NHS Risk Register

Margot James Excerpts

Wednesday 22nd February 2012 Commons Chamber

[Chris Skidmore]

Absolutely. We are debating whether we should release a register that is no longer relevant and that was written in autumn 2010, at the time of the request on 29 November. The topic is completely irrelevant, as the debate has moved on. We ought to be talking about reform and why we need it. We have wasted six hours of parliamentary time today discussing an out-of-date risk register.

[Margot James (Stourbridge) (Con)]

Does my hon. Friend envisage that some of the amendments and changes to the Bill that the Government have introduced since that time would deliberately have taken account of some of those risks and that the situation would therefore have moved on?

[Chris Skidmore]

Yes, the situation has moved on. We have had the listening exercise under Steve Field and various Select Committee on Health reports. The name of the commissioning bodies, which were called consortia, has changed. Nurses have been added and we have opened things up so it is not just about GP commissioning.

Oral Answers to Questions

Margot James Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Burns]

I do not want to disappoint my hon. Friend, but I am afraid I do not agree with that. What the Government have to concentrate on is giving the maximum amount of resources within the protected budget to the provision of health care in this country, to ensure, enhance and improve the quality of care for patients in England. That is the priority, not providing tax relief in any shape or form for people who use their choice for private health care.

[Margot James (Stourbridge) (Con)]

Professionals working in the NHS told the Health and Social Care Bill Committee that income from private patients was important to the development and improvement of NHS services. What steps will my right hon. Friend take to ensure that that income benefits NHS patients?

Breast Implants

Margot James Excerpts

Wednesday 11th January 2012 Commons Chamber

[Mr Speaker]

Order. Before I call Margot James, let me wish the hon. Member for Rhondda (Chris Bryant) a very happy birthday.

[Margot James (Stourbridge) (Con)]

I commend the Black Country Partnership NHS Foundation Trust on conducting 517 breast implant operations in the decade before 2008 without the use of a single PIP implant.

What this furore has revealed to me is the existence of a growing private sector offering a vast array of cosmetic surgery that extends well beyond breast implants. I fear that the need for tighter regulation of the industry will prove widespread, and I therefore welcome the Government’s commitment to a review. Does my right hon. Friend expect to be able to charge the private sector for the costs of any additional regulation that the review group may deem necessary?

[Mr Lansley]

I am grateful to my hon. Friend for what she said about the NHS. I think that before considering whether there is a cost associated with regulation and how it might appropriately be met, we should consider what is necessary to assure patients of safety and quality.

Oral Answers to Questions

Margot James Excerpts

Tuesday 10th January 2012 Commons Chamber

[Anne Milton]

The reality is that the Government are picking up a very depleted health visitor work force. School nurses, health visitors and the family nurse partnership are all critical. We picked up a very sorry state of affairs. The hon. Lady is right; early intervention matters, which is why we are doing it. I am just sorry that the previous Government did not take the action that was needed.

[Margot James (Stourbridge) (Con)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Andrew Lansley)]

My responsibility is to lead the NHS in delivering improved health outcomes in England, to lead a public health service that improves the health of the nation and reduces health inequalities, and to lead the reform of adult social care, which supports and protects vulnerable people.

[Margot James]

My right hon. Friend will be aware that a significant number of private clinics that fitted women with Poly Implant Prothese breast implants are no longer in business. Will he advise the House on how he plans to strengthen not just the regulation of clinics offering cosmetic surgery, but the products that they use?

[Mr Lansley]

I am grateful to my hon. Friend. I not only laid before the House a written statement this morning, but will, with permission, make a statement on the subject tomorrow. We have been very clear about the support the NHS will give to women who have had implants through the NHS, and we expect private companies to do the same. Not all will do so, and to that extent I make it clear that the NHS is there to support women in their clinical needs, whatever their circumstances.

Local Pharmacies

Margot James Excerpts

Thursday 24th November 2011 Commons Chamber

[Huw Irranca-Davies (Ogmore) (Lab)]

May I thank you, Madam Deputy Speaker, and your good offices for granting this Adjournment debate on a subject that affects hundreds if not thousands of people right across the country in England, Wales, Scotland and Northern Ireland? I hope to encourage, support, prompt, cajole and beat the Minister—in a very nice way—to put some urgency into this matter, which I know he is aware of and is working on. I think that we need to do more. I can understand why this issue has not grabbed the headlines that other health-related issues have.

A very wise MP once said to me, “Don’t go looking for issues. They will walk though your door.” That is exactly what happened. A female constituent came through my door about a year ago and said, unbelievably—it was unbelievable and I had some scepticism about it—that she could not get Femara, a cancer treatment drug. I said that that simply could not be the case because it is a readily available drug. It is not a drug that is not prescribed or that there is any shortage of. She left feeling a little disgruntled, but I agreed to take up the issue.

I contacted the chemist, who said that my constituent was absolutely right. They said, “I cannot get hold of it in my own stocks, I cannot get hold of it locally by ringing other chemists and I cannot get hold of it from my regular distributors. I actually have to ring the manufacturer.” Even having done that, there was a delay before it was delivered, leaving somebody without their cancer treatment drugs. The implications of that are not only physical and medical, but emotional.

Having looked into the matter further, it appears that this is a widespread concern. Like most people, I assumed that if a drug was a prescribed medication, it would be widely and freely available. I did not know about the systemic problem that we face in the UK in ensuring the supply of life-saving medicines. If one looks behind the façade of normality, one can see clearly the pressure on the pharmaceutical drug supply chain from manufacturers, through wholesalers and distributors, to pharmacists and right down to individual patients.

The Minister will be aware that today there are problems with about 50 products. Those medicines treat a wide range of conditions including cancer, Parkinson’s disease, schizophrenia, depression, asthma, diabetes and high blood pressure. All of those products seem to be in short supply due to the problem in the supply chain. In the midst of coming to terms with a serious medical condition, the last thing that I, the Minister, you, Madam Deputy Speaker, or anybody would want to face is the fear of not being able to receive their treatment or of having it interrupted because of a problem in obtaining the medicine. Yet that is the precise situation for too many people on a daily basis.

It is our community pharmacists on the front line who see the overwhelming reality of this problem. I know that the Minister will recognise that when pharmacists cannot get hold of a drug for their patients, they work hard behind the scenes, under the calm waters, often in a Herculean effort, to ensure that nobody is left without their vital medicine. I have seen in my constituency the hoops that pharmacists are obliged to jump through to obtain medicines on such occasions. All too often, they have to ring round other pharmacists in the hope that they have the medicines available, spend time on the phone to the wholesaler or the manufacturer, or send faxes with copies of prescriptions to manufacturers in the desperate effort to find supplies on the day for their patients. On too many occasions, they are told that there is no stock available from the wholesaler or the manufacturer. Despite the time spent on that wild goose chase, pharmacists still try to provide the multitude of other services that the NHS and we ask of them.

[Margot James (Stourbridge) (Con)]

I congratulate the hon. Gentleman on securing this debate on such an important topic. Is he aware of the survey conducted as recently as this month by Lloyds Pharmacy of its pharmacists, which confirmed the point that he is making? It found that 50% of the pharmacists surveyed were spending between one and three hours a week trying to source medicines, and that 16% were spending between four and six hours a week doing so—almost a day of their working time.

[Huw Irranca-Davies]

Absolutely. The hon. Lady makes a very good point. I am aware of that survey, and I will touch on it. This is not a party political issue at all, it is very much cross-party, and I know she has a real interest in and specialist knowledge of the matter. We can help the Minister by suggesting to him some ways forward.

