Spinal Cord Injuries

Jim Shannon Excerpts

Wednesday 4th September 2013 Westminster Hall

[Ian Lucas]

I was just talking about the extraordinary work of the Midlands Centre for Spinal Injuries, which I witnessed some years ago and which continues. In connection with the immediate response to serious accidents where people have spinal cord injuries, a miraculous transformation can be carried out, provided that the right level of care is offered by specialists in the immediate aftermath of the accident.

The continuing effects of spinal cord injuries are important, and I want to concentrate on those today. Spinal cord injury results in a combination of the loss of motor, sensory and continence function, making it unique among long-term conditions. It is also a non-improving condition. Once rehabilitation is completed and health care needs have been identified, they are unlikely to decrease. Indeed, they are likely to increase over time, with complications brought on by ageing and as the condition continues. It is essential, therefore, that needs are well managed by a dedicated and trained team who understand spinal cord injuries. That will ensure that health complications and significant cost implications for the national health service are avoided or minimised.

How care is administered is a major concern to many people living with spinal cord injuries. It is not just the individual who is affected by the spinal cord injury; often, the family and the immediate community around that individual must cope with profound pressures. There is an increasing worry that health care provision is becoming a postcode lottery, with clinical commissioning groups interpreting the national framework differently to meet their budgets, rather than the specific needs of spinal cord injury patients.

The landmark legal case of Pamela Coughlan in 1999 set a precedent for how patients with a certain level of injury should expect to be treated. Ms Coughlan, a C5/C6 complete tetraplegic with no significant additional health needs, took her primary care trust to court when they attempted to transfer care provision responsibility from NHS continuing health care, within which health care is free, to the local authority, where charges may have applied.

[Jim Shannon (Strangford) (DUP)]

The hon. Member for Wrexham and I spoke beforehand about this issue and I wanted the information to be recorded. Perhaps the Minister will take it on board as well.

We have a specialised 15-bed unit that looks after the whole of Northern Ireland and its population of 1.7 million people. That unit has everything: trauma, orthopaedics, neurosurgery, neurology and an intensive care unit. There are dedicated teams for physio, nursing, occupational therapy, social work, psychology, dietetics, art therapy and complementary therapies. All that happens under one roof for all the people in Northern Ireland. The hon. Member for Wrexham said to me, “That is the sort of thing we need in my area.” I wanted to put that case on the record. Perhaps the Minister could look to Northern Ireland as an example of something that has been done and done well.

[Ian Lucas]

I thank the hon. Gentleman.

Going back to Ms Coughlan and the issue of continuing care, the ruling found that patients with a certain level of spinal cord injury have health care needs of a “wholly different category” than can be legitimately provided for by a local authority. These are profoundly and almost singularly serious conditions. Even spinal cord injured people with greater health needs than Ms Coughlan are finding themselves assessed as ineligible or seeing their care packages severely restricted, without any evidence of reduced need.

As local health budgets for continuing health care are being squeezed and, in many cases, reduced, many of these people are experiencing reduced care packages and unfair, and potentially unlawful, decisions on eligibility for continuing health care. There are many examples of continuing health care packages being denied or dramatically reduced after reassessments, without evidence of clinical improvement.

One individual who has been affected is John Burns. He addressed the all-party parliamentary group on spinal cord injury last year, and it is occasions like that that show the importance of all-party parliamentary groups. They allow individuals such as John to speak to Members of Parliament and explain the difficulties.

John, who is married with three teenage sons, is a C2 tetraplegic following a water sports accident while on holiday with his family in 2007. Due to the extent of his injuries, John was initially put on a ventilator and awarded NHS continuing health care. After a period in a spinal cord injuries centre, John was discharged into a care home and was successfully weaned from his ventilator. Although he remained paralysed from his neck down, his continuing health care funding was consequently withdrawn, and he was told to expect to remain in a nursing home for the rest of his life. Without the appropriate funding, John was unable to receive the care and support he needed to be with his family and return home. He described that period as being like a “prisoner,” as he was denied time with his wife and sons in his own home. That is the type of individual that we, as a community, should be aiding, rather than denying them health care.

In a meeting with the Spinal Injuries Association, the then Minister of State with responsibility for care services, the right hon. Member for Sutton and Cheam (Paul Burstow), expressed concern about John’s case. Thanks to the involvement of the Spinal Injuries Association, an independent nurse was assigned to assess John’s case and immediately argued in his favour that funding should be reinstated. Yet John had to go through that process to restore the care that had been taken away from him. One can imagine the worry and distress experienced by John and his family during that period.

Despite the precedent of the Coughlan judgment, a large number of spinal cord injured individuals with health care needs demonstrably equivalent to or even greater than those of Pamela Coughlan are still denied NHS continuing health care. The culture of ineligibility continues. What action is the Minister taking to ensure that, where appropriate, spinal cord injured people have access to NHS continuing health care and that the legal ruling is adhered to? Is there a process for monitoring the level of care that individuals with severe spinal cord injuries are receiving from their immediate provider? How will the Department monitor the level of provision that is being given?

The Government must ensure that locally produced policies do not impose inappropriate and potentially unlawful care packages on a spinal cord injured person. Will the Government ensure that clinical commissioning groups adhere to the Coughlan judgment when deciding NHS continuing health care eligibility for spinal cord injured patients? Does the Minister believe that there should be a presumption of eligibility for tetraplegics when determining continuing health care? In addition to their injuries, such individuals and families should not have imposed on them the burden of worrying whether the care they received in the past will continue.

There is also concern that multidisciplinary teams assessing spinal cord injured patients for continuing health care frequently exclude health professionals with expertise in spinal cord injury when reaching their decisions. Along with the judgments that set legal precedents for NHS continuing health care, such as the Coughlan judgment, assessors and decision-making panels must carefully consider evidence from spinal cord injury clinicians and health care professionals from the NHS spinal cord injury centres. It is important that those individuals, who are so skilled in providing care, have input into the process of deciding what care the NHS is to supply in future. Will the Government take action to ensure that health professionals with expertise in spinal cord injury are included in multidisciplinary teams throughout the process?

There have been instances in which local commissioners have introduced policies that randomly restrict the amount of money available for “care at home” packages to the cost of non-complex care in a nursing home, disregarding the special care needs of spinal cord injured people and their right to family life. In an increasing number of clinical commissioning groups, local implementation policies place restrictions on the size of “care at home” packages, often based on arbitrary caps set against the equivalent cost of a placement in an establishment such as a nursing home. That has happened, for example, in the Sheffield clinical commissioning group cluster and in north-west London despite Department of Health practice guidance outlining the rights of people to choose where to live and to take risks, and despite the court’s indication that an individual’s human rights need to be balanced against cost.

The excellent spinal research charity Aspire commissioned Loughborough university to independently consider the impact on people with spinal cord injury of being discharged to nursing homes. The research found that living in a nursing home has a damaging psychological and physical impact on people with spinal cord injury. Spinal cord injury patients should not be expected to live in institutions rather than with their families. Generally, such people view care homes as a last resort.

