Contaminated Blood

Julian Lewis Excerpts

Thursday 20th July 2017 Commons Chamber

[Jackie Doyle-Price]

As I mentioned, no firm view has been taken as to which Department will run the inquiry, but as the Minister with responsibility for this area the House would consider it amiss if I were not having meetings and discussions with those affected about the inquiry’s remit. When the Minister of State, my hon. Friend the Member for Ludlow (Mr Dunne), made the statement to the House about the inquiry, we made it clear that we wanted to progress as soon as possible. The Secretary of State called this meeting because we want to hear directly from the victims about what they want from the inquiry. We are very much in listening mode. A decision has not yet been taken as to which Department will run the inquiry but ultimately, as a Minister, I am accountable to Parliament for what happens in the Department of Health in those areas for which I have responsibility, and I want to be leading from the front, having those discussions.

[Dr Julian Lewis (New Forest East) (Con)]

I thank the Minister for saying that no decision has yet been taken about which Department will run the inquiry. Does she agree that perception is as important as reality in this matter, and therefore will she gain from this occasion a mindfulness of the weight placed by hon. Members, on both sides of the House, on the idea that the inquiry perhaps would be perceived to be more objective if some other Department took the lead?

[Jackie Doyle-Price]

I say to my right hon. Friend, and I have repeated this in other discussions as well, that the Cabinet Office is very closely involved in this, and this opportunity has given me the time to make that clear to the House. The Government are listening; we want to consult as widely as possible. No decision has yet been taken, but the Cabinet Office is closely involved in all the consultation we are currently having.

Contaminated Blood

Julian Lewis Excerpts

Tuesday 11th July 2017 Commons Chamber

[Mr Dunne]

I have just described the additional contribution to the financial scheme for England. It will be for the inquiry to decide whether it wants to make recommendations about financial arrangements. At present, I am not in a position to give the hon. Gentleman the confirmation that he is seeking. That will have to come through the inquiry.

[Dr Julian Lewis (New Forest East) (Con)]

My constituent Lesley Hughes was infected with hepatitis C in 1970, but this was discovered only about three years ago. Will any consideration be given to those long years of suffering when the compensation scheme is put into effect?

[Mr Dunne]

I offer my sympathy to my right hon. Friend’s constituent for the challenges she finds herself facing. We have to say at this point that it will be down to individuals to make their applications. We will respond to the consultation in due course. I strongly encourage my right hon. Friend to make representations on his constituent’s behalf to the inquiry when it is established.

Mental Health and NHS Performance

Julian Lewis Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I will happily take a look at that. Obviously, when it comes to the allocation of capital, we prioritise any projects that will help us to improve the situation in A&E departments and reduce the stresses.

[Dr Julian Lewis (New Forest East) (Con)]

The Secretary of State has acknowledged that there is a shortage of acute mental health beds. That arises from the decision by many health trusts to close beds in favour of putting resources into services in the community. One effect is that people approaching a mental health crisis find it harder to know where to turn for help. Will he explain more about the crisis provision in which we are investing the extra £15 million? Is there a common way of knowing how one can easily access those vital services?

[Mr Hunt]

I am happy to supply more details. The £15 million is for places of safety—it is very specifically focused on support for the police service so that we can ensure that we live up to our legal commitment from this year not to send young people into police cells when they actually need mental health support.

More broadly, my right hon. Friend is right that there is a policy change—most people think it is the right thing—to treat more people in the community where we can. What is not working is the system that divides people up into four tiers, which means that we sometimes say to people, “We can’t treat you because you are tier 3.” People get sent away, which is not acceptable. That is why we are producing a Green Paper. We want to look at a better way forward.

Coeliac Disease and Prescriptions

Julian Lewis Excerpts

Tuesday 1st November 2016 Westminster Hall

[Mr Jones]

I will make a bit more progress.

We have a situation where, in places such as east Essex, the needs of patients are being discounted despite a complete lack of any type of research. I am concerned that more CCGs across the country will begin to use inadequate justifications as a precedent and follow a similar path. That leads me back to my earlier point about the big problem of under-diagnosis. I am afraid we will see a bigger problem if gluten-free prescriptions are not made available to those on low incomes.

[Dr Julian Lewis (New Forest East) (Con)]

On the specific point of failure to diagnose, until 20 years ago I had never heard of coeliac disease, and then I went out with a young lady who, as a teenager, had repeatedly gone to her GP knowing something was wrong. Coeliac disease was never diagnosed until she suffered something analogous to a stroke, which left her permanently all but unable to read. Although she has bravely developed coping strategies over the years, there is no doubt that her life and career have suffered, and she should never have been put in that situation.