The Lloyds survey to which the hon. Lady refers was of 400 pharmacists, and it showed that 80% of pharmacists were unable to dispense items, or had had to call their local GP surgery, for four or more prescriptions a week. For 26%, that number rose to more than 10 prescriptions a week. On average, half of pharmacists surveyed were spending at least one to three hours a week trying to resolve stock availability problems for patients. That includes ringing around other stores, contacting suppliers and liaising with prescribers. Critically, as she said, 16% spend at least four to six hours a week doing so, and 8% spend more than six hours a week chasing down stock.

Another survey that has been undertaken, of which the House may not be aware, is a 2011 preliminary survey on medicine supply shortages by Chemist and Druggist online. It found, echoing those earlier findings, that 93% of respondents were spending more than one hour a week sourcing key medicines. It found that 54% were spending more than two hours a week doing so, and that 10% were spending five hours or more. If they are doing that, they are not providing the front-of-counter services that we want them to, such as helping people with minor ailments and providing other assistance. That survey also found that 90% had had to ask GPs to change a prescription in the face of shortages, and that 70% had found getting hold of branded medicines even harder in the past year than in previous years. Those figures mirror those in the previous survey the year before. The problem is at least as bad as it was a year ago, and possibly getting worse.

Let me personalise the matter. I spoke to a community pharmacist from Rasharkin in Northern Ireland this week, who told me:

“Supply chain issues are becoming an increasing problem as I continually have to telephone the manufacturer directly for stock. For example today”—

Monday 21 November—

“we had four prescriptions outstanding for a drug for depression; we had ordered these electronically through the manufacturer’s chosen supplier five days ago but the stock has still not arrived. We had to telephone the manufacturer for stock today and they insisted we supply copies of the prescriptions. I refused as I believe there are issues here with patient confidentiality. They agreed to send only a partial order. Two of the above patients will be without their medication until the supply arrives, the other two have enough to keep them going for a few days.”

Patients in that situation are all too often left with only a small supply, and sometimes with none of the medicines that they need. Research by the Patients Association found that half of those surveyed had had to wait two or more days to get their medication when there were stock availability problems, and that two thirds felt from their personal experiences that medicine shortages were definitely having an impact on people’s health. That situation will see real harm caused.

The Chemist and Druggist 2011 survey has already found tangible incidents of harm caused to patients by a lack of available medicines. To cite some examples, it found incidents of a pharmacist having to refer a patient back to hospital because of a shortage of drug supply; patients describing themselves as “stressed and upset”, and suffering severe emotional trauma; a patient experiencing difficulties with anxiety that had previously been controlled by their medication; and a diabetic patient suffering a hyperglycaemic episode while waiting for their medication.

The evidence showing the problems in the supply of medicines to local pharmacists is clearly overwhelming. The reality for patients, including the one who came through my door a year ago, is frightening. Despite the hard work of pharmacists everywhere, the results could be fatal. We must avoid that. The situation was noted by the all-party group on pharmacy this week when it announced that it will hold a full-scale inquiry into the continuing problem of shortages in NHS medicines.

The reasons for the shortage in the supply of such crucial medicines, as in any situation, are varied. First, as the Minister will know, European competition policy promotes a free market in medicines. The trade is legal and encouraged by the EU. With the weak pound, there is money to be made—by pharmacists, wholesalers and others—by selling drugs to those in Europe.

The Association of the British Pharmaceutical Industry states that the recent Medicines and Healthcare products Regulatory Agency announcement that it will repeal section (10)(7) of the Medicines Act 1968 to prevent pharmacists from trading without a wholesale licence is an important step in the right direction, but it will not solve the problem. Experience has shown that supply in the market well beyond what is needed for UK patients does not solve the problem of shortages at pharmacy level —it simply results in more stock being diverted overseas.

The second reason is the number of wholesalers. There are now 1,800 wholesale dealer licences in the UK. Additionally, according to the British Association of Pharmaceutical Wholesalers, six years ago, a pharmacist could order from their chosen wholesaler almost any medicine manufactured, but nowadays, they need to order from at least two or three wholesalers, which means two or three deliveries at different times of the day, with two or three times the paperwork.

Thirdly, quotas put in place by manufacturers to control demand are crude and lack the flexibility to meet ordinary fluctuations in demand. In one case, a pharmacy was restricted by a quota to 28 days of supply for a medicine, meaning that it was unable to fulfil 56-day prescriptions. To overcome such situations, pharmacists must place so-called emergency orders directly with the manufacturers for stock to be delivered individually in unscheduled deliveries, which often arrive via courier companies one or two days after the identified patient need.

Increasingly, patients are forced to wait while the pharmacists make daily emergency orders with various manufacturers. They often have to go through quite intrusive audit questions to prove they have a genuine patient need. On top of that, the patient has to await delivery. Another pharmacist—from Gwynedd—said of this unacceptable situation:

“In many instances after phoning our wholesalers and the manufacturers and even…specialist wholesalers, we are eventually able to source the drug, but it doesn’t arrive for 2 to 3 days.”

In March 2010, the then Secretary of State, my right hon. Friend the Member for Leigh (Andy Burnham), held a summit meeting of all industry stakeholders and formulated an action plan. In February 2011, the Department of Health published guidance, but as we approach 2012, a solution is still not in sight, unless the Minister brings some clarity today. The guidance is a step in the right direction, as recognised by Pharmacy Voice, but it is not the silver bullet—there is no silver bullet. Problems remain and it is time for further affective action to be taken.

What should that action be? We should update the regulations on patient access to medicines to make them fit for purpose. Currently, there is a duty to supply, but no time scale in which to do so within the UK. Other EU nations, including Belgium, France, Finland, Germany, Greece, Hungary, Italy, Norway, Portugal and Spain, have implemented a patient or public service obligation—I prefer the phrase “patient service obligation—on the manufacturers and wholesalers to ensure that community pharmacists can get medicines to their patients when and where they are needed. It is time for the UK to implement its own, albeit adapted, version of a patient service obligation. The Minister might be hesitant to do that, but we place obligations on distribution network operators to connect people to the national grid to ensure that they receive an uninterrupted supply of electricity, and yet we have no obligations on an uninterrupted supply of medicines.

There are different ideas on what would constitute a patient service obligation, but let me suggest some principles that might underpin one. First, all those who supply medicines, whether manufacturers, distributors or dispensers, should have a duty to ensure that the medicine supply chain is economically efficient in line with the clinical needs of patients, so it delivers to them on time. Secondly, all those who supply medicines should have a duty to ensure that patients can easily and quickly obtain the medicines they need and to prioritise the supply of medicines to UK patients. Thirdly, medicine supply arrangements must be sufficiently robust and stable to guarantee a continuous supply to patients, including the rigour needed to absorb any short-term disruption—for example, through extreme weather conditions, as we saw last year.

Such a patient service obligation would receive support across the supply chain from manufacturers, wholesalers, pharmacists and patients. The National Pharmacy Association and the British Association of Pharmaceutical Wholesalers are already on board, and the Association of the British Pharmaceutical Industry is keen to learn more. Indeed, the Government have not ruled out a patient service obligation. I see no reason why active discussions between all interested parties—the manufacturers, wholesalers, pharmacies and patients associations —cannot begin immediately, brokered by the Minister and the Department of Health. Perhaps the Minister would like to know that a recent Pharmacy Voice survey has shown that such a move would find considerable favour with the public.

It is time for the Department of Health to lead on this vital issue. The evidence is overwhelming and the urgency palpable. Everyone is ready to find a solution and ensure that the aims of a patient service obligation—ensuring that no one goes without their vital medicines—are more than just an ambition, and become a reality. I hope the Minister in his response—I know that he is aware of the critical nature of this issue—can assure the House of his intention to act on this issue with real urgency.

