal struck was also set to provide newly built cottage hospitals in Millom, Keswick and Maryport, to complement the existing new one built in my hon. Friend’s constituency in Workington.
When the Government took office in 2010, they scrapped the funding for the new hospital, as they did for all other existing new build hospital projects. It is only through perseverance, hard work and a lot of lobbying by me, my hon. Friend and others that the Prime Minister acquiesced and returned some of the money, for which we are very grateful indeed. However, the full funding was not returned and funds had to be found elsewhere. The Minister will know that to this day I am still consistently making the case—through the trust development authority, NHS England and other bodies—for extra funding. Now that the new hospital site is almost completed, it is only right that the other promises that were made are honoured.
Consultant-led maternity services cannot be removed from the West Cumberland hospital, and the Government must surely intervene to ensure that this does not happen. Before the election, the then Leader of the Opposition and now Prime Minister promised a “bare-knuckle fight” to stop maternity services moving, yet that fight has never appeared. Around the country, people wonder whether it will ever appear. However, can the Minister confirm that there is set to be a nationwide maternity services review? Will he explain when that will begin and end?
I believe that the local CCG in Cumbria wants to commission the consultant-led maternity services at the West Cumberland hospital, but that the North Cumbria trust does not wish to do so. I have submitted a series of freedom of information requests to the trust, seeking its internal proposals for removing consultant-led services; to date, I have received no response. Can the Minister help in that regard? Can he impress on the trust the urgency of the matter and the need for full candour? I hope he will be able to do so in writing.
Report after report by Sir Bruce Keogh and by the Care Quality Commission has shown that there are real issues, as my hon. Friend said, that need to be addressed not only in north Cumbria, but right across the Cumbrian health economy. Staff shortages are having a major impact on the services—not just the type but the quality—that can be delivered. Will the Minister commit himself today to investigate the recruitment practices of the North Cumbria trust? Will he commit himself to assist with recruitment, with financial incentives for potential new staff? This is critical. I am inundated with complaints from staff about the poor quality of recruitment advertising, cancelled interviews for applicants and much more. As a result, we have one of the highest locum spends in the whole country. The Minister will be only too aware of the effect on the trust’s ability to provide, in some cases, even the most basic front-line services.
In the people of west Cumbria, this Government—any Government—the trust and the regulators will find a willing partner for constructive discussions about what services should and could look like. They have been through these issues year after year; they are well versed in them and up to speed with the realities of modern clinical practice—and commissioning decision making, too.
More than that, however, with the brand new hospital being built, we should be able to develop a new model of health care for health economies such as Cumbria’s that is exciting, attractive and sustainable. We should be able to attract top-class medical professionals to our hospitals, and we should be able to support them. As Bruce Keogh points out, there is excellence at the North Cumbria trust. These issues are genuinely—we can say this without exaggeration—matters of life and death.
I have asked the Minister a series of questions. There will doubtless be many more, and if he cannot answer them today—I again express my gratitude for being allowed to speak in this debate—I hope he will answer them in writing. In addition, I hope he will agree to meet a delegation of hospital campaigners—from my constituency and that of my hon. Friend—in the Department of Health as soon as possible. Most of all, I hope he will listen to the clear voice of the people of west Cumbria. We need the West Cumberland hospital and the services it provides, and we will fight to the finish to secure the hospital services we deserve and the hospital we were promised. Future generations of west Cumbrians deserve nothing less.
This has been a long-standing shortage; the trust has not been an attractive place for junior doctors to work for many years—probably for the past decade. However, the trust is now looking at ways in which it can better incentivise doctors to work there. That is an important step forward. If we want junior doctors to return to the trust—given that they have been removed from it because they were not getting the high-quality training they needed in order to become consultants—we must ensure that we incentivise the recruitment of more senior doctors to the trust. The hospital is now looking much more seriously at that than it has done in the past.
As I just outlined, recent measures have resulted in the consultant medical staff being increased by 17%, which is a positive step forward. Measures are also being put in place to ensure that nurse practitioners will be better used, where appropriate, to treat patients. The trust can be proud and pleased with the progress that it is making in that respect. An important aspect of looking after patients is to ensure that there is a full rota of junior doctors on site, and I am sure that if the progress in increasing the amount of consultant cover is maintained, that will become available again in the future.
On performance, the trust has put in place a recovery plan to meet waiting time targets from the end of 2014. It is currently working to reduce its backlog of patients who have been waiting for more than 18 weeks from referral to treatment, and it has received additional funding to support that. As hon. Members have pointed out, however, the trust has been financially challenged for some time. Last year, it reported a deficit of £27.1 million. The Department of Health provided significant financial support to the trust in 2013-14, as it has in previous years. The trust received £11.5 million from the Department, alongside support from the trust development authority and the clinical commissioning group, and £6.3 million in private finance initiative funding support. As we have discussed, however, that position is not sustainable in the long term. That is why further discussions about foundation trust status are being held.
Other critical challenges remain. Most significantly, some services at West Cumberland hospital remain fragile due to difficulties recruiting specialists and consultants and to the current heavy reliance on locums. However, I hope that that issue will be addressed in the near future if the trust can continue to recruit more consultants.
The Care Quality Commission inspection report published in July 2014 rated the safety of acute medical and outpatients services at the West Cumberland hospital “inadequate”. That reflects the difficulties that the hospital has faced for many years, and continues to face, in recruiting adequate staff to run some of its services safely and effectively. However, the trust has made significant progress in addressing the many challenges it faces. The CQC inspection acknowledged that, giving it an overall rating of “good” for providing a caring service to patients.
Another CQC inspection is expected to take place in early 2015, and I understand that the trust is working hard to make improvements ahead of that. For example, the outpatients service has greatly improved the availability of patient notes, an issue highlighted at the previous inspection. As I understand it, patients’ notes were not available when they came for an appointment. That is not helpful in providing an understanding of their previous history, which disadvantages the staff who are looking after the patient and trying to provide the best possible care. The trust has taken that issue on board and I understand that it is making good progress to address it.
The trust has made significant progress in other respects, most notably, and perhaps most importantly, in reducing high mortality rates. That means that patients in Cumbria who would have died had these changes not been introduced are alive today. Having been one of the highest in the country, the trust’s mortality rates are now within national confidence limits, and the trust and its staff must be commended for that turnaround. Further progress has also been made in, for instance, the meeting of the four-hour A and E standard, the implementation of a new patient experience programme, and a reduction in clostridium difficile infection rates. However, changes must continue to be made to secure a sustainable future, and to enable the trust to keep building on the good progress that it has made so far. It is important for the local NHS to be supported in that work to secure safe, high-quality patient care.
