Diabetes: Tailored Prevention Messaging

Liz McInnes Excerpts

Thursday 24th October 2019 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairwomanship, Ms Buck. I am grateful to the hon. Member for Strangford (Jim Shannon) for bringing this important debate to the Chamber today and for his comprehensive introduction to the subject, which included his own personal experience. I speak in my capacity as co-secretary of the all-party parliamentary group for diabetes, and I recognise the hon. Gentleman’s active role as vice-chair of the group.

My interest in diabetes comes from my background as an NHS clinical scientist, as well as the major health issues presented to our communities by the prevalence of diabetes. My constituency has a higher than average incidence of diabetes—8.5% of the population compared with 6.7% overall in England—so I am always interested in what steps can be taken to improve control of the condition and what preventive measures can be taken to lessen the risk of type 2 diabetes developing.

I want to draw attention to the difference between type 1 and type 2 diabetes, and I sometimes think it would be helpful if we considered them to be two completely separate and distinct diseases. I stress that while being overweight or obese is a major risk factor in type 2 diabetes, type 1 is caused by the body not being able to produce enough insulin and is an autoimmune disease. Although diet and exercise have a role to play in type 1 diabetes management, they cannot reverse the disease or eliminate the need for insulin. It is important to stress that, because of the number of times I have stood in this Chamber and listened to MPs saying, “If only people would lose weight their diabetes would be cured.” It is misleading, and it is unfair to people who are unfortunate enough to suffer from type 1 diabetes.

[Sir George Howarth]

I am grateful that my hon. Friend made that point. She knows that I, too, insist that we deal with them as two separate diseases. There are consequences to the myth that everyone’s diabetes is lifestyle-related. In some cases children are bullied at school for having an autoimmune condition that they have no control over. Yet people believe they have caused it themselves.

[Liz McInnes]

My right hon. Friend is absolutely right. There is an unfortunate blame culture and children can be quite cruel to each other at times; we, as adults, must be careful about the language that we use about diabetes. If I achieve one thing in this place, I would like to get people to understand the difference between type 1 and type 2 diabetes—then I would feel as though I had achieved something.

Despite the growing public pressures associated with both type 1 and type 2 diabetes, a person living with diabetes only spends, on average, three hours a year with a clinician. People with diabetes are often put under a great deal of stress, because of the challenges and complexity in managing the condition and the multiple day-to-day decisions they have to make. In order to allow them to develop the necessary skills to manage their own condition, further support is required—including, but by no means limited to, weight management support.

This debate is very timely and follows a meeting we held in parliament in June of this year, which was attended by the hon. Member for Strangford and my right hon. Friend the Member for Knowsley (Sir George Howarth), among other MPs. The meeting was about realising the potential of health coaches in diabetes care, which the hon. Member for Strangford has already mentioned, and it was supported by Roche Diabetes Care—although of course I have to say that other diagnostic companies are available.

The meeting heard from health coaches about how they support participants in a lifestyle management programme, using their professional expertise as qualified nutritionists to support people to better manage their weight.

[Paul Girvan]

Does the hon. Lady agree that sometimes GPs do not give the right advice to patients? Perhaps a patient who presents with a bad infection is put on antibiotics, which can have an impact on their absorption of insulin, and as a result they can go into a hypo or take a low. That can cause major problems unless they have someone who knows them well, who can watch the signs and knows how to deal with them. Some GPs do not relay that information to patients when prescribing.

[Liz McInnes]

The hon. Gentleman makes a very important point, which I will come to later in my speech, about the need for all health professionals to be aware of diabetes and the complications that can arise, particularly in the situation he describes, where a GP may prescribe something without asking how it will impact on other conditions. The hon. Gentleman highlights the need for more and better training for health professionals around the whole condition of diabetes.

The meeting held in Parliament in June had three main themes. The first theme was relieving workforce pressures in diabetes care by providing non-clinical advice where there are gaps in clinical capacity, which refers back to the point that the average diabetic does not spend a lot of time every year with a clinician. The second theme—it is very pertinent to this debate—was about helping people to find their own tailored solutions to immediate health challenges such as weight management, as well as changing the way they think about their situation. The third theme, which the hon. Member for Strangford mentioned, was digital solutions to deliver 24/7 services to users. The health coaches explained to us how, through apps and other devices, users can message them at any time of day or night. The health coaches will get back to the individual, talk to them and help to address the issue.

