NHS Continuing Care

Maggie Throup Excerpts

Monday 27th November 2017 Commons Chamber

[Norman Lamb (North Norfolk) (LD)]

I suspect that I will not be alone in the House in having concerns about how NHS continuing care is operating these days. Concerns about the process will have been raised by the constituents of many hon. Members on both sides of the House. It is worth recognising that the process of NHS continuing care has always been fraught because a lot of money often turns on the outcome, and the families affected are often going through a very difficult time as they cope with a loved one with serious care needs. However, particular things are happening in the system now that seem to justify our spending some time on considering whether the current situation is acceptable.

As the NHS and the care system struggle with what I think are impossible finances, some wholly unacceptable practices are emerging around the country, some of which I want to deal with this evening. First, it is clear that a postcode lottery is emerging, with no democratic legitimacy at all. The massive variation in the acceptance rate for applications for NHS continuing care has no apparent justifiable explanation. The BBC’s “Inside Out East” programme made a freedom of information request about the period between July 2016 and July 2017. It found that Birmingham South Central clinical commissioning group rejected 75% of those assessed for NHS continuing care, whereas the figure for Tameside and Glossop CCG was just 5%. Given that this is public money, how can we possibly justify such an extraordinary variation without any democratic legitimacy? The BBC’s figures also showed that 73% of people in my constituency were turned down, but that the figure for Manchester was just 17%. These are not odd examples—there are enormous variations across the country. I would be grateful if the Minister could explain how these extraordinary variations are happening and what she and the Government intend to do about them.

[Maggie Throup (Erewash) (Con)]

In my experience, this depends not just on the postcode, but on how the referral is made. If a referral is made through a hospice, the process is clear and transparent, but with other mechanisms, it is more smoke and mirrors.

[Norman Lamb]

The hon. Lady might well be right. That does not justify the variations, but it is a possible explanation for part of the problem.

Secondly, the number of people nationally who are found to be eligible is falling. The National Audit Office found that the proportion of people assessed as eligible for standard continuing healthcare by CCGs reduced from 34% in 2011-12 to 29% in 2015-16.

--- Later in debate ---

[Norman Lamb]

If it were happening, I would. I totally agree that we need to bring health and social care together in localities, with a single budget and single commissioning. I think that we need to work across parties to come up with an ultimate long-term settlement for the NHS and the care system.

Families are also in the invidious position of being asked to provide, in effect, a top-up for care if they want their loved one to remain at home, rather than being forced into a care home. That is fine for those who can do it, but not good for those who cannot afford it. It is also completely contrary to any notion of personalisation —the concept of the person, what is important to them and their priorities being at the heart of decision making—which the Government accept. When I was working with the Conservative party in coalition, we passed the Care Act 2014. Its fundamental principle was the individual’s wellbeing, yet now are saying to people, “No, you’re going to go into a care home because it’s cheaper.” That is not acceptable, but it is happening around the country.

[Maggie Throup]

rose—

[Norman Lamb]

I will give way for the last time.

[Maggie Throup]

The right hon. Gentleman is very generous. He makes a strong case, but sometimes people’s healthcare needs are so great that it is impractical for them to be looked after in their own homes, so things are not quite as cut and dry as he is indicating.

Oral Answers to Questions

Maggie Throup Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Hunt]

I am afraid that the hon. Lady will have to wait until the Chancellor delivers his Budget. There are huge financial pressures on the NHS. We inherited a financial recession but, if she looks at this Government’s record she will see that, unlike her party, we refused to cut spending on the NHS; we are now increasing it.

[Maggie Throup (Erewash) (Con)]

6. What plans his Department has to improve care for people with lung disease.

[The Parliamentary Under-Secretary of State for Health (Steve Brine)]

Me now, Mr Speaker. Improving care for people with lung disease is crucial to this Government. We do not need reams of new plans or strategies, but continued action to implement existing plans, including the NHS outcomes framework, which details NHS priority areas and includes reducing deaths from respiratory disease as a key indicator. Key initiatives include the implementation of quality standards on idiopathic pulmonary fibrosis, asthma and chronic obstructive pulmonary disease, and a national pilot to improve care of breathlessness.

[Maggie Throup]

I thank the Minister for that answer, but I think that more probably still needs to be done. Last month, I launched the British Lung Foundation’s latest report into idiopathic pulmonary fibrosis. Delayed access to diagnosis, support services and care is still commonplace for people with IPF and other lung conditions. Will the Minister agree to meet me and the British Lung Foundation, which is leading a taskforce for lung health, to establish what more can be done to address the issue?

[Steve Brine]

I thank my hon. Friend, who speaks with great passion—I know that she has tragic personal experience. I will be meeting the British Lung Foundation shortly, and I am happy for my hon. Friend to join that discussion or part of it. As I said, one of the NHS’s priority areas, as set out in the outcomes framework, is reducing early deaths from respiratory diseases such as IPF. I understand that the number of cases has risen in recent years, which is rightly a cause for concern. She is right to raise the matter, and I look forward to meeting her.

Children’s Oral Health

Maggie Throup Excerpts

Tuesday 31st October 2017 Westminster Hall

[Maggie Throup (Erewash) (Con)]

It is a pleasure to share my thoughts and experiences under your chairmanship, Mr Bone. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing this debate. As he said, it is Sugar Awareness Week, so this debate on tooth decay is timely.

