Healthier Together Programme (Greater Manchester)

Kate Green Excerpts
Tuesday 22nd July 2014

(10 years, 1 month ago)

Westminster Hall
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Kate Green Portrait Kate Green (Stretford and Urmston) (Lab)
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It is a great pleasure to speak in this debate, and I am grateful to my hon. Friend the Member for Blackley and Broughton (Graham Stringer) for introducing it.

I am here to express the concerns of my constituents in relation to what my hon. Friend has rightly described as a consultation that people are either completely unaware of, or, if they are aware of it, unsure what they are being consulted about, what the next steps might be, where decisions will be taken and by whom. As he said, everyone understands the pressures that we face within the NHS in Greater Manchester and across the country.

Andrew Bingham Portrait Andrew Bingham (High Peak) (Con)
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I know that the consultation is about Greater Manchester, but may I just put it on the record that the impact of this consultation will go far beyond Greater Manchester? My constituency is split between relying on Stepping Hill hospital and Tameside hospital, so this consultation affects us as well. I just wanted to put that on the record, so that people are aware of it.

Kate Green Portrait Kate Green
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The hon. Gentleman is absolutely right, and I am pleased to see that the hon. Member for Macclesfield (David Rutley) is also present this afternoon. The ripple effect of the consultation, on hospitals in neighbouring areas and indeed—as I will go on to talk about—on the wider north-west and northern region of the country is quite significant in one reading of what is going on.

It is true that the pressures of rising demand on the NHS are well recognised, as are the cost constraints on social care provision. However, my constituents in Trafford were told all that three or four years ago, and we went through our change programme. We feel that we have been here before and, for us, this is groundhog day and a bit worse than that. We underwent the consultation “A New Health Deal for Trafford”, which took place in 2012 and culminated in the downgrading of Trafford general hospital. Looking at how the current consultation has been launched, I am concerned that a number of lessons that were learned from that Trafford process are being totally ignored.

I say clearly that I am not against sensible reconfiguration of acute services. I am very much in favour of concentrating expertise and specialisms in a small number of expert sites. I am entirely in favour of as much provision as possible being pushed into the community to front-line, preventive, community-based care, and of keeping people at home to receive that care for as long as possible.

However, if this is a consultation about the provision of integrated community-based care, it is not possible to go down the road of consulting about that provision and withdrawing services in acute settings before we are clear what the landscape and the reality of that community provision is. Nor is it possible to go down the route of suggesting that some acute services might be rationalised or closed when existing acute services are under so much pressure already. In particular—I know that my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane) will talk about this issue too—one consequence of the downgrade of Trafford general hospital’s accident and emergency provision is that during the past nine months the waiting times and queues at Wythenshawe hospital have been significant, with little sign yet that they will be reduced.

In addition, I point out that we have some real uncertainty. My hon. Friend the Member for Blackley and Broughton mentioned the uncertainty that exists around trauma services, maternity services and so on, but we also have uncertainties in Trafford in relation to some of the primary provision that will be in place. We know that the NHS local team and the clinical commissioning group envisage a two-hub model of primary care and community-based care for our borough. The provision in the south is largely established, but in the north—including in my constituency, where we have some of the worst health outcomes in the borough—we are still completely unsure what sort of hub will be put in place, as the NHS local team and NHS England are quite unable to tell us what the funding for that kind of hub model will be.

I know that the Secretary of State for Health is aware of that particular situation and I am grateful to him and his office for what they are doing to try to unscramble it, but from the point of view of my constituents the idea that they will be consulted on a major reconfiguration, either of primary care or of acute services, does not inspire their confidence, because currently they simply see deficiencies in those services and particularly because they believe that their voice counts for little when it comes to the decision that will ultimately be taken.

Not only is there pressure in the system, but the NHS seems to make some really perverse decisions as it goes along, because of its rather hand-to-mouth approach to planning this kind of reconfiguration and strategic change. When the decision was taken to downgrade the A and E services at Trafford general hospital, the hon. Member for Altrincham and Sale West (Mr Brady) and the late Paul Goggins, my good friend and former colleague, managed between them to secure around £11 million of new investment in Wythenshawe hospital to provide for the extra capacity that it would need. We are now unclear, of course, about what will happen with that £11 million of investment; it would be good if the Minister could put it on the record today that it will continue. Given that the hospital cannot envisage even its short to medium-term future, that is a worrying situation.

We saw something similar in Trafford, when investment of around £300 million in the intensive care unit was pretty well written off two years later when the new health deal for Trafford was implemented and the ICU was closed down. That may have been the right decision, but it was certainly a waste of money if investment was being poured into a hospital just two or three years before the whole status of that hospital was changed.

Lisa Nandy Portrait Lisa Nandy (Wigan) (Lab)
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I am grateful to my hon. Friend for giving way, and I apologise for being late for the start of this debate, Mrs Riordan.

Does my hon. Friend agree that part of the problem with the process is that it does not take into account the particular needs, circumstances and history of our individual communities? For example, in Wigan we have invested in a number of our specialist services. However, we are a big borough, we have our own particular health challenges and we have real transport issues as well, which are different from those affecting other areas of Greater Manchester. Quite simply, a centrally driven top-down process that lacks any kind of democracy whatever, as far as I can make out, is not capable of delivering the sort of services that we need in our areas.

Kate Green Portrait Kate Green
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I absolutely agree with my hon. Friend, and the issue about democracy that she raises is one that we are all particularly concerned about.

David Rutley Portrait David Rutley (Macclesfield) (Con)
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I would just like to put it on record that my hon. Friend the Member for Altrincham and Sale West (Mr Brady), who cannot be here because of a commitment, shares concerns about the process and the way in which things are moving forward, which I think he has also expressed to the hon. Member for Wythenshawe and Sale East (Mike Kane). I just want to put it on the record that other Members are also expressing their concerns.

