Rural Healthcare

Luke Evans Excerpts

Wednesday 12th October 2022 Westminster Hall

[Anne Marie Morris]

That is an exceptionally fine point. I have no issue with it because we have a similar problem in Devon. The solution is not just about more recruitment and doing things in the same way, because the people to be recruited do not exist. We need to look at doing things differently, by creating new career paths with shorter training periods and trying to train, so we can then recruit, locally. Generally, people will follow a career where they are trained. We need more rural training for doctors and nurses, and that training needs to be not in the local city, but in the rural areas. For example, in Plymouth we have a fine medical school— Peninsula Medical School—but the challenge is that the experience that the individual trainee doctors and nurses gain is not rural, and it needs to be.

[Dr Luke Evans (Bosworth) (Con)]

My hon. Friend is making a fine point. From my experience, there is an opportunity: young doctors who are becoming GPs tend to be between the ages of 27 and 35. At that time, most people are looking to set up their family, go to school and get married. If we extend some of the career opportunities by extending training in those areas, they are more likely to bed down roots and gain a skill to become a GPSI—a GP with a special interest—in those areas. Does she believe that is a formula that the Government should look at?

[Anne Marie Morris]

I absolutely agree, and it is an excellent suggestion. In a similar vein, when we are asking primary care networks and others to deal with the backlog, it is important that we try to give them much more freedom in how they address the problem. I talk to many of my local commissioners, and they say that they are having to make decisions that they know are right, even though they are not currently in the guidebook as best practice. We need to give them that trust to be able to do the right thing.

C is for care. Members will not be surprised to hear that the adult social care discharge fund, although welcome, is not going to be enough. The reality is that the bed count is often low in rural areas. In the south-west, we have the lowest bed count per head of population; I think it is the lowest in western Europe, although I am happy for the Minister to correct me. It seems to me that we used to be moving towards saying, just in time, “Let’s have care in the community.” However, because of the shortage of care in the community, and the lack of proper validation that it works other than whether people are readmitted, we need to put a halt to closing community hospitals and to look at how they can be used. Some could be repurposed. Perfection can often be the enemy of the good.

Teignmouth Community Hospital in my constituency is on the closure list, but to me that is not a wise decision. There are no nursing care homes in the area. Without that residential care, and without adequate care in the community, removing the only other source of beds is not the way to solve the backlog problem.

Procurement of Evusheld

Luke Evans Excerpts

Wednesday 12th October 2022 Westminster Hall

[Caroline Ansell (Eastbourne) (Con)]

rose—

[Dr Luke Evans (Bosworth) (Con)]

rose—

[Robert Jenrick]

I will make one further point, then I will come back to my hon. Friends. That does not mean that there is not a role for Ministers in interrogating the evidence, listening to the voices of those with the contrary view—both in the House and in the public domain—and ensuring that we get all the information that we need before we make informed decisions. That is the approach that I have tried to take in the three weeks in which I have been in post, and will take going forwards.

[Robert Jenrick]

I hopefully will answer as many of those points as I can in the time available. I will go to my hon. Friend the Member for Bosworth (Dr Evans) next, and then make some progress.

[Dr Luke Evans]

I entirely agree with the point about making sure that we have clinically robust evidence. We saw during covid with ivermectin how poor data influenced a debate that was sparked across the world. That said, one thing we do have control over is how quickly we look at the regulation. Is there anything that the Minister can do to speed up the decision making? That is within his gift.

[Robert Jenrick]

Yes, there is, and I hope I will be able to shed further light on that in my remarks, but given that there is relatively little time, sadly, for this debate, let me set out first the process that we have been through; I hope that that will give some comfort to those in the Chamber and listening to the debate that the issue has been handled in a very rigorous way.

Our regulator, the Medicines and Healthcare products Regulatory Agency, gave conditional marketing authorisation to Evusheld in March 2022, but—this is an important point to note—it did so noting a lack of data regarding how it responds to the omicron variant. The lack of supporting data has been noted by other respected regulatory authorities, including the European Medicines Agency and the Food and Drug Administration in the United States. Although the MHRA licenses drugs, the National Institute for Health and Care Excellence assesses the clinical and cost-effectiveness of them. The normal process would therefore be that NICE proceeds to investigate Evusheld, and that is happening as we speak. As the hon. Member for St Albans said, that process is due to conclude in April next year, but yesterday, I met NICE’s chief executive, Sam Roberts, to review her work and to seek reassurances that her work could proceed at a faster pace, and she has committed to reverting to me as soon as possible with a new timetable.

