Oral Answers to Questions

Janet Daby Excerpts

Tuesday 23rd January 2024 Commons Chamber

[Andrew Stephenson]

I was delighted that one of my first visits in the new year was to Northern Ireland to see some of the life sciences companies, particularly those based around Queen’s University Belfast. That sector in Northern Ireland is flourishing. We are keen to support companies working in research and bring together world-leading universities such as Queen’s with the private sector and the NHS to deliver improved outcomes for all patients across every part of the United Kingdom.

[Janet Daby (Lewisham East) (Lab)]

12. What steps she is taking to improve healthcare outcomes for patients with sickle cell disease.

[The Minister for Health and Secondary Care (Andrew Stephenson)]

I know this is an important issue for the hon. Lady in her role as chair of the sickle cell and thalassaemia all-party parliamentary group. We are working hard to provide the best possible care to those living with sickle cell disease. That includes boosting Ro subtype blood donation numbers, identifying improvements in clinical pathways and delivering world-leading treatments, such as the new blood-matching genetic test announced by NHS England yesterday, which will reduce the risk of side effects and offer more personalised care.

[Janet Daby]

I congratulate NHS England on the launch of the new blood-matching genetic test for sickle cell patients, but it has been more than two years since the “No One’s Listening” report, which made the key recommendation that sickle cell patients receive pain relief within 30 minutes of attending accident and emergency. Why is that still not happening for sickle cell patients, and would the Minister like to meet me and the Sickle Cell Society to discuss how to achieve that?

[Andrew Stephenson]

I of course would be happy to meet the hon. Lady and the Sickle Cell Society to look at how we can improve patient experiences and ensure that all patients benefit from timely access to the medications they need. I am delighted that she welcomes yesterday’s announcement. It is an example of how the NHS can bring forward world-firsts and is leading the way to transform patient care and improve patient outcomes.

NHS Dentistry

Janet Daby Excerpts

Tuesday 9th January 2024 Commons Chamber

[Janet Daby (Lewisham East) (Lab)]

It is clear that under this Government our NHS dentistry is in crisis. Across Lewisham East a number of dental surgeries are no longer accepting new adult patients. Recent Healthwatch polling shows that one in 10 people in England are paying for private dental treatment because they cannot find an NHS dentist, yet many others cannot afford to do this and instead are suffering. The Government promised to publish their dental recovery plan by the summer of 2023; it is now 2024 and the Government still do not have a plan.

I will focus my remarks on a specific issue facing dental patients, as well as practitioners, that is making this crisis even worse. A constituent of mine contacted me about her father who was driven to suicide after more than a decade of seeking compensation for dental work that left him in severe agony. Despite being awarded a record compensation sum, he never received a penny. The dentist who carried out the surgery was registered with the General Dental Council, which requires all dentists, both NHS and private, to have professional indemnity to be a member. However, it turned out that the dentist did not have full cover. Instead, she was covered only via her membership of the Dental Defence Union. Such organisations are not insurance companies but offer professional indemnity on a discretionary basis against the risk of dental neglect claims and professional conduct proceedings. That means that successful compensation claims by patients are not guaranteed to be paid out. The General Dental Council currently accepts that as appropriate, but in my view it is not, and neither is it in my constituent’s view, especially when it led to such a horrific experience for her late father.

The Paterson inquiry recommended that the Government should, as a matter of urgency, reform the current regulation of indemnity products for healthcare professionals. In 2018, the Government launched a consultation on indemnity cover for healthcare professionals including dentists, but little progress has come from it, despite the majority of stakeholders arguing against discretionary indemnity. I have written to the Secretary of State highlighting calls for the Government to outlaw discretionary indemnity options for what is considered appropriate cover for practising dentists, but I am yet to see a response. Therefore, I would welcome it if the Minister met me and my constituent to discuss this matter and the response to the consultation.

I am sure we all know that the Horizon scandal was a terrifying injustice, but in its own way the situation I am speaking about is also a scandal. Through no fault of their own, people are being denied huge amounts of compensation that they are legally entitled to. There is nothing in place to stop what is happening to my constituent’s father happening to many more people— I hope that it does not, but that is the reality. The Government have a duty to address safeguarding for patients and dentists. To exacerbate the problem, most patients and professionals do not know that their discretionary indemnity arrangement could still leave them out of pocket. When will the Government bring about change, or are they just incapable?

NHS Winter Update

Janet Daby Excerpts

Monday 8th January 2024 Commons Chamber

[Janet Daby (Lewisham East) (Lab)]

We have gone from no winter crisis when Labour left office to an annual winter crisis—and now a crisis all year round under this Conservative Government. Patient satisfaction with the NHS is at a record low. Instead of there being a blame culture, when will the Secretary of State accept responsibility for that appalling record?

