Oral Answers to Questions
Jim Cunningham Excerpts(5 years, 1 month ago)
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The Minister for Health (Edward Argar)
As Members will know, my hon. Friend spoke only last week about his local hospital in Blackpool and the challenges it faces. It is absolutely clear that we need not only to get leadership right there but to continue to invest in it. I believe that I am already meeting him to discuss exactly that.
Mr Jim Cunningham (Coventry South) (Lab)
Matt Hancock
Getting this right is incredibly important. The change in the guidance last month allows every single NHS trust to introduce the flexibilities, immediately, to ensure that doctors can do the work and the overtime they need, get paid properly for it and not get penalised through the impact on the pensions system. That change came in at the start of last month. I will write to the hon. Gentleman with the details, so that he can tell all doctors that these flexibilities are available so that they can do the work that they need to.
Baby Loss Awareness Week
Jim Cunningham Excerpts(5 years, 2 months ago)
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The Minister for Care (Caroline Dinenage)
I beg to move,
That this House has considered baby loss awareness week.
This is the fourth Baby Loss Awareness Week debate, and it is incredibly heartening to see how this has become an annual event in the House. It helps to send a clear signal outside this place about the importance of this subject in the Chamber, in the Department of Health and Social Care and in the national health service.
Over the years, many Members of Parliament have been brave enough to share their personal and painful accounts of baby loss, which, while heartbreaking to hear, have done so much to raise the profile of this important issue and to start vital conversations about it. It is absolutely right and fundamentally important that we continue to raise awareness of both the devastating impact of baby loss and the support that bereaved parents need through the grieving process to help them adjust to their loss. I do not think people ever fully heal or get over the loss of a much loved and much wanted child, but with the right care and support they might be able slowly to move forward with their lives.
Mr Jim Cunningham (Coventry South) (Lab)
I identify with everything the Minister has said so far. One point about these debates for members of the public who have not experienced baby loss, and for some Members here, is what we learn about the heartbreak and, in some instances, the lack of support. In general terms, it has been very good to have these debates—even if we do have them annually—because they educate the public about an issue that has too often been shoved under the carpet, for want of a better term. It is better that people now understand what other people go through in life, so I do appreciate the Minister’s opening remarks.
Caroline Dinenage
I thank the hon. Gentleman so much for that intervention. He is absolutely right. In this place, we have a unique opportunity to raise subjects that people find it difficult to talk about out there. In doing so, we shine a light on those subjects, and we are able to really begin to move the dial and to change practice.
With that in mind, I would like to pay tribute to the hon. Member for Eddisbury (Antoinette Sandbach) and my hon. Friend the Member for Colchester (Will Quince), who is desperate to speak, although, being a Minister, he is prevented from doing so, so we will have to restrain him. However, in a late-night Adjournment debate back in 2015, they began to raise awareness of the variation in care for families bereaved by baby loss. It was an incredibly moving debate—I remember listening to it at the time—and it really made such a magnificent difference. It was followed by the Baby Loss Awareness Week 2016 debate, which was about bringing the subject to light and challenging the idea that baby loss is an uncomfortable topic that we do not like to talk about. I am grateful to the Members from across this House who shared their personal experiences on that day back in 2016 and have done since.
International Baby Loss Awareness Week begins tomorrow and finishes next Tuesday. This year, the focus is on the need for specialist psychological support for bereaved parents who need it. The Baby Loss Awareness Alliance group of charities will be publishing a report highlighting that some parents need that kind of support as part of their bereavement care.
Social Care Funding
Jim Cunningham Excerpts(5 years, 2 months ago)
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Sir Vince Cable
Yes, there is a lot of joint thinking. We have the joint House of Commons Committees, and my hon. Friend the Member for Totnes (Dr Wollaston), as Chair, was critically involved in that. There is also a very good piece of work by the House of Lords, and the considerable brains of Lord Lawson and Lord Darling contributed to a cross-party consensus. A lot of think-tanking is going on in the vacuum created by the Government’s non-publication. There is no shortage of ideas, but we need to be clear what the problem is—and it is a very serious one.
Sir Vince Cable
If the hon. Gentleman lets me go through this, I will take an intervention.
The first point is the rapid growth of demand as a result of an ageing population. We all know that. As far as we can establish, because of ageing and the onset of dementia in particular, we have a growth in demand of about 3.5% a year. That is considerably in excess of the growth of the economy and the resources to fund it. That is the fundamental problem at the heart of all this. We have 800,000 people with dementia at the moment, which goes up to 1 million in 2025, rising to 2 million in 2030. At the moment, there is no clear picture of how this demand is to be met.
My second point, related to that, is that we have a large and growing hidden cost that is not quantified—unpaid caring. If we take dementia alone—just one dimension of adult social care—we have 350,000 carers at the moment, of whom 110,000 have had to give up their job, which is a cost to them, the Exchequer and their employers.
Sir Vince Cable
I will take an intervention, but I will return to the theme in a moment.
Mr Jim Cunningham
I congratulate the right hon. Gentleman on securing this timely debate. He refers to costs. The costs to families and individuals hit with dementia are 15% higher than they are for any other illness. They are about £3.5 billion because people have had to give up their jobs for all sorts of reasons. I hope that further assists him and I hope he agrees that we have to think about it.
Sir Vince Cable
Yes, that is quite right. We tend to use dementia, particularly the work of the Alzheimer’s Society and others, to illustrate the problems here but they are not unique. Many people with arthritis, diabetes and serious stroke conditions face the same set of problems.
Body Image and Mental Health
Jim Cunningham Excerpts(5 years, 4 months ago)
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The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)
I beg to move,
That this House has considered body image and mental health.
