Hearing Loss: Action Plan and Commissioning Framework

Jim Fitzpatrick Excerpts

Thursday 30th June 2016 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

I beg to move,

That this House has considered NHS England’s Action Plan on Hearing Loss and the adult hearing service commissioning framework.

I am grateful for the opportunity to open this debate, and I am pleased to see you presiding over our business, Ms Vaz. I am also pleased to see the Minister and the new shadow Secretary of State for Health, my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), in their places. I look forward to their comments.

I am disappointed that there are not more colleagues here, but given events taking place outside, it is perhaps no surprise that their focus is elsewhere. I am, however, particularly pleased that my hon. Friend the Member for Nottingham South (Lilian Greenwood), who chaired the all-party group on deafness before me, is here. She brought great enthusiasm and direction to that role and formed the work programme that the group is still following. I am also grateful to the Backbench Business Committee for granting me the opportunity to have a debate on this important issue, and to Alex Adcock and Tom Powell of the House of Commons Library, the UK Council on Deafness, the Royal College of Physicians and others for their briefings, which have helped me to formulate my comments.

I would like to put on the record how much work is being done. I do not intend to attack or criticise the Government; this debate is an opportunity to seek clarification on some of the important issues concerning deafness and hearing loss. The British Society of Audiology, the British Academy of Audiology and others have commented positively on the joint working on the action plan on deafness and the collective efforts to develop an overarching commissioning framework for hearing. That framework document is due to be published on 19 July and will be launched here in the Commons. Today was the closest date for securing a debate to give the Minister a platform to confirm the progress that has been made and to elaborate on arrangements for the day. But I am getting ahead of myself.

I am grateful for the opportunity to raise some issues for the Front Benchers to comment on. As I said, I am chairman of the all-party group on deafness, following my hon. Friend the Member for Nottingham South. We have an active all-party group, which is well supported by colleagues from both Houses of Parliament. I want to put on the record my appreciation for Dan Sumners of Signature UK, who was seconded to act as the admin secretary to the all-party group. I commend him for his support; he has done sterling work in service of the group. We are very grateful for that and wish him well in the future.

On a personal note, I wear two hearing aids. My hearing loss was originally diagnosed as industrially induced from my time in the London Fire Brigade, but I am sure that age could be contributing to my present difficulties. I thank the audiology department of the Royal London Hospital for the support and treatment that it gives me when I need assistance. I also thank the engineers and technicians who maintain the loop system here in the Palace of Westminster, which is very good in this Chamber, as it is in most of the venues in the House. In the main Chamber, it can be a little bit unpredictable, but there are speakers in the Benches to help with any difficulties we might have, so we are well served in these buildings.

Hearing loss affects more than 10 million adults and 45,000 children in the UK, which equates to one in six of the population, and it is estimated that by 2031, 14.5 million people in the UK—approximately one in five of the population—will have hearing loss. The most common form of hearing loss is age-related, and the prevalence of deafness approximately doubles with every decade of life.

The Royal College of Physicians says that NHS England’s action plan on hearing loss

“recognises significant regional variances of early diagnosis and care for children and adults with hearing loss. The document sets out a commitment to design and deliver excellent, high quality care audiology services to meet patient need. The National Improving Quality In Physiological Services accreditation programme (IQIPS)—run by the Royal College of Physicians…assesses audiology services across England to ensure they operate safely and to a high standard. IQIPS is a recognised marker of excellence in patient care and in reducing variances in audiology services.”

I recently visited Auditory Verbal in south London and attended its event held here in the Palace of Westminster. It demonstrated that the earliest diagnosis and treatment can help children who are born deaf or suffer severe hearing loss to learn to communicate normally, by using the brief window of the very early years to stimulate the auditory part of the brain before it loses the opportunity to develop. I commend Auditory Verbal for the work that it does. If the Minister is not familiar with that organisation and has not had the chance to visit it, I strongly recommend that he does so, because it is an inspiring experience. There are a lot of great people around the country working with and for that organisation.

Officers of the all-party group were grateful to the Minister for the opportunity to meet him recently to discuss the action plan and to ask about the commissioning framework. This debate is a continuation of that dialogue. We raised a number of issues, such as the provision of hearing aids; a national screening programme; promoting the prevention of hearing loss; providing innovative models of care; active support for people with hearing loss; and the recognition of British sign language.

The action plan addresses those issues and sets out five key objectives: good prevention to reduce the numbers of young people and adults with noise-induced hearing loss; earlier diagnosis to improve outcomes for babies with hearing loss and increase identification of children and adults in at-risk groups; integrated services; increased independence and ageing well; and good learning outcomes, including improving employment opportunities for young people and adults and reducing development and attainment gaps between deaf and hearing children.

The briefing from the UK Council on Deafness was very helpful in outlining the background to today’s debate. It says:

“This debate has been called prior to the publication of the NHS England adult hearing service commissioning framework. The framework will be launched in Parliament at 2pm on 19 July in the Boothroyd Room”.

I hope that a lot of colleagues will be able to turn up to support that event. It continues:

“The framework is an outcome of the NHS England Action Plan On Hearing Loss, published on 23 March 2015.”

All-party group officers told the Minister at our meeting that we commend the officials within the Department of Health and NHS England for their sterling work in drafting the report and bringing together the commissioning framework. There are a lot of great people doing great work. I have met and listened to a number of them in different meetings, and we are very grateful for all their efforts in this area of policy.

The UK Council on Deafness says:

“The aim of the action plan is to do more on prevention, early diagnosis and support for those who have permanent hearing loss.”

It makes the important point that the action plan acknowledges that

“without hearing aids people are ‘at greater risk of social isolation, and reduced mental well-being…there is a strong correlation between hearing loss and cognitive decline, mental illness and dementia’. The Ear Foundation has estimated the cost of untreated hearing loss to be £30 billion per year. It has found that hearing loss is associated with reduced income of £2,000 per year on average. Wearing hearing aids halves that loss. At least £25bn in potential economic output is lost each year because of a lack of support for people with hearing loss and deafness.”

The council also quotes Action on Hearing Loss, which

“has found that people wait on average 10 years to seek help after they first notice symptoms of hearing loss. Only a third of people who need hearing aids have them, leaving 4 million people with unmet needs. Yet hearing aids are shown to improve quality of life, and 90 per cent of people continue to use and benefit from hearing aids.”

The UK Council on Deafness also raises the issue of cuts in the provision of hearing aids, pointing out that some clinical commissioning groups proposed limiting access to hearing aids in 2015-16. Following a campaign, most decided to halt those proposals as the commissioning framework was being developed. However, North Staffordshire is reported to have implemented the cuts, and the risk of further rationing remains. Perhaps the Minister will comment on that.

The council also comments that in January, the national screening committee decided not to recommend an adult hearing screening programme. The all-party group has also made that point to the Minister. We fell that without an assessment of the scope and size of the problem, and of the quality of the response from NHS trusts across England, a question mark was left over whether hearing loss was being adequately assessed and the quality of provision adequately outlined.

On the recognition of British sign language, the UK Council on Deafness says that deafness has been put firmly on the agenda by the British Sign Language (Scotland) Act 2015 and the announcement by the Northern Ireland Executive that it plans to bring forward legislation relating to British and Irish sign languages. Perhaps the Minister will comment on BSL. There is a campaign for recognition in England, as there has been in Scotland and Northern Ireland.

As chair of the all-party group, I should put on the record my thanks—I am sure I echo the thoughts of my hon. Friend the Member for Nottingham South from when she was chair—to colleagues from both Houses who support the group so positively. The Minister knows from the parliamentary questions that come across his desk and from occasional debates and early-day motions that deafness is a matter of interest in the Commons. However, the number of parliamentary actions that my colleagues and I initiate do not reflect the importance of the matter or the number of people affected in this country. I hope that our efforts today and the positive progress that the Government and NHS England are making will reassure the people affected, and those campaigning with them and on their behalf, that the Government and NHS England recognise the condition of hearing loss and that it is being addressed.

As I started by saying, the all-party group requested this debate to demonstrate how much NHS England has done, to raise matters of ongoing interest or concern and to see what more we could solicit from the Minister on the issues that he knows are live within NHS England and the Department. I know he is very much on top of his brief, and I look forward to his comments. We look forward to 19 July and the publication and launch of the framework document, so that the provision for people suffering hearing loss can be not only understood but maintained and improved.

--- Later in debate ---

[The Minister for Community and Social Care (Alistair Burt)]

It is a pleasure to speak under your chairmanship, Ms Vaz. Thank you for chairing this important debate.

Whatever else may be going on in this place at the moment, it is important that every now and again we return to what most people would regard as real life. As both Government and Opposition Members, we should give a strong sense of how we remain very engaged with matters that affect people every day. We will continue to do so.

I am grateful to my friend, the hon. Member for Poplar and Limehouse (Jim Fitzpatrick), for bringing the subject before the House. It is some time since we played football together—too long—and we will have to find another way to do that. I have great fondness for the hon. Gentleman, who represents his constituents well, and who has always raised this cause in the best possible way, being informative as well as challenging when in opposition. I appreciate his work, and the work of the hon. Member for Nottingham South (Lilian Greenwood), in particular with the all-party group, which is so essential to keep Members informed about what is going on and what we need to be engaged with. I endorse the thanks to those who promote and support the all-party group and its work.

I welcome the hon. Member for Hackney North and Stoke Newington (Ms Abbott) to her role as the shadow Health Secretary. I thank her for her contribution today, and I look forward to hearing more from her. I appreciate the many burdens on her and her colleagues, so I appreciate her taking part in the debate.

