Oral Answers to Questions

Debate between Jane Ellison and Helen Jones

Tuesday 25th October 2016 Commons Chamber

[Jane Ellison]

The hon. Lady is absolutely right to draw the House’s attention to the importance of prioritising vulnerable claimants. HMRC held a further drop-in for colleagues recently, on 19 October; it was attended by 15 Members, and a number of complaints and issues were raised, which we are on the way to resolving.

On restarting claims, the key is to get the right information. HMRC has taken back a vast number of cases, and I will say more about this tomorrow. The priority is to get the right information, to get claims started again as soon as the facts are established.

[Helen Jones (Warrington North) (Lab)]

When the Minister wrote to me after I asked a previous question, she said:

“Amounts to be paid to the supplier are reduced if actual performance fails to meet standards set in the contract.”

Does that include penalties for withdrawing tax credits when they should not have been withdrawn?

[Jane Ellison]

The terms of the contract between HMRC and Concentrix are obviously in the public domain, and it is right that when performance is not as per the contract there are associated deductions, but I will be in a position to give the House more information about the contract in tomorrow’s Opposition day debate.

Tax Credits: Concentrix

Debate between Jane Ellison and Helen Jones

Wednesday 14th September 2016 Commons Chamber

[Jane Ellison]

I hope I can give that reassurance for the future. To date, it has always been the case that, when the Government contract a supplier to provide a service, it should be provided to the right standard, and that contracts are monitored and we ensure that service levels are acceptable to Members and their constituents.

[Helen Jones (Warrington North) (Lab)]

Despite what the Minister has said, I have constituents who have had their tax credits cut off with no prior notification, and who have spent up to 70 minutes on the phone trying to get through, which is a huge drain on their resources. Will she tell us whether the contract included penalties for Concentrix if it did not provide an acceptable service level or answer calls within a set time? If not, who will take the responsibility for negotiating such a flawed contract?

[Jane Ellison]

Waiting 70 minutes to have a call answered is clearly not acceptable. I can imagine the distress that would cause somebody trying to get through. If you will forgive me, Mr Speaker, and if the hon. Lady will let me, I will write to her about the points she made about the contract—I do not have that detail to hand, and I need to assess what we can say given commercial confidentiality. If I can give her the answers she seeks, I will do so, but I will write to her if that is acceptable.

Oral Answers to Questions

Debate between Jane Ellison and Helen Jones

Tuesday 2nd June 2015 Commons Chamber

[Jane Ellison]

I welcome the hon. Lady back to her place. It is good to see her back in that job and not on the Government Benches. It is far from the case that we took a passive approach—far from it. Some important things were learned from the way we have worked with industry and we are looking to build on those, but as I have said, there is no silver bullet. There is not a single academic study in the world that says that the way to respond to obesity in the developed world is through a single mechanism. We have to look at a whole-system approach, and that is what we are doing.

[Helen Jones (Warrington North) (Lab)]

12. What estimate he has made of the anticipated levels of deficits in hospital trusts for the current financial year.

Transient Ischaemic Attacks

Debate between Jane Ellison and Helen Jones

Wednesday 5th November 2014 Westminster Hall

[Helen Jones (Warrington North) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Riordan. I am glad to have the opportunity to debate transient ischaemic attacks, or TIAs. They are also known as mini-strokes, but we should be careful with our terminology, because a TIA is a serious matter; it is a warning of a possible future stroke. Because it is a serious matter, I am a bit perturbed that no one is sat on the Government Front Bench. I hope that the Minister will join us shortly. A possible future stroke could kill or incapacitate someone temporarily or permanently, and the risk is greatest in the first few days after a TIA. In fact, one in 12 people will go on to have a stroke within a week of a TIA, yet TIAs are often not taken seriously by members of the public and are sometimes not recognised by health staff.

We have known for some time, however, that dealing with TIAs urgently can prevent future strokes. In fact, research published in The Lancet in 2007 indicated that 10,000 strokes a year could be prevented if all TIAs were treated urgently, but that still does not happen. Those strokes could be prevented, people could avoid serious disability and the NHS could save a huge amount of money.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I intervene only to apologise most profusely for not being here at the start of the debate. We checked with the Doorkeeper following the Division and were advised that a quarter of an hour would be added and that this debate would start at quarter to 5. I would never be so discourteous to the hon. Member for Warrington North (Helen Jones). I really am extremely sorry, but that was the advice that we received. We were only next door.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

Once again, my apologies to the hon. Member for Warrington North (Helen Jones) for missing the first two minutes of her contribution, because of a misunderstanding on our part.

