Patient Transport Services: Northern Lincolnshire

Melanie Onn Excerpts

Tuesday 16th January 2018 Commons Chamber

[Andrew Percy]

It is saddening that the same experiences are happening just across the river in the city of Hull as well. This appears to be a consistent theme wherever this company provides ambulance transport services. Unfortunately, the hon. Lady describes an experience that many of my constituents have shared.

In fairness to the north Lincolnshire clinical commissioning group, it has, through the scrutiny processes at North Lincolnshire Council, effectively put the company on notice and informed it that the service is not good enough. Despite that, the improvements have not happened.

[Melanie Onn (Great Grimsby) (Lab)]

I thank the hon. Gentleman for giving way. It is fair to say that all our constituents have suffered for reasons that Thames Ambulance Service Ltd has brought on itself to some extent. It has decided not to pay volunteer drivers, who have been the backbone of the service for some time, to travel to and from where patients must be collected. That means that it has lost 40 of those volunteer drivers. Should it not be rewarding the people who have been the backbone of the service rather than treating them that shoddily?

[Andrew Percy]

I could not disagree with a word the hon. Lady said. She has stolen my thunder—[Interruption.] No, it is good! I was going to come on to the company’s treatment of volunteer drivers. Not only has it said that it will not pay them for mileage unless a patient is in the vehicle, but at three months’ notice it told them that if their vehicles were more than five years old, they could no longer be volunteer drivers. Despite that having been its policy for a considerable time, a company cannot give volunteers three months’ notice like that—say, effectively, “Change your vehicle or give up on the service.” Through its own actions, the company has made an already struggling service much worse. It has absolutely brought the situation on itself.

I have dealt with the issue of volunteer drivers, and I thank the hon. Member for Great Grimsby (Melanie Onn) for raising it. I want to give a couple of examples from my constituency to demonstrate how poor the service has been. One of my constituents in Brigg was given short notice that their transport was to be cancelled because there were no ambulances. That meant that this person, who suffers from mobility issues, had to cancel an important scan. It is impossible for them to get in or out of vehicles unless they have been specially arranged.

The mother of another constituent from Crowle on the Isle of Axholme is 87 years old; she suffers from dementia, is partially sighted and has been repeatedly left stranded following appointments arranged way in advance. My constituent has completely lost trust in the service and family members have had to take time off work to ensure that the lady gets to hospital. The service is there to ensure that that does not have to happen. The situation is completely unacceptable.

Another constituent from the Isle of Axholme has repeatedly been left stranded and unable to book an ambulance. They have been forced to use expensive taxis, which meant that the trip doubled in length. On one occasion the service failed to fulfil a pick-up arranged in advance, and that again required them to use a taxi. The service is totally unacceptable.

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[Andrew Percy]

That is absolutely right. There is an argument for saying that those who provide the emergency services—East Midlands Ambulance Service in the case of Scunthorpe—are better able to provide the patient transport services, just as in Goole we would want Yorkshire Ambulance Service to provide the patient transport. There seems to be some sense in that, unless it is a very strong local community transport organisation that we know we can trust. Yes, there are always examples of failure, but we did not have this recurrent theme of failure under the previous system.

[Melanie Onn]

rose—

[Andrew Percy]

I will give way to the hon. Lady, but then I want to give the Minister enough time to respond.

[Melanie Onn]

I thank the hon. Gentleman for giving way; he is being very generous this evening. Following on from the point made by my hon. Friend the Member for Scunthorpe (Nic Dakin), our local hospital trust is already in special measures—it has gone into special measures for the second time—and senior board members are raising Thames as a potential difficulty and challenge in their efforts to meet their key performance indicators and get out of special measures. This is something the Government need to take really seriously.

[Andrew Percy]

It is incredible that what is judged to be a failing trust has a failing transport patient service that is making it even more difficult for it to get out of special measures. That is another reason I brought this matter to the House today.

Following on from the intervention of the hon. Member for Scunthorpe (Nic Dakin), one of my requests is to the Department for Transport—so not directly in the gift of the Minister in the Department of Health and Social Care—which is currently undertaking a transport accessibility consultation. It might be sensible if the issue of patient transport were to be wound up as part of that. That is one of my asks. I know that the Minister cannot respond, as it is not her Department, but it would be useful if she could pursue it interdepartmentally.



I want to give the Minister enough time to respond, so I will not say much more, but the concerns that I have described are shared by the clinical commissioning group, which has raised these issues with North Lincolnshire Council’s health scrutiny panel on a number of occasions and has told the panel that there will be further sanctions if the service does not improve. Sadly, that was said at the end of October, and, as other Members’ interventions have made clear, there has been no turnaround since then.

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[Caroline Dinenage]

Of course, we have devolved this matter locally and it is up to the local CCG to take action. I know that a recovery plan is in place and the delivery of the plan is now being monitored weekly, but the hon. Gentleman is right, and, like my hon. Friend the Member for Brigg and Goole, he has kept on articulating this issue and asking these questions on behalf of his constituents, to try to find out when they will see a visible difference to the service, because it is currently not good enough.

