PANS and PANDAS

Debate between Maria Caulfield and Ruth Cadbury

Tuesday 12th September 2023 Westminster Hall

[Maria Caulfield]

The Department does not regularly write to GPs because the NHS is operationally independent, but NHS England does and we can certainly speak to NHS England colleagues. They send out regular bulletins on a range of issues to GPs, so I will speak to my primary care colleagues to see whether that is possible. We do not have enough information at the moment about how many children in the UK are affected by PANS and PANDAS. In the US, scientists have suggested that the prevalence there could be as high as one in 200 children.

We have specifically talked about the United Kingdom and England today. Although there is a classification now by the World Health Organisation, very few countries issue guidance on the diagnosis, treatment, assessment and management of PANS/PANDAS, because the scientific evidence is so sparse. When I met my hon. Friend the Member for Aberconwy, we talked about how we can get that evidence base so that we can issue guidance to primary and secondary care providers. We know that symptoms tend to come on suddenly.

We heard from my hon. Friend the Member for North Devon (Selaine Saxby) about the example of Jack and the difference that a diagnosis made. It is often following an infection that children who are healthy and developmentally on track suddenly start exhibiting OCD or other neuropsychiatric symptoms. The hon. Member for Brentford and Isleworth (Ruth Cadbury) is correct that very often a course of antibiotics can improve and tackle some of the symptoms that parents say can change a child overnight such that they can no longer attend school and are suddenly plagued by anxiety and other neurological symptoms.

PANS and PANDAS require a clinical diagnosis based on specific signs and symptoms observed by a clinician. There are currently no lab tests or biomarkers that specifically diagnose those conditions. There is also an element of excluding other diagnoses in the process of diagnosing PANS and PANDAS. That means other illnesses or diseases are considered first rather than assuming it could be PANS and PANDAS.

Although there are currently no national or European clinical guidelines on assessment, investigations or diagnosis, a multidisciplinary team referral often helps speed the process up. That is why we need our primary care colleagues to be aware that this could be the cause of symptoms and to get those referrals in as quickly as possible.

[Ruth Cadbury]

I thank the Minister for her response. She mentions the fact that there is no lab test that can diagnose PANS/PANDAS, but is that not true for other neurological conditions that I mentioned, such as ME and some of the ongoing conditions that people are experiencing from long covid? Sometimes a lab test does not exist because of the nature of what caused the symptoms. Perhaps the medical profession and NHS England need to think slightly outside the box in their search for answers.

[Maria Caulfield]

I absolutely agree with the hon. Lady. NHS England has been happy to work on such issues with the working group. It is embarking on work to roll out a nationwide surveillance study designed to identify the signs and symptoms because, again, it is probably unlikely that we will reach a definitive test that will ever give us a diagnosis, and it is about matching symptoms with a diagnostic criteria. NHS England has committed to doing that, and the Department is happy to support it in its work.

There is the issue about how quickly antibiotics should be prescribed and dispensed, but while one antibiotic may work for one child, it may not work for another, and it is sometimes a case of trial and error before the appropriate treatment is found. Although there is an evidence base for the treatment of symptoms, such as obsessions, compulsions and tics, it is recommended that children and families affected should be offered evidence-based treatments. That is why we absolutely need to build that research base to provide evidence-based guidance to clinicians, whether they are in primary or secondary care. At the moment, NICE says that it does not have the evidence base to put that guidance together, whether that relates to psychological treatments or to medications such as antibiotics. The commitment I can give today is to push and work with the working group, organisations and Members in this place to try to develop that research base.