I do not have the local knowledge that would enable me to understand why that happened, but what is important is the need for action to be taken in cases in which there is a history of higher than expected standardised mortality rates—cases in which patients have died when they should not have died. That is why the Government asked Sir Bruce Keogh to investigate this trust, and, indeed, many other trusts, as a result of which some were put into special measures.
Although a number of challenges remain, and the trust must address them, it appears to be making good progress in terms of standardised mortality rates, which means that—as I said earlier—patients who might have died in the past are now surviving. That is testimony to the hard work of the trust’s front-line staff. I know that Members will be pleased, and that, more importantly, local patients and their families will be very grateful.
The subject of reconfiguration was raised. The issues affecting west Cumbria were discussed during a debate secured in 2012 by the hon. Member for Copeland (Mr Reed), and I know that the future of services at the hospital is a matter of continuing concern to both him and the hon. Member for Workington. As I said earlier, the local NHS is committed to ensuring that West Cumberland hospital has a viable and successful future, and that west Cumbrian patients continue to receive treatment there. That is why £95 million—£70 million of it from the Government—is being made available to improve its facilities. The money will allow it to offer 21st-century facilities, including seven new operating theatres, four of which will have full laminar flow, which will make them suitable for use in any operation. That will allow the hospital to offer a wide range of surgical services, and to become a centre of excellence for elective surgical procedures.
The hon. Member for Workington asked what excellence would be provided at the hospital. I can tell him that the investment in new facilities will allow patients to receive elective surgical procedures of a much higher quality, which will hugely benefit the local population. That investment is supported by additional investment in other local health care facilities, including, not far away, the new £11 million Cockermouth community hospital—which was officially opened in August 2014—and the new health centre at Cleator Moor.
Alongside the financial investment in the hospital, there are continuing efforts to attract and recruit new clinicians to North Cumbria University Hospitals NHS Trust. International recruitment campaigns have already taken place, and financial incentives are now available to support recruitment to the posts that are the most difficult to fill. That point arose earlier in the debate. Hospitals often have the flexibility to offer incentives in the event of recruitment challenges and difficulties, and I am pleased that the local trust is taking advantage of the opportunity to offer such incentives to attract new consultants and permanent staff.
To build on the progress that is already being made, clinicians are working towards changes that offer the best opportunities for better outcomes to be given to patients suffering from the most serious illnesses. No changes will take place unless there is clear clinical evidence that they will result in better outcomes.
Understandably, people have concerns when any change to local health care services is being discussed, but it is important that such concerns are not exploited for any political or other purpose, and that all changes that take place are in the best interests of local patients. The five-year plan for the local health service being developed by local doctors and clinical commissioners is looking at how services can be delivered safely and sustainably in the future. In developing the plan, I expect the local NHS to give important consideration to the distance patients need to travel to access services, particularly emergency services. As we have discussed, rural areas are very different from urban areas, and the distance patients may have to travel to access services is an important factor in determining what is safe for patients. Local commissioners need to take note of that.
That actually may have to happen in my constituency, for example, in cases where my local hospital does not have the right support for a very premature baby in utero once it is born. Neonatal services are not always as well developed at every hospital, and some areas tend to have a regional centre of excellence for neonatal care. As the hon. Gentleman said, there may be a regional centre of excellence for cardiovascular services, heart surgery or other specialist services. We want to ensure that bread and butter, day-to-day medical services are always provided by local hospitals—that is particularly important in rural areas—but we have to ensure when taking these decisions that where there is a clinical case for better patient care to be delivered at a centre of excellence, that case is made and communicated effectively. So, for example, although I would want to ensure, as I have done, that in Suffolk patients are able to receive the best possible care from the local NHS, if they needed super-specialist services and other services that are better provided at a specialist centre, they receive that care from those centres. I have always advocated that important case on clinical grounds.
This is about seeking to provide high-quality day-to-day services, while recognising that some services have to be provided at specialist locations. So when dealing with the potential birth of a very premature baby, it is important that the right support after birth is available, and that is provided by more specialist neonatal intensive care units—for example, Brighton is a regional centre for the south of England for some of those services. It is also important that, where possible, an intrauterine transfer takes place to make sure that the right care is available upon birth and after delivery.
It is also important to stress that in designing and working through what the right patient services are, and in putting together the local five-year plan in Cumbria, certain guarantees and reassurances have been made to the local population. I spoke just now about important day-to-day medical services, and a commitment has been given that there will continue to be an accident and emergency department at West Cumberland hospital. That is part of what I was just speaking about: high-quality, immediate services available for patients in more rural and remote areas. An independent review is looking at maternity services across Cumbria and will feed into work locally to find the best possible solution to providing safe and sustainable maternity care in the future.
While the five-year plan outlines the direction of travel for the local health service, no definite proposals have yet been put forward, and work remains at an early stage. In developing its proposals, I expect the local NHS to ensure that patient safety is a key focus, and that any movement or change of services is based on clear clinical evidence of better outcomes for patients.
I wish to make some important points about public engagement, which was raised by both hon. Gentlemen. It is important that people who use NHS services get a say in any changes to those services. We are very clearly committed to that as a Government, and it is important that local clinical commissioning groups, and the doctors and nurses who run them, properly engage with the public when they are making the case for the future shape of local health care services. I encourage local patients to continue to engage with the NHS as plans for west Cumbria are developed.
I understand that Cumbria CCG has met local MPs and the local campaign group to discuss their concerns and is happy to maintain that dialogue and continue to meet to discuss issues of concern in the weeks and months ahead.
The local NHS held a period of engagement to inform the development of the five-year plan. Both the CCG and the trust are committed to undertaking more engagement and communication with local people in the coming months.
Any proposals put forward for significant changes to local health services will be subject to a full public consultation in which patient and public views can be fully engaged in helping to shape future health care services. That is an important reassurance to give Members. No decisions will be made without that full public consultation if and when any changes to services are proposed.
In conclusion, I know that local people care deeply about the future of West Cumberland hospital—that has come across clearly from the contributions this evening. The provision of health care services affects all members of the community. We have only to look at the example of 10-year-old Maddy Snell who last week received a reply from the Prime Minister to her letter about potential changes to local health care services to see how the whole community in west Cumbria wants to be involved in the future of its hospital.
Patients should keep up that engagement with the local NHS and make their opinions known to those developing proposals for the future of local health care services. I also want to encourage the people of Whitehaven to listen to the reasoning behind any proposals that their local doctors bring forward for improvements in the way in which people are cared for in the local area.