The individual must be at the centre of the assessment process. Improving the implementation of NHS continuing health care will benefit its members, the clinical commissioning groups and the wider spinal cord injury community. Such issues affect people across the UK. They cause families and individuals profound worry, and they must be addressed urgently. The legal ruling must be adhered to, and the culture of ineligibility must end.

Tobacco Products (Plain Packaging)

Jim Shannon Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Member for Harrow East (Bob Blackman) for bringing this important matter to Westminster Hall for consideration.

I put a question to the Minister in June in which I referenced the fact that, when a patient is ill and visits their GP, they do as the doctor orders. One hundred thousand people will die of lung cancer this year and doctors support the campaign for plain packaging, so the question I put to the Government today is, when will they do as the doctor orders and bring in plain packaging for tobacco?

Numerous individuals, as well as groups such as Action Cancer and Cancer Research UK have contacted me. Schoolteachers have asked me to support the introduction of plain packaging in the hope that some of the cool factor will be lost and children will not take up the habit. Government research shows some 567 children start smoking every day. Half of those go on to become regular smokers, who will die as a result of their habit, despite anti-smoking advertising campaigns, attempts to educate children at school about the dangers and the fact that it is now illegal to sell cigarettes to anyone under 18 in Northern Ireland.

After much research, Cancer Research backs standardised plain packs due to the evidence that such packaging will help to save lives as part of a comprehensive tobacco strategy. No one here is claiming that it is the answer and will stop people smoking, but it can be and must be part of a campaign to save lives. Eight in 10 smokers start smoking by the age of 19 and 207,000 11 to 15-year-olds become smokers each year.

[Ian Mearns]

I hope that the hon. Gentleman agrees that marketing and advertising aimed at reaching young people on their birthday when they can buy and smoke legally for the first time will also have an effect on those who are only 13 or 14. From a marketing perspective, they are in the same age bracket.

[Jim Shannon]

I thank the hon. Gentleman for his intervention. It is clear that cigarette companies target young people and we need to address that. Cancer Research points to substantial evidence that shows advertising and promotion drawing young people into smoking and that packaging is an important part of tobacco promotion.

Standard packs would build on the success of the advertising ban. Eighty five per cent. of people back Government action to reduce the number of young people who start smoking and 63% of people support standard packs, with only 16% opposed. One hundred and ninety health organisations support standard packs, including the royal medical colleges and health charities, as well as the World Health Organisation.

I was not aware that we waited for countries, such as Australia, to implement initiatives before we would do so in the UK. It was my impression that we sought to lead the field in safety. Even if we are waiting on smoke signals, or hopefully a lack of smoke signals—forgive the pun—from Australia, research from Cancer Research that is making its way back from Australia shows early indications not only that the policy is making cigarettes appear less appealing, but that there is no evidence of problems for retailers.

I spoke to my colleague, Northern Ireland Health Minister, Edwin Poots, about the issue and he said that he fully supports the concept of plain packaging. He further told me that it was essential that there is a UK-wide scheme to tackle smoking.

[Roger Williams]

Will the hon. Gentleman give way on that point?

[Jim Shannon]

I cannot. I urge the Government not to put off the measure by waiting to get the all clear from Australia, when too many people are not getting the all clear from lung cancer and other diseases. Take the steps necessary. They might prevent some of the 567 children who may start smoking today, every day and every week, from doing so.

Brain Tumours in Children

Jim Shannon Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

Will the hon. Gentleman give way?

[Mr Raab]

I will just make a small amount of progress before giving way, because I do not want to give a disjointed account.

David’s case is tragic and moving, but it is not a one-off; that is why we are here in Westminster Hall today. The cases I have mentioned are not isolated incidents. Each year, 500 children are diagnosed with a brain tumour and brain tumours take three young lives every fortnight. Brain tumours kill more children in this country than leukaemia does; only traffic accidents take more young people’s lives than brain tumours. Brain tumours pose as great a danger to our children as meningitis, and yet most parents and doctors have at least a rough idea of how to identify the symptoms of meningitis. Of course, it is not just those children who lose the battle with a brain tumour who suffer. Of the children who survive a brain tumour, 60% of them are left with life-altering disabilities, including blindness and brain damage.

[Jim Shannon]

I congratulate the hon. Gentleman on bringing this matter to the House for consideration; it is a very important issue. He will be well aware that it is better for a child to be diagnosed with a brain tumour in the United States of America, for instance, than in the United Kingdom; to be precise, it is three times better. One reason why the United States does better in its diagnosis of children with brain tumours is that education and health work together there. Does he feel that perhaps what the Minister could do here is to have better co-ordination between staff in schools and the health system, to achieve better early diagnosis?

[Mr Raab]

I thank the hon. Gentleman for his intervention, and he is absolutely bang on. I will come on to discuss the three specific measures that are key as part of that co-ordination.

Many of these tragedies could be averted. Whether it is preventing avoidable deaths or limiting the permanent damage inflicted by brain tumours, early diagnosis is the key, as has already been said; I suspect that there will be consensus on that.

Managing Risk in the NHS

Jim Shannon Excerpts

Wednesday 17th July 2013 Commons Chamber

[Ann Clwyd (Cynon Valley) (Lab)]

As on six previous occasions, I shall read from testimony showing a lack of care and compassion from the 2,500 people who sent letters and e-mails to me.

The family of an 89-year-old patient wrote:

“During our daily visits, we had to locate a cup from the kitchen on the ward in order to give her some fluid. She never had a drink of any sort within reach. This resulted in severe dehydration, which was apparent by her sunken eyes, dry, scaly skin, fatigue and her unquenchable thirst when we provided her with drinks. The staff informed us that she was not eating but we found she would eat any food we brought in for her. Whilst in bed the staff neglected to move her on a regular basis and this resulted in circulatory problems and ultimately necrosis of both feet. She also developed many infections…the wound on one heel was so advanced that the bone was visible.”

A man whose son suffered further brain damage due to lack of care said:

“He was left lying in his own urine, faeces, etc. He was left without fluids for over 12 hours then he had a huge seizure. The doctor would turn up at 5 o’clock stating ‘What’s the plan for today?’ when the day was clearly over…I witnessed nurses allowing drugs and feed to go to the floor…the floor was in such a state my feet were sticking to it. You can’t blame the cleaners for MRSA!”

A woman writes about her father’s death in hospital:

“I used the term ‘conveyer belt to death’ at the time we lost our beloved dad. On that chaotic Friday afternoon, when all the Consultants and senior staff are dashing off for an early week end finish, a poor young doctor was pushed into our path by one of these Consultants from the palliative team and uttered the immortal words that will stay with me—“Is Tuesday OK?”…I only twigged later that night that that was the date to cancel any care and pull the plug.”

A woman writes of her father’s experience in hospital:

“I’ve tried to find out what he’s eating and how much but no one seems to know and the nursing staff just tell me they have too many plates to clear to remember who was eating what. My Dad is wasting away in front of my eyes and they just keep telling me they’re too busy to help. My Dad is 76 and he has always been fit and well but I’m fearful now that he will never come home from hospital alive.”