I am delighted to open this debate on this very important matter about which a number of parliamentary colleagues are showing increasing concern. How we think and feel about our bodies can affect any one of us at any point in our lives. I am sure I am not alone in not liking my body shape and in wanting to lose more weight. Frankly, we know there is no magic route to that. We just need to eat less and drink more—[Laughter.] I should say: eat less, drink less and exercise more. Too often, however, people are seduced into seeking body shapes that are less than attainable. While for most of us that is an aspiration, for some people it becomes uncomfortable and an obsession that does them no good.
This is a particular issue today, because the pressure on people, especially young people, to achieve an idealised image is everywhere. Often, the images that people are being subjected to are unattainable because those images have been airbrushed and touched up. Those shapes are really not what any normal person could begin to achieve.
Mr Jim Cunningham (Coventry South) (Lab)
The Minister is quite right. Some of the television reality shows today put pressure on young people, particularly young girls, to imitate shapes, weight and size, and all that goes with that. This is a timely debate and we need to have a good look at this issue. At the end of the day, young people get very disappointed and that can have an effect on their mental health. That is the important point we should not lose track of.
Jackie Doyle-Price
The hon. Gentleman raises an issue close to my heart. When we talk about so-called reality TV programmes, it is as if the people participating in them are normal people. The reality, however, is that they are not normal people. They are semi-professional celebrities who have often undergone enhancements to become attractive to be chosen to go on these television programmes. The whole thing starts to develop insidiously in a culture, making people think that they should aspire to look like that and that it is normal. Everyone is chasing a lifestyle that is frankly not attainable.
We have all enjoyed watching such programmes. I often say that we have become a nation of voyeurs, but perhaps we all need to remind society that there is no quick route to fame, fortune and success—that comes as a result of hard work—and that spending a bit of money on a nip and tuck and a lip filler will not be the route to earning a lot of money. We all need to start to address that, because we have allowed magazines and our media to develop this image. We have been complicit in it happening, because we have enjoyed that entertainment, but we are reaching a position where our society is extremely unhealthy.
The problem has been made particularly acute by the growth of social and digital media, which have increased exposure to unrealistic and unattainable images of beauty. As we all know, when we are browsing on our iPad we can look at one thing and straight away be bombarded with sites that squirrel us down a route where we are exposed to more and more such content. People who are looking at unrealistic body images will see ever more images that they aspire to. There is another insidious thing: a friend of mine was speaking to me only last night and said that she was looking at cosmetic procedures when, all of a sudden, an advert popped on to her screen encouraging her to spend a few thousand pounds so that she could learn to administer lip fillers herself. She thought how horrendous it is that our social media does that.
NHS Workforce: England
Jim Cunningham Excerpts(5 years, 5 months ago)
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Eleanor Smith (Wolverhampton South West) (Lab)
I beg to move,
That this House has considered the legal duties of the Secretary of State for Health and Social Care for NHS workforce planning and supply.
I am a nurse. My daughter is a nurse. Nursing is in my family and fundamentally informs who I am and what I do. Last November, I triggered a debate about investing in nursing higher education. I am here today to again carry the burning flag for the nursing profession, the wider health and care workforce, and society.
I will start by directly addressing the notion that we should not seek to further clarify the Secretary of State’s legal duties and powers. I have heard that the latest legislation sought to remove political interference in our health system. I have heard people say, “Don’t make health a political football.” Lastly, I have heard that changing the legislation to give the Secretary of State accountability for the workforce would put health and care back under political control—as if our ability to access health and care was ever out of political control.
I am sorry, but those are laughable positions. Which- ever side of the fence we sit on, it is a serious point that health is fundamentally political. It can never not be political, in terms of what we can access and what happens to people. Our great health service was created within a political agenda, and creating it was a fundamentally political act. Supporting our health and care service to thrive will never not be a political decision. Let us be proud of our history, recognise that health is political, and find a solution to the problems we face.
Now that I have addressed those weak positions, let me state that I, and many others across the political spectrum, take no issue with the idea that there should be explicit clarity in the law about the Secretary of State’s responsibilities. I am not alone in my gratitude for all that our health and care staff do. They work constantly to provide quality care by putting patients at the heart of what they do. In the NHS and the independent sector, nursing accounts for one in 10 of the labour market of the whole of England. We are, and ought to be, a fundamental force to be reckoned with.
Thanks to the scale and urgency of the workforce crisis, many people have been looking into these issues—some of us would say for far too long, and to poor result. We have a long-term plan for the NHS and an interim NHS people plan, so we have seen some movement in the way that agencies work together. However, we have no understanding of what the social care sector needs, and no assurance of workforce funding, which is entirely dependent on the forthcoming spending review and subject to the whim of a new Prime Minister. We do not have a workforce strategy that meets health and care service requirements, or that projects the future needs of the people who live in this country.
The vacancy rate has reached alarming levels, with almost 40,000 nursing vacancies in the NHS in England alone. That is not the full picture. The extent of the vacancies within social care and public health is unclear because it is not mandatory to collect workforce data. It is not possible for services designed with staffing built into their planning to run safely and effectively with so many missing staff.
Fewer people are joining the nursing profession and more are leaving. Since the referendum on the UK’s membership of the EU, more than 10,000 EU nurses and midwives have left the UK workforce. I will not be drawn on Brexit in this debate. However, while we are trying to find our way through the referendum result, frontline staff are propping up the health and care system with no credible assurances that the situation will be resolved. Our professionals are holding on as best they can, but we need to be realistic about what we can reasonably ask of them. They are starting to vote with their feet, and there is not yet the accountability to help us navigate the future that is to come.