Patient transport providers are also required to be registered and inspected by the Care Quality Commission, the independent regulator of health services. This Government have given the CQC more powers, and it is now able to rate independent healthcare transport providers in the same way as NHS ambulance services. We fully support the CQC in its work to ensure that users of patient transport services are protected, and where services are not good enough and the necessary improvements have not been made, it can take further action, including issuing fines, service restrictions, and ultimately the cancellation of a provider’s registration.

Additionally, we are very supportive of the Department for Transport-led total transport initiative, which I think was what my hon. Friend the Member for Brigg and Goole was referring to, and which is currently piloting the joint commissioning of public sector-funded transport in order to reduce the risk of services overlapping, improve efficiency, and provide a better overall service to passengers.

From the local work carried out so far, it has become clear there are a range of potential benefits for the NHS, including helping to avoid bed blocking—where patients sometimes cannot go home because non-emergency patient transport is not available—and improving access to NHS services by reducing missed appointments due to late or unavailable transport. We have asked NHS England to ensure that CCGs are all engaging in this important work.

[Melanie Onn]

I welcome the Minister to her new role and wish her the best of luck, but from what she is saying I am not entirely clear how the Government will follow up and pressure will be brought to bear on the CCGs in the delivery of the contract. I had a 97-year-old lady, whom the new chief executive of the Diana, Princess of Wales Hospital and the Northern Lincolnshire and Goole NHS Foundation Trust met. She had had to wait for eight hours in the emergency care centre for transport to go home. There needs to be a little more urgency in the Minister’s response.

[Caroline Dinenage]

I completely understand why the hon. Lady is articulating that; every one of these incidents is absolutely unacceptable and in many cases very distressing. The issue with devolving such clinical decisions to local areas, however, is that we have to allow the CCG to take the necessary steps to ensure the service is put back on to a better footing.

Oral Answers to Questions

Melanie Onn Excerpts

Tuesday 19th December 2017 Commons Chamber

[Jackie Doyle-Price]

I thank the hon. Gentleman for his support. The figures from Wales come at an early stage, but the system that we are looking to introduce has much in common with that in Spain. The issue is not so much about the register moving towards an opt-out system, but the wraparound care that goes with it, such as the specialist nurses who speak with relatives when they are going through the trauma of losing a loved one, and the public debate that raises awareness. Taken together, they are what will lead to more organs becoming available.

[Melanie Onn (Great Grimsby) (Lab)]

2. What steps he is taking to ensure that information on group B streptococcus is available to NHS patients.

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

As the Secretary of State has set out, our ambition is for the NHS to be the safest place in the world to give birth. Information on prevention and the implications of a group B streptococcus infection is available on the NHS Choices website. Just today, the Royal College of Obstetricians and Gynaecologists published a new patient information leaflet that, from the new year, will be given to all pregnant women for the first time. Because it is Christmas, I have a copy here for the hon. Lady. [Interruption.] I see she has one, too.

[Melanie Onn]

I thank the Minister—he has anticipated my question. I reassert that, on average, two babies die each month from complications relating to group B strep. Awareness of the effects of that infection is incredibly low. Will the Minister meet me and Group B Strep Support to discuss how we can get this leaflet to mums-to-be at the earliest possible stage?

[Steve Brine]

I know this is a subject about which the hon. Lady cares greatly. I would be very happy to meet her and to bring together the people I work with from Public Health England to see how we can make the best of this new leaflet and ensure it is the best and most important Christmas present.

Baby Loss Awareness Week

Melanie Onn Excerpts

Tuesday 10th October 2017 Commons Chamber

[Mr Tanmanjeet Singh Dhesi (Slough) (Lab)]

Following on from the very moving and courageous speeches by hon. Members about Baby Loss Awareness Week, I rise as someone whose own family members have suffered from the trauma of baby loss. Stillbirths and neonatal deaths affect so many in our community, including in my Slough constituency. The son of my very good friend Councillor Madhuri Bedi was born prematurely. He had strep B, which gave him brain damage. The family had to make the harrowing decision to switch off his life support machine only one day into his precious life. As they remarked, there is very little awareness and not enough support. That is something that we all need to work towards.

I commend the excellent work done by so many individuals, campaigners and hon. Members, on a cross-party basis. I also pay tribute to members of the all-party parliamentary group on baby loss.

[Melanie Onn (Great Grimsby) (Lab)]

On that point, will my hon. Friend join me in welcoming the recommendations in the updated clinical guidance from the Royal College of Obstetricians and Gynaecologists, which include the recommendation that all pregnant women should at the very least be provided with an information leaflet on group B strep, as a tool to raise awareness and prevent what he has just described?

[Mr Dhesi]

I fully concur with my hon. Friend and thank her for her intervention. In that regard, I would very much like to pay tribute to hon. Members in the all-party group. I look forward to joining them tomorrow to provide whatever little support I can.

It is wonderful to see the advances made and also the pledges made by the Minister, whether on maternity safety champions, funding for safety and training at hospitals or the national bereavement care pathway. I for one most sincerely hope that he and the Government will continue in this endeavour to ensure that we make further advances and minimise the trauma suffered by so many.

