Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 11th June 2013 Commons Chamber

[Mr Hunt]

I agree with my right hon. Friend on this issue. It is extremely important that all these plans take a holistic view both locally and nationally. That is why, in looking at how to resolve the A and E issues we have faced and the severe pressures last winter, we are looking not just at what happens inside A and E departments, but at primary care alternatives and the integration of social care services, which are all equally important.

[Mr Jamie Reed (Copeland) (Lab)]

Perhaps it took the Secretary of State so long to visit an A and E unit because he could not get in. In the midst of England’s A and E services experiencing their worst waiting times for a decade, the Secretary of State criticised hospitals for coasting. Does he regret waiting for six months before first visiting an A and E unit and finding out for himself what damage his policies were doing to the front line of the NHS? Hospital consultants, A and E consultants and patients look forward with interest to hearing his answer.

[Mr Hunt]

We will take no lessons on being connected with the front line from the party that missed 50 warning signs about what was happening at Mid Staffs. The hon. Gentleman cannot make the narrow point about how many A and Es I visited during a particular period without addressing the broad point about how connected Ministers in his party were when they were in power. They rejected 81 requests for a public inquiry because they did not know what was happening at Mid Staffs.

111 Telephone Service

Jamie Reed Excerpts

Wednesday 5th June 2013 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to be called to speak under your chairmanship for what I think is the first time, Mr Robertson. I extend my most sincere thanks to the hon. Member for Thirsk and Malton (Miss McIntosh) for securing this important debate. We have worked closely on a number of issues during my time in Parliament, and she is rightly respected across the House as an independently minded Member. I must express my most sincere sympathies to her, but also my profound thanks for the real courage she has shown in sharing her family’s experiences with us.

It is a mark of the severity of the crisis our A and Es are experiencing that Members of all shades of political persuasion have spoken at some length about their constituents’ experiences. It is no exaggeration to state that members of the public are very concerned about the situation regarding NHS 111. A and E is arguably the most visible part of our NHS, and what happens there is felt throughout the system. From the patient waiting at home for an ambulance to the person waiting on a trolley for a bed, what happens in A and E touches every patient in the NHS.

The crisis in A and E has happened on this Government’s watch. When Labour left office, A and E was performing well, with 98% of patients seen within four hours. However, the number of patients waiting for more than four hours has now doubled, and ambulance queues have doubled too. Let us not forget that the target for the number of patients seen within four hours in A and E has been reduced under this Government, from 98% to 95%. Today’s debate is therefore extremely important, and the Government must finally offer some real solutions to address the crisis they have caused.

[Andrew Percy]

I find it incredible that the shadow Minister states that the issue was caused by this Government. A lot of my constituents are having to ring 999 because 50,000 beds were taken out of our hospitals nationally on his party’s watch; wards were closed in my local hospital on his party’s watch. Elderly, vulnerable patients who do not have local hospital beds to go to are now forced to ring 999 to get access to emergency services, so it is pretty shameless of the hon. Gentleman to attempt to politicise the issue.

[Mr Reed]

I have to say I am staggered by the hon. Gentleman’s manufactured indignation. I do not know how long he has been a Member of the House, but he will recall that, between 1997 and 2010, the Labour party took the NHS budget from about £30 billion to £110 billion. However, on every occasion the budget was put before the House of Commons, the Conservative party voted against an increase. He should think again about his manufactured indignation.

[Andrew Percy]

rose—

[Mr Reed]

I am going to make some progress, because I want to get on to the substantive issues in play.

When Labour first suggested a new NHS 111 service, we were clear—the hon. Gentleman should listen—that it would not replace NHS Direct. Our manifesto in 2010 said:

“A new national 111 telephone number will make nonemergency services far easier for people to access and book.”

The 111 service was planned to help people find an emergency dentist, a late-night pharmacy or an out-of-hours primary care GP. This Government scrapped that and instead pressed ahead with the botched implementation of a system that just could not cope with what it was expected to do. They were warned, but, as usual, they did not listen.

There is no doubt that the 111 service is not fit for purpose. The statistics show it, the examples given by Members today show it and, most importantly, patient testimonies show it. Indeed, the Minister herself acknowledged it in response to the right hon. Member for Mid Sussex (Nicholas Soames) in late May, when she stated:

“We recognise that the service has not been good enough and we are working closely with NHS England to ensure improvement in performance. NHS England have put a number of measures in place already.”—[Official Report, 21 May 2013; Vol. 563, c. 740W.]

I hope the Minister will outline what those measures are and what their effects have been, because the contributions we have heard today suggest they are having a negligible effect.

The implementation of the system has undoubtedly caused serious problems; indeed, in my area, NHS Direct is having to be maintained alongside the 111 service to cope with demand. The Minister must explain in detail how a botched, fragmented implementation was allowed to happen despite there being a significant pilot scheme.

[Barbara Keeley]

On the issue of propping up NHS 111, I wonder whether this is the point at which to give credit to the NHS Direct nurses whom Janet Davies of the Royal College of Nursing cited. Even though some of them are being made redundant, they were prepared to prop up the service during its few weeks in places such as Greater Manchester. We really should give those nurses credit. What a dreadful experience, just before they were made redundant, to have to prop up the service that was replacing them.

--- Later in debate ---

[Mr Reed]

I could not agree more. We must give credit to all the people in the NHS coping and labouring under a creaking system right now. The case of the NHS Direct nurses my hon. Friend draws our attention to, who are about to be made redundant but are propping up the system, speaks volumes about their commitment to the ethos underpinning the NHS. I thank my hon. Friend for that contribution.

The 111 service data for March published by NHS England show that only 122 patients responded to the NHS 111 patient experience survey. When the Minister responds in a few minutes, I hope she will not try to justify the implementation of a system that needs to serve millions of people on the basis of the experiences of just 122 patients.

The main purpose of the debate is to look at the implementation of NHS 111 and its impact on A and E attendances. There is no better place to look than the Isle of Wight—the hon. Member for Isle of Wight (Mr Turner) was present earlier. The 111 service there went live on 25 October 2011. The area has had a long time to address teething problems and to ensure that the service operates properly. What has A and E performance looked like over the past few months? Since the end of September, almost 2,000 patients have waited more than four hours, and the trust has missed its target for 23 out of 35 weeks. That is hardly a ringing endorsement of the system, even when it has had a chance to bed in.

Consultants on the Isle of Wight have even said that although patient numbers would be falling and the pressure would be easing if NHS 111 was working as intended, that is not happening—patient numbers are rising, and the pressure on the NHS is increasing. Indeed, Chris Smith, the director of NHS 111 on the Isle of Wight told the BBC that the service is fragmented and that that has led to problems. In response to the hon. Member for Tewkesbury (Mr Robertson), the Minister said that every NHS 111 provider is able to handle inquiries from any part of the UK, but I would challenge her to repeat that assertion today, given Mr Smith’s comments. If a system is fragmented, and CCGs are commissioning different providers, it will be almost impossible for those trained to handle calls to work within different systems. For example, the process for referring people through the system in an area with which they are unfamiliar will be totally alien to them, which is bound to cause further problems.

That brings me to my final point about the system. Following Labour’s A and E summit in Westminster last week, it was revealed to us that 111 call handlers do not necessarily have clinical backgrounds, as my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) said. Even more shockingly, it was revealed that some areas have an enforced threshold on how many calls nurses can answer, and that that was as low as one in five. The fragmentation of the system means that the figure varies from area to area, because it would have been negotiated in local contracts. Therefore, the service provided is not universal. That is in stark contrast to NHS Direct, under which 60% of calls were directed to nurses. Under 111, however, the figure stands at less than 20%. Does the Minister believe that the low level of engagement between trained medical practitioners and patients in the service is contributing to A and E pressures?

The chaotic reorganisation of the NHS is clearly producing a deteriorating experience for patients. In the last week of March, one patient in the south-east waited for 11 hours and 29 minutes for a call back. In the area covered by NHS Gloucestershire and NHS Swindon, 43% of calls lasting longer than 30 seconds were abandoned by the patient before they were answered. Will the Minister outline the lessons that have been learned from that experience and explain what measures will be put in place to ensure it is not repeated on a national scale?

In four weeks, the 111 service will be live across the country, and the Government need to be more honest about how the service is performing before wider implementation. Royal colleges, patient groups and other stakeholders have long warned the Government that the health and social care reforms brought about by the Health and Social Care Act 2012 would be distracting and cause chaos, and that such top-down reforms would stop the clinically driven reforms needed to help address the crisis in A and E.

That there is now a crisis engulfing accident and emergency services is beyond doubt. It was caused by the Government. We have heard today of a political vacuum and we have heard legitimate fears about the lack of accountability. Patients deserve better; we all do. If the hon. Member for Thirsk and Malton will allow me to say so, her family and her father deserve better. I hope that the Minister will take the time to address all the issues, and to outline the Government’s plan to deal with the current A and E crisis that they have caused.