Kate Green Portrait Kate Green
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I am grateful to the hon. Gentleman for that contribution.

I am sure that my hon. Friend the Member for Wythenshawe and Sale East will talk particularly about the situation at Wythenshawe hospital, which is in his constituency, and our particular concern for the status of that hospital as a fixed-site specialist centre of excellence for a number of specialisms that matter not only to the population of south Manchester, or even to the population of Greater Manchester, but to the whole population of the north-west region. Some of those specialisms matter to the whole population of the north of England, and parts of Scotland too. It is deeply concerning to us that the Healthier Together consultation appears not only to be unaware of the difficulty of protecting those specialisms in the proposed process of remodelling hospital configurations, but to be completely unaware of the interdependency of specialisms and general acute and medical provision. If one element is removed from a cocktail of clinical support that is available to support high-level specialisms, those specialisms are completely undermined and eventually will probably be unable to survive.

I have a particular example of that process that I will draw to the Minister’s attention; it arises from my visit last week to Wythenshawe hospital and its highly regarded cystic fibrosis unit. The doctors and clinical staff there told me that the unit benefited from being part of a much broader, fixed-site specialist team, and indeed survived on that basis. It draws on a range of other specialisms around the hospital, including interventional radiology, transplantation, urology, nutritional support teams, gastroenterology, diabetes, endocrinology, ear, nose and throat services, obstetrics, extracorporeal membrane oxygenation and so on. Picking out some specialisms and moving them cannot be done in isolation, but Healthier Together does not seem to be aware of that at all.

Finally, as my hon. Friend the Member for Blackley and Broughton said, there are concerns about process—about how the public are being engaged in this debate. He said that we have a consultation taking place over the summer holidays, exactly as happened with the new health deal for Trafford, although we told them not to do that again, and during the working day. I understand that few people attended the public meeting in Trafford; I am not surprised, because it was difficult to know that it was even taking place. I would not be able to tell when it happened, because I was not notified directly, let alone my constituents.

Andrew Bingham Portrait Andrew Bingham
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I thank the hon. Lady for giving way again; she is being generous. I tend to agree. There is a consultation meeting in the High Peak as we speak, although it is a Tuesday afternoon. I, for one, should have liked to be there. I just wonder: next week during the recess would have been a lot easier for me.

Kate Green Portrait Kate Green
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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 Portrait Julie Hilling (Bolton West) (Lab)
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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 Portrait Kate Green
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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.

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Kate Green Portrait Kate Green
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rose

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

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Norman Lamb Portrait Norman Lamb
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I have made the case very clearly that the whole purpose of the pioneer programme is to use the pioneers—although we are not simply focused on them—to identify the barriers to integration and to remove them. That is the whole point. There are concerns about all sorts of things that could block integrated care, such as information sharing across different providers and competition.

I should stress, incidentally, that in the section 75 regulations is a specific recognition that integrated care is an ambition that should be achieved, so commissioning can be for the whole integrated care pathway. There should be no problem in securing our ambition. Where barriers are found, they need to be addressed and removed.

I am conscious that the hon. Member for Stretford and Urmston asked to intervene—

Kate Green Portrait Kate Green
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indicated dissent.

Norman Lamb Portrait Norman Lamb
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The hon. Lady has moved on, so let me make some progress.

It is important to recognise that we are discussing proposals that originated with local clinicians. Dr Chris Brookes, who is not a politician or a bureaucrat, who too often get condemned, but an accident and emergency consultant and a medical director of Healthier Together, says—

Norman Lamb Portrait Norman Lamb
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May I make this point? I am sure that the hon. Lady will be interested to hear it. Dr Brookes said:

“Currently, there are too many variations in the quality of treatment, whether its emergency surgery or getting to see a GP when you need to. Not one of our hospitals in Greater Manchester meet all the national quality and safety standards.”

I am sure that all hon. Members present are concerned about that. He goes on to say something which, if we think about it, is shocking:

“At present your chance of being operated on by a consultant surgeon in an emergency at the weekend is much less than midweek. Your chance of recovering well from surgery carried out by a consultant is greatly improved.

But it’s not just about hospitals. It’s about access to a GP, and better community-based services—more services provided locally or at home and joining up the care provided by local authorities.”

That is a clinician making the case for integration.

Before I turn to the Healthier Together changes, it is probably best to make a few points about service changes in the NHS generally and Government policy towards them. The Government are clear that the design of health services, including front-line services and A and E, is a matter for the local NHS and, critically, the health and wellbeing boards, which have democratic accountability. Our reforms put doctors in charge of the care that people receive and how it is delivered to best serve their populations.

The NHS has a responsibility to ensure that people have access to the best and safest health care possible, which means that it must plan ahead and look at how best to secure safe and sustainable NHS health care provision—not only to meet today’s needs, but to plan ahead for next 10 or 20 years.

Kate Green Portrait Kate Green
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In Trafford, my understanding is that neither the local authority nor the CCG supports the proposals before us. Will the Minister explain the role of the health and wellbeing boards in the final decision on the plans?

Norman Lamb Portrait Norman Lamb
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I understand that the health and wellbeing boards are keeping a watching brief throughout. They will have a decisive voice at the end of the consultation process in declaring whether they support the outcome. They bring together the local authority and the NHS, so they are pretty central to the whole process—and rightly so. The local NHS is constantly seeking to modernise delivery of care and facilities to improve patient outcomes, to develop services closer to home and, most importantly, to save lives.