Incontinence

Melanie Onn Excerpts

Tuesday 5th September 2017 Commons Chamber

[Mrs Madeleine Moon (Bridgend) (Lab)]

Incontinence is not an issue that is often discussed in the Chamber. Society sees the condition as a taboo, which is hidden from public view while sufferers cope in private. However, an estimated 14 million people in all age groups will, at some point in their lives, experience a problem with bladder dysfunction. A further 6.5 million will have bowel dysfunction.

It is generally assumed that incontinence is a condition that affects older people, but that is only half the story. The National Childbirth Trust estimates that almost half of all women experience urinary incontinence after childbirth; there are around 700,000 births a year, so as many as 350,000 women could face this problem. NHS figures suggest as many as 900,000 children and young people experience some form of problem.

More than 300,000 people are diagnosed with ulcerative colitis and Crohn’s, otherwise known as inflammatory bowel disease, and the most common age for diagnosis is between 18 and 30. Those conditions affect the digestive system to different degrees, but one in 10 people will experience regular incontinence. A 2012 survey by Crohn’s and Colitis UK found that 61% of people had not sought medical advice for the incontinence. Like all other conditions that have associated problems with incontinence, that leads to social isolation. Crohn’s and Colitis UK surveyed 1,000 young people on their experience, and 75% said that their condition made socialising impossible because of always needing to know of the proximity to a toilet. On a very simple level, given how many local authorities are closing access to public toilets, is it not time that we looked at alternatives? It is surely not beyond our wit in this House to look at issues such as rate relief, so that hotels, restaurants, pubs and cafes provide access to their toilets for those who urgently need to have it.

[Melanie Onn (Great Grimsby) (Lab)]

I draw the House’s attention to my entry in the Register of Members’ Financial Interests. Does my hon. Friend agree that businesses with a high footfall could do an awful lot more to support their customers’ needs in respect of incontinence issues, and consider additional aids such as the Crohn’s and Colitis UK “Can’t Wait” card—a facility to enable individuals who suffer from incontinence issues to access the toilet facilities of businesses that would not ordinarily allow people to use them, but which support their customers as and when they might need it, to avoid any emergency situations?

[Mrs Moon]

I thank my hon. Friend for her work in this area. That most certainly would help, and it is so simple; it is not a huge thing to do. Another example is simply having a shelf in toilets where someone with a colostomy or ileostomy can place the clean bag, so it is readily available while they remove the full bag. That would make things so much easier and healthier, by ensuring there is no cross-infection. Instead, people often have to scrabble on dirty toilet floors, trying to access what they need.

All the figures I have to hand today are estimates—as one patient group pointed out to me, the collection of statistics in this field is patchy at best, and putting a true figure on the scale of the problem is very difficult—but we will not tackle taboos until we start talking about them: we must destigmatise the subject so that no one faces humiliation if they admit to a problem. We need to bring this issue out into the open once and for all, so that people no longer suffer in silence and we can reduce the long-term health implications and additional costs for the NHS.

An analysis of calls to the Bladder and Bowel Foundation’s helpline in 2015 suggested that half the people with a continence problem had never spoken to a healthcare professional. Another study found that only one in three families seek help for children and young people with a continence problem. Imagine the long-term impact on a child’s health of having to try to manage such a problem at school, with all the stigma of being the smelly kid and all the fear of having an accident during a lesson.

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[Mrs Moon]

I commend my hon. Friend’s work for the all-party parliamentary group on continence care, which does invaluable work in this area.

I am going to jump to another section of my speech. It is shocking how many people go into hospital with no continence problems but may be incontinent or doubly incontinent and have major problems by the time they leave. It is far too easy for nurses and doctors to see the use of pads as the only solution. At some point, I hope the Minister will look at how we can gather figures from hospitals on how many patients enter with continence problems and how many leave with continence problems to get some idea of how great the problem is.

I chair the all-party parliamentary group on Parkinson’s, and the Minister will be aware that Parkinson’s UK has campaigned for many years due to the problems that people with Parkinson’s have when they go into hospital and their carefully timed medication regime is changed to fit in with drugs rounds on the ward. A perfectly mobile and continent person can become immobile and incontinent due to NHS failure. That cannot be allowed to carry on. It is shameful that we are facing such problems in 2017.

Diagnoses are not made in a huge number of cases. Healthcare professionals do not provide consistent assessments, diagnosis and follow-through according to standard practice. Even basic things, such as an assessments of where the toilet is in relation to where someone sleeps, are not carried out by social workers. I cannot begin to tell the House how many times people are admitted to hospital as the result of a fall at night caused by them trying to negotiate the stairs to go up or down to a toilet that is on a different level from where they sleep. It is shocking that people face having to wear an incontinence pad because they cannot use the stairs or because there is a risk of them falling at night when accessing the toilet. We simply must get this sorted out.