--- Later in debate ---

[Anna Soubry]

I will take interventions, but I want to make these points first.

The population is also living considerably longer. That is good and welcome, but there are many frail elderly people with complex illnesses and diseases, so they attend A and E in a way they did not previously. In addition, we suffered under the previous Government from a lack of integration between health and social care. That was one of the things that the Health and Social Care Act 2012 addressed, and will solve. It is about better integration. The hon. Member for Copeland sneers at that.

[Mr Jamie Reed]

I do not sneer; I laugh.

[Anna Soubry]

He laughs at it, Hansard will record. It is not a laughing matter at all. What I was describing is one of the achievements of the Act. I am confident it will deliver.

[Anna Soubry]

I, too, know that it does no one any favours to make out that someone forcefully and passionately giving a view based on their experience is manufacturing it. I know that that is not true of my hon. Friend, and I thank him for his valuable contribution. He is right.

[Mr Jamie Reed]

I think casual outside observers will struggle with the concept that politicians from different political parties should seek to have different political opinions about the services and Department for which the Minister is responsible. She makes an almost Kafkaesque defence of the Government’s NHS record, but will she accept that the awful implementation of the 111 scheme, the collapse of adult social care, the closure of walk-in centres and the huge pressures on the NHS elsewhere in the system have resulted in the crisis in A and E?

[Anna Soubry]

I will not accept any of what the hon. Gentleman says, because he does his cause no service when he makes cheap political points. The matter is hugely complex, but it is wrong to say that the Government caused the problems in A and E. He is wrong in that. It is difficult and complex.

--- Later in debate ---

[Anna Soubry]

Indeed. I will answer as many of my hon. Friend’s questions as I can. There are some questions I will not be able to answer, but I will certainly write to her.

One of the reasons we introduced pilot schemes was to learn from them, and I can tell my hon. Friend a few things as a result. The university of Sheffield did an evaluation report, which said that there was “no statistically significant” impact on services in most of the pilot areas. Importantly, NHS England is collecting data on 111 and its impact on other services, especially, as one would imagine, on A and E. NHS England is in a position to monitor that, and it will report in due course. I am told that the April data will be published this Friday.

I am reliably informed that the A and E performance of York Teaching Hospital NHS Foundation Trust, which serves my hon. Friend’s constituency, is that in 2013-14 so far, 96.1% of people have been seen within the four-hour target. That is above target. I think the average across England for people being seen in A and E is some 55 minutes.

[Mr Jamie Reed]

This question is not a trap in any way, shape or form. The Minister just said that NHS England is assessing data on the performance of 111 thus far, which will be made available in due course. This is an empirical question: will the system be rolled out across the country without the data on the effect of the 111 service on the rest of the system being fully understood?

[Anna Soubry]

I do not know the answer, and I will not start speculating because it invariably gets one into terrible trouble.

[Mr Reed]

Will the Minister write to me?

[Anna Soubry]

I am more than happy to write to the hon. Gentleman with some sort of answer from either NHS England or the Department.

I should say, of course, that we know that 111 has not been successful in the way it should have been in many parts of the country, and we know that there were particular problems over the bank holiday and Easter periods, but we also know that it has now been rolled out to 90% of England. NHS England is monitoring, overseeing and collecting the data, as we would all hope.

I will do my very best to respond to the content of today’s debate and the questions that have been raised, with apologies for those questions that I do not answer.

The ratio of call handlers to professionals, about which my hon. Friend the Member for Thirsk and Malton asked, is 4:1. That ratio is not specified, however. There is no prescription that it must be 4:1. As 111 is locally commissioned in the way that I have explained, it is for local commissioners to decide whether to change that ratio, depending on the particular needs of the people in their area. One of the great benefits of the 2012 Act is that we have enabled local commissioners, either as a CCG or as a cluster, to commission services to meet the specific needs of their patients. I hope that will mean that a cluster or CCG in a rural area, obviously knowing that its patients live in a rural area, will ensure that its service is tailor-made to suit the needs of those patients, which may be different from the needs of patients in, say, a city and its surrounding suburbs. That is one of the joys of local commissioning.

My hon. Friend asked whether the three to three-and-a-half hours—in truth, I think it was really four hours—before her father was seen is normal, and the unequivocal answer is no. Is it acceptable? In my view, it is certainly not acceptable.

My hon. Friend then asked who pays. She is concerned about whether the debt in which her primary care trust found itself will have an impact. The 111 service is paid for by CCGs, which is one reason why CCGs are involved in the local commissioning of the service.

How are the concerns of GPs being addressed? The NHS is having a review in the way that I described. My hon. Friend the Member for Brigg and Goole (Andrew Percy), who must be a member of the Select Committee on Health—that shows my profound ignorance, and I apologise to him—has helpfully reminded me that Dr Gerada, who is the chair of the Royal College of General Practitioners, said in her evidence yesterday that she has not seen such queues since the flu epidemic of two to three years ago. She said that the reasons for the high demand are mixed and complex, including the nasty flu virus that went around earlier this year and at the end of last year. I reiterate my point: if only it were so simple to cure the problems in A and E.

A and E Waiting Times

Jamie Reed Excerpts

Tuesday 23rd April 2013 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to speak under your chairmanship, for what is, I think, the first time, Mr Hollobone. I thank my right hon. Friend the Member for Cynon Valley (Ann Clwyd) for securing the debate. She has an exceptionally powerful voice in these matters, and all of us, on both sides of the House, have a common interest in ensuring it is heard not only today, but throughout this Parliament. I pay tribute to the work she is doing not only in her own right, but in tandem with the Government.

I also pay tribute to the work other Members who have spoken undertake on behalf of their constituents in fighting for A and E services in their constituencies. It would be remiss of me not to thank my local A and E unit at the West Cumberland hospital for saving my life probably twice in the past two years, although I appreciate that that makes me sound careless.

Before I begin, I wonder whether the Minister can answer this fairly simple question. What have Barking, Havering and Redbridge University Hospitals NHS Trust, Burton Hospitals NHS Foundation Trust, Milton Keynes Hospital NHS Foundation Trust, North West London Hospitals NHS Trust, Portsmouth Hospitals NHS Trust, Sheffield Teaching Hospitals NHS Foundation Trust, Shrewsbury and Telford Hospital NHS Trust, University Hospital of South Manchester NHS Foundation Trust, University Hospitals Coventry and Warwickshire NHS Trust, University Hospitals of Leicester NHS Trust and York Teaching Hospital NHS Foundation Trust all got in common? I am more than happy to give way to the Minister if she would like to hazard a guess.

[Anna Soubry]

These are serious matters and should be above such cheap party politics. The hon. Gentleman clearly knows the answer to his question, and is asking me to speculate. Given that the debate is about accident and emergency, no doubt the answer is that their waiting times are longer. The Government accept that, and also agree that it is not acceptable; and we are doing something about it. If the hon. Gentleman wants to play party politics, that is against him, not against anything else.

[Mr Reed]

That was a regrettable answer, and did not become the Minister. She clearly does not know the answer. I wonder, as do, I think, many hon. Members, whether the Government know the answer to the question. It is that those trusts have missed the A and E target for major type 1 units—

[Anna Soubry]

I just said that.

[Mr Reed]

Can she tell me for how long?

[Anna Soubry]

I am not playing silly games with our NHS.

[Mr Reed]

They have missed it for each of the last 29 weeks. These points are not silly; they are matters of fact.

[Anna Soubry]

Will the hon. Gentleman give way?

[Mr Reed]

Of course; I look forward to an answer.

[Anna Soubry]

The point that I am making is that the hon. Gentleman is playing silly games with serious matters. Other right hon. and hon. Members have addressed the issue positively, with compassion, but he is just playing silly party political games.

[Mr Reed]

I now know what it feels like to be handbagged.

[Anna Soubry]

That is sexist.

[Mr Reed]

I do not think it is sexist at all.

Does the Minister know how many times her local trust has missed its A and E target, since the end of September? [Interruption.] I will tell her. Nottingham University Hospitals NHS Trust has missed its target for 17 weeks since September.

[Anna Soubry]

Would the hon. Gentleman care to refresh his memory? If we refer to the most recent statistics produced by Nottingham University Hospitals NHS Trust for the A and E department at the Queen’s medical centre, we can compare those for the week commencing 14 April this year with those for the week commencing 15 April last year. Last year 440 patients failed to be treated or seen within the four-hour target, whereas this year the figure had fallen to 259.

[Mr Reed]

I note that the Minister prepared an answer, and I am grateful for that.

