Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Hunt]

I am afraid that the hon. Gentleman will have to wait until the result of that consultation is published. I visited the trust last week, although I went to the Romford end of it, and I think that it is making great strides in improving the quality of care. I congratulate all the staff at the trust on what they are achieving.

[Maria Caulfield (Lewes) (Con)]

13. What steps his Department is taking to reduce suicide rates.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

We remain committed to reducing the national suicide rate by 10% by 2020, and our record investment in mental health will ensure that we can achieve that ambition. Local suicide prevention plans now cover 98% of the country, and we updated the cross-government suicide prevention strategy in January to strengthen key areas for action, including by focusing on self-harm as an area in its own right.

[Maria Caulfield]

My constituent Justin Bartholomew, a young man of just 25, recently committed suicide by hanging himself. His family are convinced that the high-energy drinks that he was taking—more than 15 cans a day—increased his anxiety and contributed to his suicide. As there is growing concern about the safety of such energy drinks, may I ask the Minister what assessment of that the Department is undertaking?

[Jackie Doyle-Price]

I thank my hon. Friend for sharing that very moving case. We have no evidence at this stage that those drinks cause such outcomes, but we know that all stimulants, whether alcohol or caffeine, have consequences that can affect people’s mental health. That is something that bears examination.

King’s College Hospital Foundation Trust

Maria Caulfield Excerpts

Tuesday 12th December 2017 Commons Chamber

[Mr Dunne]

I share the hon. Gentleman’s support for the staff, and I have already paid tribute to the hard work and commitment that they are showing to their local population. His question regarding a royal commission is rather beyond the scope of this urgent question and rather above my paygrade.

[Maria Caulfield (Lewes) (Con)]

We do have a problem with NHS managers; not only are there too many of them, but many lack clinical skills, which is probably why they make so many bizarre decisions. On Lord Kerslake’s watch, £715,000 was spent off payroll last year on an interim director, and £30,000 a month was spent on temporary managers. There is a problem with this scandalous waste of taxpayers’ money.

[Mr Dunne]

My hon. Friend takes a close interest in what is happening in London’s hospitals, where she regularly works shifts. From time to time, there is a need for some interim managers to fill vacancies and gaps, but she is absolutely right that we have taken significant action to limit the excessive amounts that some have been paid. The amounts have now been capped and are being driven out of the service, and the interim mangers are being encouraged to take up substantive positions.

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Hunt]

Let us be clear: we took the difficult decision on nurse bursaries precisely so that we could have the biggest expansion in nurse training places we have ever had. When we had the higher education reforms in 2011, which the right hon. Gentleman’s party opposed, we also saw a drop in initial applications, but then we saw them soaring to record levels. That is what we want to happen with nurses, because we need more nurses for the Royal Devon and Exeter, and all the hospitals that serve our constituents.

[Maria Caulfield (Lewes) (Con)]

I welcome the apprenticeship route and the associate nurse route into nursing because living on a bursary of £400 a month is no fun, believe me. However, will the Secretary of State look at nurse training so that when nurses qualify they are able to take on courses such as venepuncture and cannulation as soon as possible? Many student nurses and newly qualified nurses are frustrated that they cannot be used in those roles.

[Mr Hunt]

I will certainly look into that. Of course, my hon. Friend understands this issue better than many in this House. The really exciting change is that it will now be possible for healthcare assistants who could make fantastic nurses to progress to being nurses without needing to take out student loans because they will be able to carry on earning while they learn. That will open up big opportunities for many people.

NHS Pay

Maria Caulfield Excerpts

Wednesday 13th September 2017 Commons Chamber

[Chris Philp]

rose—

[Maria Caulfield (Lewes) (Con)]

rose—

[Jonathan Ashworth]

The hon. Lady has often spoken out on this matter, so I feel I should take her intervention, but then I will make progress, if the House will indulge me.

[Maria Caulfield]

It is generous of the hon. Gentleman to give way. As he says, I support the lifting of the pay cap and I am pleased that the Government are moving on this. My concern about supporting this motion is that Labour do not seem to have learned the lessons from crashing the economy in the first place. Could he outline what level of pay rise the Labour party is proposing for public sector workers—1.5%, 2% or 3%—and how it will be paid for? That is crucial to influencing the voting intentions of Members like me.

[Jonathan Ashworth]

I have a huge amount of respect for the hon. Lady; we have had conversations outside the rough and tumble of this Chamber, and I know she takes these matters extremely seriously. I would ever so gently say to her that she has been telling newspapers that she supports getting rid of the cap; she has been hosting nurses in Parliament, saying that she would get rid of the cap; well, this evening she has an opportunity to take a stance, ignore the Tory Whips and vote for getting rid of the cap.

[Maria Caulfield]

In this debate, we must be honest with the British public about how we are going pay for the lifting of the pay cap. If Labour wants to lift the pay cap, can the hon. Gentleman explain how the Labour party will pay for it? Will it be through increased taxation or more public borrowing, or will Labour shift spending priorities? We need to know the detail in order to be able to support this policy.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford). I pay tribute to her for her work on the Select Committee on Health in the previous Parliament. That work was inevitably full of expertise and always constructive; I thank her for that. I agree with her that the NHS is a team, but that team should also include the wider social care staff because we cannot continue to look at the two systems in isolation. I echo her point, thanking all our NHS and care staff for the contribution they make not just to our wider economy, but—most importantly—to patients. Those are the people we should keep at the heart of this debate.

I welcome this debate. I also welcome the relaxation of the cap because we need to give the NHS Pay Review Body greater flexibility to make recommendations about what we need to put in place for our NHS staff. I agree with the hon. Member for Central Ayrshire that we should look at the impact of pay on morale, recruitment and retention—this is an international workforce, as well as a national one—but we also need to look at pay across regions and within specialties because there is great variation. We should focus our efforts on ensuring that we are looking at the situation from the patients’ perspective by, for example, looking at the greatest areas of deprivation, which very often have the lowest ratios of NHS and care staff and who are under the greater pressure.