Incontinence can cause additional problems. Urinary tract infections, pressure sores, anxiety, depression and falls cost the NHS a great deal of money, and we could save money by making relatively simple changes. I have not been able to find any comprehensive analysis of the cost to the NHS and other services that would demonstrate potential savings from early interventions. As far as I am aware, such an assessment has not been carried out. A series of parliamentary questions tabled last year revealed that data are not held by the Department of Health on the number of people admitted to hospital for catheter-associated urinary tract infections, for non-catheter-associated urinary tract infections or with urinary incontinence generally. If it existed, such information would help to clarify the extent of the problem. An estimate was offered in 2014-15, with NHS trusts reporting an annual cost of £27.6 million, which is almost certainly an underestimate.

Too many individuals are bearing the brunt of managing their condition. Buying a regular supply of pads costs anywhere between 10p a pad, for a child, and 60p a pad, depending on the type of pad required.

[Melanie Onn]

My hon. Friend is being generous with her time. Does she think that now is the time for the Government to reconsider the VAT on these products?

[Mrs Moon]

We need to reconsider the issue of VAT on a whole range of sanitary and continence products. As a society, we need to take responsibility for the facts of our daily life. For a person on any sort of restricted income, such as those on benefits, the costs even of simple laundry are huge when dealing with incontinence.

Some families are spending up to £100 a week buying incontinence products. It is ludicrous if they are not able to access those products through the health service or joint stores with local authorities. It is a postcode lottery whether or not a person can access the help and support they need, which is shocking. Think of the savings in sickness pay, in hours of work lost and in mental health and wellbeing if we started to tackle this problem.

It is time to raise a number of issues, including what happens when things go wrong.

Adult Social Care Funding

Melanie Onn Excerpts

Thursday 6th July 2017 Commons Chamber

[Mr Speaker]

What an array of riches! I call Melanie Onn.

[Melanie Onn (Great Grimsby) (Lab)]

One among many, Mr Speaker.

This Government have pushed a national crisis on to hard-pressed local councils and hard-up local residents, forcing council tax rises that will barely cover the minimum-wage salaries paid to carers. The Minister says that the precept has been welcomed, but I would ask: by whom?

[Steve Brine]

The precept is welcomed by local authorities that want to get extra money into their social care system.

[Melanie Onn]

It’s not.

[Steve Brine]

I understand that the hon. Lady wants to play politics with this issue, but as I said in my response to the urgent question, I honestly think that we can do better than that.

Preventing Avoidable Sight Loss

Melanie Onn Excerpts

Tuesday 28th March 2017 Westminster Hall

[Melanie Onn (Great Grimsby) (Lab)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate the hon. Member for Wealden (Nusrat Ghani) on securing the debate. To lose one’s sight partially or wholly, gradually or rapidly, is a life-changing experience. Ordinary, everyday activities that were once straightforward become increasingly complicated, with simple tasks taking longer, and people create their own adaptations in order to cope. The number of people who live with sight loss in the UK is predicted to double to about 4 million by 2050. Due to our ageing population, more people are living with conditions that can lead to visual impairment, such as diabetes.

Loss of sight is more prevalent in my constituency, which is having a dramatic impact on quality of life, particularly among older people, yet we are failing to provide sufficient access to preventive treatment. In October last year, Northern Lincolnshire and Goole NHS Foundation Trust was found to have nearly 22,500 appointments overdue at its three hospitals. More than 12,500 of those were at the Diana, Princess of Wales hospital in Great Grimsby, with hundreds of people at least eight months overdue for appointments. Across all three hospitals, the department most affected was ophthalmology, with 2,200 appointments overdue in Grimsby alone.

By 2030, there are expected to be 7,050 people in north-east Lincolnshire living with sight loss, an increase of 32.5%, and 980 living with severe sight loss, an increase of 38%. That increase is largely because we have an ageing population and, generally, the older someone is, the more likely they are to suffer from loss of sight. That is important, because visual impairment has a considerable impact on our psychological wellbeing, which means that older people are three times more likely to experience depression caused by sight loss, not to mention isolation and loneliness.

Yet as the RNIB and the hon. Member for Wealden have pointed out, nearly half of sight loss is avoidable. Timely access to treatment, including follow-up appointments and the effective monitoring and management of eye conditions, is vital to preventing unnecessary loss of or deterioration in sight. It is important because successful treatment of many conditions is time-dependent. That is why it was so shocking to learn in late October last year that up to 800 patients in the eye department of Northern Lincolnshire and Goole NHS Trust who are potentially at risk of harm were left waiting—many of them for months on end—to be told what treatment they needed. Additional clinics were arranged to deal with the backlog, but patients should never have been left for such an extensive period of time without any check-ups or assessment of their condition.

In that area of the world there is a shortage of clinicians across the board, but particularly in ophthalmology, which adds to the strain on the system. When asked about the backlog of patients, the leadership at Northern Lincolnshire and Goole Trust said that they knew about it and saw it grow, yet they failed to draw up a coherent plan to address it, despite it being a year on from the tragic 2015 case of Brian Critten, a patient at Scunthorpe general hospital, which is run by the trust. In an investigation that was launched after Mr Critten alleged a failure in duty of care, the hospital acknowledged that there might have been an opportunity to identify his cancer earlier if a cataract operation had not been cancelled and subsequent appointments not repeatedly postponed.