Oral Answers to Questions

Margot James Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Paul Burstow]

If the hon. Lady had prefaced her question with an apology for failing to sort out the problem for 13 years, I might have taken it more seriously. This Government moved urgently to establish the commission chaired by Andrew Dilnot, we are now actively working through his proposals, and we will come forward with legislation and a White Paper in due course.

[Margot James (Stourbridge) (Con)]

Does my hon. Friend agree that the integration of health and social care should be leveraged by commissioners to encourage savings in the acute sector, to contribute to funding much-needed improvements in long-term social care?

[Paul Burstow]

There is no doubt that more integration between health and social care is a way of improving the quality of services delivered to the public, and of releasing resources that can then be reinvested in improving services. We know, for example, that the use of reablement services can reduce costs and improve the quality of life outcomes for the people who receive them.

Social Care Funding

Margot James Excerpts

Thursday 10th November 2011 Westminster Hall

[Margot James (Stourbridge) (Con)]

It is a pleasure to serve under your chairmanship, Mr Bone. I must apologise to you and to the Front-Bench spokespeople. Unfortunately, I will not be able to stay to the end of the debate. I apologise, but I have a pressing engagement in my constituency this evening.

I would like to begin by congratulating my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing a Backbench Business debate on such an important topic. Several speakers have alluded to the crisis in care funding at the moment and to the service being chronically underfunded. I want to throw some light on why I think that that has become the case.

Age UK reported earlier this year, in June I think, that spending on adult and social care rose by only 0.1% between 2004 and 2010. Crucially, during that period the numbers of older people needing care expanded significantly, to say nothing of those in other generations who also need care. The number of older people aged over 65 increased by 7.7%, while the number of very elderly—the over-80s—increased by 11.6%. While the care budget for older people was static—rising by 0.1% in real terms, to be precise—the numbers requiring that care have expanded, and that rise is continuing. It is interesting to note that, at the same time, other budgets were rocketing: spending on the NHS increased by 27%, on the police by 20% and on schools by 12%. That is salutary, because we can see how older people’s care has been treated and valued over time. We arrive at the point where—I agree with everyone in the Chamber—it is not enough. Most councils have therefore been under pressure in that area for a considerable length of time, which precedes the public spending review of the past 12 to 18 months. Most have responded to the challenge by tightening the eligibility criteria for the provision of care at home and by making far more use of private providers.

The situation in my borough of Dudley exemplifies the problem. I have visited approximately 10 private care homes in my constituency, and I apply my own inspection criteria—crudely, whether I would have willingly allowed my mother to be cared for in the home. We are fortunate in Dudley—certainly in my part of it, Stourbridge—with the overall quality of our homes, but the fees paid by the local authority for people to be looked after are imposing on the good will of the management and staff in the homes.

The local authority pays roughly £380 per week per resident, but for the past three years there has been no increase in the fees, while those homes have had to contend with rising costs including for fuel, food and even, to a certain extent, staff. So private homes are struggling; if they are small or family-run concerns, the show has been kept on the road with an enormous amount of dedication and hard work. The result is that self-funding residents are often charged significantly more than the local authority-funded residents. I have consulted Age UK, which has consulted lawyers, about whether cross-subsidisation can be proved, because that would be against the law. However, it is difficult to prove, although it strikes me that the discrepancy is so high that some homes must be using the fees of self-funding residents to cross-subsidise the local authority-funded residents.

The care at home situation is just as bad. The proportion of local authorities providing care to people in moderate need fell from 36% in 2004 to 21% in 2010. I do not doubt that the figure is still falling. That must surely be a false economy, because the less care provided to those in moderate need, the greater the speed at which they will develop substantial needs. In some ways, the home care sector is in worse shape than the residential sector. What I mean is that, in my own borough, the transfer from public to private provision appears to have worked less well for older people who need care at home than for those in residential care. Like the hon. Member for Luton North (Kelvin Hopkins), I have received a steady stream of complaints from the recipients of such home care, and the complaints are always the same, even though the providers might be different. There is a constant change in carers and no consistency of personnel, with a great variation in the standards of care provided, as well as in the kindness and compassion.

[Kelvin Hopkins]

I am interested in and sympathise greatly with what the hon. Lady is saying. Recently, I spent a day touring with a district nurse professionally employed in the national health service, and I saw the care and compassion that she gave to all her patients, whether it was re-bandaging or dealing with people suffering from cancer, and so on. The contrast between that professional, publicly employed person and what I hear about some of the private providers with inadequate staff is great.

[Margot James]

I have considerable sympathy with the hon. Gentleman in the context of home care. I find quite a few of my constituents bemoaning the rapid transfer from the local authority staff who used to provide care to the private sector. I am often in favour of bringing in the private sector, but it has to be done carefully and intelligently, and with proper checks and monitoring.

Another point, also made by the hon. Gentleman in his speech, is that carers come at very different times, without any consistency or reliability; they often come too early to help someone get to bed and too late to help them get up in the morning. In too many cases the service is patchy, inconsistent and fundamentally unreliable, and something needs to be done. Perhaps the business model needs to be looked at. It cannot be beyond the wit of an employer to employ more people at certain times of the day. That is probably the only answer, which means that more money might be needed, which I appreciate is a vexed question in the current climate.

I agree with other hon. Members that the Dilnot report is an excellent contribution to the debate, but it has some drawbacks. First, Dilnot has commented—perhaps not in the report but I have certainly heard him in speeches made about the report—that residential care means-testing is the biggest cliff face across the entire gamut of social care policy. Savings of more than £23,250, including the capital tied up in your home—68% of householders aged 65 and over own their homes outright, without a mortgage, so we are talking about a lot of people—disqualify people completely from funding support. No banding, no scaling up or down, only one figure, below which people receive 100% funding support and above which they receive nothing. In response, people have had to sell their homes. We have heard some sad examples, in particular from the hon. Member for Lewisham East (Heidi Alexander), and listening to several contributions I have appreciated the difficulty for people from a working-class background who have struggled and saved and whose assets are small in total. I will make a point about that.

People who are fortunate in their health will not need residential care and will not have to sell their home. For people who need residential care and have no assets and nothing to lose, that is okay as well. However, people who own their own home and need residential care are at a striking disadvantage to others of their age group. That is why I appreciate Dilnot’s broad strategy to cap an individual’s contributions to the care needed and to raise the threshold at which people become eligible for support. More work remains to be done, however, to identify the actual figures deemed fair and affordable for the taxpayer to fund. Raising the threshold to £100,000 is a bold move, but is it affordable? I do not doubt that that conundrum is on the Minister’s plate, and there are more problems with the cap.

[Kelvin Hopkins]

Dilnot pointed out that £100,000 is a crucial point at which the cost starts to take off, and his proposals would cost £1.7 billion a year, which is not a great deal in the scheme of things. After that, it starts to rise more rapidly. A £100,000 threshold would protect many people, such as my hon. Friend the Member for Lewisham East (Heidi Alexander) and her family.

[Margot James]

I thank the hon. Gentleman for his intervention. It is true that a £100,000 threshold would provide protection, and I hope very much that we can afford that element of Dilnot’s proposals. That threshold would provide a huge amount of help and protection for just the sort of cases that he and the hon. Member for Lewisham East mentioned.