The hon. Lady is a great expert on the subject and, as she said, we have debated it in the past—in fact, it was the subject of the first debate that I responded to as a Minister, about a year ago. It is good to see her commitment. As the chair of the all-party group on stroke—she is one of Parliament’s great champions of the issue—she also takes great interest in transient ischaemic attacks. The debate is timely, because it was world stroke day last Wednesday, which this year focused on the impact of stroke on women.

As ever, I will try to respond to as many of the points that have been made as I can, but the matter is obviously the responsibility of the NHS. In a debate of this nature, I always undertake to draw to it the attention of the key people in NHS England, in particular the national clinical director—

[Helen Jones]

I am sorry to interrupt, but Ministers are in the end responsible for what happens. If they are not, there is no point in them being Ministers. A huge bureaucracy has now been set up, but it is still open to a Minister to pull the strings to ensure that the things that need to be done are done. I hope to see the Minister doing that.

[Jane Ellison]

I note the hon. Lady’s comments. NHS England is the lead on the subject, because it is ultimately a clinical matter. I always draw the attention of our clinical leaders to the views of Parliament and, where I need to underline them, I of course do so, but it is also important to recognise that in a large organisation the views and leadership of senior clinicians are vital. I will refer to that.

[Helen Jones]

The Minister is gracious to give way, but I am sorry, I had to intervene at that point. The clinical details are not in doubt. We know what works and what best practice is; the problem is that best practice is not always followed.

[Jane Ellison]

I note the hon. Lady’s comments.

Turning to the Act FAST campaign, when people have a TIA, getting medical attention quickly is key, as the hon. Lady said. Ensuring that the general public are familiar with the signs and symptoms is important. Public Health England continues to run the highly impactful Act FAST stroke awareness campaign, which covers similar signs to those of a TIA—I note that she is right to draw the distinctions—and the simple message to call 999 if such signs are witnessed. The campaign was run again in March this year, and new adverts feature an Afro-Caribbean man to underline the fact that people from some ethnic groups, whether south Asian, African or Caribbean, are at higher risk of TIA and stroke than others. PHE plans to run the adverts again later in the financial year. Over the summer, the Stroke Association also ran a campaign to raise awareness of TIA, “Not just a funny turn”. It was welcome and many of us saw it.

The hon. Lady also referred to front-line staff and to raising awareness of signs and symptoms. Act FAST and the Stroke Association’s campaign were aimed at public and professionals alike to ensure that everyone acts swiftly. PHE plans to run its adverts, which do not only face the public, again before April 2015.

In addition, NHS England has produced a resource for clinical commissioning groups, to support them in setting and delivering on the level of our ambition to reduce premature mortality. TIAs form an important part of that. The resource includes information on the most high-impact interventions that CCGs can consider commissioning to reduce premature mortality, and TIAs fit into that description. One such intervention is to increase the proportion of patients suffering a TIA treated within 24 hours from 71% to 100%. Let us recognise that TIAs sit right at the core of all the resources being distributed to our front-line staff and produced by NHS England.

NHS England has also been working with the 111 service to ensure that the protocols and triaging systems on the phone lines are used to identify as many people with stroke and TIAs as possible. We recognise that there is more to do and that such work is ongoing.

On getting patients the treatment that they need, quite a lot of work is under way in many parts of the country to reorganise services. That involves reconfiguring care for patients with TIAs as well as acute strokes. For example, in Birmingham and the black country, Warwickshire, Surrey and Sussex standards for TIA care have been set and services are being redesigned to ensure that patients with high-risk TIA can be seen and managed within 24 hours.

The reorganisation of vascular surgery services into a smaller number of higher-volume units is also improving the efficiency of the provision of surgery for TIA. There have been huge improvements in TIA patients’ access to neurovascular clinics in recent years. That is important because, as the hon. Lady said, we know that the risk of stroke in the first four weeks after a TIA can be as high as 20%. It is vital that people are seen urgently and their symptoms investigated, and that a management plan is put in place.

The hon. Lady said that services can be inconsistent. We want to ensure that we work towards making all services as good as the best, but part of that work is to define what the best standards are and to disseminate best practice. I will talk about some of the ways in which that is done.

The 2012 national clinical guidelines for stroke recommend that patients who have had a TIA are seen, investigated and treated in a neurovascular clinic within one week. A few years ago, such clinics were relatively unusual and waiting times could run to weeks or months. Information from the latest Sentinel stroke national audit programme organisational audit published in 2012 shows a picture of real improvement. According to the audit, 100% of trusts in England, Wales and Northern Ireland now have a TIA or neurovascular clinic, with a median of 20 clinics held in each four-week period. There has been a really big improvement in access to those clinics.