We cannot continue with a situation where preventive treatment is missed. The NHS must work with stakeholders, including the RNIB and other charities, to develop and implement a strategy that ensures adequate eye care services across England. I was contacted by Scartho Eyecare, an optician in my constituency, and informed that we are one of the few areas with no optical enhanced services—services that can ease the burden on GPs and on hospital ophthalmology services. There is apparently capacity to help at a lower cost to the NHS, but it has not been taken up. Perhaps the Minister will reflect on that in his speech.

It seems irresponsible that eye care strategies exist in Scotland, Wales and Northern Ireland, but that England does not have a strategy to meet the future needs that have been highlighted. Surely now is the time to get that right.

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[The Parliamentary Under-Secretary of State for Health (David Mowat)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I congratulate my hon. Friend the Member for Wealden (Nusrat Ghani) not only on leading the charge today but on her work on the APPG more generally. A number of Members have made the point this morning that we have not debated eyes and sight in this place very much over the past few years. It is good that we have the time to put that right today, so I congratulate her on doing so.

I start by acknowledging what a number of Members have said—that 50% of sight loss is preventable. I think my hon. Friend said that 85% of people regard sight as the most precious of all our senses. Frankly, I am surprised that the figure was not higher than that. This is clearly massively important. We can debate numbers—the hon. Member for Burnley (Julie Cooper) just talked about £28 billion—but the key figure is the statistic that my hon. Friend the Member for Twickenham (Dr Mathias) started with. Some 20 people a month are losing their sight, whether due to lack of prevention or lack of early treatment, in ways that are preventable. That is not acceptable, and we need to work collectively to address it—I will try to set out the Government response to it now.

I will talk first about prevention and the need for early detection and improved treatment. We heard about waiting lists in Great Grimsby, which I will come to. I will also talk about the social exclusion that can occur, and the mental health issues that can come from that. As I go through, I will try to address the points raised during the debate by Members on both sides of the House. If I do not, I am sure Members will remind me that I have not; in any event, we will write on any points that are not directly addressed.

The UK vision strategy was produced jointly with the RNIB, which does a lot of extremely good work in this space, for which the Government are grateful. Both the Department of Health and NHS England fully support that strategy, and need to continue to drive it forward. We also support global issues; Members have talked about the WHO global plan, which intends to eliminate preventable sight loss by 2020, and my hon. Friend the Member for Wealden talked about some of the work we do globally. She talked about patient choice and the referral process—whether it is via GPs or direct—which is an interesting point that I will come to. She talked about STPs, as did the hon. Member for Burnley, cancelled appointments and the need for a national strategy in England. I will come back on those points, if I do not get to them during my remarks.

To frame the issue, 2 million people in the UK have sight loss—because sight loss is so related to age, 4 million people will almost certainly be affected by 2050—and 80% of those are over 60 years old. Several Members cited statistics illustrating the demographic changes, including the hon. Member for Strangford (Jim Shannon), who spoke about Northern Ireland. As we debate these things across health and social care, we have to recognise the incredibly significant changes to our demography.

When the national health service was set up in 1948, one person in four lived to be over 65. We have totally fixed that, in the sense of increasing longevity. In the last 10 years, our population has increased by 10% and our population of over-85s has increased by nearly 28%. That trend will continue and accelerate, which gives us all challenges, including resourcing and all that that means. I heard a very apposite phrase recently: “We have done a good job of increasing quantity of life, but we haven’t yet increased quality of life to the same extent.” That is true of sight loss. As we heard, 148,000 people are certified blind in this country, with all that that means in terms of benefits and tax changes. That figure has been fairly stable—indeed, it has gone down slightly in the past three years—but nevertheless, it presents us with a big challenge.

In responding to those changes, we have to look at prevention and understand the risk factors. I have just covered the first risk factor, which is age. We cannot do a great deal about that, other than note that we are all getting older. Like the hon. Member for Strangford, I am over 50—considerably so—and the fact is that the sight loss numbers are driven by age. Smoking and obesity also play a big part in eye health, as they do in other aspects of health. Our tobacco control strategy will be produced imminently. We have done a good job in this country of reducing smoking, but we need to go further and faster, and I hope that the strategy will be a big part of that. There will be specific targets by age group for what we need to achieve. Obesity is equally and possibly more important; it is a risk factor for all sorts of things. I perhaps did not fully understand that obesity affects people’s chances of getting cancer, dementia and suffering from sight loss as much as it does. We need to drive home the potential benefits of the obesity strategy that we published, which aims for a 20% sugar reduction by 2020.

Hon. Members, including the hon. Member for East Kilbride, Strathaven and Lesmahagow (Dr Cameron), mentioned cataracts. Obesity doubles the probability of getting a cataract. That is an extraordinary statistic given that it is not intuitive that those are linked, even though they clearly are. I do not want this debate to be about money—what we are talking about is more important than money—but the cost to the country of obesity and diabetes put together means that we now spend more in the NHS on treating them than we do on the police service, the judiciary and the Prison Service combined. That puts into perspective the magnitude of the cost and what we need to achieve.