Major accident and emergency units—type 1 facilities, nationally—have missed the target for at least the last six months, and all A and E units, including minor incident units, have not hit the target for 12 weeks in a row. If anyone needs help analysing the figures, I would be happy to oblige. They are easy to find and they reveal some interesting points. For example, I wonder whether hon. Members know that only one trust with a major accident and emergency unit in England has hit its target every week since the Secretary of State took his position. That is relegation form, and if this were a football match the cry from the crowd would be “You don’t know what you’re doing.”

Before the Minister attempts yet again to dismiss those statistics, I hope she will take a moment to attend to what has been said by the chief executive of the Royal College of Nursing, by Dr Clifford Mann of the College of Emergency Medicine, and by David Behan of the Care Quality Commission. Earlier this month, Dr Peter Carter, of the Royal College of Nursing said:

“These figures are yet more proof of a system running at capacity, and patients are suffering as a result. Our members are regularly telling us that pressure on the system is rising while staffing levels fall, and as a result any increase in demand results in unacceptable waits for patients who are already going through a difficult time.”

Dr Clifford Mann, of the College of Emergency Medicine said:

“We are seeing...ambulances queuing outside departments, and patients waiting too long on trolleys before they can be admitted to hospital.”

The Care Quality Commission said:

“It is disappointing that people have said they have to wait longer to be treated than four years ago. People should be seen, diagnosed, treated and admitted or discharged as quickly as possible”.

Like me, the Royal College of Nursing, the College of Emergency Medicine and the Care Quality Commission will be appalled that the key performance indicators for the NHS, such as A and E waiting times, are getting steadily worse. In the past six months, 582,811 people waited more than four hours in major A and E units, compared with 420,921 for the same period in the previous year. That is an increase of 161,890 people. That is not silly: it is a question of people’s lives. Those figures relate to people in need who did not get treatment in the time when they needed it. They represent more than 500,000 extra waiting hours in one year. People will find it hard to stomach the fact that there are now about 5,000 fewer nurses than there were in 2010, at a time when, as hon. Members on both sides of the House have mentioned, demand in our A and E units is increasing.

One way to get the figure down—it has been touched on already in the debate—would be to offer services for people with non-emergency ailments, so that they do not feel the need to travel to an A and E department. However, instead of NHS Direct being used as a tool for easing pressure on A and E departments, the roll-out of NHS 111 has turned into a trade marked Government shambles. Patients calling the new 111 service wait hours for advice. One patient waited 11 hours and 29 minutes for a call back. No wonder they feel that they have to go to A and E, when they cannot trust a telephone service with such an inadequate response rate.

Accident and emergency departments are a litmus test, or a barometer, for the performance of the NHS as a whole. If people are waiting in A and E, it means that there are too few beds or too few staff to cope with demand. That is just a fact of health service planning. If there are too few beds, it is because community services are being cut and patients who should be at home are kept in hospital. That reverberates back through the entire system. If patients who could be at home are in hospital, beds are occupied. If beds are occupied, A and E staff cannot admit patients. If A and Es are full, paramedics cannot hand over patients. If patients are queuing in the back of ambulances, those ambulances cannot respond to a potentially serious call-out. One failure leads to another. Each compounds the other. That is what is so serious about the debate. It is not just about the patient sitting in A and E for hours on end; the statistics I have highlighted show much more than that—the experiences of patients throughout the entire system.

[Martin Horwood]

In my remarks I suggested another possible factor in the current problems of emergency departments: the difficulty in recruiting emergency doctors. That may have something to do with the attractiveness of emergency medicine as a specialty—the long hours, and so on. However, it also obviously dates back to the training numbers that I am afraid prevailed under the Labour Government. Does the hon. Gentleman accept that there may be some such responsibility, dating back several years, in relation to attracting sufficient numbers into training for emergency medicine?

[Mr Reed]

I expect the Minister to talk about new doctors in the NHS when she replies to the debate; and, of course, we trained those doctors. We commissioned, paid for and put in place the training of those doctors, so I take what the hon. Gentleman says seriously. I also commend him for being the only Member of Parliament from either of the coalition parties to attend the debate to defend the Government’s record.

The statistics highlight more than the simple numbers: they show the experience of patients throughout the system. One person waiting in A and E can reflect one person in a bed on a ward and another waiting at home for an ambulance. I hope the Minister will acknowledge and accept that, and explain what the Government plan to do. It is essential that they explicitly acknowledge the problems faced by accident and emergency in England. Constant denials do them no credit. They must acknowledge the scale of the problem before any solutions can be introduced.

The NHS in England is completely different from the NHS in Wales. I expect the Government will be tempted to compare the two, but I want to address the issue head on. The reality is that Welsh Ministers are dealing with a £2.1 billion real-terms cut to their budgets. Yet, despite that, they have still managed to protect NHS services. There are now more GPs working in Wales than in 2010, and the number of nurses, midwives and health visitors has remained consistent. That is in stark contrast to England, where nurse numbers are falling. I am sure that hon. Members who have heard such tired comparisons over and over would be interested to know that there are differences in the way A and E waiting times are measured in the two countries, and in how frequently performance is measured.

Before any comparison is made—and I hope that none will be—I want to point out that it is misleading to try to make a direct comparison. However, it is fair to say that all parts of the UK are experiencing increased pressures on A and E. The key difference is that in Wales, Labour are doing something about it, whereas in England the coalition is sitting on its hands. In Wales, 270 additional beds were opened this winter to cope with demand, easing pressure throughout the system. The Welsh Government have also agreed an all-Wales action plan for unscheduled care, which means that health boards must ensure that they have sufficient capacity to meet demand.

Will the Minister inform us today what the Government plan to do to help A and E services in England? When and where will they start to provide such help, and how much will it cost?

That aside, will the Minister also answer a few important questions on A and E waiting times? First, will she explain why, when demand is clearly so high and the current services are at breaking point, the Government have handed P45s to almost 5,000 nurses? Will she also explain why the Secretary of State chose a period of intense demand and structural reorganisation to roll out the 111 service when it was clearly not ready to be rolled out?

May I tempt the Minister to speculate on the causes of that rise in A and E waiting times? Does she agree that a combination of inadequate staffing levels, a distracting reorganisation of the NHS and deep cuts to council care budgets is the principal reason for the sharp increase in A and E waiting times? If she does not agree that they are having a major impact on the NHS, can she explain why the Government think that fewer nurses and a distracting reorganisation have improved services?

The problems that others and I have outlined today are well known to many, but they are still sadly neglected by the Government. Despite its imperfections and its many real challenges, the NHS remains one of the best models of national health care in the world. It is filled with dedicated professionals who believe passionately in the aims and values of the service, but it is clear that an expensive, unwanted and unloved reorganisation, combined with Government-induced staff shortages, are causing and have caused deterioration in performance. That is unfair on health care professionals, and, far more importantly, it is unfair on patients. I look forward to the Minister explaining in detail how her Government intend to get a grip and bring all A and E services in England back up to national standards.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is a pleasure to serve under your chairmanship, Mr Hollobone.

I have just about eight minutes to respond to all the valuable contributions made in this debate. I will not be able to answer all the questions, but I will write to anyone who has asked a question that I cannot answer.

Obviously, I begin by paying tribute to the right hon. Member for Cynon Valley (Ann Clwyd) for securing this debate and for the way she is championing the cause of the patient. She will not hesitate to leave no stone unturned. As many others know, she is doing great work in leading our independent review of NHS complaints. She mentioned just some of the many cases that have come her way. She did not give dates, but I suspect the cases were not all fresh by any means, because, as she, I and many others recognise, this is by no means a new phenomenon; it is a serious problem that requires serious action, which the Government are taking. Would it not be refreshing and brilliant if we could have a debate on a serious issue without falling into the trap of cheap party politics, which, unfortunately, has been a little evident in some, but mercifully not all, the speeches? As the right hon. Lady said in her speech, there are no easy answers.

Some important points have been raised. We know that there is a problem, and we recognise that. It is not uncommon for the four-hour waiting time standards not to be met, especially during the winter period. That happened under the previous Government as well as under this Government. Indeed, in 2008-09 there were 23 weeks in which the waiting time target was breached, and it was breached during a further 14 weeks in 2009-10 up to May 2010. We know that those problems continue. We want to know and understand why, and we want to take quick action.

[Mr Jamie Reed]

Will the Minister give way?

[Anna Soubry]

I have only six minutes to address all the contributions, so the hon. Gentleman had better be quick.

[Mr Reed]

I am grateful to the Minister for giving way. This is a very important point. Does she accept that Labour’s A and E target for hospitals was tougher than the one set by her Government?

[Anna Soubry]

No. I am not going to go into all that in the short time that is available to me. We accept that waiting times are a problem—we are not trying to hide from that, and we are up for transparency—and I will address the data in a minute.

