Coronavirus

Lindsay Hoyle Excerpts

Tuesday 3rd March 2020 Commons Chamber

[Several hon. Members rose—]

[Mr Speaker]

Order. I will let this statement run for about an hour, so let us help each other.

[Dr Luke Evans (Bosworth) (Con)]

With regard to the impact that coronavirus can have, the Secretary of State is right to balance the difference of health and the economy and I welcome his caution in that regard. I want to raise a point about small businesses. If coronavirus does become a more significant problem, are the Government considering making emergency loans available to otherwise good businesses? If not, will he ask other Departments whether they might consider that?

Coronavirus

Lindsay Hoyle Excerpts

Wednesday 26th February 2020 Commons Chamber

[Several hon. Members rose—]

[Mr Speaker]

Order. I expect to run this statement until around 1.30 pm.

[Greg Clark (Tunbridge Wells) (Con)]

Has the roll-out of diagnostic testing facilities to 11 laboratories in the UK been completed? Does my right hon. Friend have plans to extend that coverage if there were to be a wider outbreak?

East Leake Health Centre

Lindsay Hoyle Excerpts

Tuesday 25th February 2020 Commons Chamber

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on getting her first Adjournment debate. It will be the first of many, I have no doubt. I congratulate her as well on fighting hard for her constituents. I spoke to her beforehand.

[Mr Speaker]

And she will always have Jim intervening.

[Jim Shannon]

To support the hon. Lady; that is why I am here.

Does the hon. Lady agree that a vibrant and smoothly functioning health centre is a key facet of any local community, that if more funding were given to this frontline service there would be less unnecessary pressure on A&Es and that we really must get back to having GPs and nurses in place and functioning to provide an acceptable standard of the national health service?

[Alicia Kearns (Rutland and Melton) (Con)]

I commend my hon. Friend and neighbour for securing this important debate for her constituents. The issue she raises applies to many rural constituencies such as mine; the numbers are important. In Melton, 30,000 people in my constituency are served by just one GP practice. [Interruption.] I respect very much that gasp of awe, which I did not pay for or prearrange. In Oakham, 16,000 people are served by one GP service. Does she agree that if we are truly to be the party of the NHS, we need to invest in primary care, because that is what people feel and experience on the ground that makes them feel that the NHS is truly on their side and we are on their side. It will also get those numbers down, so that people get the fair, honest and decent primary healthcare they deserve.

[Mr Speaker]

Order. I just need to help a little. Unfortunately, I have been very soft with Mr Shannon in previous times. This debate is about the East Leake health centre and therefore we should not be widening it; the danger is that people’s Adjournment debates are going to be captured. I understand why people want to raise these things, but I think we are going to have to tighten down in the future if people are going to start spreading the debate around everybody.

[Ruth Edwards]

Thank you, Mr Speaker. I completely agree with my hon. Friend’s point; we need to invest in health centres in our rural communities, because that will also take the pressure off accident and emergency units, and hospitals

There has been a 25% increase in patient numbers at the East Leake practice in the past five years. With the new housing I referred to earlier being built in the next four or five years, an additional 3,000 patients—a further increase of 27%—are forecast. The medical team and services needed to effectively serve the growing population can no longer fit inside the building. At present, there are more doctors than consulting rooms, and the district nursing team has had to move out of the health centre due to a lack of space.

A few weeks ago, I visited the practice. I am hugely grateful to the practice manager, Nicky Grant, to doctors Neil Fraser and Nicolas Milhavy, and to Conrad Oatey, the chairman of the patient participation group, for showing me the great work done at the practice and the ingenious use they have made of their already limited space to try to accommodate growing demand. It is a rabbit warren of rooms, squeezed in to accommodate 45 members of staff, including nurses and 12 doctors. They are dispensing advice, immunisations, vaccinations, blood tests, treatment for minor injuries and illnesses, antenatal care and palliative care, and they are helping people to quit smoking——the list goes on. The building has already been expanded four times on the current site, and there is no further land for it to be expanded again. Having been there myself, I cannot see how a further 3,000 patients could possibly be served from the current practice building. As I mentioned in my opening remarks, I would like to invite the Minister to visit the practice with me, both to see the current conditions in which the team are working and to hear more about the exciting proposals for a new health centre.

The proposals are indeed very exciting. We will have a bigger, modern practice that is designed for the number of patients being served today, rather than 10 years ago, but it will be much, much more than that. The proposal is for the practice to relocate to a new site, still based in East Leake, which will accommodate a range of primary, social and community services. Those include community pharmacists, dentists, social services, the public library and the parish council, and the return of the district nursing team. It will also enable new diagnostic services and out-patient services, such as ultrasound and physio- therapy, to be located on site. Treatment will be delivered in the heart of the community, meaning that fewer people will have to make trips to already stretched hospitals. It will also provide a proper space from which local mental health services could be delivered—that is a priority that many of my constituents have raised with me.