The hon. Member for Poplar and Limehouse set out, broadly, the situation affecting the action plan and looked forward to the next stage, including the commissioning framework, which I will touch on. He spoke about the practicalities of life, paying tribute to those who put in the loop systems, and about how well technology has improved over the years—a sentiment I share. He made reference to a couple of specific topics that I will cover.

The hon. Member for Nottingham South did the same and spoke about the effects of deafness. Some years ago, as colleagues might be aware, I was Minister with responsibility for people with disabilities, and when she spoke about the importance of communication, I remember in particular a visit I made to Sense, the deaf-blind charity, at its premises in Peterborough, where I was introduced to a number of people. The importance and value of communication were brought home to me when I engaged with one particular gentleman, who understood what people were saying because he put his finger on their lips to follow the conversation. He could not see or hear, but his finger on their lips meant that he could follow the shape of the mouth. He then tapped out his reply on the back of his carer’s hand. Think how easily we communicate, at the drop of a hat, and see what someone was prepared to do because he was desperate to communicate. That reminds us of the absolute value of communication to human life and existence. I remember that example to this day, even 20 years on.

When the hon. Lady and other colleagues were talking about what being deaf means, how it affects life, how hearing and communication are a vital part of people’s existence, and about the absence of those and the difficulty that it brings, they brought home to me just how important the subject is. That is why I value the debate, and I am grateful to the Backbench Business Committee for allowing it and to the hon. Member for Poplar and Limehouse for securing it.

The shadow Secretary of State for Health also raised matters of rationing, financing and screening, so I will now cover those with my prepared remarks.

I congratulate the hon. Gentleman on securing the debate on NHS England’s action plan on hearing loss and the adult hearing service commissioning framework. The advent of the commissioning framework on 19 July will mark an important milestone. I share his sense that it is an important event. We hope that many people will come to the launch. It is only right, therefore, that we come together to discuss the opportunities and challenges that the publication presents.

As colleagues have mentioned, hearing loss is widespread. More than 10 million people in the UK are affected, and our rapidly ageing population means that that number is set to grow. As mentioned, projections show that by 2031 there will be more than 14.5 million people with hearing loss in the UK. Those demographics alone provide compelling evidence for why the UK needs to step up its response to hearing loss to enable further research, to take action on prevention and to enable people with hearing loss to access the services and support they need.

The Department of Health and NHS England’s action plan on hearing loss, published in March 2015, recognises the impact of deafness and hearing loss on individuals and society as a whole. Crucially, in my view, the plan accepts that hearing loss is not only a health issue, as we have been saying, but a cultural one. Tackling that societal challenge requires an integrated approach across the public, private and third sectors.

NHS England is therefore committed to delivering 20 outcome measures across five key areas, which have been touched on: prevention; early diagnosis; patient-centred, integrated management; ensuring that those diagnosed do not need unscheduled care or become isolated; and enabling inclusion and participation. That work will be spearheaded by a range of multidisciplinary groups with cross-sector representation.

The publication of the plan heralded an important new chapter in driving essential improvements, but we know that there are significant challenges for hearing services. Adults with hearing loss wait, on average, 10 years before they seek help—again, as colleagues have said—and, when they do visit their GP, 30% to 45% are not referred on for a hearing assessment. We know about significant unmet need and variation in services. For example, only about two fifths of people who need hearing aids have them. I have also heard some disquieting anecdotal accounts that some clinical commissioning groups have been taking difficult decisions and considering the rationing of hearing loss services.

Some of the news is helpful, such as the statistics on when referrals are made and things move forward. In 2013-14, 84% of people seen were seen within 16 days of referral; 92% were fitted with hearing aids within 20 days; 97% had their first follow-up within 70 days; and 800 different types of hearing aid were available from the NHS supply chain. So once someone is in the system, things are available, but we want to improve the provision of services.

[Jim Fitzpatrick]

Will the Minister give way?

[Alistair Burt]

I was about to come on to rationing, but I am happy to give way at this stage.

[Jim Fitzpatrick]

My hon. Friend the Member for Nottingham South (Lilian Greenwood) mentioned—I think this was in my notes, and the Minister just repeated it—the numbers who are not referred on by GPs. I have not got to the bottom of why that is. GPs are not auditory specialists, so we would think that if someone comes to them and presents with audiological problems, the logical thing would be to send them to their local trust, who are the experts and have sound-proof booths, technicians and specialists, to identify and assess the nature of the problem. I have read that figure a couple of times. but I have not got to the bottom of why they are not being referred. I am not sure whether the Minister will have an answer, but I thought I would raise that point.

[Alistair Burt]

I must confess that I do not have an answer. He makes a perfectly fair point. Whether or not that is what people raise at the time they are in the surgery or whether they recognise it themselves or minimise it by saying, “I’m just getting old” or whatever, I do not know. I will make an inquiry and see what research we have at present. Family practitioner care and GP services are under constant review, and we have a number of different pilots and vanguards looking at the provision of primary care services.

I will see what emphasis is being given to this particular aspect. Certainly we recognise that the demographics indicate that all issues associated with getting older, which can include hearing loss, are rising up the scale and the agenda. I will make specific inquiry about whatever reasons we have at present in relation to this matter and write to each of the hon. Members present to give that information. I am very happy to do that.

--- Later in debate ---

[Jim Fitzpatrick]

Thank you for the opportunity to make a couple of closing comments, Ms Vaz. I am grateful to the shadow Health Secretary, my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott), for being here today and for her contribution. I especially thank my hon. Friend the Member for Nottingham South (Lilian Greenwood) for her contribution. She demonstrated her complete awareness of these matters and her long-standing commitment to campaigning on them in her constituency and here in Parliament, as a former leader of the all-party group on deafness.

I thank the Minister not only for his response and the reassurances he gave but for the obvious personal commitment he brings to the role he now commands. He is held in high regard by many of us. We look forward to working with him, supporting him and encouraging him in his continued endeavours in this area. I am grateful for the opportunity to have this debate.

Question put and agreed to.

Resolved,

That this House has considered NHS England’s Action Plan on Hearing Loss and the adult hearing service commissioning framework.

Antibiotics: Research and Development

Jim Fitzpatrick Excerpts

Tuesday 26th April 2016 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is a pleasure to see you in the Chair, Mr Evans, and I certainly hope to follow your request without any difficulty; I do not expect to speak for too long.

I congratulate the hon. Member for York Outer (Julian Sturdy) on securing this debate and on his comprehensive introductory speech. As a former firefighter myself, I had to chuckle a little bit about his fire analogy. Also, in the main Chamber now, new clause 20 of the Policing and Crime Bill, which deals with the role of the fire brigade under police and crime commissioners, is being debated. So there is a little bit of continuity between the two Chambers in that regard.

I also speak as a member of the all-party group on global tuberculosis and because my previous constituency of Poplar and Canning Town had the highest TB rate in the UK and one of the highest TB rates in the world, despite being situated in central London. I congratulate Barts Health NHS Trust, which includes the Royal London hospital, as well as the local authorities of Tower Hamlets and Newham, on the work that they have done in tackling that problem and the efforts that they are making to address these issues.

I am very grateful to Dan Sharp, the policy adviser for the all-party group on global TB, for the briefing that he has sent me; I will quote from it extensively. The first quote is from Dr Margaret Chan, the director general of the World Health Organisation:

“antimicrobial resistance is a crisis that must be managed with the utmost urgency. As the world enters the ambitious new era of sustainable development, we cannot allow hard-won gains for health to be eroded by the failure of our mainstay medicines.”

The report goes on to congratulate the Government on the lead they have taken, as referred to by the hon. Gentleman. It states:

“The UK Government prioritised tackling drug-resistance within its aid strategy, published last November, and created the related Ross Fund. In addition, it brought the issue to the attention of the international community by commissioning the independent Review on AMR in 2014”,

as mentioned by the hon. Gentleman. The report continues:

“The Ross Fund is a commitment to spend £1 billion over the next five years on research and development...including £315 million to fight AMR.”

As the hon. Gentleman mentioned, the Prime Minister appointed Lord O’Neill to lead a review, and its recommendations are expected next month. The Chancellor highlighted the issue of AMR in a speech to the IMF. He said:

“Unless we take global action, antimicrobial resistance will become an even greater threat to mankind than cancer is”.

TB, as we know, is the leading infectious killer. It kills 1.5 million people in a single year—4,000 every day—and is the biggest killer of people with HIV. I met Dr Chan in Brazil in November last year at the UN World Health Organisation second world summit on road crashes; road crashes kill 1.25 million people a year. The Government are committed to sustainable development goals 3.6 and 11.2. It is to their credit that they are leading on TB also.

The number of cases of drug-resistant TB is increasing, with nearly 500,000 new cases last year, and almost 200,000 deaths. Multi-drug-resistant TB already accounts for one third of the 700,000 annual deaths from AMR. The all-party group produced a report last year entitled “The price of a pandemic: Counting the cost of MDR-TB”, which called for several measures: a pooled research development challenge fund to support innovative approaches such as the Médecins sans Frontières 3P proposal to incentivise the pharmaceutical sector, as mentioned by the hon. Gentleman; and investment in basic research to address key gaps that remain in our fundamental understanding of the biology of the TB bacterium.

I have questions for the Minister. When will funding provided through the Ross fund be allocated? Investment in TB diagnostics, drugs and vaccines through the fund is critical, as he knows. Which Department is ultimately responsible for the commitments pledged through the Ross fund, given that the remit is cross-departmental? I assume from the Minister’s presence here today that his Department will lead.