[Mr Jones]

The right hon. Gentleman raises a serious point about the life-changing effects that coeliac disease can have. I was only diagnosed by accident, in my 30s; my mother was not diagnosed until she was over 70. Early diagnosis is important, but it is not uncommon for people to live a long time without one being made.

The Health and Social Care Act 2012 included a duty on CCGs to have regard for National Institute for Health and Care Excellence quality standards, but NICE guidance on prescribing gluten-free food for the management of coeliac disease has only recently been published. It says:

“Gluten-free products are more expensive and are usually only available from larger retailers, making access more difficult for people on low incomes or with limited mobility. As coeliac disease can affect more than one member of a family it can also be an additional burden on the family budget”—

as the hon. Member for Aldershot (Sir Gerald Howarth) said.

“To address this, healthcare professionals should help people who may need support to find suitable gluten-free food products on prescription to enable them to maintain a gluten-free diet.”

Junior Doctors: Industrial Action

Julian Lewis Excerpts

Monday 5th September 2016 Commons Chamber

[Mr Speaker]

I call Dr (post-war strategic military planning) Julian Lewis.

[Dr Julian Lewis (New Forest East) (Con)]

In other words, I am totally unqualified as a medical doctor. Therefore, may I ask a question about democratic mandates? I appreciate that, unlike a referendum, a general election does not give an entirely specific mandate on every proposal put forward, but will the Secretary of State take the opportunity to remind the House and the country of how central the proposal for a seven-day NHS was to the Conservative manifesto as far as his Department was concerned?

[Mr Hunt]

My right hon. Friend is right, as that was our only really substantive promise in terms of a commitment to the NHS at the last election. We are funding it and we have an absolute obligation to the British people to deliver on it. That is why in that short period after the last election I felt I had to be clear with the BMA that we were going to deliver on that manifesto promise. If the BMA had reflected on that, it might have perhaps behaved differently from how it did.

Southern Health NHS Foundation Trust

Julian Lewis Excerpts

Wednesday 8th June 2016 Westminster Hall

[Dr Julian Lewis (New Forest East) (Con)]

My hon. Friend the Member for Fareham (Suella Fernandes) has done the House a service by bringing this debate to the Floor. The measure of cross-party support that she has achieved is evidenced by the powerful speech of the right hon. Member for Oxford East (Mr Smith).

I hesitated to contribute to this debate because I have not been involved in the cause of the current crisis, which is about the deaths of patients being insufficiently explained. However, I have a history with Southern Health. I explained in the course of an urgent question, which the present Minister responded to on 6 May, that back in 2011 and 2012 my dealings with the trust were, in 19 years in Parliament, the only constituency issue that caused me genuinely to suffer sleepless nights. It was a question not about the way in which people were treated as inpatients in Southern Health establishments, but about a determination by the trust, in concert with a number of other trusts in other parts of the country using similarly questionable techniques, to follow what appeared to be a trend, if not a fashion, to close a significant proportion—35%—of the existing inpatient acute mental health beds.

My hon. Friend the Member for Eastleigh (Mims Davies) said in her intervention that she detected something of a “bunker mentality”. She is absolutely right. The mentality that I detected at that time was a culture of stubbornness and denial about whatever it was that Southern Health wanted to do, irrespective of what other people might wish it to do. The issue at the time hinged upon something that ought to have been straightforward: namely, what was the necessary number of acute inpatient beds to retain. I raised that subject in two debates. Although I have not yet had the chance to meet Tim Smart, the new chairman of the trust, of whom I hear good reports, I hope he will take the opportunity to look up the two debates. One was on 10 November 2011 and, most importantly, the second one was on 18 April 2012. I had information from within the trust that the bed occupancy rates were high. In fact, the bed occupancy rates on average were between 91.9% and 96.7% when I was surveying the data. So it made it rather hard to argue that one could safely close two out of the six acute inpatient units, thus reducing the number of available acute inpatient beds from a total of 165 to only 107.

Part of the reason for the reduction was given quite frankly as a cost saving. It was proposed to save £4.4 million; £2.9 million out of that total would be absolute savings and the remaining £1.5 million would be invested in something called “hospital at home”. The group that we set up in the New Forest, which continues to meet regularly—usually three or four times a year—is called Support our Mental Health Services. It has found no evidence whatever that there has been any significant increase in the amount of support or the quality or quantity of support that people get at home.