Seven years of sustained pressure on NHS pay is taking a toll. Nobody anticipated that it would go on for this long, so it is time to relax the cap. We should look not just at the issue of pay, but at the wider pressures within the NHS. I am delighted to announce that the Health Committee, which held its first meeting just before Prime Minister’s Question Time, has agreed that its first inquiry of the Parliament will be on the nursing workforce. We will look not just at pay, but at the wider workforce pressures, including the increased workload that comes from increasing demand across the system, morale and all the other non-pay issues that contribute to the pressures on nurses. We will also look at bursaries and the new routes into nursing, and at their impact on people entering the nursing workforce. We have heard about that already today. For example, we know that those who drop out of nursing courses are more likely to be in the younger age groups, whereas those who go into nursing as mature students are much more likely to stay. We need to look at all those wider impacts.

[Maria Caulfield]

I really welcome the news that the Select Committee is going to do a review of nursing. Will the Committee look into pay structure? The current Agenda for Change structure is being used by some trusts, in hospitals and communities, as a way of downgrading nursing roles. For example, a senior sister in one place may be paid a band 7 salary, whereas someone in the same role somewhere not too far down the road may be paid a band 5 salary. There is inequity in the current system.

[Dr Wollaston]

That is an important point. I very much hope that my hon. Friend will contribute to the Committee’s inquiry. As well as looking at the new routes into nursing, we will look at the skills mix, roles within health and social care more widely, the impact of Brexit and language testing, workload and morale. We will be seeking contributions from hon. Members across the House and from people outside.

As I said, we will miss something if we just look at the issue as one of pay. Pay restraint is estimated to contribute between £3.3 billion and £3.5 billion of the five year forward view efficiency savings up to 2019-20. If that goes, what will fill the gap? We have to be careful that there is no loss of services or losses in the workforce, because workforce pressures—probably more than any other issue—contribute to nursing staff leaving the profession. We have to look at the bigger picture.

--- Later in debate ---

[Maria Caulfield (Lewes) (Con)]

I declare an interest as a nurse who has worked for over 20 years in the NHS, and who still works as a nurse on my hospital bank. I worked through 2010 to 2015, when the pay freeze and then the pay cap was introduced, so I know exactly how difficult it is to manage on a nurse’s wage and not see an increase. Inflation is now close to 3%, so it is becoming increasingly difficult. Seven years is enough for anyone to have lived with a pay cap or a pay freeze, so I support the RCN’s campaign to scrap the cap.

No political party comes out of this unscathed. There was a recognition among colleagues back in 2010 that we in the public sector had to tighten our belt if we were to protect jobs and frontline services. We recognised that we had to step up to the plate and play our part, and we did. However, we were promised by those on the Government Benches that that would be for roughly a five-year period. The Government have to take responsibility for not having tackled the deficit completely and for keeping the pay cap going. It is not fair on frontline staff that they are the ones still picking up the pieces of the mess the last Labour Government left the country in.

It is time now to scrap the cap. Nursing has changed dramatically over the last 20 years. It is now a graduate-only-entry profession. Nurses are taking more advanced roles, including nurse prescribing, and extended roles, such as biopsies and minor ops. Today is National Sepsis day. In A&E, it is often a nurse who sees a patient and, if they suspect sepsis, cannulates, takes blood, does the blood cultures and, if they have done their prescribing course, starts the first line antibiotics. That is done long before the doctor ever sees the patient. That is not because nurses are becoming mini-doctors; it is because they are extending their role, improving outcomes for patients and improving patient experience.

I want to send a message to Ministers: there are two myths doing the rounds at the moment about nurses’ wages. The first is that nurses are on an average of £43,000 or even £37,000. That is completely untrue. Most nurses are in bands 5 or 6, the average wage for which is £27,000—for an experienced nurse—and the starting salary roughly £21,000. The banding system is used to downgrade nurses and pay them as little as possible. When I do a hospital bank shift, I am on the lowest band 5 wage—after 20 years of working as an experienced cancer nurse who is chemo and intravenous-trained.

The incremental rise we hear about is also a myth. The banding system is used to start nurses on the lowest-possible salary. They have to wait seven years—each year going up a little bit—till they reach the top of their banding. In no other profession would that happen. We do not see MPs in the 2017 intake being paid less than those in the 2015 intake because they are less experienced or new to the role, but that is exactly what we do to nurses, and then we tell them they should be grateful for that incremental rise. They should be paid what is due for that job, not wait seven years to get the actual pay the job is worth. We do not say to the editor of the Evening Standard, “You’ve never been a journalist before, so you should be paid less than any other journalist in this country.”

This is about fair pay for a fair day’s work. We are asking people to save lives or put their own lives on the line to save the lives of others. The time has come to end the public sector pay cap, and I welcome the moves by the Government. As for the motion, I hear that the Labour party wants to scrap the cap, but there is not the money to do it across the board, although there are ways to give nurses, public sector workers and other NHS staff a pay rise. If we focus that pay rise on bands 1 to 7 and help those in high-cost areas with high-cost living allowances, we can make a difference, but using this as a political football will not score any goals. It is incumbent on all of us from all parties to work together.

When Ministers stand up at the Dispatch Box and say, “More schools than ever are good or outstanding”, “More patients are being treated than ever before” or “There is less crime than ever before”, they should remember it is because of the hard work of public sector workers. We need to reward them for their hard work and effort.

Oral Answers to Questions

Maria Caulfield Excerpts

Tuesday 4th July 2017 Commons Chamber

[Mr Hunt]

The capped expenditure process is an NHS England initiative to meet its statutory duty to live within its budget, and I support the principle that in a period where real expenditure on the NHS is going up by £5 billion, those benefits should be spread fairly among patients in all parts of the country.

[Maria Caulfield (Lewes) (Con)]

8. What progress is being made on improving end-of-life care.

[The Parliamentary Under-Secretary of State for Health (Jackie Doyle-Price)]

In July 2016 the Government published “Our commitment to you for end of life care”. This set out what everyone should expect from their care at the end of life and the actions we are taking to make high quality and personalisation in care a reality for everyone. By 2020 we want to significantly improve patient choice, including ensuring an increase in the number of people able to die in the place of their choice, including at home.

[Maria Caulfield]

I thank the Minister for her reply, and it is welcome news that there is such a focus on end-of-life care. Will she meet me to discuss the Access to Palliative Care Bill presented in the other place, to look at how we can improve access to palliative care across the whole of the UK?

[Jackie Doyle-Price]

I will be delighted to meet my hon. Friend, who is a committed and passionate campaigner in this area. I am keen to explore anything that improves care and choice for all patients at the end of their life.

