Oral Answers to Questions

Julie Hilling Excerpts

Tuesday 24th February 2015 Commons Chamber

The Secretary of State was asked—

[Julie Hilling (Bolton West) (Lab)]

1. How many NHS staff have been made redundant and subsequently re-employed by the NHS since May 2010.

[Graeme Morrice (Livingston) (Lab)]

9. How many NHS staff have been made redundant and subsequently re-employed by the NHS since May 2010.

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

Over the four and a half years between May 2010 and October 2014, 5,210 people—equivalent to, annually, less than 0.1% of the NHS work force—have been made redundant and then returned to work elsewhere in the NHS.

[Julie Hilling]

But at a time when A and E is in crisis and there are not enough nurses, how on earth can the Minister possibly justify firing and rehiring thousands of NHS staff? What greater sign could there be of a Government with their priorities totally wrong?

[Dr Poulter]

I am not sure I recognise that picture of the NHS. We know that there are between 6,000 and 8,000 extra nurses, midwives and health visitors working in our NHS than there were under the previous Government. Also, in respect of A and E, the average length of stay in hospital has steadily come down from about eight days in 2000 to about five days now. So our NHS is getting better and improving under the current Government.

A and E (Major Incidents)

Julie Hilling Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I am afraid that that is an example of the politicisation of the NHS that people find so distressing. Those reforms were not enacted in Wales, which is run by the hon. Lady’s party, and A and E performance there is significantly worse. It does not make any logical sense to blame A and E performance on those reforms.

[Julie Hilling (Bolton West) (Lab)]

Royal Bolton hospital says that it is in crisis because it cannot discharge patients. The Secretary of State says that the hospital and local authority in Bolton are talking to each other, but Bolton council has had £100 million-worth of cuts. What will he do to reverse the cuts in social care that have created the crisis in our hospital?

[Mr Hunt]

If the hon. Lady is making a criticism, I would ask her what she is going to do, because the shadow Chancellor confirmed this week that he will not find extra money for social care. I will tell her what we are doing. We are merging the social care and local NHS systems to try to stop people being pushed from pillar to post, and to give them the joined-up, compassionate, safe care that we think is an absolute priority. That is happening in Bolton—I have visited facilities in Bolton that are displaying excellent care—and we should support such efforts, not criticise them.

Five Year Forward View

Julie Hilling Excerpts

Thursday 23rd October 2014 Commons Chamber

[Mr Hunt]

I thank my hon. Friend for what he has done for Medway Maritime. That was a very good visit: I met both management and staff, and gained a better idea of the challenges faced by the hospital.

The report makes it clear that we must become much better at tackling variations in care. Never again must we have a system in which hospitals are struggling and delivering poor care, and that poor care is swept under the carpet and nothing is done about it. The Government have put 18 hospitals into special measures—more than 10% of all the hospitals in the NHS—and that has been very challenging. We have been accused by Opposition Front Benchers of running down the NHS when we have done it, but do you know what has happened? Six of those hospitals have now come out of special measures, and nearly all the others have improved dramatically. It is time that the Labour party got behind what is a really good inspection programme, based on openness, honesty and transparency about problems.

[Julie Hilling (Bolton West) (Lab)]

Bolton clinical commissioning group is putting mental health services out to tender, which seems to involve a cut of between a half and a third on the basis of current spending. Are such cuts in mental health services what the Secretary of State means by his vision?

[Mr Hunt]

No, and that is why the Government legislated for parity of esteem between mental and physical health. As I said earlier, we have introduced maximum waiting times for some mental health conditions, and we have focused on improving access to psychological therapies—IAPT—and on dementia. Anxiety and depression and dementia are two of the most common mental health conditions in respect of which we can make a real difference, and we are doing more all the time.

Surrogacy

Julie Hilling Excerpts

Tuesday 14th October 2014 Westminster Hall

[Stephen McPartland (Stevenage) (Con)]

It is a pleasure to serve under your chairmanship, Sir Edward, and to follow my hon. Friend the Member for Watford (Richard Harrington) who, as always, has given an impassioned defence of his constituents’ interests. I congratulate my hon. Friend the Member for Erewash (Jessica Lee) on calling this important debate.

Surrogacy is a complex minefield, as we are all aware. Many Members of Parliament are concerned about the issue but, as we can see from the Chamber today, they are not keen on speaking about it publicly, because it is complicated, with many facets and problems. There are some religious undertones to the subject. I am pro-life and support all life. As a Catholic, I know that some Churches do not support surrogacy, but my view is that, whether or not it is supported, there is a system in place that we need to try to fix, as the exploitation of people using surrogates must stop.

Some of my constituents have fertility problems. They have looked into surrogacy as an option, but they have found it to be such a minefield that they do not wish to pursue it, despite the fact that having a child is their lifelong dream. At the moment, there is a real problem that is affecting our constituents.

As technology moves on, the way in which surrogacy is done has evolved over the years, but essentially we are still talking about a woman carrying and giving birth to a child for somebody else. There are a huge range of problems. For example, in the United Kingdom, we do not know how many children are conceived through surrogacy. We are a 21st-century modern democracy, but we do not have the full figures. There are no official records apart from the parental order register. To put that register into context, an estimated 1,000 children are born through Indian surrogacy each year, but in 2012, the family court granted only 213 parental orders. That suggests that there maybe thousands of children in the UK living with adults who are not their legal parents.

That may not be an issue for many people, but let us consider what my hon. Friend the Member for Watford said about families wanting to do what is legally correct and best for those children. As my hon. Friend the Member for Erewash stated, many of the children are born stateless. If they try to get into university, for example, which type of fees will they pay—the fees for foreign students or those for domestic students? How will they access and enter higher education in the United Kingdom? What if they have a problem accessing benefits in future because of some of the changes that we have made to access to benefits—if someone is considered stateless, how will they access benefits? Surrogacy impacts on a huge range of issues for families. As we change laws in the UK, the impact on those families will get bigger and worse. We need to look at that and work out a way of moving forward and creating some kind of international agreement.