I should like to reiterate that local health services in west Cumbria have a strong future. There is a commitment from the local CCG, led by doctors and nurses, for a continuing accident and emergency service, and the Government support a £95 million investment in health care facilities at West Cumberland hospital.
The Keogh report makes it very clear that meaningful engagement with the staff both at the Cumberland infirmary, Carlisle, and the West Cumberland hospital is nothing like it should be. That is one of the key reasons the trust entered special measures. All of us from all parts of the House want to see the hospital trust emerge from special measures as quickly as possible. However, latterly, that engagement internally has demonstrably worsened. How can we get out of special measures if these behaviours persist?
Part of the challenge may well be challenging some of the existing work practices at the hospital. I accept what the hon. Gentleman has said about the quality and commitment of local NHS staff. In my experience, I have never found a member of the NHS who has been engaged in health care with anything but the best intentions and the wish to help people. That is why I am a doctor and why many people go into health care; they want to provide compassionate care for people and to improve the human condition. I know that that is what drives local staff in Cumbria. Sometimes when profound issues have to be faced, such as higher than expected local mortality rates, challenging conversations have to take place. Such issues are the result of not a lack of commitment or dedication from the staff, but the fact that some working practices need to be improved. Additional training and support may need to be put in place to improve those working practices. It is important that that is done in a way that brings staff along in a collaborative working environment.
When things go wrong in health care, it is rare that there is one single causal factor, although sometimes there is; sometimes it is the negligent act of one person. Often, however, it is the system in a hospital that has let someone fall through the gaps. This is about challenging working practices, and as far as possible, that has to be done collaboratively. Clearly, there have been huge improvements in the way health care is delivered locally. Mortality rates have fallen, and patients are being looked after in the way we would all expect. That is down to the hard work of the staff who are facing up to some of the challenges, and making sure that they put right what may have been wrong.
It is important that when there are discussions about reconfiguring, changing or developing health care services, local clinical commissioners engage effectively with the hospital and properly with hospital staff. Part of the broader consultation and engagement exercise needs to be focused on proper engagement between the clinical commissioning group and the clinicians and other dedicated staff who work at the trust. From what hon. Members are saying, there may be more work to do in that area. I urge the clinical commissioning group to put right any issues, because it is important that everybody signs up to dealing with future challenges.
As I have said, I am confident in the local clinical commissioning group’s commitment to supporting a viable A and E at the hospital. The Government have provided investment to develop facilities further, particularly facilities for surgical procedures, in the hospital and the local area. With that investment, there is a strong future for local hospital services. It is important that local clinical commissioners continue to engage with staff at the trust, and particularly with local patients. After all, if we want a health service that is fit for purpose in Cumbria and elsewhere, it has to be based on the needs of local patients. It is to them, more than anybody else, that local commissioners need to listen.
Question put and agreed to.
(9 years, 10 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
It is a pleasure to serve under your chairmanship, Mr Chope. I also extend my thanks to the hon. Member for York Outer (Julian Sturdy) for securing this critical debate. He has done a great deal of work on raising the profile of antimicrobial resistance since he entered this place in 2010. Like him, and every other Member who has spoken today, I understand the issues at stake if we do not do everything within our power to tackle this threat. As well as being a shadow Health Minister, I am also chair of the all-party parliamentary group on antibiotics, which is co-chaired by the hon. Member for Richmond Park (Zac Goldsmith), who has just made a superb contribution to the debate. The hon. Member for York Outer did an excellent job in setting out the scale of the challenge that we face today.
The APPG on antibiotics was formed in June 2013 specifically to raise the profile of antibiotic resistance. Through working with key stakeholders and experts on the issue, we hope to build a cross-party consensus on tackling the threat of AMR. Before moving on, I want to praise the work of Professor Laura Piddock and the British Society for Antimicrobial Chemotherapy. That organisation works tirelessly to highlight the threat of antibiotic resistance; without it, the APPG might not even exist.
In the foreword to the document “UK Five Year Antimicrobial Resistance Strategy 2013 to 2018”, Dame Sally Davies gave a concise explanation of the scale of the challenge that we currently face:
“There are few public health issues of greater importance than antimicrobial resistance…in terms of impact on society. This problem is not restricted to the UK. It concerns the entire world and requires action at local, national and global level. AMR cannot be eradicated but a multi-disciplinary approach involving a wide range of partners will limit the risk of AMR and minimise its impact for health, now and in the future.
The harsh reality is that infections are increasingly developing that cannot be treated. The rapid spread of multi-drug resistant bacteria means that we could be close to reaching a point where we may not be able to prevent or treat everyday infections or diseases.”
Her sentiments and judgment have been echoed by scientist after scientist and medical professional after medical professional. Dame Sally Davies must be commended on her commitment and work on this issue—I am pleased so many hon. Members have recognised that today—and her leadership should be applauded. The Government must take heed of what she says and take the actions she recommends.
A report published on 10 October by Public Health England, “English surveillance programme for antimicrobial utilisation and resistance”, highlights that the problem is already real now and, as Members have observed today, is getting worse. Antibiotic prescriptions are rising—they increased by 6% in the past three years alone. At the same time, resistant bacterial infections are also on the rise. Resistant E. coli infections have risen by 12% since 2010. Dr Susan Hopkins of Public Health England told the BBC recently:
“We know that less than 1% of bacteria are extremely multi-drug resistant at the moment…But in countries like India they are approaching 10% to 20% of individuals they are not able to treat effectively with the antibiotics.”
The threat is real and we all agree that something must be done; inaction cannot be tolerated.
The Science and Technology Committee published its report, “Ensuring access to working antimicrobials”, on 7 July. At Health questions on 15 July, responding to the hon. Member for York Outer, the Minister said that the Government would publish their response to that report in September. We are now into October, so I hope she will explain when that response will be ready.
Government action is overdue. With that in mind, I would be grateful if the Minister would update Members on the progress made towards the three strategic aims and the seven key areas for future action as prescribed in the chief medical officer’s report on the five-year antimicrobial resistance strategy. The three aims were to improve the knowledge and understanding of AMR, to conserve and steward the effectiveness of existing treatments and to stimulate the development of new antibiotics, diagnostics and novel therapies. Will she explain how the findings by Public Health England on increasing antibiotic usage and increasing proliferation of resistant bacteria square with the first of those strategic aims? According to the five-year plan, the aims were informed by the 2011 European Union AMR strategic report, so we should recognise that we are already behind the curve.