This crisis has come about because there is no clarity in the existing legal powers and duties that would ensure that enough staff with the right skills are in the right place at the right time to provide safe and effective care. That is true not just of nursing but of every profession working within our commissioned, taxpayer-funded services, including nurses, medics, psychiatrists, physiotherapists, psychologists, paramedics, pharmacists, social workers, support workers, occupational therapists and dietitians. Literally no one—no one person—is accountable for growing and developing our health and care workforce to meet patients’ needs, now and in future.
The Secretary of State’s current legal duty is to provide a comprehensive service. The Government may say that the Secretary of State has oversight of the workforce through those general duties and powers. With all due respect, the Secretary of State’s responsibilities are too broad to understand what aspects of workforce provision they include. There are also no particular workforce duties within the range of national organisations responsible for service design and delivery. In a health and care system as complex as ours, it is easy for everyone to lose sight of ensuring that we have enough people. Clearly, that is exactly what has happened.
Mr Jim Cunningham (Coventry South) (Lab)
Surely two reasons for the number of vacancies are low pay in the public sector generally and the lack of bursary provision to recruit new nurses. Does my hon. Friend agree that there is a golden opportunity for many mature women, whose children have grown up, to enter that profession? Recently, even ambulance drivers had to pay extra for their certification—I had a debate on that a couple of months ago.
Eleanor Smith
My hon. Friend is right, and I will touch on the removal of bursaries later.
A huge amount of effort has been required to try to fix this mess. There has been progress in the NHS, but it is too little and too slow. It does not include social care and deals only with the immediate context. Many of us in this House are here to challenge the position that the existing so-called responsibilities are clear and robust enough for use by the Government and the health and care system, and for the public to have confidence that the Government can be held to account—now and in future, since the pressures on the system will continue to grow and change.
Yesterday, many of us met nursing staff, having been brought together by members of the Royal College of Nursing, who are all passionate about patient care and public safety. I am moved by their advocacy for the profession, patients and society. I also feel their desperation in the situation they face, trying to keep people safe in challenging environments. Given that professionals have been raising the alarm for decades, hopefully our demands for an end to the boom-and-bust cycle in the workforce will be met.
Even the High Court recognises how vague the current powers and duties are. The legal dispute between the Secretary of State and junior doctors over their contract resulted in a judicial review in 2016. The Court judgment said that, as stated in the National Health Service Act 2006, the objective of “protecting the public”, with a duty on the Secretary of State to take appropriate steps, leaves
“considerable leeway to the Minister as to ways and means”
of running the service.
Anyone who looks at the content of the law can see clear holes and gaps. In addition to the Secretary of State having no explicit responsibility, we have other problems with the duties and power of the national guidance. For example, Health Education England is the organisation responsible for developing our workforce, but its hands are tied because it does not have sufficient legal powers or funding to invest properly in the educational provision needed to grow our workforce. HEE can do planning but not supply, which ought to be the responsibility of the Government. The current legal framework is simply not fit for purpose.
Some people might say that Simon Stevens, the chief executive of NHS England, should be accountable for not addressing the workforce needs. The development of the long-term plan provides another clear example of the ambiguity and conflicting expectations playing out in practice. In June 2018, the Prime Minister said:
“Growing demand and increasing complexity have led to a shortfall in staff. So our ten year plan for the NHS must include a comprehensive plan for its workforce to ensure we have the right staff, in the right settings, and with the right skills to deliver world class care.”
That was a clear signal of the Government’s commitment that the long-term plan would address the workforce crisis. On publication, NHS England acknowledged significant workforce issues but said that staffing was additional to service planning and was outside the £20 billion financial package that Simon Stevens was given. Again, NHS England does not have any explicit legal duties that relate to the workforce, so it is not obliged to act.
Just last week, Simon Stevens said there is a need for a
“much bigger upturn in the pipeline of new nurses… There has been a big debate about bursaries and their removal, which as we look at the way the student loan system is working, that is clearly back in play as a big question we’ve got to answer as a nation.”
However, the reasons for these supply problems are not within Simon Stevens’s control. They include the reform of higher education for nursing, which has not grown as we were promised. The ability to boost and fund the workforce sits with the Government, and the ambitions set out in the long-term plan will not be met if we do not have trained and qualified staff to achieve those goals. Although the Government have committed to transforming services, they must also commit to building the workforce we need. To do that, the lack of accountability must be addressed.
A nurse who walks into a shift that is short-staffed has no power to safely and effectively staff services. They have no option but to carry on, yet the buck stops with them when patient care is unsafe. Nurses have no power to recruit more staff, and they rely on Parliament to ensure that the incredible position we find ourselves in is addressed; to fix things not just now, but for the future. I know how heartbreaking it is for a nurse to be unable to give the care they want to. I know the guilt we feel when care is left undone, and the stress of being unable to do our job to the best of our ability. Patients pay the highest price when the number of nursing staff falls too low.
Understanding that the health and social care system is a safety-critical industry should be the starting block for any consideration made by the Government. The Royal College of Nursing and other professional and patient organisations have a clear solution. With cross-party support, they are calling for a legal framework for workforce accountability that sets out who in Government and across the health and social care system are accountable and responsible for workforce supply—recruitment, retention and remuneration.