Health and Social Care

Maria Caulfield Excerpts

Monday 27th February 2017 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

It is a pleasure to follow the hon. Member for Lewisham East (Heidi Alexander), although she will not be surprised to learn that while I agree with some of the points she made, I do not agree with all of them.

In the time that I have, I want to cover a few points; I do not want to repeat much of the excellent statements many Members across this House have made, but I do want to go over a few issues.

While I welcome the Government’s extra funding, and the £6 billion this year in particular, with the changes in national insurance contributions and pension contributions, the costs of running the NHS are going up all the time, so the extra money is being swallowed up without it necessarily going to frontline staff. I particularly agreed with my hon. Friend the Member for Newton Abbot (Anne Marie Morris) when she said that in an estimates debate we should not just be talking about the money we need to spend, but also need to look at the demand and the type of services that we need to fund. There is no doubt that the demand for NHS services and social care is increasing, so even by providing extra funding we are really just standing still in terms of the services we are providing.

We know there is an increase in numbers across the country. We know, as has been said, that there are new treatments that need to be provided. We know that patients are changing, too; they often have multiple co-morbidity, so whereas in years past they would have been admitted with one illness, treated and gone home, now when they are admitted they have many illnesses that are not so easy to treat, and that is often why discharges are delayed.

From NHS England’s own data, we know that there is around a 7% increase in demand for services across the board. There is also a 7% increase in the number of ambulance calls made. There is a 3% increase in the number of A&E visits. We know that the Tuesday after Christmas was the busiest day ever in the history of the NHS, and it takes extra money to be able to deliver that service. We know that there is a 6% increase in diagnostic tests, and consultant-led treatments are up 6%, too. So demand is rising, and although the extra money is welcome, it is not dealing with the level of service that is required.

I want to make a plea, as someone who still works in the health service and sees, and works with, colleagues across the NHS on a regular basis. While the services are under a lot of pressure and there is a lot that we can be concerned about, some amazing work is going on in our NHS, and I welcome NHS England’s announcement only last week that it is again going to start to fund second stem cell transplants. We have had debates in this place about how important that is to those patients whose first transplant fails. We also know that there are going to be new drug treatments for kidney disease and for pulmonary hypertension. All those announcements are really welcome, and we must recognise that there is great work being done on the frontline.

I am particularly pleased that the Department of Health has given £1 million to the British Heart Foundation to provide defibrillators up and down the country. That will make a tremendous difference, given that 12 young people a week die from cardiac arrest in this country. Innovative, ground-breaking work is also being done in cancer care. My old hospital, the Royal Marsden in London, is making strides in cancer research that are not only innovative in Europe but making breakthroughs worldwide. We should never forget that we often lead the field in research at a global level. We should be extremely proud of that.

In response to the Health Committee’s report, the Government made a number of recommendations on tackling the problems facing the NHS and social care, and I want to touch on two of them. The first dealt with the need to arrive at a degree of financial discipline in the health service. For years, there have been problems of financial mismanagement. As someone who has worked in the health service, I know how heartbreaking it is to see money being squandered. We have talked about the PFI deals, which have affected many parts of the country, but we must also remember the IT system that cost billions of pounds but never saw the light of day. It was supposed to move us away from paper records to a paperless system. Today, the NHS spends huge amounts of money on the storage of paper notes in offsite facilities. Hospitals have to pay to store those patient records. The agenda for change, which was introduced many years ago, was supposed to reconfigure the staff pay structure and improve patient productivity, but it never really worked. It just rearranged the deckchairs on the ship. It was a huge wasted opportunity that cost the NHS millions of pounds that could have been used to give staff a well-deserved pay rise.

Financial discipline is important. There are two big general hospitals near my constituency. They have the same financial settlement and a similar group of patients to look after. One of them is in special measures and struggling to cope with its discharging, while the other, less than five miles down the coast, is rated as outstanding and is able to provide excellent care. This has to be about more than the amount of money that is given out; it is also about what is done with that money. We need to look at that, and hospitals need to share best practice. It cannot be right that one hospital is able to manage its budget while another one is not. My experience of 20 years working in the NHS is that there are lots of opportunities in this regard. Financial discipline should not be about top-slicing; it should be about using the available money as wisely as possible. If Ministers want suggestions about how to make financial savings, I would recommend that they speak to the healthcare professionals. They often have the answers, and if they were only asked on a more regular basis, they would be able to provide some fantastic solutions.

The other recommendation that the Government want to take forward relates to reducing demand, which is easier said than done. I started by saying that demand was increasing by about 6% a year. For too long, we have focused on hospitals and—I say this with no disrespect to doctors, as my hon. Friend the Member for Totnes (Dr Wollaston) is sitting next to me—we have been much too medically focused in the way we manage our NHS. We have missed the opportunity to look at what other healthcare professionals can offer.

Pharmacists, for example, are highly educated, experienced and qualified individuals, and there is ground-breaking work happening out there in community pharmacies. This can involve simple things such as the scheme in Scotland in which patients have to register with a pharmacist as well as a GP. That would make a tremendous difference to patients’ lives if we were to introduce it here. Why are pharmacists not contacted on discharge, as GPs are? I was recently talking to a pharmacist who said that around 30% of readmissions are caused by patients not taking their medicine properly. If pharmacists had a list of chronically ill patients whose medicine they were in charge of, we could easily avoid so many readmissions. We heard earlier about nurse practitioners who are doing blood tests to predict bacterial infections and work out who does and does not need antibiotics. We need to upskill those healthcare professionals so that they can take on more roles. Some paramedics in the community are going to people’s homes instead of those people going to A&E, for example.

This is an estimates debate about how we use the money, but we need to forecast demand properly, use existing resources better and look at best practice to share the good work that is happening in our NHS.

[Several hon. Members rose—]

Stem Cell Transplants

Maria Caulfield Excerpts

Tuesday 24th January 2017 Commons Chamber

[Mark Tami]

I hope that it will not do so tonight, Mr Deputy Speaker.

I declare an interest as co-chair of the all-party group on stem cell transplantation. I am very pleased to see my co-chair, the hon. Member for Enfield, Southgate (Mr Burrowes), in the Chamber; I am sure he will make some comments later. May I also put it on record that my oldest son received a life-saving stem cell transplant a number of years ago?