My particular passion is to ensure that those families are safeguarded against exploitation. However, I would not wish to push too hard on that matter: as my hon. Friend the Member for Erewash clearly stated, there have been only two recorded cases of surrogates changing their mind in the past 30 years, but thousands of surrogates who, because they have enjoyed carrying a child for somebody else, have happily given the child over and helped the family to have another child. That is important, and I would not wish to scaremonger. However, it is incredibly important to me—as it is to my hon. Friends the Members for Erewash and for Watford—that surrogates are safeguarded and that the families who use surrogates are not exploited.

My hon. Friend the Member for Erewash raised the issue currently in the news of families who are being broken up, and she mentioned the case of the two children. Whoever is right or wrong, the reality is that the case has been a huge problem for the families and countries involved because there is no way of dealing with the situation or of identifying whether any law—rather than a moral and ethical code—has been broken. The issue needs to be looked at, and I support my hon. Friend’s wonderful campaign for some kind of international agreement on surrogacy.

I also want to make a plea to the Minister on parentage. At the moment, the surrogate and her husband are considered to be the child’s parents. That leads to the problem of statelessness that we have mentioned and the problem that my hon. Friend the Member for Watford raised concerning his constituents, where one parent was kept separate from the family for many months—in some cases, no doubt, it is for years. We need to tackle that, as it has a detrimental effect on our constituents and our society. I congratulate my hon. Friend the Member for Erewash on her wonderful campaign, and I thank her for raising the matter in the House.

[Julie Hilling (Bolton West) (Lab)]

rose—

[Sir Edward Leigh (in the Chair)]

Order. I will call the hon. Lady, but she did miss most of the opening speech. I am sure she will want to apologise, although I am also sure that there is a good reason why she was late.

[Julie Hilling (Bolton West) (Lab)]

I am grateful for being called in the debate. Of course I give my full apologies for missing a great deal of the speech by the hon. Member for Erewash (Jessica Lee). I congratulate her on securing a debate on this important issue.

I want briefly to tell the story of a wonderful surrogate family in my constituency. Members might remember that I have talked quite a lot about Kiran and Bina Salvi because, sadly, they got caught up in the passport debacle. They had also been trying for a baby for 12 years. They went through all the normal tests and goodness knows how many rounds of in vitro fertilisation until, in the end, the doctors said they had to stop because it was damaging Bina’s health. They had had years of IVF and years of terrible disappointment every time the pregnancy did not work out.

The couple considered adoption, but the problem they then had was one that many couples have: by the time people have gone through all those years of trying, they are often considered too old to adopt a baby, so they are really in a cleft stick. The Salvis did much research and eventually took the brave decision to use a world-renowned specialist surrogacy clinic in India. They had five attempts at surrogacy, and their wonderful surrogate mum eventually became pregnant with their baby. On 3 March, they had a beautiful boy and girl—and they are beautiful; I went to visit them, and it was a proud moment to see them.

The babies were extremely underweight when they were born—they were little more than 2 lb. They were then stuck for four months in a hotel room in India with no passports, and they got more and more distressed. Spending the first four months of your life in a hotel room is no joy for anybody. The couple were also frightened about malaria and the rainy season. In addition, of course, it was not a four-star hotel, but the kind of hotel the couple could afford to stay in for that long.

The Salvis were with many other couples from the UK who were caught up in the same situation. They saw, however, that couples from other countries went through a much quicker process. Within a couple of weeks, couples from America and Canada were back at home with their babies. I therefore absolutely support the call for an international agreement on this issue.

Getting citizenship was extremely quick and easy for the Salvis, and the children were British citizens within two weeks. However, there was a difficulty. Rightly, the Indian Government require an exit visa for any children leaving the country, but because the couple’s children could not get passports, they could not get an exit visa. The couple had to go to New Delhi to sign more documents—something that they were not aware of in the first instance.

That shows the problems we have. The situation was probably compounded because we had closed the passport office in Hong Kong, which would normally have dealt with the issue. The office in the UK did not know how to deal with such cases, and that compounded the problem for the Salvis. We need to make sure we have experts in our passport offices in the UK who can deal rapidly with these cases and understand their intricacies. Eventually, however, the family got the passports and returned home.

The other point I want to raise is about the benefits to the surrogate parents. In this case, they gave the precious gift of life. The Indian mum was so pleased to have been able to help the Salvis, and the two couples are still in close contact. However, the surrogacy also gave the Indian couple a real lift in their lives, and they managed to start two businesses on the basis of surrogacy. Giving the gift of life, and the financial benefit from it, therefore fundamentally changed their life and that of their family.

There are strict rules in India about the number of cycles of surrogacy people can have, but the rules are not necessarily the same in other countries. Any international agreement therefore needs to make it clear how many rounds of surrogacy there can be, and to guarantee the health of the surrogate mother and the babies born to her.

I absolutely agree that we need international agreements, so that parents who seek surrogacy understand the rules that are in place and are not held up in the country where the children are born and so that surrogates are not exploited in their home countries. We also need to examine surrogacy in this country to see whether we should have different rules to allow payments to be made for surrogacy, rather than the deals we have at the moment.

Many thousands of would-be parents are suffering badly because they cannot have children. They see their friends around them having children, and becoming parents themselves becomes their life goal. I think we can all share their pain, and anything we can do to assist them will be really important. Again, I congratulate the hon. Member for Erewash on raising this important issue.

Obstructive Sleep Apnoea

Julie Hilling Excerpts

Tuesday 2nd September 2014 Westminster Hall

[Julie Hilling (Bolton West) (Lab)]

I am very pleased to have secured this debate and to be—[Interruption.]

[Mr Dai Havard (in the Chair)]

Order. Could we have quiet, please, including in the Public Gallery?

[Julie Hilling]

Thank you, Mr Havard. I am very pleased to be serving under your chairmanship. You will not be surprised to learn that I first got interested in this subject from a road safety perspective. When a member of the Select Committee on Transport, I received an e-mail from the parents of a young woman who was killed by a lorry driver who fell asleep at the wheel, so I raised the issue on a number of occasions when we were doing different inquiries on things such as freight transportation and road safety. However, as soon as I started to talk about sleep apnoea, I discovered that it was far more common than I had thought—with a number of friends and acquaintances declaring that they had it—and that, in Bolton West, predicted rates of the condition are higher than the national average. I asked for the debate today to coincide with the launch of the British Lung Foundation’s obstructive sleep apnoea health economics report, because an estimated 1.5 million people have the condition in the UK, yet only 330,000 people are currently diagnosed and treated.