The hon. Member for Cheltenham (Martin Horwood) rightly identifies the seasonal nature of waiting times. He speaks with passion about changes in his constituency, and rightly so. It is right and proper that people who have such concerns, as other hon. Members have said, come to this place to champion the cause of the health service within their own communities, especially when it faces reconfiguration. He spoke about 111, which is an important thing to talk about when considering some of the causes that may contribute to the unacceptable failure to hit targets. I know that the data are being monitored on a daily basis by NHS England, and the deputy chief executive of NHS England is meeting twice a week to consider what is happening and to make sure that action is taken to ensure that any problems are addressed.

The hon. Gentleman makes an important point on the difficulty of filling posts, and I will write to him on that because I know it is a problem. I also know that action is being taken by some of the royal colleges, and it is probably best if I give a fuller answer, because he makes a very important point. Of course, I can say that the Keogh review is considering exactly the other problems that he mentioned. As the Secretary of State announced, the Keogh review, which has been alluded to, will report next month. All those matters will be reviewed by Sir Bruce, and it is much to be hoped that some positive forward-thinking will come out of that.

The hon. Member for Stretford and Urmston (Kate Green) raised various issues. I am particularly concerned that she says she is not getting the answers to the questions she has quite properly asked. I think there is sometimes a problem with hon. Members not going in the first instance to the actual hospital, trust or whoever it might be. Her point, and it is a good point well made, is that when she asked my Department, she did not get those figures, and I will make further inquiries.

Only today I saw a question from the hon. Member for Ashfield (Gloria De Piero) asking precisely what the figures are for her hospital in Sherwood and, as it happens, the hospital she and I effectively share, the Queen’s medical centre A and E department. I have given those figures, and I want to set the record straight because, in fact, for the same week last year in Sherwood, 75 people waited more than four hours; this year the figure is 266.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 16th April 2013 Commons Chamber

[Anna Soubry]

I am grateful to my hon. Friend for those comments; as he knows, these are now matters for NHS England. I will make sure it is aware of what he has said and his urging it to do both those things for the obvious benefits they would have for a cancer patient’s experience.

[Mr Jamie Reed (Copeland) (Lab)]

The hon. Member for Basildon and Billericay (Mr Baron) is absolutely right: it is essential that the NHS is held to account for the experiences of cancer patients and patients with other conditions, too. Accountability has undoubtedly been weakened, however, as a result of the NHS reorganisation that came into effect this month. Last week, the outgoing deputy chief executive of the NHS, David Flory, said that the loss of experience in the NHS is greater than he has ever seen and that hospitals have been left struggling as a result. How can a service stripped of so much skill, knowledge and expertise provide the accountability that patients deserve?

[Anna Soubry]

I am afraid that the hon. Gentleman’s question depicts a situation that I simply do not recognise. As I visit hospitals and other organisations, both in my constituency and across the country, I am told that there has been a huge improvement, especially in commissioning—[Interruption.] No, by front-line clinicians, who talk with enthusiasm about how the commissioning of services has improved because now at last the clinicians—those who know best—are in charge, and not, as has often been the case, faceless bureaucrats and managers.

Medical Implants (EU and UK)

Jamie Reed Excerpts

Wednesday 6th March 2013 Commons Chamber

[John Pugh]

I am coming to that, Mr Deputy Speaker. In a way, that illustrates my point, because what we are actually debating is the supplementary estimate. My hon. Friend the Member for Gainsborough and I were tasked with looking at how the House debates supplementary estimates, and the answer we came to was this: not very well. Our report, a copy of which is in the Library for hon. Members to consult, testifies to that finding, and we produced adequate evidence for it, because the report was co-ordinated to some extent by the Treasury, which keeps a close eye on these things. I am suggesting that the work of examining the nation’s finances is boring, dull and, at times, anorakish, but it certainly needs to be done, and it probably should be done by Parliament, and on occasions like this.

[Mr Jamie Reed (Copeland) (Lab)]

On that point, which the hon. Gentleman is making very well, can he recall when the House last divided on an estimates debate?

[John Pugh]

I certainly cannot. There are occasions when we talk about general topics, but I think that I am right in saying that the reasons we have estimates days is so that Parliament, as well as the Treasury, can scrutinise the nation’s accounts. I regard that as highly desirable in this age of austerity, when we need to count every penny and record the overspend, underspend, virement and so on.

I will now turn to the subject that appears to be the subject of this debate but is not actually on the Order Paper: medical devices and implants. I would like to make a few observations on what the hon. Member for Ellesmere Port and Neston (Andrew Miller) calls post-market surveillance, which we agree needs to be improved. That is obviously wholly desirable because it will eliminate problems, improve patient security and so on. I would not disagree with a single word voiced by him or his Committee. I agree that there should be more transparency and more feedback from patients and clinicians so that devices are safe and do exactly what they are supposed to do. However, we can improve regulatory vigilance. The MHRA has done a good job so far, but it obviously could do better. There is clearly a role for increased manufacturer responsibility. That is all very important.

The simple point I want to make about implants—I am not allowed to talk about the huge sums of money we are voting through—is that detecting failings is quite a complex matter. It is not as simple as it was with the breast implants, which was a case of the wrong substance being provided, which is fraud. I will illustrate my point with a real-life example. I am familiar with a case in Nottingham involving a number of unfortunate episodes that followed heart surgery in which a particular type and brand of stent was used. A number of people were called back for second operations because the stents leaked. I believe that there were a number of deaths and some litigation. Initially it was thought that the device was at fault, because it looked as though the people who had the device experienced certain problems and complications, and there had been other problems with it elsewhere. It was subject to a court case and prolonged investigation. Ultimately, the blame was attributed—this bears out the point made by my hon. Friend the Member for Truro and Falmouth (Sarah Newton)—to the surgical procedure, rather than to the device itself.

Therefore, there is a particular problem when it comes to post-market surveillance. Is it the equipment or how it is used that is responsible, because the equipment is only as good as its user? That is a particular issue in surgery, because surgeons up and down the land are very particular about what bits of kit they use and what type of equipment they work with.

--- Later in debate ---

[Mr Jamie Reed (Copeland) (Lab)]

The report of the Science and Technology Committee was produced under the chairmanship of my hon. Friend the Member for Ellesmere Port and Neston (Andrew Miller). I congratulate him on the work of the Committee and on an excellent report. He is known in this House for his diligence and attention to detail, and the report illustrates those instincts. It is also a pleasure to follow the hon. Members for Southport (John Pugh) and for Strangford (Jim Shannon), who have made telling and important contributions.

The House has demonstrated not only a shared understanding of the issues before us in this brief debate on medical implants, but a welcome unity of purpose. The House is at its best when it acts in such a fashion. Debates like this allow us to break through what actors call the “fourth wall”. I hope that anyone who is watching this debate can see that, as should always be the case, we are not making by-the-numbers political arguments, but are making a sincere effort to address the issues before us for the benefit of the people who send us here.

In health care regulatory systems, medical implants and devices hold a unique status. The synthesis of new medicines and other pharmaceutical products is done through highly precise chemical processes, whereas implants are developed largely through an iterative engineering process. As we can see from the Committee’s report, that presents unique challenges. The bulk of the regulatory framework for medical testing focuses on the side effects and efficacy of new drugs. Although the emphasis is on medicines, there need to be mechanisms for the effective regulation of safe medical implants, given the fundamental differences between implants and medicines.

As the Committee’s report highlighted, there are weaknesses in the current regulatory system. As Members have mentioned, those have been highlighted by the recent PIP breast implant scandal and by faulty metal-on-metal hip replacements. In looking at those high-profile scandals, we must recognise the role of criminal activity, especially in the PIP scandal. In that case, it quickly became apparent that the company that manufactured the implants was engaged in a clear case of fraud. There is no reasonable and workable system that could prevent such cases. That fact is recognised by many in the industry and, I am sure, by Members across the House.

Although the PIP scandal was caused by criminal activity, it presented the opportunity for us to take a deep look at our regulatory framework and to assess its strengths and weaknesses. The system is obviously not perfect, as I am sure Members across the House will agree, and improvements need to be made. The case of the DePuy metal-on-metal hip implants shows that faulty products have been certified under the current system.

There is a fine balance to strike when debating the regulatory framework of medical impacts because it is essential that all products are safe, and that they bring only benefits to patients and are not harmful. It is also necessary for access to products to be improved and expedited. The ideal is to bring safe medical implants to patients in an efficient and timely manner, and that is the sole purpose of a regulatory system in this context.

We must be increasingly aware of how the regulatory system can affect the entire health economy. To emphasise the importance of that let us consider a condition that poses enormous public health, policy and financial questions, as well as questions of patients’ rights and expectations: type 1 diabetes.