It is well recognised and accepted that the amount of sugar that children eat has an impact on both oral health and obesity rates, and that there is a link between poor oral health and some of the most deprived parts of the country. Poor oral health and obesity are both issues of health inequality. Tooth decay and obesity also represent major public health issues. If we put measures in place to tackle one, we will tackle the other at the same time.

Tooth decay is the leading cause of hospital admissions for young children. Local data show that one in five children in Erewash suffers from tooth decay by the time they are five years old. That is better than the national average of one in four, but children in my constituency are still twice more likely to have tooth decay than their peers in the parts of the country with better performing local authorities; even though the data are better than the average, they are still not good enough.

In the last five years, 170 children in Erewash have been admitted to hospital to have their teeth extracted under general anaesthetic. That is 170 too many. Nationally, about two thirds of such hospital extractions are due to extensive tooth decay. When I looked further into local data, I found that almost half of children in Derbyshire did not see an NHS dentist in the year to April 2017. I find that extremely disturbing because children should have check-ups at least once a year. Tooth decay is 90% preventable; as has already been said, NHS dentistry is free for under-18s, so there is no excuse. Stopping tooth decay would prevent a great deal of pain and stress for children and the potential for bullying. If tooth decay was made a priority for the NHS, a great deal of money would be saved.

I am extremely concerned about the impact of sugar on our nation’s teeth, but I want to expand a little about the impact of sugar generally. Almost a year ago, Cancer Research UK revealed that, on average, teenagers drink almost a bathtub full of sugary drinks a year. Hopefully, such a visualisation—a bathtub full of sugary drinks—will shock some teenagers into changing their habits rather than suffering the consequences that we have heard about. The average five-year-old consumes their own weight in sugar every year. That is horrendous. There is no doubt that such sugar consumption will have an impact on dental health, but also it will have an adverse effect on the current and future health of our nation.

Sugar, tooth decay and obesity are linked. Obesity is now recognised as a major cause of type 2 diabetes, which is now a disease seen in teenagers rather than just the elderly. Obesity is also a major cause of cardiovascular disease and cancer. If young people’s sugar consumption continues and our young people manage to escape tooth decay, there are other health issues waiting for them down the road.

As a member of the Health Committee and chair of the all-party parliamentary group on adult and childhood obesity, I was disappointed by the “Childhood obesity: a plan for action”, published by the Government in August last year. The Committee asked for bold and brave action, but sadly we did not get that. Tackling obesity also tackles tooth decay, so I welcome the sugary drinks levy and the ring-fencing of the moneys raised from that for children, but I want to go one step further. Could some of that money be dedicated to teaching children how to clean their teeth—perhaps through the breakfast clubs some of that money will be dedicated to?

The levy is only a drop in the ocean. I want to take the opportunity to ask the Minister, first, to work with retailers to limit price promotions on high-sugar food and drinks and to encourage the removal of those products from the point of sale—to consider legislation if necessary. Secondly, will the Government update broadcasting regulations, to ensure that high-sugar products cannot be advertised on TV before the 9 pm watershed? Thirdly, will the Government build on the new rules from the committee of advertising practice, to prevent high-sugar products from being advertised in non-broadcast children’s media and to close the loopholes?

Let us really show that we care about both the dental health and the general health of our future generations, and take action now.

Social Care

Maggie Throup Excerpts

Wednesday 25th October 2017 Commons Chamber

[Maggie Throup (Erewash) (Con)]

It is a pleasure to follow my fellow east midlands MP, the hon. Member for Leicester West (Liz Kendall).

Like many Members from across the House, I was compelled to speak in today’s debate because of my personal experience with the social care system, and because of my deep respect for all who work in it and contribute to it. For five years, my father has been in the care of a nursing home in Keighley. At age 94, my dad is still in good spirits, but he has significant care needs as a result of a massive stroke in 2012. It is a testament to the fantastic work of our NHS that we now find ourselves in a position where every care home in the country has residents who 10, 20 or 30 years ago would not have survived serious health issues such as a stroke, a heart attack or cancer. For the Government, however, this success in the NHS can be seen as a double-edged sword, with successive Administrations failing to prepare our social care system adequately for an ageing population living with co-morbidities.

Let me be clear, when I talk about adequate preparation, it is not just about additional funding. As we have heard, the Chancellor has already announced an additional £2 billion of funding for local authorities to fund social care over the next three years and has also introduced a precept. That must be welcomed, as it rightly acknowledges the significant extra pressure that our social care system, and consequently our NHS, is now under.

Opposition Members seem to want to blame the Government, whereas successive Governments, going back to when they were in government, failed to act. They failed to act on the royal commission they set up, and they failed to act on the Wanless report and their own Green Paper. As my hon. Friend the Member for Totnes (Dr Wollaston) indicated, we now have the opportunity to effect radical change to the current system, as the Government embark on their comprehensive consultation on adult social care. Others have alluded to the fact that Britain needs a sustainable programme of social care for the long term. We need to stop thinking short term. To achieve that, I would like to explore the idea of removing the social care remit from local authority responsibility and instead placing it under the wider umbrella of the Department of Health, which would become the Department of Health and Care. This stems from the fact that health and social care have now become intrinsically linked, but are currently administered in vastly different ways. If the two are unified, it would allow for closer integration of services and a greater understanding of what demand there will be for future needs from both the social care and health perspective.