The Government seem no closer on the third aim, the development of new antibiotics, although I recognise that that is a difficult problem to solve. The Science and Technology Committee report states that
“the Government needs to work with researchers, investors, small and medium sized enterprises, large pharmaceutical companies and other Governments to urgently identify appropriate economic models that might encourage the development of new antimicrobials.”
Since the Prime Minister’s announcement of the commission to review the situation we have heard nothing further from the Government. I hope that the Minister will be able to give assurances that the review, which will clearly take some years, will not be simply a substitute for any action that could be taken immediately and that, in giving those assurances, she will explain what action the Government are taking in the meantime and what discussions they—or officials, critically—have had with the stakeholder groups highlighted by the Committee’s report.
It is clear that this is an international issue that requires work across Governments. We warmly welcome the G8’s commitment to tackling it, but it is clear that more needs to be done. It cannot be solved simply by eight countries acting by themselves; wider engagement is needed. Will the Minister therefore update Members present on discussions with counterparts throughout the world and the actions that are being taken internationally?
Finally, I want to question the Minister on the pressures on primary care. One often-cited solution to over-prescription of antibiotics is to administer them only if a patient’s condition worsens. While that is a sensible approach that, where clinically appropriate, reserves antibiotics for the most serious cases, in reality the pressure on GPs means that that is not always a credible or deliverable solution.
At present 13 million people wait more than one week to see their GP. During that time, symptoms could worsen and antibiotics could be the only treatment available to people when they are seen. If they had been seen earlier, however, alternative clinical options might have been available to them. Relieving the pressure on primary care must form part of the toolkit that should be employed to tackle AMR, yet it seems that, at the moment, the Government have no response.
The tackling of antibiotic resistance is incredibly important. The CMO has said that the threat posed by AMR is on a par with international terrorism and the Government’s wishes and rhetoric must be backed up with action. That is the settled will of the Chamber and I am sure that it is also that of all 648 sitting Members of Parliament. Where the Government do the right thing, they will have the full support of the Opposition without question. This is too important to be subjected to the banalities of party politics, so let us get on with it.
(9 years, 11 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
It is a pleasure to serve under your chairmanship, Mr Davies.
I congratulate my hon. Friend the Member for Scunthorpe (Nic Dakin) on making a truly superb speech to open this debate, and the hon. Member for Lancaster and Fleetwood (Eric Ollerenshaw) on proving that inspiration is not simply found in one’s own party; his contribution to the debate was tremendous. Through their leadership of the all-party group on pancreatic cancer, I am aware of the importance of this debate and I thank them for their efforts to raise awareness of this vital issue. I also thank other hon. Members for their contributions to the debate, which are a testament to the strength of feeling across the House about this subject. Also, to find such an uncommonly well-attended debate while we face a looming constitutional crisis demonstrates how important this issue is to Members from all parties in the House.
We need only to consider the number of people—106,399—who signed the petition calling for the Government to look at pancreatic cancer to appreciate the strength of feeling right across the country. Like those who have preceded me, I must take this opportunity to pay tribute to Maggie Watts, who launched the petition to help push pancreatic cancer higher up the political agenda, raise its profile and encourage more funding for research into the disease. I say to her that hers is a job well done and she is indeed an example to others.
The story of Maggie’s husband, Kevin, shows why we here today. It has been said before, but it is shocking that when Kevin died in 2009, aged only 47, the survival rate for pancreatic cancer was no different from that when his mother died of the same disease in 1969; as many colleagues have said, not to have made any progress in 40 years is an appalling situation, and one that requires all of us to give this issue our urgent attention. It is shocking that only 20% of people diagnosed with pancreatic cancer survive a year, compared with the 68% average for all other cancer diagnoses, and it is appalling that only 5% of pancreatic cancer patients will survive for five years after diagnosis, compared with an average of 50% for patients with other cancers. So I am glad that Members have had this opportunity to highlight pancreatic cancer and examine in detail ways to improve the situation for future pancreatic cancer patients.
However, as we have heard today, we have much further to go to ensure that we raise awareness of pancreatic cancer and diagnose it earlier, refer people swiftly when pancreatic cancer is suspected, and treat the disease more effectively. In addition, we must not lose sight of the importance of working to prevent the disease from developing in the first place. I will consider each of these issues in turn.
On raising awareness and earlier diagnosis, we know that finding cancer early can make a real difference. When pancreatic cancer is diagnosed at an early stage, the treatment is often simpler and the outcome more likely to be positive. We also know that one in four people with cancer are diagnosed after an emergency admission, and for those with pancreatic cancer that figure almost doubles; almost half of pancreatic cancer diagnoses happen after an emergency admission. Tragically, a diagnosis at that stage means that on average patients are around twice as likely to die compared with those who have been referred by their GP.
The Government’s cancer strategy sets the welcome target that by 2014-15 some 5,000 additional lives will be saved each year and rightly states:
“It is mainly through earlier diagnosis where these lives will be saved.”
We all agree with that. I would welcome an update from the Minister on what steps the Government are taking to achieve that goal through improving earlier diagnosis. More must be done to raise awareness, so that people are able to spot the signs of cancer and visit their GP sooner rather than later. Efforts to promote public awareness, such as the Be Clear on Cancer campaigns, are very welcome and do great work, but we do not yet have a specific campaign for pancreatic cancer. Can the Minister say whether she has any plans to introduce such a campaign, so as to promote better awareness of the symptoms of pancreatic cancer?
Of course, I recognise that raising awareness of pancreatic cancer, the symptoms of which are not always clear, is more difficult than raising awareness of cancers that have more specific symptoms. However, the low levels of public and professional awareness about pancreatic cancer must be addressed. A 2012 survey of more than 250 GPs undertaken by Pancreatic Cancer UK found that although most GPs could list one or two possible symptoms, half of those surveyed said they were not confident that they could identify the signs and symptoms of possible pancreatic cancer. I am concerned about how frequently I hear of people going to see their GP with a concern or worry, returning a couple of times, only for them to be diagnosed with cancer a few weeks or months later. How many times have we all, as constituency MPs, heard of that? I am sure that all of us here today can recount tales of such episodes. Does the Minister have any plans to improve training for GPs to help them to spot the signs of pancreatic cancer?