[Victoria Atkins]

I think the hon. Lady was claiming that there was no winter under Labour, but perhaps that is yet another thing that does not quite stack up. I fully endorse her call for an end to blame culture, but point her to the real and practical measures that we have taken to improve urgent and emergency NHS care. I assume that she joins those on the Government side in condemning the unprecedented strike actions that the junior doctors committee has called at this particular time of year.

Future of the NHS

Janet Daby Excerpts

Tuesday 24th October 2023 Westminster Hall

[Janet Daby (Lewisham East) (Lab)]

It is an honour to speak with you in the Chair, Mr Pritchard. I thank my hon. Friend the Member for Wirral West (Margaret Greenwood) for securing such an important debate.

The NHS was set up in 1948. It was the first of its kind in the western world, leading the way for free medical care—what a great achievement. So many societies still wish that they had what we have.

As has been said by other hon. Members, we have already had 13 years of the Conservatives leading the way—unfortunately with much failure and neglect. We do not have enough doctors or nurses, there are long waiting lists for appointments, and primary care is also not what it should be. People are finding it very difficult to get a GP appointment, there are no NHS dentists, and even pharmacies are really struggling to ensure they have enough medicines to give to people. In addition, mental health services remain the poor relative to the NHS. Under this Government, there has never been enough investment in NHS mental health services.

I will focus my remarks, conversations and questions on the future of the NHS for sickle cell patients. Sickle cell disease is a serious condition which predominantly occurs in people with African and Caribbean backgrounds, and approximately 15,000 to 18,000 people live with it. It has been two years since the “No One’s Listening” report was published by the Sickle Cell Society, which found evidence of serious failings. Failings were found in acute services, and there was evidence of attitudes “underpinned by racism”, meaning that patients were not treated with care. They were ignored, often not believed, and not given the pain relief and oxygen they needed. Unfortunately, we have seen many fatalities because of this.

In January, the NHS Race and Health Observatory found that sickle cell patients undergoing a crisis were deprioritised and undermined. This is in keeping with the “No One’s Listening” report, which presented evidence regarding the death of Evan Nathan Smith in North Middlesex University Hospital in April 2019. The inquest found that Evan’s death would not have happened if it were not for failings in the care that he received. It is shocking every time I say that and every time I mention that.

I have worked with Government Ministers, the NHS and other important bodies to get implemented in full the recommendations that have come out of the “No One’s Listening” report. I ask the Minister to go further and to focus more on those recommendations. If we are looking at the public purse, which has been mentioned a few times in this Chamber, we see that it is more cost-effective to put in preventative measures that help and support people to not get into a crisis where they need to be in hospital.

I therefore ask the Minister: will the NHS develop individual care plans in partnership with the sickle cell patient? Will all NHS trusts require haematology teams to be told when a sickle cell patient accesses outpatient or inpatient care? Will the Minister instruct all integrated care systems to develop plans to provide community care in this area? Will the Minister ensure specialist training opportunities for nurses? Will the Department co-ordinate work between organisations and senior sickle cell service representatives to engage in effective workforce planning for sickle cell services?

If the Minister cannot answer all of those questions towards the end of this debate, I ask him to put it in writing, to do his best, and to also attend the all-party parliamentary group on sickle cell and thalassaemia, which I chair.

[Will Quince]

indicated assent.

[Janet Daby]

The Minister is nodding, so I take that as an indication that he is willing to do that, which is really good. I also implore him to consider that sickle cell is a long-life disease, a hidden disease, a disability, and very serious.

The disease, however, has not had the research funding that it really needs. Looking at people with cystic fibrosis and haemophilia, we that they have had so much more funding invested into medicines to improve the treatment of those illnesses. The National Institute for Health and Care Research funds research programmes, but sickle cell research is woefully inadequate compared with the diseases that I have already mentioned. According to the data produced by that organisation, approximately 18,000 people are living with sickle cell, compared with the 10,000 that are living with cystic fibrosis, but in 2017-18 over a million pounds more was spent on research for cystic fibrosis. In the present day, 2022-23, still over a million pounds more is being spent on research for cystic fibrosis compared with sickle cell. That is entirely unacceptable, especially when there are more people living with sickle cell. I do not wish to take away funding from other research, but I do want equality of funding. I am sure the Minister also wants this as well.

As I draw to a close, I have already mentioned that prevention has to be the ultimate way to help people live a good quality of life and to keep them out of hospital, and it also helps to take of care of the public purse. In conclusion, the NHS is a wonderful creation that has helped every single person in this Chamber, and indeed every single person in our country.

[Mark Pritchard (in the Chair)]

I am afraid that we are going to have to restrict the last two Back Bench contributions to five minutes each.

Mental Health Treatment and Support

Janet Daby Excerpts

Wednesday 7th June 2023 Commons Chamber

[Dr Allin-Khan]

I thank the hon. Member; it has been a pleasure to work with him in every single debate about mental health that I have held in the past three years, since I started my role. He speaks to the important point that prevention is the watchword that counts when it comes to mental health.