The Government recognise the serious threat posed by TB within the frame of AMR. In addition to the Ross fund, the Government’s aid strategy included the creation of a global challenges fund. Will that be used to address AMR? Can the Minister provide further details on that? Finally, what discussions have the Government had with pharmaceutical companies on addressing the challenge of AMR? I note the request by the hon. Member for York Outer to lead a delegation of pharmaceutical companies that he is associated with. What does the Minister say about that?

The Government have provided a positive lead on this matter, and more information will be reassuring. I look forward to hearing the Minister’s comments and those of the shadow Minister, my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders), and of the Scottish National party spokesperson, the hon. Member for Glasgow North West (Carol Monaghan), in response to contributions to the debate.

Draft National Health Service (Licensing and Pricing) (Amendment) Regulations 2015

Jim Fitzpatrick Excerpts

Monday 30th November 2015 General Committees

[Ben Gummer]

I thank the shadow Minister for taking the care—I mean this in all sincerity—to look at a complicated area of health economics and for providing me with so many questions and challenges; he is right to do so. It is good for the House that we are considering the regulations in such detail, because the mechanism by which the tariff operates lies at the heart of how the NHS has worked not only since the 2012 Act but for several decades, under different Administrations.

I will provide a quick gloss for why the tariff is a difficult mechanism to get a perfect line on at any one time. It is, by its nature, a complicated beast, encompassing a huge number of procedures. Having to set a price is a function of the NHS, which is effectively a monopoly purchaser. The tariff is not the product of a whim of Monitor. Monitor does not sit down one day and say, “I believe the tariff for a cardiac procedure should be x, and for a knee joint procedure it should be y,” although I know the shadow Minister is not suggesting that to be the case. The tariff goes through a rigorous costing process to try to understand what advances in efficiency and medical technology can be brought to bear and how the costs of different procedures have gone down, remained the same or increased. At the termination of that process, which involves clinicians all the way through and a whole gamut of health economists, the tariff is put to providers across the country.

There is a balance that we have to strike as a Government. It was acknowledged in the passage of the 2012 Act—which I remember, though mercifully I was not on the Public Bill Committee that scrutinised it—that the changes would need to be finessed over time. That was the nature of the reforms to the health economy that were proposed and then passed by Parliament. The initial thresholds of 51% were not drawn scientifically, but on the basis of probing Ministers and Parliament and on the understanding that they would have to be reviewed in future. It is important that we get the balance between the tariff setting and the tariff challenge absolutely correct.

The situation that we have found ourselves in, as the hon. Gentleman said, is that a proportion of providers that do not represent in totality a significant number—a proportionate majority—can challenge the tariff successfully if it is not in their interest. It is our judgment that at the moment we are not correctly balancing the ability to challenge and the threshold at which we find that ability to challenge, and the interests of commissioners who are acting on behalf of patients and of taxpayers.

We consulted on three different thresholds, including a continuation of 51% and a higher threshold of 75%. We took a slightly different view from the hon. Gentleman of the outcome of the consultation. He mentioned some figures, but I merely repeat that 46% of respondents to the consultation, many of whom were commissioners and mental health providers, agreed that the tariff needed to be changed. Those who opposed a change to the tariff were, not surprisingly, providers. That is their right and it is not surprising in many instances that they chose to do so. One should question, however, whether it is right that 37% of providers by number—even if they make up a larger proportion by revenue—have the ability to challenge the tariff set by Monitor in its extensive process and consultation. That tariff also has to be used by commissioners on behalf of patients.

There are two effects. The first is to delay the implementation of the tariff at all, which creates massive financial uncertainty in the system. I am conscious that, with time, with the 51% threshold and given the number of providers able to reach the bar, that that would become a constant. Financial planning in the NHS would therefore become less about planning and more about responding to challenge after challenge. Secondly, and perhaps more importantly for why we need to look at things again, we have to balance the interests not only of providers by number and revenue throughout the entire sector, but of commissioners, the people buying care on behalf of local people. In order to buy that care, the commissioners are using a significant part of the revenue raised in taxes.

Members of all parties understand that achieving the move that we all want to a care system based on primary care, strong community services, full integration with social care and increasing resource committed to mental health services is about addressing the balance between providers and others modes of care rather more subtly that has been done in the past. I think we agree on that.

The question is how we go about that. That process will bring some challenges to some providers, who will have to do things more efficiently and differently. That is in the nature of creating a more productive NHS. It is precisely the kind of productivity challenge that Simon Stevens indicated in his five-year forward view.

Our contention is that we have to create a realistic objection threshold that can be met if there is overwhelming response to a tariff in one particular area that is unfair, but that, on the other hand, does not create a continued roadblock because a proportion, even a smaller proportion within the NHS as a whole, continues to hold up tariff changes—the tariffs discovered scientifically by Monitor.

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

The Minister is being generous and patient in the way in which he is trying to explain this to the rest of the Committee, because we are not all quite as well briefed as my hon. Friend the Member for Ellesmere Port and Neston. However, the Minister seems to be saying—he will forgive me if I have got this wrong—that we have moved to 66% because there was an agreement, or an understanding, that 51% was basically a finger in the air, and we would have to adjust it at some point in the future. The Minister wants to remove what he sees as a veto by providers, whereas my hon. Friend says that if all the providers got together, they would never reach the 66%. So what is the gap between the two?

[Ben Gummer]

That is not entirely the gloss I would give to my comments.

There is no veto to all providers, because we are talking about 66% of providers in total meeting the objection threshold. This means that one particular bloc in the healthcare system as a whole that uses the tariff—it is not just used by NHS providers—will not be able to block the proposed tariff. Currently a smaller proportion of NHS providers—it is not even the full number—can block the tariff. It is not a scientific process, but in trying to balance the interests of commissioners and a healthy provider sector, which incidentally we will fund considerably more in years to come, we feel it is not right to give an objection threshold of 51%, and that we need to show a more significant number. That is why 66% of all providers would have to meet the objection threshold.

I would not like to speak for Earl Howe, who I know spent many hours explaining this matter and going through it in detail during the passage of the 2012 Act, but I think it was understood at the time—this was why the Bill developed as it did during its gestation—that, as with any health economy, the regulations would need to be finessed as issues emerged. To be blunt, we are at a time when NHS spending has gone up over the past few years, although it has been under significant pressure, as the hon. Member for Ellesmere Port and Neston said, because of changing demographics, and the way in which the tariff system and the changes made in the 2012 Act have enabled the tariff and the whole health economy to operate has allowed us to manage funds in an efficient manner.

I am conscious that others may want to speak, so I want to cover some of the other issues that the hon. Gentleman raised. He mentioned patient safety. I hope that I can place the issue in the larger context of all our reforms around the Care Quality Commission, introducing a simple grading system that gives complete transparency, and our additional funding to the commission over the past five years. By everyone’s estimation, the commission has improved its performance significantly, although we all want to it to improve still further.

We believe that patient safety is ensured by a raft of measures, not just by increasing NHS funding, but by increasing transparency on outcomes, by better regulation and inspection, and by giving a voice to NHS workers—giving them freedom to speak out through the whistleblowing champions that we have introduced and the efforts we are making to bring in a learning culture in the NHS. We are making those efforts in order to develop an NHS that learns from mistakes, can point out and shout about failures in patient safety, and can improve patient care in an iterative process.

That cannot, and can never be, about just pumping money in at one end and expecting to get improved care out at the other. We know that increased resources are one component, but to characterise tariff as a patient safety alarm is itself a little alarmist. It is one part of a health economy. As I explained, it is set by clinicians and economists, and the whole architecture that the Government have tried to reinforce and in parts introduce is there to underpin patient safety in the round. This is merely one component of that.

The hon. Gentleman raised specialised services. He could also have raised the issue of emergency admittances. Both those things are being looked at in the current tariff proposals. I understand the concerns that he raised, and I know that officials and Monitor will have heard them.

I must finally address the consultation process itself. I am not sure that the hon. Gentleman’s characterisation is fair on this. The consultation lasted a month. I do not think we can count a Spanish summer as happening in the NHS in the way he might suggest, as if everyone had vanished and was unable to respond. We received a significant number of responses. Given the fact that there are roughly 147 NHS acute trusts and a significantly larger number of commissioners—we are not talking about thousands, however—receiving 221 responses is good. They were full responses and I was completely open about their nature and the fact that, frankly, they were split, if not 50:50, about as close to 50:50 as a public consultation gets, on the quality of the Government’s proposals. The Lords sits in the summer months in a way that the House of Commons does not when we are back in our constituencies, but the 20-day scrutiny period is significant, and their lordships will have looked over it with due care and attention.

I understand the hon. Gentleman’s concerns about the nature of the changes, and it is understandable that he wishes to raise them. In part, they are the objections of some providers, and I am glad that he has brought them to the Committee’s attention, but I hope that, after this discussion, he understands that the regulations are part of a larger balance between different parts of the NHS to ensure that the additional money that we are putting into the NHS—the NHS budget will exceed half a trillion pounds over the course of this Parliament—goes towards reforming the system, new models of care and the primary, social, community and mental healthcare that all our constituents want improved on the ground. This tariff reform will help the process by ensuring that a bloc of providers cannot obstruct that change without significant enough numbers.