It would also protect the social care system from political manipulation, which has happened in Derbyshire at county council level, where the new Conservative administration found itself facing a social care bombshell left by Labour. Over the previous four years, and despite holding around £233 million of Derbyshire taxpayers’ money in its reserves, Labour failed to maintain care homes such as Hazelwood in Cotmanhay in my constituency, in order to trot out the same old line about Tory Government cuts. As a result of this shameful political practice, the county council must now consider closing the care home altogether, because of the significant repairs required to make it safe and warm for residents. I urge the Minister today to do all he can, from the local government point of view, to help Derbyshire County Council to keep this much-loved care home open. There is no doubt that Derbyshire County Council and others face more tough decisions over the next five years. As the MP, I will continue to do everything in my power to ensure that Erewash residents remain well provided for, for both their health and social care needs.

Oral Answers to Questions

Maggie Throup Excerpts

Tuesday 10th October 2017 Commons Chamber

[Jackie Doyle-Price]

The hon. Gentleman is quite right: many people would elect to die at home, if the opportunity were available. We need to ensure provision to allow people to do that, if that is their choice, because we should be supporting people to honour their choices at the end of their lives, and it enables us to treat more people in hospitals and hospices.

[Maggie Throup (Erewash) (Con)]

Hospices, such as Treetops Hospice Care in my constituency, provide outstanding end-of-life care. Although these services benefit from generous charitable donations that enable them to operate on a day-to-day basis, what more can the Government do to help support hospices when capital investment is needed to improve the current setting of new build?

[Jackie Doyle-Price]

One of the strengths of our hospice movement is that it relies heavily on charitable donations, which shows that people are generous and that they want to support good, locally focused care. However, CCGs should look at where they can support hospices with their care costs, and we will certainly consider including that in the end-of-life care programme.

Oral Answers to Questions

Maggie Throup Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

I suggest that the hon. Lady gets in touch with the details. What I would say is that when care is not satisfactory—whether it is delivered by the public sector or the independent sector—we have an independent inspection regime to root out the problems.

[Maggie Throup (Erewash) (Con)]

I was delighted to hear that, in answer to my hon. Friend the Member for Boston and Skegness (Matt Warman), the Minister was positive about the progress of genome screening. On a recent visit to Nottingham University, I saw similar techniques applied to Alzheimer’s research. Will he back using the process for that, as well as for cancer diagnosis and treatment?

[Steve Brine]

The chief medical officer’s report—I am sure that my hon. Friend will read it in due course—is clear that this is an exciting new innovation in medicine. We will tackle cancer first, but there is real potential for applying it to rare diseases and the other disease that she mentioned.

Preventing Avoidable Sight Loss

Maggie Throup Excerpts

Tuesday 28th March 2017 Westminster Hall

[Nusrat Ghani (Wealden) (Con)]

I beg to move,

That this House has considered preventing avoidable sight loss.

I thank the Backbench Business Committee for allocating me this debate, the Chairman of Ways and Means for approving it and you, Mrs Gillan, for being in the Chair. I am also grateful to all the MPs who supported my application and to Lord Low of Dalston, my co-chair on the all-party parliamentary group on eye health and visual impairment, who, with his passion and experience of these issues, is a fantastic source of knowledge and support for the group. I believe that he is with us today in the Gallery.

The latest information from local authorities, which is from 2014, shows that almost 300,000 people in England and many thousands in Northern Ireland, Wales and Scotland are formally registered as blind or partially sighted. Many thousands more suffer from sight difficulties without being registered with their local authority. I thank the Royal National Institute of Blind People for its support as the secretariat of the all-party group, which I have the honour of chairing. The RNIB estimates that almost 2 million people in the UK live with sight loss. It is predicted that that will double to around 4 million by 2050 due to our ageing population and the fact that more people will live with conditions, such as diabetes, that can lead to visual impairment.

[Maggie Throup (Erewash) (Con)]

My hon. Friend talks about sight loss increasing in the future. Does she agree that obesity, which has the knock-on effect of causing type 2 diabetes, is one of the causes of sight loss? Children in their teens are being diagnosed with type 2 diabetes, so we really need to think about how we tackle and prevent that in the long term.

[Nusrat Ghani]

I definitely agree that we need to think about the long term and look at childhood obesity and diabetes, which are on the rise. I would like to put on the record that my application for this debate—I applied for a debate in the main Chamber—was supported by the right hon. Member for Leicester East (Keith Vaz), who chairs the all-party parliamentary group on diabetes.

It is estimated that half of sight loss is potentially avoidable. Glaucoma is the single biggest cause of preventable sight loss. Some 600,000 people in the UK have glaucoma, but half are undiagnosed. If it is detected and treated early, around 90% of people with glaucoma retain useful eyesight for life.