A stem cell transplant offers a last chance of life to people with a blood cancer or blood disorder. It works because stem cells have an incredible ability to replace damaged blood cells. This remarkable treatment has great potential in our healthcare system. There are different types of stem cell transplant. Some involve people taking back their own cells, while others involve cells from a donor, who can be a relative. Tonight I will talk about stem cell transplants that come from a donor.

About 2,000 people in the UK need such a transplant each year. Two thirds of them will not find a matching donor in their family and will therefore require an unrelated donor. In that regard, I pay tribute to Anthony Nolan trust, which provides patients with matching donors from its stem cell donor register. As well as sourcing transplants, it supports patients and, importantly, their families through the transplant journey and advocates on their behalf. Last year, Anthony Nolan helped to find a match for more than 1,200 people with a blood cancer or blood disorder. I know that the House will join me in thanking the selfless stem cell donors who made that possible, and all those who have joined the stem cell donor register and might donate in the future, of whom there are more than 600,000.

Sadly, one in eight people does not receive the life-saving transplant they need because there is no donor available or a donor cannot be found quickly enough. The odds drop dramatically for patients from a black, Asian or ethnic minority background. Anthony Nolan is working hard not only to build but to diversify its stem cell donor register to ensure that it is able to provide people with the best match. After a lot of work, the situation is much better than it was a number of years ago, but it is still shocking that the chance of finding a donor is so much slimmer for people from a BAME background than for white people. I am sure that the Minister will show her support for efforts in that area.

Despite the fact that stem cell transplants are a well-established treatment, the huge financial pressures on the NHS are causing problems for patients. The situation is most serious for those who need a second stem cell transplant. Sometimes, after having a first transplant, a patient’s blood cancer or blood disorder will come back or relapse. That is devastating news in itself. For about 20 patients a year, the clinician will recommend a second stem cell transplant as their best, and often only, chance of life.

It is worth emphasising that this is not some unknown, experimental treatment that people are simply taking a punt on. We know that one in three patients who receives a second stem cell transplant will reach the milestone of five-year survival, and the results for children are even better, as seven in 10 will reach that milestone. We know that the medical profession recommends the treatment, which is routinely available in other parts of the UK, as well as in countries across Europe and the United States. We also know that the treatment used to be available in England before 2013 and that many people are alive today, leading active lives with their families, because they received a second stem cell transplant.

[Maria Caulfield (Lewes) (Con)]

I thank the hon. Gentleman for raising this important issue. In my time as a nurse, I have looked after patients who have had a stem cell transplant. My haematology colleagues would agree with his statement that between 20% and 40% of patients who have a second stem cell transplant can be cured. The treatment is indeed offered in many parts of Europe and in the US, so it is shameful that it is not offered here.

[Mark Tami]

I totally agree with the hon. Lady. We are talking about a very small number of people but, for them, it is their only chance after they relapse.

Despite everything we know, NHS England confirmed in December 2016 that it would not routinely fund second stem cell transplants. In effect, it decided that these people’s lives were not worth the money.

One of those people is Sasha Jones, a 34-year-old mother of two from Greenwich, who, in March 2015, was given the devastating news that she had acute myeloid leukaemia, a type of blood cancer. Over the next few months, she had rounds of chemotherapy and her first stem cell transplant. It was not without its difficulties, but by the beginning of October 2015, she was well enough to go home to her husband, Lloyd, and their two young children, aged just 13 and eight at the time. In August 2016, she was told that the blood cancer had come back, but by this time NHS England had decided that it would not routinely commission second transplants for patients in Sasha’s situation, despite such treatment being recommended by her doctor.

Doctors tried to get Sasha a second transplant by going through the individual funding request route, which allows NHS England to fund treatment for patients on an individual basis if they are deemed to be an exceptional case, but what is an exceptional case, how is that decided and, importantly, how long does it take to be considered? It has to be done at a time when the family and patient are dealing with the devastating news that their illness has not been cured but has come back, so they have to cope with that while also going through this process.

Sasha’s request was turned down and she has effectively been left with no alternative treatment. She now has two choices: find the money to pay for the second transplant herself; or accept that she might have only months to live and that her two young children could be left to grow up without their mother. I think it is fair to say that Sasha and her friends and family are desperate. A petition that they started to call for a reversal of NHS England’s decision not to fund second stem cell transplants now has more than 165,000 signatures, while a fund that was set up to raise the money that Sasha would need to pay for a second transplant currently stands at £90,000, but that is still not enough. Can hon. Members imagine the enormous pressure on Sasha and her family? In Sasha’s own words, she has been “condemned to death”. She says:

“In having been denied access to a second stem cell transplant, it has been decided that ‘I’m not worthy of a second chance a life; my children do not need a mother, my husband will become a widower’.”

It is a scandal that someone like Sasha should find herself in this situation—denied life-saving treatment that other patients have had in the past because NHS England says it is neither affordable nor justifiable.

--- Later in debate ---

[Mr Burrowes]

The point I am trying to make is that everyone has been on a journey of discovery and understanding in relation to the development of the life-saving potential of stem cell transplants. This is all part of a partnership involving collection, more effective transportation, research and clinical networks. We all recognise that, in this complex world, there is a risk of relapse, so the journey of treatment is a continuing one. Once someone is having treatment, they are part of that journey, and the hon. Gentleman is right to say that they should not simply be cut off and told that they have had their go.

We know of many other patients with a chronic illness who go back to their doctor or to hospital because they have had a relapse. We have to recognise that that happens in this field, where we are getting better quality outcomes. There is still an issue of resistance, however, which needs extra research and clinical expertise. When a clinician says that a transplant is the only option available to that small number of patients, and when we are investing so much in ensuring that there is greater access nationally to treatments for blood disorders and blood cancers, it makes no sense to cut those people off and give them no further opportunity for treatment.

[Maria Caulfield]

I am listening to my hon. Friend’s powerful argument. I do not know of any other illness in which, if a patient would have a 30% chance of a cure if they had a second transplant but otherwise had no chance, they would be denied that treatment.

[Mr Burrowes]

Indeed, that 30% chance is taken away from those people. The chance of recovery is even greater for children, but that chance is taken away from them as well. We are getting into the issue of the exceptionality of circumstances here, but children are losing out too. These decisions seem to be made regardless of whether someone has a better chance of a cure. Routine commissioning has gone, but we are also finding that the treatment is being refused even in relation to individual funding requests. I will say more about that in a moment. People need not take our word for this—we are not the experts—because 30 clinicians wrote to The Times to make the point that these decisions were effectively passing a death sentence on the individuals involved.