Turning to the cap that Dilnot recommends, I believe that it should be rethought. He said that it should be between £25,000 and £50,000, beyond which no one should have to pay. Although my suggestion would introduce some complexity—I accept that that is a disadvantage—we must consider a scale on the cap that is linked to people’s assets. A one-size-fits-all approach, whether it is £50,000 or £25,000, does not reflect the huge variation in house prices throughout the country. The average house price in Dudley borough in my constituency is £145,000, but the average house price in Greater London is £420,000, so for families in my constituency, and perhaps in that of the hon. Member for Luton North, the cap on care represents a third of their assets, whereas for families in London in a house with an average value it represents little more than 10% of that value. That is unfair, and I hope that the Minister and his team will look at ways in which the problem can be overcome.

I am afraid we will to have to ask more of people who have seen the value of their home spiral over the last 25 years. I trust that with better use of resources, and thanks to Dilnot and the Government’s commitment to seek a cross-party solution to the vexed problem, we will no longer have to ask people to sell their home to fund their care. However, if we cap the amount that people must spend on care, we may have to ask them to remortgage part of the value of their home to contribute to the overall cost that Dilnot recommends. I cannot see a magic pot of £1.5 billion in the Government’s credit balance, so we must be realistic in what we ask them to do. Asking people to remortgage part of the value of their home to contribute to their care is not as bad as the current system, which requires so many to have to sell their home and to invest so much of the proceeds, if not all, in residential care costs.

In conclusion, the reaction to Dilnot has not been as favourable among health and social care managers as it has been among those of us, including organisations outside Parliament, who campaign on behalf of older people. They fear that they will have to find money from their cash-strapped adult and social care budgets. As the other main activity outside residential care is home care—I have described a situation that is far from satisfactory, as have other hon. Members—they fear that there will be less money to fund home care if they have to implement the Dilnot report to fund the higher cost of residential care. I share that concern.

What else can be done? I have said that I do not expect the Government magically to conjure up £1.5 billion in the serious and perhaps worsening economic situation. We must find a better way of managing our resources, and that money must probably come from one of the only protected areas of Government spending—the NHS. Hon. Members have mentioned that the Government have diverted £1 billion from the NHS to social care, and that has been well received, but I do not believe that it goes far enough. NHS spending has risen hugely in the past 10 years, and 27% for the six-year period does not cover the half of it. It does not cover the private finance initiative costs, which have been astronomical.

Too many older people in hospital would be better managed in the community. We have heard about bed-blocking, and that occurs in Dudley borough. People are waiting for residential care places, but the funding is not coming through to meet the need. That funding should be reconfigured more substantially in favour of community care. Many experts who know more about the NHS than I do—the King’s Fund, some hospital consultants and so on—recognise that we have too many hospitals. I am not saying that there is an easy answer, and no one wants hospitals on their patch to be closed, least of all me, but there may be a way of utilising that space and resource more effectively. I urge the Minister to discuss that with the Secretary of State to see what can be done. That would be a more fitting tribute to the Dilnot inquiry than trying to implement every detail in his report.

[John Pugh]

rose—

NHS Care of Older People

Margot James Excerpts

Thursday 27th October 2011 Westminster Hall

[Margot James (Stourbridge) (Con)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Betts. I thank the Backbench Business Committee for allowing us to have the debate this afternoon, and I am grateful to colleagues on both sides of the divide for supporting it. I look forward to hearing the views of other people who have a great interest in the subject.

We are here because of troubling reports about the care of older people in the NHS. I was prompted to confine our debate to the NHS by the report from the Care Quality Commission two weeks ago, which studied 100 NHS hospitals. The report was by no means an isolated study; it came on the heels of the ombudsman’s report in February and Age UK’s “Care in Crisis” report in May.

That we have a worrying problem is beyond doubt, but I hope to bring a balanced view to the debate. It is important to note that even when reports give cause for serious concern, there are significantly more examples of good and acceptable care than there are of bad. Indeed, the ombudsman’s report stated that the overwhelming majority of patients say they receive good care. I will return to the balanced view that I promised, but first I will outline the concerns raised by the latest findings of the CQC.

The Secretary of State commissioned the CQC to undertake a series of unannounced inspections in response to the ombudsman’s report. The inspections focused on outcomes, interviews with patients and staff, and observation on the wards. Two outcomes were measured: respecting and involving people who use services, which includes care, dignity and respect for privacy, and meeting nutritional needs. Forty-five of the 100 hospitals met both standards in full; 35 met both standards but needed some improvement, and 20 were not even delivering care that met minimum legal standards. Of those 20, Sandwell General hospital and the Alexandra hospital in Worcestershire—both quite near my own constituency —were found to be putting patients at unacceptable risk of harm.

If we look in more detail, we see that 60 of the hospitals were found to be meeting a good standard in respecting the dignity and privacy of patients on both the wards observed by the CQC. Staff behaved in a way that respected patients; they were positive, sensitive and respectful; they involved patients in decision making and explained treatment options properly. Where there were problems on this measure in the other 40 hospitals surveyed, not one of the hospitals was found to be failing on both the wards observed. It is noteworthy that the report found a large degree of variation in practice, and I will return to what I think that says about management and leadership later.

On the nutrition outcome measure, 17 hospitals were failing to reach an acceptable standard. Patients in need of assistance at mealtimes were not getting help; food was placed out of reach; there was no monitoring of whether patients had eaten their meal and there were constant interruptions during mealtimes. For example, a clinical round would suddenly start during lunchtime. Age UK’s report, “Still Hungry to Be Heard”, found that 157,000 people left hospital malnourished in 2008, and that the figure had increased to 185,000 in 2009. Astonishingly, 239 patients died from malnutrition in 2007.

New research published last month found that across the NHS, 9 million meals are returned uneaten per year at a cost of £22 million. One of the problems is whether we can serve three appetising meals of decent nutritional value for less than £5 per patient, which is what my own local hospital budgets for. I would say that we cannot.

As I see it from the two reports, when the scale of the problem is considered across the entire older population who are being cared for in our hospitals, it is not as great as is often reported by the media in the immediate aftermath of yet another report. However, for the older patient on the end of the worst care, it amounts to cruelty and neglect by staff.

[Andrew George (St Ives) (LD)]

My hon. Friend makes a very good case. On the key findings of the CQC report, which the media seem to report as a failure of nursing when the bulk of them are really issues of care, will she also cover the issue of the resources that appear to be going into hospital wards, particularly with the increasing acuity and turnaround of patients, and nursing and care staff to patient ratios, which appear to be on the edge in many cases?

[Margot James]

I thank my hon. Friend for making a very good point. I will return to the resourcing issue. I do not have statistics on the staff to patient ratio, but it is noticeable that it is much better in paediatric wards than in wards with large numbers of older people. Perhaps we can learn from that.

I was talking about cruelty and neglect. Staff are paid to care in institutions that are for the most part monopoly public services; the patient has no choice but to be there. In Age UK’s 2010 research, 21% of patients said they were not always treated with dignity and respect, and there has been no improvement in that figure since 2002. The figure is fairly consistent with the CQC findings and it seems to be consistent with other reports. It leads me to think that the problem we must address is twofold: first, the overall figure of one in five being essentially ignored—or worse—in our hospitals is simply too high, and secondly—the worst aspect—nothing ever changes that figure. Despite all the reports and information, nothing actually changes that figure.

Care is failing one in five of our older patients two or three times a year. The new research confirms that failure, but no effective action is taken to remedy it or to reduce the problem. I hope that as a result of our collective ongoing efforts, we will finally make a significant impact on the problem. It is likely that one of the reasons for the inaction that has persisted for a decade or more has its roots in a wrong or partial diagnosis of the causes of the problem, so I will turn to the various causes that have been advanced by research and informed commentators on this state of affairs.