OSA affects people of all ages, including up to 4% of middle-aged men, 2% of middle-aged women and 20% of those aged over 70. Although not everyone with OSA is overweight, many are, and with an increasingly overweight and ageing population, it is anticipated that the rates of OSA will increase in the coming years.

What is obstructive sleep apnoea? It is a condition whereby the muscles in the throat relax, causing an obstruction in the airway during sleep, meaning that a person stops breathing. Some people stop breathing hundreds of times a night, and others have periods during which their breathing is restricted. Untreated OSA can have a profound impact on the quality of life of those affected and it has been proven to cause high blood pressure, as well as being associated with a host of other health conditions such as heart disease, heart failure, stroke and diabetes. The life of someone whose OSA is not treated can be dramatically shortened. Correct treatment has been shown to increase the probability of survival of OSA patients by 25%.

There is a strong link between OSA and an increased risk of road traffic accidents, with individuals who have uncontrolled OSA three to seven times more likely than the general driving population to have an accident on the road.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this issue to the House for hon. Members’ consideration. Many people will look on OSA as something that perhaps is not all that worrying, but from what the hon. Lady has said, it very much is. Does she feel that probably what we, the Minister and the devolved Administrations now need to do is to raise awareness of the condition through GP surgeries, leaflet drops and education?

--- Later in debate ---

[Julie Hilling]

I thank the hon. Gentleman for that intervention. I absolutely agree that we need to do more and I will go on to talk about what the Government should be doing.

[Rosie Cooper (West Lancashire) (Lab)]

Before my hon. Friend gets to that, I congratulate her on securing the debate. Does she agree that with 80% of OSA cases not being diagnosed and the economic and social aspects of that being so dramatic—it costs so much to deal with strokes and heart attacks—we must do more to ensure that the National Institute for Health and Care Excellence regulations are implemented? The Government and the Department of Health cannot walk away from the health and social costs and the costs to the patient.

[Julie Hilling]

I thank my hon. Friend for that intervention. It feels as though she has looked at my speech, because I am going to cover in detail a number of the aspects that she has raised.

OSA can reduce a person’s ability to work and impair the quality of life of the person and their family. The story of Steve, one of my constituents in Bolton West, shows only too well what can happen when OSA is not diagnosed. When Steve was 36, he started to get lots of daytime sleepiness; indeed, he was sleeping all the time. He became very aggressive and went to his doctor, who treated him for depression. The first medication did nothing, and the second medication made him even more aggressive. He managed to maintain his job, but with great difficulty, often having to slope off for a sleep, and he was being threatened with dismissal. He did not have a relationship with his young daughter; between the ages of four and six years old, she had no relationship with her dad at all. He could not play with her or interact with her, except to snarl at her. Indeed, he did not have a relationship with his wife or anyone else at that time. The family went on holiday, but his wife said that she would never go away with him again because he slept the whole time. Eventually, he had to take sick leave from work, and for five months he never left his bed. He was so bad that his wife had to change the bedclothes around him. He had a constant headache and felt worthless as he was not contributing anything to society or his family. He could not eat properly and just could not function. He attempted suicide twice.

Steve was referred to a mental health consultant at Royal Bolton infirmary who immediately asked whether he had been tested for sleep apnoea and he was referred to Wythenshawe sleep clinic. There are three stages of sleep: a top layer, a lower layer and deep sleep. The sleep clinic discovered that every minute and 43 seconds, Steve went back to the top of the sleep cycle and was never getting into a deep sleep. He was given a continuous positive airway pressure—CPAP—machine. He went home, slept for 11 hours and was back at work the next day. Eight years later, he still uses the machine every night and has never looked back. It does have its downsides. He will not go abroad because he has a great fear of electricity cuts and he cannot sleep in the same room as his wife because of the noise of the machine, but he believes that that is a small price to pay for getting his life back. Steve feels like he suffered two years of torture. Let us not forget that sleep deprivation is listed as a proscribed method of torture. However, with a very low cost treatment, he can now function and live life to the full.

My friend’s sister, 52-year-old Jean, also had difficulty in getting her GP to take her issue seriously. She went to him because she was very tired all the time and kept falling asleep in work and on the bus home. She would go to bed and sleep all night, but wake up feeling just as drained and tired. After three visits, her GP started to take her problem seriously and, after running a number of tests with no result, referred her to Wigan infirmary. She got an appointment within three weeks, had her sleep monitored and then got a CPAP machine. It has not solved her problem completely, but it has much reduced the number of times she wakes up and she is able to enjoy life again.

[Yasmin Qureshi (Bolton South East) (Lab)]

I congratulate my hon. Friend on securing this Adjournment debate. On the point that she raises about how long it takes for people to be diagnosed, is it not correct that about 1.5 million people in this country probably suffer from this condition, but only about 330,000 people are ever diagnosed? Presumably, therefore, one thing that we need to do is to make medical practitioners aware that this condition is perhaps a lot more prevalent than we think it is.

[Julie Hilling]

I thank my hon. Friend for that intervention. She is right. We need to make both the public and medical practitioners aware. Also, we need to ensure that the services are in the right place. I will talk more about that in a moment, but first let me tell hon. Members about one more person. My office manager, Noelene, also surprised me by saying that she suffers from OSA; I never had any inkling that she did. She has an underactive thyroid and was extremely tired and forgetful. She would have no recollection of doing something or no memory of how she had got somewhere. She just blamed her thyroid, but her endocrinologist told her that her thyroid levels were fine and that she could not keep blaming everything on her thyroid. He referred her to his friend the sleep specialist. She collected a monitor that afternoon and less than four weeks later was given a CPAP machine. As the specialist said, if the mask works, it is OSA, and if not, it is something else and they will have to continue to investigate. She had problems with the mask initially and found it very uncomfortable but persevered. She could not get on with the full mask, because, as she said, a full mask and hot flushes are not a great combination, so she tried two other masks and now has a nose mask. Occasionally she does not use it, but immediately feels bad. She is now four years on from diagnosis and treatment.