The hon. Member for Stalybridge and Hyde focused on specialisation, and expressed scepticism about the case for it. Let me give him a case. It is from during the Labour Government and should be applauded—the lessons from it should be learned here. Stroke care in London, centralised into eight hyper-acute stroke units, now provides 24/7 acute stroke care to patients, regardless of where they live across the city.

Transport links are not that great across much of London—[Interruption.] Hon. Members should listen to Members from London complaining about transport links. Stroke mortality is now 20% lower in London than in the rest of the UK and survivors with lower levels of long-term disability are experiencing better quality of life. Hundreds of lives have been saved as a result of the specialisation undertaken predominantly under the previous Government.

Organ Transplants

Kate Green Excerpts
Tuesday 8th July 2014

(10 years, 1 month ago)

Westminster Hall
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Kate Green Portrait Kate Green (Stretford and Urmston) (Lab)
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It is a pleasure to see you in the Chair this morning, Mrs Osborne. I thank the Backbench Business Committee for finding time for this debate during national transplant week. I also thank my hon. Friend—if I may call him that—the Member for Strangford (Jim Shannon) who went to the trouble of taking the proposal to the Committee. It has been really good to hear so many powerful speeches this morning, in particular that of my hon. Friend the Member for Bridgend (Mrs Moon), who moves me every time she talks about what is happening to her and her husband. It is incredibly brave to talk about such things publicly. For people paying attention to this debate, what she said will have brought home why they must talk to their families tonight about being an organ donor not only so that they will know their wishes, but also to inspire other family members and friends to join the register. We must remember that being on the register does not mean that just one life could be saved; up to nine lives could be saved or improved. Being an organ donor is an incredibly good, generous, human thing. If we can achieve one thing from today, I hope that more people will confidently register as donors and that families will give their consent to organs being donated at what are difficult and traumatic times.

The progress that we have made in increasing the number of registered donors is great. I was grateful for the tribute paid by the hon. Member for Montgomeryshire (Glyn Davies) to my right hon. Friend the Member for Kirkcaldy and Cowdenbeath (Mr Brown), who has a family interest in the matter. It is particularly powerful when hon. Members’ personal circumstances inform our debates and policy decisions. However, one under-represented group on the donor register is families from certain ethnic minority communities, which is a big issue in my ethnically diverse constituency. What steps are the Minister and NHS Blood and Transplant taking to increase donation rates among minority communities, because their need for donations is as great as any other?

I want to talk specifically today about lung transplantation, which I have discussed before not least because I was introduced to the issue by a constituent of mine, Natalie McCusker, who received a double lung transplant at Wythenshawe hospital last year. As did other hon. Members, I want to thank the Cystic Fibrosis Trust for the helpful briefing and support given for today’s debate and more generally. I also welcome the progress made since my Adjournment debate on the subject almost exactly a year ago when I talked specifically about the problems with the allocation system and how certain parts of the country, including my region of the north-west, were losing out. It is not just that in comparison with other European countries the UK performs less well; within the UK some zones do much better than others. The north-west is one zone where people have a particularly long wait for lung transplants. I welcome the allocation of super-urgent cases on a national basis and the annual review of the size of zones, which are both good steps forward.

There is, however, scope to do more. We could look at extending national allocation to all super-urgent cases and then perhaps to urgent cases. In due course, we could run the whole country on a national allocation basis. I realise that NHSBT and the Minister will want to examine carefully the possible consequences for patient outcomes, but can she assure us that the proposal remains under live and active consideration? International evidence suggests that a national allocation system could produce as good if not better outcomes. When we are so far down the European league table, it is right to consider what we might learn from other countries.

I am also pleased that NHSBT has reissued some of the guidance relating to transplantation, in particular guidance on the difficult transition from child patient to adult patient, which was exactly the situation that my constituent Natalie found herself in. She was initially being treated at Great Ormond Street hospital, but when it became likely that she would need a transplant, she was coming up to her 16th birthday and so had to transfer to the adult list and effectively lost about a year in terms of her being deemed ready to receive a transplant. I understand that improvements have been made in the guidance on handling that transition. I will be grateful for any update that the Minister can give us.

Supply of organs has been discussed by other hon. Members this morning. There have been important and welcome developments on resizing, which is especially important for children, women and CF patients, who are likely to be of smaller stature. Colleagues also pointed out, however, that only a tiny handful of doctors are able to carry out the resizing operation. What steps are being taken to extend that capacity?

Similarly, what about extending the criteria for usable lungs, which is clearly a sensitive issue? Patients’ own wishes and—I do not say the word in a pejorative sense—prejudices have to be taken into account. As the hon. Member for Strangford said, however, international research suggests considerable potential for more marginal lungs to be reusable, while differentiation between different transplant centres even within the UK is apparent. Harefield is doing particularly well, perhaps showing the way.

Will the Minister update us on what is being done to assess the evidence further on extending criteria and revising guidance? Will she also tell us what is being done about looking at the very different rejection rates in the different centres around the country? That is of particular importance when we are stuck with the zoning system, which means that people may be forced to go to a centre where rejection rates are much higher than if they were in treatment elsewhere.

Like the hon. Member for Strangford, I shall comment on some of the other techniques being developed. For example, the ECMO technique is highly specialist, as he said, and it is clearly appropriate, not in all, but in some circumstances. It will be useful to hear what work is being done to provide detailed guidance.

In particular, I wanted to raise an issue that has not yet come up this morning, which is funding for transplantation. There is no use doing what we are doing so successfully to increase the number of donors and to improve the usability of lungs and the techniques that mean more transplants can be carried out because the surgery and the science are there to enable them, if we have not in parallel put in place the funding to ensure that we can pay for an increased number of transplants. The national commissioning team understood well that the funding models had to be designed and progressed alongside and in parallel with the science, the improving clinical strategies and the successful public registration and awareness campaign.

