Patient Safety

John Howell Excerpts

Wednesday 28th March 2018 Commons Chamber

[Dr Johnson]

I congratulate my hon. Friend on passing that private Member’s Bill, which has undoubtedly saved many lives.

I am proud to work in a health service that, just last year, was rated the best and safest healthcare system in the world by the independent Commonwealth Fund think-tank. To err is human: we all make mistakes. The consequences of a doctor’s error, though, are potentially catastrophic. Doctors live with that responsibility and, as a doctor, I live in fear of making a mistake because I do not wish for anyone to suffer harm.

[John Howell (Henley) (Con)]

My hon. Friend may have seen that the Medical Protection Society is asking for the bar to be lifted on criminal proceedings and for the General Medical Council to be shaken up a bit to improve its approach to dealing with this issue. Does she have any sympathy with that?

[Dr Johnson]

I will come on to that later, but I agree with my hon. Friend.

I have worked with at least two colleagues who made significant errors. Many lessons were learned and widely disseminated. Training was provided to stop recurrence, but neither doctor was prosecuted. Throughout my career it has been the case that, if a doctor does their best but makes a genuine error, they will not face criminal charges. Gross negligence manslaughter was seen to be an appropriate sanction for the doctor who refuses to see a patient, who turns up intoxicated or who deliberately does something wrong. That facilitates a no-blame or airline safety-style culture, promoted by the Secretary of State, in which errors are identified and continuous improvements are made.

Following the case of Dr Bawa-Garba, that safety culture and those improvements to patient care are now in jeopardy. Although she was newly back from maternity leave, had not received induction, was covering two people’s jobs, had inexperienced junior staff to supervise and had reduced consultant cover, a very busy unit and a broken IT results system to contend with, Dr Bawa-Garba was convicted of gross negligence manslaughter and, more recently, struck off the medical register by the GMC. Those events followed the very sad and tragic death of a little boy, which of course saddens all of us in this House and is something from which his family will never truly recover.

Whatever the rights and wrongs of this particular case, many professionals have seen sufficient ambiguity in the decision that Dr Bawa-Garba was criminally culpable that it has shaken their confidence that they understand the boundary between a genuine error of medical judgment and conduct so exceptionally bad that it amounts to criminal behaviour. It has, in the words of the chair of the Royal College of General Practitioners,

“shaken the entire medical community”.

Although the GMC is an independent organisation, the Government will be aware of concerns raised about its decision making on this case. Perhaps the most high-profile concern was raised earlier this month at the local medical committees conference, where GP leaders passed a vote of no confidence in the GMC. I would be grateful if the Minister elaborated on what the Government are doing in their work with the GMC to ensure it is executing its functions correctly and to restore medical and public confidence in it.

It is right that individuals are held accountable for their actions, but there is always a balance to be struck between accountability and blame. Where the balance is tipped towards blame, individuals become fearful and may attempt to cover their mistakes, preventing them and others from learning; the same errors will therefore be repeated. Since the case of Dr Bawa-Garba, many doctors have become fearful. That culture of fear means that some doctors are being advised to anonymise reflective practice and to avoid uploading those reflective practices on to their e-portfolio. They might unnecessarily escalate decisions previously undertaken themselves or refuse to do more than contracted. That cannot be good for patient safety.

Eating Disorders Awareness Week

John Howell Excerpts

Tuesday 27th February 2018 Commons Chamber

[Edward Argar]

The hon. Gentleman makes a very important point. This is one of those issues on which I would hope we can see the widest engagement across the UK, across all involved in government and the provision of services, to come up with a coherent and common approach to beating eating disorders.

[John Howell (Henley) (Con)]

My hon. Friend is making a very good point. I wonder whether he has a feeling for how much extra training GPs will require to be able to spot the signs of these disorders.

[Edward Argar]

My hon. Friend makes a very important point and if he will perhaps be patient for a few more minutes, I will turn to, among other things, exactly that point.