The Secretary of State for Health and Social Care should have explicit powers in law for the growth and development of the health and social care workforce across England. Such accountability would ensure that there are enough staff to care for the number of patients, and that there is an incredible and fully funded workforce strategy. These requirements are not an either/or position; we need both. Alongside the Secretary of State’s accountability, there are other ways in which the responsibilities need to filter down across all layers of the health system. Never again would the system be able to sidestep workforce planning when setting a 10-year vision for the future of our NHS. The ultimate aim in clarifying accountability for the workforce at Government level is to ensure that all health and social care services are of a high quality, and that they are equipped to provide safe and effective care to guarantee patient safety. The current pressure faced by the healthcare workforce puts that guarantee at risk.
Successive Governments have missed opportunities to fix the health and social care workforce crisis. Boom-and-bust approaches to workforce supply have been an afterthought, with the focus on glossy new services and sparkly new plans, rather than on worrying about the staff who are needed to deliver them. That has led to a situation in which the system currently defaults to discussing how to fix the workforce gap. We need to plan strategically for what workforce will be needed to deliver the future healthcare services that have been designed to meet the needs of the population.
An opportunity to rectify the workforce crisis is coming right towards us. NHS England and NHS Improvement have finished engagement work on the legislative changes that they feel are needed to make a success of the long-term plan. Their engagement work sets out proposed changes to the remit of the Secretary of State, but currently these legislative proposals are missing crucial accountabilities. It is down to right hon. and hon. Members to expand the proposals when the law is presented to Parliament. The legislation must include accountabilities for the workforce, because it is too clear an opportunity to miss.
A simple legal change would turn the tide for patients, and support is growing across the political spectrum for a legal fix as part of addressing the workforce crisis. I found myself at a roundtable discussion on this very matter, with a Government Member with whom I share no political allegiance. We found ourselves in full agreement that we must explicitly clarify the responsibility for putting our workforce on a sustainable footing.
As a nurse in Parliament, I commit to seeking the change that is being called for. I hope that others call on Parliament to speak loudly and clearly in adding their voices to ours, and that all right hon. and hon. Members will commit to pursuing change. This is a truly cross-party issue, and rightfully so. There is a crisis and everyone points fingers at others, but ultimately no one is responsible. There are moves to make the system better, but they must be set out in law and strengthened further. There is an opportunity to fix this cleanly and easily. We are not adding burdens, but clarifying mandates. The moment is now—we must commit to ending the workforce crisis once and for all.
Batten Disease: Access to Drugs
Jim Cunningham Excerpts(5 years, 5 months ago)
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Caroline Dinenage
Thank you for clarifying that, Mr Speaker. I very much share the passion that I detect my hon. Friend the Member for North East Somerset feels about this issue, which I know is shared by Members on both sides of the House.
Mr Jim Cunningham (Coventry South) (Lab)
On the basis of what Mr Speaker has said, surely if those who are taking this issue to the courts withdrew their challenge, or if the Minister gave them a satisfactory answer to help the hon. Member for North East Somerset (Mr Rees-Mogg), it would not be sub judice. The Minister has the power to do that.
Caroline Dinenage
I am very tempted to do so, but I would like to try to make progress on some of the things I can say, and then we can maybe move on to a more satisfactory conclusion.
Caroline Dinenage
Thank you, Mr Speaker.
The legal position, as I understand it, is that NHS England and NHS Improvement have been in discussions with the manufacturer BioMarin for some time to try to seek a deal that would enable NICE to recommend the drug for use on the NHS, but so far an agreement has unfortunately not been possible. As hon. Members know, and as I said at the beginning of my speech, NICE’s assessment is currently subject to an ongoing legal procedure. NICE has published its draft recommendation and was unfortunately unable to recommend the use of the drug, despite its meeting the criteria for consideration under the highest cost-effectiveness threshold. NICE has not yet re-published its final word on this issue, and that may provide more clarity. In the meantime, it is of course open to the company to enter into an agreement with NHS England that would make the drug cost-effective and would make the legal procedure unnecessary.
Mr Jim Cunningham
If NHS England got a satisfactory agreement with the drug manufacturer, would that have any bearing on the decision of the Secretary of State or on NICE?
Caroline Dinenage
I do not think it would contravene any legal recommendations if I were to say that if the manufacturer, NHS England and NICE were to get around a table and agree a satisfactory price, there would be no need for the legal challenge. In actual fact, the desperately poorly children we have heard about today would therefore be able to get the treatments that they desperately need.
Caroline Dinenage
I completely understand what the hon. Lady says, and I completely agree with her. I would love to be able to solve this problem straightaway and give these children the lifeline they need. Unfortunately, that is not the case today. I have committed to make a statement before the House finishes for recess at the end of next week, so I will come back shortly with all the information I am allowed to give. I really do not want her to think that this in any way suggests that I do not understand how the families must be feeling. I can only begin to imagine how desperate it must be to have such a poorly child.
Mr Jim Cunningham
I do not want to be difficult for the Minister, because she is doing a very difficult job, but could she clarify something? I got the impression from something she said a minute or two back that if NICE and NHS England concluded negotiations and agreed a price with the drug manufacturer, that would be acceptable to the Government.
Caroline Dinenage
My understanding is that if the manufacturer of this vital drug gets around the table with NICE and suggests a price within a reasonable scale, NICE would be very open to listening. That is my understanding. Certainly, I understand calls from Members across the House for NHS England, NICE and the manufacturer to get around the table to try to find a solution. That seems to me to be the most sensible way forward.
Children and Mental Health Services
Jim Cunningham Excerpts(5 years, 5 months ago)
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Andrew Griffiths (Burton) (Con)
I beg to move,
That this House has considered children and mental health services.