Barts Health NHS Trust

Jim Fitzpatrick Excerpts

Thursday 19th March 2015 Commons Chamber

[Jane Ellison]

The failings at the site are laid out in black and white in the CQC’s report and it is important that people accept that. There will be intensive support to address that, and the management have already said that they are looking at the problems and have begun to address them. My hon. Friend is right that management and leadership are critical. We have seen that in his area and in others, and that is what those involved must now face up to.

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

My hon. Friend the Member for Bethnal Green and Bow (Rushanara Ali) and I have been assisting the save our surgeries campaign in Tower Hamlets for 18 months, because, like many other GP surgeries in east London, ours are feeling under threat. Today’s response from the Minister indicating that the trust for Barts and the Royal London is in special measures, as well as the Barking, Havering and Redbridge University Hospitals NHS Trust, demonstrates that there is anxiety across east London about the state of the national health service. We did not hear anything in the Budget statement yesterday to give any reassurance to the people of east London. Does the Minister not recognise how serious this is for east London?

[Jane Ellison]

This report alone is a very serious report, and of course it is recognised. But it is right that we are transparent about it. As a London MP, I know some of the challenges that parts of the London health economy face. The issues need to be addressed, but this Government have put record amounts into the health service. We are also committed to backing the NHS’s own “Five Year Forward View”, and moving forward new ways of delivering GP care is a part of that vision. We have to make sure that that delivers for the hon. Gentleman’s constituents, as well as for mine and for other people in London.

GP Services

Jim Fitzpatrick Excerpts

Thursday 5th February 2015 Commons Chamber

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is pleasure to follow my right hon. Friend the Member for Knowsley (Mr Howarth). I congratulate my hon. Friend the Member for Halton (Derek Twigg) and his supporters on securing this important debate.

I first raised this question on behalf of GP practices in Poplar and Limehouse on 13 May last year and the issue has not gone away, as the Minister is aware. The motion states that the House

“notes the vital role played by local GP services in communities”.

I am sure that we all feel that we do more than note those services—we are very appreciative of them, we value them and have high regard for them. Doctors at the Ettrick Street practice on the Aberfeldy estate in east London, especially Dr Phillip Bennett-Richards, do a first-class job for us and are highly regarded by the local community.

I was grateful last year when the Minister’s colleague, Earl Howe, agreed to meet me and a small delegation from two practices in my constituency.

[Mr George Howarth]

Earl Howe refused to meet me to discuss the problem I described earlier, which is an unusual thing for a Minister to do.

[Jim Fitzpatrick]

I am surprised that the Minister declined to meet my right hon. Friend. The Minister certainly showed me every courtesy and I was grateful for the opportunity to meet him, his officials and officials from NHS England. As a result of that meeting, we identified solutions for both the Jubilee Street practice and the St Katharine’s Docks practice, which were under severe pressure at that time. Indeed, last Friday I had the pleasure of attending the opening of the refurbished St Katharine’s Docks practice, which is run by Dr Sarit Patel. I pay tribute to Ms Sue Hughes and the Friends of St Katharine’s Docks for the central role they played in supporting their local GP and his practice. The Jubilee Street campaign, also supported by its local community, was also effective.

Now we have a borough-wide save our surgeries campaign, with banners across Tower Hamlets outside every GP practice. The Jubilee Street and St Katharine’s Docks practices have solutions, but they are not permanent. On Tuesday, I received an e-mail from Sue Hughes. She reports, among many other matters, that

“Dr Patel has found it impossible to have a meaningful dialogue with our local representative of NHS England to discuss in detail the future funding of the Practice. NHS England insist on using one size fits all formulas to calculate additional financial support for GP Practices which clearly have differing requirements. NHS England are not paying the Practice for work they already do over technicalities which NHS England refuse to discuss with them. NHS England disregard ‘quality of outcomes’ when deciding on funding formulas—why is this?”

Having received that e-mail, I wrote to the Minister and I look forward to a response in due course.

The Limehouse practice in Gill street is also struggling to secure its future and is under great threat. I have written separately to the Minister on the Limehouse practice. Other GP practices are under huge pressure. In addition, there is the worry over the future of the walk-in centres at the St Andrews and the Barkantine health centres.

I wrote to the Department of Health about Barkantine because it combines a walk-in centre with a 10-handed GP practice and as a result is able to offer 8 am to 8pm, seven-day-a-week services to patients, which are under threat. The Prime Minister announced some time ago that the Government were going to spend significant sums trialling 8 am to 8pm, seven-day-a-week services, but there was not any need. The Department could have easily sent officials to east London and we could have shown them how such services can operate efficiently and effectively. However, that is all under threat.

During recent years, when the PCT was in charge, we had the fastest improving GP services in the country. The CCG has done excellent work and is staffed by first-class people. It is doing all it can to assist but we need NHS England and NHS England London to provide reassurances that all will be well.

Yesterday I received this e-mail in response to my correspondence on the walk-in centres—I thank my hon. Friend the Member for Halton for securing this debate because it is a great coincidence that the e-mail arrived the day before it. The response from the Department of Health is efficient and I am grateful for it. It has some good news. It says:

“NHS England have agreed to extend the existing break clause”—

this is in relation to the walk-in centres—

“in each of these two contracts by 9 months moving this date from 30th September 2015 to 30th June 2016.

Tower Hamlets CCG has applied to become the commissioner of primary care services under delegated approval arrangements from NHS England. If approved, this will become effective from 1 April 2015 and this will become a matter solely for the CCG.”

That is good news as it lifts the immediate threat to the walk-in centres, but it is not a permanent solution; it is a temporary reprieve. However, this is clearly new, certainly to me, and shifts the focus from the Department of Health and NHS England to the local CCG, which I hope will be able to fund the right decisions for local residents on a permanent basis.

On the temporary solution for the Jubilee Street practice, the practice manager, Virginia Patania, reports that meetings have been held with Department of Health officials, including Simon Stevens. She says that there should be protections for

“practices whose MPIG”—

the minimum practice income guarantee—

“has been removed”,

and that

“NHSE is completely ignoring the issue of cumulative losses. In any reply to our challenges to NHSE, there is no mention of the cumulative effect of losses—this has not been addressed by NHSE in any correspondence or response. It is unfathomable to us that NHSE is not or cannot be held to account for having only looked at 25%...of overall losses and estimating these as final.”

She concludes that

“we can demonstrate that populations of the most deprived adults attend GP surgeries up to twice as often as populations of the country’s wealthiest adults. This makes the Carr Hill formula entirely inadequate for areas such as Tower Hamlets”.

Tower Hamlets GPs have offered solutions and we have asked for another meeting with Earl Howe. I hope that we will be successful in that.

Like other colleagues, I have received briefings from the BMA, the RCGP and Londonwide LMCs. What is significant are the stats they all have in common, which my hon. Friend the Member for Halton and others have mentioned. Only 8.3% of the overall NHS budget goes to GPs but they are dealing with 90% of patient contacts. The royal college has estimated that at least 500 practices are at risk of closure and that nationally we need to recruit 10,000 more GPs, which has also been mentioned. I got a sticker from Londonwide LMCs this morning saying, “I love my GP.” I refer to it cautiously because I do not want to suggest that I am trying to have a relationship with my GP, no matter how much respect I have for him. Everybody does love their local GP, however, on the basis of the service we receive in east London.

The most threatened practice in Poplar and Limehouse is Limehouse. I have mentioned that I have written in detail about its problems, and I would appreciate a response. There has been extensive contact with NHS England and between NHS England and the practice manager Mr Warwick Young on the minimum practice income guarantee, the quality and outcomes framework and other issues. It is looking like it will lose more than £600,000 over the next seven years. That makes a great deal of difference and the practice could close.

Last year I began my remarks by saying the debate I had asked for was about three things. The first was to find out the nature of the problems facing GP services. The second was to determine whether the Government accepted there was a problem. The third was, hopefully, to identify a solution. We are still looking at the problem. The Government seem to accept that there is a problem and are trying to find solutions, but they have only been partly addressed and not resolved. There is still great concern not only among clinicians and staff, but among patients and residents in Tower Hamlets, that their GP services are not safe.

I know the Government have their five-year forward review and their focus on giving GPs a more central role. I look forward to hearing more about that from the Minister in due course, but the issues are not resolved, and I would be grateful if he would take back my request to Earl Howe for a meeting with him, or at least with his officials, on the three main practices I have mentioned and collectively on GP services in Tower Hamlets.

NHS Specialised Services

Jim Fitzpatrick Excerpts

Thursday 15th January 2015 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is a pleasure to see you in the Chair this afternoon, Sir David. I am sure you took huge pleasure from your ennoblement. I am also sure that you took some pleasure from West Ham’s good cup win on Tuesday night—at least we are both smiling as a result of that experience.

I congratulate the hon. Member for St Austell and Newquay (Stephen Gilbert) on the strong case that he made to the Minister. I look forward to hearing the responses of both Front Benchers to that contribution in due course. It is a pleasure to follow the hon. Member for Congleton (Fiona Bruce), who made an eloquent plea on behalf of the RSA in her constituency and nationally.

I will raise two issues. The first is sickle cell disease, an issue raised with me by two constituents who suffer from that condition and are worried that the change to local commissioning might affect the care that they receive. I promised that I would mention their concerns in my contribution today, and a simple statement of reassurance from the Minister would be very welcome.

The second issue I wish to raise—in greater depth but not too lengthily—is neurological and headache services. We have corresponded on the issue before, so I will just remind the Minister that I am chair of the all-party group on primary headache disorders. I should acknowledge the assistance that the all-party group receives from the Migraine Trust, which offers great support through Wendy Thomas, its chief executive, and Drew Lindon, who acts as our administrative secretary.