[Janet Daby (Lewisham East) (Lab)]

My hon. Friend is making a powerful speech. Does she agree that the Government are failing people who are experiencing mental ill health, or even a mental health crisis? Psychiatrists are leaving the country because they are finding jobs overseas more accessible. People experiencing mental health crises are having to wait in A&E departments for too long; they waited for a total of 5.4 million hours during 2021, which is entirely unacceptable. Things need to change.

[Dr Allin-Khan]

I thank my hon. Friend for assisting me in writing my speech; she has pre-empted much of what is to come. She is a powerful advocate for her community and I am proud to share the Opposition Benches with her.

--- Later in debate ---

[Neil O’Brien]

I completely agree about its tremendous importance, and I take this opportunity to mention the incredible work on this hugely important issue by brilliant charities such as Beat. I will outline some of the general things we are doing to increase capacity further.

[Janet Daby]

Only a few weeks ago, I met a constituent who endured an awful kidnapping and rape. She had some initial counselling and therapy from specialist services, but she has now been on the waiting list for more than a year and a half. What would the Minister say to my constituent, who desperately needs therapy?

[Neil O’Brien]

I am terribly sorry to hear about the hon. Lady’s constituent’s case, which I will look at extremely closely. This is why we are putting in extra investment and tackling waiting lists.

Eye Health: National Strategy

Janet Daby Excerpts

Wednesday 17th May 2023 Westminster Hall

[Marsha De Cordova]

I thank my hon. Friend for his intervention, and he is absolutely spot on. I will come to the workforce plan and the Government’s expectations, but he is absolutely right that it must include this specialism. There must also be an element of training and upskilling.

[Janet Daby (Lewisham East) (Lab)]

I, too, congratulate my hon. Friend on securing such a significant debate. I recently visited Greenvale School in my constituency, which is a school for children with special educational needs and disabilities. It is one of the schools involved in the initial roll-out of the special school eye care service, and I have met the ophthalmologists, who do absolutely brilliant work. Does my hon. Friend agree that if the Government end this service in the summer they will be neglecting children’s eye care, and a huge responsibility and onus will be placed on families?

[Marsha De Cordova]

My hon. Friend makes a really crucial point about special schools and about ensuring there is enough capacity to support children who have complex needs with sight loss. What is really troubling is that, in many instances, sight loss is not always picked up, so having specialist ophthalmologists in schools is crucial. There absolutely should be no way of reducing that provision—in fact, we need to build capacity.

To respond to the current crisis in eye healthcare, the Government must commit to a national eye health strategy for England, as set out in my Bill. The strategy would include measures to improve eye health outcomes, remove the postcode lottery of care, reduce waiting times, improve patient experiences, increase the capacity and skills of the workforce, and make more effective use of data, research and innovation. An eye strategy would ensure that, regardless of where someone lives, they can have access to good-quality eye healthcare, which would address eye health inequalities and ensure that there is more equity of access to eye care among different communities and people who are more at risk of sight problems but who may not be accessing NHS sight tests.

[Marsha De Cordova]

I thank my hon. Friend, who highlights the fantastic eye care department at St Thomas’s Hospital. She is absolutely right: my strategy already sets out how to address the backlogs in eye healthcare, and the Government could just say, “Yes, we are going to take it on, reduce those backlogs and address the workforce issues.”

Ensuring that we have equity of eye health must also include people who are homeless and those with learning disabilities, as my hon. Friend the Member for Lewisham East (Janet Daby) mentioned. A strategy would focus on five areas. The first is the eye health and sight loss pathway, which outlines the care and support for those diagnosed with loss of vision. A pathway would focus on the physical and emotional impact of being diagnosed with sight loss. Research has shown that blind and partially sighted people are likely to experience poor mental health outcomes, such as depression and anxiety, in their lifetimes. As part of the pathway, more emphasis should be placed on the provision of non-clinical community support, which would complement the work of community optometrists, ophthalmologists in hospitals and rehabilitation officers. Where is the plan to improve non-clinical and community support as part of the eye health pathway?

The second area the strategy would aim to improve is collaboration between primary and secondary care, and it would emphasise integrated care systems to ensure timely and accurate referrals. Demand for eye care services is expected to increase by 40% over the next 20 years, so we need to pay more attention to joining up care to meet future demand. Some of the burden on hospitals from that increased demand could be eased through more investment in high street community optometrists and by changing the way services are commissioned, to make more use of resources and infrastructure in our communities.

Two million people attend NHS accident and emergency services each year with an injury to or disease of the eye, and over 65% of those cases could have been treated in primary care optometry, which is not only more accessible but saves money—it costs less. Despite that, only 23 out of the 42 integrated care boards commission a minor eye condition service, or MECS, consistently. Five have no MECS provision at all—patients must attend a hospital eye service either via their GP or A&E. That is unfair and inequitable, and it is a waste of NHS resources to have patients go to A&E when they could access something in the community, which is easier for the patient, improves outcomes and saves us money.