Another woman wrote:

“Having continually pushed for the best care available during his time there, it seemed that complaining wouldn’t make any difference, other than making me relive every humiliation, discomfort, stupidity and indifference…My father spent a month in hospital, and he said it was worse than his experiences in the Second World War…We watched one man fading away, naked apart from a soiled nappy, in full view of visiting families.”

The wife of a whistleblower wrote:

“My husband was a senior nurse who recorded what he considered to be gross ill treatment of patients to his senior Consultant…he was subjected to prolonged bullying campaigns and subjected to pseudo disciplinary procedures. He was supported by the RCN who managed to keep him in his job…To cut a long story short, after six years of abuse, stress and fear my husband suffered a major stroke while working at the hospital. He was later subjected to a vicious attack”

by the management

“at his back to work interview. He retired from the NHS on medical grounds. He was 46 years old. He lost the job he loved. The NHS lost a highly skilled super intelligent practical nurse who loved his patients and worked hard for them. His colleague who supported him lasted a bit longer but was also forced into retirement after her health was destroyed by bullying because she also witnessed and reported the abuse of patients”.

[Jim Shannon (Strangford) (DUP)]

The right hon. Lady is telling us some very compassionate and emotional stories. Does she feel that the voice of families, which she has illustrated very well, needs to be heard more by management and staff, and does she feel that the process should be improved to enable that to happen?

[Ann Clwyd]

Many people are afraid to complain. Some complain many years later, and some never do so at all. It must be made easier for people to complain.

Organ Transplants

Jim Shannon Excerpts

Wednesday 17th July 2013 Commons Chamber

[Kate Green (Stretford and Urmston) (Lab)]

Last week was national transplant week, and the NHS highlighted an important campaign to increase organ donation. Donor rates have, pleasingly, increased by 50% since 2008, but although almost every one of us would accept a donated organ if we needed a transplant, only 57% of relatives agree to organs being retrieved. However, that proportion rockets to 95% if the deceased has discussed his or her wishes in advance with family members. Some 19.7 million of us are on the organ donor register, but three people still die each day while waiting for a transplant, so I wholeheartedly support the efforts of NHS Blood and Transplant to increase the number of organs donated. I add my voice to those who advocate an opt-out scheme.

Having met and talked to transplant survivors, I can testify to the immense gratitude that they feel to donors who have literally given them a new lease of life, but donation is only half the story. Although the selection and allocation of organs for transplant is much less widely discussed, it is also a complex and controversial issue.

A few weeks ago, I met my constituent, 18-year-old Natalie McCusker, who had been on the waiting list for a lung transplant for 19 months. She described to me what it is like to live in a state of limbo waiting for a suitable transplant. She has been too unwell to go to school, although her school arranged for her to participate in classes via Skype. She wanted to study sciences, but could not because oxygen cylinders and science experiments do not mix. As a young girl, she had enjoyed and been very good at sport, but that has become impossible since she became too ill. The effects on her family have also been profound; for example, her mum has taken a five-year career break.

Natalie was first told that she would need a transplant when she was 15. She initially hoped it would be carried out at Great Ormond Street children’s hospital, but people transfer to the adult register at the age of 16, so she was advised to delay transplant surgery until she moved to the adult list.

When Natalie first moved on to the adult system, she was able to access treatments that are deemed unsuitable for children. At first her condition improved, but seven weeks after taking her GCSEs, she became much more unwell. She was eventually listed for a transplant in November 2011. I completely accept that there are different clinical demands when treating children and adults, and that there is a need for separate systems. However, from the patient’s point of view, it seems that the transition may lengthen waiting times, and it also means that a new relationship of trust and confidence must be built up between the patient and new teams of clinicians.

[Jim Shannon (Strangford) (DUP)]

I am grateful to the hon. Lady for bringing the matter to the House. I have a particular interest in organ transplants and donation because I have carried a card since I have been able to do so. In Northern Ireland, we carried out about eight transplant operations in 2008, but now in 2013 we carry out more than 50 a year—almost one a week. That has happened not only because those who carry the card pass on their organs when they die, but because we have the largest number of live donors in the whole of the United Kingdom—far above the average for England and Wales. If more effort was made on live donors, it could help to address the problem faced by the hon. Lady’s constituent. The evidence from Northern Ireland indicates that the longer one is on a donor list, the less one’s health deteriorates, so perhaps the Minister will address that point when she responds to the debate.

[Kate Green]

I note with interest what the hon. Gentleman says and I am sure that the Minister will want to respond to that point. Obviously, we would want to explore all methods of increasing the number of donor organs available. We should bear it in mind that one person may donate up to nine organs following their death.

I was talking about the crucial importance of a sense of trust and confidence between patients and clinicians. For a course of treatment as massive and life-changing as transplant surgery, that is certainly no trivial matter. I cannot suggest any easy answer to that, but my first point to the Minister is to ask her to consider ways in which the disruption of the transition process between childhood treatment and the adult list could be minimised, with a particular interest in ensuring that waiting times are not extended unnecessarily.

There are other concerns relating to the allocation of organs for those on the waiting list. The current process for allocating hearts and lungs for transplant is based on dividing the country into a number of zones. That means that if someone lives in one zone and a suitable organ becomes available in another, they might not receive it simply because they are on the wrong waiting list. In following a rigid zonal approach, important considerations of equity across the country could be neglected. A patient can be registered on only one list, and the result can be a postcode lottery for treatment.

Patients in my region, the north-west—it is your region, too, Mr Deputy Speaker—wait the longest in the country for lung transplants: over 400 days in Manchester, compared with under 200 in Cambridge. According to a written answer I received from the Minister on 15 May, between April 2008 and March 2011 62.2% of patients in the north-west waited more than six months for a lung transplant, compared with an England average of 47.3%, and 23.2% of patients in the north-west waited more than 18 months for such a transplant, compared with an England average of 15.8%. The north-west also has among the highest death rates for those on the waiting list for a lung transplant—between 20% and 30%.

I believe that we need to look again at the operation of the zonal system so as to get the balance right between the underlying issues of urgency, geographical proximity between donors and recipients, and waiting times. The most urgent cases should clearly take priority. One approach could be to treat urgent cases on a national basis and, if no urgent case exists, to allocate on a zonal basis. If that approach were adopted, zones would need to be more dynamic. In other words, if the waiting list grew the zone would also expand to give access to more organs.

More radically, we could move to a fully national allocation system, whereby patients could be matched with suitable organs across the country. I recognise that geographical considerations are of course important, not least if the ischemia time, the time between organ retrieval and transplant, is integral to the success of the operation. For heart transplants, in particular, it very often is, and the system for heart transplants in fact appears to work effectively. That seems to be much less true for lung transplants. Equity is also a consideration. It is of course important to have regard to the interests of those who have been on the waiting list the longest, and that really should not be dependent on where someone lives and which list they are on.

I understand that the NHS is now considering whether to move to a national registration system, which would be fairer to patients in regions such as ours. In the US and much of Europe this approach has already been adopted or is being considered. The evidence suggests that it could achieve greater equity without any increase in mortality rates, or indeed cost.

So what is the block? Inertia and convenience undoubtedly play a part. I acknowledge that there is already better sharing of organs between zones when a suitable match cannot be achieved within a zone, but it seems that some transplant centres might be more interested in building up the scale of their own activities rather than progressing the idea of a national scheme that could deliver greater equity for all patients. Progress towards delivering a national list scheme in this country is proving painfully slow.