I declare an interest as a type 1 diabetic who was diagnosed through diabetic ketoacidosis just two weeks before the 2010 general election—ideal preparation, I must say. I raise the issue not to bore the House with my personal interests but because figures released this week by Diabetes UK show that the number of people in the UK who have been diagnosed with diabetes has reached 3 million for the first time. That is an increase of 132,000 over the last year and a further 850,000 people are now believed to suffer from undiagnosed type 2 diabetes. Each year an estimated 24,000 people die from diabetes-related medical conditions and the situation is expected to worsen—I know the Minister is aware of the figures. Barbara Young, the chief executive of Diabetes UK, has called the situation a “public health emergency”, and she is right.

It cannot be stated enough that type 1 and type 2 diabetes are different conditions and differ in many ways. Type 2 diabetes is often the result of lifestyle circumstances or choices, but type 1 diabetes is a genetic, sometimes hereditary auto-immune condition that is not related to the lifestyle of an individual. The latest breakdown of figures that I have comes from 2009. Research undertaken by the university of Birmingham and the National Institute for Health Research showed that at that time, 488,089 people in England and Wales had type 1 diabetes, some 15,000 of whom were children and young people between nought and 24 years of age. In 2009-10, 27,200 hospital admissions and 96,651 bed days were due to type 1 diabetes in England. To be blunt for a moment, apart from concerning ourselves with the needs of the patient, that is costing the NHS a fortune.

Also this week the US-based Diabetes Research Institute announced details of its research into what it describes as a “quantum leap” towards a biological cure for type 1 diabetes with the development of its BioHub—a bioengineered “mini-organ” that mimics the pancreas. It contains real insulin-producing cells that can sense blood sugar and release the precise amount of insulin needed in real time. In short, if successful, such a treatment could transform the lives of 500,000 people in England and Wales, save the NHS a fortune that could be spent elsewhere, and help begin to meet the challenge of the public health emergency we face. With that case study we see that the improvement of a system that expedites access and demonstrates the safety of medical implants for patients could not be clearer or more important.

The report covers four main points, and I will take each one in turn. First, I will discuss the system of pre-market approvals and the difficulties surrounding them, before looking at transparency in the regulatory system, post-market scrutiny of products and international co-operation. Pre-market scrutiny of medical products is the minimum prerequisite when it comes to health care products, whether medicines or implants, but there are fundamental reasons why there is no one-size-fits-all system for testing them. With medicines, doses can be reduced and increased to test for side effects and efficacy, but, as I am sure all Members will recognise, it is impossible to change the dosage of a hip replacement. Furthermore, once an implant has been placed, it is difficult to remove it.

Similar issues present themselves with clinical trialling procedures. Medicines pass through the body relatively quickly, meaning that medicinal trials can be conducted within a reasonable time frame. A hip implant is typically designed to last over 10 years, and to obtain reliable clinical data that can withstand proper scrutiny, trials on those implants would have to last a number of years, which in many cases is simply not practical. A system has therefore developed that uses different types of clinical evidence to assess safety and efficacy. Where possible and practical, clinical trials on products should take place, but for implants, regulatory bodies will take what are known as equivalence data as the basis for their decision making. That was mentioned by my hon. Friend the Member for Ellesmere Port and Neston and is covered extensively in the report. These are data obtained from similar products. As I have said previously, products are developed in an iterative process and these data can be from earlier iterations that may have been available to patients for a number of years.

There are a number of issues with this method. First, the British Medical Journal has argued that, owing to the progression of new products and advances in this field, regulators may have difficulty assessing which products, and therefore data, are equivalent. This difficulty is, to some extent, surmounted by the differing regulatory requirements of different classifications of medical devices. Most medical implants are categorised as class 2b and class 3. These are the higher risk categories and this ensures that extra safety checks are in place.

Class 2b manufacturers are subject to annual detailed assessments of their facilities, practices and staff training levels to ensure they are performing to a high standard. With class 3 products, notified regulatory bodies also have access to technical documentation to ensure safe practices. So the difficulties inherent in the pre-market assessment of medical implants mean that post-market scrutiny and surveillance of products are essential in maintaining standards in the industry and in improving future regulatory regimes.

The Medicines and Healthcare products Regulatory Agency and other groups agree that this is one of the most important tenets of a regulatory system. It is almost impossible, and certainly not accurate, to predict the medical performance of devices after a considerable number of years. Continued, randomised testing of devices should form part of the regulatory processes and should make a keen contribution to assessing the efficacy and safety of products.

Looking at the level of international co-operation when it comes to regulating medical devices, it is crucial to realise that this is now a global industry. The EU Commission has recommended greater co-operation between member states in this field. It recommends that there should be a European body responsible for dealing with notifications of devices prior to market entry. I understand the Committee’s report does not accept this recommendation as it would lead to another layer of bureaucracy and delay. However, greater harmonisation of practices to ensure high standards are met by manufacturers throughout the world is interesting, and this is an issue that needs to be looked at in greater detail.

[Sarah Newton]

Another important reason we decided it would not be in the national interest to support that recommendation is that we believe that it contained the potential for a race to the bottom. Other European countries do not regulate as well as we do, and effective regulation is really important. We felt that a lowering of standards in other European countries might mean that implants could get in through the back door.

[Mr Reed]

The hon. Lady makes an excellent point. The Committee’s thinking on that point is clearly justifiable and robust. It also raises another issue. We all need to ensure that the industries we are talking about have a predictable, stable and safe environment in which to operate so that they can innovate, attract investment and continue the advanced manufacturing processes we need to secure advances in treatment and more.

It is important, however, that the focus upon constant improvement should be one of the core underpinnings of any regulatory framework and this is sadly lacking in the system at present. The key to improving the regulatory framework—and in many ways the key theme of the Committee’s report—is transparency. The BMJ acknowledges that there are

“many vested interests that disincentivise manufacturers and clinicians from highlighting problems”.

Commercial confidentiality is another stumbling block. This need not be the case as a more open system, with more published information and greater access to assessments of products, will foster greater trust in the system, which will then translate into wider public trust of the industry and of manufacturers within it.

An article in The Lancet from June 2012 argues that patients and medical professionals should have a greater role in reporting adverse effects from their devices. Who could disagree? It should be clear to everyone that the fairest and safest way of assessing medical products is to allow experts access to as much information as possible. The Committee’s report makes it clear that the default position on information should be transparency and openness, and should be confidential only in extreme circumstances. It is right that the MHRA has a specialist committee to assess the safety of products: the committee on the safety of devices. What is totally wrong, however, is that it works in secret. The Select Committee expressed its disappointment at not being able to evaluate the work of the CSD, and it seems impossible to evaluate the system as a whole when such a key part of it appears to be shrouded in secrecy.

The Committee’s report does not advocate widespread changes to the system, but it rightly recommends a significant improvement in the transparency of information available to medical professionals. In medicine, negative data, as the hon. Member for City of Chester (Stephen Mosley) said, are as crucial as positive data in assessing what is right for a patient. I assure the Minister that the Government will have the support of the Opposition if they wish to make quick progress on improving transparency in the system.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 26th February 2013 Commons Chamber

[Mr Hunt]

There is far too much bureaucracy in the NHS, which is why I have asked the chief executive of the NHS Confederation to report to me on how we could reduce the bureaucratic burden on hospitals by a third. If there is a lesson from the Francis report on the tragedy at Mid Staffs, it is that we need to free up the time of people on the front line to care, which is what they went into the NHS to do.

[Mr Jamie Reed (Copeland) (Lab)]

The hon. Member for Ealing Central and Acton (Angie Bray) asked a key question. Under the secondary legislation being introduced by the Secretary of State under section 75 of the Health and Social Care Act 2012, local commissioning groups will be forced to allow private providers into the NHS. These private providers will be exempt from the Freedom of Information Act, which will make it harder for patients to compare data between providers. It cannot benefit NHS patients for core clinical services to be given to private providers that do not have to conform to the same standards of transparency as those in the NHS. Will the Secretary of State see reason, ensure a level playing field for the NHS and withdraw the section 75 regulations without delay?

[Mr Hunt]

Who exactly are the section-75 bogeymen that the hon. Gentleman hates: Whizz-Kidz who are supplying services to disabled children in Tower Hamlets, or Mind, which is supplying psychological therapy to people in Middlesbrough? The reality is that those regulations are completely consistent with the procurement guidelines that his Government sent to primary care trusts. He needs to stop trying to pretend that we are doing something different from what his Government were doing when in fact we are doing exactly the same.

Accident and Emergency Departments

Jamie Reed Excerpts

Thursday 7th February 2013 Commons Chamber

[Mr Jamie Reed (Copeland) (Lab)]

First, let me commend my hon. Friend the Member for Ealing, Southall (Mr Sharma) and the hon. Members for Newark (Patrick Mercer) and for Eastbourne (Stephen Lloyd) for initiating this debate and the Backbench Business Committee for agreeing to it. As we have heard, given the geographical spread of concerns, this will clearly be the first of many such debates.