This will mean that the elderly gentleman can collect his repeat prescription, take out a book from the library and talk to the parish council about an issue in his street all in one trip. It also means that the young pregnant mum who needs an ultrasound scan, but also a dentist’s appointment for her eldest child, can access both on the same day in the same place. Someone who has been injured at work can see their physiotherapist and GP, and pick up their painkillers.

The cost of the new building will be £12.4 million. Rushcliffe clinical commissioning group is asking for £7.3 million in capital funding from the Government, which it will supplement with contributions from developers, plus investment from the other organisations that would co-locate into the building. The cost is therefore significantly less than if the co-location model was not pursued, and the primary care aspect of the health centre was moved to a refurbished site on its own. It will allow delivery of enhanced primary care services and community facilities in the most cost-effective way, serve as a model for modern delivery of multiple services in the community and relieve the huge pressure on the A&E department at Queen’s medical centre.

Furthermore, this will help to deliver on many of the priorities for primary care networks, as set out in the NHS long term plan, providing better management of financial and estate pressures, a wider range of services to patients and better integration of GP services with the wider health and care system. It will also enable better integrated care for people with complex needs, including many elderly residents, and better enable the provision of proactive, preventive measures and holistic solutions, such as social prescribing.

I strongly welcome the Government’s focus on levelling up investment and opportunity across our country. For the benefits to be fully realised, this will also need to involve levelling up between urban and rural areas, as the latter have historically often seen lower investment. Investment in healthcare is one of the many levers for doing that. This Government’s hospital building programme of 40 new hospitals and 20 upgrades—the first in a generation—is fantastic news for everyone. However, it needs to be matched with investment in primary healthcare, particularly in rural areas like many parts of my constituency, to offer better access to integrated healthcare services within rural communities. This will make it easier, more convenient and cheaper for patients to access healthcare services, drastically decrease the number of times people even have to go to a hospital for treatment due to better joined-up care and a focus on prevention, and help to care for elderly patients with complex needs in their homes for longer.

With its growing population, East Leake and the surrounding areas have growing need, but its health centre can no longer grow to match it on its current site. Its practice team have an exciting, forward-thinking vision for the future delivery of health and social care services. Its future provides us with a golden opportunity to invest in local, community-centred care. I thank the Minister again for taking the time to listen and to respond to this debate. I would be most grateful for any guidance on Government plans for future investment in primary care, and any reassurances she can give me about the bigger, brighter future for East Leake health centre. Once again, I reiterate my invitation to visit.

Maternity Services: East Kent

Lindsay Hoyle Excerpts

Thursday 13th February 2020 Commons Chamber

[Mr Speaker]

We now come to the next urgent question, which I will run for up to 30 minutes.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health and Social Care (Ms Nadine Dorries)]

I will set out the situation concerning East Kent Hospitals University NHS Foundation Trust in line with the written statement laid in Parliament this morning. In fact, I took steps to inform Parliament of this matter before the UQ was requested, and I hope that reflects the importance I place on this issue. Before I begin, I would like to express my deepest and most heartfelt sympathies for the patients and families who have been affected.

I made a statement on 28 January on concerns about maternity services in East Kent Hospitals University NHS Foundation Trust, and I would now like to update the House based on the reports from the independent Healthcare Safety Investigation Branch and the Care Quality Commission. I requested that both HSIB and the CQC report back to me within 14 days when I instructed them to go into East Kent trust two weeks ago, and they reported to me on Monday.

HSIB has already conducted a number of maternity investigations at the trust as part of its national maternity investigation programme. These identified a number of safety concerns, including the availability of skilled staff—particularly out of hours—access to neonatal resuscitation equipment and the speed with which patients’ concerns are escalated up to senior clinicians and obstetricians, along with failings in leadership and governance.

As requested, the CQC carried out an unannounced inspection of the trust’s maternity services between 22 January and 5 February. It has written to the trust with an oversight of its findings, and the full inspection report will be published in due course. The CQC received additional information from the trust this week, following its request for further assurances on triage, day care and medical staffing. The CQC is considering this information. It is important that everyone is aware that the CQC is in regular contact with the trust and will continue to be so for the foreseeable future.

From the findings provided to me by HSIB and the CQC, it is clear that the challenges at East Kent point to a range of issues, including having the right staff with the right skills in the right place, effective multidisciplinary working, clear collaborative working between midwives and doctors, good communication and effective leadership support, but it would be wrong to speculate that there is indeed one single cause.