What steps are being taken to make progress towards a more equitable national scheme of allocation, and what is the Minister’s attitude to the development of such a scheme? What work, if any, is being done to develop a national approach, and over what time scale might progress be expected? How best can we make use of technology and the sharing of data to facilitate the allocation of organs between zones? What learning and best practice can be adopted from other countries? What incentives would encourage a more equitable system of allocation between transplant centres and protect or improve outcomes for patients?

I am very pleased to report that Natalie had a successful lung transplant two weeks ago. She is growing stronger every day and it is hoped that she will be well enough to return home next week. She and her family are of course absolutely delighted and hugely appreciative of the treatment she received from the transplant team at Wythenshawe hospital. However, for 19 months, while waiting for her transplant, her life was put on hold. Perhaps that wait could have been shorter if she had not been restricted to a single zonal waiting list. Yesterday she wrote to me to say how pleased she is that this debate is taking place in Parliament, which she says she hopes will help “to achieve something that will in future benefit the thousands of people that will need life saving transplants.”

I hope that the Minister will be prepared to commit tonight to working towards a national system of organ allocation that offers equity of access to organs for transplantation and rapid progress towards achieving this. I am very grateful for the opportunity to raise this matter and look forward to her response.

--- Later in debate ---

[Anna Soubry]

As the hon. Lady has anticipated, I do not have the answer to that question in my brief, but I will make sure that she receives a proper answer.

Over the past five years, we have been strengthening the donation infrastructure by implementing the 14 recommendations of the organ donation taskforce, which were published in 2008. Is it not nice that in this sort of debate we can pay tribute to another Government of a different political persuasion? We are all united on this issue; it is not a party political issue and it is always a pleasure to take part in these sorts of debates.

The number of donor co-ordinators across the United Kingdom has nearly doubled. They are working closely with intensive care clinicians and families to identify potential donors and obtain consent. As I have said, it is difficult work but, goodness me, what a difference it can make when it is successful.

We have appointed clinical leads and established donation committees and chairmen in all trusts. This has driven improvement in hospitals, optimising the potential for organ donation. I am delighted that we have achieved an increase of 50% in organ donor rates and of 30% in transplant rates over the past five years, helping many more people to have the transplant that they so desperately need. We need to do more, however, to enable many more people like Natalie to receive the organ transplant that in many circumstances will save or enhance their life.

On 11 July, NHS Blood and Transplant published the new UK strategy for organ donation and transplantation. “Taking Organ Transplantation to 2020” sets the agenda for increasing organ donation and transplant rates to world-class standards over the next seven years by aiming to improve consent rates to organ donation to more than 80%—they are currently 57%—and transplant more organs and increase the number of people receiving an organ. The strategy calls for a revolution in public attitudes and behaviours, and emphasises the importance of individuals and families agreeing to donation. That important work needs to take place irrespective of someone’s background, ethnicity, religion, faith or whatever else. We need to ensure that more people in all parts of society sign up to donate their organs and that we are able to persuade people’s families to allow their organs to be donated upon death.

[Jim Shannon]

The Welsh Assembly has recently taken a decision on organ donation, which is a positive step. Is it the intention to consider having that system in England, because that might help the hon. Member for Stretford and Urmston (Kate Green) in her quest?

[Anna Soubry]

The Welsh Government have introduced legislation under which people will have to opt out. We need to work with the Welsh Government to ensure that that system works, because there are concerns about the effect it will have across the United Kingdom when one country has people opting out as opposed to opting in, as in the rest of the United Kingdom.

The independent organ donation taskforce examined the case for moving to an opt-out system in 2008 and its recommendation was against such a system. Spain had an opt-out system, but I think that it has now rejected it. In any event, it no longer has an opt-out system. I know that because I had a conversation with Spain’s Health Minister at a recent EU conference, as one does at such events, where people learn from each other, which is extremely useful. Spain has one of the highest uptake levels for organ donation and there is an awful lot that we can learn from it.

When people apply for a driving licence, they can now tick a box to sign up for organ donation. That has its value. I think we should take every opportunity to encourage people to donate. However, if people are applying for a driving licence, there will be a tendency to skip that box because they want to get on with filling in the form.

I will be quite frank. When I got this job, ITV ran an excellent campaign for about a week in which it encouraged its viewers to sign up to be donors. I suddenly realised that I did not have a donor card. I was informed by my brilliant officials that I did not need a donor card and that all I needed to do was go online. I went online and signed up extremely easily and quickly. I was highly impressed by that system. I would not have known about it if ITV had not run that campaign. There are many opportunities to encourage and positively enable people to sign up and donate.

I will keep an open mind on the opt-out system. We will look at what happens in Wales. We may well have a great deal to learn from it. It may be that that system, which the Welsh Government have great hopes for, will be successful and that, in looking at it, we will form a different view. It is important to keep all one’s options open.

As I was saying, NHS Blood and Transplant announced its new strategy on 11 July. It has a new chair who is full of vigour and who I am sure will do an extremely good job.

In conclusion, transplantation offers many people the opportunity of life and enhances the lives of many others. I am delighted that Natalie has had that opportunity and we all wish her a long, happy and healthy life. We have made significant progress over the past five years and we must thank all the families of donors for agreeing to or supporting donation and giving the gift of life at such a terrible time in their own lives. We want to build on that progress and increase our donation and transplantation rates up to 2020 to match the world-class performance in many other countries. There is no reason why we cannot do as well as the Spanish or even better. We will continue to monitor the procedures in the United Kingdom for the selection and allocation of organs, and to consider whether changes to the allocation of organs need to be made to ensure equity of access for all people on the national waiting list.

I hope that the hon. Member for Stretford and Urmston, whom I congratulate again on securing this debate, has been heartened by the points that I have made. If there are any questions that I have not answered, I will of course write to her, unless she wants to make a quick intervention before I finish. She seems content and I am grateful for that.

Question put and agreed to.

Oral Answers to Questions

Jim Shannon Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

My hon. Friend is right to point to the fact that we estimate that we collect less than half the money for which we invoice for “overseas operations” and we identify fewer than half the people who should be invoiced in the first place—that applies in respect of those from inside the EU as well as from outside the EU. We can get refunded for the care we give EU nationals if we are sensible about collecting this money and we put those systems in place. Given the pressures in the NHS, we are absolutely determined to make sure we do so.

[Jim Shannon (Strangford) (DUP)]

I thank the Secretary of State for his statement. Last year health tourism cost the NHS £24 million—that was in one year alone. He has outlined the new system coming in, but will he say how it will be administered? Many of us feel that it might not be as easy to do in practice as it is on paper.

[Mr Hunt]

The hon. Gentleman is absolutely right. If this is to work, we need a slick system that is easy for hospitals to operate. We have done this in another area, as the NHS successfully and seamlessly invoices insurance companies for the costs of coping with road traffic accidents. At the moment, however, if hospitals declare that someone is chargeable for their NHS care, they do not get paid by the NHS for that care, meaning that they have to collect the money themselves from overseas, so the incentives for hospitals are wrong and we need to sort them out.