Health coaching should be seen as a complement to clinical work and not as a tangent to it. It does not necessarily have to be done by discrete health coaches and could be incorporated into the day-to-day work of NHS staff; that relates to the point made by the hon. Member for South Antrim (Paul Girvan) on GP coaching. It should be incorporated into the day-to-day practice of all staff who work with people with diabetes. That is a point that NHS England and Health Education England should be considering.

Some would say that coaching on lifestyle and weight management is a role that should be fulfilled by the diabetes specialist nurse. I am interested to hear the Minister’s comments on the decline in the numbers of those who perform that very important specialist role. The National Diabetes Inpatient Audit reported that more than a quarter of hospital sites do not have a dedicated in-patient specialist nurse—there is a real gap that we need to examine. The specialist nurse is recognised by most diabetics as their go-to person, so it is quite shocking to hear that they are no longer available in a quarter of our hospitals.

I agree with the basic premise of the hon. Member for Strangford on tailored solutions and prevention messaging for diabetes. I hope the Government will follow the issue up, as well as ensuring that provision is equitable and that variations in uptake are addressed.

Of course, underpinning the whole issue is the need for better public health funding. It is no coincidence that just yesterday in this very Chamber in a debate on the declining numbers of health visitors, I quoted the figures for the national reduction in public health funding and the local reduction in my own borough of Rochdale. Nationally, there has been a reduction of £531 million on public health spending. In my local borough, there has been a cumulative reduction of £8 million over the last four years.

We cannot provide important services on an ever-decreasing budget. It was short-sighted of the Government to try to cut costs by reducing public health funding, and the chickens are now coming home to roost on this ill-thought-out decision. Given the emphasis on prevention in the NHS long-term plan, I will be interested to hear what the Minister has to say about how the cuts to public health funding will be reversed, and how quickly.

Finally, I understand that a National Audit Office report on health inequalities will come out at midnight tonight. I suspect that that report will lay bare the health impacts of cuts to public health services. I will certainly read it with great interest, and I hope the Minister will too.

Health Visitors (England)

Liz McInnes Excerpts

Wednesday 23rd October 2019 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bone, and I am grateful to the hon. Member for East Worthing and Shoreham (Tim Loughton) for securing this important and timely debate.

Before I was elected to this place, I was a lay representative who chaired Unite the union’s national health sector committee. As a result, I had a great deal of involvement in the work done by our health visitors and community practitioners under the umbrella of the Community Practitioners and Health Visitors Association, which operates under the auspices of Unite the union.

I gave up that role in 2014 when I was elected to serve the constituents of Heywood and Middleton. However, I recall that at that time there was great deal of disquiet and unrest about health visitor services, which, as a result of the Health and Social Care Act 2012, were being transferred from NHS commissioning to be commissioned by local authorities. It seems, from what the hon. Gentleman has said and from readily available figures, that the worries that existed at that time have come to pass, as the number of children’s health visitors fell by 31% between 2015 and 2019.

The Local Government Association says that the number of health visitors who are retiring or taking other NHS jobs, combined with too few trainees entering the profession, has led to the workforce being stretched to its limits, at a time when the number of vulnerable children and families is rising.

With cuts to public health budgets, councils are struggling to afford the number of health visitors needed to cope with the workload. Figures from the Office for National Statistics show that the number of under-fives in the borough of Rochdale, in which my constituency is situated, is just over 15,000. With just 52 health visitors in the borough, that gives an average caseload of 290 children per health visitor, when the recommended maximum—as recommended by both the CPHVA and the Institute of Health Visiting— is 250.

With health visitors being so overworked, they may, through no fault of their own, fail to spot child abuse, domestic violence and post-natal depression, and they may also have too little time to help mothers to bond with their babies. A survey conducted by the Institute for Health Visiting showed that health visitors themselves are voicing fears about child tragedy, as a result of increasing case loads and high levels of stress.