The same audit also said that there are very few areas of the country where a high-risk TIA patient would need to wait more than a week, and that over half of high-risk in-patients could be seen the same day, seven days a week. We are waiting for an update of that audit, which is due to be published quite soon. I hope to see further improvement.

In the mini-exchange I had with the hon. Lady at the beginning of my contribution, we touched on best practice. The strategic clinical networks are important for that. They bring together clinicians from across health care settings and the wider health and care system in 12 geographic areas. The SCNs share best practice and promote initiatives on their core service areas, which include cardiovascular disease. The networks hold regular meetings to enable communication and information sharing. As an MP for a London constituency, I saw the benefit of bringing that clinical excellence to bear in the reorganisation of stroke services in London. Such work is ongoing, to make sure that best practice is disseminated around the country.

Oral Answers to Questions

Debate between Jane Ellison and Helen Jones

Tuesday 26th November 2013 Commons Chamber

[Jane Ellison]

My hon. Friend is right to champion early diagnosis and he has raised these issues in the House on many occasions and with me. Improving cancer survival is a key priority for this Government. We aim to save an additional 5,000 lives each year by 2014-15. Clinical commissioning groups have a duty on early diagnosis. It is part of their crucial outcomes indicators set, and they will be held to account for that because we cannot deliver those improvements in cancer outcomes without early diagnosis.

[Helen Jones (Warrington North) (Lab)]

When the Government decided to slash council budgets and, therefore, adult social services, did they know what effect that would have on hospitals, particularly A and E, and decide to carry on anyway, in which case they are too callous to be running the NHS, or did they not know, in which case they are too stupid to be running the NHS?

Stroke (Emotional and Psychological Consequences)

Debate between Jane Ellison and Helen Jones

Monday 21st October 2013 Commons Chamber

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I congratulate the hon. Member for Warrington North (Helen Jones) on securing this debate on an important issue that affects so many of our constituents. She spoke with great knowledge and passion about the subject. I am also aware of the great work that she does as chair of the all-party parliamentary group on stroke.

Stroke is one of England’s biggest killers. It is the single largest cause of adult disability. Its effects can be devastating, both for those who have a stroke and for their families and loved ones. It is worth reiterating the great progress that has been made in tackling stroke, particularly the physical aspects, in recent years. Many thousands of people have benefited from that. Fewer people now die from stroke; mortality rates dropped by 37% between 2001 and 2010.

Treatment for stroke has improved in a number of areas, as the hon. Lady mentioned. Stroke patients do better when they are treated on a stroke unit, and over 83% of stroke patients now spend the majority of their hospital stay on a stroke unit. Access to immediate brain scanning is vital, and has improved considerably, as has access to clot-busting drugs, which give people a better chance of regaining their independence following a stroke. We all want that progress to continue, and that is why stroke remains a priority for the Government and the NHS. We also know, however, that we need to do more to improve support for people after stroke, which is the subject of tonight’s debate.

When it comes to national incentives to improve outcomes, stroke is covered in two parts of the NHS outcomes framework and the mandate to NHS England. Through the mandate we are monitoring how the NHS performs both in reducing mortality from cardiovascular disease, including stroke, and in improving recovery from stroke. Some stroke survivors are unfortunately left with long-term disabilities, as was said, so how we support people with long-term conditions will be important to them. Through the mandate, we are monitoring how the NHS is performing in supporting people to look after themselves; whether a person is able to live as normal a life as possible; and how successfully the NHS manages long-term conditions by looking at unnecessary hospital admissions and excessive length of stay in hospital.

[Helen Jones]

The Minister refers to the outcomes framework, but will she ensure that it focuses not just on physical rehabilitation, but on psychological support, because both are essential if people are to go on and build a life for themselves after stroke?

[Jane Ellison]

Quite. As the focus of the framework is about recovery from the stroke, it includes exactly what the hon. Lady says—not just physical recovery, but psychological and emotional recovery, too. Much of what we are trying to do is to set about getting people on that full pathway towards recovery, not focusing only on acute symptoms and the immediate aftermath of the stroke.

The clinical commissioning group outcome indicator set mirrors the areas we are monitoring for stroke and for long-term conditions. This is the indicator set that will be used to hold CCGs to account and to provide information for the public on the quality of services and the health outcomes achieved through that local commissioning. The CCG indicator set also contains measures to ensure stroke survivors are discharged from hospital with a joint health and care plan, and receive follow-up assessments within about six months. I have heard what the hon. Lady said—that this is not happening. I have taken note of it, and it will be discussed with NHS England and all those responsible. It is our clear objective to do that. I appreciate the information the hon. Lady has given us about the Stroke Association’s work in monitoring whether it is really happening. It is obviously a priority. The new Sentinel stroke national audit programme will also monitor the outcomes of stroke care in all patients six months after stroke.