Elective Treatment

Luke Evans Excerpts

Tuesday 8th February 2022 Commons Chamber

[Sajid Javid]

I welcome the hon. Gentleman’s comments. With respect to life-saving tests and scans, including for cancer, the plan sets out a huge amount of new investment in diagnostic capacity. One area of investment is the new community diagnostic centres, some 69 of which have already opened across England in convenient places such as shopping malls and car parks, which people can access much more easily and get their results from much more quickly.

[Dr Luke Evans (Bosworth) (Con)]

I welcome the plan. I am most intrigued by the “my planned care” website, because one of the biggest problems for clinicians is that they spend a lot of time chasing admin. It is a great opportunity for pre-operative checks and for people to know where their follow-ups are. Will the Secretary of State look at expanding it to out-patient settings? People over the age of 80 may well have four, five or six specialists, so trying to keep track of their letters, of where they should be and of their appointments is really difficult.

During covid, 29 million people downloaded the NHS app and we had the fantastic covid dashboard, so we have seen what we can do with technology to help our patients and clinicians. Will the Secretary of State encourage the NHS to build on the measures that he is bringing forward to help with the backlog?

[Sajid Javid]

Yes. My hon. Friend is absolutely right to talk about the importance of technology in delivering world-class care. He will know that I have already announced that the parts of our health system that contribute to the best use of technology, NHSX and NHS Digital, will become part of the wider NHS so that we have a more joined-up strategy. “My planned care” will start as an online platform, but will move to an app-based service as soon as possible. My hon. Friend is right to talk about the importance of having something similar for out-patient care; we are already on it.

Public Health

Luke Evans Excerpts

Tuesday 14th December 2021 Commons Chamber

[Dr Luke Evans (Bosworth) (Con)]

The Secretary of State is absolutely right. I am overjoyed that boosters are the key to getting the country out of this issue. I have raised, over the past couple of weeks and last week in PMQs, the issue of the 15-minute wait post-Pfizer. I wonder if the Medicines and Healthcare products Regulatory Agency or the Joint Committee on Vaccination and Immunisation have come to a conclusion on that, because that would free up a huge amount of capacity when it comes to delivering the boosters?

[Sajid Javid]

My hon. Friend did raise that point yesterday. It is being looked at very urgently. I am sure he will agree that if it is done, it should be done in a safe way that our regulators are happy with. I can confidently say that I expect an urgent update later today as soon as I leave this Chamber.

--- Later in debate ---

[Dr Luke Evans (Bosworth) (Con)]

I applaud the Government for their massive scale-up and huge ambition in respect of the booster programme. It truly is the way out for our nation, and I commend them for their approach. Critics will argue about whether the target of the end of this month will be reached, but we must not listen to them. Their myopic political point scoring will be forgotten in the light of the fact that the Government are doing everything they can to get jabs into arms, because that is the way out. However, I accept that further measures are necessary.

The Government will have my support on both the mandating of face coverings and the change in isolation procedures. While masks are of course inconvenient, they are a relatively easy way of reducing the risk of not only covid, but other viruses such as flu. Let us not forget that the number of flu admissions places a huge amount of pressure on the NHS, so a reduction in both conditions—as evidenced—makes sense to me.

Those who argue about the nuance of settings for masks often miss the point. I have heard on numerous occasions, both in the Chamber and among the public, the question, “How does the virus know whether it is in a restaurant or a shop?” Of course the virus does not know, but that is not the point. The point is this: what are the easiest measures which, when applied to the population as a whole, will reduce the risk as far as possible? The Government have to balance that at mass levels. What measures can be implemented to reduce the risk of covid, while mitigating the instant economic and non- covid damage that could occur in vulnerable sectors such as hospitality? A change in the self-isolation procedure suggests itself. This is a difficult but fair balance.

Let me now say something about mandatory vaccinations for NHS workers. I spoke about the issue during a debate in the House on 13 July, and I am not going to rehash the entire argument; I urge anyone who wishes to look up my speech to do so. However, for me the argument still stands as it did then. It was based on the duty of care for those in positions of responsibility to the most vulnerable. That stands even more starkly today. One only undertakes that commitment in their decision to pursue this career and the precedent already exists. However, that argument must not be used as a slippery slope argument for mandatory covid vaccination for the general population. I was glad to hear the Health Secretary confirm that that would not be the case, because I do not believe that the House, or indeed most of the UK population, would accept that.

