Organ Donation (Deemed Consent) Bill

Liz McInnes Excerpts

2nd reading: House of Commons
Friday 23rd February 2018 Commons Chamber

[Mr Robinson]

The whole House will be touched by the constituency case that my right hon. Friend raises, and it will wholly agree with what she says about the need to increase the availability of organs. We believe in a system that everybody is part of unless they choose to opt out. I have made it clear that the opt-out procedure would be simple and that we would respect those who choose to do so. If we can get the Bill through, it will not make an immediate difference tomorrow, but I am sure that over a period of years, as the activity rates and our capacity to handle donations successfully increase, the availability of organs donated will also increase. That is why I am so keen to get the Bill through Second Reading today.

Since those early successes, some 50,000 people in the UK have been given a second chance and a new lease of life, thanks to organ donation. I am sure that the whole House will join me in expressing the gratitude that we all feel to the NHS for that. Even if our history is a proud one, we cannot rest on our laurels. Unaccountably, over the past few years, the steady increase in the rate for donation and transplantation has slowed. In the past four years, to be more precise, it has in effect plateaued in England.

Against that background, there has been growing concern about the fact that a certain amount of inertia is setting in. The most recent figures for the whole United Kingdom make disquieting reading. As of March 2017, 6,388 patients were registered on the active waiting list for a transplant; in the same year, 457 died while on the active waiting list. Perhaps more significantly, over the same period, 857 people died after being removed from the active waiting list because while on it they had become too ill to receive a transplant. That shows how severe the situation is.

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

I congratulate my hon. Friend on the Bill, which I support. Many of my constituents have contacted me about children who have died for want of a suitable organ donor. I wonder whether my hon. Friend will explain at some point how the Bill will benefit children who need an organ donor.

Medicines and Medical Devices Safety Review

Liz McInnes Excerpts

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

I wish it was easy to give the hon. Gentleman a straightforward answer, but the truth is that there is much scientific disagreement about whether there is a causal link, which makes it difficult to give clear answers to his constituents and, indeed, to mine. I hope that the review will shed some clarity on the situation, because that is what many people want.

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

What advice has the Secretary of State sought from the Royal College of Midwives, the Royal College of Obstetricians and Gynaecologists and the Royal College of Pathologists? What involvement will those bodies have in the review?

[Mr Hunt]

Baroness Cumberlege has honorary fellowships at the Royal College of Nursing and the Royal College of Physicians, so she is well connected with all the organisations that the hon. Lady mentioned.

Hospital Car Parking Charges

Liz McInnes Excerpts

Thursday 1st February 2018 Commons Chamber

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

It is a pleasure to speak in this debate and to follow the right hon. Member for Hemel Hempstead (Sir Mike Penning). Much of what he said echoes the complaints that have come to my constituency office.

I thank the right hon. Member for Harlow (Robert Halfon) for securing this debate. This subject is close to my heart because I used to work for the NHS. I well remember when car parking charges were introduced for patients, carers, visitors and staff. I remember the controversy it caused at the time, and it still causes controversy now. This issue has not gone away.

I worked for the NHS as a clinical scientist, but I was also a workplace rep for Unite, the trade union. I remember the resistance that all the health unions put up against the introduction of car parking charges, which we saw then, and still see now, as a tax on staff coming to work and on patients, visitors and carers.

The practice of charging for car parking in my area was started by Central Manchester University Hospitals NHS Foundation Trust, and the issue of people using the free parking at the hospital and then going elsewhere was the reason for introducing those charges, but once Central Manchester University Hospitals did that, all the other hospitals in Greater Manchester followed suit.

The only reason anyone would go to North Manchester General Hospital, where I worked, is because they work there, because they are getting treatment there or because they are visiting as a friend, a relative or a carer. There is no other reason for someone to visit that hospital, so there was no real reason to start charging people to park there.

The trust claimed that the moneys taken would be put towards improving the car parking facilities, which I admit were absolutely dire. We used to park on unsurfaced, potholed areas, which were eventually improved once the charging system became embedded—that is one positive thing that came out of it.