Other interventions, however, are now competing with transplants for funding, while the specialist services budget, which funds transplants, is under pressure and might even face cuts. At the same time, commissioning is moving to local area teams, which will not have the same understanding of some of the decisions that need to be made on transplantation priorities, which risks us moving to an unco-ordinated approach and widening inequality of outcome between centres.

Transplantation risks becoming underfunded even as the numbers that can be treated are on the rise. We have already seen a significant increase in the number of transplants carried out in recent years, and that will increase further as allocation methods improve, donation rates increase and technology allows more lungs to be used. It would be an absolute crying shame if the strides forward in good practice were stymied by a lack of resource or by a commissioning model that cannot optimise the clinical progress and the public engagement being made.

I am, like others, pleased that we have had the opportunity to explore the subject this morning. I look forward to hearing the Minister’s response.

Learning Disabilities (Care in the Community)

Kate Green Excerpts
Tuesday 8th July 2014

(10 years, 1 month ago)

Westminster Hall
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Tom Clarke Portrait Mr Tom Clarke (Coatbridge, Chryston and Bellshill) (Lab)
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It is a pleasure, Mr Streeter, to serve under your chairmanship, and I am grateful to have been granted this debate. There are 1.4 million people with a learning disability in the UK and many require care and support to live full lives in their communities. Many do so, supported by families, friends, charities and funded social care. However, a small but significant number—just over 3,000—are far from their homes and communities, stuck in assessment and treatment units. They are some of the most vulnerable people in our society. Many display challenging behaviour and require skilled support from a range of professionals, but that is no reason why they should not be cared for and supported in their community.

In 2011, the BBC’s “Panorama” programme exposed truly horrific abuse and neglect of patients with learning disabilities at the Winterbourne View assessment and treatment unit. Many hon. Members will remember the deeply distressing images of people being hit, verbally abused, viciously restrained and thrown into seclusion. Some of the perpetrators were rightly sent to prison, but Winterbourne shone a light on the wider scandal of how the NHS and local authorities throughout the country have failed to give people the right support to enable them to live in the community. They had hidden that failure by sending people with learning disabilities to in-patient settings, in many cases for years and often hundreds of miles from their families and communities, isolated and alone. That was against Government policy and was a scandalous misuse of what assessment and treatment beds should be used for. It was estimated that the cost was around £500 million.

Kate Green Portrait Kate Green (Stretford and Urmston) (Lab)
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I am glad that my right hon. Friend is raising this important matter this afternoon. Does he agree that the situation, far from improving, may be worsened as a result of the closure of the independent living fund if it means that more learning-disabled people who are currently able to live independently are forced into residential care?

Tom Clarke Portrait Mr Clarke
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My hon. Friend makes a valid point and was right to do so.

Some £500 million of public money was spent to pay for people to be over-medicated with anti-psychotic drugs and kept in seclusion at risk of assault and self-harm. In December 2012, the Government put in place an action plan with the objective of giving people with learning disabilities support to enable them to move out of places like Winterbourne View and to return to their communities. A joint improvement programme was also put in place, and the NHS and local authorities were given a deadline of 1 June this year to make that happen.

The result is nothing short of a scandal. Not only has the deadline been missed, figures from the NHS show that more people are going into those units than coming out. Not only that, there seems little appetite to move people. Recent NHS data showed 90% had no discharge date. Meanwhile the human suffering continues. The learning disability census showed that 57% had experienced self-harm, an accident, physical assault, hands-on restraint or had been kept in seclusion.

NHS Investigations (Jimmy Savile)

Kate Green Excerpts
Thursday 26th June 2014

(10 years, 2 months ago)

Commons Chamber
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Jeremy Hunt Portrait Mr Hunt
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The hon. Gentleman is absolutely right and touches on a matter that we have not touched on so far this morning. Recruitment is a very important area that we must get right in this process, and I wholeheartedly agree with what he said.

Kate Green Portrait Kate Green (Stretford and Urmston) (Lab)
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Today will be an emotional day for victims and their families as the report is published. Will the Secretary of State tell the House how victims have been supported and informed about the publication, particularly today and in the run-up to today, and how they will be kept informed as subsequent actions are carried forward? In particular, what efforts have been made to inform and support those who are most vulnerable, such as those with learning difficulties or who are severely mentally unwell, perhaps as a result of the abuse they suffered many years ago?

Jeremy Hunt Portrait Mr Hunt
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The hon. Lady is right to raise that issue, and the guidance that I have issued to NHS organisations today makes it clear that I want to give maximum protection not just to the victims identified in these reports, but to people going forward. That is the least we owe them.

Oral Answers to Questions

Kate Green Excerpts
Tuesday 10th June 2014

(10 years, 2 months ago)

Commons Chamber
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Jeremy Hunt Portrait Mr Hunt
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My hon. Friend is right to say that some bad changes were made. What will most benefit his constituents, whether or not they are part of the initial tranche of the Prime Minister’s challenge fund, is the reintroduction of named GPs for the over-75s. For people with complex long-term conditions, continuity of care is extremely important, and every single one of his constituents aged 75 or over will now get a named GP.

Kate Green Portrait Kate Green (Stretford and Urmston) (Lab)
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We are very pleased in Old Trafford to have secured funding for 80 extra care beds for one of the most deprived parts of my community. We also hope to be able to bring health care services, including GP surgeries, on to the same sites, but we are experiencing difficulty in unblocking funding via the NHS area team. Will the Secretary of State meet me to discuss this issue and how we might be able to move forward?

Jeremy Hunt Portrait Mr Hunt
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Yes, I would be more than happy to meet the hon. Lady and see what I can do to help her to improve health care in her area.