Regarding swift referrals, as vital as awareness-raising is, it will not be enough on its own if people are not referred quickly after pancreatic cancer is first suspected. Before Christmas, we heard that the Government are missing their target for 95% of people with suspected cancer to be seen by a specialist within two weeks in as many as half of all cases. Today’s report from Cancer Research UK adds to concern about that situation by highlighting that, after decades of progress, cancer patients are now waiting longer for tests and treatment, and that is particularly true for pancreatic cancer patients. The all-party group’s report on pancreatic cancer, which was published earlier this year, revealed that patients are experiencing delays in referral to specialist centres or completely missing out on the opportunity to receive specialist treatment. Can the Minister say what the Government are doing to ensure that suspected pancreatic cancer patients are referred for testing and treatment as soon as the cancer is suspected, and that after they are referred they do not wait longer than two weeks to see a specialist? The Cancer Research UK report shows that the number of cancer cases is going up as the UK population ages. If that is the case, how will the Government ensure that the NHS will be fit for the purpose of diagnosing more people, treating more people and helping more people to recover from pancreatic cancer in the coming decades?
On the issue of high-quality treatment, after being diagnosed with cancer, patients need to feel safe in the knowledge that they will receive the most effective treatment possible, yet the paucity of treatments for pancreatic cancer is shocking; surgery remains the only way to cure someone. However, less than 20% of those who are eligible for surgery go on to have curative procedures, because for most people by the time they are diagnosed the disease is far too advanced. Can the Minister say what action the Government are taking to support research into the development of a wider range of treatments for pancreatic cancer?
Pancreatic cancer patients do not just need treatment; they also need high-quality and patient-centred care. I, too, pay tribute to Macmillan Cancer Support; the briefing that it provided to all Members in advance of today’s debate is exceptionally. Also, the findings of the 2013 national cancer patient experience survey, run by NHS England, show that patients affected by upper gastrointestinal cancers, including pancreatic cancer, experience poorer levels of care than those affected by common cancers. Only a quarter of upper gastrointestinal cancer patients were offered a written assessment and care plan; a third reported not being definitely involved in decisions about their care and treatment; and a quarter indicated that test results were not completely explained to them. Moreover, a shocking 37% said that they had not been given written information about their type of cancer.
Those findings were echoed in the all-party group’s report. In its inquiry, it found that there are serious shortcomings in providing patients with consistent access to high-quality, patient-centred care, including the provision of support and information. Will the Minister set out how she is improving the experience of pancreatic cancer patients in our NHS?
On prevention, we all know that our battle against cancer cannot be won with better care and treatment alone. Around 37% of pancreatic cancers in the UK are, sadly, linked to lifestyle, and risk could be reduced through such measures as smoking cessation, promotion of a healthier diet, exercise and drinking alcohol in moderation. We all know this.
Tobacco smoking is one of the biggest risk factors in developing pancreatic cancer; almost a third of pancreatic cancers in the UK are linked to smoking. Under the previous Government, the number of smokers dropped by a quarter, which in my view is a significant achievement. Yet the proportion of our population who smoke today—20%—is still too high. Experts have warned that current decreases in smoking-related cancer incidence will eventually stop unless further progress can be achieved in reducing exposure to tobacco.
Earlier this year, Parliament voted in favour of introducing standardised packaging of tobacco and, together with Labour’s proposal to ban smoking in cars carrying children, this is a great step forward in protecting children and ultimately creating, we hope and believe, a shift in smokers’ behaviour. As the independent report from Sir Cyril Chantler concluded, it is
“highly likely that standardised packaging would serve to reduce the rate of children taking up smoking”.
We must maintain momentum and push ahead with the regulations and ensure that these two victories are not seen in isolation but are part of a much bigger, broader, more effective ambition. I would appreciate an update from the Minister on where we are with regard to the regulations.
As we have heard today, although we are making progress in our fight against cancer, this does not apply to all types of the disease, not least pancreatic cancer, for which survival rates have not improved in 40 years. As pancreatic cancer threatens to overtake breast cancer as the UK’s fourth biggest cause of cancer death by 2030, we need concerted action from the Government to improve diagnosis, speed up referral times and improve care and the development of treatment.
This is something we all care about, something that touches all of us and something that we all want to do something about. The all-party group report is right to say that it is time to change the story. I appreciate that the Minister has a slew of questions to answer, and I look forward to her considering them.
(10 years, 1 month ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
It is a pleasure to conduct a debate under your chairmanship for the first time, Mrs Riordan. I congratulate hon. Members on both sides of the House on the spirit with which they have conducted themselves today and on their genuinely well informed and impassioned contributions. I also congratulate my hon. Friend the Member for Blackley and Broughton (Graham Stringer) on securing the debate.
Members of all parties will appreciate the concerns expressed in the House over many months on behalf of communities that are worried about changes to their local NHS services. Consultations and how they are conducted are vital to ensuring that people have the necessary information to participate effectively in the consultation process, but that does not always happen. The Healthier Together review of health and care services across Greater Manchester is intended to deliver improvements to primary and community-based care to reduce the need for people to go into hospital, and that principle has received broad endorsement from colleagues today. The intentions of the review for primary care are admirable, including that by
“the end of 2015, everyone living in Greater Manchester who needs medical help, will have same-day access to primary care services…seven days a week; by the end of 2015, people with long-term…conditions…will be cared for in the community…supported by a care plan which they own; community-based care will focus on joining up care with social care and hospitals, including sharing electronic records which residents will also have access to; and by the end of 2016, residents will be able to see how well GP practices perform against local and national measurements.”
The plan also aims to improve joined-up care and hospital care. Although the aims are good, it is essential that the review also provides reassurance and clarity. From what I have heard today, it is clear that that is missing by some measure and has not been achieved—at least not yet.
As is too often the case, the review started with what services will be taken away from hospitals. Instead, it should have begun with what services people will in future be able to receive in their own homes or in a local community setting. Rather than identify the services that will be taken from the general hospital and put into a specialist hospital, the review should have identified the services that will be repatriated from the specialist hospital to the general hospital.
We all recognise that how and where services are delivered does need to change, but it is a quid pro quo process and the specialist hospitals also need to put some services back into a general hospital setting. When the proposals from a review appear to be a power grab by the big players in the local health economy, it is no wonder that people fear for the future of their services. If services are taken away, “How viable will we be?” becomes a worrying question. We need specialist hospitals, as shown by the case of Fabrice Muamba, who was taken not to the nearest hospital but to the specialist hospital that would save his life, but we also need general hospitals serving their local communities.
The Healthier Together review has the chance to shape services across Greater Manchester, moving out into the home and community setting, at the same time as securing the future for the general hospital. However, several colleagues have raised genuine concerns about the process. If a review of health services is to command support and achieve success, it must be open and transparent and provide all the necessary information to the public. Members have expressed grave doubts about whether that truly is the case with the Healthier Together review. The future viability of all hospitals needs to be secured, the continuation of A and E services has to be ensured and the issue of travel times across a conurbation such as Greater Manchester has to be taken into account in precise detail.