We have heard about the desperate situation facing Sasha, but there are other individuals who will perhaps be able to overcome these obstacles. One who is more fortunate than most is Emily. She was studying when she was first diagnosed with leukaemia at the age of 21. She had a transplant from an unrelated donor in February 2014, but she discovered in December 2015 that she had relapsed, as can often happen. She was told that she would die without a second transplant, so she applied via an individual funding request, which was turned down by NHS England. The situation was the same for Sasha and others. Emily’s consultant felt strongly that she had a good chance of survival and, despite the financial risk, the hospital paid for the transplant itself. She had her second transplant in March 2016. She was very fortunate.

Sadly, because of the decisions that have been made since December, the edict now is that routine commissioning has gone. No risks will be taken by any hospital. Even though crowdfunding initiatives are trying to raise the money for Sasha and others, they will not be in such a fortunate position as Emily, who says:

“I am so grateful I have doctors who will fight my corner and who refused to give up on me. But it shouldn’t be the case that they have to find loopholes and face an uphill struggle to push this lifesaving treatment through. How many others wouldn’t be so lucky?”

Frankly, after the decision in December, hardly anyone will be so lucky now.

I appreciated and recognise that NHS England has difficult choices and decisions to make in prioritising specialist services, and they have to be based on evidence. We are pleading with NHS England to look at the evidence in this particular case. Treatment must be prioritised in cases where the alternative presents significantly lower survival rates.

As the hon. Member for Strangford (Jim Shannon) said, it is an issue of cost. We need to look at the value and cost-effectiveness of such treatment. Second stem cell transplants are well established and are potentially curative treatments, as evidenced by the survival rates. The treatment is recommended by leading clinicians. The alternatives have to be carefully considered but, without such treatments, the mortality rates and the costs can be considerable.

After the original decision was made in July 2016, patients were effectively dependent on making individual funding requests. We have to ask whether that is the way out, whether it is the safety net. Frankly, it is not. Although it says on the tin that people can make the case for there being exceptional circumstances, and we might think it sounds pretty exceptional if, say, someone is facing death and there is no alternative—whether they are a child or an adult—such requests are highly bureaucratic and highly stressful. Sadly, the APPG has seen evidence that people are being pretty much routinely refused.

We are talking about small numbers of people. There is a lack of transparency, and the responses to IFRs do not give full reasons for refusing exceptionality. They appear to be refusals based on policy, rather than discretion based on the available evidence. I implore the Minister to look at the need for transparency on such decisions, which sadly at the moment only add to the anguish and distress of these very vulnerable patients.

For patients with a blood disorder, the fear of relapse is real—relapse is a real and present danger. The decision not to fund second transplants means that, from their first transplant, patients now fear they may relapse and not be able to access a second transplant, which is part of their treatment cycle. The situation is desperate: a death sentence is essentially hanging over them when they should be able to look to a more positive future. We need to be there alongside those patients in the long term, to the end, whatever happens, to ensure that they have the best alternatives.

The impact assessments need to look at the situation properly, and the offsetting of costs must include not only the specific treatment cycle but the overall treatment costs and the cost of not funding this treatment, including the cost of palliative care. In recognising the NHS’s degree of independence, I hope the Minister will use her good offices to ensure that it recognises that all steps need to be taken in conducting a full cost-benefit analysis of second transplants so that, when we revisit the decision in the spring, we will not be back in this situation; otherwise, we will be back here again to make the case and to say that it is not acceptable. A full understanding of the benefits of second transplantation is essential, so that those 16 to 20 patients a year can receive what all clinicians say they need. Their lives should not be lost.

Defibrillators in Public Areas

Maria Caulfield Excerpts

Monday 16th January 2017 Commons Chamber

[Maria Eagle]

I thank the hon. Lady for that very useful information, from her own experience as a doctor. It is important that the availability of this kit is widened across our society in order to save lives.

Current legislation surrounding public access to defibrillators is practically non-existent. Last year, the Government produced a guide for schools recommending the purchase of AEDs. While I welcome that move to highlight the issue, the Government should do more. Will the Minister undertake to meet Mark and Joanne and the OK Foundation to discuss a realistic programme of providing AEDs in public places and training for people such that they feel confident to use them? Will he facilitate a meeting with the Prime Minister? I know that the OK Foundation would welcome an opportunity to argue its case at the highest possible level of Government.

[Maria Caulfield (Lewes) (Con)]

I thank the hon. Lady for raising such an important issue in this Adjournment debate. I, too, pay tribute to the Oliver King Foundation for all its hard work. This is one of those rare occasions when there is cross-party agreement. We agree on the need for these defibrillators, but the Bill that will come here for its Second Reading on 27 January is unlikely to make progress simply because of its nature as a ten-minute rule Bill. Does she agree that it would be good if the Government adopted the Bill, because this procedure does save lives, it is relatively cheap to introduce, and it would make a difference to young people? As she eloquently explained, 12 young lives are lost each week through these incidents.

[Maria Eagle]

I congratulate the hon. Lady on bringing forward her Bill. Yes, it was done under the 10-minute rule procedure, but it is now there, and I echo her call for the Government to adopt it. As she realistically observed, the only reason it may not progress in this Session is that there is no time given its position on the list for private Member’s Bill Fridays. The Government could transform that in an instant by taking on board aspects of the Bill—or the whole Bill, preferably—and putting them into some of their own legislation. The Minister might have something to say about that.

--- Later in debate ---

[David Mowat]

As I have said, I am not in a position to say tonight what the Government will do in respect of the Bill. I am willing to say that we will meet and talk about it after this debate. As I will come on to say, there is a question about the extent to which defibrillators should be mandatory, as was raised in relation to schools, versus dealing with this through guidelines and other forms of help. I will try to make some of those points later.

The hon. Member for Garston and Halewood made the point that the survival rate of people who have an out-of-hospital cardiac arrest is in the order of about 10%. It varies a little by ambulance service—it can be between 7% and 12%—and if we could get all ambulance services up to 12%, that in itself would save many lives. There is no question but that if defibrillators were available in time, the figure would be at least doubled and perhaps increased by more than that. We also accept the figure from the British Heart Foundation, which I think she cited, that every minute of delay reduces the probability of success by something like 10%.