On prevention, we have not talked about the screening programme that we have introduced for diabetic eye disease, which was the principal cause of blindness in working-age people until recently. As a result of the programme, which involved offering a digital photograph to all people with diabetes over the age of 12, something like 2 million people were screened last year. For a screening programme, there was a very high uptake—over 80%—and some evidence shows that it has resulted in significant progress in preventing that type of blindness. This is the first year for which we have those figures, and diabetic eye disease is no longer the principal cause of blindness in working-age adults. That has largely been achieved through that very effective screening programme.

Let me talk briefly about the four most common causes of blindness, which are cataracts, age-related macular degeneration, glaucoma—that is the most prevalent, as we have heard—and diabetic eye disease. All of those can be treated most effectively through early diagnosis—frankly, that applies in most areas of health, but it is particularly true of eye health—and the first part of that is timely sight tests. Sight tests are free for children at school, although parents have to arrange them. They are also free for the over-60s, for anybody who is in a high-risk group, including those with diabetes or glaucoma, and for people on various income-supported benefits. There were 13 million eye tests last year, which was an increase of 2%. There is always a case for doing more, and I say to anyone who is listening to this debate, even if they are not of such an advanced age as me or the hon. Member for Strangford, that these things are worthwhile.

Treatment is CCG-led in this country. The principal reason relates to some of the issues that we heard about from the hon. Member for Great Grimsby (Melanie Onn), who spoke well about the large numbers of people on the waiting list of the Northern Lincolnshire and Goole NHS Foundation Trust and the extra clinics that had to be put on. That is a CCG responsibility. With national strategies, there is a choice about whether something should be locally focused, with local commissioners having the resources and money—although resources are a different issue—or whether there should be an overarching national plan.

I was struck by what the hon. Lady said about the actions that were taken. Those were local actions, which were completely appropriate. In England, we produce a public health outcomes framework—I do not think that is the case in Scotland, notwithstanding the excellent speeches by the Scottish National party Members about what is done in Scotland. The framework sets out for every local authority area in the country the extent to which there is glaucoma, diabetic eye disease and age-related macular degeneration, and the total number of people who are certified blind. Those data are tracked over the years and ought to inform local commissioners, and indeed, local health and wellbeing boards in the priority areas. There are striking differences and clusters of different types of blindness and different issues in different areas.

To cite a few of those differences, Barnsley has three times the national average of age-related macular degeneration and twice the national average of people who are certified blind. To me, that suggests that the commissioners in Barnsley should, in particular, be putting effort and resources into treating AMD. London has something like 20% more diabetic eye disease than other parts of the country. That may be to do with the large south Asian population in parts of London and the diabetes that that implies. Those sensible decisions should be taken by local commissioning groups in the knowledge of the facts. I commend the public health outcomes framework to hon. Members, who may not have looked at it for their own constituencies and patches. That should be considered and understood, because for this and other issues, it tells us where the priorities ought to be.

[Melanie Onn]

If CCGs are to focus on providing more support for a particular service, it prompts the question, “What will support be taken away from?” The trust in my constituency has now gone into financial special measures. There is only so much give in the system. What does the Minister think is the solution?

[David Mowat]

I did say, when I was making the point, that I was not talking about priorities in terms of total resource there. We must make choices. I will come to the point about the £20 million budget.

The hon. Member for East Kilbride, Strathaven and Lesmahagow mentioned concerns that cataract operations were being rationed. In response, the Secretary of State requested that NICE issue guidelines this year rather than next year, and we will pursue that. However, I make the point that 17% more cataract operations are being done in England now than five years ago. That does not imply rationing to me, but we need to be careful. Operations should not be rationed, and we want NICE guidelines in place to ensure that they are not.

I will address some of the points made by hon. Members. My hon. Friend the hon. Member for Wealden mentioned referral pathways. She is right to say that different CCGs do things differently. Some CCGs will require an optician to refer a patient to a GP, who then refers onward to the hospital or ophthalmologist; around 11% of CCGs do not do so, which is quite odd. I will ask officials to investigate why. The principle is that CCGs are responsible for setting their own pathways. It is not for the Government to tell them what to do, but it is possible—indeed, likely—that some might not have wholly addressed the issue.

There is a general drive right across the health service to do more things in the community and fewer things in hospitals. Part of that involves using opticians in the best way possible, and not just on this issue. Although it has not been mentioned in this debate, I would like to see opticians used much more for glaucoma monitoring and other such things that, at the moment, tend to happen in hospitals, because as we have heard, there is a great deal of strain on a number of hospitals. We will try to make progress on that issue. I am happy to sit down with my hon. Friend and the Royal National Institute of Blind People, as she asked, to talk about it in more detail.