NHS England and NHS Improvement are working closely with the trust and have taken some immediate actions. First, the regional director and regional chief nurse are providing support to the trust, and the medical director will address concerns surrounding appropriate senior medical oversight. Secondly, the regional chief nurse is providing support to the director of nursing and head of midwifery, to prioritise and focus their local maternity improvement plans and address identified safety concerns. They will also review the effectiveness of clinical governance and executive leadership support. That will include ensuring that the trust learns from all historical cases, and disseminates that learning throughout the trust.

The Chief Midwifery Officer, Jacqueline Dunkley-Bent, has sent an independent clinical support team to the trust to provide assurances that all possible measures are being taken. That expert team includes a director of midwifery services from an outstanding trust, two consultant obstetricians, and a consultant paediatrician and neonatologist. She has placed the very best at the heart of the trust, on the wards, and at the bedsides of patients, with fresh eyes to oversee the care currently being delivered. The independent team is working with trust staff to deliver immediate improvements to care, and to put in place robust and comprehensive processes to support improvements in standards over the long term. Jacqueline Dunkley-Bent has personally visited the trust to assess the changes being put in place, and to ensure that improvements are moving at pace.

Jenny Hughes, chief midwife for the south-east region, is working with the trust directly, and regional and national teams from NHS England and NHS Improvement will continue to work with the trust. The trust is taking the issue seriously and is working closely with NHS England and NHS Improvement. It has created and filled several specialist midwife posts. Safety huddles, where safety issues are regularly and frequently discussed, have been embedded on both sites to anticipate problems before they occur, and multidisciplinary teams are working collaboratively.

[Mr Speaker]

Order. The Minister is supposed to speak for three minutes, but we are now at five minutes plus. I realise that she has been given a lot of notes, and I think officials ought to take on board the time. I am not looking to you, but I am looking to others to help in the future. I am sure we will be coming to the end of the remarks, as there are lots of questions.

[Ms Dorries]

Thank you, Mr Speaker. I think in defence of my officials, because this is such a sensitive issue—

[Mr Speaker]

Order. I am not getting into a debate about this. I do not make the rules of the House. The House makes the rules, and it has decided that responses should be for three minutes, not me.

[Ms Dorries]

I will go straight to my closing statement, Mr Speaker. I reiterate my condolences, particular to the family of Harry Richford and all those affected. I also thank my right hon. Friend the Member for North Thanet (Sir Roger Gale) for raising this important issue. The Government are fully committed to reducing patient harm and improving the safety of maternity services.

Wuhan Coronavirus

Lindsay Hoyle Excerpts

Monday 3rd February 2020 Commons Chamber

[The Secretary of State for Health and Social Care (Matt Hancock)]

Nick? It is not “Room 101”, Mr Speaker.

With permission, Mr Speaker, I would like to update the House on the ongoing situation with the Wuhan coronavirus. On Friday, the chief medical officer announced that two patients in England who are members of the same family tested positive for coronavirus. They were transferred to a specialist unit in Newcastle, where they are being cared for by expert staff. Public Health England is now contacting people who had close contact with these two confirmed cases. Close contacts will be given health advice about symptoms and emergency contact details to use, should they become unwell in the next 14 days. These tried and tested methods of infection control will ensure that we minimise the risk to the public.

On Friday, a Foreign Office-chartered aircraft carrying 83 British nationals left Wuhan for the UK, and I want to thank all those involved in that operation, including staff at my own Department, the Foreign Office, Border Force, the Ministry of Defence and military medics, as well as all the NHS staff, officials at Public Health England and many more who have worked 24/7 on our response so far.

Yesterday, we brought back a further 11 people via France, and returned UK nationals have been transferred to off-site NHS accommodation at Arrowe Park Hospital on the Wirral, where they will spend 14 days in supported quarantine as a precautionary measure. I thank all the staff there who have done so much to make that possible. There, they will have access to a specialist medical team who will regularly assess their symptoms. In addition, one British national has been taken to a separate NHS facility for testing.

We will take a belt-and-braces approach that makes public protection the absolute top priority, from a virus that is increasingly spreading across the world. As of today, there are more than 17,000 diagnosed cases in mainland China, with a further 185 in other countries, including France, Germany and the United States. There have been 362 fatalities so far. The World Health Organisation has now declared the situation a public health emergency of international concern, and the UK chief medical officers have raised the risk level to the UK from low to moderate. We are working closely with the WHO and international partners to ensure that we are ready for all eventualities.