We need to achieve two things: we need to create more access to defibrillators; and, as my hon. Friend the Member for Calder Valley (Craig Whittaker), who is not now in the Chamber, said in relation to the incident in his family, we also need to increase training and CPR awareness. I recall doing CPR training and being taken through all this two years ago in a church hall in Warrington. It really did not take very long, and I hope I can still remember how to do it. Using these things must be done in parallel with other training. I understand that some defibrillators work fairly easily without too much training, but experience of and ability in CPR buys time, which is what we need to achieve.

I will talk about what the Government are doing in relation to public places, schools, the workplace more generally and, as I have mentioned, sports. I will also take a few minutes at the end of my speech—I do not think that we will be here until 10 o’clock—to talk about screening, which was mentioned as something we ought to consider.

Since 2007, ambulance trusts have had responsibility for the defibrillators around the country. That is because they are where 999 calls go, and they ought to know where the nearest defibrillator is when they get one. If there is a code or the defibrillator is locked, they are responsible for that. In addition, the British Heart Foundation in England—this is also happening in Scotland—is trying to create a database of the defibrillators that we believe are out there. The BHF thinks that there are something like 14,000 defibrillators. Unfortunately, for historical reasons that have grown up over time, there could be maintenance issues with some of them. We need to bring all that up to date, and the BHF is leading the charge on that.

In the past two years, the Government have allocated £1 million per annum for defibrillators in public places. That money is for England only and has led to some success. We had 700 new defibrillators last year as well as the cabinets that go with them, in addition to a range of CPR training, and we expect the same thing to happen this year. That represents an appreciable increase in the number of defibrillators. As I have said, we are doing that because we believe that defibrillators save lives, as does the training around them.

The Member for Garston and Halewood talked about schools. She rightly said that schools have been issued with guidance saying that we expect them to consider the installation of defibrillators, but it is also true to say that not every school has a defibrillator. The hon. Lady also talked about defibrillators costing in excess of £1,000. The scheme that we have put in place for schools uses NHS Supply Chain, which means that they can source a defibrillator for something like £435, which is clearly better than £1,000. I accept that that still comes out of a school’s budget, but nevertheless a great number of schools are taking that up. Schools can also apply to the British Heart Foundation scheme that we talked about earlier, provided that the defibrillator is publicly accessible, which in many cases it would be. However, I accept that we have not mandated such provision, as the Bill asks us to—I will talk about that a little later.

There are workplace health and safety aspects that every employer must consider. We have put in place a requirement that, from 1 January this year, everybody in a workplace who is first aid-accredited—obviously health and safety regulations require that there are such people—must have defibrillation training and be in a position to use those facilities. That is now happening, and it includes everybody who will have to do a first aid refresher course.

As I mentioned, sport is a priority area. Sports governing bodies will have formal responsibility, and many sports are taking this forward. We know of the incidents that have occurred. I think it was Fabrice Muamba during a Tottenham game who was saved by a combination of a defibrillator and a doctor in the crowd who knew CPR, and rugby league and rugby union are also involved. The Football Association has made available a £1.2 million grant to buy 1,300 defibrillators for use at football grounds up and down the country—and not just at the very large grounds. I am involved at Warrington Town football club, and we will be getting a defibrillator under that scheme as well. All FA-accredited coaches will also have to be CPR trained.

I know from the sports Minister that the sport strategy has made defibrillators in sports a priority. She has nominated Baroness Grey-Thompson to take this forward, in terms of putting a duty of care on the various governing bodies. It is an area of priority.

It is also important to understand more about sudden cardiac arrest and to make progress through research. The Government have provided funds through the National Institute of Health Research particularly to deal with the genetic aspects of the condition, given that it has a generic element. Work on gene discovery is also going on at the Oxford Biomedical Research Centre. I am not saying that we are close to a solution or a clear way forward, but this is a research priority. If we understood the genetics better, it would help us to do screening better, so let me move on to screening.

There is a school of thought that screening for children’s genetic predisposition to heart problems could make a difference. In 2015, the UK’s screening authority, the screening committee, considered screening people between the ages of 12 and 39. It did not support that, however, and I believe that that position is consistent with that of every other country in Europe. We have looked into this, and my understanding is that no other country carries out such screening. A number of reasons have been given: it is difficult to get clarity about the numbers of people who would be affected; there is concern that even if screening were to identify people with a potential weakness, there is no consensus on how that should be managed; and, finally, there is a significant concern about the efficacy of a test, especially regarding the number of false negatives and false positives, which it was felt could do more harm than good. If peer-reviewed evidence came forward, based on the findings of places that had conducted screening work, the matter would be reconsidered, but without that, it will not be looked at again until 2018. That leaves us with the issue of how to make more progress on the number of defibrillators available. Perhaps the difference between the hon. Lady’s remarks and my response is not whether it is a good thing to make progress on defibrillators, but whether the Government should mandate putting defibrillators in every school and sports facility.

[Maria Caulfield]

I understand the Minister’s concern about whether this should be mandated. However, these days we would never operate a school without a smoke alarm or fire extinguishers, and we would not put children on a school bus without seat belts. For me, defibrillators are as essential a piece of safety equipment as any of those things.

[David Mowat]

I accept that. As I say, the guidelines are clear: any school can make use of the NHS Supply Chain facility to put in a defibrillator for £400 or so.

NHS and Social Care Funding

Maria Caulfield Excerpts

Wednesday 11th January 2017 Commons Chamber

[Jonathan Ashworth]

If I may, I will make a little progress. I promise to try to give way to as many hon. Members as possible.

I assure the Secretary of State that I will pass on the names of the trusts and hospitals that I highlighted, so perhaps he can look into them. Let us be absolutely clear that these desperate stories are not the words of politicians trying to score political points but are the honest, heartfelt, considered testimonies of doctors and clinicians on the frontline in our hospitals. They simply want to do the very best for their patients. Indeed, many clinicians want to speak out but feel that they cannot, which is why the remarks were made anonymously.

According to reports on the BBC’s “You and Yours”, the Prime Minister has sent instructions to hospital trust chief executives telling them not to speak out. I would be grateful if the Secretary of State verified those reports.

[Maria Caulfield (Lewes) (Con)]

I worked in the NHS over the Christmas period. Although it has been a very tough winter so far, this is nothing new. I have worked in the NHS for more than 20 years, and under previous Governments we had ambulances queuing around the block to get into A&E. Major incidents were declared in A&Es because they were too full. Will the hon. Gentleman accept that this is not a new problem?