At the launch that I referred to, I met and heard from some impressive and inspiring people, who had grappled with eating disorders and who wanted to share their experience and raise awareness. I subsequently met Beat to discuss its work and what more needs to be done. The people I met at Beat’s launch event did something important and brave in speaking out, but they had already done something brave in seeking help for their illness in the first place.

Diabetes

John Howell Excerpts

Monday 26th February 2018 Commons Chamber

[Liz McInnes]

I completely agree, and I will discuss FreeStyle Libre patches later on. I am beginning to feel like everybody here has had sight of my speech before I have even delivered it.

The next point arising from the survey is that people living with diabetes want better access to healthcare professionals who understand diabetes. Many respondents said that they felt they were being treated as a condition and a set of symptoms rather than as a human being.

[John Howell (Henley) (Con)]

I feel I want to ask a question just to participate. Given that lifestyle choices play a big part in type 2 diabetes, what value does the hon. Lady put on the information courses that are made available to people to help them to manage such lifestyle choices?

[Liz McInnes]

The information and education courses are really important in helping to manage the condition. I will come on to talk about that very subject later in my speech.

To go back to the role of specialists, I know from my involvement with the all-party group on diabetes that the role of the diabetes specialist nurse is valued by many. Evidence shows that diabetes specialist nurses are cost-effective, improve clinical outcomes and reduce the length of stay in hospital. With rising numbers of diagnoses of diabetes, I ask the Minister to encourage employers to respond to this with appropriate workforce planning.

The third point from the survey is that people want better access to technology and treatments. Diabetes treatment is ever evolving and advancing, but 28% of those who took part in the survey reported problems in getting the medication or equipment they needed to manage their diabetes. The Minister may recall that last year the Prime Minister was seen at an event wearing a FreeStyle Libre glucose monitoring device, which has already been mentioned. It is this type of non-invasive device that makes life so much easier and more manageable for those living with diabetes, and it is a great example of the technological advances taking place today. This device is designed to liberate patients from the hassles of routine finger prick testing. However, so far, only one third of CCGs and health boards have placed FreeStyle Libre on the formulary, demonstrating the problem faced by many in obtaining access to new technology.

The fourth point is that there is also a need for education and information to be widely available. No one should be given a diagnosis of diabetes without also being informed of where to go for information and support. People’s ability to self-manage is essential for the successful management of diabetes. Self-management reduces the risk of complications and demand on health and care services.

NHS Staff: Oxfordshire

John Howell Excerpts

Tuesday 20th February 2018 Westminster Hall

[John Howell (Henley) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I congratulate the hon. Member for Oxford West and Abingdon (Layla Moran) on securing this debate, and I echo her praise for NHS staff who do a fantastic job—indeed, only the other day I was approached in the street by a constituent who told me just how fantastic his NHS treatment had been.

The issue under discussion is not a new problem or something that started only in the past year. I have chaired a group of Oxfordshire MPs and the clinical commissioning group for a number of years, and this issue has been there from the beginning. If I can segment the NHS market a bit, perhaps we can consider how different elements of the NHS can play their part. First, however, let me say that the release of information to The Times by Churchill Hospital must be opposed. It created much stress among patients, and it bore no resemblance to the policies of that hospital. We should send a firm message to Churchill Hospital that the way it behaved was unacceptable.

Perhaps my constituency is very fortunate, but on several occasions I have been told by constituents that a surgery is full and can take no more people, and that that is all down to new housing. Each time I rang the GP surgery, however, I was assured that that is not the case and it still had a tremendous amount of room to take more people. Nevertheless, that does not reflect the current problem with the GP practice system which, however we look at it, we must admit is in need of considerable reform. There are at least two reasons for that. First, we have the problem of young doctors who are unable or unwilling to take on the stress burden created by taking out the loans necessary to buy into the surgery. Secondly, there is a limitation on the ability of GP practices to do some of the minor operations that they have done in the past, and which allowed them to carry on the excellent work that they do for their communities. I urge the Minister to look at that, and perhaps to remove some of the restrictions that apply to the ability to operate in GP surgeries.