Health Ministers from G7 countries spoke this afternoon, and agreed to co-ordinate our evidence and response wherever possible. The number of cases is currently doubling around every five days, and it is clear that the virus will be with us for at least some months to come; this is a marathon, not a sprint. On existing evidence, most cases are mild and most people recover. Nevertheless, anyone who has travelled from Wuhan or Hubei province in the last 14 days should immediately contact NHS 111 to inform the health service of their recent travel, and should stay indoors and avoid contact with other people just as they would with the flu—even if there are no symptoms. Anyone who has travelled to the UK from mainland China in the past 14 days and is experiencing a cough, fever or shortness of breath should self-isolate and call NHS 111, even if symptoms are mild.

We will do all we can to tackle this virus. We are one of the first countries in the world to develop a new test for it. Testing worldwide is being done on equipment designed in Oxford, and today I am making £20 million available to the Coalition for Epidemic Preparedness Innovations to speed up the development of a vaccine. I can announce that Public Health England has sequenced the viral genome from the first two positive cases in the UK, and is today making that sequence available to the scientific community. Its findings suggest that the virus has not evolved in the last month. We have also launched a public information campaign, setting out how every member of the public, including Members of this House, can help by taking simple steps to minimise the risk to themselves and their families: washing hands and using tissues when they sneeze, just as they would with flu. That goes for all of us.

We remain vigilant and determined to tackle this virus with well-developed plans in place. I commend this statement to the House.

[Mr Speaker]

I expect questions on the statement to run for up to 45 minutes.

Speaker’s Statement: Select Committee Chairs

Lindsay Hoyle Excerpts

Wednesday 29th January 2020 Commons Chamber

[Mr Speaker]

We now come to the announcement of the results for the election of Select Committee Chairs. The results for Chairs who were unopposed were announced on Monday and the election for the contested votes were held by secret ballot today. Five hundred and eighty-six ballot papers were submitted. The results are as follows:

[The Secretary of State for Health and Social Care (Matt Hancock)]

On a point of order, Mr Speaker. Earlier this week at Health questions, my right hon. Friend the Member for Chelsea and Fulham (Greg Hands) raised a question about scaremongering around the Parsons Green walk-in centre. The Parsons Green walk-in centre is not closing and anyone who claims that is not following the facts, but I wanted to come to the House at the earliest moment to apologise, Mr Speaker, to you, to the House, and to the hon. Member for Hammersmith (Andy Slaughter), because I did not follow the parliamentary custom of letting him know in advance that I was going to mention him. I am afraid that I did not know the subject was going to come up, although I should not have been surprised given my right hon. Friend’s assiduousness. I do not apologise for the substance of what I said, nor for the force with which I said it, because I think that this sort of scaremongering worries the most vulnerable, but I do apologise for not letting the hon. Member know in advance.

[Mr Speaker]

I hope the Secretary of State will go a little bit further than that. Calling an hon. Member a total disgrace should be retracted.

[Matt Hancock]

I am very happy to retract that and I hope that this will be the end of the matter.

[Mr Speaker]

Let us leave it at that.

Oral Answers to Questions

Lindsay Hoyle Excerpts

Tuesday 28th January 2020 Commons Chamber

[Matt Hancock]

Tax is, of course, a matter for the Treasury, and the Chancellor would not be thrilled if I announced tax policy in the middle of health questions, tempting as that may be. However, we have been working with the Treasury, and also with the Academy of Medical Royal Colleges, the British Medical Association, employers in the NHS and others, to deliver on our manifesto commitment to sort this out.

[Mr Speaker]

Jonathan Ashworth.

[Jonathan Ashworth (Leicester South) (Lab/Co-op)]

You rather surprised me then, Mr Speaker!

The Secretary of State mentioned primary care networks. As he will know, two weeks ago GPs rejected the new service specifications in those networks. This has been described as a debacle, and as leading to more red tape and taking GPs away from patients. If the Secretary of State is going to fix these contracts, can he tell us how he is going to do it—or is he content to see more GPs walk out of primary care networks before they have even got off the ground?

--- Later in debate ---

[Dehenna Davison (Bishop Auckland) (Con)]

rose—

[Mr Speaker]

This is limited to Hartlepool, so I presume your question is around that.

[Dehenna Davison]

Thank you, Mr Speaker. As another north-east MP concerned about local healthcare, I asked the Prime Minister two weeks ago about retention of the stroke service at Bishop Auckland Hospital. Has the Minister made any progress on that point?

--- Later in debate ---

[Several hon. Members rose—]

[Mr Speaker]

Order. I am sure the Secretary of State would acknowledge that I am trying to get the last few questions in, and I think we can speed up rather than trying to make any last final points.

[Stephanie Peacock (Barnsley East) (Lab)]

May I ask the Secretary of State what screening plans are in place for those arriving in the UK from China, and has a contingency fund been established to tackle the potential effects of the coronavirus?

[Several hon. Members rose—]

[Mr Speaker]

Order. Unfortunately, that is the end of questions. I hope that we will get in a few more next time.