Although the aims and objectives of the Healthier Together review are commendable and, if introduced properly, would deliver improved health and care services across Greater Manchester, as we have heard in detail today, many worries have not been addressed and significant concerns remain. It is now for the Healthier Together review team to provide the answers and reassurance that are needed for the review to be successful. I look forward to hearing from the Minister.
(10 years, 1 month ago)
Commons ChamberI had hoped for a little more consensus on the issue of dealing with poor care. I am afraid that what we had from the right hon. Gentleman was a set-piece speech. However, let me go through the points that he raised.
First, the right hon. Gentleman spoke about nursing numbers. Let us look at the number of nurses since the Government took office. We have 6,200 more nurses on our wards than when he was Secretary of State for Health. Why is that? It is because we took the difficult decision, which he opposed every step of the way, to get rid of the bureaucracy, the primary care trusts and the strategic health authorities—19,000 administrators—so that we could afford more nurses, more doctors, more paramedics and more front-line staff. It is time that he admitted that he was wrong to oppose those important reforms.
The right hon. Gentleman then talked about trusts missing A and E targets. Despite the fact that we are doing better on A and E than he did as Health Secretary, he has missed the point about targets. It was an obsession with targets under Labour that led to the problems in Mid Staffs and many of the trusts that are in special measures today. Let us just take one example. [Interruption.] The Opposition should listen to this example because it provides an important lesson about targets that the Labour party has still not learned. Buckinghamshire had a terrible tragedy in 2004 and 2005, when more than 30 pensioners died in a clostridium difficile outbreak. Why did that happen? The independent report said that the trust was too focused on Government targets.
That is the dividing line. The Opposition want an NHS that is obsessed with targets. The Government recognise that targets matter, but that treating people with dignity, respect and compassionate care matters. Is it not extraordinary that the party that founded the NHS has got itself into a position where it does not care how people are treated in the NHS?
The right hon. Gentleman talked about social care. If he wants more funding for social care, why has he called for the better care fund to be halted, when it will put an extra £1.9 billion at the disposal of the people who commission adult social care?
Let us look at some of the examples that the right hon. Gentleman raised. He talked about Basildon. When he was Health Secretary, the CQC sat on a report about that trust for six months that talked about bloodstains on the carpets, blood on the floors and vital safety measures being ignored. When the reason why the report was not published for so long was looked into, people at the CQC said that they were afraid to publish something that could embarrass the Government of the day. Is it not time that he admitted that the way the Labour Government ran the CQC was wrong? We now have an independent inspections regime, which is a big step forward.
The right hon. Gentleman talked about Cumbria. There are real issues in some of the hospitals in Cumbria. However, when Labour was in office, somebody in one of those hospitals—North Cumbria—was paid £3.6 million because they were disabled for life. Should that not have been a warning sign? There were also issues at Morecambe Bay involving children.
What are we doing? We are doing what I set out in the statement. We are putting more nurses and doctors into hospitals that are in special measures. We are turning around the failing hospitals that Labour swept under the carpet.
Even if Labour has not understood the lessons of Mid Staffs, the NHS has. We have 6,000 more nurses; five hospitals are out of special measures; there is record public confidence in safe and compassionate care; and, from today, we have new plans to stamp out poor care in adult social care. When everyone in the NHS is so keen for those plans to work, is it not time that Labour ended its denial about the past and backed them as well?
(10 years, 1 month ago)
Commons ChamberOrder. If the right hon. Gentleman would face the House, it would greatly avail us. I understand the natural temptation to look backwards—[Laughter.]—as in, behind him! But he must face the House.
On 20 June, I wrote to the Secretary of State informing him of the claims of doctors in Cumbria that unless drastic action were taken to reduce the pressures on GPs’ work loads, patients could die. I have not even received a response. Why, having being given such a stark warning, is the Secretary of State sitting on his hands? There are fewer GPs today than there were during Labour’s last year in office. How can standards in general practice be improved when surgeries are dealing with a recruitment crisis?
Let me give the hon. Gentleman his answer now. According to the Royal College of General Practitioners, 40 million more appointments with GPs are being made in every single year than were made when Labour was in office, and we have 1,000 more GPs than we had when his party was in power.
Let me say very clearly that the way in which we will deal with this problem is by increasing the capacity of general practice and the capacity of primary care. The hon. Gentleman should be supporting that—and he might just think about the 48-hour target that Labour has been talking about. If a new target for GPs is introduced, they will simply cut the amount of time that is available for them to deal with the most frail and vulnerable patients, and that would be wrong.
(10 years, 2 months ago)
Westminster HallWestminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
It is, as usual, a pleasure to serve under your chairmanship, Dr McCrea, and it is a pleasure to follow the hon. Members for Torbay (Mr Sanders) and for Strangford (Jim Shannon). The hon. Member for Torbay, in particular, has been making a superb contribution across this entire policy area for many years. As someone who is also “blessed” with type 1 diabetes, I look to him for inspiration, and he readily provides it on a regular basis. I cannot thank him enough for introducing a debate in this House on this subject yet again. His work as chair of the all-party group on diabetes, as president of the Parliamentarians for Diabetes Global Network and in the Global Parliamentary Champions for Diabetes Forum is commendable. His position and work there mean that the UK can be a world leader in ensuring high-quality treatments and support for those with diabetes. I am very sincere in all those comments. They are heartfelt.
The hon. Gentleman spoke on this subject in April, in a debate to which I contributed. He raised some very important issues, not least of which was the importance of an approach that respects the distinction between causes and treatments of type 1 and type 2 diabetes. In opening today’s debate, he has again raised matters of the utmost importance and concern, which I will also touch on.
The Melbourne declaration on diabetes was formally adopted on 2 December 2013, as we have heard, at the first Global Parliamentary Champions for Diabetes Forum. The declaration contains eight action points for parliamentarians, including encouraging the creation and adoption of a national plan that acknowledges that diabetes is a national health priority and that leads to action. I will focus my remarks today on the need to create an action plan. I hope that the Minister, whom I welcome to her place, can confirm that the Government are committed to that, especially given the clear will of parliamentarians from those parties that have contributed today, although I know from discussions and conversations with colleagues right across the House that there is a clear understanding of the need to support an action plan as a way forward.