When patients leave hospital, it is important that the NHS and social services work together to get the right services in place to ensure they have the support they need to make the best possible recovery. The measures and indicators I have talked about, alongside a shared measure in the adult social care outcomes framework on the success of re-ablement and rehabilitation services, provide an incentive for the NHS and social services to work together to ensure that happens.

The adult social care outcomes framework is helping us to gauge the progress made by local services and to promote improvement in standards across the country. A key area of the framework is to reduce the need for care and support—exactly as the hon. Lady said—and delay any dependency. Those measures will support the sector to maximise people’s level of independence and minimise their need for ongoing support. Under the framework, local authorities will be able to compare their performance with that of other authorities around the country—we obviously want everyone to match up to the standards of the best—and to make improvements based on what has been proven to work elsewhere. Through that common focus for improvement, the NHS, public health and adult social care outcomes promote joined-up, integrated care, driven by the needs of the individual. For stroke survivors, this means providing access to the support they need to get that better quality of life.

I shall now deal more specifically with the issue of emotional and psychological support for people who have had a stroke. The cardiovascular disease outcomes strategy, published earlier this year, recognises that stroke services that incorporate psychological care deliver the best outcomes for people who have had a stroke. There are also national stroke strategy recommendations and evidence-based national guidance that patients should be routinely screened for mood and cognition after their stroke. These recommendations are included in the National Institute for Health and Care Excellence quality standard on stroke. That answers the question the hon. Lady posed about whether these were at the heart of what we saw as best care—very much so.

It is, of course, the responsibility of NHS England and CCGs to ensure that stroke patients receive the psychological and emotional support they need. NHS England recognises that this area of stroke care is of great importance for many patients. Improvement in community services with greater access to early supported discharge teams and longer-term rehabilitation is also high on NHS England’s agenda.

NHS England is also exploring ways of improving the use of existing resources. The hon. Lady will be aware of Improving Access to Psychological Therapies, an NHS programme that is rolling out services across England that offer interventions for people with depression and anxiety disorders. Many areas now have IAPT, which benefits people including those who are suffering from symptoms following a stroke. I understand that there have been discussions about how the IAPT teams might increase the proportion of the time that they spend with people whose psychological problems are secondary to physical disease, but are none the less important and—as the hon. Lady said—sometimes become more important as time goes on.

Some IAPT services have developed psychological support skills through enhancing the training of nurses and therapists, and some have employed the services of counsellors to support people who have had strokes in the community. I know that some of the good local examples of support for stroke survivors and their families are in the hon. Lady’s constituency. She will be well acquainted with initiatives such as the family support service, which helps stroke survivors and their families to adjust to life after a stroke, and the communication support service, which helps people with aphasia and other communication problems to cope. Stroke sufferers and their families can also receive emotional and psychological support via the local IAPT service.

It is for NHS England to consider how to spread best practice from services such as those in Warrington, using some of the frameworks that I have described. However, I am glad that the hon. Lady has taken this opportunity to bring the issue to Parliament, because I feel strongly that Parliament has an important role to play in highlighting great practice and spreading the word about good local initiatives such as those to which I have referred.

We recognise that, while supporting those who have had strokes, we must also support those who care for them. We set out our priority areas for action on carers in our paper “Recognised, Valued and Supported: next steps for the carers strategy”, which was published in November 2010. We have also made available to the NHS additional funding of £400 million between 2011 and 2015 so that carers can be given much-needed breaks to sustain them in their caring role. Carers are central to the Government’s proposals for care and support, and, as the hon. Lady will know, the Care Bill offers significant improvements in that regard. I am sure that we shall hear far more on the subject as the Bill progresses through Parliament.

Once again, I congratulate the hon. Lady on securing the debate and raising the profile of this very important issue. I shall consider the specific issues that she raised with which I have not been able to deal tonight. I shall also be happy to engage in a continuing dialogue with her and with the Stroke Association. I have read the association’s 10 key indicators and familiarised myself with them. However, the issue is so important to so many people that there must clearly be an ongoing debate about how we can ensure that the very best care is provided throughout the country, because we need the consistency to which the hon. Lady referred.

Let me end by paying tribute not just to all those who work in the NHS, but to those in the voluntary sector who care for stroke patients and their families.

Question put and agreed to.