[Janet Daby]

I thank my hon. Friend for giving way. Does she agree that the Government party claim to take care of the public purse, but in this case they are clearly not doing that at all? They are actually doing the opposite—wasting money from the public purse—because they are not making sure that the funds address the right issue.

[Marsha De Cordova]

Again, my hon. Friend makes an intervention that is 100% accurate. We obviously have to ensure that spending is done effectively and properly, and ensuring that resources are allocated in the community and alleviate pressures on hospitals will obviously lead only to better outcomes and savings.

At the most recent meeting of the all-party parliamentary group on eye health and visual impairment, ophthalmologist Dr Seema Verma from St Thomas’s Hospital spoke about the importance of MECS and locally commissioned optometry clinics in south-east London, which prevented 32% of referrals from being sent to hospital eye care services. If my hon. Friend the Member for Vauxhall (Florence Eshalomi) does not mind, I would very much like to invite the Minister to visit the eye department at St Thomas’s and the MECS community service, if he has not already done so.

Better joined-up care requires spending on infrastructure. Improved IT connectivity for two-way transfer of patient and clinical data would enable better patient care, and improved use of clinical skills and facilities in primary care, enabling more patients to be seen and treated closer to home. Everyone can get the theme here: community, community, community.

The eye care sector has been championing a single national electronic eye care referral system or EECR—there are so many acronyms—that would facilitate direct optometry to ophthalmology referrals, without people having to go through their GP. That would reduce the administrative burden on GP services, devolving some of the lower-risk cases to optometry and addressing unwarranted variations in referral and follow-up pathways.

--- Later in debate ---

[Dr Matthew Offord (Hendon) (Con)]

It is a pleasure to serve under your chairmanship for the first time, Mrs Harris. I congratulate the hon. Member for Battersea (Marsha De Cordova) on securing today’s debate. She knows that I feel strongly about eye health and sight-related issues. On one hand, I am pleased to come along to support her. On the other hand, I am disappointed to be having to speak in this debate, because it was not long ago—in fact, it was 11 January last year—that we had the previous debate.

That debate, introduced by the hon. Member for Strangford (Jim Shannon), was on eye health and macular disease. As well as the hon. Gentleman, we heard from the hon. Member for Rutherglen and Hamilton West (Margaret Ferrier), my hon. Friend the Member for Sedgefield (Paul Howell), the hon. Member for East Londonderry (Mr Campbell), my hon. Friend the Member for Darlington (Peter Gibson), the hon. Member for West Ham (Ms Brown), the right hon. Member for Hayes and Harlington (John McDonnell), my hon. Friend the Member for Great Grimsby (Lia Nici), the hon. Member for Coatbridge, Chryston and Bellshill (Steven Bonnar), my hon. Friend the Member for Gillingham and Rainham (Rehman Chishti) and the hon. Member for Denton and Reddish (Andrew Gwynne)—and we all came to the same conclusion.

There were a lot of kind words from the Minister in that debate, and a lot of sympathy for our enthusiasm for a national eye strategy. However, I never actually heard the Minister say that she would agree to an eye strategy. That was surprising considering that, during the debate, we learned that over 2 million people currently live with sight loss, and 350,000 people are registered blind or partially sighted. We also learned that age-related macular degradation is a leading cause of blindless. That can be averted with more accessible healthcare provision. We also learned that more people suffer from macular degradation than dementia. Considering the political priority we give dementia, that seems quite shocking.

During that debate, people took the opportunity to talk about sight loss. I do not use the Chamber as a confessional, but I admit that when I first had macular degradation, I had a conversation with my wife to ask whether life would really be worth living if I lost my eyesight. That has always stayed with me. It is an important issue, and not only to me. When I first experienced the problem, I was amazed at how many constituents told me that either they or their families also had sight loss problems. It is a big issue for many people.

During the previous debate, the Minister was keen to stress the additional £2 billion provided through the elective recovery fund. She also mentioned the additional £5.9 billion of capital funding to support elective recovery diagnosis and technology. I was left mystified about how many people would actually be treated for issues relating to their sight, be it cataracts, macular degradation or anything else. A week later, on 18 January last year, I asked the Department how many cataract operations would be performed as a result of the £2 billion allocated to the NHS through the elective recovery fund. The response was:

“This information is not held centrally, as this funding will not be distributed through set allocations.”

So the answer is none.

I have asked several other questions of the Department. I was most disappointed when I realised that the Minister had no intention to introduce a national eye strategy—something that I called for in last year’s debate—so I asked the Secretary of State, straightforwardly,

“if he will introduce a national eye care strategy.”

The response was:

“There are currently no plans to introduce a national eye health strategy. However, NHS England and NHS Improvement are recruiting a National Clinical Director for Eye Care to lead improvements in eye care services.”