The trust initially purchased some wheel clamps and threatened to clamp the car of those who did not pay. I worked with some interesting people in the NHS, and one colleague decided to buy his own personal wheel clamp, which he attached to his car when he parked in the morning. The hospital is not in the most salubrious of areas, so the clamp served two purposes: it immobilised his car and kept it secure; and it gave the impression that he had been penalised for not paying to park. Within a few weeks his wheel clamp had paid for itself.

Not everyone was that inventive, however, and gradually the idea of paying to park at the hospital became commonplace, if not accepted, although the trade unions always strongly opposed the practice. The wheel clamps were quickly phased out—rumour had it that the trust had been successfully sued, although we never found out the full facts—and the trust began to impose fines on those deemed to have breached the rules.

The whole issue of car parking fees and fines generated a huge amount of controversy, discussion and debate, not to mention a huge number of visits, phone calls and emails to the trade union office. Anyone who might question the need to give trade union reps facility time to do their job might like to reflect on the massive pressure put upon them by issues such as this. When I left the trust, having been elected to this place, I was paying £20 per month in car parking charges, which was taken directly out of my salary. That staff fee is now £22.10, which might not sound a lot, but represents an increase of more than 10% over the past three years. That pays scant regard to the fact that NHS staff have had their pay either frozen or capped to a maximum of just 1%—this is completely disproportionate.

As an MP, I have helped many constituents who were sent demands for car parking fines by a company called Civil Enforcement Ltd, which is contracted by my local Pennine Acute Hospitals NHS Trust to pursue those deemed to have breached car parking regulations. I have had constituents aggressively chased for payment when they have parked in a staff parking space by mistake, and the practices of this company do seem to lack the human touch. Most people attending hospital usually have more important matters on their mind and could be forgiven for being slightly distracted while trying to work the myriad instructions posted in a hospital car park prior to visiting sick relatives or going for treatment themselves.

The charges can be prohibitive: £1 for one hour, £4 for 8 hours and £8 for up to 24 hours. As many Members have pointed out, most of the time the patient or visitor does not know how long they will be in the hospital for, so most will err on the side of caution and pay more than they should. The ticket machines also do not take banknotes. When I worked at the hospital, I was regularly asked for change by patients and visitors struggling to feed the machines. I am sure that all those people had more important things to deal with and could have done without that additional stress. I accept that my local trust will provide a weekly ticket for £15 and will make arrangements for those with long-term illness, but that is not immediately clear to patients and visitors, and it requires action on their part at an already stressful time.

The motion calls on the Government to provide a means whereby car parking charges may be abolished and I fully support that, but hand in hand with that has to go an improved public transport system, so that staff, patients, carers and visitors are not as reliant on private cars. Sadly, in my constituency, we have just had a bus service between Rochdale, Middleton and North Manchester General Hospital withdrawn. Retrograde steps such as that do nothing to reduce the demand on hospital car parks, and we absolutely need a comprehensive public transport policy to support the abolition of hospital car parking charges.

The other step we need to take is to reduce NHS trusts’ dependence on income from car parking. Department of Health guidelines used to stipulate that income earned from car parking should be spent only on the maintenance and running of car parks, but those guidelines now appear to have been relaxed, and cash-strapped trusts are now using that income for patient care. In fact, when I visited North Manchester General Hospital recently I was disappointed to see that a staff car park that had been in a very poor state when I worked there many years ago had been allowed to deteriorate even further. Clearly, no income had been spent there on improving conditions for staff. The Pennine Acute Hospitals NHS Trust alone made £3 million from car parking charges last year. The NHS underfunding issue must be addressed in any consideration of the abolition of car parking charges.

North West Ambulance Service

Liz McInnes Excerpts

Monday 22nd January 2018 Commons Chamber

[Tony Lloyd]

Absolutely. If this is one of the skill shortages at the crisis end of our health service, let us begin to use the paramedics much more intelligently than we do now. The Minister will be delighted to know that I will come on to money, but this is not about money; it is about intelligence. I am bemused by the incompetence of the management of the North West Ambulance Service, who do not seem able to give me even semi-credible answers to this crisis. Ministers now need to seize the opportunity—and possibly even seize the throats of those who manage the process—to make them begin to deliver.