I guess I am not surprised that I did not know that people had the condition, because snoring and falling asleep all over the place are still treated as a great joke, and the first reaction of most of us when we are told that we snore is immediately to deny it. The cost of undiagnosed sleep apnoea is enormous, however. Up to 80% of cases of OSA remain undiagnosed. Awareness of the condition is poor, and the risks associated with it are underestimated even by doctors. The British Lung Foundation led a three-year project to raise awareness of the condition and to campaign for the setting of quality standards for the treatment and care that OSA patients can expect. The OSA patients’ charter, published in 2012, was designed to do that, and it calls on the Government to prioritise OSA by increasing awareness, ensuring adequate data are collected for good service planning and investing more research into the condition.

Progress has been slow, however. The British Lung Foundation commissioned a report on the health economics of OSA, which will be published later this week, to demonstrate the economic and social arguments for greater focus on, and treatment of, the condition. The report finds that treating OSA can generate direct health benefits to OSA patients, and reduce costs incurred by the NHS, in comparison with not treating the condition. Currently, only 22% of OSA patients are treated across the UK, but increasing diagnosis and treatment rates to just 45% could yield an annual saving of £28 million to the NHS, as well as 20,000 quality-adjusted life years. That includes savings that result from reductions in road traffic accidents, heart attacks and strokes, as well as the positive impact on patients’ quality of life and improved survival rates over time. Other sources suggest that NHS expenditure on undiagnosed patients is estimated to be approximately twice that of people of the same age and the same gender. It is estimated that if everyone in the UK with moderate to severe OSA was treated, approximately 40,000 road traffic accidents could be prevented—accidents that not only affect sufferers of OSA, but cause injury and death to so many others.

The main treatment for OSA, continuous positive airway pressure, is very cost-effective. NICE usually values a treatment as cost-effective if it costs £20,000 to £30,000 per quality-adjusted life year gained, but the main treatment used for OSA costs the NHS only £5,000 per quality-adjusted life year gained. Because OSA is associated with other conditions such as heart disease, stroke and diabetes, some savings may also be made in the reduction of medication for those conditions. A Canadian study found that 38% of patients being treated for OSA reported a reduction in their intake of medicines to manage their other conditions.

What do we need to do? In July 2012, the Department of Health set up a working group on OSA to look at areas for improvement in care and services for the condition. However, the group was disbanded early in 2013 during the NHS restructure, and no one is responsible for taking forward the recommendations from the group’s work. The Department of Health should appoint a body to take forward those recommendations. In 2012, NICE was asked to produce a quality standard on sleep-disordered breathing. That has not been developed, and it should be taken forward as an immediate priority so that those with OSA know what to expect from their care.

Everyone who has symptoms of OSA should be diagnosed quickly and accurately, and they should receive the highest standard of care. That will help to reduce NHS costs and improve patients’ quality of life, and it could reduce the number of road traffic accidents that are caused by sleepy drivers. The level of risk of OSA varies across the UK depending on the prevalence of risk factors, and there is a mismatch between the geographical distribution of need and the regional distribution of services. Local commissioners must ensure sufficient availability of services in areas such as Bolton West that have a high estimated OSA prevalence. OSA screening and specialist referral should be introduced into the quality outcomes framework. Doing so would allow for more accurate data on the number of referrals being made from primary care and provide an immediate financial incentive for early intervention that would reduce costs and improve outcomes in the long term.

Finally, let me return to where I started on my journey of interest in OSA. Those who drive for a living, frequently on monotonous roads and motorways, are at risk of falling asleep at the wheel. Their lifestyle also puts them at increased risk of developing sleep apnoea. Those who fear that they have the disorder are often worried about seeking treatment, because they are concerned about losing their livelihood. I hope that the Minister will support the call of the sleep apnoea partnership group to expedite the treatment of vocational drivers so that they can be driving again within four weeks of referral.

[Rosie Cooper]

Before she reaches the end of her speech, will my hon. Friend emphasise that it makes absolutely no sense not to raise awareness of the condition, diagnose sufferers and provide treatment to improve the health of individuals, save the NHS money and reduce the number of sleep accidents? That is a no-brainer.

[Julie Hilling]

My hon. Friend has kindly done so for me. Clearly, OSA is a major issue, and one that is as serious in Bolton West as it is throughout the UK. The Minister assured me in February 2013 that a model care pathway and service specification to reduce variation in diagnosis and treatment would be developed, but we are still waiting. The time for talking is over. Research has been done and professional groups have informed the Government, so it is now time to take action. I will listen with great interest to the Minister’s response.

Healthier Together Programme (Greater Manchester)

Julie Hilling Excerpts

Tuesday 22nd July 2014 Westminster Hall

[Kate Green]

I agree.

Meanwhile, Healthwatch Trafford says that there is concern about whether the committee-in-common model in Manchester is sufficiently transparent, regarding its ability to engage with and represent the concerns of local people and to oversee, in the wider public interest, what is being proposed.

I am utterly unconvinced that local people are aware of or understand the steps that are being put forward now that could result in major changes to health care provision in our area.

[Julie Hilling (Bolton West) (Lab)]

Before my hon. Friend moves away from the consultation, does she agree that the questions asked in the consultation document are ridiculous? For example:

“Do you…disagree that children and young people should be cared for closer to home where appropriate?”

Nobody would ever disagree with such questions.

[Kate Green]

That is absolutely right. Again, that is exactly what we saw in the consultation on the new health deal for Trafford. We raised concerns about that at the time, but the NHS has learned nothing about how proper engagement and debate with the public can be managed and take place.

There is real concern that a lot of groundwork has gone into producing this consultation but that much of it has happened behind closed doors. If the significant changes that are being advocated, or significant changes in other forms, are needed— the document says that they are, which may well be the case—it is imperative that the public be brought on board through a process of careful, systematic, dedicated engagement. It is not good enough to land a document out there without that work being put in and without any clarity about how decision makers will be informed by the views and opinions of the public at large and of elected Members who represent them.

--- Later in debate ---

[Mike Kane]

I agree. It would be odd not only for my constituency, but for constituencies to the south in the Cheshire belt and the Cheshire plain that those hospitals serve.