That came on 17 January 2022, a week after last year’s debate. If there is a national clinical director for eye care, what are their achievements so far? Will the Minister provide an update on that?

I went back to the Department on 3 March to ask why its policy is that a national eye care strategy is unnecessary. The answer was:

“Regionally based National Health Service commissioners are responsible for commissioning secondary care ophthalmology services, out of hospital services from primary eye care providers and the NHS sight testing service. These services are put in place to meet local identified needs, which vary across the country. It is therefore important to allow local areas to set their own priorities.”

I have to ask the Minister: is it the case that we will not get a national eye strategy following today’s debate?

I attended an event with the hon. Member for Battersea where the person who I thought was the eye Minister, my hon. Friend the Member for Colchester (Will Quince), said that he would think again about a national eye strategy. I thought that this issue was probably important to him, and I asked him some questions in Parliament. I asked him for his assessment of the impact of ophthalmology waiting times on patient outcomes. I did so to try to understand whether he felt that this was an important issue and that we needed to establish a national eye strategy. His response was:

“No formal assessment has been made.”

I asked the Secretary of State yet another question:

“what assessment his Department has made of the potential economic benefits of additional funding in sight loss research.”

For Conservatives, that would be good fiscal policy, because we could ensure that people are not dependent on the state and are not a burden through increased taxation on others, but the answer came back:

“No specific assessment has been made.”

So the answer is that we simply do not know, and we are not going to get any answers by asking the Department.

I ask the Minister to say today that this is an important issue. It is important, especially for people who have gone through the process of thinking that they may lose their sight—they may even question whether it is worth living. As I said, I have certainly been through that. I would like to see greater provision, because the impact of eyesight loss and partial sightedness is huge.

[Janet Daby]

I thank the hon. Gentleman for talking about his personal experience. Among children who have special educational needs and disabilities, sight loss often goes undetected, which is why it is so important to have ophthalmology treatment within SEND schools. Does he agree that if the Government are going to introduce a national eye health strategy, that issue should be one of their priorities?

[Dr Offord]

I certainly do, as the hon. Lady would expect. The implications of having problems at an early age are much longer term, so we will find people without access to education and, ultimately, to employment, and their quality of life will certainly be much reduced if that provision is not implemented. I believe that it should be a major component of a national eye strategy.

In conclusion, I simply say to the Minister that he should make a national eye strategy his legacy, before it is too late.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Neil O'Brien)]

It is a pleasure to serve under your chairmanship, Mrs Harris. I must begin by thanking the hon. Member for Battersea (Marsha De Cordova) for bringing forward this very important debate. She is a very strong advocate for improving eye health in England. Likewise, I thank other hon. Members who made important points in the debate, including the hon. Members for Ealing Central and Acton (Dr Huq), for Lewisham East (Janet Daby), for Vauxhall (Florence Eshalomi), for Mitcham and Morden (Siobhain McDonagh) and for Sheffield Central (Paul Blomfield) and my hon. Friend the Member for Hendon (Dr Offord). I will try to address the points that have been made as I go through my speech.

I am haunted by the point made by my hon. Friend the Member for Hendon about wondering whether life would be worth living. To address the question directly: yes, of course. This is a hugely important issue for us, for exactly the reasons he set out. As the Minister for both primary and secondary eye care services, I reassure the whole House that I am working actively on the issue.

Since we last debated the topic in December, I met with the hon. Member for Battersea to discuss how we can make progress on all those things. Although I am unable to say exactly in what form the output of that work will come out, I reassure her that we are looking at pace at absolutely all the different issues she raised, both previously with me directly and in this debate.

I also met with Louisa Wickham, the new national clinical director for eye care—the lady who my hon. Friend the Member for Hendon asked about—to talk about NHS England’s eye care transformation programme. To address another question that was raised, I also met directly with the eye care sector, which talked passionately about how it is ready to deliver more out-of-hospital care to alleviate secondary care pressures. That is an exciting opportunity that we are keen to seize.

Although it is not the main topic of today’s debate, the future of sight testing in special schools is a very important area of concern to a number of hon. Members present, and to me as well. I recently convened a roundtable of experts to discuss the future of sight testing in special schools, and I will continue to engage with NHS England on their proposals for the future. I hope that it will not be too long before I am able to update the House on that.

I am absolutely seized by the arguments I have heard today—and earlier—from the hon. Members for Lewisham East and for Mitcham and Morden, and from the experts and people in special schools who have seen the advantages of the service. I join the hon. Member for Mitcham and Morden in paying tribute to Tina Harvey for her work. Some of the people in those special schools are just totally inspirational.

[Janet Daby]

I thank the Minister for seeking to address special educational needs ophthalmology in schools. Can he say when the outcome of the roundtable on what the future will be like for ophthalmology in schools is expected? It is due to come to an end in July but, in actual fact, in previous years there were promises that it would be a long-term service.