It is a great pleasure to serve under your chairmanship, Mr Pritchard. We could not be in better hands. It is a delight to have the Minister here. I know she comes to this issue with great personal interest and a commitment to deliver for all our constituents. It is fantastic to see so many right hon. and hon. Members from across the House here to take part in the debate. That is testament to the interest in this place and the concern across the country about mental health, particularly that of children.
I praise the Government for what they have done to date. When it comes to mental health, there is no doubt that this Government get it, making it a priority like no other. They have tackled the stigma of mental health and put in much-needed resources, but although they have done great work, like Oliver, we would all say, “Please, Minister, can we have some more?” because although we are getting on board with the issues, and royals, TV stars, politicians, and people from sport and all spheres talking about mental health, the problem is snowballing, getting bigger and bigger. Such are the pressures and stresses placed on our children’s mental health that this is an ever-increasing problem, which demands our attention, resources and commitment as a Government.
One in eight five-to-19-year-olds—12.5%, or 1.25 million children across the country—have a mental health difficulty, according to the Government’s own survey of November 2018, “Mental Health of Children and Young People in England”. The Local Government Association says that children’s services are seeing more than 560 cases of mental health issues every day. Some 75% of adult mental health illnesses begin before the individual turns 18 and over 50% start before the age of 14. Some 23% of the population are affected by mental health difficulties at some point each year. The economic and social costs of mental illness in England total £105 billion.
Mr Jim Cunningham (Coventry South) (Lab)
I congratulate the hon. Gentleman on securing the debate. About 10 or 11 years ago I introduced a Bill that would have provided a specialist to a cluster of schools, to help teachers to identify children with health and mental health problems. Does he agree that the Government should think about that? Secondly, and most important, employers do not recognise the problems young people have with mental health when they start out in industry, nor do they recognise adult mental health problems. Does he agree that more could be done in that area?
Andrew Griffiths
I could not agree more with the hon. Gentleman. It is a pity that more people did not share his foresight, so that we could have acted sooner. We are laying the foundations for mental health problems in adulthood. Childhood mental health has a lifelong impact, so it is important that we do not waste a moment. Rates of depression and anxiety among teenagers have increased by 70% in the last 25 years.
Electromagnetic Fields: Health Effects
Jim Cunningham Excerpts(5 years, 5 months ago)
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Tonia Antoniazzi
We do need to take climate change and insect life into consideration when we discuss the impact of electromagnetic fields.
As MPs, we have a duty of care to our constituents. There is no escaping the fact that when MPs, schools, local authorities and others ask questions about the safety of new technologies, Government’s give a standard reply. People who question the health-related effects of electromagnetic fields come up against a brick wall, and today I want to break through that brick wall and ask the Minister several questions. I like to think that the smart way to move forward is to consider safety and sustainability when developing products.
Mr Jim Cunningham (Coventry South) (Lab)
Many years ago, the Trade and Industry Committee investigated the matter with all sorts of experts, but nobody could come to a conclusion. That is not to say that my hon. Friend is wrong, but it was looked at about 20 years ago. Is there any evidence that electromagnetic fields can affect the behaviour of animals?
Tonia Antoniazzi
There is evidence about the effects on animals. I cannot quote from it now, but I have read about it. We must remember that animals do not use screens, but there is evidence of the impact on them of electromagnetic fields from things such as smartphones and 5G. I would have to find that evidence and send it on to my hon. Friend.
Living with Dementia
Jim Cunningham Excerpts(5 years, 5 months ago)
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Debbie Abrahams (Oldham East and Saddleworth) (Lab)
It is lovely to see you in the Chair, Mr Paisley. I thank the Backbench Business Committee, which granted the debate, and I want to recognise my hon. Friend the Member for Cambridge (Daniel Zeichner) as its co-sponsor. I also thank the Alzheimer’s Society, which provides superb support to the all-party parliamentary group on dementia, and the parliamentary digital team for promoting the debate. We hope to hear the views of many people from across the country on the recommendations in the report we shall discuss.
The subject of dementia and people living with dementia is particularly close to my heart. As many Members will know, my mum was diagnosed with Alzheimer’s disease at 64 and I was one of her principal carers. Having had that caring experience and seen some of the issues my mum faced, I wanted to raise awareness about dementia and the many different brain diseases that cause it. As many will know, dementia is now the leading cause of death in the UK, having overtaken heart disease and cancer. It is estimated that 850,000 people in the UK have a dementia, and Alzheimer’s disease is the most common. That is expected to increase to 2 million by 2050. Globally, there will be 152 million people living with dementia by 2050—a 204% increase. If there is anyone who does not now know someone with dementia, they soon will.
There is already much work under way at the UK Dementia Research Institute, where there is a search for programmes to identify people at risk of different dementia types and prevent them from contracting the disease, as well as for treatments and cures. In spite of the commitment by the former Prime Minister, David Cameron, to invest in dementia research, it still receives only one tenth of the research funding that cancer receives. However, there is also a need to invest in dementia research that could improve the lives of people affected by dementia today. I have campaigned with many others to raise the issues affecting people living with dementia, including becoming the first MP to be a Dementia Friends champion, working with Oldham Dementia Action Alliance to develop a dementia-friendly Oldham and Saddleworth, and undertaking various all-party group inquiries on how to improve the quality of life of people living with dementia.
The report from our latest inquiry, on dementia and disability, was launched last week. More than 2,500 people affected by dementia responded to our call for evidence—one of the largest responses to any all-party group inquiry. What the respondents had to say is very important. According to the Equality Act 2010 and the United Nations convention on the rights of persons with disabilities, dementia is a disability. As one family carer put it:
“If this isn’t a disability then I don’t know what is.”