Oral Answers to Questions

Debate between Maria Caulfield and Ruth Cadbury

Tuesday 6th December 2022 Commons Chamber

[Maria Caulfield]

I thank my hon. Friend for all her hard work in this space and for leading our debate on childhood cancer outcomes in this Chamber. I was delighted to meet her constituent Charlotte, who is campaigning so hard on the issue. I promised her that we would look at a child cancer mission; we will update the House on our progress shortly.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

6. What progress his Department has made on its commitment to recruit 6,000 additional GPs by 2024.

Oral Answers to Questions

Debate between Maria Caulfield and Ruth Cadbury

Tuesday 19th July 2022 Commons Chamber

[Maria Caulfield]

I am very sad to hear of the experience of my hon. Friend’s constituent and he is right to say that emergency services need to be able to access public areas. I am happy to talk to him about that afterwards to see what more can be done.

[Ruth Cadbury (Brentford and Isleworth) (Lab)]

“24 hours in A&E” was a reality TV programme but now it appears to be the reality for far too many people. The zero tolerance standards on 12-hour A&E waits and 30-minute ambulance handover delays are being systematically and seriously breached. So when do the Government plan to achieve those standards, which were set and delivered by the Labour Government?

[Maria Caulfield]

Let me place on record my thanks to all the ambulance staff up and down the country who have gone above and beyond in the past 24 to 48 hours to be able to respond to extreme pressures that are only really seen in winter times. Let me give a scale of the pressures they are under. Compared with the situation in May last year, there have been over 100,000 more calls to the ambulance service, and there were 2.1 million attendances at A&E departments in June, which is 3.6% higher than the figure for June 2019. So they are under incredible pressure, and I pay tribute to all of them doing their best.

NHS Bursary

Debate between Maria Caulfield and Ruth Cadbury

Monday 11th January 2016 Westminster Hall

[Maria Caulfield (Lewes) (Con)]

I welcome the opportunity to speak in such an important debate. I acknowledge that the changes affect all sorts of healthcare professionals, including midwives, physios and speech therapists, but I will keep my remarks mainly to student nurses because I am a qualified nurse and have worked in the NHS for more than 20 years—I was even working as a full-time NHS nurse until just after the last general election.

I trained under the bursary scheme. I was one of the second intake, after the scheme was introduced in the early ’90s, so I have first-hand knowledge of how it works. I have met student nurses, the Royal College of Nursing—the RCN—and qualified nurses to discuss some of the issues that the changes raise. I have also met the Minister to express my concerns, and have been reassured that alternatives to a student loan mechanism for entering nurse training are in the pipeline. These might be better than the nurse bursary scheme, and they will certainly be better than the proposed student loan scheme.

Let us not pretend that the bursary system is ideal—I speak as someone who went through that method of training. It started in the early ’90s as a replacement for the old-style nurse training system in which student nurses were part of the workforce and were on the payroll. Let us be honest though, the students were used as a spare pair of hands and often there was not a huge opportunity for them to learn on the job. At that time, there were two ways for someone to become a nurse. They could do a two-year course to become a state-enrolled nurse, in which role they could do only so much, or they could do a three-year course and become a fully qualified state-registered nurse, taking on all aspects of the role of a registered nurse. The bursary scheme, when it was introduced, was a move to make nursing more academic, and to create supernumerary student nurses. Or rather, that is what is supposed to happen. As my hon. Friend the Member for Sutton and Cheam (Paul Scully) pointed out, in practice, student nurses are still used as a spare pair of hands and are rarely supernumerary when they are on placement.

Student nurses were, however, taken off the payroll and the bursary scheme was introduced as a sort of income to acknowledge that, although the students were not counted as part of the workforce, they still had to do a huge number of hours while on placement, including night shifts and weekend and evening work. The bursary was supposed to compensate the students for their loss of income, but a bursary is not a wage, and it certainly does not reflect the number of hours student nurses put in during their training.

Let us not miss the point. Someone can do a three or four-year academic nursing degree, but unless they do the clinical placement hours, they cannot register as a nurse. That is the crux of the matter. In addition, a bursary certainly does not reflect the increase in experience and skills that students gain as they go through their training. A first-year student nurse gets exactly the same bursary as someone who has almost qualified and is practically working—under the supervision of a qualified nurse—as a qualified nurse.