With year-on-year cuts to our public health grant, it is difficult to see where the funding will come from to provide and improve this vital service. In the borough of Rochdale, the public health grant is now £3 million lower than it was in 2016-17, having decreased from £19.7 million then to £16.7 million in 2018-19. For this financial year—2019-20—the budget has been cut yet again, to £16.3 million, giving cumulative cuts over the past four years in the borough of Rochdale of more than £8 million. Nationally, councils’ public health budgets have reduced by £531 million between 2015-16 and 2019-20.

I welcome the fact that in the NHS long-term plan the Government pledge to look again at commissioning arrangements, not only for health visitors but for school nursing and sexual health—areas of health provision that are also suffering with increasing caseloads and staff shortages. It is my hope that the responsibility for commissioning will revert to the NHS, and that it will be adequately funded and resourced. I will be very interested to hear the Minister’s comments on that.

Before I conclude, I will just mention some good news about the CPHVA. It has just appointed two high-profile vice-presidents: Professor Gina Higginbottom, who was the first black, Asian or minority ethnic nurse to hold a professorial role at a Russell Group university; and Sara Rowbotham, who is a friend and colleague of mine. Sara worked for Rochdale’s crisis intervention team from 2004 to 2014, and she helped to expose the Rochdale grooming gang scandal. She is also currently the deputy leader of Rochdale Council.

These appointments are welcome at a time when health visiting and school nursing are facing this crisis of falling numbers. Professor Higginbottom has declared her commitment to reducing health inequalities in the role, while Sara has pledged to fight for members’ voices to be heard. I hope that the Minister might find the time to meet these two inspiring women. I am sure that she will find such a meeting productive and helpful in preparing a much-needed clear plan to improve health visiting numbers and the quality of care provided for children and families.

Community Pharmacies

Liz McInnes Excerpts

Wednesday 2nd October 2019 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Sir David. I thank my hon. Friend the Member for Halifax (Holly Lynch) for securing this important and pertinent debate and for giving me an opportunity to raise an issue of great concern to residents of Heywood and Middleton.

We know that community pharmacies have struggled with the funding cuts that the Government have introduced since October 2016. As my hon. Friend pointed out, figures compiled in March by the Pharmaceutical Services Negotiating Committee show that 233 community pharmacies in England have had to close since those cuts were introduced. Evidence from local pharmaceutical committees across England supports the picture of community pharmacies struggling financially. Independents are being hit the hardest and have been forced to cut hours or staff as a result.

A consequence of that was highlighted to me last week by my constituent Karen, who told me that her local independent community pharmacy was to start charging £5 for the home delivery of medicines. As my hon. Friend said, the same measure has already been adopted by the four multiples: LloydsPharmacy, Rowlands, Well and—the latest to join—Boots, which recently announced that it would charge a one-off fee of £5 or a 12-month subscription fee of £55 for delivery of prescriptions ordered in branch.

The actions of those multiples seem to be having a knock-on effect on our local independent community pharmacies as they struggle to cope with year-on-year funding cuts. With the cost of a prescription now at £9, the additional charge bumps up the total cost to a hefty £14 for those who pay for their prescriptions and makes an absolute mockery of free prescriptions for those who qualify. If someone is on free prescriptions but cannot get to their local pharmacy because of illness or disability, the delivery charge means that their prescription is no longer free.

As a result of these decisions, some of the most vulnerable people in our communities will suffer, including many who rely on the delivery service to access much-needed and essential medication. Sadly, many people in our communities suffer from chronic loneliness and simply do not have the social contacts to ask someone to collect their medicine for them. I would be interested to hear the views of the hon. Member for Eastleigh (Mims Davies), the Minister for loneliness, on this draconian measure; I will write to her after this debate, when I hope I will have received some response from the Minister who is present.

I urge the Minister to look carefully and seriously at this really important issue, which appears to be a growing problem. The Association of Independent Multiple Pharmacies says that continuing challenges to pharmacy funding are not helping the situation, with the five-year funding cap not covering

“inflation, volume increases and national minimum wage increases.”