Hospital Mortality Rates

Jim Shannon Excerpts

Tuesday 16th July 2013 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

High mortality rates are unacceptable and their effect on people’s confidence in, and satisfaction with, the NHS is a problem. We in Northern Ireland are fortunate that there have not been such disclosures, but it is important that lessons can be learned. Does the Secretary of State intend to share the data and findings with regions of the United Kingdom and the devolved Administration in the Northern Ireland Assembly?

[Mr Hunt]

When there are excess mortality rates, there is some controversy about exactly how many avoidable deaths they correspond to, which is why Professor Keogh has asked Professor Nick Black and Lord Darzi to carry out a further study to try better to understand the link between excess mortality and avoidable deaths. We will be happy to share that information with the devolved Administrations.

Herbal Medicine (Regulation)

Jim Shannon Excerpts

Tuesday 9th July 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Bosworth (David Tredinnick) on bringing this matter to the Chamber for consideration. Many of us have herbal shops in our constituencies. We are aware of their good work, and that has been backed up in interventions today.

I have been contacted about the issue by a small local health food shop in the main town of my constituency, Newtownards, and by numerous patrons of that little shop who benefit from it. That is the point I want to make. The issue is clear: if EU interference continues, it will put businesses out of operation and people out of jobs, and it will result in more people searching the internet for remedies that may not be safe. That will not bring about any benefits. The EU lingers like a shadow over almost everything. Regulation is needed, but it is also necessary for common sense to prevail, and the balance may be difficult to achieve.

[Mr Gregory Campbell (East Londonderry) (DUP)]

My hon. Friend has touched on the crucial point of the debate. Balance is needed to try to avoid people accessing unauthorised, unprofessional and perhaps harmful products, but to enable them to access products made by professional herbalists that they believe and evidence shows improves their condition. We must ensure that we get the balance right between the pursuit and prosecution of those who engage in bad practice and the promotion of those who engage in good practice.

[Jim Shannon]

My hon. Friend has gone to the crux of the debate in those few words. It is about getting a balance between allowing people to continue to use their herbal medicines and ensuring that they do not indulge in anything outside that.

I beg your indulgence, Mr Bone, because I would like to take this opportunity to highlight the save our supplements campaign, which has been well publicised. We should all be aware of the goals of that campaign and the ramifications for today’s topic of regulation. The issue that is causing concern in health shops is maximum permitted levels. It has been suggested to me that interference by Brussels—the shadow of Europe is almost like the grim reaper who hangs over everything that we do in the House—will set low doses for dietary supplements, so removing choice from consumers and adversely impacting on high streets.

[Mr Hollobone]

It would not be a Westminster Hall debate without a contribution from the hon. Gentleman, and I am enjoying it hugely. I am all for bashing Brussels and agree that there is no need for the EU to interfere with the issue, but the EU has given this country a way to address the matter through the establishment of a statutory register, which the present Government undertook to do by the end of 2012. Surely, there is complicity in the Department of Health, and we need the Department to explain why it has not fulfilled that undertaking.

[Jim Shannon]

I thank the hon. Gentleman for his valuable intervention, which gets to the crux of the matter and makes a point that I will come to later. We have an opportunity to address the issue, and I hope that the Minister can put the record straight when he responds.

Some high street health food shops are struggling to compete with internet retailers, which often offer a cheaper price, even though, more often than not, the product is inferior. Again, that uncertainty must be addressed. We have been made aware of the facts through previous speeches and interventions on the subject. For example, in a statement on the regulation of herbal medicine and traditional Chinese medicine, the Secretary of State said that he aimed

“to have the legislation in place in 2012.”—[Official Report, 16 February 2011; Vol. 523, c. 77WS.]

We are very aware of that and are wondering why it has not been done. Will the Minister indicate what is going to happen?

I have not been in Westminster long—I am one of the new intake from 2010—but I realised early on that things do not happen in a flash. However, “subject to parliamentary procedure”, should, in my opinion, not involve such a delay. I share the concern of my constituents and of Members present that the issue has been hijacked by EU regulations. In conjunction with the hon. Member for Bosworth, I reiterate that that was never the intention. Let us get the legislation working in Westminster and ensure that it delivers for our constituents.

The idea of the legislation is to ensure that people are licensed to sell and offer advice and that the trade is as safe as can be. On the issue that my hon. Friend the Member for East Londonderry (Mr Campbell) referred to, the girls in my office, who are always trying to get me, as an MP, to slow down and take better care of myself—that is what they tell me anyway—told me that they went to the local health food shop and were amazed at the wealth of knowledge that the lady who helped them had. She clearly was tremendously knowledgeable, and someone could spend the afternoon discussing what the best herbal medicine for them is. It turned out that that lady had a degree in herbal medicine and was able to suggest many different things.

There is a very real fear that should the legislation not go through and should our health food shops continue to suffer from our inaction, or from the Government’s inaction, such closures will mean that more people will order online with no face-to-face interaction or advice. They will not be told that they should not take certain supplements if they are on other medications, or that two supplements may counteract each other. The problem will not only mean fewer jobs on high streets, but potentially more pressure on our GPs in surgeries, as they try to figure out symptoms that may have been caused merely by people taking the wrong combination of supplements. In other words, the expertise and knowledge of people in herbal medicine shops is critical.

Not many of us question the benefits of supplements, especially in the busy lives that we lead, which often mean that we cannot eat as healthily as we would otherwise like. However, who here knew that taking the blood thinner warfarin with a multivitamin containing vitamin K would put people’s health in jeopardy? The lady in the health food shop did, and she was able to advise people who came to her about it. What happens when there is no local shop? Will GP calls be taken up with queries from, for example, people suffering from nausea, dizziness and so on, who find out, after extensive and expensive tests, that when they read in their magazine that vitamin E encourages glossy, thick hair, they had not realised that the aforementioned symptoms could be caused by too much vitamin E. That did not appeal to me, but if I had thought that vitamin E would have given me glossy black hair, or even roots, I would have bought it by the gallon. However, unfortunately, that was not the case. When people are buying supplements in health food shops, they ask what they are taking and are given advice. I hope that the point I am trying to make can be seen; it is very clear.

It is my belief that regulation by those who are knowledgeable is essential, and that should not be diluted by trying to ensure that the latest round of EU tick-box regulations are checked. The issue merits Government attention and a full debate process, and we are glad to have this opportunity in Westminster Hall. I again congratulate the hon. Member for Bosworth on securing this critical debate. I will support him in continuing to bring the issue to the Government’s attention to see action in terms of health and safety, as well as job security. I apologise, Mr Bone—I have guests in the Gallery that I have to take round the Chamber in a very short time, but like the character says in the film, “I’ll be back.”

--- Later in debate ---

[Dr Poulter]

I reassure my hon. Friend that I am not aware of any points of disagreement with the devolved Administrations, but I will write to him and provide reassurance if there are any issues of which I am unaware. My understanding is that there is a unified position across all of the different health Departments.