Of course GPs need to adapt to new ways of working, and they need to use the internet in a much better way. My own results from what is, I hasten to say, a minor health issue are dealt with by the internet. I email the information in on a regular basis, and the results come back on the internet—fortunately they come back clear each time. [Interruption.]

[Mr Edward Vaizey (Wantage) (Con)]

We are all speculating now.

[John Howell]

I know, and I will leave that issue there.

Social care has been mentioned in terms of its competition with the retail sector in Oxford, which I think is a very real threat. Another issue goes back to one of the more substantial points in the Care Quality Commission report, which is that the joining up and interlinking of different aspects of social care in Oxfordshire leaves a lot to be desired. For example, the amount that was paid by the NHS health trust was different to the sum paid by the county council for the same number of people doing the same amount of work. Evening up that difference must be something to concentrate on, and I wish people success in doing that.

The income of the clinical commissioning group amounts to about £880 million. Staff costs are about 70% of that, at just over £600 million. A 1% pay increase means at least £6 million to £7 million as an unfunded pressure on the health care system, and that is not a very productive way forward. There is no getting away from the fact that the biggest problem with recruitment and retention is living costs in Oxfordshire. There are a number of ways that we can tackle that problem, such as by building more houses—the Oxford-Milton Keynes-Cambridge express way is a good joined-up process for dealing with that, and I hope it comes to fruition.

The second thing we can do, I am afraid to say, is change the housing policies in Oxford city. That goes back to conversations that I had ad nauseam with the predecessor of the hon. Member for Oxford East (Anneliese Dodds). We were known for our fighting over the green belt, and I am glad to infer from what the hon. Lady has said that Oxford is changing the way it deals with issues of planning and housing.

We are talking about a marginal increase across the board, and the uplift that that will bring will not have a big impact on retention and recruitment. It would be much better for us to focus any increase in funds on the issue itself. I ask the Minister, formally, to agree to a weighting for Oxfordshire that gives it some of the strength that London has. As we have already heard, housing costs in Oxfordshire are at least as great as those in London, and that must be tackled. We need a specific weighting, not a marginal increase in pay, and since there will be only a limited pot of resources for increasing pay, it makes a lot of sense to concentrate the impact of that in those places with more intractable problems, such as the housing market and living costs in the city.

PACE Trial: People with ME

John Howell Excerpts

Tuesday 20th February 2018 Westminster Hall

[Carol Monaghan]

Absolutely. In fact, I will be calling for the patient voice to be heard in any treatments.

Calls to publish the raw data—basic protocol in good research—were ignored. Queen Mary University spent an estimated £200,000 on keeping the data hidden. Finally, after a long battle, patients won a court order to force the PACE authors to release the data. It was discovered that the authors had altered the way in which they measured improvement and recovery, to increase the apparent benefit of the therapies. Re-analysis showed that the improvement rate fell from 60% to 21% and the recovery rate fell from 22% to just 7%.

The method of patient reporting has also been questioned. As one participant says:

“After repeatedly being asked how severe...my symptoms were—in the context of…it’s just me not trying hard enough...I started to feel like I had to put a...positive spin on my...answers. I could not be honest about just how bad it was, as that would...tell the doctors I wasn’t trying and I wasn’t being positive enough. When I was completing questionnaires...I remember second guessing myself and thinking for every answer: ‘Is it really that bad? Am I just not looking at things positively enough?’”

[John Howell (Henley) (Con)]

I thank the hon. Lady for securing this debate. The PACE trials have been roundly condemned by many scientists as being totally inappropriate. Does she have a feel for what an appropriate trial might have found?