On the topic of slippery slopes, that leads me on to the final regulation—that of the lateral flow test and the covid pass exemptions for certain venues. I am against vaccine passports. I do not believe they are practical, moral, ethical or indeed evidence-based in a scientific rationale. The closest comparison we have is Scotland, and the Scottish Government’s 70-page report does not provide the evidence for passes. To introduce such a huge change in the health management of our nation requires a full and thorough debate and I do not believe it will be done justice tonight. I am so pleased that the Government have listened and added lateral flow tests as an alternative because at least that provides a choice, but I cannot support covid passes. I worry about the slippery slope. What businesses, what society interactions, what infections might come in scope in future months or years?

In closing, looking to the future, I said in the House on 16 June 2021 that what was most needed was a full debate on the risk that we as society are prepared to tolerate when it comes to covid for those vaccinated and for those unvaccinated who will never get vaccinated, and the trade-off between covid and non-covid health implications, health protection measures and our economy, society and liberty. I hope that the House will bring such a debate next year.

Covid-19 Update

Luke Evans Excerpts

Monday 13th December 2021 Commons Chamber

[Sajid Javid]

We of course keep under review the support that is available throughout the pandemic. It is important that the House decided to extend the availability of sick pay from day one. There is also a hardship fund that is administered by local authorities.

[Dr Luke Evans (Bosworth) (Con)]

I commend the Health Secretary for bringing forward the boosters and aiming so high to get them out. One of the key things is to make sure that we have enough vaccinators and staff to do it, as well as volunteers. In that vein, will he ask the integrated care systems—all 42 of them—to review the bureaucracy they have around signing people up to give vaccinations, and potentially even to allow people from GP practices to work in hospitals and vice versa, because one of the practical issues over the past year has been that people have been turned away or have lost interest because of the paperwork around vaccinating. Given the challenge ahead, I would be grateful if he considered asking for that approach.

[Sajid Javid]

My hon. Friend speaks with great experience, and he is right to ask how the training programme for vaccinators, especially volunteer vaccinators, can be streamlined. That work is going on at urgent speed both within the NHS—within the ICSs—and in support of the fantastic work that St John Ambulance has been doing in this space.

Covid-19 Update

Luke Evans Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

We do work very closely together across the Union, and I have regular contact with my counterpart in Northern Ireland. I have not been able to discuss these particular measures with him today, but I know that we will do so shortly.

[Dr Luke Evans (Bosworth) (Con)]

I am grateful to the Secretary of State for coming to this House first, and for providing a copy of his statement. In it, he said that

“we will introduce mandatory certification, based on vaccines or tests, for nightclubs and large events.”

Could he explain if this will look like the Euros, when people had to present whether or not they had had a test? Failing that, if we are to have mandatory certification, which is the concern for Conservative Members, will there be an explicit vote on the regulations?

[Sajid Javid]

The NHS covid pass already has an in-built capability to allow for either a vaccination or the result of a negative lateral flow test, and next week there will be a debate on these regulations and a vote.

Public Health

Luke Evans Excerpts

Tuesday 30th November 2021 Commons Chamber

[Alex Norris]

I have given way to the hon. Gentleman before; I do not rule out doing it again, but will not do so immediately.

On ventilation, which links in to education settings, throughout this pandemic we on these Benches have called for a radical upgrade in the ventilation of public buildings, particularly schools. We know that is not something we can just click our fingers and do; it is more expensive and time-consuming and much harder to do than asking people to wear a mask, but it is a particularly effective intervention. Some 18 months into this pandemic, can the Minister update the House on how many public buildings now have proper ventilation systems as a result of decisions taken during the pandemic?

[Dr Luke Evans (Bosworth) (Con)]

Have the Opposition done any analysis of how much it would cost to implement ventilation en masse across educational settings?

[Alex Norris]

The hon. Member goes slightly further than I did in saying that ventilation should be rolled out immediately across all schools. Of course, that would have significant financial implications. It would also, of course, be very good for British business. We are saying that, as has been clear throughout the pandemic, better ventilation in public buildings should be a significant part of building regulations in general. What I seek from the Minister is a sense that any of that, never mind all of it, has been done at all.