The all-party group recently concluded an inquiry into headache services in England. The Minister has a copy of our report, and I hope the shadow Minister has one as well. I put on the record my thanks to the parliamentary participants in the inquiry, as well as to the witnesses—many of them eminent clinicians—and to Hannah Verghese of the Migraine Trust, who all gave up their time to make sure that the sessions were useful and worthwhile and that the report would be a useful tool for the Government and for anybody interested in the issue.

I will not go into any real detail, but the report’s main conclusions were that there are large gains to be made in the NHS by treating headache appropriately—gains for the patient, for the NHS and for the wider economy. The report also makes well the argument for the need for

“a national strategy to improve the provision for headache sufferers in England.”

There is a lot of good provision on the ground, but it needs to be more evenly spread across the country.

Our report makes 10 recommendations. Again, I will not go into detail about them all but members of the group would like to meet the Minister and/or his officials at some point over the next few months to discuss the issues. We will also put a bid in to meet the shadow Minister and his colleagues; given that the general election is coming up, he might well be sitting in the Minister’s position in only a few months—certainly many of us expect that to happen—either as part of a new ministerial team running the country or perhaps sharing the running of the country with others, in which case the Minister might still be there. At any rate, we want to take the issue forward and would be grateful to engage with both Front-Bench teams. I have corresponded with the offices of the Minister and the Secretary of State for Health, on 12 January and 23 July last year, respectively, raising some of the issues that we have identified.

Headache disorders cost the UK economy an estimated £5 billion to £7 billion per annum. They are the most common neurological reason for accident and emergency attendance, with more than 19,000 finished emergency admissions in 2012-13. Indeed, 90% of the public are affected by a headache at some point, and approximately 6 million people live with migraines. In 2012, the Public Accounts Committee identified that 70% of clinical commissioning groups have not produced a needs assessment of people with neurological conditions and have no plans to do so.

The Minister will have seen the Neurological Alliance’s report, “The Invisible Patients”, which included the findings that only 14.7% of CCGs have assessed local costs relating to the provision of neurology services; only 20.4% of CCGs have assessed the number of people using neurological services and only 26.2% have assessed the prevalence of neurological conditions in their area; and only 33% of CCGs obtain vital feedback from patients about the neurological services that they commission. The report sets out a number of recommendations in response, which I am sure the Minister has seen.

I should declare an interest: I am a sufferer of trigeminal neuralgia. I have personally accessed the neurology services of the Barts Health NHS Trust, and had neurosurgery at the National Hospital for Neurosurgery and Neurology at Queen square in 2009. I am grateful to all the clinicians who assisted me, as well as to the Trigeminal Neuralgia Association UK—TNA UK—a charity that tries to help suffers and their families and campaigns on the condition.

In conclusion, we need a national strategy, including an appropriate and targeted public awareness campaign for primary headache disorders, as well as better diagnosis and treatment by GPs, specialised clinics and clearly defined local headache pathways. If we had that, the burden of headache disorders might finally receive the attention that the all-party group thinks would be helpful for individuals, the NHS and society.

Time is short before the general election, but I repeat my request for a meeting, which, I assure the Minister, would not take long. We would be grateful if he found half an hour in his diary before the end of March. We extend that request to the shadow Minister as well, so that we can take these issues forward and try to give greater assurance to those who are suffering that matters are being taken seriously.

General Practices (Coventry)

Jim Fitzpatrick Excerpts

Thursday 30th October 2014 Commons Chamber

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. It being Five o’clock and there being a total lack of Whips in the Chamber—

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

I beg to move that the House do now adjourn.

[Madam Deputy Speaker]

I am grateful to the hon. Gentleman for his attempt to be helpful, but I will invite the Minister to move that the House do now adjourn, after which he may recommence his speech.

Motion made, and Question proposed, That this House do now adjourn.—(Dr Poulter.)

--- Later in debate ---

[Dr Poulter]

I am pleased to have brought some good news about future planning to the debate. As I will be writing to the hon. Member for Coventry North West in detail about some of the initiatives with medical students, I am happy to outline further the future plans for that practice in the letter.

GP patient survey results from 2014 indicate that 85% of people who responded in the Coventry and Rugby clinical commissioning group area rated their GP surgery as “very good” or “fairly good”. Although this is a high proportion, it could of course be improved further. The figure is, however, testament to the work of local GPs and the quality of care they provide, alongside everybody who works in those practices. I am also aware that Coventry local medical committee had concerns that Coventry and Rugby CCG was not following NHS England planning guidance and investing more in general practice to support it in transforming the care of patients aged 75 and older. I understand the LMC has now reached agreement with the CCG on that, which is good progress. Our plans for personalised care for the most vulnerable patients included NHS England asking CCGs to set aside £250 million from existing funds. However, as has always been the case, CCGs are not restricted to using this funding on general practice only. For example, in some areas, CCGs have used the funding to employ extra district nurses for local practices.

On the important point about the wider community work force, it is increasingly the case that although a nurse may be counted as a member of hospital staff, their role goes across not just the hospital, but the community. That is particularly the case for nurses who support patients with long-term conditions such as multiple sclerosis and diabetes. Although that nurse is officially counted as a hospital employee, they play an increasingly important role in supporting the patient in the community. Having visited the local hospital in Coventry, I know that there is a great emphasis on the hospital working much more collaboratively with the community. The role of the hospital is about not just picking up the pieces when things go wrong but proactively supporting patients, especially those with long-term conditions, when they are at home.

[Jim Fitzpatrick]

I apologise to the Minister for intervening on him while he is replying to a debate on Coventry. He just mentioned collaborative service. The Barkantine practice in my constituency combines a 10-handed GP practice with a walk-in centre. It is able to offer appointments from 8 o’clock in the morning to 8 o’clock at night seven days a week, which is what the Prime Minister made a big point about in his conference speech. However, because of restructuring, the practice is having to hand over its walk-in centre finances to the local CCG, which means that the critical mass for providing the 8 am to 8 pm service seven days a week is no longer appropriate. Will the Minister look at that with regard to collaborative working, as we are talking about breaking down a system that the Prime Minister wants to see replicated across the country?

[Dr Poulter]

I hope the hon. Gentleman will excuse me if I do not detain the House in addressing that specific point today, but I will look into it and write to him separately about it. We have discussed local issues in his constituency before. I will take away what he says and get back to him, hopefully with some reassurance on the points that he has raised.

The CCG is developing a pre-hospital model to help manage urgent care and reduce attendance and admission to hospital. The development includes operational and clinical staff from a number of organisations including patient champions, primary care, local trusts and authorities, and unscheduled care providers.

The model being considered at the moment describes a community urgent care system designed around the patient, ensuring easy and timely access at a convenient location without blocks or diversions. The CCG and its partners at the Coventry urgent care board have developed and agreed a winter capacity and resilience plan. NHS England has made £2.8 million available to support the plan, and a number of specific winter schemes are already being put in place. They include: additional home care capacity for both planned and unplanned support; additional social worker capacity to support A and E and ward board rounds; GP responders; and hospital at home.

The plan sets out a clear mechanism for engaging and developing leaders and staff to enable the cultural changes required to support clinical commissioning activities, performance improvements and services changes necessary in the changing NHS environment at a local level. As we have said, this is about ensuring that the emphasis is moved away from a reactive care model in the hospital—having met the staff in Coventry I know that it is a very good reactive care model—and giving people better support and care at home. That is what investment in local GP practices and increasing GP numbers is about. It is also about ensuring that the right relationships are engaged at a local level to support the right type of care being delivered to patients in Coventry. Its focus is on developing internal capacity and capability to ensure that the emphasis is on upstream interventions, preventing people from becoming so unwell that they need to go into hospital, and making sure that people with long-term conditions and disabilities get the proper community-based support that they need.

I hope that I have brought some reassurance to the hon. Members for Coventry North West and for Coventry South, and I have a couple of points on which I will write to both of them. Once again, I convey my gratitude to the front-line staff working in Coventry. I have seen the local hospital for myself and know how hard local staff work. It is clear that investment is going into GP premises locally and that there is a commitment to continuing to support general practice in Coventry and the development of improved community services to ensure that the big challenge that faces the NHS, which is to support people with long-term conditions, is met, not just nationally, but in particular for those patients who need services from the NHS in Coventry.

[Jim Fitzpatrick]

On a point of order, Madam Deputy Speaker. On 16 October, during the Backbench Business Committee debate on cycling, I said that

“the proportion of cars on that stretch of road is already less than 9%”.—[Official Report, 16 October 2014; Vol. 586, c. 502.]

Further research has clarified that the 9% figure refers to an assessment of the percentage of private cars using the A3211 route at certain times of the day. This is based on counts carried out by transport consultants Steer Davies Gleave for Canary Wharf Group. It would have been more accurate for me to have said, “the proportion of private cars on that stretch of road is already less than 9% at some times of the day.”

I am grateful to be able to set the record straight. I apologise for not accurately reflecting the position. I am not sure whether this qualifies technically as misleading the House as it was an incomplete picture, but I apologise unreservedly for doing so, as that was clearly not my intention.

GP Services (Tower Hamlets)

Jim Fitzpatrick Excerpts

Tuesday 13th May 2014 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is a pleasure to see you in the Chair this afternoon, Mr Streeter. I am grateful to Mr Speaker for affording me the opportunity to hold this debate, to the Minister for being here to listen and respond and to my parliamentary neighbour, my hon. Friend the Member for Bethnal Green and Bow (Rushanara Ali), for taking an interest and supporting the debate.