Nothing I have said tonight is meant in anything other than absolute admiration for the people who are in our ambulances, trying to make the service work. They live very stressful lives. The Minister will know that across the country—the north-west is as bad as many places—the amount of down time because of paramedics and ambulance technicians being off work from stress-related sickness is high and growing. That is symptomatic of a system going terribly wrong. Let us reform it. Let us make sure that we put the quality of life back into their jobs, so that they can put the quality of life back into those they care for.

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

My hon. Friend and I share the same area, covered by the Pennine Acute Hospitals NHS Trust, and we have very similar experiences. I used to work at the North Manchester General Hospital and at the Royal Oldham Hospital, and I am well aware of the issues. Is he aware of the latest Care Quality Commission report, which was published last year, on the North West Ambulance Service? It identified safety and leadership as “requiring improvement”. From the story that he is telling, it sounds as though those two issues have not been addressed, and that report was produced a year ago.

[Tony Lloyd]

My hon. Friend makes a really interesting point. The Minister needs to look seriously at the consequences of that kind of report. I have looked at different aspects of this issue over a number of years. I find leadership mainly in its absence. Safety is more difficult for me to comment on, except that if we have such high sickness rates among the staff, it very much indicates that the working environment is not safe for the people we want to work there.

My final point to the Minister is that we have a shortage of paramedics nationwide. As I said, we have had an uplift of something like 50% in the most critical cases in the north-west and an increase of some 16% in the number of paramedics. We are simply not keeping pace. Of course this is about money, but we have to put the resources into that kind of training. However, training is between two and four years. The Minister has to look at whether there is something in the intelligent transfer of people in the health service who already have the equivalent skills. With the right kind of incentive, they may be prepared to move across from different occupations in the health service to the paramedic and ambulance service. However, they will only do that if they believe there is a quality of job that would allow them to enjoy their work, as they are entitled to.

We have a crisis that is putting people at risk, whether that is in the east of England or in the north-west, as I and my hon. Friends the Members for Heywood and Middleton (Liz McInnes) and for West Lancashire (Rosie Cooper) have said. It is dangerous and in the case of my constituent, Pat Gerner, it is unacceptable for an elderly lady, needing to be in hospice care, to be treated in the way that she has. I look to the Minister to give not simply sympathy, but some credible belief that he will seize the day and make sure that we have the quality and determination to drive through the kind of management change that will make a difference. As well as that, he has to say to his colleagues in the Treasury that we need to see some transfer of resource into our ambulance service, if we are not going to face this crisis not simply in the winter, but every day of every week of the year.

NHS Winter Crisis

Liz McInnes Excerpts

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

Clinical commissioning groups have a responsibility to provide cover in every area, so if a practice does close, it is up to the CCG to ensure alternative provision. That responsibility is part of the NHS mandate and remains with it.

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

Pennine Acute Hospitals NHS Trust, which serves my constituency, has advised the public to attend A&E for serious or life-threatening conditions only and the rest to visit the local pharmacist or call 111. What immediate help will the Minister give to community pharmacies and the 111 helpline to help them to cope with the increased demand?

Oral Answers to Questions

Liz McInnes Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Speaker]

Order. Members can ask questions consisting of no more than one sentence each.

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

What funds are being made available to our mental health services to meet the additional demands placed on them by changes in the Mental Health Act 1983, which came into force on 11 December this year?

[Mr Hunt]

I can reassure the hon. Lady that we are putting a lot of extra funding into mental health— £575 million last year alone—to meet those and other obligations.

Social Care

Liz McInnes Excerpts

Thursday 7th December 2017 Commons Chamber

[Jackie Doyle-Price]

In a nutshell, my right hon. Friend has neatly summarised one of the debates we need to have in this area, which is how we can ensure that people obtain care when they need it and have it paid for, while at the same time achieving intergenerational fairness. I hope he engages fully in the debate on the Green Paper when it comes out. That is exactly that kind of thing we need to discuss to inform the public about the challenges and encourage everyone to think about how to plan for their long-term care needs.