[Jonathan Ashworth]

I entirely respect the hon. Lady’s work as a nurse before she came into this place—[Hon. Members: “She still is.”] I beg her pardon. She is still a nurse, and I genuinely respect her, but if we are not raising these matters on behalf of our constituents, we are failing in our responsibility as Members of Parliament. We must never forget that this is not just about the staff in our NHS; it is about patients and their safety, which must always be our absolute priority.

--- Later in debate ---

[Mr Hunt]

I want to make some progress but I will give way to my hon. Friend the Member for Lewes (Maria Caulfield), who is a serving nurse.

[Maria Caulfield]

May I reiterate the Secretary of State’s point about the four-hour target? During the Labour Government, I was working in the NHS. Significant pressure was put on us by managers to meet the four-hour target, negating clinical need. Patients were often prioritised according to meeting the target, rather than by clinical need. That was a disgrace.

[Mr Hunt]

That is exactly the problem we had with Mid Staffs. We had a culture in the NHS where people were hitting the target and missing the point. Although targets are important management tools in all organisations, it is important that they are followed in a sensible way that puts the interests of patients first.

--- Later in debate ---

[Dame Rosie Winterton]

I do not agree with the hon. Gentleman. The four-hour target led to much better diagnoses and much improved provision of the type of treatment that people needed, as well as better interaction with communities. And I want to come on to that point because the Secretary of State has been trying—perhaps the hon. Gentleman is guilty of this as well—to separate the target for A&E departments from what happens outside, whereas I see the importance of putting the two together. Providing alternative treatment, which is perhaps part of what the hon. Gentleman was getting at, means having proper support in the community. It was bringing those two things together that made it possible to achieve the target, so it was a driver.

[Maria Caulfield]

Will the right hon. Lady give way?

[Dame Rosie Winterton]

I give way to the hon. Lady, who I know has some experience of this.

--- Later in debate ---

[Maria Caulfield]

In my experience of trying to meet the four-hour target, it is often—or was in the past—prioritised over everything else, including patient care and clinical need. It was sometimes abused, with huge pressure put on staff to meet the target, and as a result patient care suffered. I saw that myself.

[Dame Rosie Winterton]

It is always important to look at the feedback from clinicians, and I did that as a Health Minister. It started during my time as a Minister, and I remember that we had constantly to consider whether there was a clinical reason for reducing the 95% target. It became clear that some patients needed longer to be assessed owing to their particular condition. In such cases, I could see why the target might need to be reduced, but that was based on clinical need. By contrast, the impression given last week was, “My goodness! We’re going to have to cope with some winter pressures. Let’s reduce the target in order to meet it,” rather than there being an assessment of clinical need. That sent completely the wrong message to the NHS. I think it was the wrong thing to do.

I want briefly to set out some areas in which we can bring the community input together with what is happening in emergency departments to reduce some of the pressures. The first point was that made by my hon. Friend the Member for Leicester South (Jonathan Ashworth), who spoke from the Front Bench. Good social care is vital to ensuring that people do not end up in A&E. I have previously raised problems with the Government’s current proposition to, in a sense, move responsibility for raising money to local councils. That is particularly unfair in areas such as mine, which simply cannot raise the same amount of money through a council precept as better-off areas can. It simply does not work. We need it probably more than any other area, but we will be less able to raise the money.

On shortages, I have been talking to senior NHS staff in Doncaster, and there are real problems with emergency care staffing. They tell me that although more doctors are being trained—I accept that—it will take years for them to come through. The single most effective step we can take to ease pressure on A&E departments is immediately to increase funding for social care, because it would keep people out of A&E departments, and it could be done straightaway. The personnel are out there; the Government just need to increase the funding, as my hon. Friend said from the Front Bench.

We also have to look seriously at the problem of GP shortages. As others have said, if patients are waiting three weeks to get an appointment with a GP, they are bound to end up in A&E. This needs to be addressed very quickly, with proper forward looks at exactly where the gaps are in GP services. I have said before that PCTs—now clinical commissioning groups—or NHS England should be able to take over practices and employ salaried GPs. That would make a huge difference.

Furthermore, on community pharmacies, if people are confident that going to a pharmacy will save them a visit to A&E, again that will relieve pressure on the system. I hope, therefore, that the Minister will assure us that he is looking seriously at the community pharmacy forward view, which sets out how pharmacies can be integrated into the NHS and social care.

Briefly on mental health, the Prime Minister answered a question today about mental health and the crises that people can get into, which mean that they end up in A&E. She talked, in particular, about young people. I urge the Minister to consider the role that educational psychologists can play in children’s mental health and in keeping them out of A&E.

It was my experience as a Health Minister that we needed people on the ground locally to help organisations across the spectrum—local government through to social care, pharmacies, GPs and ambulances—to work with A&E departments, yet the £2 billion reorganisation that removed PCTs and strategic health authorities has made it much more difficult to drive through the necessary changes. I hope, therefore, that the Minister will look very seriously at what has happened, because local knowledge can be vital.

On the basis of the Secretary of State’s contributions, it seemed that he was trying to use every excuse not to face up to the reality of what is happening. I think that sends a terrible message to NHS staff. I hope that, as a result of today’s debate, the concerns raised will be taken on board by Ministers and the Secretary of State and that they will come back to us with a proper plan that recognises the problems and offers real solutions.

--- Later in debate ---

[Maria Caulfield (Lewes) (Con)]

I appreciate the opportunity to speak in this debate. For the record, the last time I was in an NHS hospital was when I was working a night shift on Saturday. I declare an interest in that I am a nurse who has worked during this year’s winter crisis, but I have also worked during winter for the past 20 years.

[James Heappey]

I apologise for intervening so early in my hon. Friend’s speech, but the hon. Member for Dewsbury (Paula Sherriff) is too busy congratulating herself on her own speech to note that my hon. Friend was working in an NHS hospital on Saturday night.

[Maria Caulfield]

I thank my hon. Friend, but that is obviously not of interest to Labour Members. I have been a nurse for over 20 years and have seen 20 years’ worth of winter crises. They are not unusual. There is no doubt that there is more pressure this year than ever before—we have heard about record numbers of people attending A&E—but there have been winter crises under many previous Governments. It was not unusual when I worked in A&E for patients to be treated in corridors or on chairs—wherever there was space. It was not unusual for ambulances to be queued up around the block, waiting for hours to unload patients—[Interruption.] I still work in the NHS and disagree with the chuntering from the Opposition Benches.