The causes that I have read about can be grouped under the following headings: leadership, management, resourcing, training and what I loosely call societal. The leadership of individual hospitals such as Stafford—to take the worst example—sets out daily through a series of explicit and subliminal messaging what it is important for staff to deliver in that institution. At most, the focus from the top will resonate further down the line in only one or two areas. Staff know, either consciously or unconsciously, that if they deliver on one or two variables, they will not be seriously picked up for partial or non-delivery elsewhere. That is the same in any large organisation. Often, the overriding concern at the top in NHS hospitals is about meeting financial targets, just as it was in Stafford. In other cases, rigidly applied clinical outcomes might bear little relation to how a patient is treated by staff before and after their care or surgery.

Leadership does not come only from the chief executive and key board members. I served on the board of an NHS trust that was answerable, in a mechanistic, command-and-control way, to the Department of Health, which in turn was accountable to the Secretary of State—I am going back 10 or 12 years. Political pressures on a Secretary of State are principally financial, but they also concern global outcomes in politically sensitive areas such as cancer. The day-to-day treatment of patients is often delegated to a regulatory quango, but irrespective of the party in power, the Secretary of State will survive the occasional embarrassment and discomfort caused by yet another report. That explains the extraordinary situation whereby the care problems at the James Paget University hospital in East Anglia were serious enough to warrant a warning notice from the Care Quality Commission, but nurse training at the same hospital was well rated by the Nursing and Midwifery Council.

Although overall management and culture is set by the board, the main divide between good and bad management depends on the effective deployment of resources, the motivation and discipline of staff, and the systems for gathering customer—or patient—intelligence. The CQC noted that in some wards, levels of under-resourcing made poor care more likely—the point raised by my hon. Friend the Member for St Ives (Andrew George). Patients commented to the CQC about how hard pressed the nurses seemed, and that was confirmed by comments about the report by nurses writing on blogs. Even allowing for a certain amount of, “They would say that wouldn’t they?”, some of the remarks seemed heartfelt and genuine.

Interestingly, however, none of the hospitals where care was found to be poor was found wanting in all the wards inspected. Unacceptable levels of care were seen on well-resourced wards, and excellent care was found on wards that were understaffed. That indicates that the issue has more to do with ward leadership and the personalities and values of nurses in leadership roles than with the overall budget at the disposal of hospitals where problems were encountered.

[Andrew George]

I am not sure that I draw the same conclusion as my hon. Friend. She suggests that resourcing is not particularly relevant when considering the quality of care achieved, but surely she accepts that the situation is far better, and high levels of care more likely, when resources are adequate.

[Margot James]

I agree that care is more likely to be good when resources are adequate, but poor care has been observed on wards that the CQC regarded as well resourced. I do not draw a neat and fast conclusion, and having worked in business for many years I accept that resourcing is important. It is difficult to generalise from the available research, but I take my hon. Friend’s point.

On nurse training, the CQC found that half of hospitals were ailing in the areas of privacy and dignity; staff had little training in matters of privacy, dignity, rehabilitation and dementia. Training, and the lack thereof, is a symptom of the growing and unregulated use of health care assistants. In a report out today, the Royal College of Nursing states that in some parts of the country, 40% of staff on a ward are health care assistants. I will return to that point.

Another important issue is the general training of nurses. Consensus seems to suggest that although Project 2000 brought benefits to nursing status and career paths, the effect on care has been less positive. Earlier this year, Camilla Cavendish, a journalist from The Times, undertook extensive research across the country. Her observations suggest that Project 2000, which moved training from hospitals to universities and gave it degree status, has led to nurses spending too little time on wards during their training, and they are under-prepared to deal with patients when they graduate. Project 2000 has also led to gaps on wards, which have been filled by health care assistants. Such assistants are supposed to be supervised by nurses, but although I have no evidence either way, I wonder whether nurses have the training for such supervision.

Patients often think that health care assistants are nurses, and it is not always easy to distinguish the two posts. Health care assistants, however, have almost no training and perform non-medical tasks such as providing help with feeding and washing. I am sure there is a degree of mission creep into areas that require some form of training, and I shall return to that point. Perhaps it is no wonder that many nurses feel that certain aspects of caring are menial work.

[Andrew George]

My hon. Friend suggests that nurses see caring as menial, but that is not an observation I would make. I had the opportunity to shadow nurses in four wards, and they told me that they wished they had more time to perform a caring role in addition to their clinical duties. Such a role would fulfil the observational function that nurses are trained to perform in order to continually assess a patient and review their diagnosis. That nurses believe themselves to be above a caring function is not a conclusion that I would draw, and I believe that it besmirches the professional standing and pride felt by a lot of nurses.

[Margot James]

My hon. Friend makes some good points. Camilla Cavendish visited hospitals across the country as part of her research and spoke to many patients and nurses, and the view I have mentioned was expressed not only by patients but by nurses. I am sure that such cases are in a minority, and I certainly do not intend to besmirch the good reputation of the majority of nurses. However, the research leads me to believe that a minority of nurses either do not have time for care or feel that although care is not beneath them, it should be carried out by staff at a different level. That is a legitimate view and has been expressed in a variety of nursing journals and other forms of media by retired nurses who have visited hospitals. My hon. Friend should not dismiss that element of concern, and I emphatically do not wish to besmirch the reputation of our many good nurses. However, when we read in the CQC report about the problems engendered by the very poor care that some patients receive, we realise that we cannot afford to dismiss any of the conclusions reached by people who have done a lot of research.

I want to move on to some societal observations. The ever-increasing use of scientific and technological advances brings many benefits, but it also creates a work environment that requires nurses to concentrate on aspects of treatment and care that isolate them from the patients whom they are serving. The workplace in general outside hospitals is becoming more mobile. People connect with one another far more via devices of various sorts. That presents a risk to the caring professions that needs managing.

Then there is the issue of the pool of talent from which nurses and other caregivers are drawn. This summer saw an explosion of violence, avarice and selfishness on our streets on a major scale. Although work is ongoing to identify the cause of that phenomenon, it is clear to many of us that the fault lines in our social fabric are every bit as wide and deep as suggested by the research undertaken by my right hon. Friend the Secretary of State for Work and Pensions, before he came into government. These incidents affect all walks of life. Much more could be said on that point, but I do not intend to elaborate on it now. For the purposes of this debate, the implication is that nurses are as much a reflection of modern Britain, with its drawbacks—a society in which a significant minority seem to be more aware of their rights than their responsibilities—as well as its strengths.

Likewise, patients and their families reflect society. Melanie Reid, a columnist for The Times, spent a year in a spinal injuries unit following a tragic accident. She wrote an excellent piece on the nursing debate three weeks ago. She said:

“If you want to change nursing, you have to change society. You also have to change the patients. Today’s sick are…not deferential sufferers in silence. They and their relatives can be aggressive and unreasonable.

Everyone’s a professional complainer. During my spell in hospital, I saw some patients whom, had I been forced to cope with their constant demands, I would have smothered at dawn. Instead, the staff treated these people with civility and good humour.”

I shall turn now to some conclusions and recommendations. I shall conclude with what I think needs to change and I hope that the list of areas to which I refer will provide a platform for further consideration by the Government. I note that the Government are already making positive changes in some of the areas, and that is welcome. My priorities for change would centre on the importance of food and nutrition in hospitals and the standards in that respect; the accountability of boards and chief executives for the care of patients; resource allocation; the inspection regime; hospital complaints procedures; and nurse and health care assistant training.

[Alison McGovern (Wirral South) (Lab)]

The hon. Lady’s final point before she reached her conclusions and recommendations made some quite clear criticisms of the values in society. Will she add to that list how she would like the values in society to improve?