Wythenshawe hospital is very much looking to the future and its long-term sustainability. It is developing the Manchester MediPark in partnership with Manchester city council and private sector developers. MediPark will exploit the huge strengths of Greater Manchester and the north-west in health and life science services. Research and development forms a key part of the new Manchester airport city enterprise zone, which I had the opportunity of updating Members on only last week during my Adjournment debate on regional airports.

UHSM is recognised as a centre of excellence for research and development, and is a founding member of Manchester Academic Health Science Centre. The partners of the science centre share the common goal of providing patients and clinicians with rapid access to the latest discoveries and improving the quality and effectiveness of patient care. It is clear that the hospital is going from strength to strength, but I fear that the planned Greater Manchester Healthier Together proposals, to which my hon. Friend the Member for Blackley and Broughton referred, could fundamentally destabilise the trust and lead to a loss of its major emergency service, many of its specialised services, its trauma service and even its teaching status.

The additional reorganisation is set against the backdrop of the Government’s £3 billion reorganisation of the NHS, which has siphoned off money from the front line to pay for back-office restructuring. In the first three years of this Government, attendances at A and E have increased by 633,000, yet Trafford general, to which my hon. Friend the Member for Stretford and Urmston referred and which serves many of my constituents, has seen a downgrading of its A and E department. It has got harder to get a GP appointment since the Government scrapped the previous Government’s guarantee of an appointment within 48 hours, and cut funding for extended opening hours. That is a key cause of Wythenshawe’s A and E problems.

[Julie Hilling]

Does my hon. Friend agree that the major vision that seems to be emerging is simply one of pitching hospital against hospital—fighting about whether to have a hospital in Wigan or Bolton, or four or five specialist hospitals, when, as has been said, we all want a good local service? Should not the concentration be first and foremost on getting primary care services correctly in place? That should be sorted out, and afterwards we can look at what hospital care we need.

[Mike Kane]

I agree; the most important thing is to get primary care in place first. Starting a consultation nine months from a general election that will pit MP against MP is not a good idea.

A quarter of walk-in centres, including Wythenshawe, have closed, and NHS Direct has been dismantled. On top of all that, the new Healthier Together proposals mean there is potential for a downgrade at Wythenshawe hospital. That would, as has been pointed out, be a broken promise for people in Wythenshawe and south-west Manchester, who following the downgrading of the A and E at Trafford general were assured that University Hospital of South Manchester would not be affected.

The aim of Healthier Together, to give patients across the region the same excellent standard of service wherever they live, is the right one. The challenge is huge. Manchester has the highest premature death rate of any local authority in the country. There can be no doubt that health care services in Greater Manchester need to change. Almost £2 billion has been taken out of the budget for adult social care. We need to do things differently to meet the challenges of the time and better integrating local authority services with the NHS will be a key part of that change. However, the current process is flawed and is moving too fast. The proposals fail to recognise that Wythenshawe is already a major specialist site that provides many vital services to the people of Greater Manchester.

The public are not being provided with enough detail to enable them fully to understand the implications of the proposed changes. The consultation meetings have been criticised—as they have today—for being jargon-ridden and held at inaccessible times. No financial models have been provided in the information for the public and UHSM believes that the current proposals could destabilise the finances of the trust.

Wythenshawe is a level 1 major trauma centre, and is currently the only site capable of developing a single level 1 trauma site for adults for the whole of Greater Manchester. As my hon. Friend the Member for Blackley and Broughton pointed out, it covers Manchester airport, and if an accident were to happen such a nearby centre would be vital. The current proposals could leave the southern sector of Greater Manchester and north Cheshire with no specialist major emergency hospital. The proposal does not reflect the view of providers and local commissioners in the southern sector that Wythenshawe should remain and be developed further as the sole specialist site in the southern sector.

The failure of the proposals to acknowledge Wythenshawe as one of the fixed sites threatens the future clinical, operational and financial sustainability of the trust. For changes at such a level to have the desired impact on services across Greater Manchester, all the partners must be firmly on board. I urge Healthier Together to look again and ensure that the baby is not being thrown out with the bath water, because of a rushed consultation and flawed proposals.

--- Later in debate ---

[Jonathan Reynolds]

That is absolutely true. If someone lives near the station in Stockport, it is sometimes quicker to get to London than to another part of Greater Manchester.

I am pleased that the hon. Member for High Peak (Andrew Bingham) was here, because something that is forgotten across the conurbation is that the health economy and structures are not coterminous with the political structures of Greater Manchester. Glossop is part of Tameside’s health economy and getting from Glossop to Ashton-under-Lyne is not an easy journey, but trying to get to a different part of Greater Manchester in an ambulance or with a need to access a particular service would be extremely worrying.

[Julie Hilling]

It must be recognised that people living within Greater Manchester will also travel to hospitals outside. Some of my constituents might travel to Chorley for treatment, for example, because it is much closer than Bolton or Wigan. My hon. Friend is absolutely right that there is no wall around Greater Manchester in terms of people travelling in or out.

[Jonathan Reynolds]

That is absolutely true and has been mentioned by several colleagues today. My specific point about Glossop is that it shares an NHS trust hospital and clinical commissioning group with Tameside and that must be considered in a manner that people do not fully appreciate at the moment.

Looking at the financial picture for the NHS in Tameside and Glossop, we see many challenges to meet in future. I cannot see the utility in a big hospital reorganisation such as this unless there is much wider reform of out-of-hospital care, because we will still face the problem of too many medically healthy people being in hospital because they have nowhere else to go. Such reform would require much stronger integration of social services, public health, the CCG and the hospital, but the Government’s entire direction of travel is towards a more fractured and competitive system. I understand the motivation, but I cannot see how it tallies with something such as the Healthier Together programme.

The Minister has several points to address in his speech, but I hope that he can respond to that one in particular, because I am unsure about why we are going through this process if it will not deliver the improvements in health care that should be the ultimate goal of any kind of reorganisation.

--- Later in debate ---

[Norman Lamb]

I take that concern on board, and the hon. Lady should respond to the consultation. It is really important for hon. Members to do that.

Incidentally, I should say something on behalf of my hon. Friend the Member for Cheadle (Mark Hunter), because he is a Whip and so is unable to speak in the debate, although he has attended it all. He has expressed particular concerns about the potential implications for the University Hospital of South Manchester and Stepping Hill, and about options 4.1 and 4.2. It is important that I place that on the record.