NHS Efficiency

Luke Evans Excerpts

Tuesday 2nd November 2021 Westminster Hall

[Paul Bristow]

That is a characteristically well-made point by my hon. Friend. In the current system, NHS chief executives spend 18 months in one trust, then travel to another, spend 18 months there and then travel to another. That is no time at all to get to grips with the challenges that these organisations face. We absolutely need people from the private sector to come in and do these jobs. If they were doing these jobs on a larger scale, that would be welcome. I am specifically requesting that we look to local government, where people have come in and transformed services. I suggest we do the same in our NHS.

My second point is on innovation and new ways of working. Innovation is the way an organisation develops. It should be a constant process—trying to do things better, improving outcomes for patients and trying to be more productive. Across the NHS there are those that innovate with new technology, those that adopt new pathways and service delivery, and clinicians who want to train and learn new techniques. However, the NHS can be poor at spreading best practice at pace and scale. Like any bureaucracy, it can be slow at looking at new ways of working.

There have been attempts to address this. We spent millions funding organisations such as Getting It Right First Time—GIRFT—under Professor Tim Briggs, which is a national programme designed to improve the treatment and care of patients and collect best practice. We created the National Institute for Health and Care Excellence—NICE—which, when it was created, was considered to be a model for the world to emulate on determining the cost-effectiveness of technologies and drugs. NICE also produces quality standards that set out priority areas for quality improvement in health and social care. After all this work has been done and all this money has been spent, many parts of our NHS just ignore it. They say things such as, “This can’t possibly apply to us,” or, “This is merely guidance, and we don’t need to do this here.”

The use of insulin pumps and implantable cardiac defibrillators or vascular technologies should not depend on where someone lives, but it does. The solution is certainly not to reduce GIRFT’s budget from £22 million to £10.8 million, but that is what has happened. GIRFT should be empowered to develop best practices in primary and community care, and we should look at the GIRFT model of hot emergency and cold elective centres to help us power through the backlog.

What is the solution? How do we make outliers adopt best practice and do the right thing? A KPI, and perhaps even GIRFT or NICE, can help us with technology and pathway adoption, which could transform productivity, powering us through the backlog. Backed up with an incentive such as a generous and workable best practice tariff, a KPI could focus attention. If outliers persist in a practice that has been shown to be outdated and to follow pathways that do not lead to optimum outcomes, why would we give them the extra money?

On capacity, staffing is recognised to be a risk factor in delivery for our NHS. The money is there, but it takes a long time to train a doctor, GP or nurse. That is why every hour of a medical professional’s time is valuable. We have to make sure that they are doing what they are paid for and what they went into medicine to do.

[Dr Luke Evans (Bosworth) (Con)]

My hon. Friend is making a fantastic speech. Does he agree that every hour of a clinician’s time is valuable? The average clinician loses about 10% of their workload simply chasing up letters, following up blood tests or trying to find scans, which is a complete nonsense in our current system. It could easily be ironed out by joining up simple IT between primary and secondary care. Is that a KPI my hon. Friend could support?

[Paul Bristow]

My hon. Friend is a champion of efficiency in the NHS and in his profession, and he makes such points regularly in the meetings of the Select Committee on Health and Social Care. Perhaps he has already read my speech, because I think that the winter access fund is an excellent start. It will address what many GPs have rightly complained about for some time, which is the amount of time they spend on fitness notes and chasing appointments, as well as something that I only realised when I met GPs in my constituency. I want to give a quick shout out to the super Dr Neil Modha and his team at the Thistlemoor surgery, who are doing a fantastic job in a very challenging catchment area. What I realised was how much time GPs spend providing medical records to insurance companies and other bodies, which just is not their job.

We need clinicians to practise at the top of their licence. We need GPs seeing ill patients, not prescribing things a nurse could easily do. Nurse-led prescribing has been around for a long time, but it has not been rolled out across as many areas as it should. We need a revolution in physician associate and nurse-led prescribing, which will free up the time for GPs and consultants to do what they need to do.

That same waste of clinician time happens in secondary care. We need surgeons using their skills in the cath lab or the operating theatre. They should not be in theatre only one day a week; they need to be there multiple days a week, every week. I hope surgical hubs and other initiatives will help, but I fear that without a strict KPI on clinician time on highest-skill, highest-value activity—and I am not opposed to backing that up with financial incentives—we will not make the savings in clinicians’ time that we need. Only with such a KPI, together with an effort to demonstrate how valued our clinicians are, will we ensure that their valuable time is not wasted. If an integrated care system or the management structure at an NHS trust cannot or will not do that, we should make it dependent on the extra cash.