[Carol Monaghan]

Yes. I will come on to how an appropriate trial could be done. First, I will mention the self-reporting that was a part of the trial. Questionnaires provided the data and measures of success. There were no physiological or scientific measurements. For patients the damage was done. I am a science teacher by profession and I always told my pupils that there are a number of stages to any scientific investigation: “Start with a hypothesis. Decide how you will test this theory, what measurements you will make, how you will record your results and how you will use these results to draw your conclusions. Those conclusions, which might be different from the original hypothesis, must be based on the evidence you have gathered.”

That did not happen in the PACE trial, which relied on patient self-reporting, rather than measurable physiological parameters. Furthermore, when the results were not as expected, rather than revise the original hypothesis, the investigators simply changed the success criteria. Thus patients participating in GET who had deteriorated during the study were considered recovered.

There are, of course, ways of measuring the physiological impact of exercise. The two-day cardiopulmonary exercise test can objectively measure post-exertional malaise. We know that a person with ME can perform adequately—sometimes even well—on the first day, but can have greatly reduced cardiopulmonary function on the second. The test requires the participant to exercise on a static bicycle, and allows data on oxygen consumption, workload and gas exchange to be measured. Two identical tests, separated by 24 hours, must be carried out to properly measure the impact of exercise. Results from a single test could be interpreted as a lack of fitness. Two tests change that to something quite different. A healthy person will perform better the second time; an ME sufferer will most likely be worse.

Of course, the failure of the PACE trial to do that could simply be put down to bad science, but unfortunately I believe that there is far more to it. One wonders why the DWP would fund such a trial, unless it was seen as a way of removing people from long-term benefits and reducing the welfare bill.

Acute and Community Health

John Howell Excerpts

Thursday 8th February 2018 Commons Chamber

[Stephen Barclay]

My hon. Friend is right. Professor Ted Baker, the chief inspector of hospitals, has drawn attention one of Dr Kirkup’s findings, which is that the CQC is now in a much better position to challenge and fine those responsible for unsafe care and poor standards. That also reflects the excellent work that Professor Baker and his team have been doing to ensure that inspections become much more rigorous in identifying issues such as those that we have been discussing today.

[John Howell (Henley) (Con)]

I am a member of the Justice Committee, which has taken a particular interest in Liverpool prison. Will my hon. Friend assure me that there will be a review of the suicidal potential of prisoners to ensure that the systems are right?

[Stephen Barclay]

My hon. Friend is right to allude to the importance of learning lessons, especially given that there are many vulnerable people in prisons, and given the risks that accrue as a result. Yesterday I spoke to the Under-Secretary of State for Justice, my hon. Friend the Member for Bracknell (Dr Lee), who is responsible for offender management issues, and the Prisons Minister, my hon. Friend the Member for Penrith and The Border (Rory Stewart), visited Liverpool prison last week. I know that they have both taken a great interest in the report, and that they will take any further action that is needed.

NHS Blood Cancer Care

John Howell Excerpts

Wednesday 17th January 2018 Westminster Hall

[Henry Smith]

My condolences to Emily’s family. There are all too many examples of young people passing away from blood cancer. I pay tribute to Emily’s mother for a fine legacy. It is sad that a young life has been lost to this condition, but wonderful that so much good work has been done as a result. I would be grateful if the hon. Gentleman passed on my best wishes to them.

[John Howell (Henley) (Con)]

I congratulate my hon. Friend on the excellent work he is doing in this sphere. Blood cancer is a bit of a hidden cancer. If someone has a solid tumour, it can be seen and treated and they can see what is happening with it, but blood cancer is difficult to detect. What is he doing to encourage early detection?

[Henry Smith]

My hon. Friend anticipates some of my remarks in a few moments’ time, but he is absolutely right to use the words “hidden cancer”. Blood cancer is very different from solid tumour cancers—that is a key point and problem.

I was going to say that, from four o’clock, right hon. and hon. Members are very welcome to come along to Strangers’ Dining Room for the launch of our report.