Future of Stoma Care

Janet Daby Excerpts

Wednesday 17th May 2023 Westminster Hall

[Giles Watling (Clacton) (Con)]

I beg to move,

That this House has considered the future of stoma care.

It is an honour to serve under your chairmanship, Mr Betts. In July last year, I hosted a truly inspirational event called Stomas in Parliament, which welcomed participants in a unique relay race from a London hospital to Parliament. For colleagues who might be unaware, a stoma is an opening on the abdomen that can be connected to either the digestive or the urinary system to allow waste to be diverted from the body. The race was led by people of all ages who have a stoma, including a seven-year-old girl called Jessica, and other members of the stoma community, such as incredible nurses and charities, and suppliers of stoma services and products, as well as my hon. Friend the Member for Peterborough (Paul Bristow). Sadly, I did not and do not have the legs for such running, but the event was a symbolic display of the activities that people with a stoma can do when they receive high-quality care and support. I am delighted to see representatives here today. Thank you so much for coming.

The purpose of the race was to deliver a “calls to action” statement, which was passed to me in Victoria Tower Gardens, just outside Parliament. The statement was developed by people with stomas, and it sets out the improvements needed to ensure that everyone with a stoma has access to optimal care so that they can live their life to the full. It was good to see people doing that, but sadly many individuals still receive suboptimal care, which has a significant impact on their quality of life, including their ability to work, as well as placing additional pressure on the NHS through potentially avoidable GP or nurse appointments and emergency admissions.

[Janet Daby (Lewisham East) (Lab)]

Will the hon. Gentleman give way?

[Giles Watling]

I would be delighted to give way. The hon. Lady has chosen a great moment to intervene.

[Janet Daby]

I thank the hon. Gentleman for making such a powerful and significant speech to open the debate. I had a stoma in my late 20s, so I understand and recognise the significance of having great care. Does he agree that much more needs to be done to ensure that people get the care and support they need when they have a stoma?

[Giles Watling]

The hon. Lady is absolutely right. This is the message I intend to deliver today: we need more care, and we need to get it right and give it at the right time to the right people. This is about individual cases, as I shall touch on later.

Complications with a stoma can include leakage, which in turn can lead to painful skin rashes, unpleasant odour and isolation, all of which can lead to career and relationship difficulties. I admit that before I was approached about taking part in the Stomas in Parliament event, I had little knowledge or understanding of stomas, or of how many people of all ages across the country are living with stomas. In my Clacton constituency, there are at least 300 people living with a stoma. In the UK, there are between 165,000 and 205,000 people living with a stoma.

People with a stoma face many physical and emotional challenges in their post-surgery life. However, access to specialist stoma care is highly variable across the health system. In addition, such intimate healthcare conditions are often stigmatised and under-prioritised. That leaves too many people suffering in silence, which should not happen.

As I have learned more from people with intimate healthcare needs, I have realised that patient choice and shared decision making are essential. I have with me a fantastic prosthetic, which gives some idea of what a stoma looks and feels like. People live with the condition day in, day out. Unless people are users of particular stoma care services or products, they will not realise how transformative such positive treatment can be.

That message came across strongly during the Stomas in Parliament event. The attendees gave me a strong understanding of how important personal appliance choice is, and needs to be, to help people to live their life to the full. Of course, everybody is different and bodies change over time, which means that getting the right stoma appliance is vital. I hope my hon. Friend the Minister will commit to ensuring that people living with stomas are able to access the right products for them at the right time. I know that work is continuing on the next stage of the Department’s medtech strategy.

The formation of a stoma is a lifesaving procedure for many, but it also produces difficulties. More needs to be done to address those difficulties, and providing equitable access to defined specialist pathways will improve the consistency and quality of care and patient outcomes. Getting that right will support the NHS prevention and self-care agendas while reducing pressure on emergency hospital services and, in the long run, saving the NHS money.

Great work on patient pathways is under way in the stoma community. Just this month, the Getting It Right First Time programme was formed. It is led by the industry and joined by the charities and the surgery lead for the NHS, and its work includes applying an NHS Getting It Right First Time approach. As part of that much-needed work, the group will be undertaking a national audit and developing a best practice and evidence-based stoma care pathway to address the postcode lottery of stoma care, ensure long-term, follow-up services and ensure equity of access to care.

I wish to mention that I have spoken separately with Crohn’s and Colitis UK, which is the leading charity for the 500,000 people affected by Crohn’s and colitis in the UK; I have with me a briefing note from the charity, which I will be happy to share with colleagues. I have also received representations from the Urostomy Association, which has asked me to highlight, regarding the choice of equipment, that one size does not fit all: we need the choice of a variety of products from different companies. In some cases, people can have serious skin issues with a particular type of adhesive used by one company and may therefore need to change suppliers.