However, the all-party group was told that society is lagging behind in that understanding and failing to uphold the legal rights of people with dementia. Evidence presented to the inquiry revealed that, across the country, the disability rights of people with dementia are not being upheld. Shockingly, 98% of the survey respondents thought that people living with dementia are treated differently from people with other health conditions or disabilities. They believe that that is due to the hidden nature of dementia, and the stigma that surrounds the condition. That is simply not good enough, and we need to do more.
Mr Jim Cunningham (Coventry South) (Lab)
I congratulate my hon. Friend on obtaining the debate, and those who supported her. I hope she will touch on the cost of care. The cost of looking after people with dementia is astronomical, as it is with care generally. I hope she will also touch on progress with dementia research.
Debbie Abrahams
I thank my hon. Friend, who anticipates me. I shall certainly talk about social care in relation to people living with dementia and their carers. My speech is focused on our inquiry report, but other hon. Members may want to touch on progress being made in research.
A central finding of the inquiry is that the public, employers, organisations, Governments and public bodies need to do more, and need to recognise the rights of people with dementia. The inquiry also revealed that a range of societal barriers prevents people with dementia from living independently. Action needs to be taken across a number of key areas to ensure that people with dementia receive the protections and safeguards provided by legislation and convention. The key areas that were identified as having a direct impact on people’s daily lives include employment, social protection, which is also called social security or welfare benefits—I consider that a misnomer because most people who receive so-called welfare benefits have contributed, so they are an entitlement, not a benefit—social care, transport, housing and community life.
On employment, the importance of work in giving people a sense of purpose, self-esteem, status, companionship and income was raised. Work can also provide a routine. Without it, people can feel a loss of identity and sense of purpose. One person with young onset dementia told us:
“I applied for so many jobs and I just got rejections. I used to lecture at a university and now I can’t get a job collecting trolleys. Any job is worthwhile. Not having a job destroys self-esteem.”
At the launch of the inquiry report last week we heard of a woman who had worked in a Government Department and had been diagnosed with early onset dementia. She became ill because of the condition, was then disciplined about that and, ultimately, was forced to take ill-health redundancy. I know that the Minister will be as concerned as I am about that disgraceful position. If Departments are setting out how we should lead, we must make sure we have our own house in order.
There needs to be more awareness among both employers and employees of the employment rights of people with dementia. People need to feel empowered to tell their employers about their diagnosis and employers should feel supported in fulfilling their responsibility to make reasonable adjustments so that people with dementia can continue to make a meaningful contribution in the workplace. The Government have a hugely important role to play, by providing guidance and support for employers. The Access to Work programme could go some way to addressing the unmet needs of people with dementia in relation to employment. However, as I know the Minister recognises, that is a small pot of money, which currently supports only about 35,000 of the 4 million or so disabled people who are fit and able to work. We need to make sure that that is extended.
In relation to social protection, people raised issues about the extra costs associated with living with a disability. Access to extra financial support can provide a lifeline for people with dementia and help people to continue getting out and doing the things they enjoy. One of the key challenges for people affected by dementia is knowing what financial support is available to them. One family member told the all-party group that they felt that
“people with dementia are effectively ignored by the disability benefits system.”
People with dementia and their carers need access to more support to enable them to know what financial help they are entitled to and how to make a successful claim. The Minister knows my views on both the fit-for-work and personal independence payment assessments. Until those assessments are scrapped, people with dementia deserve to be assessed by professionals who understand the condition, and they should not have to undergo unnecessary reviews or reassessments, as currently happens.
Assessment processes need to be clear and appropriate for people with cognitive impairments. That is why we are calling for the Government to mandate the Department for Work and Pensions to convene an expert group to review access to social protection for people living with dementia and their carers, recognising their specific needs. This group must include those who are experts by virtue of their own lived experience. The Government should also mandate the DWP to exempt personal independence payment claimants below the state pension age and with a dementia diagnosis from reassessments, which are unnecessary and cause a lot of distress for people living with dementia and their families.
A further key issue was social care. The inquiry received considerable feedback about inadequate or inaccessible social care for people affected by dementia living in England. There are many ways to improve the lives of people with dementia, but it is difficult in the current context of the well-documented social care crisis across the country. It is now recognised that that social care crisis is a dementia crisis. We need to fix the broken care system, and I am proud to support the Alzheimer’s Society’s “Fix Dementia Care” campaign. I know the Minister is eager to publish the Green Paper as soon as possible, and I urge the Government to recognise that.
In the context of social care reform, I will mention the Alzheimer’s Society’s campaign for a dementia fund. The system of dementia care in this country is in urgent need of reform and extra investment. In May, I tabled early-day motion 2360 in support of the campaign, calling for a financial injection into the social care system in the short to medium term, allowing for greater provision of safe and quality care, longer visits and savings to the NHS. My EDM now has the backing of more than 100 MPs of all parties, and I know that thousands of Alzheimer’s Society campaigners have written to their own MPs as well. I would welcome a commitment from the Minister to look at the proposal, and her support in getting the Government to include a dementia fund in the forthcoming spending review, to end the unfairness for people with dementia.
Another key area is transport. Access to public transport can have a huge impact on the lives of people affected by dementia, helping to reduce loneliness and social isolation by linking someone to their community and friends, and providing links to essential services such as necessary respite care. Access to public transport is therefore critical to maintaining someone’s quality of life. However, accessing transport can be very challenging for people with dementia. We heard many stories of how poor or inaccessible transport is, preventing people with dementia from participating in society, despite rights to accessible transport being enshrined in the Equality Act 2010.