The bursary system undervalues the contribution that student nurses make, and it means that student nurses across the country live on little more than £3,000 a year. The system has changed over time—it was not means-tested when I was doing my training, but it is now. Let us not pretend, therefore, that the system is ideal. The bursary has never adequately supported student nurses, and I welcome the chance to change it. Let us look at other professions. I certainly do not want people sitting in the Public Gallery to suddenly rush out and change profession completely, but a trainee police officer has a starting salary of £19,000 and a trainee firefighter starts on £21,000. Airlines are now moving to in-house training. A new pilot with no flight experience training with British Airways is on £23,000 and Virgin has a similar policy, with Richard Branson saying that he welcomes those with no experience to be part of the Virgin family from day one. Yet for student nurses, who take similar life and death decisions every single day, we propose not just that they work in clinical areas for free but that they pay for their training as well.

I believe Ministers when they say that this is not a cost-cutting exercise, because the money will instead increase the number of student nurse placements. Currently, more than 50% of people who apply to become student nurses are turned away simply because the places are not there in the universities. The RCN’s figures from only last year show that there were 57,000 applications, of which 37,000 were rejected.

[Ruth Cadbury]

Will the hon. Lady give way?

[Maria Caulfield]

I will not, if the hon. Lady does not mind, just because I know that so many Members want to speak.

Although not all of those 37,000 will have been rejected because of a lack of places, a significant number of them will. The current system restricts the number of student nurses that enter the profession so, in theory, the changes should increase the numbers of qualified nurses in a few years’ time. From my clinical practice I know, however, that what works in theory will have the opposite effect in reality.

My main concerns about moving from a bursary scheme to a student loan scheme are, first, that many nurses go into a degree system simply because there is no other way to become a nurse. They do not necessarily want a degree in nursing; they want to be a qualified registered nurse. If we commit to a student loan scheme, we are committing them to take on debt for years to come. As we have heard, many of them—more than 30%—are mature students, and by mature students we do not mean people in their 40s and 50s. They are people in their mid-20s and early-30s. They have young families; they are single mums; and they have a first degree and have to take on a second one just to become a nurse. It is a crazy situation. For someone who already has a student loan, and/or a mortgage and/or childcare to pay for, the thought of taking on more debt will definitely put them off entering nursing, and to say otherwise is madness.

The difference between student nurses and other undergraduates is that the starting salary for a nurse is £21,000. Most nurses will only ever be a band 5 or 6, and the maximum they can earn as a band 6 is £34,000—that is if they do not have a break to have children or go part time for some other reason. They will never be in a position fully to pay off their student loan. Student nurses are different, therefore, from other undergraduates, and that has not been recognised in the debate. An issue in the wider debate about graduates is that a graduate is, on average, £100,000 better off than a non-graduate, but that is not the case with nurses. Other graduates earn, on average, more than £40,000 a year, but nurses do not earn anything like that and that difference needs to be recognised when decisions are made.

We have heard how much time student nurses spend on clinical placements—more than 50% of their course, including nights, weekends and evenings—which makes it almost impossible for them to get any other income from part-time work. We must recognise that. Being dependent on a loan is not a great way of life either, but other students are able to supplement their loans by working in pubs and shops, and doing other evening work. Student nurses are not in a position to do that.

My second concern is that, if I am completely wrong and we suddenly have a huge increase in the number of student nurses, the placements will not be able to cope. To qualify as a student nurse, not only does someone have to pass their exams and essays and do the required hours, they also have to be clinically assessed by a registered nurse—not just any old registered nurse, but someone who has done their mentoring and assessing course. I know that there are student nurses now who struggle to find placements because there are not enough qualified nurses able to assess them. That needs to be taken into account as well. It is not just about increasing the numbers; it is about having the support services in place.

When I met the Minister, I was hugely reassured by what he said about other schemes that are being proposed. My plea is that he outlines those schemes so that student nurses are reassured that, in order to qualify, they will be able to use schemes other than the student loan system. Routes such as nursing associates and nursing apprenticeships are being proposed. I am probably getting a little old now—