[Julie Hilling]

Will the Minister give way?

[Norman Lamb]

Will the hon. Lady let me make another point that is on the tip of my tongue? I will then be happy to give way.

The hon. Member for Stalybridge and Hyde expressed the concern that, in his assertion, we are moving away from integrated care. Precisely the opposite is the case. Indeed, the hon. Member for Copeland (Jonathan Reynolds), the shadow Minister, expressed clearly some of the fantastic potential gains that could be achieved in the Greater Manchester area if the objectives were achieved. When I announced the pioneer programme to demonstrate the exemplars of integrated care, Greater Manchester was one of the applicants to get on to the shortlist and was close to securing pioneer status, so my every impression is that exciting work is going on in Manchester to change local health and care services in a way that all of us could probably sign up to.

[Julie Hilling]

rose—

[Kate Green]

rose—

[Norman Lamb]

I give way first to the hon. Member for Bolton West.

[Julie Hilling]

I thank the Minister for giving way. The bit that I do not understand is that local authorities, leaders such as Lord Smith and others, have been saying, “Yes, we need to sort out the integrated care”, but the consultation has been putting front and centre the need to change the status of hospitals. What everyone in the conurbation is saying is, “Let’s look at the integrated care and then see what comes out of that”, rather than putting changing hospitals up front, which is what exercises the whole community.

[Norman Lamb]

I note the hon. Lady’s point, but I come back to Lord Smith’s statement:

“We accept the case for change made in this consultation document”.

It cannot be clearer than that.

--- Later in debate ---

[Norman Lamb]

I acknowledge that, just as in London, there are real bottlenecks in Manchester. I have a son who was at university in Manchester—and found it to be a very fine city—so I understand the transport challenges there completely. The point remains that specialisations can save lives. We all have to recognise that.

All service changes should be led by clinicians and be based on a clear, robust clinical case for change that delivers better outcomes for patients.

[Julie Hilling]

Will the Minister give way?

[Norman Lamb]

I really cannot. I have been pretty generous in giving way many times, so I will make a bit more progress.

It is therefore for NHS commissioners and providers to work together with local authorities, patients and the public in bringing forward proposals that will improve the quality and sustainability of local health care services. Government policy has been to emphasise local autonomy and flexibility in how NHS organisations plan and deliver service changes, subject to meeting legal requirements, staying within the spirit of Department of Health guidance and ensuring schemes can demonstrate robust evidence against four tests. Those are that there is support from GP commissioners; there is a focus on improving patient outcomes; that schemes consider patient choice; and that they are based on sound clinical evidence.

I recognise that change is often difficult to achieve because the consequences of not getting it right could be so profound—hon. Members have been absolutely right to raise their concerns. It is therefore right that the NHS does not rush into change without fully understanding all the potential consequences, sometimes including unintended consequences. Change can be difficult to explain to patients who have had quite reasonable anxieties exacerbated by speculation—in many cases, in the media—about whether this or that service might close. Services are sometimes described as closing when in fact they are simply being provided in a neighbouring facility or changing for the better in response to advances in treatment.

For example, my hon. Friend the Member for Macclesfield (David Rutley) referred to the possibility of hospitals closing, but I am not aware of any proposal to close hospitals. When we communicate to patients and the public, it is important that we are clear on what this issue is and is not about, so as not to raise anxieties. From my perspective, we have to be careful to avoid ramping up anxieties inappropriately by playing on fears. We see that too often; unfortunately, it stifles genuine debate and discussion about what health services will need to change in order to do better in future. But I applaud all hon. Members for speaking in this debate very reasonably and about legitimate concerns.

The right hon. Member for Leigh (Andy Burnham) has agreed that the NHS needs to have the freedom to change the way services are provided. He said:

“If local hospitals are to grow into integrated providers of whole-person care, then it will make sense to continue to separate general care from specialist care”—

the point made by the hon. Member for Wigan a moment ago—

“and continue to centralise the latter. So hospitals will need to change and we shouldn’t fear that.”

Perhaps the hon. Lady will take the point better from her party’s health spokesperson than from a Minister, but the right hon. Member for Leigh was making the case for the specialisation of services.

Oral Answers to Questions

Julie Hilling Excerpts

Tuesday 15th July 2014 Commons Chamber

[Mr Jeremy Hunt]

No one could have campaigned harder than my hon. Friend and his hon. Friend the Member for Milton Keynes North (Mark Lancaster) for improving the services at their local A and E department. A consultation is currently taking place. There is no question of closing both A and Es in that area, and I understand that a very good capital bid for £2 million for his local A and E has been put in which, subject to the usual value-for-money requirements, looks like it is very strong.

[Julie Hilling (Bolton West) (Lab)]

My constituent, 81-year-old Rita, was taken seriously ill on holiday and had to spend two weeks in hospital. She was discharged with a letter saying that she needed very urgent surgery, but has had to wait five weeks before she even sees a consultant, let alone getting any treatment. What can the Secretary of State do for Rita and others like her?

[Mr Hunt]

We are working extremely hard to make sure that people do not have those long waits. We are doing about 3.5 million more diagnostic tests, for example, every year in the NHS than four years ago. I am happy to look into the individual case and see what lessons can be learned and to see whether we can help the hon. Lady’s constituent.

Patient Safety

Julie Hilling Excerpts

Tuesday 24th June 2014 Commons Chamber

[Mr Hunt]

I am absolutely determined to make that the case. The biggest example—a number of them have been raised today—is the issue of hospitals put in special measures. Over the last year, we have put more than 10% of NHS acute trusts into special measures. That was a very difficult decision and was not welcomed at the time. The result, I am pleased to say, is that we are seeing real and significant change in all those hospitals. I hope as many of them as possible will get out of special measures quickly, but we can achieve that change only if we are honest about the problem in the first place.

[Julie Hilling (Bolton West) (Lab)]

Bolton hospital is having to go abroad to recruit qualified nurses this summer because there are no British-trained nurses available. Will the Secretary of State now take responsibility for cutting nurse training places by 10,000 since the last election and accept that the lack of qualified nurses is just making the problem of safety worse?