The five-year period will be increasingly painful for many pharmacy businesses already under heavy financial pressure. It is only to be expected that many pharmacies will reassess all their existing costs, including the costs of services that they currently deliver for free. The financial model is simply unsustainable for the next five years. I ask the Minister to think about the impact that the changes will have on vulnerable, lonely and housebound people, and to consider approaching the Chancellor to request funding for this vital service and bring an end to this tax on the sick.

--- Later in debate ---

[Jo Churchill]

As I said, there is no one size that fits all. As the hon. Lady articulated in her speech, the difficulty is that we are not looking at a system where businesses are run on the same scale model. At any one point, there are single pharmacists. She stated that the pharmacy she visited was part of a seven-strong business. Then there are the multiples. We need to look at what is the best scheme. However, I would argue that independents have a much higher footfall from their local population, because they are more trusted than many of the multiple pharmacies due to the continuity that comes from their having been in their communities for longer. There are opportunities there for independents.

We know we will need to design new ways of working to make a success of this, and we will need patients to be confident in how they use the services. The enhanced role for community pharmacy will support patients in getting access to help where required and in using the NHS in the best possible way. When people are suffering from minor conditions such as earaches or sore throats and need health advice, we want them to think “Pharmacy First”.

We want to build on that, with other parts of the NHS proactively signposting to local pharmacists. We want everyone to recognise the high-level skills held by pharmacists and to get people to understand that we need them as a first-line service to go to. That will grow trust in the system and spread the load. We will, of course, need to reform the way we work to free up pharmacists’ time so that they are able to deliver these new services.

[Liz McInnes]

I am sorry to interrupt, but the Minister has not referred to delivery times yet, and we have only two and a half minutes to go. Will she mention what she is going to do about those?

[Jo Churchill]

I thank the hon. Lady, but I would like to push through and to come on to the supply of medicines, which the hon. Member for Halifax spent much of her speech discussing.

We must recognise that we need to work in partnership and that this is not only about treating ill health. One of the first services to come online under the new arrangements will be the community pharmacist consultation service, which will start on 29 October. It will establish the first ever national triage system, which will look at community pharmacies referring patients into pharmacy directly from NHS 111 for minor illnesses, wellbeing support and self-care advice, as well as urgent problems. It is important that everybody involved makes this work a success, because we want this to be a two-way process. Over the next five years, we want to include referrals from GPs, urgent treatment centres and NHS Online, but we want to do that based on evidence, sensibly and in collaboration with those in the sector. Registration opened only last month, and more than 2,000 pharmacies have been signed up.

Additionally, by 2020, being a level 1 healthy living pharmacy is expected to be an essential requirement, so that pharmacies can give advice. Integration across primary care is hugely important; the new contractual framework is about not moving minor illness, but about using the whole system better. Community pharmacies are a vital part of the picture if we want to think “Pharmacy First”.

Coming on to the question of medicine supply and shortages, I appreciate the issues that the hon. Member for Halifax mentioned, but, as recognised in last week’s National Audit Office report, we have done an enormous amount in collaboration with pharmaceutical and medical device companies. There are always ongoing shortages, but the Department works all the time to ensure that they are mitigated and that a proper supply of medicine can be got to people. With the issues of Brexit, we know that that is doubly important, and that is what the Department has been doubling down on.

Health Infrastructure Plan

Liz McInnes Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

Again, I am happy to welcome the positivity from my hon. Friend and the welcome for this money; the welcome for this massive additional investment into our NHS has been clear on the Conservative Benches. I am, of course, happy to give him the commitment that he wishes, which is to work with him and his colleagues to make sure that his constituents continue to get the healthcare that they need.

[Liz McInnes (Heywood and Middleton) (Lab)]

The King’s Fund has commented on the recent announcements:

“these piecemeal announcements are not the same as having a proper, multi-year capital funding plan.”

So could the Minister clarify by what criteria these schemes have been selected, and what are his spending plans for the long term to repair our crumbling NHS?