Given that, at the time, with 165 beds 53% of patients were detained and just under half the total were people who opted to go into an acute bed if they suffered some dreadful breakdown, I predicted that the figure for those detained would rise proportionately to about 82%. When I made these remarks in public, Katrina Percy took objection to them and sent a letter to Ministers, councillors and Hampshire MPs denouncing my comments as “unfounded”, “scaremongering” and with “no place in the 21st century” because I had pointed out that if someone suffered a severe breakdown, perhaps their best chance of getting a bed if they needed one under the Southern Health regime would be to cause as much mayhem as possible. But it remains a fact that today, as I understand it from sources within the trust, some 80% of the remaining beds are occupied by people who have been sectioned or detained, and that means that the opportunity for getting a bed if you need one, other than if you are sectioned, is correspondingly reduced.

The difficulty that I had at the time in trying to save the beds was that the trust’s clinical director, Dr Lesley Stevens, was determined to go on repeating figures over and over again that there were between 20 and 30 beds vacant at any one time. There were not. Exceptionally, in a short period—if I remember correctly around Christmas time—there was a figure of that sort, but even by the time she was continuing to put that bogus figure forward, that temporary departure from the norm of high bed occupancy had already been left behind and we were back to business as usual with pressure on bed numbers. Eventually, even a proposal that instead of closing both units at once the trust should close just one of the two units scheduled for closure, and see how that panned out, was rejected.

As you can imagine, Mr Hanson, the relationship between me and the trust was pretty much at rock bottom after all the controversy, but both sides decided we had better try to make the best of what was now a fait accompli. Katrina Percy, for her part, promised—and I believe she kept the promise—that no patient whom the trust judged to be really in need of a bed would be denied one, even if one had to be bought in from the private sector. In return I volunteered never to criticise the trust if it bought in such beds; and I never have, because it is most important that it should give beds to those who need them, and that it should not be deterred because of a politician saying “I told you so; look, you are now having to buy in private beds.”

To bring the story up to date, and conclude: there was a double tragedy. The individual tragedy was the death of a young man called James Barton. He was taken on by the trust and became the director of mental health and learning disabilities. That was in about 2014, and in my opinion James was a total breath of fresh air. He reached out to us, and said, “I know we have had all these troubles in the past; I want to build a new relationship”—and he did. In the course of a number of times when James came to liaise with and participate in our group he confided to me that he believed that the bed cutting had gone too far, and he was experimenting with different configurations, in the hope that bringing perhaps about 15 or 18 beds back into the system—approaching approximately half of what had been lost—might get things back into balance. Tragically, in February 2015 James was suddenly found dead at the age of 36, from an unexplained medical condition. That was a huge personal loss to people such as myself, who knew him only slightly. I can only imagine the catastrophic loss it was to his nearest and dearest.

It was also a tragedy from the point of view of people who need acute beds, in my opinion. Although James’s successor, Mark Morgan, has maintained the contact and is a very pleasant person to deal with, the message that I am getting back from Southern Health now is exactly what it was: “Well, we were having to buy in these beds, but we are not having to do it now, and we seem to be back in balance. We don’t need any extra beds.” Incidentally, one of the two units that were closed was at Woodhaven hospital and was only eight years old. I had performed the opening ceremony. The Winsor ward in Woodhaven hospital remains empty to this day.

[Mims Davies]

I have had families coming to see me—particularly the families of people aged 19 or in their early 20s—for whom beds and in-patient availability are the biggest issue. The treatment at home is working, but they need more sustained treatment, and the closure of bed spaces is having a profound effect on the development of those young people.

[Dr Lewis]

Furthermore, the beds at Woodhaven were state of the art, with en suite facilities—which is terribly important if someone has to be an in-patient in such circumstances. Many of the remaining beds do not have those facilities. That ward has been standing empty for several years now. I believe a change of culture is needed in the trust. Certainly there is no difference of opinion between us on the point that it is desirable if possible for people to avoid going into a mental health unit as an in-patient. However, to have the confidence to be treated in the community they must know that there will be in-patient beds for the occasions when they need extra support. I hope that that lesson from the past will be borne in mind in future restructuring of the trust. I called the trust’s culture one of stubborness and denial. That may lie in the minds of individuals, rather than in its structure, but that is a matter for people other than me to decide.

--- Later in debate ---

[Alistair Burt]

Genuinely, I am unaware of that. The police may review evidence at any time. If CQC has certain evidence that it wishes to take to the police for prosecution, that is a matter for it. I understand the processes that people would want to go through. It is important for me to offer reassurance that those processes are in place, and that things that for too long have been swept under the carpet are open for examination, which I understand to be the case.