[Dr Rosena Allin-Khan (Tooting) (Lab)]

Will the hon. Lady give way?

[Maria Caulfield]

I will not. I must make progress and others want to speak.

It was not unusual for my hospital to declare a major incident because we could not take any more patients. It was not unusual for us to take on the extra work when neighbouring hospitals declared major incidents. The truth hurts, but that is what has happened over my 20 years of working in the NHS and what has happened over the past few days of this winter crisis. It outrageous for Labour Members to suggest that it is something new. They are in denial if they believe that it has not been happening for many years.

The Labour Government was so fixated on the four-hour rule that managers used to bully us and tell us which patients would get a bed based not on clinical need, but on the need to meet a target that was about to expire. I want to tell the House a story. One night I was working in a busy A&E when an elderly gentleman was admitted. He had fallen at home and broken his hip and had to be nursed on a trolley in the middle of a busy corridor. The four-hour target was looming, and at three and a half hours he called out to me and said, “Nurse, I desperately need to go to the toilet.” I had no cubicle to put that man in. He could not get off his trolley owing to his broken hip. The best that I could do under that Labour Government was to wheel a curtain around him and he went to the toilet there in the middle of a busy hospital corridor, with his war medals on his chest. Now, he got to a ward within four hours—his target was met—but that was not good care. If Labour Members think that it was and think that this is a new problem, they have buried their heads in the sand.

[Dr Allin-Khan]

Will the hon. Lady give way?

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

Will the hon. Lady give way?

[Maria Caulfield]

I will not.

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. If the hon. Lady wants to give way, she will. Unfortunately, she is not, but Members cannot just stand there—two at once—shouting all the time. It is recognised that if a Member is to give way, they will, but it is up to them.

[Maria Caulfield]

These problems are not new. I have also worked in out-patient settings where A&E targets have had an impact on patients waiting for elective surgery. The sheer determination to meet those targets due to pressure from the Labour Government led to patients with breast cancer having their elective operations cancelled time after time owing to emergency admissions. I had to tell a young mum, whose mastectomy operation following breast cancer had been cancelled three times while her young family were waiting for Christmas, that the only bed we had left was in a post-natal ward, where she woke up and recovered from her operation next to young mums learning to breastfeed. That was in an attempt to meet four-hour targets, so do not tell me that services have reduced. Targets were met, but staff were put under severe pressure not with quality of care but with targets in mind. I make no apologies in making that clear.

I am a supporter of four-hour targets. I was enthusiastic when they were introduced as a way of monitoring performance and improving the service, but they became the absolute king, above everything else. I congratulate the Secretary of State on introducing the consideration of outcomes. What happens to a patient when they are admitted? If they have to stay for four and a half hours to avoid admission or to get full care, what is the problem with that? If they can leave within two hours because they have been adequately treated, fantastic, but we should not be held to account by an arbitrary four-hour rule that has no clinical significance. I support the four-hour rule, but there are other measures that we also need to be aware of and that should be treated with equal status to the four-hour target.

Of course money is important. As our ageing population and our ability to treat more patients grows, we will need more funding for both healthcare and social care. It is worth noting that the trusts either side of my constituency receive the same funding and look after the same types and numbers of people. One is in special measures, is unable to deal with its discharges, has queues and is unable to meet its four-hour targets; the other, five miles along the coast, is rated outstanding, does not have the same pressures or four-hour waits and is able to discharge its patients speedily. There is something about what happens to the money, as well as about how much the money amounts to.

Labour did put huge amounts of money into the NHS over the years, but much of it was squandered—£10 billion on a failed IT project that never saw the light of day, and PFI deals that are still costing the NHS £2 billion a year. How much could be done with that £2 billion?

[Dr Daniel Poulter (Central Suffolk and North Ipswich) (Con)]

Will my hon. Friend give way?

[Maria Caulfield]

I will take one brief intervention.

[Dr Poulter]

I commend my hon. Friend for making a balanced speech and for rightly saying that meeting targets does not necessarily equate to delivering good healthcare, although they do have their place. Does she agree that one of the biggest challenges is the consistent inability of a number of A&Es across the country to recruit middle-grade doctors? That is one of the biggest problems that has not been addressed to date.

[Maria Caulfield]

I absolutely agree that there is a problem in recruiting staff, particularly in the south-east—including in my constituency—in all healthcare professions because it is an expensive place to live. I agree that there is an issue with recruitment, but if we are to move forward, we need to work in a more cross-party way. Continually using four-hour targets as a stick to beat the Government with does nothing for cross-party working, so we need to stop the political cheap shots and recognise that money is not always the solution—it is about how the money is spent and the difference it can make. This also has to be clinically led. We can work together as politicians, but if we do not work with healthcare professionals, in both primary care and secondary care, I fear that we will be sitting here again in the years to come to talk about another winter crisis.

Mental Health and NHS Performance

Maria Caulfield Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I accept that more funding needs to go into social care, and that is why we are putting an extra £3.5 billion per annum into social care by the end of the Parliament. Despite the very real pressures in social care, however, there are many local authority areas and hospitals that have no delayed discharges at all. Half of all delayed discharges are in just 20 local authorities. As we wait for that funding to come on stream—it is not all coming on stream at the start of the Parliament—there is lots that can be done.

[Maria Caulfield (Lewes) (Con)]

I thank the Secretary of State for paying tribute to frontline staff. I declare an interest as someone who worked in the NHS over the Christmas period and who saw at first hand some of the pressures that staff are facing, but I know from my 20 years’ experience working as a nurse that these are winter pressures that are faced every year. On mental health, will my right hon. Friend pay tribute to the mental health care nurses in Sussex and to Sussex police? Through their joint working, they have reduced the number of patients being placed in prison cells as a place of safety by 50%. That is a huge achievement in the county that contains Birling Gap and Beachy Head.

[Mr Hunt]

I welcome my hon. Friend’s contribution as a practising nurse; it adds greatly to the House. I am more than happy to pay tribute to our brilliant mental health nurses. They have one of the most stressful jobs anyone can have, and I pay particular tribute to the ones in Sussex, which has those tragic suicide hotspots.