The House will wish to be aware that there will be a statement today after the conclusion of proceedings on the Direct Payments to Farmers (Legislative Continuity) Bill. I cannot confirm a time exactly, but it should be before 3.30 pm, and the start of proceedings on the Third Reading of the Bill will serve to give some notice of the likely start time. I hope that is helpful to Members.

The National Health Service

Lindsay Hoyle Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Dr Wollaston]

On a point of order, Mr Deputy Speaker. Frankly, I am astonished that at such short notice the Prime Minister has sent a note to the Liaison Committee refusing to appear before us in the morning. This is the only Committee that can call the Prime Minister to account, and it allows us to ask detailed questions with follow up on behalf of the public. This is now the third occasion on which the Prime Minister has cancelled. May I seek your guidance, Mr Deputy Speaker, because this is entirely unacceptable?

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I recognise that three times is very difficult, and quite rightly we have to hold all officers, even the Prime Minister, to account. However, I also recognise that these are very difficult times at the moment, and I would hope that the point of order has been listened to by Ministers and that we can come forward with a date for the Prime Minister to appear, but, more importantly, that the Liaison Committee can get that meeting in—and, as Chair, I recognise the need to do so. So, both ways, there is a need to try to make sure we can make this happen.

[Sir Patrick McLoughlin (Derbyshire Dales) (Con)]

Further to that point of order, Mr Deputy Speaker. As a member of the Liaison Committee as well, I can say that of course the Liaison Committee is disappointed that the Prime Minister is unable to appear before it tomorrow, but the truth is that the Prime Minister is held to account in the Chamber by all Members of Parliament every week for over an hour, so it is simply not true that the Prime Minister is not being held to account.

[Mr Deputy Speaker]

I can see that tensions are running high. I have given a very honest answer that I think is fair to both sides.

[Yvette Cooper (Normanton, Pontefract and Castleford) (Lab)]

Further to that point of order, Mr Deputy Speaker. As the Chair of the Liaison Committee, the hon. Member for Totnes (Dr Wollaston), has said, this is now the third time, and the purpose of the Liaison Committee is to take more detailed evidence and scrutinise the Prime Minister in a more detailed way. The Prime Minister has said that he does not want to come now until five or six months after his initial appointment; that means in December or January. At such a time when there are so many important decisions to be made for the country, surely it is utterly irresponsible for the Prime Minister to refuse to answer detailed scrutiny questions from the Committee, and if he has done this three times before, how on earth can we have any confidence in a December or January date either?

[Mr Deputy Speaker]

Well, if we can get to January and February that is more than I am expecting at the moment. I hope that the message has gone out that three times the frustration has quite rightly been there. I do not know the reason for the decision tomorrow, but I do know we are in very serious and dangerous times in the future of this present Parliament. I am sure, as I said earlier, that that message will go back, and I would like to think that the earliest possible date will be proposed—sooner rather than later; this year, not next year, unless other events overtake us.

[Mr Steve Baker (Wycombe) (Con)]

Further to that point of order, Mr Deputy Speaker. Can you advise me whether there is any way we can highlight in this House the profound injustice whereby some Members can achieve high office in the Committee system by virtue of their party affiliation, yet continue to hold high office after they have abandoned their party?

[Mr Deputy Speaker]

I am not going to get into that argument. I have enough on my plate without going down that road.

[Mary Creagh (Wakefield) (Lab)]

Further to that point of order, Mr Deputy Speaker. I think that that last comment was unworthy of the hon. Member for Wycombe (Mr Baker). The Prime Minister got out of the first date by, I believe, proroguing Parliament. Clearly, the programming of the business for this week, which would have seen us on the Report stage on the withdrawal agreement Bill, would have meant that the Prime Minister, quite rightly, would have had to be in the Chamber. Is it in order for the Prime Minister to use smoke and mirrors to pretend that he is coming to the Liaison Committee but always find a way to wriggle out of the back door and never be accountable?

[Mr Deputy Speaker]

I am not going to enter into speculation. I have been very clear, and I have made the point. I am not going to change any more.

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

Further to that point of order, Mr Deputy Speaker. Further to some of the comments that have been made, may I seek your advice about the accountability of the Prime Minister? Truly, he is accountable to the Liaison Committee as well as to the House, and in other matters—

[Mr Deputy Speaker]

Order. I have been down that road already, and I am not going to change what I have said.

[Dr Wollaston]

Further to the point of order made by the hon. Member for Wycombe (Mr Baker), Mr Deputy Speaker. May I seek your confirmation that Select Committee Chairs are elected by the whole House of Commons because they are trusted not to take a tribal party political viewpoint in their role as Select Committee Chairs?