There are more than 380 million people with diabetes in the world, and that figure is expected to reach almost 600 million by 2035. That is deeply worrying. In the UK, 3.2 million people are living with diabetes. That includes almost 35,000 children. One pound in every £10 spent by the NHS is spent on treating diabetes and the complications that arise from it. We have heard an awful lot about the economic and financial modelling of the effects of diabetes on the NHS. I think that we need to spend more time on that as a country. Diabetes UK says that diabetes is responsible for 20,000 premature deaths each year, and that 80% of cases of type 2 diabetes could be prevented or delayed. Let us just think about that: 80% of cases could be prevented or delayed. The financial savings that we could make, irrespective of the improvements that we could make to the lives of those people who go on to develop type 2 diabetes, are phenomenal.
We must always be aware of the distinction between type 1 and type 2 diabetes. Type 1 is a chronic, life-threatening condition that affects 400,000 people in the UK, including 29,000 children. Type 1, as we have heard, is not caused by lifestyle factors such as obesity, lack of exercise or poor diet. I should know, and I never resist the temptation to remind people that I did the London marathon earlier this year. Thanks go to the Juvenile Diabetes Research Foundation, if its representative is in the room. I want to do it again next year, by the way. Whereas those with type 2 diabetes can sometimes be treated with a change in diet and exercise and modest medication, those with type 1 diabetes need multiple insulin injections or pump infusions every day. I did mine before the debate started. My blood glucose level was 14.7, which is not particularly good—I will be getting told off for that.
Each year, a person with type 1 diabetes will undertake more than 2,000 finger-prick blood tests, have 1,500 insulin injections and count the carbohydrates in more than 1,000 meals. It is clear that any action plan will have to develop coherent and effective strategies for both conditions. A one-size-fits-all strategy simply will not do, so I hope that the Minister can reassure us today that she will not be cutting corners. Any plan must be workable and tailored to meet the specific needs of both conditions.
Diabetes UK has done excellent work, as always, on this matter. Its briefing in advance of today’s debate was superb. It endorses the view that there is a clear need for a national action plan. It has identified five key areas that must be included. Those are improvement in support for self-management; integration of care; improving safety; a focus on children and young people with diabetes; and prevention of type 2 diabetes. I am sure that if the Government introduced a comprehensive action plan built on those five principles, it would receive the support of the entire House.
Starting with self-management, it is obviously crucial that individuals and their families can successfully manage their condition, and the keystone of that is effective care planning and education. Positive care planning and strong education can ensure that an individual is equipped with the tools and resources needed effectively to manage their condition. Diabetes UK calculates that each year, care in a clinical setting totals about three hours, whereas self-care accounts for almost 9,000 hours. Improving self-management is not optional—it is absolutely essential. I appreciate that it could be culturally difficult for us to achieve that as a Parliament and a country, but it is something we absolutely need to crack.
Opposition Members have long advocated the benefits of integrated care across the whole NHS. With diabetes, a person will routinely have contact with many parts of the wider health care system, such as primary, community and secondary care. To improve integration, Diabetes UK has identified five key points that would, in effect, provide an integrated diabetes care pathway. Such a pathway would require strong networks of clinicians, commissioners and patients, a more integrated system of commissioning services, better information-sharing across services and the improving of skills in primary care, all of which should be overseen by effective clinical governance. Those actions are not out of reach, and the Government could easily ensure that they are part of any action plan.
The third point I want to cover is patient safety. There are major issues regarding the safety of in-patients with diabetes in hospitals. According to research undertaken by Diabetes UK relating to the past year, about 40% of in-patients experienced at least one medication error, more than a fifth experienced one or more hypoglycaemic episodes and fewer than a third were seen by a member of the diabetes team. Those problems can, as the hon. Member for Torbay said, contribute to patients with diabetes having to remain in hospital more than three days longer than patients without diabetes. Again, we should consider the cost implications for the health service in these tough times. Any plan the Government introduce must surely address that, because it is bad for patients, clinicians and the health service.
There must also be space in the Government’s plan to address young people’s experiences. There are 35,000 children with diabetes in the UK, which has the fourth highest number of children diagnosed with type 1 diabetes in Europe. Many children and young adults experience a marked deterioration in their care as they make the transition from children’s to adults services. Adolescence is often a time when many lifelong behaviours are established, including those that are health-related, so it is essential that young people can complete the transition at a time that is right for them. A deterioration in care and a forced transition have been shown to disengage young people from the service, resulting in worse outcomes and complications. There is an acute need to address that.
In the last debate on this issue, in April, I referred to support and education for young people, which are key to ensuring that they can manage and cope with their condition. Being diagnosed with any form of diabetes can be overwhelming if the proper support is not in place.
My next point relates to a focus on preventing type 2 diabetes. Recent reports by the British Medical Journal have shown that a third of adults have higher than normal blood glucose levels, which is an indication of pre-diabetes, and many health professionals project that there will be a huge increase in the numbers of those with type 2 diabetes. I am sure that that worries policy makers on both sides of the House, whether on the left or the right or in the centre. As I said, any action plan must take into account the differences between type 1 and type 2. Critically, any strategy for type 2 must be based on prevention.
I would be grateful if the Minister could outline what the Government are doing on the points I have raised, and I would expect her to be able to give us some indication of when they are likely to introduce a plan to address the issue. Given the importance of such a plan, I hope she will make a statement to the House when any plan is published, to give Members who are not present the chance to scrutinise the Government’s proposals. Indeed, I would go further. Every time we have such a debate, it strikes me that there is a real wealth of experience and understanding of these issues across the House. It would, therefore, be a tremendous gesture—not for its own sake, but from the point of view of those living with this condition—if Members who understand type 1 and type 2 diabetes were allowed to contribute their knowledge and experience to the production of a better plan that would better suit those with this condition.
Through the Melbourne declaration, the International Diabetes Foundation makes the incredibly important point that
“disadvantaged people in every country carry the greatest burden”
with regard to diabetes. That is important when looking at the levels of clinical care for diabetics across clinical commissioning groups throughout England. Speaking to diabetics around the country, I have seen for myself that if we are to make self-management as effective as it can be—we have a long way to go on improving not only the culture but the clinical ability of CCGs and other primary care providers regarding self-management—we must make a concerted effort to look at the literacy and numeracy of some of the people with this condition. Every day, before every injection, people must undertake a fairly simple and routine mathematical calculation of their insulin to carbohydrate ratio, but many of them simply cannot do the maths. There is no assistance, tool or device on the market to help them make those calculations simply, so we need to look at that, because it is a big cultural issue. There is an issue with not just numeracy, but literacy, and there are also issues about social exclusion, which I am sure we are all aware of. We need to put some time and effort into understanding and resolving those issues if we are properly to increase self-management among diabetics.