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

The leader of Rochdale Borough Council says that he needs about £20 million to meet growing demands on the adult care service. Given that social care was not mentioned in the Budget, will the Minister give the leader of my council some advice about where to find that £20 million?

[Jackie Doyle-Price]

As the hon. Lady knows, we have made an additional £9.25 billion available to local authorities, and they are now able to raise more through the social care precept. Some local authorities are very creative and imaginative in how they tackle that need, and we have increased the money available through the disabled facilities grant. That is taking a lot of demand out of the system, not least because it enables people to live independently at home without the need for care support, because of the extent to which it reduces falls. I encourage the hon. Lady to look not just at money, but at what else local authorities can do better.

Hormone Pregnancy Tests

Liz McInnes Excerpts

Thursday 16th November 2017 Commons Chamber

[Steve Brine]

With respect, I do not think I am struggling at all; I am just setting out a very clear position. Ministers are confident in the report and the review process. I say again that this was a comprehensive independent scientific review of all available evidence by experts across the expert working group who have a broad range of specialisms.

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

It is my understanding that in the research on fish, the researcher was reluctant to submit the findings because they had not been peer-reviewed. Is the Minister confident that all the animal studies that were considered in this review were properly and adequately peer-reviewed?

Oral Answers to Questions

Liz McInnes Excerpts

Tuesday 14th November 2017 Commons Chamber

[Steve Brine]

Consistency personified, Mr Speaker. It is the responsibility of local NHS organisations to make decisions on the commissioning and funding of any healthcare treatments for NHS patients, such as and including homoeopathy. Complementary and alternative medicine treatments can, in principle, feature in a range of services offered by local NHS organisations, including general practitioners.

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

What safeguards will the Secretary of State put in place to ensure that NHS trusts do not finance the lifting of the pay cap by making staff cuts, downgrading roles or reducing terms and conditions under the guise of reforms?

[Mr Hunt]

NHS trusts are under pressure to make very ambitious efficiency savings anyway. We have listened carefully to their case that they would not be able to make further efficiency savings to finance an increase in pay beyond the 1% cap.

Valproate and Foetal Anticonvulsant Syndrome

Liz McInnes Excerpts

Thursday 19th October 2017 Commons Chamber

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

I am pleased that we are having this important debate, and I pay tribute to the right hon. Member for North Norfolk (Norman Lamb) for securing it and for setting out so clearly the issues involved.

My career before I was elected was as an NHS clinical scientist. Working in a biochemistry laboratory, I was very familiar with sodium valproate as part of the battery of anticonvulsant drugs for which we regularly tested patients to help their clinicians better monitor their treatment and ensure that their dosage was at the optimum level. Until I met Emma Murphy, however, and became aware of her campaign, I was not aware of what appeared to be a systematic failure to inform women of the potentially damaging effects of taking valproate during pregnancy.

Only after watching a television programme about foetal anticonvulsant syndrome did Emma herself became aware that her own children’s health problems were probably attributable to the anti-epileptic drugs she had taken while pregnant, which had been prescribed to her from the age of 12. Like everyone in the House, I pay tribute to Emma Murphy and Janet Williams for their great campaigning work.

The damage to the developing foetus is thought to be caused in the first trimester of pregnancy when the anti-epileptic drug crosses the placenta into the foetus, and the effects depend upon the dosage and the drug. Sodium valproate, or Epilim, is indicated in 80% of cases of foetal anticonvulsant syndrome. Experts such as Dr Peter Turnpenny, clinical geneticist at the Royal Devon and Exeter Hospital, say that Epilim may affect about 560 babies every year. He adds:

“About 10% of foetuses exposed to sodium valproate will have a major congenital malformation such as cleft palate. 12% are likely to be diagnosed with a neurodevelopmental disorder.”

Reports linking valproate to birth defects started to appear, most notably, in 1981, with a paper by H. Nau entitled “Valproic Acid and its Metabolites”. In 1983, the British Medical Journal published an article in which the Royal Liverpool Hospital cited two cases suggesting a link between birth defects and valproate taken during pregnancy. The American Journal of Medical Genetics cited seven cases in 1984 of children born with malformations to mothers taking valproate, and the Journal of Paediatrics cited 26 cases in 1986. The list goes on. It would appear that the evidence was steadily building up with the publication of more and more cases linking valproate to birth defects. The Committee on Safety of Medicines and the Medicines and Healthcare Products Regulatory Agency noted those reports, and, I hope, monitored the use of valproate, particularly during pregnancy.