The recent events in south-east London have demonstrated just how timely this debate is. Members from all parts of the House have made compelling cases and shown the depth of feeling on this issue, which cannot be approached easily or without extremely strong emotion. I have always fought for the services provided by West Cumberland hospital in my constituency and I always will. I know just how Members feel about the issues facing their hospitals and I am sure the Minister does too. Indeed, I am sure we have all faced them.

The needs and best interests of patients were at the centre of the inspiration to create the national health service, almost 65 years ago, from the ashes of the second world war. The needs and best interests of the patient must remain at the centre of any discussion about health services today. This is the crux of the issue. With that in mind, the recent decision that the Secretary of State for Health took on the A and E department at Lewisham has set the NHS on a dangerous path whereby the core principle underpinning and shaping the design and delivery of hospital services—that which is in the best interests of patients—now looks set to be redefined. This Government have introduced a new basis on which to take decisions—namely, that financial considerations should take precedence over clinical considerations. Any A and E department in the country is vulnerable to change on that basis.

Those two fundamental points—financial considerations taking precedence over clinical considerations and the Government allowing the reorganisation of well functioning hospitals on that basis—create a toxic mix that could have consequences for patient care and well-being. As we have seen—today’s debate is testament to this—the new emerging principle has consequences for the legitimacy of the decision-making process for reconfiguration and the accountability of those behind such processes. We must return to the first principles of health care provision. The patient comes first. Their health care and well-being are paramount. The needs of the patient must always take priority over the needs of any other interest in the system. Services should reflect that, as should their design and delivery.

If a clinical case and clinical evidence suggest that services and, most importantly, patient care can be improved by reconfiguration, we have a duty to support those arguments in the interests of the patient. Where a reconfiguration is shown to improve patient care and ultimately save lives, we cannot and must not stand in the way. Where services can be better provided to those who use them, changes cannot and should not be opposed simply for the sake of opposition.

My right hon. Friend the Member for Leigh (Andy Burnham), the shadow Health Secretary, has made clear the massive challenges facing our health-care system. It is a 20th-century system struggling to answer the questions asked of it by a 21st-century society. There is a huge sustainability challenge characterised by an era of economic austerity, for which there is no line on the horizon, and rapidly rising demand. However, any community that is experiencing reconfiguration without clinical evidence should know that the Opposition will be by its side fighting with it every step of the way. The NHS is our greatest achievement and we guard it jealously.

There are important progressive principles at stake. First, every penny of taxpayers’ money should be spent to its maximum effect, even more so in austere times. As arguably the nation’s most valued public service, the first duty of the NHS is to the patients and public of our country, not to public servants.

Last week, we published a report on the state and condition of A and E services throughout the country. The scale of demand and the pressures on the system are frightening. In the financial year to date about 100,000 more patients are being left to wait for more than four hours in A and E waiting rooms before being seen. That does not show the full scale of the pressure, as an extra 23,000 patients were left waiting on trolleys for more than four hours after being seen and before being admitted to A and E. The pressure then backs up through the ambulance services and, because of the lack of capacity in A and E, patients are being left waiting in the back of ambulances for, in some cases, many hours. This is an issue of capacity or, to be more accurate, lack of capacity. It shows that the system is creaking under the pressure, so reconfigurations based purely on financial considerations are simply unacceptable.

The distinction between the different forms of reconfiguration is important. If a change in services is supported and motivated by clinical evidence, it can offer real improvements to patient satisfaction and to overall levels of care; but if a closure is motivated purely by financial reasons—and if it is taken in the absence of clinical evidence or consultation—that is simply a cut to services hidden beneath the label of reconfiguration, and that is not acceptable.

There are always genuinely hard choices to be made in the national health service, but I would never accept a reconfiguration of hospital services in my constituency based on non-clinical considerations. I am sure that the Minister would not either, and I am convinced that no Member of this House would accept reconfiguration on that basis.

Lewisham A and E was not downgraded because it performed badly or because the level of care for local residents could be improved by focusing services elsewhere; it was downgraded because of financial problems in neighbouring trusts, and that is wrong.

The figures that I have quoted show a system that is on the brink. Further increasing pressures by reducing capacity without clinical reasons has the potential for truly dangerous consequences. Closing without clinical evidence an A and E department that is relied upon can be damaging to local patients and a community, but it also has wider implications for the health care system as a whole. Performance in A and E departments is a barometer of how the wider NHS is performing. Patients on trolleys indicate lack of capacity on wards, and the increased number of delayed discharges shows that patients are being kept in hospitals when they could be receiving care in their communities, but there are clear gaps in primary care provision. A and E departments are under immense strain. Department of Health figures show as much and there is simply no justification for the financially driven closure of services or the downgrading of facilities.

At the heart of the health care service is patient need, and ensuring the right provision of health care services can only be done by speaking with patients and clinicians. That is why it is crucial that consultation is undertaken at every level in any process relating to reconfiguration. A and E services should first of all be about people and not pound signs. Those of us who care about the national health service must guarantee that people are engaged at every possible juncture in the decision-making process. That will ensure that they have a stake in the future design of services, that, crucially, they have the services they need and that they are not subject to back-door, cherry-picked reconfigurations, such as that in Lewisham.

Pressures in A and E departments are felt across the whole health economy of a local health service. Removing an A and E department without clinical support or evidence is hugely disruptive and will have a profound effect on the provision, level, quality and type of every associated service in any and every local health economy. A reconfiguration of emergency services without sound clinical guidance is not a reconfiguration— it is a cut. It is a cut in services and in provision that will be detrimental to the people who rely on those services. In real terms, national health service spending has been cut, and £3.5 billion has been wasted on a reconfiguration that was not voted for by anyone at the last general election. It is not wanted by anyone in this country, including medical professionals, and it has caused chaos in the NHS and in the delivery of its key services.

Opposition Members will never accept purely financially driven reconfigurations. I call on the Minister to commit unequivocally to that principle, and to intervene without delay on reconfigurations that are being driven not by clinical need but by financial pressures. I can only echo the powerful invitation made to the Minister by my right hon. Friend the Member for Tottenham (Mr Lammy), and remind her that she has the power to intervene and stop this happening. I look forward to her doing so.

University Hospitals of Morecambe Bay NHS Foundation Trust

Jamie Reed Excerpts

Tuesday 5th February 2013 Westminster Hall

[John Woodcock (Barrow and Furness) (Lab/Co-op)]

I am pleased to have secured this debate. It is a pleasure to speak under your chairmanship, Mr Howarth.

I represent a community in shock, reeling from the suddenly announced intention to transfer Furness general hospital’s beloved special care baby unit and consultant maternity services out of the county, from 9 o’clock this morning, to Lancaster. Pleas to rethink that emergency transfer have so far been rebuffed, leaving expectant mums distraught at the prospect of a 50-mile trip in the back of ambulance if they suffer complications in labour. I will set out our concerns in detail and stress the areas in which we hope the Minister, who is of course an expert in the field, will agree to intervene, but first I will discuss the wider issues the area faces, which prompted my application for this debate.

There is the forthcoming review of hospital services, triggered by the need for significant budget reductions across the University Hospitals of Morecambe Bay NHS Foundation Trust. All of us here are acutely aware of the long-term threat that that might pose to key provision, such as the need to sustain a consultant-led maternity service and accident and emergency provision across more than one site in the area.

There is also the campaign against the removal of A and E, maternity and intensive care units at Royal Lancaster infirmary, on which the Downing street petition in the name of Matthew Hood already has thousands of signatures. I think that my constituency neighbour, the hon. Member for Westmorland and Lonsdale (Tim Farron) wants to do exactly that—move Lancaster’s A and E department to the Westmorland general hospital. Let me simply say that any attempt to question Barrow’s need for an A and E department would be met with horror not only by every single resident of the Furness area, but by the prized and highly regulated industries on which the nation depends.

The broader question facing the Morecambe Bay trust is how best to locate services when the population is far more spread out than in most areas of Britain, and when centres of population are often connected by a single road that winds through Cumbria’s unique landscape. In other areas, a trust for hundreds of thousands of residents might naturally be based around one A and E department and one maternity unit, but that would put an unacceptable strain on residents of Morecambe bay. People in pockets of severe deprivation in Barrow and families who, for whatever reason, just do not travel would be forced to go to another county and be completely cut off from their families. In an emergency, it would result in journey times of more than an hour on routes that are prone to become blocked by breakdowns.