[Jim Shannon]

On the devolved Administrations, I speak with some knowledge of the Northern Ireland Assembly, where my colleague Edwin Poots is the Minister of the Department of Health, Social Services and Public Safety. We and the Minister in the Northern Ireland Assembly are keen to have a focus of attention and a continuity of thought among all the regions of the United Kingdom to ensure that we can support the Under-Secretary of State for Health. The quicker he and the Government move that on, the gladder the regions—especially Northern Ireland—will be to jump in behind and support them.

[Dr Poulter]

The hon. Gentleman is absolutely right to highlight the strong working relationships, particularly with his colleague in Northern Ireland. We are grateful for that continuing strong working relationship on both this and other issues, and I look forward to working with him.

I reassure my hon. Friend the Member for Bosworth, who was concerned about the short and the long grass, that the intention behind his involvement in the working party is to keep it firm to its task. I am sure that he will want, as part of his involvement, to ensure that that happens. When we meet to discuss this further after the House returns in September, we can ensure that the proposals are proportionate and fit for purpose, and that they protect the public, including through giving people an informed choice about the use of herbal products.

Complex Regional Pain Syndrome

Jim Shannon Excerpts

Tuesday 9th July 2013 Westminster Hall

[Iain Stewart (Milton Keynes South) (Con)]

It is always a pleasure to serve under your chairmanship, Ms Dorries. I am grateful for the opportunity to highlight how regional sympathetic dystrophy, now known as complex regional pain syndrome, affects those who suffer from it and to press for more research into the condition, so that a greater number of people may be properly diagnosed and treated. If Members forgive me, I will use the acronym CRPS throughout the debate for brevity and ease of description.

The earliest descriptions of CRPS apparently date back to the American civil war, but I became aware of it only through my constituent, Kevin Scardifield, who suffers from the condition. He contacted me because his experience of CRPS and the quality of care that he received led him to believe that there is neither an adequate understanding of the condition by NHS clinicians, nor good-quality care for sufferers such as him on the NHS.

Before I proceed, it might be helpful if I explain CRPS and its symptoms. The NHS Choices website describes CRPS as

“a poorly understood condition in which a person develops a persistent (chronic) burning pain in one of their limbs.”

It continues:

“The pain usually develops after an injury—which in most cases is a minor injury—but the pain experienced is out of all proportion to what you would normally expect.”

It is through an injury that my constituent developed the condition in 2009. He was undergoing carpal tunnel release surgery when the local anaesthetic failed to work and he broke his hand against the clamp when he jerked so hard because of the pain.

To give a full account of the symptoms experienced by sufferers of CRPS, I will quote directly from a letter that Mr Scardifield sent to me:

“The pain of this condition is so great that there are recorded cases of sufferers self-amputating in a desperate attempt to escape the excruciating agony. Others have had their circulation so badly damaged that they have developed gangrene and have had to have amputations to save their lives. In either case it has caused the condition to spread further into their bodies.

According to the…McGill Pain Index, it is the world’s most painful incurable condition; it is almost impossible for us to understand exactly how painful that is. Try and imagine a 3 bar electric fire with a metal grill—how long do you think you could hold your hand against the grill with one bar on? Now try and imagine that fire is inside your hand, one bar is a good day for a sufferer, three bars is a bad day and there is no off switch.

Try and imagine a pain so great and a grip so weak that you cannot pull open a packet of crisps yourself, a sneeze that turns into a scream of agony. Knowing that you will never be able to pick up and hold or play with your newly born child or grandchild because one hand is useless and they could cause your condition to spread or start somewhere new.”

My constituent recounts that his injury was missed, not only by the surgeon in subsequent visits but by the hand therapists in approximately 50 visits. Eventually, he was diagnosed as having CRPS following a referral to the hand therapy unit of Milton Keynes hospital.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Gentleman on bringing this matter to the House for consideration. I have a great many constituents who have the problem, which concerns me. Does he believe there is now a greater need for doctors to be trained to tell the difference between fibromyalgia, which some people think CRPS is, and the actual disease itself? If so, does he think the NHS should initiate training among doctors and surgeons to ensure that that happens? Should there be more research on how the pain starts and where it comes from?

[Iain Stewart]

I have much sympathy with what the hon. Gentleman says, and if he bears with me, I will address training and research funding a little later.

The NHS Choices website sets out the quality of care and treatment that CRPS sufferers should receive due to the complex nature of the condition. My constituent should have been provided with a care team comprising a physiotherapist, an occupational therapist, a neurologist, a psychologist, a social worker and a pain relief specialist. He informed me that he has not received such care, as most health professionals whom he has encountered do not even know the condition’s acronym.

That leads me to my principal argument. If NHS clinicians do not sufficiently understand the condition, how will they be able to diagnose it properly and ensure that patients are adequately treated and cared for? The NHS Choices website says that it is hard to estimate exactly how common CRPS is because many cases go undiagnosed or misdiagnosed. I think the hon. Gentleman was referring to that point.

My constituent contends that possibly 250,000 people in England have not been properly diagnosed. He is understandably impassioned about the issue and has been carrying out his own research using American sources—it appears more research is being conducted into the condition in America.

From my own research, I learned from one study that as many as one in 3,800 people in England may be affected by CRPS. Therefore, going by the 2011 census estimates, 14,000 people could either have been misdiagnosed or remain undiagnosed. Although that might appear to be a small number by comparison with my constituent’s estimate, it does not diminish the issue’s importance.

The core principles of the NHS state that good health care should meet the needs of everyone and should be based on clinical need. Kevin Scardifield is unable to do the everyday things that other people take for granted. He was a police officer before the onset of the condition—a profession he greatly loved but had to give up. So debilitating is the condition that, by the middle of last year, he had been able to leave the house only six times, which was just for a few yards to the GP.

I am sure that Members can appreciate why this is such an important issue and why Kevin Scardifield has been campaigning hard for proper diagnosis and treatment. Since he made me aware of the condition, I have made a number of representations to the Department of Health, the local hospital, the primary care trust—now the clinical commissioning groups—and even the Department for Work and Pensions.

I am grateful to the Minister and his predecessor, the right hon. Member for Sutton and Cheam (Paul Burstow), for their replies to my constituent’s concerns when I brought them to their attention. Had my constituent felt that his concerns had been fully addressed, however, we would not be having this debate, so if the Minister will forgive me, I will raise a number of specific issues. First, as I have mentioned, people are either being misdiagnosed or remain undiagnosed because NHS clinicians do not appear to have sufficient awareness of the condition.

--- Later in debate ---

[The Minister of State, Department of Health (Norman Lamb)]

I congratulate my hon. Friend the Member for Milton Keynes South (Iain Stewart) on securing this debate on an issue of intense importance to people who suffer from complex regional pain syndrome. The condition can be debilitating, with a devastating effect on sufferers and their families. I know that there are those, including my hon. Friend’s constituent, who campaign tirelessly to raise awareness of the condition. The description that he gave of what people go through—attempts at self-amputation, for example—are unimaginable.