NHS Winter Crisis

John Howell Excerpts

Wednesday 10th January 2018 Commons Chamber

[John Howell (Henley) (Con)]

I do not want to go through the increase in the number of operations carried out by the NHS, or to describe the enormous pressure of the numbers of people being seen by the NHS—plenty of other Members have already done that. I wish to concentrate on delayed discharges of care, which are an important factor not only when it comes to increasing the throughput of people in the health system, but in ensuring that people do not go into hospital in the first place.

In Oxfordshire, we have addressed delayed discharges of care in two ways, as part of our future planning for the NHS. First, with respect to the hospital in the town of Henley, I have been among those who have been active in trying to achieve the right balance with social care by ensuring that there are no beds in the hospital. There are beds in the neighbouring care home for those people who urgently need to stay, but all the emphasis is on ambulatory care—the treatment of patients in their own home—on which I have worked closely with the Royal College of Physicians. More and more patients now understand that they can get the right sort of treatment in their own homes and do not have to spend time in hospital. The approach has been taken on the best of medical advice and I am grateful to the doctors who have supported it. I invite Ministers to come to see for themselves how the hospital works.

Secondly, we do cross-party work in the county involving all MPs who represent Oxfordshire. I chair the group that has a relationship with the clinical commissioning group, not so much to hold it to account, but to ensure that it is focused on the things on which it says it will focus. One of the CCG’s great achievements is its focus on delayed discharges of care. I shall cite a couple of the figures so that Members will understand the CCG’s enormous achievement over the past year in planning for the better treatment of delayed discharges of care. At the end of December, the number of Oxfordshire patients whose discharge of care was delayed was 96, whereas the number in May had been 181. That is a magnificent achievement, as the number of delayed discharges of care has been almost halved. When Ministers hear about that half, they should understand that it is not a half increase but a half decrease in the number of people whose discharge of care was delayed. That improvement has been achieved by making sure that the right resources are in place for those patients who need them to return home. It has not happened because people are going home without the support that they need.

Finally, on the story in The Times this morning about Churchill Hospital, I have with me a letter from the hospital saying it has not implemented any changes to cancer treatment whatsoever. I am happy to provide a copy of that letter to the Library so that Members can read it.

NHS Winter Crisis

John Howell Excerpts

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

A significant amount of funding—some £3.4 million—was made available to the hon. Lady’s area. Reconfiguration proposals are being driven by the STP process. It is down to local authority leaders and local NHS leaders and clinicians to determine what is the best configuration of services in their area.

[John Howell (Henley) (Con)]

In Oxfordshire, considerable effort is being put into growing home-based health and social care systems. Does the Minister accept that that will solve the problem of delayed discharges of care by preventing them in the first place?

[Mr Dunne]

I agree that prevention is an important part of the long-term solution to improve healthcare outcomes for the population. I believe we are on the cusp of some significant technological advances that will allow more treatment to take place at home and more diagnostic tests to be taken without the necessity of attending acute facilities. Oxfordshire is a good leader in that.

King’s College Hospital Foundation Trust

John Howell Excerpts

Tuesday 12th December 2017 Commons Chamber

[Mr Dunne]

I share the hon. Lady’s support for the clinicians and professionals working in her trust, who are doing the best job they can in admittedly challenging circumstances. I do not accept her characterisation of a lack of capital provided to King’s. I have been there myself and seen some of the building work going on. I am happy to look at the circumstances surrounding what happened in 2013, but they are not as relevant to today’s situation as the way the trust’s financial management has deteriorated in recent months.

[John Howell (Henley) (Con)]

What has NHS Improvement said about this, and what has it recommended that King’s should do?

[Mr Dunne]

As I have indicated, the chief executive of NHS Improvement said yesterday that no other trust

“has shown the sheer scale and pace of the deterioration at King’s. It is not acceptable for individual organisations to run up such significant deficits when the majority of the sector is working extremely hard to hit their financial plans, and in many cases have made real progress.”

That is from the regulator responsible for putting the trust into special measures for now.