[Mr Hunt]

What I will take responsibility for is agreeing to a public inquiry into what happened at Mid Staffs—something rejected by the Labour party—that has woken up the whole NHS to the need for safe staffing in all our wards. We are implementing the report and that will indeed be reflected in the nurse training numbers going forward.

NHS

Julie Hilling Excerpts

Wednesday 5th February 2014 Commons Chamber

[Andy Burnham]

I began by saying that the reasons for the rise in A and E attendances were complex. I did not say—if the hon. Gentleman was listening—that there were any simplistic reasons. I did say that there had been a rise in malnutrition and diseases linked to it. If hon. Members on the other side of the House want to dispute that fact, I will have that debate any time they wish. They seek to suggest that malnutrition is not a problem, but they are confirming how out of touch they are.

As I was saying, the number of emergency admissions of pensioners has topped 500,000 for the first time. It is rising faster than the increase in the ageing population. There were 65,000 more emergency admissions in the last 12 months compared to the previous 12 months, a clear sign of more frail, elderly people ending up in A and E. Hospitals are operating way beyond safe recommended bed occupancy levels, with increasing numbers of frail, elderly people on the wards. That means that A and E finds it increasingly difficult to admit people, and pressure backs up through A and E.

The Government’s amendment seems to have been written in a parallel universe. Let us get this clear: the last 12 months have been the worst in A and E for a decade. Hospital A and Es have missed the Government’s target in 44 out of the last 52 weeks. How can that equate to A and E performing strongly, as the amendment suggests? It serves only to confirm an impression that has been building about this Secretary of State since he took office: that he seems to spend more time paying attention to spin doctors than he does to real doctors.

[Julie Hilling (Bolton West) (Lab)]

One problem my food bank has reported to me is that people are reducing the number of drugs they are taking because they cannot afford to buy them. There is a queue in A and E departments to register. Not only are people waiting in ambulances outside, but there are queues of people, as happened in a hospital very close to this place, waiting to be registered.

[Andy Burnham]

My hon. Friend is absolutely right. She knows the pressure people are under in our area. What we have heard from the Government is denial that this is the reality in many parts of the country. [Interruption.] We can hear them shouting now, claiming that it is a myth that people are using food banks and not eating properly, and that they cannot afford to heat their homes because of the rise in fuel bills under this Government. All of that is placing extra pressure on A and E, and people are waiting longer and longer to be seen.

--- Later in debate ---

[The Secretary of State for Health (Mr Jeremy Hunt)]

I beg to move an amendment, to leave out from “House” to the end of the Question and add:

“notes the strong performance of NHS accident and emergency departments this winter; further notes that the average waiting time to be seen in A&E has more than halved since 2010; commends the hard work of NHS staff who are seeing more people and carrying out more operations every year since May 2010; notes that this has been supported by the Government’s decision to protect the NHS budget and to shift resources to frontline patient care, delivering 12,000 more clinical staff and 23,000 fewer administrators; welcomes changes to the GP contract which restore the personal link between doctors and their most vulnerable patients; welcomes the announcement of the Better Care Fund which designates £3.8 billion to join up health and care provision and the Integration Pioneers to provide better care closer to home; believes that clinicians are in the best position to make judgements about the most appropriate care for their patients; notes that rules on tendering are no different to the rules that applied to primary care trusts; and, a year on from the publication of the Francis Report, notes that the NHS is placing an increased emphasis on compassionate care, integration, transparency, safe staffing and patient safety.”.

The right hon. Member for Leigh (Andy Burnham) today made some strong accusations. He talked about the worst winter in A and E for a decade. For months now, he has been predicting a winter crisis in A and E, but as ever, when we look at the facts, they simply do not stack up. Let us look at the last week available for A and E statistics, which is the week ending 26 January. Over 96% of patients were seen within four hours. At this stage in the winter, we have missed the target four times; at the same stage when he was Health Secretary, he had missed it 12 times. That is three times more. [Interruption.] He says the target is different. It is true: on the basis of advice from clinicians, the target was reduced from 98% to 95%, so let us strip out the targets altogether and just ask a simple question. How many people every day are being treated within four hours? Under him, it was fewer than 52,000; under this Government it is nearly 55,000. That is 3,000 more people every day.

The right hon. Gentleman did not just say that; he also said that people were waiting longer and longer to be seen, but that is simply not true. When he was Health Secretary, shockingly, people had to wait on average over an hour to be seen in emergency departments. With 350 more A and E consultants—as my hon. Friend the Member for Mid Norfolk (George Freeman) rightly mentioned—under this Government we have cut that to just 30 minutes. The right hon. Gentleman has the gall to stand up and criticise a record that is better than his.

[Julie Hilling]

In relation to those targets, the Secretary of State ignores the number of people who have not registered because they are in ambulances or because there is a huge queue to be registered. I wonder how that is factored into his claim that people are always seen within half an hour, when patently they are not.

[Mr Hunt]

With great respect to the hon. Lady, it was under her Government that we had the horrific tragedy of ambulances circling round hospitals because hospitals did not want to admit them in case they missed their four-hour A and E target. There is a lot of pressure in the system, but the fact is that 3,000 more people every day are being seen within four hours than when her Government were in power. That is something that A and E departments up and down the country can be rightly proud of.

Care Bill [Lords]

Julie Hilling Excerpts

Monday 16th December 2013 Commons Chamber

[Mr Hunt]

With the greatest of respect to the right hon. Lady, who, I know, played a good role in the G8 dementia summit last week, the Bill is extraordinarily ambitious. Nearly £4 billion is going into a merger of the health and social care systems. The previous Government had 13 years to do something about this and they did nothing. We are delivering. I hope, if she believes in this, that she might at least support the Bill in the Lobby tonight and not decline to support it, as her party’s amendment suggests.

The fund will ensure joint commissioning and the seamless provision of services, preventing the nightmare of people being pushed from pillar to post with no one taking responsibility. It has led to the unprecedented step of the NHS and local authorities working together in all 152 local authority areas to plan joined-up services.