[Margot James]

I welcome that intervention because whenever one is preparing for a debate such as this, one is conscious of how much more there is to say than one has time for. I was not intending to draw too many conclusions on what needs to change in society. I was concentrating on what needs to change in the domain that we are discussing, but perhaps the hon. Lady would care to call for a debate on the topic to which she has referred. I am sure that we could fill an afternoon with such a discussion and I should be delighted to take part.

[Neil Carmichael (Stroud) (Con)]

One matter that needs to be thought about carefully in this debate if not elsewhere is, of course, the integration of the NHS and social care, because that will help the process along and deal with many of the issues to which my hon. Friend is referring.

[Margot James]

I thank my hon. Friend. That is a very good point. The integration of health and social care should, with the weight of joint commissioning behind it, make quite a difference. My speech has concentrated on care in hospitals, but I hope that other hon. Members will bring out issues to do with care at home and other aspects of what the NHS delivers.

I shall go through my list of recommendations briefly. On nutrition, the Age UK report, “Still Hungry to Be Heard”, advocated that ward staff needed to be “food-aware”. Training should include nutrition and the importance of assistance with meals when needed. I agree with these recommendations. Older people should be assessed for signs of malnourishment on admission, during their stay and on discharge. Hospitals should introduce protected mealtimes. Where they are using a red tray system, which involves a red tray being given to patients who require assistance with eating, staff should be trained in how to use it. It sounds as though that system works well where it is used properly.

[Alison McGovern]

I thank the hon. Lady for her generosity in giving way to me again. Does she question, as I do, the red tray system, in that if nurses and nursing staff understand the needs of a person, surely they should understand what their nutritional assistance needs are without the use of a red tray? Surely they should know patients well enough already. Is that not a question that we should ask?

[Margot James]

I thank the hon. Lady for her excellent point. In an ideal world, I would strongly agree with her. I agree that what she has suggested is to be desired. The trouble with relying on that is that the throughput of patients through wards these days is quite fast, the rostering system for nurses is very complicated and the continuity of care is certainly not as good as it used to be. Many nurses work intensively for a week and then have a substantial amount of time not working. Therefore the personal relationship, which is so desirable, has been compromised to the extent that we can no longer rely on it to ensure that patients’ nutritional needs are met. That is why I believe that the red tray system is useful. However, I am very concerned that people could easily think, “Oh well, that sorts the problem out,” and not feel that they need to relate to the patient in the way that the hon. Lady suggests.

I come now to accountability. I realise that this is not something that the Government can mandate, but chief executives should come on to the wards regularly—every day that they are in work. Nurses used to be accountable to a matron, who would turn up unannounced to check on standards. We must replicate that discipline again, and I recommend starting at the top.

Managers need to ensure that budgets are used wisely to support front-line staff and that front-line staff are not distracted by other, non-patient-care “priorities”. I looked at nurse blogs when I was preparing my speech and I sympathised with one nurse who said that nurses are

“at the beck and call of so many departments who wish to give work away and have no qualms in ‘getting the nurses to do it’. Loan stores, training, HR, to mention a few who seem to have forgotten that their role is to support us—not the other way around.”

I have sympathy with busy nurses who are pulled in all directions.

[Andrew George]

I am grateful to my hon. Friend for giving way to me a fourth time, which shows how patient she is with me. Quite apart from falling into the trap of conflating care with nursing in some of her remarks—she did make the point about needing to ensure that there is a clear distinction between care assistants and nurses—does she not also agree that in terms of the management on wards, a lot of nursing time is taken away from the patient interface as a result of the enormous amount of bureaucracy and paperwork required and the pressure that many nurses come under from bed managers, who appear to overrule them when it comes to determining when a patient should be discharged or admitted to a ward?

[Margot James]

I thank my hon. Friend for his observation, and I certainly agreed with the first point he made. I shall conclude in a minute as I am aware that many Members wish to speak.

The CQC should be resourced to ensure that its inspections include weekend visits. All the observations it makes in its recently published report were based on visits it paid during the week—for cost reasons, I imagine—but I was delighted to hear the Secretary of State announce yesterday that there will be more inspections. I hope, however, that the Minister will discuss with the CQC the possibility of visits being paid at weekends, when—I hear—care can sometimes deteriorate rapidly.

Some complaints are very serious, and I am not commenting on serious medical negligence, but with many complaints the system comes over as a sledgehammer to crack a nut. A patient or family member should be able to make an informal, non-legalistic and reasonable complaint and receive a sensitive hearing from a senior member of staff, rather than be instantly given a form that starts a three-week process of churning and often ends in Members’ surgeries. I ask the Minister to discuss with the Justice Department how we enable that but avoid opening the hospital to legal challenge, which is one of the motivators to the heavy-handed system we have at present.

We must be able to distinguish between the training needs of nurses and health care assistants.

[Andrea Leadsom (South Northamptonshire) (Con)]

It seems that the nursing profession lacks some accountability. What does my hon. Friend think about the idea of bringing back matrons, who are visible on the ward and who manage nurses?

[Margot James]

I thank my hon. Friend for that intervention, and I am attracted to that good idea. Somebody must be in charge of the ward—a nurse manager or a matron. Although that happens in the best wards, it is not universal.

We must look at the training of health care assistants, who increasingly perform sensitive, caring roles; the system cannot be left as informal as it is at present. There must be minimum standards and training. We know that there is pressure to register health care assistants. I am not sure that that is necessary, but training and minimum standards certainly are.

I challenge where Project 2000 has got us. Nurse training could remain at degree level but follow a more apprenticeship-based model. I ask the Minister to meet the Nursing and Midwifery Council to discuss how the nursing degree can learn from the apprenticeship model so that far more time is spent on the ward, alongside the academic study that has brought such benefits.

There is much more to be said, and I look forward to hearing from other hon. Members and learning from their contributions. I thank the many organisations that have been in touch with me and helped with my research since I secured the debate last week.

[Several hon. Members]

rose—

--- Later in debate ---

[Margot James]

It is a pleasure to speak under your chairmanship, Mrs Brooke. We have had an extremely illuminating and, at times, distressing debate. I am very grateful to all hon. Members who took part, including those who have had to leave, for bringing so many aspects of this difficult problem into the open and for making so many constructive suggestions about how we might improve things. I should like to set out a few of the lessons that I have learned from hon. Members during the debate.

My hon. Friend the Member for Suffolk Coastal (Dr Coffey) set an example of the importance of the job that we sometimes have of challenging the institutions on which so many of our constituents depend. I wish her and my hon. Friend the Member for Waveney (Peter Aldous) every success in dealing with the hospital on their patch and working with the CQC to bring about a quicker resolution to the problems that they encounter there.

I found noteworthy the issues facing rural areas to which my hon. Friend the Member for Suffolk Coastal referred, because I represent a suburban area. It is interesting to note that ambulance response times can be so long in rural communities. It is very important that the NHS is able to be flexible enough to cope with all the communities in our country.

The hon. Member for Blaenau Gwent (Nick Smith) gave us the benefit of his experience as a member of the Public Accounts Committee. I was pleased that he focused so much on the residential home sector, which is so relevant to the lives of many older people and about which a similar level of concern has been expressed in many reports. I was horrified, although slightly amused, I suppose, by the tambourine example. It was so powerful and so wrong. It will stay with me as a reminder of the many challenges that we have ahead in dealing with this issue.