I turn to the issue of access to a specialist care stoma nurse. Ideally, annual checks with a stoma nurse would be useful, but in the main that is not possible. Some people with a stoma may rarely need to see a nurse, but others may have constant leakage problems and would benefit from more regular specialist nursing advice. Finally, GP surgeries are required to approve prescriptions for stoma supplies but have been known to delete items requested on a cost basis, not realising that doing so will cause suffering for patients.

I turn to my asks of the Minister. First, I would be most grateful if he committed to a meeting with me and the Stomas in Parliament organisers, Colostomy UK, the Urostomy Association, the Ileostomy and Internal Pouch Association, and Coloplast UK, to discuss the calls to action and the possible impacts of the medtech strategy on stoma.

Secondly, many people in the stoma community and the industry are concerned that the UK is sleepwalking into a position in which our science medtech industry is so stretched that it is seriously considering not having the UK as a primary market for research and development investment. Will the Minister commit to discussing those issues with me and the stoma community?

Finally, will the Minister commit to meeting the group working on the first NHS Getting It Right First Time stoma care pathway and ensure equitable care in the UK for every person with a stoma?

[The Minister for Health and Secondary Care (Will Quince)]

It is a pleasure to serve under your chairmanship, Mr Betts. I congratulate my hon. Friend the Member for Clacton (Giles Watling), my near neighbour, on securing this important debate. He is a tireless advocate for his constituents and for patients across the country who suffer from conditions such as bowel cancer. They are fortunate to have him as their advocate.

Let me start by touching on the importance of reducing stigma. Stoma care is a topic that not everyone feels comfortable talking about, and as a Minister at the Department for Health and Social Care I want to play my part in reducing the stigma around living with a stoma. I hope that this debate and the event to which my hon. Friend referred will play some part in encouraging people to talk more about stomas and to come forward for services such as bowel cancer screening. I am hugely grateful to him for the opportunity to discuss this important issue in Parliament.

We know how important prevention and early detection are to health. Bowel cancer screening is available to everyone in England aged 60 to 74, and since 2021 we have been expanding the screening offer in England to younger patients so that everyone aged 50 to 59 will be included by 2025. We also know that the early proactive management of bowel disease is far better for patients, as my hon. Friend rightly pointed out. In many cases, it will reduce the amount of surgery resulting from stomas.

My hon. Friend referred to patient choice and the differing quality of stoma products. I know how important patient choice is, not just in this area but in so many areas across our NHS. I also know—my hon. Friend put this point eloquently and articulately—that one stoma product does not always work for all patients, which is why it is so important that there is patient choice. I recognise that having the right stoma product to support patients’ quality of life is as important as the medical need itself. My hon. Friend raised a serious point about general practitioners deleting items; I will ask my officials in the Department to investigate that point and write to him.

I am grateful for the opportunity to update the House on the levels of NHS spend. Current NHS expenditure in this field is about £350 million every year, which is predominantly used to provide stoma products to patients. Over 9,500 different stoma products are available on the NHS, and these products are prescribed to patients under part IX of the drug tariff. I am pleased to remind colleagues that one area of focus in our inaugural medtech strategy published in February this year, which has been widely and largely welcomed by industry, is medical devices used in the community, which include prescribed stoma products.

We have a stoma products consultation, which I will touch on, and the Department of Health and Social Care is leading a piece of work to review how the tariff operates in order to ensure that appropriate and effective products are prescribed to patients. I acknowledge that it is currently difficult to know the position and to compare the differences between products on the drug tariff. We will work to make things as transparent as possible so that clinicians are far better informed and can provide the right product for each and every individual patient.

We will also continue to support the provision of a range of stoma products through part IX of the drug tariff to ensure equitable access for patients, an issue that my hon. Friend touched on. We do not want a postcode lottery. I want to make sure that patients, regardless of where in the country they live, have a voice in determining the product range available on the tariff, so that the interests of patients are at the heart of how the tariff operates.

[Janet Daby]

I thank the Minister for responding to the questions that have been asked. When the Government are looking to purchase products for people who have a stoma, will there be some consultation with patients so that they can help to make a decision as to the types of product that they feel will work for them?

[Will Quince]

I thank the hon. Lady for her intervention and for sharing her personal experience, which is a hugely valuable part of this debate. As I have said, a large number of products are already available on the NHS. She is absolutely right to say that we should engage with patients, because product selection should always be based on the clinical need of individual patients, not on manufacturing brand, pressure from particular companies or relationships with individual trusts. Yes, patients will be at the heart of the decision-making process, and rightly so. We are currently engaging on that exact point with a number of patient groups and with the industry, which is an important part of this as well. We will launch a targeted consultation over the summer, and I encourage patients, charities, organisations and industry to take part; I think they naturally will. We must ensure that the tariff continues to provide effective products to patients, wherever they live in the country.