Our report stresses the importance of reviewing any changes to bus and community transport services in the context of the public sector equality duty, to ensure that reasonable adjustments are made to enable people with dementia to continue to use public transport. Local authorities have a huge role to play here, and I hope that they will take steps to support people living with dementia in their communities.
On housing, the inquiry found that people with dementia are frequently being denied their right to live independently in their own homes, where they are able to make their own choices. It is important that people with dementia are supported as much as possible to stay as long as possible in their own home or to access suitable supported housing. People with dementia have the right to personal choice over where and how they live. We believe that people living with dementia must have access to adaptable housing, trained home care staff, and specialised supported housing schemes.
The final area is community life. The evidence supplied to our inquiry reaffirmed the importance of supporting people with dementia to continue to lead full and independent lives. That means creating communities where no one is excluded or has to face dementia alone. The all-party parliamentary group praised the work of the Dementia Friends programme, which helps to raise awareness of the condition and has created almost 3 million Dementia Friends in England, Wales and Northern Ireland—5,000 of them in my constituency of Oldham East and Saddleworth, a fact that I am very proud of.
A particularly relevant recommendation of the report is for Westminster to become the world’s first dementia-friendly Parliament, including ensuring that the parliamentary estate is a safe and welcoming place for people affected by dementia to work and visit. I have met a number of people today who are visiting Parliament; I hope they will be able to report positively on how they have been received today.
Our report is wide-ranging and covers a number of different issues that need to be addressed if the disability rights of people living with dementia are to be realised. Over the coming months, the all-party parliamentary group on dementia will work with the Alzheimer’s Society and other partners to turn the report’s recommendations into reality. That has the potential to have a huge impact on the lives of people living with dementia and their carers, and I hope that everyone in the Chamber today and beyond will offer their support.
University Hospital Coventry
Jim Cunningham Excerpts(5 years, 6 months ago)
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Mr Jim Cunningham (Coventry South) (Lab)
I am grateful to Mr Speaker for granting me the opportunity to raise this issue, which is very important to my constituents in Coventry South. I am sure it is also important to the constituents of colleagues from Warwickshire.
I thank my colleagues—my hon. Friends the Members for Coventry North East (Colleen Fletcher), for Coventry North West (Mr Robinson) and for Warwick and Leamington (Matt Western), and the hon. Members for Nuneaton (Mr Jones), for Rugby (Mark Pawsey) and for North Warwickshire (Craig Tracey)—for their support. Together, we sent a letter to the Secretary of State for Health and Social Care to request a meeting to discuss these issues, and I am keenly awaiting a response. Many of those colleagues also attended an informative meeting with two surgeons from the hepato-pancreato-biliary unit at University Hospital Coventry, Mr Khan and Mr Lam. The point of the letter was that we wished to discuss the transfer of the HPB unit, which provides pancreatic services at University Hospitals Coventry and Warwickshire, to hospitals in Birmingham and Worcester.
UHCW has been developing pancreatic cancer services since 1990. It has an excellent team of doctors, specialists, nurses, surgeons and other healthcare professionals, and has completed more than 1,000 major operations and thousands of other therapies. It deploys cutting-edge robotic, endoscopic and radiologic technology to treat patients in Coventry. It takes a patient-centred approach to its service, resulting in excellent feedback from those who have undergone treatment in its care. The success of the department cannot be denied. The outcomes of therapies are on a par with international standards in all spheres. Proposals to shut down this extremely successful department will be a great loss to the NHS.
Matt Western (Warwick and Leamington) (Lab)
I thank my hon. Friend for giving way. He is making a very important point. Does he agree that one of the key issues, as he was just alluding to, is that with any potential loss of service comes not just the potential loss of reputation but what haemorrhaging effect it may have on the rest of this great hospital?
Mr Cunningham
Yes, I fully agree with my hon. Friend. That was one of the points made by the surgeons whom I and the hon. Member for Nuneaton met a few weeks ago.
These proposals stem from the 2014 regional review of services. They are based on the fact that the UHCW was not providing care for enough people, according to the requirements of the Department of Health and Social Care and commissioning guidelines. There were serious capacity constraints at University Hospital Birmingham, leading to multiple cancellations of operations on the day and prolonged waiting times. The process of the review was in fact challenged by a legal notice. The initial proposal stated that UHB and UHCW services should be amalgamated, with the teams working together to develop a model that would provide more efficient services in the west midlands and maintain operating at both sites, with the joint service to be led by UHB.
Mr Marcus Jones (Nuneaton) (Con)
I congratulate the hon. Gentleman on securing this debate. These are important services that my constituents also access. Clearly, amalgamating these services is of concern to me as it will take away the choice of residents as to whether they want treatment at Coventry or Birmingham. As the population is growing significantly in our area, amalgamating those services may also lead to longer waiting times. Does he agree with me?
Mr Cunningham
The hon. Gentleman makes a valid point, and I will be touching on that a little later on in my comments.
As a bigger hospital in one of the UK’s biggest cities, UHB had a great deal of influence over these discussions. It soon became apparent to the UHCW team that the sacrifices would be one-sided. UHCW felt that it must pull out of the talks, as it was clear that its services would be downgraded and its specialised work would be removed completely—services that it had worked hard to develop. That would be detrimental to the people of Coventry, Warwickshire and beyond.
In November 2018, NHS England served a formal notice on UHCW to transfer specialised liver and pancreas services to UHB in Birmingham or risk decommissioning. UHCW was denied the opportunity to establish the population base required to be an independent centre. There is now a concerted effort from UHB trust management and NHS England to enforce the takeover of the HPB centre at Coventry.