I want to ask the Minister four questions about the four tests in the Government’s forthcoming consultation. His first test is the evidence base. Will he ensure that the options and risks are properly weighed, so that the risks inherent in long-distance ambulance travel are set alongside what might otherwise be the optimal configuration of services? The second test is whether there is the support of GP commissioners. The past 24 hours have shown the damaging shambles that can occur when a trust attempts to press on against the will of local commissioners. The Government back the new system, so will the Minister ensure that local GPs have the teeth to insist on the services that communities need? The third test is choice for patients. Will the Minister ensure that problems of isolation and lack of access to services are an integral part of the assessment when it arrives on the Secretary of State’s desk? It is hard to imagine the test of choice being passed if, for example, an isolated peninsula’s only consultant-led maternity unit were downgraded. The fourth test is strengthened public engagement. The trust needs to do much better than the mess of the past few days, which has left women desperately worried and confused. I shall say more on that in a moment, but the underlying point is that engaging means listening and acting. Of course, health professionals have a duty to present the options and a proper assessment of safety in each case, but if the public weigh that up and say that they want to keep the services they need close to home, the Government should listen to them.

Another major issue is the need for Ministers to ensure that our local hospitals and the wider national health service adequately learn the lessons of the significant and prolonged failings in hospital management at the Morecambe Bay trust. There have been tragedies about which people are still demanding answers and which apparently did not trigger sufficient improvements, despite laying bare shortcomings in areas such as maternity provision several years ago.

[Mr Jamie Reed (Copeland) (Lab)]

As usual, my hon. Friend is making an excellent case on behalf of his constituents. Many people in the south of my constituency use Furness general hospital, as well. Does he share the fear that some of them have expressed to me that the rapid removal of the special care baby unit heralds a stealth reconfiguration of services there?

[John Woodcock]

My hon. Friend is absolutely right that that is indeed the great fear. It is up to the trust, and ultimately to Ministers and the Government, to demonstrate that that is not the case, but there are still questions to be answered.

The need for lessons to be learned has been shown by such problems as the basic lack of grip in key areas in recent years—for example, the failure of new computer systems designed to remind patients about repeat appointments, which has clearly put lives at risk. A police investigation into a number of deaths is ongoing. There is also a lack of openness at the trust.

I pay tribute to the hard work of the staff in the maternity unit and across Furness general hospital. They are dedicated people, who come to work wanting to help others and to save lives. There have been real improvements of late, and we should recognise the immense strain placed on staff by the ongoing spotlight on the hospital and the longer-term uncertainty over their future. None the less, families are still grieving because of past mistakes made in a poorly managed system. The Minister was good enough to write to me in response to a letter from my constituent James Titcombe, and again recently on the need for a genuinely independent inquiry into the lessons for the wider NHS of management failings at Furness general hospital.

--- Later in debate ---

[Dr Poulter]

Absolutely. There will be a full response to the Mid Staffordshire inquiry tomorrow, so I will not pre-empt it or go into detailed discussion of that issue. However, it is absolutely right that we must encourage staff who have concerns about patient care to raise those concerns and air them in an open way. Moreover, when we know that there have been long-standing failings at a trust about the quality of care provided to patients and concerns raised about those failings—although Morecambe Bay NHS Foundation Trust, for example, has made some good progress in recent months, there are some long-standing issues there—it is important that, when an investigation is carried out, it is carried out in a transparent, open and independent way; there must be a great degree of independence involved.

If a trust sees fit to launch an investigation and a review of what has happened, it is important that the investigation and review pass the test of transparency. There may well be a role for local MPs and other interested parties in that process, and when the hon. Member for Barrow and Furness and I meet, that is an issue that I will be very keen to discuss further, to ensure that we can discuss with the local trust ways in which we can ensure that there is that transparency and independence in the process. That is very important to ensure that those patients, and their families who have had problems in the past—in some cases, there have been deaths at the trust—feel that the investigation addresses their allegations.

Obviously, this debate is not just about maternity services at the Morecambe Bay NHS Foundation Trust; there have been other issues around the trust, and any investigation will need to take account of all those issues. I understand that that is what will happen.

[Mr Jamie Reed]

I am very grateful to the Minister for his considered and thoughtful response to the debate. I agree with him wholeheartedly on the importance of transparency and openness. However, where there are different clinical groups commissioning services from a single trust that operates a number of different hospitals, who actually holds the ring and decides which services are commissioned where?

[Dr Poulter]

The hon. Gentleman asks a very good and thoughtful question. It is the duty of the commissioning groups to work collaboratively for the best interests of patients. They obviously have responsibility for their own budgets and, as I say, they all ought to work collaboratively for the benefit of patients. However, if there are concerns about that, there is also a role in this process for the commissioning board, which will have some oversight over the process, to help to ease it through. In many parts of the country, there is already good evidence that the emerging local commissioning groups are working together collaboratively in just the way that I have described. I hope that that is reassuring for the hon. Gentleman.

We know that the Morecambe Bay NHS Foundation Trust has had a very long and troubled history. We also know that it serves a very important purpose in looking after people throughout north Lancashire and Cumbria. My hon. Friend the Member for Lancaster and Fleetwood (Eric Ollerenshaw) made clearly the good point that the configuration of the trust geographically is challenging. We, as a group, are going to meet together to talk through some of these issues and the troubled history of the trust, to ensure that we can do our best to work through these issues.

There have been problems in the past with the trust and local patients have not been treated properly, and they and their families have suffered. There have been long-standing concerns over local care quality issues. That may mean that we have to redesign the way that services are delivered; that may be an inevitable consequence of improving patient care in the long run. Nevertheless, the driver of this process must be delivering high-quality local health care within the envelope of providing improved patient care with better outcomes and safer care for patients. However, the only way that we will achieve that is if all the commissioners are working collaboratively with the trust in a more integrated approach to care. The failure to do that is where things have gone wrong in the past, and that is what needs to change in the future.

Terminal Illness (Access to Medicines)

Jamie Reed Excerpts

Wednesday 23rd January 2013 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to be called to speak under your chairmanship again, Mr Caton.

I extend my sincere thanks to the hon. Member for The Cotswolds (Geoffrey Clifton-Brown) for securing this important, emotive and timely debate. He laid out the issues in a compelling fashion, complemented by the testimony of other Members from across the House. The debate comes a day after my right hon. Friend the shadow Secretary of State held a specialist commissioning summit in the House to discuss some of the very issues before us today.

When dealing with terminal illnesses, it is important to recognise all of the lives affected by terminal and degenerative illness. It is important that stories and experiences of those with such diseases inform our debate, so that we do not focus purely on statistics. Behind every statistic is an individual and a family with real human issues that wear no party colours, and they may have no interest in our party colours. I am sure that all hon. Members have experience of constituents who have suffered from such debilitating illnesses and realise the importance of doing whatever we can whenever we can to improve their access to treatments that could improve their quality of life. I express my most sincere best wishes to those people dealing with terminal conditions today, and to their families, carers and everyone whose lives they touch.

I also praise the constituent of the hon. Gentleman, Mr Halpin, for the work that he does to highlight the issue and to push for improvements and greater access to drugs to improve palliative care. Today’s debate is proof that this place can be influenced by the public and by individuals—individuals can make a difference. We must look at what we can do to improve access to medicines and we must continue to explore ways and methods to encourage the synthesis of new drugs and to make those available to patients as soon as possible, while also maintaining the fundamental focus on patient safety, as has been said. That is a fine balance to strike and I look forward to learning how the Minister plans to address it.

Making new, safe and effective treatments available to all patients who require them must be the end goal, but it cannot be an isolated goal. We must look at ways to increase the availability of already licensed drugs and we must look at non-drug-based treatments as well, which can vastly improve the quality of life for patients in need. A number of charities have expressed a view that a move to adaptive licensing of drugs could benefit patients. The European Medicines Agency suggests:

“Adaptive Licensing seeks to maximise the positive impact of new drugs on public health by balancing timely access for patients with the need to provide adequate evolving information on benefits and harms”.

It must be recognised that adaptive licensing would bring a number of benefits, such as encouraging pharmaceutical industries to develop new drugs and to bring them into service quickly. It is suggested that new drugs could be available after phase 2 testing, the main focus of which is safety rather than efficacy.

There are, however, a number of issues with that approach. After phase 2 testing, drugs might be expected to be safe for human consumption, but the efficacy of any drug would still not be proven. Going on to prove efficacy at stage 3 could raise some ethical and personal difficulties. At present, a phase 3 trial is needed to demonstrate that any drug is effective. Under adaptive licensing, would those with early access be classified as part of a conventional phase 3 trial? If early access formed part of a conventional phase 3 trial, would existing trial guidelines be maintained for the use of data received on early access recipients? Clearly, ethical and personal issues would arise from both questions.