O’Neill Review

Maggie Throup Excerpts

Tuesday 7th March 2017 Westminster Hall

[Kevin Hollinrake]

I defer to my hon. Friend’s in-depth knowledge in this area. I recognise my father’s habits in taking antibiotics when he felt a bit unwell—he had a little cupboard in the corner of his lounge. That is a problem, and that is why we need to improve the education on treatment of illnesses for which people are prescribed antibiotics.

The point about antibiotic resistance spreading is that it can be spread in so many ways: on aeroplanes; in our water; from contact with unwashed hands of people who carry bacteria resistance; coughing and sneezing; and from animals to humans. Some Members may have come across the excellent BBC Radio 4 drama “Resistance” —the first episode was aired on Friday and the second episode is this Friday—which talks about the transference from animals to humans. That means we must tackle this problem both in agriculture and in our health services.

Bacteria do not recognise national borders, so, as many hon. Members have already pointed out, this is a global problem. We would think that with those apocalyptic visions of the future we would be spending an awful lot of money on tackling this issue, but that is not the case. About $100 billion is spent every year on cancer research, but only about $5 billion is spent every year on tackling antimicrobial resistance. The reason for that is the commercial return that large pharmaceutical companies will get from bringing forward a new antibiotic to tackle this issue. Almost by definition, any new drug is held as a last line of defence, so there is not a significant commercial return for the pharmaceutical companies who we rely on for such new drugs. About $50 billion a year is spent on antibiotics but only about $5 billion a year is spent on patented antibiotics, which is equivalent to one cancer drug. It is a better commercial activity to be involved in cancer research and cancer drug development than in antimicrobial resistance. There has been a huge reduction in the number of pharmaceutical companies involved in research and development—in 1990 there were 18 and in 2010 there were only four—and no new classes of antibiotic drugs have been developed in the past 25 years.

Of course, the O’Neill review has studied that and come up with clear and compelling recommendations such as rapid diagnostic testing, which the right hon. Member for Oxford East (Mr Smith) referred to. Yesterday we had a Twitter debate, which was interesting, listening for an hour to people’s experiences. Many clinicians got involved in that particular Twittersphere, and we trended nationally at one point, which was certainly a new experience for me. One thing that came across was the pressure that clinicians were under to prescribe antibiotics to people who felt ill. Obviously, if we had diagnostics that could show people that they did not carry something that could be treated by an antibiotic, they would be much less likely to put that pressure on doctors.

[Maggie Throup (Erewash) (Con)]

My hon. Friend makes a good point about educating patients so that they appreciate that they do not have to come out of the GP surgery with a prescription in their hand if a diagnostic test can be carried out to prove that antibiotics will not work in their case.

[Kevin Hollinrake]

That is right. I had a test myself at a drop-in session in Portcullis House that showed me that I was not ill—I did not think I was ill, but they told me that I was not, which was reassuring. Again, we need to ensure that prescriptions are given when they will be effective. One other area that we do not seem to have control over at the moment is the online sale of antibiotics: whether through UK-based pharmacies or those based overseas, it is too easy to access drugs without a proper prescription.

The second key point that the O’Neill review highlights is the need for a global public awareness campaign so that people are aware of the issues. Again on Twitter yesterday, a student who had undertaken some analysis said that 80% of the people she had spoken to had no awareness of antibiotic resistance. We need a significant national and international effort to draw public attention to the problem. As people have already said, we need a reduction of usage in agriculture. That is clearly set out in the O’Neill review as one of the four main recommendations.

--- Later in debate ---

[Maggie Throup (Erewash) (Con)]

I congratulate my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake) on securing this important debate. I will focus on Lord O’Neill’s call for antibiotic prescriptions to be informed by a rapid diagnostic test “wherever one exists” by 2020. Such tests do exist and have for probably at least 25 years. I know that because I tried to launch such a test previously. At that stage it was about better prescribing, but it is now more about tackling the huge problem of antimicrobial resistance, which Dame Sally Davies has said is as big a risk as terrorism and climate change.

Why are we still only talking about these point-of-care and diagnostic tests, which could make a huge difference? I think it is partly due to the way that in vitro diagnostic tests are block funded through centralised hospital labs. In Scandinavia, point-of-care tests are a lot more widespread, including for C-reactive protein—CRP—and funding is decentralised. There is not yet a mechanism for such tests to be funded in the UK. It is so important to look at how such tests will be funded, whether they are to be used in a GP surgery or local pharmacy. It has been calculated that £56 million could be saved in prescribing and dispensing costs alone if point-of-care tests were introduced, as they can be vital in deciding whether to prescribe antibiotics.

Let me explain. High levels of C-reactive protein are found in somebody with a bacterial infection. The level is normally only slightly raised when the patient has a viral and not a microbial infection. When my hon. Friend was tested, the results showed that he was either healthy or had a viral infection. Point-of-care CRP tests are available and can be carried out by GPs, practice nurses and community pharmacists, and they take just four minutes to determine whether a patient needs antibiotics or not. It sounds very simple, and it can be. As I said earlier, patients feel they have only had their money’s worth from a GP appointment if they come out with a prescription, but studies have shown that giving them a point-of-care test can also leave them feeling satisfied and as though they have had their money’s worth. In one study, 90% of respondents felt reassured by a point-of-care CRP test if they were not prescribed an antibiotic.