[Dr Whitford]

We have heard about various scandals. In the case of Vioxx, which was mentioned by the hon. Member for Newport West (Paul Flynn), trials did not show a problem but real-world use did. Does the hon. Lady think that we need some kind of reform of the reporting system? There is something that we call a yellow card, and patients can now fill it in themselves, but many of them do not realise that. I feel that there is not enough “flagging up” when patients suspect that they are suffering from side-effects.

[Liz McInnes]

The hon. Lady is absolutely right. She and I are well aware of the yellow card system, because we have both worked in the NHS, but how many people out there know that they can report side-effects of drugs, or even suspected side-effects? We really have a job to do in conveying that message to the general public, and we also need people to collate the information and act on it.

A definitive paper stating that there was a clear link between valproate taken during pregnancy and birth defects was published in 1995. It was entitled “Foetal Valproate Syndrome”, and was written by geneticists at St Mary’s Hospital, Manchester. It is clear that the evidence has been building up for a long time, so why does it appear that women were not warned about the potential dangers of taking the drug in pregnancy?

[Fiona Bruce]

That 1995 report concluded that the “risk” of foetal valproate syndrome when babies were exposed to valproate was “significant”.

[Liz McInnes]

That was probably the first research paper to suggest that it was not just coincidence and that there was a causal relationship, which is why it is seen as definitive.

The pharmaceutical company Sanofi, which many Members have mentioned, has stated that it has kept in line with scientific knowledge when reporting side-effects in a foetus. However, from as early as 1983 the CSM and the MHRA reported the problems caused by taking sodium valproate in pregnancy, but did not insist that Sanofi issue warnings in the form of a patient information leaflet.

Even now, to this day, epilepsy charities report that women are not aware of the potential risks when taking the drug in pregnancy. A survey has shown—I know it has already been mentioned, but it does no harm to reinforce these findings—that 18% of women taking sodium valproate were not aware of the risks during pregnancy, and 28% said that they had not been informed of any risks. That is despite the production by the MHRA of a valproate toolkit designed to help healthcare professionals to talk to women with epilepsy about the risks of taking valproate during pregnancy.

[Norman Lamb]

The hon. Lady is making an incredibly valuable contribution to the debate. Does she agree that if it is clear during a period of time that the amount of a drug that is being prescribed is significantly more than the guidance suggests is appropriate, it is not acceptable for the drug company, the regulator and the Government simply to be passive and to allow that to continue? If we knew that this drug was being over-prescribed, which appears to be the case, why on earth was action not taken?

[Liz McInnes]

That is a very good point, and if we manage to establish an inquiry, it should look into the issue of over-prescribing.

I want to mention other agencies. The European Medicines Agency has also recommended a strengthening of measures to reduce the risk of harm to babies born to mothers taking valproate. Information from the House of Commons Library outlines a situation in France, which has already been referred to, with an estimate that between 425 and 450 children were affected by birth defects attributable to valproate from 2006 to 2014. The French Parliament this year voted to set aside €10 million for claims related to valproate. The Health Minister, Marisol Touraine, described this as a “starting point” and stated that compensation would ultimately be paid by those deemed responsible:

“I regret that Sanofi didn’t seek an amicable settlement as a matter of principle. I hope Sanofi will change its position.”

Sanofi had no comment to make on the Minister’s remark. A class action has also been brought by the French association for people affected by sodium valproate against Sanofi.

In the UK, in 2004 a class action was brought by a group of families under the Consumer Protection Act 1987, which was expected to go to trial in 2011, but the litigation was discontinued prior to this after the Legal Services Commission withdrew funding. It is disappointing that this Government have said that there are no current plans to introduce a compensation fund similar to that in France, and I urge them to reconsider.

I fully support the remedial steps outlined in the motion, including the call for an inquiry, and this Government must bring forward a care plan and financial assistance for the victims of this national scandal.