The simple and accepted solution, which is in line with the professional recommendations, is to implement the agreement between UHCW, Worcester Acute Hospitals NHS Trust and Wye Valley NHS Trust to provide the liver and pancreas specialised service at UHCW NHS Trust. It is important to highlight the ongoing capacity constraints at UHB. The realignment from Worcester and Hereford to UHCW would effectively fulfil the required population base to be an independent centre—as per Department of Health and Social Care guidelines—and also reduce the very long waiting times for cancer operations and improve access.
The proposals demonstrate more short-sighted, efficiency-obsessed thinking from NHS England based on the National Institute for Health and Care Excellence guidelines. The findings of the 2015 review, which stated that UHCW’s HBP unit does not serve enough people, totally ignored the good standard of pancreatic care at UHCW. It is of the highest quality and helps to provide patients with the best possible outcomes. NHS England’s proposals threaten the standard of care, which I will raise shortly. The proposals will have a detrimental impact on those in need of this care in Coventry and elsewhere in Warwickshire. Although the 2015 review stated that the HPB unit—
Mr Cunningham
Although the 2015 review stated that the HPB unit did not reach the population requirements, thousands of lives are saved because of the outstanding service that the team at UHCW have developed. The most obvious problem that my constituents in Coventry South, and people in east Warwickshire, will be faced with is geographical, as the hon. Member for Nuneaton said. Many of them will have to travel about 16 miles for treatment, which will be very costly. They will have to take trains, and we all know the problems associated with that. The time it will take patients who currently use the service to travel to Birmingham is unfair. Patient access will no doubt be reduced, as the journey time, as my colleagues from Coventry will be well aware, is about an hour by car and over 80 minutes by public transport. The journey time for patients who currently use the service at UHCW and live outside Coventry, in rural areas out of the reach of public transport, will be considerably longer and the journey will be considerably more expensive. NHS England will directly increase the stress and physical discomfort that patients and family members will have to endure. In addition, once patients have made the hour-long, or hours-long, journey to UHB, there will be a good chance that their treatment will be cancelled or delayed.
University Hospital Birmingham specialises in liver transplants, and it has a success rate that the whole of the west midlands is immensely proud of. Understandably, those operations take priority because of the speed with which they need to take place. Patients at the hospital who have other, slightly less urgent, conditions find that their operations are routinely cancelled in place of a liver transplant. Moving pancreatic services to Birmingham will dramatically increase the number of patients at risk of having their vital operation cancelled. Any patient who suffers from pancreatic cancer, or people who have a family member who has died from this terrible disease, will know that the speed of detection and the speed of treatment are absolutely vital to survival. It is extremely hard to detect, and, as a result, doctors need to act quickly after a patient has been diagnosed. Any delay to operations decrease the chances of survival even further.
The closure of the HPB unit at UHCW also poses a risk to the overall status of the hospital. By closing a key unit, the hospital is at risk of losing its specialist status, and, as a result, being downgraded to a district hospital. That will have a domino effect on the rest of the hospital.
Matt Western
My hon. Friend is making some very powerful points. For me, one of the most staggering facts —I am sure he will agree—is the sheer scale of the number of such operations that are undertaken at Coventry—5,000 over the past two years, I believe. That does not seem a small figure to me. Does he agree that it is surprising that this is even being considered in the first place?
Mr Cunningham
Of course, I totally agree. As I have outlined, it is not about just the volume of operations but their quality, and the skill of the surgeons, the nurses and all the auxiliary staff who do the best that they can for the patients. UHCW will inevitably lose its most skilled doctors and staff, and see the disintegration of the team, service and leadership that the unit has spent so long building.
Finally, I understand that UHCW has written to NHS England outlining its opposition to these proposals—something that I fully support, as I am sure my colleagues here do. It is concerning that UHCW may face these proposals being forced upon it by NHS England, justified by guidelines that have little thought or respect for the quality of care already being provided and the concerns of local people. Not only do these guidelines ignore the quality of care, but NHS England has shown an incapacity to implement them fairly and equally across the country. There was a similar case in Stoke, but rather than close the unit, NHS England allowed it to carry on operating as normal, despite not meeting the population requirements. Will the Minister guarantee that NHS England will work with UHCW and support it by allowing it to continue to provide these outstanding services to the people of Coventry and Warwickshire?
Stephen Hammond
My hon. Friend is assiduous in representing his constituents and making his points. As I have said, these discussions have not yet concluded, and it would be hugely inappropriate for me or any politician to try to prejudge the right clinical outcomes. When those clinical outcomes have been worked through and the discussions finalised, I have no doubt that University Hospitals Birmingham and the Coventry and Warwickshire Partnership NHS Trust will wish to publicise the result of those discussions as widely as possible.
Mr Jim Cunningham
Following the intervention by the hon. Member for Nuneaton (Mr Jones), the Minister mentioned a wider discussion and involving the public. We met some representatives, including Mr Peter Burns, who is the former chair of the local chamber of commerce and a very influential person. Such organisations, as well as other public bodies, must be brought in and consulted. Will the Minister agree to do that?
Stephen Hammond
It would have been inappropriate for me to be involved in clinical discussions, but I hear what the hon. Gentleman says. Before we have that meeting, I will write to him on that point. I hope that we will have a meeting relatively soon, so that we can finalise what should be done.
Service change is often controversial. We should rightly scrutinise any service change, but that should be based on patient safety and the right clinical outcomes. I thank the hon. Gentleman for raising this matter and continuing to hold us to account, and I look forward to meeting him and other hon. Members to discuss the issue further in the near future.
Question put and agreed to.