I pay tribute to Mr Scardifield for his persistent campaigning to raise awareness. It is highly laudable that he has chosen to campaign and maintain the pressure for increased understanding. The experience that my hon. Friend described—the diagnosis was missed by several clinicians, and there was no proper care team or personal care plan—is of concern. I am grateful to him for alerting me to the extent of the challenge faced by his constituent. One great benefit of Adjournment debates such as this is that they ensure that Ministers and officials focus on a particular condition that might not otherwise get the attention it needs. I am grateful for this opportunity. I hope that this debate will prove informative for those here who wish to learn more about the condition and be helpful to those affected, as I say more about the help and support that ought to be available for CRPS sufferers and the research into the condition that is currently under way.

Although it has been recognised as a medical condition for more than 100 years, diagnosing CRPS at its earliest stages remains a problem, as my hon. Friend rightly said, because it is often misdiagnosed or completely undiagnosed. The explanation is threefold. First, CRPS is relatively uncommon and patients do not routinely present to GPs with it. When the Department looked at the representations that we have received on the subject over the last few years, the number of individuals who have approached us is small. The fact that the condition is relatively uncommon and that GPs do not come across it that often creates a problem in terms of their capacity to diagnose it accurately.

Secondly, the range of symptoms associated with CRPS are shared with a number of other, more common conditions, so that when patients do present, they may not be correctly diagnosed in the first instance. Thirdly, there is no single diagnostic test that accurately identifies the condition; a diagnosis is made primarily by excluding other conditions with shared symptoms that can be accurately diagnosed. Those difficulties also mean that there are no reliable figures for the number of people living with the condition, and estimates produced by researchers and clinicians vary considerably, as my hon. Friend said in his speech.

I understand his concerns about having a clear picture of the number of people affected by CRPS. I will approach NHS England to ask whether there is any scope to improve our understanding of how many people are diagnosed with the condition. Ultimately, I think that we can all agree that a better understanding of the extent of the condition and the numbers affected would be a considerable advantage. Let us explore whether it is possible to achieve greater accuracy.

As my hon. Friend may be aware, since 1 April 2013, NHS England has been responsible for delivering improved outcomes for people with long-term conditions such as CRPS.

[Jim Shannon]

On the subject of statistics and information, does the Minister intend to make contact with the regional Administrations, whether in the Northern Ireland Assembly, the Scottish Parliament or the Welsh Assembly, to ensure that all the information comes together so we can galvanise action and respond better?

[Norman Lamb]

I will certainly explore the possibility of understanding how much information is available to the devolved Administrations to increase our understanding of the prevalence of the condition. They may be in exactly the same position as England, where our understanding of the prevalence is ultimately still limited, but let us explore that further.

NHS England draws on a wide range of clinical advice when developing commissioning policies and statements. It has a specialised pain clinical reference group to provide expert clinical advice on pain issues. I will therefore put forward my hon. Friend’s concerns about the need for CRPS expertise.

Turning to the identification of CRPS, an increasing range of guidance is available to improve awareness of it among members of the public and health professionals to support early diagnosis. NHS Choices, to which my hon. Friend referred, provides comprehensive advice on the causes, symptoms and treatment of the disease. More detailed clinical guidance is provided via the NHS Evidence website.

In May last year, the Royal College of Physicians published a guideline for clinicians on CRPS, setting out best practice on the identification and management of the disease. The guidance was developed with the involvement and endorsement of 21 key organisations involved in the care of people with CRPS, including the Royal College of General Practitioners, the British Orthopaedic Association, the British Pain Society, the British Society of Rehabilitation Medicine and the British Society for Rheumatology, to name but a few. I am confident that that collaborative guidance will prove useful in supporting clinicians to identify and treat patients with CRPS more effectively. When such guidance, produced by clinicians, is developed, one does not achieve a sea change in understanding overnight. It takes time to get the message across, in particular throughout the whole of primary care. The production of the guidance, however, is the starting point, and it will aid clinicians in diagnosing and treating appropriately.

Once a patient has been diagnosed with CRPS, a range of treatment options is available. Unfortunately, there is no cure for the condition, but many patients with pain disorders can be managed through routine primary and secondary care once they are appropriately diagnosed. For patients with CRPS, treatment can involve: physiotherapy; occupational therapy; a neurologist to examine the effect on the nervous system; sometimes a psychologist, who may be appropriate, because of the psychological problems caused by living with CRPS, as well as with a host of physical health conditions; a social worker for advice about what extra help and services are available; and a doctor or other health care professional trained in pain relief, which is critical.

NHS England is aware that more needs to be done to identify those patients with the most severe and complex chronic pain who need access to nationally commissioned specialised services. NHS England’s specialised pain clinical reference group is working with the royal colleges and the British Pain Society’s guidelines to ensure that the needs of those patients are appropriately met.

I am aware that the absence of clinical guidance from the National Institute for Health and Care Excellence is a real concern of patients with CRPS. I am advised, however, that NICE is consulting on a short clinical guideline on the pharmacological management of neuropathic pain, including CRPS. The draft guidance, setting out recommendations for further research, highlights the need for more research into CRPS. Final guidance is expected for publication shortly, in October of this year. In addition, a quality standard topic on pain management in young people and adults has also been referred to NICE for development. Quality standards are a concise set of statements designed to drive and measure priority quality improvements within a particular area of care; they support commissioners to be confident that the services they are purchasing are high quality, cost-effective and focused on driving up quality.

My hon. Friend specifically raised research into CRPS. The Government are supporting a range of research projects into the condition, including a major trial of low-dose intravenous immunoglobulin treatment, funded via the Medical Research Council and costing more than £650,000. The investigators involved have previously treated patients with IVIG and reported encouraging results on pain relief in a pilot trial. IVIG may provide pain relief for patients for whom classical treatments are not satisfactorily effective. If IVIG treatment is proved effective, the trial may also stimulate research on the efficacy of IVIG in treating other chronic pain syndromes.

The National Institute for Health Research clinical research network is also supporting a multi-centre international study to define recovery and the priorities for recovery from the perspective of patients with CRPS. The NIHR welcomes high-quality funding applications for research into any aspect of human health, including CRPS, and judges them on an objective basis.

More generally, I reassure my hon. Friend of the Government’s commitment to improve outcomes for the 15 million-plus people in England who are living with a long-term condition, including those with CRPS. Through the mandate—the set of Government priorities for NHS England—we have asked NHS England to make measurable progress towards making the health service among the best in Europe at supporting people with ongoing health problems to live healthily and independently, with much better control over the care that they receive.

Through the NHS outcomes framework, we will monitor the performance of the NHS in supporting people with long-term conditions, such as CRPS, to live as normal a life as possible and to improve their quality of life. Improvements will be measured in three main areas: how well the NHS is performing in supporting people to look after themselves; how well a person is able to live as normal a life as possible; and how successfully the NHS manages long-term conditions by looking at unnecessary hospital admissions and excessive lengths of stay in hospital. The improvement areas are mirrored in the clinical commissioning group outcomes indicator set—apologies for the jargon—which will be used to hold CCGs to account for and to provide information for the public on both the quality of services and the health outcomes achieved through commissioning.

At service level, the new NHS improvement body, NHS Improving Quality, has made the development of evidence-based tools for the management of long-term conditions a key improvement programme for 2013-14. Interventions will involve care plans, care co-ordination, use of technology, risk stratification, self-care and, crucially, the role of carers. That work will be evaluated and best practice identified to help drive improvement in the management of long-term conditions such as CRPS in every local area.