Let me deal with the question of a public inquiry. Ministers face many calls for inquiries, and it is important for public inquiries to be considered only where other available investigatory mechanisms would not be sufficient. Public inquiries are rare events. I argue that the processes now being followed by NHS Improvement and CQC are the best way to put right the safety and governance issues at Southern Health. That does not rule out the dissemination of wider learning from this case through NHS Improvement or, where appropriate, the holding to account of individuals via professional regulation or normal performance management routes.

It is right and proper that we should ask such questions. We can perhaps examine whether the system would have responded in the same way had the trust been an acute trust, as I mentioned earlier. I am passionate about improving the care and outcomes for people with mental illness or learning disabilities by ensuring that all aspects of healthcare for people, whatever the issue that has brought them into the care of the NHS and others, are given equal priority with physical health. That must include regulation.

Let me now deal with the point made by my hon. Friend the Member for Oxford West and Abingdon (Nicola Blackwood). As I have indicated, what I have observed over the past year has worried me. That is to say, there seems to be greater tolerance of when things go wrong in mental health than in acute services. We need to ask ourselves why it has taken so long to resolve those difficulties and to reach the regulatory decisions that are now starting to take effect.

I will therefore be looking at the matter with NHS Improvement, to consider both the effectiveness and the timeliness of regulatory interventions in mental health and learning disability services. I am keen to bring independent leadership into that work, alongside NHS Improvement. A task-and-report group will do a piece of work specifically on that.

Let me name the other places that have upset me during the course of the year. In Hull, there has been a problem with in-patient beds and an inability on the part of the NHS to make decisions about it for more than three years. There was the case of Matthew Garnett, the young man with autism in the wrong place; I could not get information on him for weeks, because of the failure of the NHS to provide what I needed. There are the problems in Tottenham with new mental health facilities, similar to what happened in York, at Bootham Park—how that was closed, and the inability of people to handle it correctly. That is a whole series of cases in which I think things could have been done better. The response has not been good enough. An inquiry into one thing is not sufficient, and the processes are in place to deal with that. Looking at the whole range of why such things happen is really important, and that work is now underway.

[Dr Julian Lewis]

Will the Minister give way?

[Alistair Burt]

No, I cannot, because my hon. Friend the Member for Fareham has to have her two minutes.

A further review of the investigation of deaths is being done. It was announced by my right hon. Friend the Secretary of State for Health, but it will not be completed until the end of the year, when the Department will give its response. This has been a hugely important debate, but it is not the end of the matter. It is a staging post, and people will be able to see things following it. I commend my hon. Friend for raising it.

Southern Health NHS Foundation Trust

Julian Lewis Excerpts

Tuesday 3rd May 2016 Commons Chamber

[Alistair Burt]

The frustration in the NHS is that although what the right hon. Lady says is not true in some places, it is in others; the special measures process in effect at the moment has effected change and has done so more quickly. There are other places where that does not happen. I am concerned that in mental health the sense of defensiveness which we know has characterised parts of the NHS for too long has probably had too great a grip, and we have not always got things done more quickly or demanded that things are done with the degree of urgency that we would expect, on behalf of constituents. I am very determined that any difficulties in getting things done locally in trusts when they need to be done will not be aided or abetted by any lack of urgency in the Department or the upper reaches of the NHS with which we have contact. The concern to make sure that urgency is there is rightfully expressed by the House, and we have to see that that is delivered.

[Dr Julian Lewis (New Forest East) (Con)]

In 2011 and 2012, I was locked in a bitter confrontation with Southern Health Foundation Trust over the determination of its top management to close no fewer than 58 out of its 165 acute in-patient beds for people suffering from mental health illnesses and breakdowns. It is the only constituency issue over which I have ever suffered sleepless nights, and I failed to stop the trust closing the Winsor ward in the relatively new Woodhaven hospital in my constituency. Today, apart from this terrible issue about the deaths, the system remains overfull, the beds remain too few and I understand that at least 80% of the in-patients are people who have been sectioned, leaving people a very low chance of getting an elective bed from Southern Health unless they are prepared to wait a long time. Can the CQC look into this wider issue, given that it has so many other serious concerns about the trust?

[Alistair Burt]

The CQC’s powers are extensive and I know that it will absolutely know what my right hon. Friend says. The debate comparing the provision of beds for treatment with community treatment has been going on for some time in mental health, and different pathways are taken by different trusts. Some trusts put more people into beds, while others are doing more in the community. The general sense is that more should be available in the community, but that must not preclude the availability of emergency beds when they are needed. I will ensure that the CQC is aware of my right hon. Friend’s concerns about that particular trust.