[Julie Hilling (Bolton West) (Lab)]

rose—

[Barbara Keeley]

rose—

--- Later in debate ---

[Andy Burnham]

The issues are huge. They affect every family in this country and the worries they have about how they will look after their mum and dad in later life. They did not hear any answers from the Government this afternoon. I hope my hon. Friend will hear a few from me. I know that she has campaigned on the use of zero-hours contracts in our care system. Is it not a sad reflection on both sides of the House that today in England around 300,000 care staff are working on zero-hours contracts? They do not have the security of knowing what they will earn from one week to the next, so how can we expect them to pass on a sense of security to those they care for? Is not the message that we are sending to people who work in our care service, particularly young people coming into the service, that looking after someone else’s mum or dad is the lowest calling they can answer, when really it should be the very highest?

[Julie Hilling]

Would my right hon. Friend have been as shocked as I was yesterday when I met the carer of a woman who will be 99 next week and discovered that she has a five-minute call at tea time and a 10-minute call at bed time?

[Andy Burnham]

I would like to say that I would have been shocked, but I know that the system just gets worse and worse each year as the pressure builds and corners have to be cut, and it is older people and their families who are paying the price. How can any “care” be given in five minutes? Of course it cannot. It does not make financial sense in the long run, because we have a care system that does not provide people with support in their own homes, buts leaves them to drift towards hospital, leaving our acute hospitals increasingly and unsustainably full of frail older people.

--- Later in debate ---

[Julie Hilling (Bolton West) (Lab)]

Like my constituents, I was relieved when the Government said they would act on the Dilnot report and cap the cost of care, and I was pleased when the Secretary of State told me in this Chamber that money spent on home care would be treated as part of that cap. But the legislation that this Government introduce never lives up to expectations, and it is deeply disappointing that the Bill will still leave people having to sell their homes and does not solve the care problem facing people every day of the week. Many thousands of people will be deciding today whether or not to put their loved ones into residential homes or whether or not to sell the family home. This is a very real, very live issue.

The lack of joined-up care is also presenting big problems for our accident and emergency departments. There has been a 66% increase in the number of people over 90 being “blue lighted” into A and E, and the number of over-65s admitted to hospital with avoidable conditions has been increasing—last year, it reached half a million. Of course, we also have a problem at the other end, as we cannot discharge people because of a lack of care in place. There has been a 42% increase in delayed discharge, and in October alone 78,400 delayed days were lost, so people who are admitted, often because of the lack of appropriate care in the first place, are not being discharged because of the lack of appropriate care to deal with them when they come out.

The Government cannot wash their hands of the problem and say that it is down to local authorities, because their drastic cuts to local authority budgets have had a drastic effect on local services. Bolton has had to find £100 million of cuts, which has meant that it can no longer give support to the nearly 2,000 people who have “moderate” care needs. They may be moderate to the decision makers, but they are still care needs; we are talking about care that enables people to stay safe and well in their own homes in the community and to lead independent lives. Bolton has reluctantly had to make cuts to day care and respite care, which is a real problem for real people.

Other Members have mentioned the financial cap and other elements of the Bill, so I will use the rest of my time to talk about the realities of home care, which do not appear to be solved by this Bill. As many Members know, I have a vested interest in the issue of care. Like millions of others, I entrust the care of my mothers to carers every day of the week. Most of the carers are lovely, but they are paid only just above the minimum wage and only for the time they spend with the person they are looking after; they are not paid at all for their travelling time. I find that absolutely disgraceful, but it is normal in this sector. I have been told that it is common for carers to be on zero-hours contracts, and I have been told today of the pressure put on workers in Manchester to work beyond 70 hours a week or else lose their jobs.

Caring for disabled and elderly people is a precious job, and the Bill does nothing to address the fundamental flaws in the way that care workers are treated, which of course impacts on the care that people receive. Yesterday, I met a woman and her 98-year-old mother—I will call them Valerie and Lilian. Valerie told me about a few of the problems she was encountering and why she had to change the care provider for Lilian for the second time. She told me about the endless stream of different care workers who do not know Lilian or her needs. One carer had written in the logbook that Lilian had already washed and dressed herself one morning. How did they know that she had washed, and why did they think that the bed jacket she was wearing was appropriate clothing?

Another carer wrote that Lilian was eating toast for her tea when she arrived. How did they think she had made the toast? Of course she was eating the remnants of her breakfast, and her tea, which was made by the morning carer, was still sitting untouched in the refrigerator. Another carer left Lilian with her food tray in her lap, which meant that she was unable to move until the next carer arrived a few hours later. It is no wonder that Lilian’s carers make mistakes. Her tea-time visit is a mere five minutes, and her bedtime visit is only 10 minutes. Lilian only got the tea-time visit because she now attends a day centre for two extra days, which freed up some money to spend on the visit.

Lilian lives in sheltered accommodation where, years ago, there would have been a warden who made regular visits. Now there is just a housing manager whose role does not include checking on the residents. Valerie told me about the strain being put on her because of the expectation that she would be available at all hours. As she said, she is nearly 70 herself. She has already suffered a stroke and cares for her 76-year-old husband. Once she has taken her own medication, she cannot go out in the middle of the night, but there is no other support.

Valerie and Lilian’s story is just one, and a depressingly familiar one. The reality is that carers themselves are ageing and the elderly and disabled are not getting the care that they need. I was told just this morning of a carer who left an elderly person in bed in the morning when she should not have done. When the lunchtime carer turned up, the person could barely breathe. The lunchtime carer called the doctor who, after some prevarication, came out. He left a prescription on the elderly person’s table. I do not know how he thought it would miraculously be filled in or how this ill person would miraculously be able to take the necessary medication.

I have seen first hand the distress that is caused when a carer turns up more than an hour late. There is chaos when different carers turn up and do not know what to do. I understand too the realities of inadequate care. I have also experienced the unresponsiveness of the system when care needs change temporarily. Indeed, Marie Curie Cancer Care has raised the issue of the time it can take for a terminally ill person to get care. They can often wait weeks while local authorities test their means and their level of need. Sadly, some people die before they ever get any help at all.

Care should not be determined by the cheapest provider. This most fundamental service of the most personal nature needs to be provided by workers who are appropriately trained and remunerated. I hope the Minister will confirm that every home care worker will have to be trained and qualified. We entrust the care of our most precious loved ones to strangers every day of the week. The Government should use the Bill to ensure not only that our loved ones are treated properly but that the care givers are treated properly too.