I thank my hon. Friend once more for securing today’s debate. I very much hope that our discussion has been helpful to him and to his constituent. I am more than happy to discuss further how we can improve outcomes for people suffering from such a pernicious condition.

Question put and agreed to.

Health and Care Services

Jim Shannon Excerpts

Wednesday 3rd July 2013 Commons Chamber

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

It is a pleasure to close this debate and to respond to my right hon. Friend the Member for Charnwood (Mr Dorrell) and to his Committee’s report. I had the great privilege of serving under his chairmanship before I was appointed as a Minister, and he has been perhaps the greatest advocate of joined-up and integrated care, both as a distinguished member of previous Governments as Secretary of State for Health, and in all the work he has done as Chair of the Health Committee. His work has helped to lead to the great emphasis that the Government are placing on integrated and joined-up care, both through the Health and Social Care Act 2012 and in the statement by the Chancellor last week.

Friday marks the 65th anniversary of the NHS. I am proud to work in the NHS and to look after its patients. I think every Member in this House wants to see a health service of which we can all be proud. We are proud of our health service, but this 65th year of the NHS has also been marked by many challenges, which were outlined in the Mid Staffs report, the response to Morecambe Bay and in the comments on Tameside hospital made by the hon. Member for Denton and Reddish (Andrew Gwynne). We have to respond to those challenges, and the Government are taking strong steps to ensure that we deliver and stamp out the small pockets of poor care in the care system.

If we are to deliver a health service that is fit for the future, it has to be a joined-up health and care service. We can no longer afford to see the NHS and the social care sector as silos in their own right: we have to have a joined-up integrated approach. It is for that reason that we are proud to have increased the NHS budget by £12.7 billion. We are driving integration with that budget increase. We are encouraging local authorities and the NHS to collaborate in treating the needs of patients, and to address the problem highlighted by the Select Committee of people being passed, like pass the parcel, from one part of the system to another without any joined-up thinking or integrated care. I know that Members on both sides of the House want an end to that. In the spirit of consensus, we all want a health and care system that truly looks after the needs of individuals and is not run by the different financial and cultural silos of the whole.

We have heard strong contributions from hon. Members on both sides of the House in what has been a consensual debate. If we are to tackle the challenge outlined by Sir David Nicholson in 2009, when the previous Government were in power, to make 4% efficiency savings year on year just to stand still and to meet the increasing demand of an ageing population and the increasing health care expectations of patients, then we need consensus. To meet the challenge, we have to see a fundamental service transformation and redesign. We also have to see a far more productive NHS. Productivity gains and efficiency savings have to be made, while the challenges outlined by the Mid Staffs case and others are just as true today.

My hon. Friend the Member for Witham (Priti Patel) outlined clearly the importance of cutting back on bureaucracy and waste in the NHS where possible. Under the Health and Social Care Act 2012, £1.5 billion of bureaucratic savings will be put back into front-line care on an annual basis. She was right to highlight the importance of clinical leadership in delivering better services. There is good evidence that clinical leadership is not just about improving patient care. We can improve productivity through clinical leadership by improving the procurement of services and goods in the NHS. Procurement of services and goods makes up £20 billion of the NHS budget. There is good evidence that strong clinical engagement and leadership will help us to deliver greater productivity.

My hon. Friend the Member for Bosworth (David Tredinnick) talked about a number of other opportunities that the Health and Social Care Act offers to drive integrated care. I am pleased, as late converts, that the Opposition are now supporting the arguments we outlined during the passage of the Act about the importance of integrated health and social care. He also looked forward to the debate, which I will not enter into today—I hope he will forgive me—about the importance of complementary and alternative therapies. I look forward to furthering that debate with him next week.

[Jim Shannon (Strangford) (DUP)]

I thank the Minister for giving way—I asked to make an intervention beforehand, so he knows the subject matter. In the last year health tourism cost the NHS some £24 million, ranging from £100,000 in some trusts to £3.5 million in others. The Secretary of State made an important statement this morning about addressing that issue. Is the Minister in a position to set out the time scale for saving the NHS that £24 million a year?

[Dr Poulter]

The hon. Gentleman is absolutely right to highlight the fact that health tourism presents challenges. We need to look at them, which is why we have launched a consultation on exactly how to do so. We should recognise that we hugely value the fact—it is very beneficial to the British economy—that students come here from overseas to train and, sometimes, to work. Part of ensuring that they do so in a responsible manner and do not short-change British taxpayers and British patients means making provision for their health care needs, if necessary, and ensuring that the NHS does not pick up the tab. That is something we have opened a consultation on. It will report back later this year, and I am happy to discuss the matter further with the hon. Gentleman away from this debate.

In opening the debate, my right hon. Friend the Member for Charnwood was absolutely right to ask how we would deliver greater productivity in the NHS and to say that pay plays a part. Improving procurement, driving greater productivity and, crucially, service reconfiguration all play their parts too. It is worth highlighting the fact that the NHS needs to become more efficient at how it manages its estates, with £3.1 billion or so spent on NHS estates annually. There is much that can be done to improve the energy efficiency of those estates, which is why the Government launched a £50 million fund to support that work. A lot also needs to be done to reduce the £2.4 billion temporary staffing bill. That is something we will be talking about when we launch a paper later in the summer. There also needs to be greater focus on good leadership at board level—something we have touched on before—and engaging clinical leaders in helping to drive productivity and improvements in patient care.

It is also worth outlining the role of tariffs, which were touched on in the Committee’s report and in today’s debate, in driving more joined-up care. It is true that tariff change in itself is not good enough to drive improvements in patient care. Tariff change must drive service change and transformation at the same time, driving the more integrated care model that we all believe in. When my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) was Secretary of State, he initiated a review of the tariff system and looked specifically at best practice tariffs. We are now seeing the emergence of tariff change in a way that not only reduces costs, but drives service transformation. In the case of fragile hip fractures, day case procedures—such as cholecystectomies and similar procedures—and major trauma, we are seeing service change and transformation being driven by improved tariffs, which often cut across primary and secondary care.

If we are to deliver an NHS that is fit for the future, both financially and in human terms, that will be down to major service transformation and moving towards a system that provides integrated health and care. That is why last week my right hon. Friend the Chancellor outlined in his statement a £3.8 billion fund that will be shared between the NHS and local authorities to deliver integrated services more efficiently for older people and disabled people, ensuring that health and social care work together to improve outcomes for local people. Importantly, the Health Committee’s calls for health and wellbeing boards to play a vital role in overseeing the fund is something that we envisage becoming a reality.

In conclusion, we know that there are big challenges to the NHS in driving up productivity, and we know that we have already met some of them by cutting out, through our reforms, £1.5 billion of bureaucracy in the NHS—money much better spent on patient care. Crucially, in the years ahead, we will focus on the service transformation that is required to deliver a more integrated health service, continuing to develop those best practice tariffs that drive integration and bring together health and social care. It is not just about finances, because it is also about good care, which is why it is important to deliver the integrated system that patients deserve.