My remarks are designed to defend Tower Hamlets GP services. I am a great admirer of all that they have achieved, especially over the past 15 years. I called for this debate for three reasons. The first is to find out more about the nature of the problem facing GP services in Tower Hamlets. The second is to determine whether the Government accept that there is a problem. The third is, hopefully, to identify a solution.

The picture is confused and many aspects must be considered, but the real concern is that primary care budgets are being cut, and not only in Tower Hamlets. In response to my written question about average annual changes to GP income in Tower Hamlets, the Minister stated that there would be

“a decrease of £184,000 spread across 21 GMS practices.”—[Official Report, 6 May 2014; Vol. 580, c. 126W.]

However, The Guardian has reported that the Jubilee Street practice alone

“will be down £77,263 by the end of 2014-15”

and that it had “already lost £30,000 QOF”—quality and outcomes framework—

“income last year and will lose its £219,508 a year MPIG allocation incrementally over the next seven years—the accumulated loss due to MPIG alone amounting to over £903,000.”

The figures do not add up.

[Rushanara Ali (Bethnal Green and Bow) (Lab)]

As well as the Jubilee Street surgery, four other practices in Tower Hamlets are reported to be part of the 98 surgeries facing closure, but we do not know where they are. Will the Minister commit to publish a list of those surgeries and to place that list in the House of Commons Library?

[Jim Fitzpatrick]

I am grateful to my hon. Friend for asking the Minister that question and look forward to his response.

The Jubilee Street and St Katharine Docks practices are the two main affected surgeries in my constituency. They are professional, efficient and well-loved and respected by patients. Jubilee Street says that if its proposals to solve the dilemma are not addressed and no agreement is reached, it will have to give notice of closure by October this year.

Today, I accompanied my right hon. Friend the Member for Leigh (Andy Burnham) and my hon. Friend the Member for Leicester West (Liz Kendall), my colleagues in the shadow health team, on a visit to Jubilee Street to see first hand the problem. At the same time, we launched Labour’s NHS pledge on GP appointments within 48 hours, which I am sure the Minister has noted. What is causing the problem? I will be grateful for the Minister’s views. Is it the shift from deprivation indices to age in the new allocation funding formula from 2012? Is it the elimination of a percentage of the QOF indicators? Is it the seven-year phase out of the minimum income practice guarantee?

--- Later in debate ---

On resuming—

[Jim Fitzpatrick]

I had just asked the Minister three questions relating to what he thinks might be causing the problems confronting our GP practices. The fourth is whether it is because of the range of different contracts negotiated over the past decade, awarding different levels of funding for numbers of patients to different practices; and the fifth is whether it is because there is a shift of funding away from primary care, and, if so, where the money is going. Some 90% of NHS contact with patients is through primary care, but it receives less than 10% of the NHS spend, a point I will come back to later.

I would also be grateful if the Minister indicated who makes the decisions. Practices, in discussion with the local clinical commissioning group and NHS England, have been unable to identify exactly who determines the funding levels. Obviously, it is NHS England that implements ministerial policy, which is why I have an outstanding request to speak to the Minister responsible, who I understand is the noble Earl Howe. I have briefly mentioned that request to the Minister, who kindly said that he would pass on the message and reinforce the request that we have made directly to his office. I would like to have that meeting, and would be accompanied by clinicians and practice managers from Tower Hamlets to put the case.

Tower Hamlets primary care has much to be proud of in the past 15 years; at one point it was the fastest improving primary care trust in the UK. Practices such as Jubilee Street have cupboards full of awards. When I was first elected in 1997, complaints about NHS services and GP practices were numerous and regular, but they disappeared due to the investment by the Labour Government over many years and the dedication and professionalism of clinicians and staff in primary and secondary care.

My own GP practice in Ettrick street on the Aberfeldy estate in E14 is a great example of that first-class service and improvement; I thought that I had better mention it, because if the staff there knew that I was complimenting other practices but left out Dr Phillip Bennett-Richards, Dr Sarah Pitkanen and their colleagues, they would be mightily disappointed.

The local worry is that all that is about to change. Not only have Labour stalwarts such as London assembly member John Biggs—our mayoral candidate—and Councillor Rachael Saunders been on the issue, but local Conservative councillors have been expressing concerns, so the issue is not party political in that sense. I attended a meeting last week at the Mile End hospital with nearly 100 people and many GPs in attendance. I have had numerous e-mails from constituents concerned about what is going on, and I know that my hon. Friend the Member for Bethnal Green and Bow has, too. There are petitions with hundreds and hundreds of signatures springing up all over Tower Hamlets.

All that is against the background of increased pressure. The British Medical Association has said:

“It is estimated that 340 million consultations are undertaken every year. This is up 40 million since 2008.”

As I mentioned, it also said:

“Over 90% of all contacts with the NHS occur in general practice.”

The then-chair of the Royal College of General Practitioners, Dr Clare Gerada, called for

“an urgent increase in general practice’s share of the NHS budget from 9% to 10% so that 10,000 more GPs could be hired, in order to make GPs’ work loads sustainable.”

[Rushanara Ali]

Does my hon. Friend agree that, in a borough such as Tower Hamlets, with high levels of health inequalities, the fact that people cannot get GP appointments for days on end is scandalous? It will devastate people’s lives further and actually cost more, particularly by putting pressure on accident and emergency services while we are having an A and E crisis.

[Jim Fitzpatrick]

I agree entirely with my hon. Friend, and I am sure that the Minister also agrees that if we can treat people in general practice and prevent them from going to A and E, that is a much more efficient use of NHS resources. Her point is valid.

The House of Commons Library has produced for me a table of data on GP funding, which

“shows a shift on the share of funding for general practice from 10% in 2005-06 to 8.3% in 2012-13. The real terms change in spending over the past three years shows a fall of £432 million”.

At the same time, there has been an equivalent

“annual percentage decrease of 2.1% per year”

in GPs’ salaries through the same period.

So there we have it. There has been a 40 million increase in appointments but cuts in the share of the NHS budget; a significant real-terms fall in salaries; huge variation in funding at local level; and crises affecting many local practices in my constituency—some looking at closure, which would be a disaster for some of the most vulnerable people in our country.

I want not just to return to the Jubilee Street practice but to take the issue wider. The NHS deputy head of primary care for north central and east London, Rylla Baker, recently wrote:

“The situation has, unfortunately, developed further and we met with the Jubilee street practice earlier this week. Although the situation with the loss of MPIG”—

the minimum practice income guarantee—

“is, for most practices manageable, when the practices take into account other changes in funding that impact on them, the cumulative impact is significantly greater and practices such as Jubilee Street have said that if there is no mitigation against the loss the practice will not be viable… I have copied in Neil Roberts, Head of Primary Care for North Central and East London and Jane Milligan from the CCG as discussions are ongoing about the best way forward. It is also relevant to point out that this is an issue that is not limited to Tower Hamlets.”

We are hearing of numbers of practices in Hackney and Newham, two other impoverished boroughs, that are facing similar problems.

The Royal College of General Practitioners has said:

“In total, the phasing out of a key NHS funding stream called the Minimum Practice Income Guarantee…could affect a total 1,700 practices with the care of 12.2 m patients potentially under serious threat.”

I know that the Minister is deputising for his colleague Earl Howe—that is why I would like a face-to-face meeting with Earl Howe, or indeed with the Secretary of State—but I am keen to hear his response to the points I have raised. I am sure he has some information and data for us.

In Tower Hamlets, we have some of the poorest and most vulnerable people in the United Kingdom. There is the lowest life expectancy, on average, of anywhere in the UK. It is estimated that between 10% and 12% of residents are not registered on GP lists. Now, this crisis is coming to a head. I look forward to the Minister’s response, but I look forward more to a proper meeting with Earl Howe or with the Secretary of State, and I look forward most to arriving at a solution for the patients, the staff and the clinicians, so that we can protect and continue to provide first-class primary care services in Tower Hamlets.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

It is a pleasure to serve under your chairmanship, Mr Streeter, for what I believe is now the third time, and to respond to this debate. I congratulate the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) not only on securing the debate but on his advocacy on behalf of local patients. We have discussed that before during meetings in my office in the Department on other issues. I am sure that my noble Friend Earl Howe will be happy to meet him, and I extend that invitation on my noble Friend’s behalf.

[Jim Fitzpatrick]

I apologise for intervening so early, but I do not remember having any meetings with the Minister in his office on any subject. I would not want to mislead the House, or for people to think that we had held meetings in which I had not raised this issue.

[Dr Poulter]

A congregation of MPs from London came to see me and I believed that the hon. Gentleman had been there, but I am obviously mistaken. I apologise for that mistake, but I can recall similar conversations in the past during meetings with other MPs from other parts of the country, in which we talked about not just GP services but other local health care services of a similar nature. During those meetings there was advocacy of similar strength to that which we have heard today.

Indeed, a previous debate in Westminster Hall, led by my hon. Friend the Member for Westmorland and Lonsdale (Tim Farron), focused on the impact of the minimum practice income guarantee changes on more rural practices in his constituency. The topic has come to the fore for many hon. Members, who I know will wish to discuss it further with the relevant Minister. I therefore want to put on record a formal invitation to come and see my noble Friend Earl Howe to discuss the subject further at some point after this debate.