Cystic Fibrosis

Kate Green Excerpts
Thursday 10th April 2014

(10 years, 4 months ago)

Commons Chamber
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Kate Green Portrait Kate Green (Stretford and Urmston) (Lab)
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I am grateful to my hon. Friend for raising the issue of allocation of lungs for transplant. In the north-west of England we have poor levels of transplant. People wait longer and are more likely to die on the waiting list. Does she agree that it is important that the Minister presses for the modelling, which I understand is being carried out, on the impact of a national allocation scheme to be given great attention and accelerated if possible, so that we can have the evidence on the benefits of such a scheme in this country as quickly as possible?

Kerry McCarthy Portrait Kerry McCarthy
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I agree entirely with my hon. Friend. As I have said, it makes such a difference if more people come forward as donors, not just for lung transplants but for many other types of donation as well, from blood through to other organs. I urge the Minister to give this the utmost priority, because, as we have said, it can make such a difference to people’s lives.

The Department of Health has advised that the most recent analysis showed no significant difference in allocation across UK lung transplant centres. But the Cystic Fibrosis Trust clearly believes that an improved allocation system could address the shocking fact that one in three cystic fibrosis patients die before they get to the top of the waiting list. So I ask the Minister to review this with NHSBT, and consider the evidence from the Cystic Fibrosis Trust. It would also be helpful if she could provide more information on the current review by the cardiothoracic organs advisory group, and say whether it is considering a national allocation system, as referred to by my hon. Friend, or consulting stakeholders such as the Cystic Fibrosis Trust and specialist centres, and when it is likely to report.

The “Hope for more” report also highlights that 62% of survey respondents reported that psychosocial support during the whole transplant process is insufficient, and concludes:

“The demand for services that assist the family and individuals in coping with cystic fibrosis is drastically underestimated”.

In response to a parliamentary question that I tabled, the Minister explained that decisions on psychosocial support are a matter for clinicians and commissioners, but I would urge further consideration of the report’s findings and how the Department of Health can help to improve provision and ensure that clinicians have the resources that they need, working with commissioners to address gaps in information, support and psychosocial services for patients waiting for a transplant and post-operative.

It is clear that the specialist centres, working with the Cystic Fibrosis Trust, are making an incalculable difference to their patients’ lives. The trust is putting real money into the provision of services for cystic fibrosis patients. In 2012-13, the trust contributed more than £1.6 million to research projects, and more than £1.1 million to clinical care. It also provides a helpline that takes more than 3,000 calls every year, and it is able to provide limited welfare grants to people with cystic fibrosis and their families who are, understandably, struggling with the impact the condition can have on their lives.

I congratulate the Cystic Fibrosis Trust on its work and all those people that I met at the cystic fibrosis centre in Bristol, who were so dedicated and keen to get across to me the fact that with more resources they would be able to do an even better job in coping with the increased number of patients. I hope that the Minister takes that on board.

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Jane Ellison Portrait Jane Ellison
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I join the hon. Lady in congratulating the lord mayor. That is exactly the sort of local leadership that can help. One of the big pluses of the devolution of public health to local government is that we see such leadership from people who know their community best and understand the diversity in their locality. I am keen to encourage that. Only recently we celebrated examples in other areas, where we saw that specific leadership in some communities where health outcomes were not as good as they could be. We are always looking for such opportunities, and I am delighted that the hon. Lady has taken the opportunity to highlight local leadership in that regard.

Our focus in the strategy is initially on increasing consent rates. We want people to support transplantation. We can all imagine that families are being asked to agree donation at probably one of the worst times in their life, but many families find that they get comfort from knowing they have helped others to live. We will keep a close eye on what happens in Wales following the changes there, to which the hon. Lady alluded. NHSBT also keeps international experience under careful review. I mentioned the good success rates in Spain, for example.

We need to make sure that we make the best use of the donated organs. Currently donor lungs are procured by a retrieval team and allocated to the transplant centre on a zonal basis, based on the location of the donor. The transplant team at the centre will decide whether or not to accept the lungs and will select the most appropriate recipient.

The trust’s report recommends the implementation of a national lung allocation system whereby donor lungs are given to the most urgent patients, regardless of where they live.

This is something that NHSBT’s cardiothoracic organs advisory group, which includes both lung clinicians and lay membership, will be considering very shortly, and in particular whether we should introduce a national lung allocation scheme for people who need a lung transplant urgently, with all remaining donor lungs continuing to be allocated on a zonal basis. The advisory group’s recommendations will then be considered by NHSBT’s transplant policy review committee, and if a change of allocation procedures is agreed, it will be implemented as soon as the governance arrangements can be put in place.

Kate Green Portrait Kate Green
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Will the Minister clarify whether the work that is going on now to review the allocation system is looking at the possibility of a national allocation system only for urgent cases, or whether it will also consider the advantages and disadvantages of a national allocation system in all cases?

Jane Ellison Portrait Jane Ellison
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I imagine that the advisory group is considering that, but I would rather check and get back to the hon. Lady after the debate. I should have thought that it was looking at the broader issue, but I will come back to her, if that is acceptable, and confirm that after the debate. It goes without saying that I will follow up this debate with NHSBT, which I am sure will be extremely interested to know that Parliament has an interest in the subject. We will revert to any hon. Member to whom I am not able to respond in detail.

The issues are complicated. I have only begun to get a sense of some of that complexity, partly in preparing for this evening’s debate. NHSBT will wish to be certain that any change of policy can be introduced in a fair and safe manner. We need also to ensure that people with cystic fibrosis receive the best quality of care for them and are involved in decisions about that. NHS England has published two CF service specifications, one for adults and one for children, recognising that, although similar, adults and children with CF have differing needs and it is important that the services provided should reflect that.