Junior Doctors Contracts

Julian Lewis Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

We have had eight studies in the past six years—those were independent studies, not commissioned by the Government, and they covered areas such as paediatric and cancer care, emergency surgery and a whole range of other areas. Six of those eight studies mentioned staffing levels at weekends as something that seriously needs to be investigated. Today there are higher mortality rates for weekend admissions, and the Government have a responsibility to do something, not to commission further studies. That is why we are determined to press ahead.

[Dr Julian Lewis (New Forest East) (Con)]

May I reiterate my concern that there appears to have been no ballot of junior doctors specifically on the question of withdrawal of emergency care? Does the Secretary of State share my fear that if, despite his best efforts, people die as a result of this withdrawal of emergency cover, public demand for a legislative change to ensure that that can never happen again will become irresistible?

[Mr Hunt]

My right hon. Friend is right to say that the public will be extremely disappointed that professionals are putting patients at risk in such a way, and it is extremely tragic that they are doing so. I am afraid that I think this is a crossing of the Rubicon—crossing a line in a way that has not happened before. I think it is totally tragic, and I support the concern of my right hon. Friend.

Brain Tumours

Julian Lewis Excerpts

Monday 18th April 2016 Westminster Hall

[Helen Jones]

Again, we were given various reasons when we took evidence, and we want the Government to consider the matter carefully. There is no doubt that if we are to improve scanning procedures, we must accept that a number of scans will come back clear. The issue is, what proportion that comes back with no tumour shown is acceptable? Surely it is better to invest in a scan than to let a tumour grow, because later treatment is much more difficult, complex and costly. We want more people to have access to scanning.

Early diagnosis is important, but it will not solve the problem without more research. Despite the excellent scientists and clinicians who gave evidence to the Committee, there is no doubt that they are working in an underfunded system. The Government response to the petition said that about 1.5% of cancer spending is devoted to brain tumours, but that includes fundamental research and non-site-specific research.

The National Cancer Research Institute told us in evidence that some non-site-specific research undoubtedly benefits brain tumour research, but it was unable to put a figure on that. We heard from Professor Tracy Warr of the brain tumour research centre at the University of Wolverhampton that brain tumours are less likely than other cancers to benefit from non-site-specific research because of their complexity and location, and the blood-brain barrier, which means that drugs that work in the bloodstream do not transfer to the brain. That is an unscientific explanation, but I am sure hon. Members will know what I mean.

We found that spending records are very unclear. The Government’s own records are not clear. The National Cancer Research Institute was unhelpful when trying to find out exactly how much of the spending benefited research into brain tumours and there is no central record of spending by people who are not partners with the National Cancer Research Institute. There is no doubt that spending is low. The only figure that we can be certain of is the 3.3% of spending on site-specific research, which is about £7.7 million a year. At that rate of progress, it is estimated that it would take 100 years for the outcome for brain tumours to be as good as for many other cancers.

[Dr Julian Lewis (New Forest East) (Con)]

Does the hon. Lady agree with the assessment of my constituent, Mrs Alison Hutchman, who has been living with what she calls “this devastating disease” for the last six years, about that estimated time of 100 years? Why is this terrible disease so low down the priority order?

I saw the recent death of my friend, Richard Webster, at the age of only 50, from a brain tumour, despite the loving care of his family and his long-term partner and later husband, Jamie Norton. I know only too well, as only someone who has seen it can know, what is entailed when this disease strikes.

[Helen Jones]

I am grateful for the right hon. Gentleman’s intervention and I agree with his constituent. Brain tumours are perceived to be rare, although my argument is that they are not as rare as we think and the number of life years lost and the burden of the disease mean they have to be tackled. We know there is a correlation between the amount of money spent and survival rates in cancer. Survival rates for those with brain tumours went up by only 7.5% between 1970 and 2015. For cancer overall, they have doubled.

Junior Doctors Contracts

Julian Lewis Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

With respect, not very far away from the hon. Lady’s constituency is the Salford Royal, whose very respected chief executive concluded that a negotiated outcome was not possible. That is why I reluctantly took the decision to proceed with the new contracts. As for the studies on mortality rates, we have had eight studies in the past six years, six of which have said that staffing levels at weekends are one of the things that need to be investigated. The clinical standards say that we need senior decision makers to check people who are admitted at the weekends, and junior doctors, when they are experienced, count as senior decision makers, which is why they have a very important role to play in delivering seven-day care.

[Dr Julian Lewis (New Forest East) (Con)]

I know that the BMA very properly balloted its members before embarking on a policy of industrial action, but has it yet balloted junior doctors on the specific question of withdrawing emergency cover?

[Mr Hunt]

No, it has not, and I think that is what is causing many junior members to pause for thought. Many people say that this escalation is something that the BMA should consults its members on, once again.