The tests are very simple. Patients have their finger or thumb stabbed and a small drop of blood is taken. It is then tested within four minutes, while the patient waits in the doctor’s surgery. Lots of studies have shown a reduction in antibiotic prescribing, including by 30% in one and 23% in another project, which was cost-neutral; the cost of carrying out the tests versus prescribing is very effective. I am mystified as to why we have this problem yet are not tackling it with tests that are already on the market, which is in line with current National Institute for Health and Care Excellence guidelines. I ask the Minister: why can we not change the funding streams for these tests to make sure that they are carried out exactly where they are needed?

Health and Social Care

Maggie Throup Excerpts

Monday 27th February 2017 Commons Chamber

[Maggie Throup (Erewash) (Con)]

I would like to start by paying tribute to the many thousands of health and social care workers who every day support some of the most vulnerable people in our society.

We are talking today about how to balance the books. The NHS “Five Year Forward View” identified that, if the trajectory of healthcare spending continued at the same rate as just a couple of years ago, an extra £30 billion would be needed by 2020. It also stated that over £20 billion could be identified in savings and efficiency measures over that period, which is why the Government have allocated an additional £10 billion to 2020-21. We can quibble about whether it is £8 billion or £10 billion, but it must be recognised that NHS England asked for £8 billion and that the Government are delivering it.

To some extent, what has not happened yet is the other side of the bargain: finding the savings of £22 billion. Perhaps it was never possible. Perhaps the timescale for delivery was too short. Next year we celebrate 70 years of the NHS. So to change how it worked in less than five years was probably too big an ask. That said, in many areas of the NHS, change is happening and savings are being made. But it takes time. I want to give a couple of examples to illustrate where savings can be made. They might involve upfront costs but for long-term savings.

Prior to being elected to this place, I spent a lot of time and energy promoting diagnostic tests that could be carried out at a patient’s bedside, in a GP surgery or even in a patient’s home—possibly also in community pharmacies. Such testing is used extensively in Scandinavia and other European countries, but we are lagging behind. If we adopted such tests more widely, many savings could be made, but, more importantly, it would better for the patient, which surely should be the key determinant.

One example is the point-of-care test measuring a protein called C-reactive protein. The protein is raised when someone is suffering from a bacterial infection but not if the infection is caused by a virus. Without the test, patients might be prescribed unnecessary antibiotics, which is not good for the patient or the NHS budget, and in some instances, patients might be admitted to hospital unnecessarily. Yet all that is needed is a small device and a drop of blood. I know all this from personal experience: had such a test been readily available for GPs to carry out in surgeries or patients’ homes, it would have saved my mother a five-day hospital stay. Not only would that have saved the health service money, but my mother would have been far better off staying in her home at the time of her illness. We cannot continue doing as we have been and expect different outcomes.

[Jason McCartney (Colne Valley) (Con)]

My hon. Friend talks a lot of sense. Does she agree that the NHS should not make the mistakes of the past by going down the route of more disastrous private finance initiative deals? As she might know, my local CCG is developing a business case to bulldoze Huddersfield royal infirmary, replace it with a small planned care unit and move everything else to Halifax, including A&E, and is coming forward for £285 million. If it does not get that from the main funds, it will go down the PFI route, but the trust is already crippled by the disastrous PFI at Halifax, which cost £64 million to build but will eventually cost £774 million.

[Maggie Throup]

I thank my hon. Friend for his pertinent comments. I did my training as a biomedical scientist at Halifax general hospital and the royal infirmary in Halifax, so I know the area very well. Yes, we must not go down the route of more disastrous PFI agreements.

[Fiona Mactaggart (Slough) (Lab)]

On the hon. Lady’s point about tests that are not being deployed, but which could save money, I have long been concerned that many areas do not issue women at risk of ovarian cancer with the CA 125 test. It is not a definitive test, but it can help identify the cancer early, which can save money. Does she agree that we need leadership from the top of the NHS on such clinical issues to ensure that short-term savings decided by an individual CCG are not putting patients’ health at risk?

[Maggie Throup]

The right hon. Lady makes a very good point, and we could have an entire debate on the topic of prevention and screening.

The spending of the NHS budget affects social care, and the spending of the social care budget affects the NHS. As we have heard from other hon. Members, the two are linked, but are funded in different ways. All too often, these budgets are costed only in silos.

Taking the treatment of stroke patients as another example, there is a new technique available called mechanical thrombectomy. I recently met a young man who was fortunate enough when he had a massive stroke to be near one of the few centres in the UK that carries out that procedure—if a young man in such a situation can be viewed as fortunate at all. As a result of the procedure, the young man can lead a full life rather than being disabled for the rest of his life and possibly dependent on social care, too. However, the procedure cannot yet be rolled out across the country due to the limited funding available to train specialists to carry it out and to fund the procedure itself. What are the lifetime costs, mainly imposed on social care, for those patients who do not get that procedure or other such procedures, irrespective of the personal costs to the individuals?

There are great examples of integrated working between the NHS and social care, but it is far too slow to spread new and best practice. Locally in my constituency, Erewash CCG is a Vanguard site. One of its actions is to carry out what are classed as “ward rounds” in residential and nursing homes. There is already strong evidence to show that that is reducing hospital admissions for elderly people. However, it is not being rolled out quickly enough to other areas.