I mentioned the issue with the James Paget hospital that my hon. Friend the Member for Waveney is dealing with. He raises the question that many Governments have grappled with—how to get resourcing out of the acute sector and into the community, the area of prevention and helping people with long-term medical conditions. That is very important. I wish the present Government well in seeing whether they can crack that pressing problem, which has been with us for least two decades, to my recollection. My hon. Friend also mentioned what I think is a very good idea—mandatory malnutrition rates and finding out what can be done to ensure that we target that area of deficiency in the NHS.

My hon. Friend the Member for Truro and Falmouth (Sarah Newton), who has secured a Back-Bench debate on the Dilnot report to be held two weeks today, which I am sure as many Members as possible will attend, focused on the complaints process, which I touched on briefly. It is important that the Government learn from the ombudsman’s report, “Listening and Learning”, and implement improvements.

My hon. Friend also mentioned something I have come across in my work with older people in the NHS—language skills. It is completely unacceptable if any carer—any caring member of staff—cannot communicate competently in English with older people, and we should tackle that. She also touched on the rural dimension and on the fact, which was terrible to hear, that her constituents have only one hospital, which inevitably makes people frightened to complain; there is no other choice.

The hon. Member for Wirral South (Alison McGovern) talked movingly about dignity and about older people in society, on which I hope we will hold a debate at some point. The hon. Member for Leicester West (Liz Kendall), whom I congratulate on her new role as shadow Minister, said that the topic could be a debate in its own right, and I am sure that a Member will secure one at some point. I share her belief in the importance of values: most people who work in the NHS have the values that we expect, and as she said, they have to be empowered to make choices and decisions that reflect those values.

The hon. Lady talked about many important areas and enlightened us about the Royal College of Nursing’s staff-to-patient ratios. It is quite wrong that the accepted ratio in a ward with a considerable number of older people is 1:10, whereas a paediatric ward is quite rightly staffed at a ratio of 1:4. The Government should also consider what can be done about concerns regarding the skill mix and the management of resources.

The hon. Lady made some interesting observations about the history of the NHS—how it began in response to cures and to treating people with illnesses that were likely to get better, and how it has not quite kept pace with the number of people who grow to an old age, some of whom need help with care and, perhaps, dying with dignity.

The hon. Lady made a point, on which neither I nor any other Member had focused, about doctors, who provide a huge amount of care in hospitals.

The hon. Member for Bolton West (Julie Hilling) commanded our attention with the moving story of the dreadful time that she and her family had experienced with her mother. I think I can speak for everyone when I say that we wish her mother a continued recovery. It was impossible to determine how the story would end when the hon. Lady was speaking, but it is marvellous that after all the family has been through her mother is on the mend, and we hope that she will recover as much of her former joy of life as possible.

I am grateful for and most encouraged by the Minister’s reply to the debate. He reminded us of the Government’s recent decision to ensure that ageism is not tolerated in the NHS or the Department of Health, which is a good development. He cited many examples of good work and guidance, of which he said there was no shortage, of leadership and management and of spreading good work and guidance into more areas of the delivery of NHS care. I am particularly delighted that he has promised to discuss with the nursing Minister, my hon. Friend the Member for Guildford (Anne Milton), my proposals on nurse training, and how an apprenticeship model should increasingly underpin the degrees nurses take to qualify.

I hope I have covered the important issues that Members have raised today. I thank those who supported my bid for a debate to the Backbench Business Committee and all those who attended this afternoon and made such an important contribution.

Question put and agreed to.

Innovation (NHS)

Margot James Excerpts

Wednesday 12th October 2011 Westminster Hall

[John Glen]

I certainly contend that there are significant pockets of innovation. The challenge is bringing those ideas to their full commercial potential and getting them into the NHS so that they are cheaper for the user. The adoption and uptake of NHS-grown ideas is not wide or deep enough, few hospitals showcase their ideas and the wider benefits are not really felt across the NHS. Some ideas, when fully exploited, might realise significant streams of revenue, easing the cost pressures that I mentioned.

The review led by Sir Ian Carruthers, announced at the beginning of July by the Department of Health, will seek in its report next month to inform the strategic approach to innovation in the modernised NHS. However, it must not simply set up another framework or broad aspirations; it must deal convincingly with the gritty realities of what is needed to take a proven idea that has been honed, challenged and assessed by the innovation hubs to its full commercially realised potential.

The report must also recognise that, unless a way is found to invest in such ideas, their commercial potential will be exploited by private sector entrepreneurs who can move more rapidly and access finance more quickly. Intellectual property will thus be patented not by individual NHS trusts, as is desirable, but by the private sector, which will then charge the NHS for products and services at rates that the NHS would rather not pay. I urge the Minister to push the boundaries and ensure that we do not risk allowing the ideas of excellent NHS employees to be lost, thus losing the value and savings that could accrue.

[Margot James (Stourbridge) (Con)]

I congratulate my hon. Friend on securing this important debate. Does he agree that, although it is important for the NHS to realise the commercial value of innovation, it is also fundamental to the improvement of patient care that innovations take hold more rapidly? Did he see this morning’s comments by Professor Williams, president of the Royal College of Surgeons, who warned of a 20-year wait before innovations start saving lives if we base innovation progress on previous experience? He cited reduced deaths from bowel cancer as a result of keyhole surgery, which took years to become widespread practice.

[John Glen]

I thank my hon. Friend for that extremely helpful intervention. I met Professor Williams last week, and he made that point to me. That is the nub of the matter. If the NHS does not move quickly on such ideas, someone else will, and it will cost more. My hon. Friend is absolutely right. The impact on outcomes is negative. We must move matters forward so that the advantages can accrue to the NHS.

It is important to realise that, in the big picture of NHS politics, there is an almost pathological fear of doing anything that could imply the use of the word “cut” or the even more toxic P-word, privatisation. I am not arguing for either, but I am saying that, unless we adopt savvy practices to incubate and develop proven concepts more speedily, I fail to see how the NHS can deal with the increasingly more intense systemic supply and demand pressures that it will face. Efficiency savings and ring-fenced budgets, although welcome, will not be enough to save the NHS and provide the money that it needs to continue in its present form. We need more realism about that and a radical solution that has the potential to create more money.

I recognise that it should not be the NHS’s primary objective to develop income streams from medical devices, new treatments or services. Equally, given that great ideas are an unintended by-product of taxpayer investment in providing a world-class national health service, it would surely be wrong not to look hard at making innovation work to the NHS’s advantage. So many ideas derive from employees whom the state pays quite handsomely.

Furthermore, after initial investment, funding innovation could be self-financing, using royalties from previous successful investment. It just needs to unlock that potential. Alongside producing efficiency savings, this significant reform need not require significant capital outlay at the outset.

It feels as though successive Governments have been so concerned to avoid the tag of allowing the waste of capital on ideas that do not immediately point to a return, or being portrayed as blurring the boundaries of the NHS, that they have not fully established the means and mechanisms of making ideas realise their potential. Lip service is paid to the desire to innovate, but practical measures that make it possible on anything like the scale that is possible are not in place. It is more a question of whether the NHS can afford not to exploit the potential savings and revenue streams presented by these ideas.

I am aware that the current position is not completely bleak. The Minister will be able to cite a pipeline of ideas and he will know that the UK has established capabilities in this field. The medical device sector alone makes a significant contribution to the UK economy, with an industry turnover of £13 billion and 55,000 employees. That industry, however, is generally a supplier to the NHS. We need to move to a situation in which the NHS itself generates devices that can save—with a small s—the NHS from bearing the full commercial costs of products that the private sector has developed in its place. Why is it not possible for the Government to establish an innovation strategy with a real focus on extracting value from the pipeline?