My hon. Friend mentioned shared delivery plans. She said that only 50% of STPs include a coherent eye strategy, and the hon. Member for Burnley said that some of those looked like tick-box exercises. I accept that, and I have two points to make. One is that an STP is not an organisation but a planning document, which must be put in place to begin to establish planning areas across the country where we can marry up prevention, primary care and secondary care. Not all STPs have yet addressed all the issues that they should; they are a process, not an event. I say to the people concerned about that that they should keep lobbying their local STP leadership, who are responsible for addressing it. Frankly, many STPs have a long way to go to become coherent plans, and eye health is just one area on which we need to make more progress.

We heard about the issue of cancelled appointments. They are a particular problem with eye appointments, which can be time-critical; the figure of 20 avoidable sight losses a month was quoted. The principles governing missed appointments across the NHS apply in exactly the same way to eyes as they do to all other things. The NHS constitution sets out an 18-week limit. I have heard speakers in this debate mention clinics where 50% of appointments are not attended. Such numbers are completely unacceptable. What is hard to understand in that context is that in the last five years we have increased the number of consultant ophthalmologists across the patch by around 27%. That does not imply that the problem is staffing, but I will take the issue away and consider it. I reiterate that the same provisions that apply to all aspects of our NHS apply to eyes and to national waiting lists. People who fail to get appointments for which they are clinically ready should be on a national waiting list. We should performance manage it in that way.

My hon. Friend the Member for Wealden mentioned choice, rightly saying that people are entitled to choice in their secondary care. The same principle applies to eye care as to all other types of care, but there is more that we can and must do to build awareness.

I will touch briefly on the issue of an eye strategy. I have asked why NHS England feels that it is better for it to be owned and controlled locally; I made the point previously about the degree of local variation. We heard some instances from Northern Ireland, where there is an eye strategy, that show that it is not a panacea. As a Minister, I have a general view. There are a lot of strategies, but many fewer clear action plans with deliverables and accountabilities. It is rather like what we heard about in Great Grimsby. My preference is to work with NHS England and with Health Education England, if it is a question of getting more people into roles and all that goes with that. Having said that, I am happy, as I said, to talk to my hon. Friend the Member for Wealden and the RNIB more generally, but overall, across the health system, I do not see a lack of strategies. I sometimes see a lack of action plans with accountabilities and clear deliverables. My bias is towards the latter, not the former.

On the point about rationing, the NICE process is an attempt to create, across the whole health system, coherent guidelines and structured ways to evaluate different medicines. Broadly speaking, a cost of £20,000 per quality-adjusted life year is used by NICE to decide whether a drug should be offered or not. However, the point about the £20 million cap is slightly different. The cap is being introduced, potentially, for new drugs; it would not apply to any existing treatment. We are accelerating new drugs coming into the system. The cap would act as a trigger point: after £20 million has been spent, a renegotiation with the manufacturer would take place. On that point, I will sit down and allow my hon. Friend to sum up.

Oral Answers to Questions

Melanie Onn Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Hunt]

I am very happy to meet my hon. Friend. He will know that the surgery got an £80,000 grant this year through NHS England’s general practice resilience scheme, but I am aware that there are lots of pressures on surgeries such as St Luke’s and I am happy to talk about it further.

[Melanie Onn (Great Grimsby) (Lab)]

I am delighted to hear the Secretary of State issue some information about the additional GPs who will be coming on stream in the coming years. How many will be coming to north-east Lincolnshire and when will they be there? We have a critical shortage of GPs and people are struggling to get appointments.

[Mr Hunt]

The hon. Lady is absolutely right that areas such as Lincolnshire find it particularly difficult to attract GP recruits, which is why we have set up a fund that gives new GP trainees a financial incentive to move to some of the more remote parts of the country. This is beginning to have some effect, and I am happy to write to her with more details.

Social Care

Melanie Onn Excerpts

Wednesday 16th November 2016 Commons Chamber

[Melanie Onn (Great Grimsby) (Lab)]

It is a pleasure to follow the thoughtful and heartfelt comments of my hon. Friend the Member for Heywood and Middleton (Liz McInnes).

Today is Unison’s SOS—save our services—day of action, so I join it in calling on the Government to ensure that social care is properly funded, so that people in this country can be properly looked after.

In the past six years, the largest share of cuts has fallen on local government. Given that councils spend a third of their budget on social care, the Government will have known from the very start that social care would be one of the biggest casualties of their spending programme.

The budget of North East Lincolnshire Council has been cut by more than £70 million since 2010, with a further £7 million of cuts to be made by next year, causing spending on adult social care in my constituency to fall by 20% since 2010. People have been forced to live in completely unacceptable conditions, because there is not enough funding to provide adequate care.

I know of wheelchair-bound adults living in a care home in Great Grimsby who have been waiting for over two years for the button that automatically opens the door out of their flat to be fixed. At the moment, until a carer comes to visit, they are effectively trapped in their own home. That is an unacceptable position to leave people in, but it is just one example of the state of social care today.

The council has had to limit access to adaptations by increasing the thresholds for accessing them and capping spending. Disabled and elderly people are therefore often left in unsuitable housing. Understandably, that is also hugely frustrating for carers who are trying their best to look after people in inadequate conditions, while having continually to fight the council and care providers for the improvements they need.