NICE has issued technology appraisal guidance recommending appropriate drug therapies—one of which has been mentioned by the hon. Member for Bristol East—in certain clinical circumstances, which NHS commissioners are required to fund where clinicians want to use them. The Government also fund a range of research on cystic fibrosis, in particular through the Medical Research Council and the National Institute for Health Research.

The hon. Member for Bristol East alluded to the need for research, so she may be interested to know that the MRC is funding a £3.3 million trial of repeated application of gene therapy for patients with cystic fibrosis. That is being undertaken by the UK Cystic Fibrosis Gene Therapy Consortium, which comprises world-leading teams at Imperial college London and the universities of Oxford and Edinburgh. The trial is testing whether gene therapy can improve the lung function of cystic fibrosis patients and its report is due to be published in May 2015. I am sure we will all await the review with interest. It has the potential for interesting and exciting breakthroughs.

I hope the hon. Lady will forgive me for responding to her points about benefits by saying that I will draw them to the attention of my colleagues at the Department for Work and Pensions. The issue is not in my remit, but her points have been noted and are on the record.

On prescription charges, I pay tribute to my hon. Friend the Member for Colchester (Sir Bob Russell), who has campaigned long and hard—but not successfully today—on the issue. I am afraid I do not have a response for him today, but I will get back to him after the debate.

I think I have covered most of the points that have been made. The hon. Lady raised specific points about local arrangements. Some interesting work is going on between the Royal United hospital in Bath and the Bristol adult cystic fibrosis centre at Bristol University hospital. They are looking at specialist commissioning and I think NHS England is looking to commission a model of adult CF care. I will look at the record after the debate and will draw that particular section of the hon. Lady’s speech to the attention of NHS England representatives, because some of the decisions about clinical care and commissioning sit with them. I will make sure they have a copy of the debate and I will ask them to respond directly to the hon. Lady on the issues within their remit.

In conclusion, I hope I have reassured the hon. Lady and other interested Members that we want to provide the best possible care for cystic fibrosis patients. Service specifications are in place to define that care and what great care looks like. We continue to do all we can to increase organ donation rates, with some notable recent success. We will look in particular at the issue of increasing consent rates so that we can give many more people the opportunity of a transplant. I have referred to the review, which is particularly germane to the current campaign, and I will ensure that interested Members are alerted to its outcome.

I will end by wishing colleagues, hon. Members, Madam Deputy Speaker and the staff of the House a pleasant Easter recess.

Question put and agreed to.

Oral Answers to Questions

Kate Green Excerpts
Tuesday 1st April 2014

(10 years, 4 months ago)

Commons Chamber
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Dan Poulter Portrait Dr Poulter
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My hon. Friend makes an important point. We were talking earlier about improving parity of esteem between mental and physical health. When we came to power, only 50% of maternity units had specialist perinatal mental health support, and we will make sure, through the mandate to Health Education England, that by 2017 all maternity units have specialist perinatal mental health support. That is something that this Government will be very proud of.

Kate Green Portrait Kate Green (Stretford and Urmston) (Lab)
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Last December the UK national screening committee advised against offering all pregnant women a routine test for group B streptococcus. The Minister will recall that I asked about this matter in Health questions last time. The issue is not to screen in all cases, but to ensure that the enriched culture medium test is available where clinicians deem it appropriate. Will the Minister look at how that test can be made available whenever it is clinically necessary?

Dan Poulter Portrait Dr Poulter
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That is a good point. On screening, we have to listen to the advice of the national screening committee, as I am sure hon. Members on both sides of the House would agree, but on the enriched culture medium test, I have had further meetings with Group B Strep Support and with the former editor of the obstetricians and gynaecologists journal, the BJOG. On the back of that meeting I have written to the Royal College of Obstetricians and Gynaecologists to ask it to look at the clinical evidence on that test, and it will take the matter forward.

Francis Report

Kate Green Excerpts
Wednesday 5th March 2014

(10 years, 5 months ago)

Commons Chamber
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Jeremy Lefroy Portrait Jeremy Lefroy
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I thank my hon. Friend for that intervention and for all the work he has done on this issue. It is salutary for all of us to remember that when we get such a letter it often represents probably another 10 people who did not write to complain because they do not want to affect the NHS. We should treat each letter of complaint as being of immense importance.

I said that I am less confident about accountability, so let me say why. This is not just a question of the resignation of executives within a trust or the NHS when things go badly wrong, although it remains astonishing to me that no one has had the courage to do this given that the failings in Stafford were so clearly systemic; it also concerns the approach of the professional bodies representing nursing and clinical staff. The Francis inquiry saw evidence of poor co-operation with the General Medical Council from other organisations, including royal colleges, even though serious matters of fitness to practise and patient safety were involved; they almost put the practitioners above the patients. Those representing the medical and nursing professions are accountable to the public first and foremost. The best way of maintaining public confidence in their professions is to ensure that they treat their members who are not fit to practise in a firm, fair and swift way; cases of doctors or others being suspended for months or even years are too frequent.

Before I discuss Stafford specifically, may I just make a few remarks about hospital standardised mortality ratios? The Francis report states that Professor Jarman

“made it clear that it is not possible to calculate the exact number of deaths that would have been avoidable, nor to identify avoidable incidents…The statistics can only be signposts to areas for further inquiry.”

I urge all those who handle HSMRs to do so with care. They are extremely important as guidelines, and it was absolutely right that they were the first statistics that showed up the need for the Healthcare Commission inquiry, but to extrapolate numbers from them can be difficult and the evidence does not necessarily bear it. We have seen examples of that happen.