First, how can the efficacy of one drug be compared with that of another, existing drug, or with a placebo? Using blind tests in which one drug is administered to one group, and another drug or placebo is administered to another group would raise ethical issues. Doctors might knowingly deny access to a drug that has been proven to be effective because of the chance that a new drug could also be effective. Secondly, on a personal level, how could we be sure that patients are fully comfortable with and aware of the risks of taking medicines before they are fully approved under the current system? I acknowledge the point made by the hon. Gentleman about the patient being in charge of the choices with which they are presented, and more fundamentally in charge of their own treatment and destiny.

We must be careful not to suggest that adaptive licensing is risk-free and the only logical solution to a problem. Patients participating in early adoption of medicines might have better access, but there would be clear and obvious risks. That is not to say that we should discourage the synthesis of drugs that are less effective than those that already exist. The development of drugs is clearly a highly precise science, but the application and treatment of medicines sometimes resembles an art form. For some patients, the most effective available drugs are useless and, for want of a better phrase, less effective drugs could be invaluable.

I raise these issues not because we should oppose the introduction of adaptive licensing, but because we must fully explore the ramifications of introducing a change on this scale, and I look forward to hearing how the Minister plans to tackle these delicate and fine issues. We must also understand what it would mean for our life sciences and our research and development capability in the UK, but first and foremost, and fundamentally, what it would mean for patients and patient choice.

In the spirit of this debate, we should look at ways to improve care and provision of other types of available treatment, such as care facilities in communities, and assistance for patients at home. The care a patient receives does not depend solely on the medicines they receive, although clearly that is hugely important, and we should continue to explore ways in which that can be widened.

It must be noted that, as other hon. Members have said, very few drug options are available to people with terminal illnesses such as multiple sclerosis and motor neurone disease. As well as doing everything we can to speed up the development of new drugs while protecting patients’ well-being, we should explore other methods of treatment for those with terminal illnesses. We must all acknowledge that the NHS is always changing as society changes. The art of drug and medicine application demands a more bespoke and tailored patient experience and more wide-ranging treatments.

The principle behind adaptive licensing is commendable, and one that anyone would find difficult to oppose. It would ensure better access to drugs, but it would not necessarily alter things that much. As has been said, pharmacology recycling bins are filled with trials for promising new medicines that ultimately proved to be ineffective or even dangerous. Loosening access to trial drugs requires greater peer reviewing of early data and methodology to ensure patient safety.

There is a strong argument for allowing more off-label prescribing of drugs that have already passed safety tests. They could be an option open to doctors and patients if they are believed to be effective in treating a condition they were not originally intended for, and I would be extremely interested in hearing what the Minister has to say about that. Even if adaptive licensing was adopted now with a robust system of safeguards in place to protect the well-being of patients, those with terminal illnesses would not start to see improved access for a number of years. We are all aware that drug manufacturing does not happen overnight.

One of the harsh realities of debates such as this is that changing regulations today will not benefit patients tomorrow or the day after. What we need right now is improved care for those with terminal illnesses, and support for their carers. Improved facilities offering specialised care would go some way to improving patients’ quality of life, as would earlier, faster diagnosis of terminal conditions. All Members of Parliament have heard of cases of suffering that could have been prevented, and diagnosis that could have been earlier, resulting in a better experience for patients and their families.

Access to drugs may vary throughout the country and that cannot be tackled by a fractured system. That is a huge concern as we move towards April and beyond. I hope the Minister will explain how she can guarantee that a clinical commissioning group in Cornwall meets the same standard in access to medicine as a group in Cumbria. Adaptive licensing would improve access to drugs, but not without risks, and I hope the Minister will be able to outline a safe and secure framework that could be put to the House for greater scrutiny. At this stage, not enough research has been done to guarantee that access to drugs can be expanded through adaptive licensing without exposing patients to ineffective and potentially dangerous drugs. I hope that much more work will be done to show that a patient’s well-being and quality of life can be protected while ensuring that more drugs are made available.

[Geoffrey Clifton-Brown]

The hon. Gentleman has touched on an important matter than has not yet arisen in this debate: the possibility of different protocols for prescription of medicines by different clinical commissioning groups. My gentle suggestion to the Minister is that it would be unacceptable if the new system developed a postcode lottery whereby people in some areas had access to a new drug, but people in others did not.

[Mr Reed]

I thank the hon. Gentleman for his contribution. He is entirely right, and I do not believe that any hon. Member in the House would want that. Many of us have seen and read accounts of the problem he illustrates, and we must not hasten any further move towards that. We should all seek to address such issues as and when they occur.

The hon. Gentleman intervened just as I was coming to the end of my remarks, and I look forward to hearing the Minister’s response.

--- Later in debate ---

[Anna Soubry]

I am grateful for that intervention and I completely agree. It is great when we see business working with our universities on research. It can be highly productive and undoubtedly mutually beneficial, including to the rest of society, and that collaborative approach is much to be welcomed. It is fair to say that many universities, at first, had a bit of resistance to working with business, seeing it somehow as sullying themselves. However, over time they have recognised the absolute mutual benefit to both and, of course, that includes, should it be successful, a benefit to society.

[Mr Jamie Reed]

I am grateful to the Minister for her contribution. It is clear that there is an emerging cross-party consensus—dare I say it, a coalition—which is a tremendous sight to behold for everyone who cares about this issue. She talks about the difficulties posed by the research and development sector when it comes to manufacturing medicines for orphan diseases, and the costs inherent in producing them because of the market basis on which they are produced—no argument there. However, could she explain how that might affect the commissioning choices of clinical commissioning groups when it comes to purchasing those very same medicines, given the inherently inflated costs?

[Anna Soubry]

I cannot give a short answer in this debate, but that is important and it has been raised by a number of hon. Members. On that basis, I will ensure that a proper and full written response is given, both to the hon. Gentleman and all other hon. Members—I suspect that my hon. Friend the Member for Southport and the hon. Member for Strangford will also be interested in the answer. All present will certainly get a written answer to that, because it is an important point; clarity is clearly being sought, and it will be given.

Returning to NICE, once effective new drugs are brought to market, it is important, as we all know, that they are made available to the patients who will benefit most from them on terms that represent value to the NHS—that means, of course, value to the taxpayer. NICE has played an important role in that by providing robust, evidence-based guidance to the NHS on drugs and treatments. In the great majority of cases, NICE now publishes draft or final guidance on significant new drugs within a few months of their launch. In 2011, for drugs appraised using its single technology appraisal methodology—the methodology used for the great majority of new drugs—NICE issued draft or final guidance an average of four months after the date of market authorisation. The end-of-life flexibilities introduced into NICE’s appraisal process from 2009 have allowed a number of important drugs for terminal illnesses affecting a small number of patients to be made available on the NHS.

The NHS constitution sets out patients’ rights to medicines positively appraised by NICE, underpinned by a statutory funding direction. In December 2011, the NHS chief executive’s report, entitled “Innovation, Health and Wealth”, introduced a NICE compliance regime to help to ensure that medicines approved by NICE are made available on the NHS quickly and consistently. Furthermore, since the cancer drugs fund started operating in October 2010, more than 25,000 patients have received cancer drugs that they would previously have been denied. Our priority is to give NHS patients better access to effective and innovative medicines. That is why we will move to a system of value-based pricing for new branded medicines from January 2014, following the end of the current pharmaceutical price regulation scheme.

Oral Answers to Questions

Jamie Reed Excerpts

Tuesday 15th January 2013 Commons Chamber

[Dr Poulter]

My hon. Friend is right to highlight a long-standing problem—it has not happened just recently —of a lack of particularly middle-grade doctors in A and Es. Although the number of consultants has increased by about 50%, as A and Es move rightly towards becoming a 24/7 consultant-led service, attracting middle grades to the specialty has been a problem. We set up a task force to consider that, as well as making better use of a multidisciplinary work force and emergency nurse practitioners to meet some of the staff shortages.

[Mr Jamie Reed (Copeland) (Lab)]

The performance of A and E services has an obvious and acute effect on the performance of ambulance services. In London, freedom of information requests show that the number of ambulances waiting more than 30 minutes from arriving at hospital to handing over their patients has gone up by two thirds over the last year, that ambulances are missing their targets in responding to the most serious life-threatening callouts, and that the average length of time that patients wait in ambulances before accessing A and E is going up, and in some cases patients are waiting almost three hours. The Care Quality Commission says that London Ambulance Service NHS Trust does

“not have sufficient staff to keep people safe”.

The question for the Secretary of State is simple: what is he going to do about it?

[Dr Poulter]

The hon. Gentleman is right to highlight the unacceptable variations in the quality of triage and handover between ambulance services and hospitals, not just in London but in other parts of the country. Many hospitals, however, do that well, and it is important that local MPs highlight the issue, champion good practice on handovers and ensure that that good practice is carried out at other A and Es. It is unacceptable that patients should wait for handover.