I do not believe that continually throwing more money at the NHS and social care is the answer. If we want different results, we need to do things differently. That is what the sustainability and transformation plans aim to do. I have read the Derbyshire STP in depth, and while I applaud the aims of the plan, there appears to be very little indication of how it will be implemented. My concerns are around workforce balance, transitional costs to implement the STP, capacity in the community and stakeholder buy-in.

I hope I am wrong with my analysis, because better integration and bold action are what are really needed. It is important for us not to shy away from the hard and difficult decisions that lie ahead.

--- Later in debate ---

[Judith Cummins (Bradford South) (Lab)]

It is a pleasure to follow my hon. Friend the Member for Bristol South (Karin Smyth). We are here to debate the financial sustainability of the health and adult social care sectors. Although health and adult social care are almost inseparable, I will focus on adult social care for brevity’s sake.

Although the acute care and adult social care sectors face similar unprecedented pressures, adult social care is different in one important way. Unlike the NHS, which has the ear of the Chancellor and the Treasury, adult social care certainly does not. All the evidence in recent months has served only to confirm that. The Chancellor’s decision not to make one extra penny of new money available in his autumn statement was met with almost universal criticism from across the health and local government sectors, and his recent decision to introduce the adult social care precept is damning evidence that a desperately outdated view of funding remains strong in the Treasury.

Adult social care is delivered locally by local authorities, so the Chancellor views its funding as a locally devolved issue. The Government’s decision to pass the blame to local councils and to underfund adult social care is nothing short of moral cowardice. They are deliberately underfunding adult social care in my home city of Bradford.

What is most desperate is the Government’s abandonment of the hundreds of thousands of older and vulnerable people who are reliant on vital adult social care services, day in, day out. We are talking not about hypotheticals but about the care happening today, right now. Real people are struggling to get by in my constituency of Bradford South. Bradford is a relatively young city; nevertheless, the number of people in Bradford over the age of 65 has grown substantially. Between 2012 and 2015, an extra 4,500 people were living in the district, and the number of people in Bradford with complex physical disabilities has grown by 400.

My local council, Bradford Council, agreed its budget last Thursday. Like many others, it had the task of agreeing swingeing cuts to scores of community services. In recent years, it has reduced its budget by more than £218 million, and a further £82 million in cuts will have to be made by 2020. Adult social care, as the biggest service overseen by Bradford Council, faces the lion’s share of the looming budget cuts. A further £19 million of cuts will fall on the city’s adult social care sector. The Government are washing their hands of any responsibility. By 2020, the revenue support grant, which is the primary source of central Government funding to Bradford Council, will drop to zero—zilch; absolutely nothing.

The Government’s half-baked answer is the adult social care precept. In the next two years, the precept is expected to raise an extra £6.6 million in Bradford, but that extra money is dwarfed by the huge cuts to Bradford Council’s revenue support grant. More to the point, the extra £6.6 million is not even enough to meet the increased cost of adult social care that will flow from the Government’s so-called national living wage. Because of the unprecedented increase in demand, such bruising budget cuts are only the tip of the funding shortfall. It is expected that the cost of supporting increasing numbers of older people, coupled with larger numbers of working-age people living with disabilities, will mean Bradford Council will have to shoulder an extra £1.5 million, each and every year.

[Maggie Throup]

Will the hon. Lady give way?

[Judith Cummins]

I am nearly at the end of my remarks, and the hon. Lady has had her turn to speak.

What is beyond doubt is that the Chancellor must act in the upcoming Budget. He faces his greatest test in this Parliament. I hope that he and his Government do not disappoint. Time will tell.

--- Later in debate ---

[Helen Goodman]

The proposal to close Darlington A&E has come up only under this Government. It was not proposed under the coalition Government or the previous Labour Government. This Government must take responsibility for what is happening now.

On Saturday, I went to Alston in Cumbria. The people there are also running a campaign to stop their local hospital closing, because they will then have to go to Carlisle, which is 34 miles away. That is a long way, especially in Cumbria, where the weather is absolutely terrible and the road is often blocked. Ministers need to take more account of this big rural issue. People in Alston are also worried that there will be a cynical saving—the hospital in Copeland—and that they will face even bigger cuts. Perhaps the Minister will give us an assurance about that. The interaction between health and social care is well understood. We all know that cuts to social care mean a worse quality of care and less time for individuals.

[Maggie Throup]

Will the hon. Lady give way?

[Helen Goodman]

I would rather not because of the speaking limit.

Cuts also mean pressure on the NHS. Durham has faced really big cuts to social care. Between 2011 and 2017, it has had to make £186 million of savings. Child and adult care services comprise 63% of the total budget in the area, and adult social care cuts have been £55 million. The much vaunted precept raises only £4 million, and we have another £40 million of cuts to come. Even taking into account the better care funding, cuts by 2019-20 will come to £170 million. That means that there will be no social care in whole villages in my constituency. We are told that the Chancellor is minded to do something about it. Will he make up the full £4.6 billion that was cut in the last Parliament?