Kate Green Portrait Kate Green (Stretford and Urmston) (Lab)
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I am grateful to the hon. Gentleman for mentioning that point. Does he agree that an important task of public education needs to accompany the transparency around such statistics, because they are complicated and, as he says, they are a signal but not a whole story in and of themselves? Has he any suggestions as to how we could enlarge that public education and understanding.

Jeremy Lefroy Portrait Jeremy Lefroy
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I thank the hon. Lady for her intervention, but that task is probably beyond my competence. I agree that we should use HSMRs and respond to their signals, but we should not say that they are the final judgment on specific numbers. Any HSMR that looks difficult and looks as though it needs to be investigated must be investigated—it is much better to do so than not to do so.

I will now discuss my own constituency, which, along with those of my hon. Friends the Members for Cannock Chase (Mr Burley), for Stone (Mr Cash) and for South Staffordshire (Gavin Williamson), has probably been the most affected. The spotlight has been on Stafford hospital for several years now, and it has been an extremely difficult time for those who raised their concerns, such as Julie Bailey and Cure the NHS, which were dismissed in a very offhand way by the NHS system and for which they endured abuse; it has also been extraordinarily testing for the many people working at that hospital and the one in Cannock, who have tried to carry out exemplary care at a time when the spotlight has been on them. They have, by and large, brought excellent care to patients, despite what has been going on around them. Understandably and rightly, the Care Quality Commission carried out an unannounced visit on the very day last week when it was announced that the Mid Staffs trust would be dissolved, so hon. Members can understand the sort of pressures that staff have faced. The great improvement that has been made has been recognised by the CQC and, most importantly, by patients and their loved ones. There is no complacency; there are still instances that should not happen, and the hospital and the trust are determined to ensure that they learn from all those. For Stafford and Cannock, however, it has also been a time of coming together and putting aside differences, as tens of thousands of people have worked together to save our hospitals and their services.

I will not dwell at length now on the process, the administration and the dissolution of the trust announced last week, but I will seek a debate on it, because some of the points made by the Opposition spokesman, the right hon. Member for Leigh (Andy Burnham), are fair in respect of the way the process works—or does not work. I have been critical of it and will continue to be so. I will, however, dwell on the unity. I have marched twice, not only with people who have had wonderful care at Stafford, but with some who have told me that they, too, experienced very poor care at Stafford but wish, for the sake of everyone, to see both patient safety and care improved, and services protected. Last week, the trust’s dissolution was announced, and although most services will continue, I continue to oppose decisions that mean the potential loss of consultant-led maternity services, consultant-led paediatrics and in-patient paediatrics. I will continue to fight for those services, because I believe they are essential in a hospital and a place that is at least 30 km away from the nearest other possibilities for patients. I urge NHS England, in particular, to take the consultant-led maternity review very seriously indeed.

Adult Autism Strategy

Kate Green Excerpts
Wednesday 5th March 2014

(10 years, 5 months ago)

Westminster Hall
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.

Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.

This information is provided by Parallel Parliament and does not comprise part of the offical record

Cheryl Gillan Portrait Mrs Gillan
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I agree entirely with my hon. Friend. When I come to talk about the actions I want the Minister to take, I will ask him to ensure that local community care assessors have autism training.

Kate Green Portrait Kate Green (Stretford and Urmston) (Lab)
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I congratulate the right hon. Lady on securing this debate. I apologise that I will not be able to stay for all of it, but I am pleased that she secured it this morning. I agree with her that it has been a good product of the 2009 Act, for which she rightly claims credit, that local authorities now have to give special consideration to meeting the needs of adults with autism. As many local authorities have now raised their threshold for support to substantial and critical levels of need, does the right hon. Lady share my concern that that may begin to exclude some of those adults?

Cheryl Gillan Portrait Mrs Gillan
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That is a point to be taken on board. There is variation across the country that we are all aware of. The Minister will have noted the hon. Lady’s remarks, and it is important that we try to get more standardisation across the country.

The Act guaranteed the introduction of the first-ever adult autism strategy, setting out how adults with autism should be better supported. It was underpinned by guidance and placed duties on local authorities and the national health service to take action. The strategy has been well supported by the National Autistic Society; I think everyone in the Chamber and beyond would pay tribute to the NAS, which does the most amazing work right across the board. Its “Push for Action” campaign has captured people’s imagination. It calls for urgent action to end the wait for the everyday support that people with autism need.

--- Later in debate ---
Jim Shannon Portrait Jim Shannon
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I thank my hon. Friend and colleague for clearly setting out the issue for the bodies responsible for helping parents. The parents I mentioned came to me about parenting skills, and they got the help, by the way, which was good. They told me what a blessing these classes were. That is why I am happy to stand with my colleagues today and highlight the needs of sufferers of autism and their families.

I am familiar with the care of one autistic young man. Many hon. and right hon. Members here have personal knowledge of such situations, and I hope that some of them will have a chance to contribute to this debate. That young man’s parents do everything for him: they dress him, cook for and feed him, clean, bathe and toilet him, amuse him, and hug, kiss and love him. He depends on his parents entirely for his every need. When he is at his day classes, they do the washing, ironing, cleaning, and shopping and try to find time to work to pay the bills at the same time.

The pressure on the parents and on the family unit is greater because of the problems and behavioural issues related to the autism of their child. They love their son—that is never in dispute—but love is not enough to get the family through the sheer exhaustion and the emotional and mental strain. Sometimes help is needed on matters outside of parental skills—through social services, for example, giving a bit of respite. Difficulties in the benefits system are practical issues for parents and those with adult autism; they relate to how parents can help their child through the school years and into the early years of adult life. It is up to the community and us as elected representatives to step up to the plate and help that boy and his parents. We can do that by supporting them and offering them the best that our society can do to ensure that they do not reach the point of no return.