It may be helpful if I outline why the minimum practice income guarantee was set up in the first place and why it is important to change the payment structure for general practice. The minimum practice income guarantee is a top-up payment to some general medical services—GMS—practices. It was introduced as part of the 2004 GP contract to smooth transition to what were then new funding arrangements, so it is now 10 years out of date. Last year, we announced that the minimum practice income guarantee will start to be phased out from April 2014. We consider minimum practice income guarantee payments to be inequitable because under the system, two surgeries in the same area serving similar populations may be paid different amounts of money per registered patient.

The MPIG will be phased out over a seven-year period, as the hon. Member for Poplar and Limehouse will know. We are phasing it out to make sure that there is more equity between what different practices in comparable areas receive per patient, and that funding follows the patient more accurately, rather than the practice. I am sure we can all sign up to that in principle. The payments will be phased out gradually with the overall intention that the funding for GP practices will be properly matched to the number of patients they serve and the health needs of the local population.

The money released by phasing out the MPIG will be reinvested in the basic payments made to all general medical services practices. Those payments are based on numbers of patients and key determinants of practice work load such as patients’ ages and health needs—deprivation is of course a driver of patients’ health needs. We are committed to making sure that patients have access to high-quality GP services wherever they live and ensuring that in the same geographical area similar practices receive effectively the same amount of funding for each patient they look after.

It is also worth highlighting the overall impact for practices, both in the country more generally and in London in particular. NHS England has undertaken analysis regarding the withdrawal of the MPIG. Inevitably, a small number of practices will lose funding, and NHS England has considered the very small number of significant outlier practices for which alternative arrangements may need to be made to ensure appropriate services are maintained for local people.

We appreciate that this is a matter of concern for some practices, including some in the hon. Gentleman’s constituency that he has mentioned today. That is why we have decided to use the next seven years to implement the changes to the MPIG, introducing them gradually through a phased transition to a new funding arrangement, rather than taking a big bang approach. Phasing the changes in over that seven-year period will allow the minority of practices that lose funding to adjust more gradually to the reduction in payments.

As the hon. Gentleman highlighted in his remarks, the changes cannot be seen in isolation but should be looked at together with the changes to the quality and outcomes framework payments for GP practices; those changes need to be set alongside the global sum paid to GMS practices. When all those factors are put together, I understand that practices in London with a GMS contract, of which there are 721, will see an overall funding increase of £731,000 resulting from the net effect of all the changes. I will write to the hon. Gentleman to outline that in detail ahead of his meeting with my noble Friend Earl Howe.

[Jim Fitzpatrick]

When we have that meeting with Lord Howe, it would be useful if NHS England could provide the Minister and his officials with an accurate breakdown of figures for the practices in Tower Hamlets. Given the order of deprivation, the chronic ailments and conditions, the age profiles of very elderly and very young people, and the language problems, even NHS England, as I quoted, is saying that the combination of changes to the minimum practice income guarantee and the quality and outcomes framework reductions is creating specific difficulties in Tower Hamlets that are not generally replicated across the rest of London.

[Dr Poulter]

I am happy to write to the hon. Gentleman after the debate to outline the more general points, and I am sure that we can ensure that more specific details are available for him to discuss in his meeting with my noble Friend Earl Howe. NHS England has made it clear that it has been looking carefully at how it can support the practices that are most affected, through its area teams, and I am sure that it will be happy to continue a dialogue with local practices and with the hon. Gentleman to work out how further local support could be given if some practices are struggling as a result of the changes. That offer has been made to those practices that have already been identified as most affected, but NHS England is continually reviewing the matter as a pathway process for phasing in the changes.

NHS England has also suggested that those practices with very small lists, which may be particularly affected, could collaborate through federating, networking or merging with other practices nearby to provide more cost-effective services. It also suggested that it would be possible to identify other ways in which practices might improve cost efficiency, such as reviewing staffing structures and other commissioning or contracting options—for example, how some patient care services are offered in the area by collaboration. Sometimes, back office costs and inefficiencies can be reduced to free up more money for patient care. We must remember that, on the whole, GP practices are small businesses in their own right. We expect NHS England to work with GPs to support best practice and technology, and to encourage general practices to collaborate and work together, and it is happy to do so. It is expected that general practices will do what they can to help themselves, and that NHS England will work with them to facilitate that for them as small business owners.

[Jim Fitzpatrick]

I recognise that there is some logic in the Minister’s suggestion about smaller practices. The Jubilee Street practice has 13,000 patients. It is a big practice and is multi-handed with clinicians and staffing, and is considered to be extremely efficiently run.

[Dr Poulter]

Indeed. I will talk in more detail about Tower Hamlets, but the hon. Gentleman is right to say that it has a long history of collaboration, efficiently run practices and good working between GPs and other community health services to support some of the most vulnerable people in our society and to address specific issues of health care and equality. The hon. Gentleman outlined that in his speech and local GPs should be proud of what they have done and their work and efforts in many cases to help deliver greater efficiencies. Nevertheless, the offer is there from NHS England to engage with area teams to see what more support can be provided. It is keen to ensure that if particular practices believe they are disadvantaged, the teams will do what they can to work with the practices to mitigate that.

It is worth talking briefly about the changes in the quality and outcomes framework. In addition to the minimum practice income guarantee from April this year, we have also made changes to QOF and reduced it by more than a third to free up space and time for GPs to provide more proactive and personalised care for their patients, particularly the frail elderly. One of the great frustrations that we are all aware of—medical staff, health care staff and particularly GPs—has been the amount of bureaucracy that GPs are sometimes required to undertake, which has got in the way of their being able to deliver front-line patient care and spend time with patients. The changes to QOF were welcomed by the British Medical Association and GPs because they will help reduce the bureaucratic burden and allow GPs to spend more time with patients and focus more on personalised care and more vulnerable patient groups. I think we all believe that to be a good thing and a great achievement from those GP contract negotiations.

As part of the QOF changes, we have retired indicators when they were either duplicating other incentives in the health care system, or were of low clinical value and use—for example, if they were just process measures rather than measures linked directly to patient care. We are ensuring that the payment system is strongly linked to delivering better care and improving care for patients rather than to process measures. That has sometimes been a criticism of QOF payments in the past, not least by GPs. Removal of these indicators will help to reduce bureaucracy, unnecessary patient testing and unnecessary frequency of patient recall and recording.

The money released from the changes to QOF will be reinvested in the basic payments made to all general medical services practices, to which I alluded earlier. The global sum will be reinvested through the GP contract and I understand that practices in London with a general medical services contract will overall be net beneficiaries to the tune of roughly £700,000. We welcome that, and I will give the exact figures in my letter to the hon. Gentleman, but I believe that what I have said in this debate is an accurate reflection of the situation.

I turn to Tower Hamlets and will address some of the concerns that have been raised in the debate today. We understand that some practices have particular concerns about the changes to the minimum practice income guarantee and to QOF funding. I assure the hon. Gentleman and his constituents that the Government and NHS England are committed to ensuring that good, high quality primary care for local people, such as his constituents, is a priority. I understand that despite being one of the most deprived boroughs in London, Tower Hamlets has developed some outstanding general practices often as a result of the hard work and dedication of the GPs who want to address health care needs, to look after vulnerable people in society, and to ensure that the health care inequalities that we have discussed are properly addressed. His local GPs and all health care staff delivering care on the ground should be proud of that.

As the hon. Gentleman outlined, Tower Hamlets is top in the country for blood pressure and cholesterol control for patients with diabetes, resulting in reduced complications of diabetes and reduced admissions for heart attacks. It is also top in London for MMR vaccination and for flu vaccination for the over 65s. That is an example of how, even in one of the most deprived areas with some of the greatest health care needs, local GPs, local primary care and local community care are delivering very good results for patients. It is also one of the 14 national pioneers for integrated care, a programme in which primary care will play an increasingly important role. We want to keep people out of hospital and it is vital that they are supported in their own homes and communities. Integrating primary care with community care and effective adult social services care from the local authority will be key in delivering that.

I understand that NHS England’s area team has set up a task and finish group to look at the support that might be offered to practices with membership drawn from local medical committees and the London office of the clinical commissioning group’s chief officers and the local area primary care commissioning team. I understand that NHS England’s area team in London has been in regular contact with individual practices in Tower Hamlets to offer them ongoing support regarding these changes. I am sure that after this debate, that important input and dialogue will intensify to recognise some of the issues that the hon. Gentleman raised.

We also recognise some of the challenges facing small practices in delivering the increasingly wide range of primary care services as more services move from hospital settings into the community. All health services, hospital trusts, community and mental health care providers, as well as GPs, are facing the challenge of meeting increasing demand with small increases in funding. That demand is coming from an ageing population with increasing levels of long-term conditions as well as the costs of new drugs, and patients’ expectations. Those issues are faced throughout the health service, but they are acute in Tower Hamlets. Local GPs recognise the need for flexibility in the way in which future services are provided and we need to support practices to work together to demonstrate how best to use their resources for the benefit of all their patients.

We have announced that NHS England is supporting practices as they phase in the changes to the minimum practice income guarantee and to QOF payments. There is an offer to meet my noble Friend Lord Howe and I know that NHS England will continue to do what it can to support local practices in Tower Hamlets.

Again, I put on the record my congratulations to the hon. Gentleman on securing this debate and to the local GPs who deliver some of the best health care outcomes in England for the patients they look after.

Question put and agreed to.