Decriminalisation of Abortion

Liz McInnes Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Jackie Doyle-Price]

That is a difficult question to answer given that the matter is now completely devolved. In respect of England and Wales, I think that the most effective method would be to revisit the Abortion Act, which is itself an amendment to the Offences Against the Person Act providing an exemption for women making that choice in those circumstances. My personal view—the Government do not have a view on such matters of conscience—is that, after 50 years, the Abortion Act does not reflect medical practice today, and therefore restricts the choices of women and their ability to exercise those choices in the safest way.

[Liz McInnes (Heywood and Middleton) (Lab)]

Other jurisdictions in Canada and Australia have already removed abortion from the criminal law without any increase in the rate of abortion or in late terminations. The Minister cloaks the issue in words such as “emotive” and “sensitive”, but this is actually a legal issue, and women in England and Wales deserve the same protection now afforded to women in Northern Ireland. Given that this is a legal issue, when will we get an answer from the Home Office, rather than the buck being passed to the Health Minister?

[Jackie Doyle-Price]

At the risk of being flippant, obviously I can only relay the policy given to me by the Home Office. I can give the hon. Lady my views on how we best keep patients safe, but clearly, when it comes down to it, how Parliament decides to manage such issues is a matter for Parliament; the Government and I as a Minister will do as instructed.

Non-invasive Precision Cancer Therapies

Liz McInnes Excerpts

Thursday 18th July 2019 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Rhondda (Chris Bryant) and all the speakers in the debate, especially my brave hon. Friend the Member for Blackburn (Kate Hollern). I also thank my hon. Friend the Member for Easington (Grahame Morris) and the hon. Member for Westmorland and Lonsdale (Tim Farron) for securing this debate on this very important subject.

Last week, I visited Cancer Research UK’s event in Parliament to raise awareness of issues around cancer. The one message that I came away with is that cancer treatment is being seriously affected by a lack of diagnostic and radiotherapy staff and equipment. In June this year, the Public Accounts Committee said that the ongoing failure of many hospitals to meet targets for cancer and elective care is unacceptable and called on officials to be more accountable for improving standards.

The Royal College of Radiologists welcomed the main thrust of that report on waiting times in England, which clearly urged increased involvement and oversight from healthcare leaders in NHS England, NHS Improvement and the Department of Health and Social Care to improve waiting times and safeguard the future care of patients. The Society of Radiographers also supports the call for a workforce increase and for investment in equipment and infrastructure to improve connectivity across radiotherapy networks. Although acknowledging that fantastic care is delivered by all professionals across the patient pathway, it highlighted a comprehensive survey on clinical staff across the country, which identified current staff shortages as a barrier to providing effective and efficient cancer treatments and excellent patient experience. It identified many problems, including missed opportunities for service improvement; insufficient capacity to undertake clinical research; the downgrading of patient experience; competition for scarce staff numbers in the local labour market; and decreased staff wellbeing and morale. There is also a great deal of concern about the impact of the loss of the bursary on staff recruitment and retention.

A recent report by the department of allied health professions at Sheffield Hallam University said that recruitment to therapeutic radiography programmes in the UK has been problematic for several years, but that this appears to have been exacerbated since the 2017 changes in healthcare education funding from bursaries to the standard student loan system for both fees and maintenance. In 2018, several programmes confirmed that they had not recruited to target, and most had needed to go into clearing to recruit students close to the start date of the course. The general trend appears to be a decline in applications, with the added problem of places being awarded at the clearing stage, which poses a risk that students may embark on courses to which they later find they are unsuited, increasing the risk of students dropping out of their courses. If I have just one ask of the Minister, it is that she commission a full assessment of the impact on allied health professionals of the replacement of bursaries with loans. These skilled, dedicated and highly qualified staff are the unseen backbone of our NHS, and it is vital that patient care does not suffer because of these changes.

In summary, plans to transform radiotherapy provision and the NHS 10-year plan more broadly must be backed with a long-term cancer workforce plan and associated investment. Without this, the NHS and the Government will simply not be able to fulfil their commitment to patients.