We can all relate to the story of Susan Boyle, who has Asperger’s syndrome, which is also autism. She found out that she had it later in life. After she was diagnosed, she said that she almost felt relieved to know, after all those years, what was wrong and why she was different. That is a practical example of how someone the nation knows has been affected. She said what she said because she felt it was important that other people knew that autism cannot and will not hold people back, but they need help to get along. That is the thrust of this debate.

Kate Green Portrait Kate Green
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Does the hon. Gentleman agree that we need to raise awareness across society of the circumstances of adults with autism? For example, a young man in my constituency, looked after by his parents in the way that the hon. Gentleman describes, got severely into debt because he did not understand what financial services companies were saying when they were pushing credit cards and loans on him. Does he agree that educating the business community, neighbours and community groups, and everyone in society, about how adults with autism respond and cope would protect people and prevent those things from happening?

Jim Shannon Portrait Jim Shannon
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I thank the hon. Lady for her valuable contribution. Yes, I agree; I think all hon. and right hon. Members would. Churches have intervened to help in a number of complex cases in my constituency. What is not complex for us is complex for people with autism. There is a clear role to be played in that regard. Only 15% of adults with autism are in full-time employment; again, that results from some of the issues that they suffer from, including epilepsy, sleep disturbance and mental health problems. Many out there are trying to help and assist.

I ought to give a Northern Ireland perspective, because we have done good, helpful work there, health being a devolved matter. The Minister is aware of that good work because he has visited a number of times. Perhaps he might comment on that in his response.

The Northern Ireland Assembly put in place the Autism Act (Northern Ireland) 2011, which is the most comprehensive autism and single disability legislation in the whole of Europe. The need to do something was recognised at an early stage, as was the fact that the power was there to do it within the devolved Administration, and that was done. It is the first legislation in Northern Ireland requiring by law all Departments to plan and work together on the delivery of the strategy. The cross-governmental attitude that the right hon. Member for Chesham and Amersham requested is there. My hon. Friend the Member for East Londonderry (Mr Campbell) and the hon. Member for Stretford and Urmston (Kate Green), who both intervened on me, have confirmed that that should happen. Departments worked together on the delivery of a strategy. No cross-Department barriers are allowed at all. When we say “comprehensive”, we mean it. I am delighted that the debate is calling for such a strategy.

Autism Northern Ireland was at the centre of the campaign for the Autism Act (Northern Ireland) with its grass-roots campaign. There was no money or external lobby company—just hard work, and determination to make it happen and to gain support from all parties, which was forthcoming. It had autism ambassadors—health and education party spokespersons—to build up expertise on issues of concern. It also formed a partnership with Autism Cymru, which was already working with the Welsh Government on implementing a Wales autism strategy. That was the foundation of the Celtic Nations Autism Partnership—Celtic as in “keltic”, and certainly not “seltic”. No offence to any Celtic supporters who might be here, of course. That is a partnership with the autism societies of Scotland and the Republic of Ireland, which has led to initiatives in the USA. The CNAP and Members of the Legislative Assembly visited the US Congress and the European Parliament.

When we say that the approach is comprehensive, we are talking about looking across Europe and the world; examples were considered and discussions took place. That led to the Autism Act (Northern Ireland). A partnership was initiated with Autism-Europe and MEPs to develop a comprehensive and well-thought-out European autism strategy.

In 2012, I highlighted the difference between the Autism Act (Northern Ireland) and the English Autism Act 2009: the Northern Ireland Act is equality-driven and lifelong-focused. Perhaps the Minister will indicate whether the Government are trying to achieve in England the equality and lifelong focus that we have in Northern Ireland through the Autism Act (Northern Ireland) 2011. That Act amends our disability discrimination legislation, too, to include those with social communication disabilities such as autism. That supersedes the Great Britain Equality Acts, which only give recognition and guidance in primary legislation. That is significantly different from how we did it back home, where we have attempted to address adult autism.

I again thank the right hon. Member for Chesham and Amersham for securing the debate. She, like me and everyone else in the Chamber, sees the gaps in the strategy and the need to enhance provision by including an adult strategy. I have raised today the cases of a young girl and a young adult male. The strain on families grows greater with time as the child becomes an adult and more difficult to handle. The legislation should be amended to provide more state help.

Oral Answers to Questions

Kate Green Excerpts
Tuesday 25th February 2014

(10 years, 6 months ago)

Commons Chamber
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Dan Poulter Portrait Dr Poulter
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My hon. Friend is right to highlight the fact that such decisions are clinical decisions and need to be made at a local level to ensure safe care, both with appropriate numbers of obstetricians in obstetric-led units and to give women the choice to deliver in midwifery-led units where appropriate. I am pleased that we, as part of the fund that I outlined earlier, have been able to give Hampshire Hospitals NHS Foundation Trust £50,000 to provide enhanced facilities in birthing rooms at Florence Portal house.

Kate Green Portrait Kate Green (Stretford and Urmston) (Lab)
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In 2012 representatives of Group B Strep Support met the Minister and received a commitment that the gold standard of enriched culture medium testing would be introduced, which can facilitate preventive treatment for women in labour. Just before Christmas, Public Health England announced that the testing would not go ahead from 1 January. Can the Minister say why not and when the test will be introduced?

Dan Poulter Portrait Dr Poulter
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Group B strep is an important issue. I have seen in my clinical practice the devastating effect that the disease can have on newborn babies and on families, so we are doing all that we can to support work on it and ultimately to develop a vaccine to prevent the condition. I would like to correct the hon. Lady on the record. I met Group B Strep Support with the Chief Medical Officer and we undertook to investigate the applicability of the test. The clinical evidence unfortunately does not support its introduction, and we have to be guided by clinical evidence.