We have discussed the long term, which we do need to think about. The discussion about social insurance is important and significant, but we should also think about which institutions we would be asking people to put their money and their savings into. A lot of private sector organisations are, frankly, ripping people off with fees of £600 and £900 per week, even in my constituency in the north, where costs are not the highest. With fees like that, we do not even see highly trained people with expertise in dementia, but the same workers on minimum wages with low levels of training. We need to look at a stronger mutual approach and cut exploitative private sector contractors out of adult social care.

Reducing Health Inequality

Maggie Throup Excerpts

Thursday 24th November 2016 Commons Chamber

[Maggie Throup (Erewash) (Con)]

It is a great pleasure to follow the very thoughtful speech of the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson).

Today’s subject, reducing health inequalities, is very far reaching. I will focus on obesity, as I chair the all-party parliamentary group on obesity, and also sit on the Health Committee and was involved in producing the report that my hon. Friend the Member for Totnes (Dr Wollaston) has alluded to.

I make no apology for talking about obesity again in the Chamber. Alongside terrorism and antimicrobial resistance, it poses a major threat to our nation. More than one in five children are overweight or obese before they start primary school; that figure rises to more than one in three as they start secondary school. Our children—our future generations—are at risk of developing serious health conditions such as type 2 diabetes, heart disease and cancer. Recent data have shown the continuing and widening inequality gap in the overweight, obese and excess weight categories for reception and year 6 children. Some 60% of the most deprived boys aged five to 11 are predicted to be overweight or obese by 2020, compared with a predicted 16% of boys in the most affluent group— 60% versus 16%. Overall, 36% of the most deprived children are predicted to be overweight or obese by 2020 compared with just 19% of the most affluent.

Those vast inequalities must be tackled, and, as the Health Committee inquiry into childhood obesity stated, we need to take “brave and bold” action. Every study around at the moment shows that higher obesity rates are linked to deprivation. Critically, the national child measurement programme showed that the gap between areas less affected and those where childhood obesity is more prevalent is growing. That cannot and should not be ignored. We need to see it as a wake-up call, highlighting the fact that many of our young people could face a future riddled with the complications of obesity—as I have said, those include diabetes, heart disease and cancer—as well as the immense strain we risk putting on our public services and the potential emotional impact on our population. Medics are reporting cases of type 2 diabetes in children. That is shocking and frightening, as until recently it was thought of as a disease only of the older population. It is a reminder, yet again, that action is needed to prevent a public health calamity.

I will focus now on the overall impact of obesity in adults. It is important we provide parents with every tool possible to make sure they can be great role models when it comes to what we eat and our lifestyles.

[Rebecca Pow (Taunton Deane) (Con)]

I am sure that my hon. Friend is aware that last week Tesco announced significant changes to the amount of sugar in its drinks. It did so off its own back. What are her views about how such pressure from the supermarkets could influence outcomes for our children?

[Maggie Throup]

My hon. Friend makes a good point. It is not just Tesco that has done that; so have Waitrose and Morrisons, to name just two—I am sure there are many more. It is really good that major retailers have taken on board the severity of the challenge faced both by us as a nation and globally. Parents need to be role models, as do retailers. Sometimes they are not quite the role models that they should be, but we need every bit of help we can get.

It is not just childhood obesity that is linked to social class and to different levels of deprivation; adult obesity is, as well. The highest prevalence of excess weight for both men and women is found among low socioeconomic groups. If current trends continue, almost half of women from the lowest income quintile are predicted to be obese in 2035.

Obesity is the single biggest preventable cause of cancer after smoking. The Government acknowledge the importance of early cancer diagnosis, and dedicated NHS staff at all levels are committed to delivering that, so surely every preventive measure that can be put in place, must be. As previously noted, as well as cancer, obesity leads to a greater risk of type 2 diabetes and heart disease. Those conditions are all life-changing and life-limiting.

I am sure people now understand that there is a link between obesity and diabetes, but, sadly, I fear that many think they can just take a pill to keep diabetes under control. Sadly, for far too many diabetes sufferers, that is not the case. The consequences are vast, with many diabetes patients needing lower limb amputation and suffering kidney disease, heart disease and sight loss—as I said, it is life-limiting and life-changing. Action needs to be taken now to turn around what I believe has become an obesity epidemic.

Everything I have talked about should prompt a reconsideration and review of the Department of Health’s childhood obesity plan. Although the Government were leading the world in producing the plan for action, when it was published, many, myself included, said that it was quite a let-down. I stand by that view. There simply was not enough detail in that 13-page document. It was aspirational, rather than a focused plan of action; it ignored the recommendations of Public Health England, which were endorsed by the Health Committee; and it did not set firm timescales for turning the tide on childhood obesity.

The plan we have is insufficient for the scale of the task we have to tackle. That does not mean starting all over again, however; it means that we need to do more. We need clear actions and timescales. I acknowledge that there is a fine balance between a nanny state, business co-operation, and parental and personal responsibility, but I am sure it is not impossible to find that common ground. Yes, it is the responsibility of parents to ensure their children eat healthily, are physically active and learn good habits that will last a lifetime, but time and again that has proven insufficient by itself. Parents need more help and the current childhood obesity plan cannot and will not give them what they need.