NHS England published “Action for Diabetes” earlier this year, but Diabetes UK said that it was not sufficient and did not present a comprehensive strategy or action plan. I have read it, and I think that is a fair comment. Diabetes desperately needs a national service framework—there are no two ways about that. The service around the country is incredibly patchy when it comes to not just the nine key diabetic tests, but other diabetic support services. Perhaps the Minister can tell us how the Government will ensure that CCGs step up to the plate. We really need a detailed plan, and I hope she can tell us when one will be introduced.
Will the Minister also tell us how many diabetics are missing their checks? That information should be understood and collated centrally, because the issue is of strategic national clinical importance. What are the clinical and financial effects on the service of people missing their appointments? We are failing people with diabetes, and that did not begin in 2010.
I touched earlier on self-management, which is incredibly important, but so are innovation and the use of data. For me as a type 1 diabetic, the most important issue in managing my condition is having access to data about it, such as my blood glucose readings and my insulin ratios. We need a framework and a strategy for medical innovation that incorporates diabetes research—from not just a scientific point of view, but a patient’s point of view—in a profound way. How can we become the best country in the world, in terms of medical companies and other pharma-based industries developing new and innovative ways of treating diabetes?
I wear all sorts of devices to monitor my fitness and my sleep—whether it is a Jawbone, a Misfit Shine or a Nike fuelband, believe me, I have them all. The data they capture about the individual is of incredible medical importance. We need, on a cross-party basis, to establish a strategy under which this country can genuinely innovate and become a global leader, with a view to enabling companies to produce the best suite of devices, applications and so on to assist in dealing with type 1 and type 2 diabetics. I look forward to the day when my data can be captured in real time and shared with my GP and my pharmacist, so that I do not have to phone up, text or e-mail to get my insulin prescription. My GP and my pharmacist will have the information and the algorithm, they will know when my prescription needs to be ready and how much I am using, and my doctor will know how I manage my condition. We can hothouse innovation—my office and I are doing an awful lot of work on this—but we need to make that innovation part of not only a national diabetes strategy, but a biotech and medical innovation strategy.
Finally, I say to the Minister that we are here to help. Will she please use the experience that exists across the House and not miss this opportunity to act?
Before I call the Minister, I want to mention that several Members have apologised for not attending because they are taking part in another debate. They wanted to be here and asked me to pass on their apology to the hon. Member for Torbay (Mr Sanders) and the Minister.
That is right. We need to make sure of that. People cannot be empowered without information. We also know, having a duty to address health inequalities, that some people and groups in the community find things much harder. I was taken by some of what the shadow Minister, the hon. Member for Copeland (Mr Reed), said about deploying technology more. Work is going on, but I agree with him that we could go further faster with that, to find ways to empower people who may not have a good sense of what to do to take care of their health, and who find it harder than others to obtain the available advice. We must work harder to reach them and I shall talk about NHS health checks in relation to that.
As to the commissioning of integrated care, NHS England is working with other organisations to help to promote services that are integrated around patients’ needs across all settings. There has been much emphasis on that. That body is implementing what it calls a customer service platform to allow patients with diabetes to self-manage, through booking their own appointments, managing their prescriptions, monitoring the care they have received and being able to view their personal health records. That picks up on some of the shadow spokesman’s points.
NHS England has also produced a sample service specification for the management of type 1 and type 2 diabetes that is based on National Institute for Health and Care Excellence standards. It provides a model for commissioning integrated care for those with diabetes, and also highlights the specific needs of those with type 1 diabetes, where they differ from the needs of those with type 2. If the current trial of the service specification is successful, it will be offered as a tool that all clinical commissioning groups can choose to use to deliver high-quality care. That is therefore an important piece of work in progress.
There is always a challenge for any of us in making sure that the rest are as good as the best. Occasionally when we talk about the challenges of our current health infrastructure I worry about the assumption that there is a model out there, somewhere, that would absolutely guarantee the delivery of completely consistent care in a given area, across the country. In a country such as ours it is not possible to give such a top-down guarantee. Yes, we must find a way to drive care from the top, with a clear sense of direction from the strategy and mandate that we have given the NHS and Public Health England, but we must also put the tools in the hands of the clinicians, as I have been discussing. Most importantly, we must empower individuals and patients to know what they can expect and to demand good care. Nevertheless, I genuinely do not think that we could devise any system in which we could just issue a notice from the centre to say exactly how care will be delivered consistently across the country. We must find other ways to do it.
I understand the Minister’s point, but we are talking about nine very simple, fairly cheap tests for people with type 1 diabetes that must be done in a primary care setting by medical professionals. We are talking about blood tests, the blood being processed and the resulting data being made available, all of which are critical to the self-management of the condition. Surely we can insist on those nine tests for every single type 1 diabetic patient.
I think that the shadow Minister has slightly misunderstood what I said. Those are the tests and that is exactly the standard to which we want everyone to work. What I am saying is that there is no top-down guarantee. We cannot sit in Whitehall and say, “It must be done like this and that is the end of it.” We have said that that is the standard, and NHS England has set a range of other standards, but to deliver that and to drive that consistency of excellence throughout the country requires a range of tools. We must acknowledge that. That is not to say that we accept patchy service—far from it—but we cannot do it with top-down diktat only; we must drive change at all levels of the system and drive towards excellence.
(10 years, 2 months ago)
Commons ChamberLast month, for the first time ever the NHS missed a target for beginning cancer treatment within 62 days of patients being urgently referred. Cancer Research UK stated:
“This isn’t just a missed target—some patients are being failed,”.
We know that the key to ensuring that more people survive cancer is to start treatment as soon as possible after diagnosis. Is it not shocking that cancer charities, including Macmillan Cancer Support and Cancer Research UK, now say that cancer is being overlooked in this Prime Minister’s national health service?
We all appreciate the wonderful work done by cancer charities such as Macmillan Cancer Support and Cancer Research UK, and the Department works closely with those charities. We want outcomes for cancer patients in England to be among the best in Europe. As I said, we know we are not there yet, but a great deal of effort and money is going into getting there. The NHS is treating more cancer patients than ever. Since 2009, we have seen numbers rise by 15%—that is 1,000 more patients with suspected cancer referred to a specialist every day. That is the success of some of the early diagnosis and awareness raising activity. Of course we want any local dips in performance to be addressed, but let us give credit where it is due to clinicians who are diagnosing more cancers and catching them earlier, because that is the key to treating cancer successfully.