My hon. Friend the Member for Clacton touched on patient care. I, too, recognise that the patient pathway for stoma care differs depending on the model of care that commissioners have adopted, hence my reference to a postcode lottery. Stoma service delivery models have been supported nationally through past NHS initiatives such as the QIPP, the national quality, innovation, productivity and prevention programme—it is a mouthful —which published recommendations on best practice for delivering stoma services. There are already really good examples across the country, such as in Rotherham, Nottingham and the midlands, of stoma services being delivered effectively based on those fundamental principles. It is important that we share that best practice and ensure that it is rolled out across all the country’s integrated care systems.

Covid Pandemic: Testing of Care Home Residents

Janet Daby Excerpts

Wednesday 1st March 2023 Commons Chamber

[Helen Whately]

My hon. Friend makes an important point about the challenges that were faced around the world in handling the pandemic, and very conspicuously for us across the UK. Decisions were having to be taken in Scotland, Wales and Northern Ireland as well as here in England. Had Opposition Members been in our position, in government, and having to make these difficult decisions, I am sure that they, like us, would have strained every sinew and done their very best to make the best possible decisions in a situation of limited information.

[Janet Daby (Lewisham East) (Lab)]

Even if we now know that the Secretary of State was not following the scientific advice, the Minister was in her job at the time these decisions were being made. Can she explain why she did not do the right thing then? Was she not listening to the chief medical officer either?

[Helen Whately]

I fear that the hon. Lady did not hear my previous answer, which was that the public health advice and the advice of the chief medical officer was followed. Of course there is a job to do when advice is given, and then there are the practicalities of implementation. As the volume of tests became available, those tests were used as advised, following the public health advice.

Urgent and Emergency Care Recovery Plan

Janet Daby Excerpts

Monday 30th January 2023 Commons Chamber

[Steve Barclay]

My hon. Friend makes an important and nuanced point about demographic pressure, which is not evenly spread and is more concentrated in certain parts of the country than others, so the pressure on ICBs is greater in those areas. That is why the ministerial team met almost all the ICBs in a series of meetings with chairs and chief execs in the run-up to Christmas, and it is why we want to bring greater transparency, so that we can right-size solutions for emergency departments and ensure that those facilities keep pace with the increased demand.

[Janet Daby (Lewisham East) (Lab)]

Last night, my constituent’s 11-month-old son had to wait in A&E for eight hours, which my constituent found extremely unacceptable. The waiting experience in our hospital is like being in a “disaster zone”, in the words of my constituent, who went on to explain about parents having to sit on floors and wait for hours for their children to be seen by a doctor. I press the Secretary of State on whether there is a plan to return to the standard of 95% of patients who come to A&E being seen within four hours.

[Steve Barclay]

As I said, we are not setting out that ambition in this statement, because the impact of the pandemic has been so severe. We need to set a target that is ambitious but achievable, which is what we have done. The president of the Royal College of Emergency Medicine said:

“This plan is a welcome and significant step on the road to recovery and we are pleased to see it released.”

It is about taking best practice from the areas that are working and ensuring that they are socialised across the piece. It is obviously concerning to hear about individual cases, such as the specific one that the hon. Lady mentioned, which are very traumatic for the families. That is why we have set out this plan and why we are putting in the extra funding.

Oral Answers to Questions

Janet Daby Excerpts

Tuesday 24th January 2023 Commons Chamber

[Steve Barclay]

We are taking a number of steps to improve performance, and not just on strike days—but I thought the hon. Lady was going to refer to the comment that she made about those on her own Front Bench, when she said:

“I think what our health team need to do is really spend more time in that environment with clinicians to really understand what drives them.”

We on this side of the House are spending a significant amount of time with clinicians, and it is important that those on the hon. Lady’s Front Bench do so as well.

[Janet Daby (Lewisham East) (Lab)]

2. If he will bring forward a plan to increase (a) retention and (b) recruitment of NHS staff.

[Jim Shannon (Strangford) (DUP)]

6. What steps he is taking to ensure that gaps in the NHS workforce are filled.

[The Secretary of State for Health and Social Care (Steve Barclay)]

The long-term workforce plan that is being developed by NHS England will help to ensure that we have the right staff numbers with the right skills to deliver high-quality services in the future.

[Janet Daby]

Is the Secretary of State fully aware that under this Government every part of the NHS is in crisis? Are the Government satisfied with the fact that, as medical students in their second year told me recently, the shortage of staff on hospital wards and the pressures on those wards are affecting their training? The students also told me that they had little aspiration to work as junior doctors in the UK after qualifying, because of the acute strain on the NHS and because they felt undervalued. Does the Secretary of State know about this, and what is he going to do about it?

[Steve Barclay]

We see a considerable number of applications for medical undergraduate places, far in excess of the number of places available. We have boosted the number of places—[Interruption.] The hon. Member for Ilford North (Wes Streeting) chunters from the Opposition Front Bench, but when I was last in the Department and the Chancellor had my role, we increased the number of medical undergraduate places by 25%. Indeed, we have more doctors and nurses than we had last year, and 3.5% more full-time equivalent staff: we have over 42,000 more people working in the NHS than we had last year.