Finally, much of this is dependent on greater transparency. I was very pleased to hear the Secretary of State for Health and Social Care say this morning to the Health and Social Care Committee that we are going to be able to see more data relating to the performance of GP practices, but that needs to happen with ICSs as well. In the past, clinical commissioning groups in this country could be guilty of hiding commissioning policies, rationing hip and knee surgeries to those with a body mass index of below 30—or even 25 in a handful of cases—on page 145 of a 278-page document on a website that no one ever reads.

NHS England is just as guilty of doing that with national service specifications and commissioning policies, and politicians have very few means of challenging that as politics has been taken out of the NHS. We need to open up the windows and let the light in. Accountability and transparency have always been the way to improve performance and efficiency, so let us have the Ofsted-style rating for ICSs and other NHS bodies. Let us know who does well and who does not. Together with clear KPIs, transparency and accountability, we can ensure that the record cash injection, which my constituents applauded, is spent well. The NHS is a source of national pride, but its performance post-pandemic can and should improve. I offer Ministers a few ideas—a few acorns—for how we might do that.

NHS England Funding: Announcement to Media

Luke Evans Excerpts

Monday 25th October 2021 Commons Chamber

[Edward Argar]

I know that the hon. Gentleman genuinely feels strongly about this issue. He and I discussed it in a recent debate in Westminster Hall, and I think I am due to meet him to discuss the 10 points that he flagged up then as genuinely practical suggestions to help improve both retention and recruitment in the NHS workforce. He knows that I am always happy to do that. Hopefully, my office will have been in touch with him. If it has not been in touch, it will be, because I want to have that conversation with him.

On the hon. Gentleman’s key point, there are number of things. This is about not only tackling the urgent backlogs now, but building a system that is resilient for the future and that can actually tackle the broader challenges that we as a society face. That means more diagnostic capacity and more diagnostic capacity at an earlier stage, as some other countries have. I am quite happy to acknowledge that, under Governments of both political complexions, we could have done more, and that is why we are doing more now, and I say that to him gently. He talks about urgency; he is right. He also makes a very important point, which I tried to allude to in my earlier answer. If I did not land it clearly, I will attempt to do so now. He is absolutely right to highlight the risk of burn out and exhaustion, for want of a better way of putting it. As I said, it is very easy for people to say that X specialty was not working during the pandemic because that surgery was not happening, but you can bet your bottom dollar that the people involved were probably helping out—the anaesthetists and theatre nurses were—so we do need to address that point. I will be happy to see the hon. Gentleman.

[Dr Luke Evans (Bosworth) (Con)]

To answer one of the points just raised, one of the key problems with driving productivity is that about 10% of a clinician’s time is spent on chasing admin. Can the Minister confirm that some of this money will be put into dealing with the primary and secondary care interface, for example, so that people do not have to spend their time chasing letters and appointments and finding out what has been happening? Those things should happen as easily as they do in our phones.

[Edward Argar]

My hon. Friend is absolutely right, which is why part of this figure—£2.1 billion—is allocated for things such as ensuring that digital patient records and shared care records are rolled out across every trust. There has been an extensive roll-out, but there is more still to do.

Health Incentives Scheme

Luke Evans Excerpts

Friday 22nd October 2021 Commons Chamber

[Maggie Throup]

My hon. Friend is exactly right. Obesity costs the NHS at least £6 billion. However, it is not just about the cost to the NHS, but the cost to individuals as well. People who are obese are more likely to have diabetes, cardiac disease and cancers, so this affects their lives. If we get it right for the NHS, we are getting it right for individuals as well.

[Dr Luke Evans (Bosworth) (Con)]

To pick up that exact point about diabetes, obesity is inextricably linked to type 2 diabetes, which can lead to damage to people’s feet, eyes and kidneys. What is even more concerning is that it is easily reversible with a healthy lifestyle. If this pilot is a success, will the Minister consider targeting it particularly at those who suffer with type 2 diabetes?

[Maggie Throup]

My hon. Friend has a lot of knowledge as a former GP.

The pilot will tell us so much. It will be fascinating and I am sure that there will be lots of learning points that we can take forward into different disease areas such as type 2 diabetes.