[Mr Deputy Speaker]

Yes.

[Dr Whitford]

On a point of order, Mr Deputy Speaker. In response to my question this morning about compensation for the victims of the contaminated blood scandal, the Minister for the Cabinet Office and Paymaster General suggested that the Government were waiting for

“the determination of legal liability, to which the inquiry’s deliberations relate”,

but surely he must recognise that under the Inquiries Act 2005 a public inquiry cannot determine liability, so how can I call for the Minister for the Cabinet Office to correct the answer that he gave?

[Mr Deputy Speaker]

You have done it for me. Those on the Treasury Bench have heard you.

Maraviroc and Progressive Multifocal Leukoencephalopathy

Lindsay Hoyle Excerpts

Monday 30th September 2019 Commons Chamber

[Seema Malhotra]

The hon. Gentleman makes a point that I will come on to about how the decisions need to be made on the medical evidence and with the voice of the consultants being clearly heard by those making the decisions.

There is no cure for this condition, but two years ago my consultant’s neurologist advised that Maraviroc had had a positive effect on patients suffering from PML in relation to her condition, immune reconstitution inflammatory syndrome in multiple sclerosis. An individual funding request was submitted by my constituent’s consultant, national expert Professor Ciccarelli at the National Hospital for Neurology and Neurosurgery. The application was refused and a subsequent appeal was also unsuccessful—this process went on through 2017 and 2018—seemingly on the same basis as was given to me in writing in October by NHS England, which was that the

“use of Maraviroc for this condition is currently seen as experimental as the current evidence is limited to very small observational studies. NHS England has concluded that there is not sufficient evidence to support the routine commissioning of this treatment for the indications listed.”

The effect on Amarjit was heartbreaking. I met Amarjit and her friend and advocate Kartik. She had a wheelchair and a walking stick, and even the most basic activities were a struggle. She had decided to fund the drug privately from her savings. Maraviroc had remarkable results for her—importantly, that was also the opinion of her consultants—without any side effects. Other treatments that the NHS had sought to prescribe, such as MRIs and monthly steroids, were not just neutral but net negative. Amarjit and Kartik explained the impact that Maraviroc had had on Amarjit’s health and quality of life. I was just staggered when she told me:

“I can talk. I can walk. I can go to the bathroom on my own”—

things that we take for granted. Clinically, the PML lesion appeared inactive and there was a reduction in the inflammation around her brain.

The drug costs around £480 a month, but by the end of June this year Ms Rai could no longer afford to pay for it herself, so she has since been without it. Although her health has been stable so far, such is the condition that it could dramatically change at any time.

Aside from the issue of funding, I have been surprised over the past year by inconsistencies in NHS policy and advice. We all believe in an NHS that is free at the point of need. This is a situation where the patient, leading neurologists and all involved in her care agree that she should have the drug. In November 2018, consultant neurologist Dr Michael Gross, who was also supporting Amarjit’s care as an expert advocate, wrote to Kartik:

“Thank you for confirming further information about Amarjit Rai... Professors Johnson and Ciccarelli agree that this is the appropriate treatment for Amarjit. Long term steroids have already generated severe osteoporosis in 2016 and are not her choice.

You will have already proved in what is an N=1 trial that her treatment would appear to be effective. There will almost certainly never be the size of trials in this rare disorder that would allow a definitive statement by a funding organisation.

I think we have to ask who is making the decision, given that there are now three senior consultants confirming this is the right decision… Quite frankly I am appalled by the lack of humanity that is being demonstrated here.”

In November 2018 I wrote again to the Minister. I received a response from Lord O’Shaughnessy in the other place, who helpfully said the following:

“Maraviroc is not licenced for the treatment of symptoms of PML. There are clinical situations when the use of unlicensed medicines or use of medicines outside the terms of the licence, known as off-label, may be judged by the prescriber to be in the best interest of the patient on the basis of available evidence. The responsibility for that falls on healthcare professionals.”

Sadly, this made no difference.

Following the lack of progress, I wrote again to the Secretary of State in March 2019. I quoted the helpful response that I had received from Lord O’Shaughnessy. The Health Minister in the other place, Baroness Blackwood, responded in May and referred again to the individual funding request process. She stated that the IFR can be considered only if the patient can be demonstrated to be clinically exceptional. She said that

“an IFR can only be considered if the patient can be demonstrated to be clinically exceptional compared to the wider group of patients and is likely to derive greater benefit from the treatment.”

At face value, all of this would appear to be true for my constituent, but the use of Maraviroc is an area where policy appears to be in some confusion.