Genetic Haemochromatosis

Liz McInnes Excerpts

Wednesday 3rd July 2019 Westminster Hall

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Sharma. I am grateful to the hon. Member for Rugby (Mark Pawsey), the chair of the all-party parliamentary group for genetic haemochromatosis, for having brought this debate before the House. It is an important subject; I asked for a debate on it earlier this year following the release of the University of Exeter’s research, which showed that this condition was 20 times more common than was previously thought, so I am pleased that the hon. Gentleman has secured this debate. I am also grateful to the charity Haemochromatosis UK, which is based in his constituency and whose website contains a wealth of useful information.

The hon. Gentleman has given a comprehensive opening speech, showing his understanding and knowledge of this condition, so I do not need to repeat it. Instead, I will talk about the research that was published this year and its implications. As we have heard, haemochromatosis is thought to be the UK’s most common genetic disorder and is inherited in a recessive manner, linked to a faulty gene passed from both parents to their child. It was previously believed to seriously affect about one in 100 carriers, but the new research has suggested that the true level could be closer to one in 10 among women, and one in five for men.

Researchers at the University of Exeter analysed data from 2,890 people from the UK Biobank who had the specific mutation to which the hon. Gentleman referred. The research was conducted on subjects aged between 40 and 70, so the point he made about that research being limited in its age range was a good one. In the light of those findings, the UK National Screening Committee has said that it will look at the evidence on screening for haemochromatosis in 2019-20, as part of its routine three-yearly review. I would be interested to hear the Minister’s comments about that.

The lead researcher, Professor David Melzer of the University of Exeter, has said that haemochromatosis is easy to treat if diagnosed early enough, which I think is the key point of this debate. However, the hon. Member for Rugby has observed that haemochromatosis can be difficult to spot, which is also a pertinent point. A lot of the symptoms can be very non-specific, and it is not a condition that is uppermost in the minds of general practitioners, which is why we are now considering routine screening. As we have heard, the treatment is relatively simple and involves regular venesection, or bloodletting. As the body makes more blood to replace that which is taken, it uses up the excess stored iron. That treatment, if started early enough, can avoid the complications of haemochromatosis that we have already referred to—liver failure, diabetes, chronic pain and severe arthritis—developing later in life.

I will illustrate the effect of having a diagnosis of haemochromatosis later in life by telling the story of my constituent, Paul Dicken. Paul has given me permission to use him as a case history, and I think his story will strike a chord with many haemochromatosis sufferers. He was diagnosed only this year after years of suffering from symptoms including liver, joint and stomach problems, for which he has been taking multiple painkillers over the years. Since his diagnosis, he has been having venesection, but he tells me that he now suffers from lethargy due to the frequency of venesection, no energy, muscle loss and joint pain. He has said that his depression is hitting a new low and, regarding his eventual diagnosis, has said that

“I was being asked for a long time if I had a drink problem because of my liver problems…but I don’t drink and the haemochromatosis was only discovered because the doctor was worried about my white blood cells being high.”

Paul’s case is a clear example of how raising awareness of the disease among GPs and medical professionals might have helped him get an earlier diagnosis and spared him some of the painful symptoms and possibly inappropriate treatment he had. I am grateful to him for allowing me to tell his story. Testing for iron overload is simple and GPs should be aware of the transferrin saturation test, where a result of greater than 50% indicates a risk of iron accumulation. If such a result is found, the patient should be referred to secondary care for further tests.

[Bob Stewart]

From what I have heard today, which is the entire encyclopaedia of my knowledge, it seems to me that we could cover the issue pretty well if every blood test included a check, because most people have blood tests at some stage—that happens fairly often these days.

[Liz McInnes]

I thank the hon. Gentleman for making that point, but I issue a caveat about blanket screening: it has to be proven to be clinically effective and it must not throw up false positives and false negatives. The tests are fairly specific for haemochromatosis, but they will have to go through an evaluation process, as I am sure the Minister will inform us when she makes her closing remarks.

At this stage, I want to mention the biomedical scientists and clinical scientists working in our NHS pathology labs. Those often unsung heroes of the NHS are the people who will be performing the tests. Indeed, that was my profession before I was elected as the MP for Heywood and Middleton.