Rare Diseases

Jim Fitzpatrick Excerpts

Tuesday 17th December 2013 Westminster Hall

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bayley. May I begin by congratulating the hon. Member for Strangford (Jim Shannon) on securing this debate? He mentioned that one in 17 of the population can expect to be affected by a rare disease. I want to speak briefly on two issues: trigeminal neuralgia and headache disorders.

Trigeminal neuralgia is a relatively rare condition, thought to affect less than 0.1% of the population, and that has included me. I secured an Adjournment debate on TN in 2010, seeking, among other things, to raise awareness of the condition.

It is important that the rarity of that or any condition does not exclude it from research, funding and the search for treatments or even a cure, as the hon. Gentleman referred to in his excellent opening remarks. One vital corollary of such research is in getting to grips with misdiagnosis, which is a particular problem when dealing with rare diseases. We need to break the chain of rarity leading to lack of research and knowledge leading to misdiagnosis. Such a chain can mean ongoing misery for the sufferer, when it might otherwise be possible to make breakthroughs that could bring hope and relief to the afflicted.

Of particular importance in the case of rare diseases is the existence of support groups and networks. They are important for all sufferers, as one often finds that the very rarity of a condition serves only to exacerbate the sense of isolation felt by the sufferer. If people do not know what they are talking about, and do not know anyone among their family or friends who suffers from a condition as rare as, for example, TN, it is crucial that one can link up with fellow sufferers, not only to overcome the sense of isolation, but, in practical terms, to share experiences, advice and the latest developments in that field of medicine, surgery and so on.

The Trigeminal Neuralgia Association UK brings together consultants, sufferers, doctors and researchers—indeed anyone with a connection to the disease. It also raises awareness among the public and medical professionals. I know that similar groups exist for other diseases, and all those groups are of immense importance and value to all of us.

I am the chair of the all-party group on headache disorders. We have initiated an inquiry into headache services in England. We have had a number of written submissions and one oral evidence session already, with another to follow in January. Evidence submitted to the inquiry so far indicates that there is significant misdiagnosis and subsequent mismanagement of primary headache disorders throughout England. Sufferers of rare headache disorders, such as cluster headaches, are further disadvantaged by the lack of medical awareness and access to specialists in the UK. The inquiry is looking into the current provision of care for headache sufferers in England and what opportunities exist in the new NHS system to improve care.

The all-party group has heard that misdiagnosis and incorrect treatment for headache disorders place a huge burden on the NHS, for example, inappropriate referrals to secondary care, costly medical procedures, and a high number of unnecessary A and E admissions. That can continue for years and comes at huge personal, financial and economic cost. The patient group OUCH reports high suicide levels among cluster headache sufferers.

Without funding for research into primary headache disorders, little will be done to improve the lives of sufferers or reduce the burden on the NHS and the UK economy. Increased education of health professionals—currently medical students receive only an average of four hours’ training on headaches—and clear treatment pathways are also required to tackle rare headache disorders.

Will the Minister meet officers of the all-party group once a report is published, which will certainly be before the summer recess, so that we can discuss its findings with him and his officials? Obviously we would like to extend that invitation to the shadow Minister. If the Minister is prepared to do that, that would be a welcome response to this excellent debate.

Trigeminal Neuralgia

Jim Fitzpatrick Excerpts

Tuesday 27th July 2010 Commons Chamber

[Jim Fitzpatrick (Poplar and Limehouse) (Lab)]

I am very pleased to have secured this debate, and I hope it might provide some comfort to many people across the UK who suffer from the condition of trigeminal neuralgia or TN. I should declare my interest: I have been a fellow sufferer. It is an interest I would gladly disown and, indeed, I fairly recently had neurosurgery to try to achieve just that—to disown it. I am grateful to the Minister for being in his place, and I am sure that he is as pleased as I would have been in his position to be closing the sitting for the Government before the recess.

If I may, I will outline some background to the condition, because part of the reason for securing this debate was to raise awareness of TN. Then I would like to express a little appreciation for those trying to deal with TN and help the sufferers. I will conclude with a few requests of the Minister, of which I have given him prior notice.

The Trigeminal Neuralgia Association UK—TNA UK—of which I am a member, is a support group for people suffering from an agonisingly painful neurological condition. Trigeminal neuralgia affects one or more of the three branches of the trigeminal nerve in the head and has been called “the worst pain known to man.” It is characterised by sudden, excruciating spasms of electric shock-like pain, usually just on one side of the face. Thankfully, it is a relatively rare condition thought to affect less than 0.1% of the population, although the latest TNA indications are that there are 12.6 sufferers per 100,000 people in the UK. It is more common in women than men, and although it usually affects people aged 50 or over, the association is coming across many younger sufferers, even young children.

I remember my first referral to a maxillofacial consultant at the Royal London hospital. He asked me to describe my symptoms. I told him and the medical students who were with him, “It makes me cry”. “There you are,” he told his team, “a classic definition of the condition. You either have a London bus parked on your foot or you have trigeminal neuralgia.”

Apparently there is nothing new about TN. It has been documented from the times of the Greeks and Romans in the 1st century, but because of its rarity research has been spasmodic and it is still a little-known condition often misdiagnosed due to lack of knowledge among some medical professionals.

The exact cause of the condition is unknown, but it is thought to be as a result of damage to the root of the nerve at the base of the skull where it emerges from the brain stem and often because the nerve is being compressed by a vein or artery. This damage causes the nerve to malfunction and send messages of intense pain to the brain in response to just a light touch on a “trigger” area of the face.

The pain can last from a few seconds to a few minutes, and there can be many bursts of pain in quick succession. Many patients suffer for months or years without correct treatment, and even undergo extensive, unnecessary dental work before the condition is correctly diagnosed. There can be periods of complete pain remission, but these gradually become shorter and shorter, and patients therefore live in constant fear of a severe attack of debilitating pain.

Any facial movement, such as eating, talking, smiling or kissing, shaving, washing the face or brushing one’s teeth can provoke an attack, and that can completely destroy any quality of life. There were several occasions in this place when I was preparing to speak and was fearful that I would be prevented from doing so because of the sense of an impending attack. That might have improved others’ quality of life in not having to listen to me, but for some patients being unable to live normally leads to their becoming isolated and depressed, sometimes to the point of suicide.

Normal painkillers do not bring any relief and initially anticonvulsants used to treat epilepsy are prescribed. However, these often have unpleasant side effects and lose their efficacy with time so ever larger doses are required. When the medication is no longer effective, or if the side effects cannot be tolerated, various surgical procedures can be considered, although these carry a risk of complication and results are not always long lasting. The data on the success of surgical procedures are only now being assessed and will be more accurately evaluated in the future. The most effective operation is a micro-vascular decompression or MVD—major surgery that involves moving the offending blood vessel or vessels away from the nerve, close to the brain stem. Unfortunately, TN has a habit of recurring, and even this operation does not always deliver long-term relief.

I should at this point express my sincere thanks to the excellent Mr Neil Kitchen and his first-class team at the national hospital for neurology and neurosurgery in Queen’s square, London. He operated on me last December, and I am happy to say that since then, when I was in considerable distress, my condition is much improved and my need for medication is now minimal. I should also say thank you to my wife, Dr Sheila Fitzpatrick, without whose care, love and attention a difficult experience would have been much more painful.

The Trigeminal Neuralgia Association was formed in 1999 by a patient and a doctor, Professor Joanna Zakrzewska. It specialises in treating TN, offers support and encouragement to sufferers, and became a registered charity in 2002. Professor Zak, as she is fondly known for obvious spelling and articulation reasons, is a beacon of hope to all TN sufferers. Worldly and wise, she is the essence of reassurance, and on her own or sometimes allied to Mr Kitchen and other surgeons, she offers sufferers real hope.

The aims of the association are to continue to provide information and offer support to members, and to raise awareness of TN among medical professionals and the general public. TNA UK receives no Government or corporate funding and is entirely dependent on membership fees and donations. All the association’s officers give their time for free, and TNA UK is now in contact with more than 1,000 patients, receiving many new inquiries each week. The officers of the association—the tireless chairman Jillie Abbott, supported primarily by Mr George Cunningham, a former hon. Member and treasurer of TNA UK, and membership officer Mr Clive Clifton—and numerous other generous individuals volunteer to spread the word, helping sufferers and raising awareness. They are all very much appreciated because of their efforts. The association can be reached by searching the web for TNA UK.

I mentioned earlier the misdiagnosis of TN as dental problems. I am pleased to report that the British Dental Association has acknowledged that its members can help in this regard. I am told that it plans to commission an article on facial pain for its British Dental Journal, and is considering a session on facial pain at next year’s BDA conference. We in TNA UK will be happy to do all we can to assist with that, and we are grateful to the BDA for looking at the issue so seriously. I have also written today to the BDA to seek confirmation of the initiatives.

I would be very grateful if the Minister advised the House on the following matters. In his briefing for this debate, have his officials acknowledged that there is an awareness issue? Notwithstanding the rarity of the condition, greater familiarity among medical and dental practitioners would save money and, more importantly, reduce suffering. TNA UK is not asking for funding, although that would be welcome—if the Minister has his cheque book, we would like to see it.

As I have said, the association volunteers work very hard. However, can the Minister advise whether there is anything that TNA UK can do to help additionally promote awareness of trigeminal neuralgia within the NHS family? Is there anything that the NHS can do specifically to support Professor Zak in her research into the condition and surgical outcomes? Finally, TNA UK and individual sufferers would welcome any advice that the Minister might have in respect of their condition and how their overall situation might be improved.

I am grateful for the opportunity to have this debate and I look forward to the Minister’s response.