In response to a parliamentary question I asked in July about the assessment that NHS England has made of the availability of Maraviroc to patients with PML, a third Health Minister, the hon. Member for South Ribble (Seema Kennedy), wrote:

“We are informed by NHS England and NHS Improvement that it does not commission Maraviroc for progressive multifocal leukoencephalopathy… NHS England and NHS Improvement have published a do not commission policy for ‘Natalizumab-induced progressive multifocal leukoencephalopathy in relation to immune reconstitution inflammatory syndrome in multiple sclerosis.’”

That response seems to contradict earlier responses and advice. First, “does not routinely commission” is different from “does not commission”. Secondly, it made no reference to the IFR process, which two Ministers had previously mentioned.

I tabled a further parliamentary question last week to ask what assessment the Secretary of State had made of the effectiveness of Maraviroc in patients with PML. A fourth Health Minister, the Under-Secretary of State for Health and Social Care, the hon. Member for Mid Bedfordshire (Ms Dorries), responded to my question. The response I received today was mind-boggling:

“Maraviroc is currently authorised for the treatment of patients who are infected with HIV type 1. The Medicines and Healthcare Products Regulatory Agency which is responsible for the regulation of medicines in the UK is not aware of any application for use in patients with PML and therefore cannot comment on the efficacy of this drug in patients with PML.”

It might be helpful if I highlight for the Minister findings from wider medical journals that the House of Commons Library has helped me to compile. In December 2016, the American Academy of Neurology published an article entitled “Severe early natalizumab-associated PML in MS: Effective control of PML-IRIS with maraviroc”. A summary of a case involving a 55-year-old Caucasian HIV-negative man diagnosed with relapsing, remitting MS in 2013 shows that that led to a subsequent diagnosis of PML. Clinically, the patient deteriorated rapidly, according to the article. Oral Maraviroc was initiated six days after his admission. Eight days after Maraviroc initiation, MRI follow-up revealed stable PML lesion size. Over the following weeks, the patient improved continuously. After 25 weeks of Maraviroc treatment, the John Cunningham virus DNA was no longer detectable. Maraviroc was continued and well tolerated at a stable dose. The patient survived both PML and IRIS.

A subsequent article was published by the American Academy of Neurology entitled “Maraviroc as possible treatment for PML-IRIS in natalizumab-treated patients with MS” in December 2016. It cited a 34-year-old man treated with Natalizumab for three years without previous immuno-suppression. After a period of time, the patient was admitted with seizures, headaches, and impaired memory, and an MRI scan subsequently confirmed PML. Twelve months after diagnosis with PML and six months after the start of Mariviroc, PML-IRIS lesions were resolved, and no new MS disease activity was detectable.

An article in 2017 by Steiner and Benninger published by the American Academy of Neurology built the medical explanation for why Maraviroc had been effective in cases of PML in MS sufferers. In summary, the condition for which the cause is believed to be the John Cunningham virus, which infects the central nervous system in patients with low immune conditions, became more prevalent and was observed in around 5% of patients with HIV prior to the availability of highly active antiretroviral therapy, or HAART. The article goes on to describe how the era of

“monoclonal antibodies for immune-mediated conditions such as Natalizumab for MS and Crohn disease heralded another context for PML. As of November 2016, there have been 698 reported cases of PML under natalizumab.”

The research goes on, and it is true that some research such as that published in The Journal of the Neurological Sciences in July 2017 confirms that it does not work in all circumstances, and steroids may be more effective in some patients. However, an article in Neurology Times in January 2018 states that in PML treatment options are limited. Maraviroc has been used successfully in some PML patients to avoid IRIS, although not all patients respond to Maraviroc. It recommends further research and testing in identifying patients at risk of IRIS and tailoring treatments accordingly.

In that context, let me make reference to the urgent clinical commissioning policy statement on Natalizumab-induced PML, which was published by NHS England in March 2018. It said:

“It has been assessed that the development of a full policy is not needed at this time as there is currently little evidence into its effectiveness for this indication”.

I do not believe that that policy statement takes account of all the research available or indeed that which has appeared subsequent to its publication. The research is more nuanced, the medical benefits for my constituent are undeniably clear, and the denial of funding is inexplicable to her and renowned experts in the country.

Maraviroc, or Celsentri, as defined by the European Medicines Agency—formerly in London, it is now based elsewhere in the European Union—is a medicine that is routinely prescribed for HIV. Although it does not cure HIV infection or AIDS, it may hold off the damage to the immune system and the development of other infections and diseases.