It would also be a mistake to think the answer lies in burdensome regulation of business, namely the food and drink sector. Demonising that sector is both unhelpful and unfair. As we have discussed, some producers, manufacturers and retailers have already taken great strides in reformulating products and encouraging healthier consumer behaviour. We must commend them and welcome those actions. Evidence suggests that the least affluent households in the UK have higher absolute exposure to junk food advertising than the most affluent households. Interventions such as reducing the promotion of junk food, or the soft drinks industry levy, are likely to have a positive impact on reducing health inequalities by delivering change across the population and consequently delivering disproportionate benefit to the most deprived communities.

Just as the current plan does not help parents, however, it likewise does nothing for business, which would be better served by clear goals for reformulation, advertising and labelling, and timeframes in which those must be achieved. Both publicly and privately, many businesses in the sector note that they would be better served by clearer, more far-reaching Government recommendations that at least gave them a measure of certainty for the future.

We may well be horrified by the national child measurement programme figures and other data we read on an almost daily basis now. Just this week, Cancer Research UK revealed that teenagers drink almost a bathtub full of sugary drinks on average a year—I hope that a visual representation will shock some teenagers into changing their habits rather than suffering the consequences.

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

The hon. Lady is making an excellent and thoughtful speech—she will be pleased to hear that there has been nothing in it that I have disagreed with so far. Was she therefore as disappointed as I was at the removal from the childhood obesity plan—we can only guess at why—of targets on halving childhood obesity, as well as measures on advertising and marketing that would have helped with the issues she has been discussing?

[Maggie Throup]

I thank the hon. Lady for that intervention. I will come on to that point when I make some requests of the Minister towards the end of my speech.

We know that childhood obesity levels will not drop tomorrow, but we need to see some signs in the next few years that they are declining. The foundations of an effective strategy are readily available in the form of the Public Health England recommendations and the Health Committee’s report.

In conclusion, when the Minister responds, I would like to hear a firm commitment to the soft drinks levy; clear goals for product reformulation and timeframes within which those should be achieved; action on junk food advertising during family viewing; and action on supermarket and point-of-sale promotions—for example, we do not want to go to buy a newspaper and be offered a large bar of chocolate. I would also like to hear what accountability will be put in place to ensure that schools provide the exercise outlined in the plan. Such measures would ensure that we had a strategy, rather than just a vision, and enable us to start tackling the obesity challenge in our society today.

--- Later in debate ---

[Judith Cummins (Bradford South) (Lab)]

Thank you, Mr Deputy Speaker, for calling me to speak in this important and, in my opinion, overdue debate. I thank the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), for initiating it, and I thank the Backbench Business Committee for allowing time for it.

I want to focus on an area of health inequality that receives disproportionately less funding than most others and, sadly, far less attention from Ministers than it is due. I am, of course, talking about dental and oral health inequality. Most people, when asked to describe what health inequality looks like in this country, would cite difficulties in seeing a GP, long waiting lists for treatment for common ailments, and the rationing of licensed drugs for those suffering from treatable diseases. I could, of course, go on. Most, however, would not immediately cite dental and oral health, although inequality in that area is just as widespread throughout the country as the many other important inequalities that Members have rightly highlighted today.

Let me underline my point by sharing with the House some unsettling figures that have caused me, as a Bradford Member, more than a few sleepless nights. Official figures reveal that five-year-old children in Bradford are four and a half times more likely to suffer from tooth decay than their peers in the Health Secretary’s constituency of South West Surrey. The number of children admitted to hospital for tooth extractions—they usually require a general anaesthetic—has risen by a quarter over the past four years. Shockingly, during the past year 667 children in Bradford alone have spent time in hospital for that entirely avoidable reason.

[Maggie Throup]

As someone who was born in Bradford, I can proudly say that, even at my age, I have only one filling. As with obesity, dental problems are often due to a lack of parental responsibility as well as environmental factors.

--- Later in debate ---

[Rebecca Pow]

I did actually go out on a boat up the Thames this morning with Greenpeace to look at the issue of microplastics in water, and we also saw some trees. Trees are important and serve a good purpose in taking in air pollution, which has an effect on health; we have a lot of asthma in our cities. If we plant more trees, we will help to combat all that.

It has been demonstrated that mental health can be aided through contact with nature. As a keen gardener, I can vouch that getting one’s hands in the soil, watching things grow, planting seeds and watching the seasons change definitely does lift the spirits and is a pick-me-up.

[Maggie Throup]

My hon. Friend makes a good point that brisk walks are not the only thing that can help health. Last Friday, I was helping some young children at Chaucer Junior School to plant bulbs in the school’s grounds. We were getting exercise out in the fresh air in an area that is quite built up and urban, which must be a good thing for their future health.

[Rebecca Pow]

My hon. Friend is absolutely right. Many schools run gardening groups. There is so much to take from gardening, and it can also help the unemployed and other groups. Gardening is physical activity, but watching things grow out of the soil is so beneficial. In fact, Royal Horticultural Society research shows that 90% of UK adults say that just looking at a garden makes them feel better. Doing something in a garden is better, but one can also just look. There were data recently about watching birds on a bird table or hedgehogs. If someone has the chance to watch a hedgehog, that could make them incredibly happy because they are so rare now. I got terribly excited when I recently saw one eating my cat’s food.