In closing, I want to say that it is important to discuss with any patient diagnosed with genetic haemochromatosis the desirability of genetic testing for other members of the family, as there is at least a one in four chance that a sibling will also have haemochromatosis. Family checks frequently lead to the detection of haemochromatosis before organ damage has occurred. That is important.

It is important we are having this debate. Early diagnosis will help save lives, help cut costs for the NHS and reduce unnecessary suffering for so many individuals, such as my constituent Paul, and families around the UK.

Interim NHS People Plan

Liz McInnes Excerpts

Wednesday 5th June 2019 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

Despite the vital role played by carers in society, they merit just a paragraph in the plan. Will the Minister ensure that his Department matches Labour’s commitment to publish a full strategy for carers and to increase carer’s allowance to the same rate as jobseeker’s allowance?

[Stephen Hammond]

I welcome Labour’s commitment to publish a paper, but the hon. Lady will know that the Department is going to publish a Green Paper on adult social care. We are finalising that. [Interruption.] The hon. Member for Leicester South (Jonathan Ashworth) shouts at me. I know he makes a lot of promises without detail. We want to make promises that have detail and can work.

Health

Liz McInnes Excerpts

Tuesday 14th May 2019 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Swansea West (Geraint Davies). I want to talk about the impact of public health grant cuts on Rochdale Borough Council, which serves both my constituency and the Rochdale constituency. Reductions in the public health grant will inevitably have an impact on a wide range of services and on the ability to plan and deliver prevention. The Rochdale borough public health team takes a broad view of health and wellbeing, seeing it as being influenced by health behaviours, wider determinants of health, such as housing and education, and relationships with others.

Local public health work is about much more than health promotion and telling people what is good and bad for them. It includes support for youth services and libraries and for victims of domestic abuse. It involves training to help to prevent suicide, support for volunteering, and reducing the impact of alcohol and drug abuse.

The work of the public health team also includes supporting people in residential homes to improve their oral health and nutrition. It includes seeking funding from grant-giving bodies to improve local health. Importantly, the work involves helping to reduce the spread of sexually transmitted diseases. However, as we have heard, cuts to sexual health services are leading to an increase in the incidence of sexually transmitted diseases. In Greater Manchester as a whole, the abortion rate is rising as access to sexual health services and contraceptive help and advice diminishes.

The work of the public health team also includes providing direct input into NHS commissioning and providing essential support for NHS services. For example, while the NHS provides cancer screening, it is work within our communities that helps to get people to attend appointments. The public health team works to increase attendance at NHS health checks and to get people tested for diabetes, which can result in lifestyle changes and real savings in treatment costs. With Heywood, Middleton and Rochdale having one of the north-west’s highest rates of type 2 diabetes, the importance of this work cannot be overemphasised. The public health team works to reduce smoking, especially in poor communities and among people with long-term conditions. When NICE looks at such prevention work, it is always shown to be highly cost-effective.

To give an idea of the health challenges facing my community, a man or woman living here in Westminster can expect to live, on average, five and a half years longer than a man or woman living in the borough of Rochdale. Such health inequalities exist here in London, too. My hon. Friend the Member for Westminster North (Ms Buck) tells me that for every tube station from here to Queen’s Park there is a year’s reduction in life expectancy.

Yet such health inequalities are not compensated for by increased funding. In the borough of Rochdale, the public health grant is now £3 million lower than it was in 2016-17—decreasing from £19.7 million then to £16.7 million in 2018-19. For this financial year, 2019-20, the budget has been cut yet again to £16.3 million, giving cumulative cuts over the past four years of over £8 million. That has led to cuts in support to HIV charities, children’s playgroups, physical activity events, pest control, smoking cessation services and other much-needed vital services.

A reduction in the public health grant has to be considered in the context of wider council savings and the contribution of public health. As cuts to services and support have to be made due to a reduction in funding, the inevitable result is additional hardship for residents.

The choices we face are stark. Do we stop support for a necessary service such as help for domestic abuse victims, or do we not recruit much-needed staff? With the shocking news that we are seeing the return of diseases of the Victorian era—cases of whooping cough, malnutrition and scarlet fever are all increasing—this Government cannot be complacent and must take another look at their false economy of cutting public health funding.