Medical research has identified that the JCV most associated with HIV patients with low immunity has found another context in patients with PML. My constituent’s condition is incredibly rare, affecting, potentially, 10 or fewer people in the country. Given that very few options are available, she is not the only patient for whom, in anecdotal studies, the drug Maraviroc has shown remarkable results. With no other options available, my very ill constituent has been paying £500 a month privately for the past year to fund Maraviroc herself, but she can no longer afford to do so. Amarjit’s consultant neurologist and other specialists support her receiving the treatment. There is an irony in the fact that more is potentially being spent by the NHS in a month on treatment and tests that do not benefit her as much, and have damaging side-effects. The IFR system in the NHS should be able to review and respond to that situation on the basis of medical need, and I cannot see how that has been done in this case.

Will the Minister tell me how her Department liaises with and challenges NHS England on cases such as this, and how well-researched the Department’s responses to me have been? Will she tell me with what medical advice the treatment has been refused, although three of the leading experts in the country support it in this rare case, and whether their advice can be shared with my constituent and her consultant, Professor Ciccarelli? Will she also agree to a meeting with me, my constituent and her consultant, and a senior member from NHS England to discuss the IFR process?

This is a matter of £500 a month, and of demonstrable medical benefits to my constituent. I should be grateful for the Minister’s response, and her advice on how we can move forward.

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

I welcome the Minister to the Dispatch Box. I believe that this is her first outing. She is obviously held in high esteem, given that so many Whips are present at once.

Health

Lindsay Hoyle Excerpts

Tuesday 14th May 2019 Commons Chamber

[Several hon. Members rose—]

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

May I just say that to get everybody in and give them equal time, five minutes will be the order of the day?

--- Later in debate ---

[Rebecca Pow (Taunton Deane) (Con)]

I am very pleased to follow the hon. Member for Westmorland and Lonsdale (Tim Farron), and to talk about the Government’s commitment to public health. This Government are providing an additional £4.5 billion for primary and community health services as part of the long-term plan for the NHS. In ensuring that this plan operates properly, a renewed focus has been put on prevention. When the Prime Minister announced the £33.9 billion funding boost for the NHS, she said that the accompanying 10-year plan must have that focus on prevention. As hon. Friends have said, none of this is possible without a strong economy and without a Government who understand that tackling the debt and the deficit is really important, because we cannot have the services we want unless we do that.

One of the key parts of the plan is the importance of new screening methods. Earlier testing for bowel cancer is one of the issues that will be dealt with. I want to say a big thank you for the grant of £79 million that we got to build new theatres at Musgrove Park Hospital, which is Somerset’s main hospital but also a really big hospital providing services across the south-west. With part of that grant, it is building a whole new endoscopy service and suite. This really will help the population not just of Somerset but of the whole south-west with early diagnosis, which is the way we have to go. We also have a new MRI scanner, thanks to the community, which contributed towards it. That will help a great many people by picking up diseases early.

Somerset has a wonderful record on diabetes. Diabetes is a big issue, and amputations are very costly. One amputation costs £20,000, and a person with diabetes who has a limb amputated—sadly, that is what can happen—unfortunately then has a life expectancy of only five years. Somerset has implemented a diabetes foot pathway, which cut amputations from 122 to 66 in 2017. Not only are people living better and more healthily, but that pathway is saving the NHS a huge amount of money. That is the kind of model we need to put in place.

The public health grant remains ring-fenced, which I am very pleased about, and protected exclusively for improving health, but local government spending on health is not just about the grant. It is about local authorities being able to prioritise what they think is important, and indeed they are, with a range of innovative models in Somerset.

One third of Somerset residents will be 65 or over in 10 years’ time, compared with 21% nationally, and that has to be dealt with as a matter of urgency. Somerset County Council is responsible for all adult social care, children’s services and special needs, which take up 70% of its budget. While I welcome the Government giving another £240 million to adult social care and enabling local authorities to add adult social care to their precept, there are still pressing issues in Somerset that must be dealt with relating to the elderly population. Despite a great number of pressures, the council has done really well in sorting out its finances thanks to some tough decisions, but we have to make the resources go further. The council will be the subject of a “Panorama” documentary soon.

We must have better models. One model I want to mention is micro-providers. A list of self-employed, accredited providers can be accessed for all kinds of care and health needs across Somerset, so that people can stay at home, and providers go in to help them. We are using it at home for my family, and it really is a good model. I hope the Under-Secretary of State for Health and Social Care, the hon. Member for South Ribble (Seema Kennedy), will visit us to have a look at it.

We need to do more. While 92% of our care providers in Somerset are good or outstanding, which is above the national average of 83%, the current spending review needs to acknowledge that the pressures from not only the growing costs of care but being a rural county are different from those in other places. Somerset gets £730 of Government funding per head of population, which is 11% less than the national average. Our school transport gets less money than urban areas, and our public health funding from Government is only £36 a head, compared with £56 nationally. Will the Minister—

[Mr Deputy Speaker (Sir Lindsay Hoyle)]

Order.