I am not suggesting that there should be centrally driven, random speculative investment of taxpayers’ money in half-baked ideas suggested by any clinician. The regional innovation hubs are already primed to sift ideas. For example, NHS Innovations South West has criteria that each product has to meet before it can receive further assistance. First and foremost, it must bring significant benefit to patients in terms of better outcomes and quality of life. It must also be patentable. The return on investment must meet a minimum threshold and it must be commercially viable—that is, there must be an assessment of a global need for the technology, making it a worthwhile investment for commercial partners.

Once that has been established, the issue is how to develop the ideas to their full potential. Several ideas exist in the south-west. A cancer diagnostic endoscope and meniscus knee repair device are both, subject to completing clinical trials, able to meet the criteria to which I have referred. Given that oesophageal cancer is one of the fastest growing cancers globally and early diagnosis can have a significant impact on savings in the NHS, it is highly desirable that that progresses quickly. The meniscus device should significantly improve patients’ quality of life and postpone the need for an expensive total knee replacement by up to five years, thereby again saving the NHS huge sums of money.

My concern is that it is purely by chance that the private sector has not taken this work further. The current NHS process for capitalising on these innovations is not quick enough. There is limited access to NHS funding, and progress is inhibited by insufficient incentives and enabling mechanisms to encourage trusts to invest in such promising cost-saving technologies. Hospitals exploit these ideas elsewhere in the world and significant royalty streams accrue. They would make a recurring contribution to the much required efficiency savings that the chairman and chief executive of my hospital trust are desperately trying to find at present.

In conclusion, I believe that the NHS is a powerhouse of innovation, but that that is not being harnessed sufficiently to accrue the tens of millions that would be available to individual NHS trusts if a bolder approach were taken by Government. I urge the Minister to consider carefully the potential of the ideas in the NHS and to do all he can to ensure that the scope of the Carruthers review is broad enough to deliver recommendations that will allow the huge value that exists to be realised.

Health and Social Care (Re-committed) Bill

Margot James Excerpts

Wednesday 7th September 2011 Commons Chamber

[Rushanara Ali]

Thank you, Madam Deputy Speaker.

Amendment 1169 would be of great benefit in tackling health inequalities. It would make a real difference to people’s lives. Requiring the Secretary of State to lay an annual report before Parliament on progress towards ending health inequalities is therefore key in ensuring that proper accountability continues to exist. What is he afraid of? He could see the impact and put in place mechanisms to continue to improve, learning from the evidence and making progress. Considering how we can reduce inequalities in constituencies such as mine is a constructive way forward. I call on the Secretary of State to think again and accept this sensible amendment.

In conclusion, as the Marmot review stated, the

“link between social conditions and health is not a footnote to the ‘real’ concerns with health…it should become the main focus.”

Tackling health inequalities should be a central aim of health care policy for any Government, and the amendment would be crucial for achieving that. I hope that Members on both sides will back it and that the Secretary of State will take note.

[Margot James (Stourbridge) (Con)]

I want to support the leadership that the Bill ascribes to public health and the role of the patient and empowered individual in taking responsibility for their health care as far as is possible. I congratulate the Government on setting public health free, as I see it, and taking it out of its ivory tower. It has been in the preserve of the primary care trusts and although in some PCTs it is given life, in others it gathers dust and is vulnerable to financial raids from time to time as budget pressures build and people seek to take money from an area where the public do not necessarily see the results for a fairly long time and to give it in preference to things that cause short-term pain. Regardless of which party has been in government, that has always been the case with public health.

If we consider where public health can make a difference in preventing ill health, we can see that the future of the NHS depends on a much better preventive strategy. Perhaps the best thing that the previous Government did in health care policy was the smoking ban, which will probably save more lives in the long run than anything else. We could consider some of the other areas that are ripe for similar treatment. I do not mean that we should ban alcohol, but we could consider public health policy and what it could do to reduce the incidence of sexually transmitted diseases, HIV, alcohol abuse and mental health problems. Many of the issues to do with drugs are about education and prevention, too.

I am pleased to see links being built into other aspects of the Bill. Our proposals for public health in relation to mental health have been strongly welcomed by the Samaritans, because there is so much to do with mental health that takes place in the community. The involvement of local authorities and the leadership role given to them in the Bill should enable aspects of local government policy such as housing, children’s social services and adult and social care to be brought to bear in dealing with these problems.

[Sarah Newton (Truro and Falmouth) (Con)]

Will my hon. Friend give way?

[Margot James]

I would love to but I am aware that others are waiting and I am trying to curtail my comments. [Hon. Members: “Hear, hear!] I will take that as a prompt to get a move on.

I want to address a point that was made earlier about where the director of public health should sit in a local authority. I think it is important that the public health director should report to the chief executive because the public health function will cover so much that is part of children’s services, adult and social care and housing that it is hard to see how they will fit in unless they report at the top level.

In conclusion, I believe that the elevation of public health will enable public health to be placed at the centre of commissioning and that the link between the wellbeing boards and the primary care commissioning groups will enable public health to be instrumental within commissioning. That is where we will see the long-term benefits outrunning the short-term imperatives.

[Alison Seabeck]

I shall cut to the chase because other Members want to speak and many colleagues have spoken powerfully about the benefits of the NHS. I have two very specific questions regarding concerns that people in the south-west have raised with me. These issues relate to part 1 of the Bill, the role of the director of public health, and the making of complaints, as covered by new clause 1. I want to link these issues to the duty of the Secretary of State to ensure that the basis on which actions are taken—indeed, the information that is used—is in the hands of and is accessible to people in the new set-ups who need that information and can use it.

The concerns that have been raised with me relate to the movement of national health service public health staff into local authority control and the fact that the Office for National Statistics currently has a duty to release certain data only to directors of public health, who are part of the NHS. I gather that the ONS has had concerns about this and I am interested to know whether it has waived the requirement for directors of public health to sign a confidentiality and proper use statement every year, or whether it has agreed to the passing of this role into local authorities. I cannot find that in the Bill, although I must admit that I am coming to this a little late—my apologies to colleagues about that—and I would be very grateful if the Minister could tell me whether that issue has been resolved.

Secondly, the Minister will know that we carry out nuclear decommissioning in Plymouth. Is he confident that public health can be fully protected in the way that it has been in the past? I note clause 54 on radiation, but will the Minister look at how H1N1 was dealt with? The first confirmed case of swine flu was in Paignton and the response was carried out by PCT public health staff in Plymouth and Torbay. They worked together rapidly to administer antiviral drugs to nearly 500 pupils and they provided reassurance and support to extremely anxious children and parents. That response was set up within 45 minutes of the initial phone call, despite the fact that it had not been done before, and it was done without any practical help from the Health Protection Agency, which was swamped with other work. The PCT public health staff just got on with it and they did a fantastic job—no other child was infected. Indeed, they compiled a guide on how to do it all, which was passed on and was commended by the Prime Minister. There is a view that such a response will not be possible in a few years’ time, so complaints from the public—this takes us back to new clause 1—will inevitably follow. Clearly, if we get health protection wrong, we can kill people.

In order to avoid complaints on new clause 1, will the Minister say what power the director of public health, sitting within the local authority, will have to galvanise staff across organisations? Will they be the appropriate authority, or will responsibility sit elsewhere? Will they have to go through another senior officer? Who is ultimately responsible if they get it badly wrong—the local authority, the director of public health or the Secretary of State? Or is it another instance when the Government are saying, “Not me, guv” and passing the buck to the local council and the political leadership of that council? If there was a viral outbreak in various parts of the country, widely spread, would the individual local authorities be held responsible for dealing with it, coming up with solutions and coping with the outcomes, or is this a case in which the Secretary of State actually has a clear duty to take the lead?