NICE Appraisals: Rare Diseases Treatments

Liz McInnes Excerpts

Thursday 21st March 2019 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to contribute to this important debate. I thank my hon. Friends the Members for Blaydon (Liz Twist) and for North Tyneside (Mary Glindon) for obtaining this debate, and the Backbench Business Committee for granting it.

Before I was elected to this House I worked for more than 30 years as a clinical scientist in our NHS. During that time, I developed a healthy scepticism for politicians advising on medical treatments, as it is a field that is best left to clinicians. However, I did want to take part in this particular debate because I know that issues around the availability of life-saving drugs and treatments for rare diseases are important to many people. My constituents have made me particularly aware of the unavailability of Orkambi to cystic fibrosis sufferers and of Kuvan to those affected by phenylketonuria.

Today’s debate is also extremely valuable because it focuses on the way NICE operates and questions whether that operation is appropriate for those suffering from rare diseases. A rare disease is generally defined as one affecting fewer than five people in 10,000, but many people are affected by rare conditions. The UK strategy for rare diseases estimates that, in the UK alone, more than 3 million people will suffer from a rare disease at some point in their life.

Given, however, that relatively few people are affected by a particular rare disease, there are specific challenges in ensuring speedy diagnoses and access to appropriate services and treatments. NICE’s technology appraisal process involves looking at evidence from clinical trials and peer-reviewed research showing how well a medicine or treatment works, including its likely impact on mortality and quality of life; at the economic evidence of how much it costs the NHS; and at the views of clinicians, patients and other stakeholders.

As well as looking at the clinical effectiveness of a treatment, single technology appraisals and highly specialised technology evaluations also assess its cost effectiveness, which, as many speakers have said, is usually measured in terms of the cost per additional quality-adjusted life year, and this is assessed by looking at how many extra months or years of life of a reasonable quality a person might gain as a result of treatment.

Following changes introduced in April 2017, NICE set a maximum additional quality-adjusted life year threshold of £300,000 for highly specialised treatments. Under that threshold, they would automatically be approved for routine commissioning. This is 10 times higher than the standard NICE threshold of £30,000 for non-specialised treatments. Owing to the nature of lifelong genetic diseases, however, the required quality of life improvements are likely to be unobtainable. The charity Genetic Alliance UK highlights that no ultra-orphan treatments—drugs used to treat extremely rare diseases—currently used by the NHS would pass this test.

It is clear that an urgent rethink is needed on these policies, which are focused almost exclusively on price, to the detriment of patient outcomes. Genetic Alliance UK has argued that these policies will halt future access to innovative treatments for rare genetic conditions in England and that they contrast with the stated aim of the UK strategy for rare diseases to ensure appropriate procedures for evaluating the costs and benefits of treatment for patients.

The problem with the current NICE appraisal process is that certain treatments, particularly those designated as orphan medicines, are neither eligible under the narrow criteria of the highly specialised technology process nor appropriate for the single technology appraisal process. The reason could be that the treatment’s patient population is marginally higher than the maximum size considered through the highly specialised technology process, while the single technology appraisal process is inappropriate for most orphan drugs because of limited trial data.

The accelerated access review, which aims to speed up access to innovative drugs, devices and diagnostics for NHS patients, recommends that NICE undertake a review of its methods and processes to ensure that they are fit for purpose, which I think everyone in the Chamber would agree is long overdue. The review warns that

“it is important that no groups of products can ‘fall between the cracks’ and struggle to find a decision-making process”.

We have heard heartfelt speeches today from my hon. Friends that have illustrated that some products are falling through the cracks and that families and young children are suffering.

The views of the accelerated access review are in line with those of the NHS five year forward view, which includes a recognition of a broad measure of value that goes beyond price alone. I have combed through the latest NHS long-term plan, and I cannot find any reference to this important issue. When the Minister responds, I would be grateful if he pointed out to me where the issue is mentioned in the most recent iteration of the plan.

NHS England and NICE need to reconsider how they account for rarity in their assessment process to support the NHS in its mission to provide a comprehensive service that is available to all at the point of need, including to those with rare conditions.