A constituent who cares for his adult son was told by occupational health about six months ago that his home needed the back door widened and a ramp and lift installed. He feels as though he is being deliberately fobbed off, rather than getting the help he needs to look after his son properly. It is as uncomfortable for the son to live in those conditions as it is frustrating for the father to be unable to look after him properly.

Today, the Communities and Local Government Committee took evidence from family and friend carers who save the state so much money. One issue that was raised was the disconnect between the NHS and local authorities at the point of discharge from hospital. There were reports of families feeling abandoned when discharge occurs, with very limited support being accessible and no single point of contact or dedicated service to guide people through the options available to them and their families. That heightens the risk of readmission to hospital for many of those patients, costing the state even more money.

The carers spoke of the neglect of their own physical and mental health, with their overriding concern being for their loved ones. Respite that had previously been offered is ending. We heard the example today of two hours of respite being provided a week. That does not seem like an awful lot, but it was a lifeline to the women who came and gave evidence. That was provided by a local charity and funded by the local authority. It is now going to end because of cuts being made to and by the local authority.

We also heard about a looming crisis in intergenerational care, with a gap of hundreds of thousands of carers predicted over the next 10 years. The pressure on social care services provided by the state is only set to increase. As we heard at Prime Minister’s Question Time today from my hon. Friend the Member for Bradford South (Judith Cummins), there are also problems with dementia and Alzheimer’s services.

The social care precept is not the way to solve this problem. As we have heard, the areas with the highest demand for care are often those where the precept will raise the least. Furthermore, the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), claimed earlier this month that the additional funds raised through the precept have been “entirely swallowed up” in higher wages for carers. Although I am glad that carers are being paid more, albeit still not a proper living wage, councils are therefore unable to allocate any of the new funds to improving care.

When the right hon. Member for Tatton (Mr Osborne) announced the social care precept this time last year, he said:

“The truth we need to confront is that many local authorities will not be able to meet growing social care needs unless they have new sources of funding.”

Although the Government have accepted the need to better fund social care, they still need to find that new money if the growing demand for care is to be met. This is not only about supporting people who need that support in their old age or because of a disability; it affects us all. As the then Chancellor also said last year:

“The health service cannot function effectively without good social care.”—[Official Report, 25 November 2015; Vol. 602, c. 1363-64.]

Failing to fund social care properly means that patients are forced to remain in hospital for weeks longer than they need to, blocking beds for new patients who need them and pushing up hospital waiting times. Meanwhile, every day the patient is kept in hospital costs the NHS far more than caring for them in a suitable environment would.

Baby Loss

Melanie Onn Excerpts

Thursday 13th October 2016 Commons Chamber

[Will Quince]

Absolutely; the hon. Lady makes a very good point. I will mention that a bit later. Charities such as the Twins and Multiple Births Association do incredible work in this field; one of my hon. Friends raised that issue earlier.

[Melanie Onn (Great Grimsby) (Lab)]

Following on from the point about mothers who experience late-term baby loss and the treatment that they receive in hospital, very often they are kept on maternity wards, which can be incredibly traumatic. The point was made about tailoring care and support for parents who lose their children. Is remaining on a maternity ward the most suitable option for them?

[Will Quince]

I thank the hon. Lady for that point, which I will come to in a moment.

Begging the indulgence of the House, I would like to share my experience, in the spirit of showing people outside the Chamber how important it is to talk about this, if we are able to. We found out at our 20-week scan that our son had a very rare chromosomal disorder called Edwards syndrome, a condition that is rather unhelpfully described as being “not compatible with life”. We knew throughout my wife’s pregnancy that the most likely outcome would be stillbirth, but our son was an incredible little fighter, and he went full term—over 40 weeks. He lost his life in the last few moments of labour at Colchester general hospital.

To pick up on the hon. Lady’s point, Colchester has a fantastic hospital that has a specialist bereavement suite called the Rosemary suite, where we got to spend that really special time—including before the birth, because we knew what outcome was, sadly, likely. I got to stay with my wife; we got to stay there overnight; we had a cold cot, so that we could have lots of cuddles. We could continue, the next morning, to spend time with our son. I completely agree with the hon. Lady, which is why my hon. Friend the Member for Eddisbury (Antoinette Sandbach) and I had a debate in November last year on bereavement care in maternity units. Bereavement suites are so important. In this country, in the NHS, there should never be any excuse for a mother and father, or a mother, who have lost a baby to go back on a maternity ward with crying babies, happy families and balloons; that is just not appropriate or acceptable. Having gone through that experience, I know that what people need is the peace and quiet to come to terms with the personal absolute tragedy that has just happened.

NHS Spending

Melanie Onn Excerpts

Wednesday 6th July 2016 Commons Chamber

[Karin Smyth (Bristol South) (Lab)]

The Public Accounts Committee, of which I am a member, has published seven reports since January on the workings of the Department of Health, including on diabetes, the cancer drugs fund, services for people with neurological conditions, access to GP services, acute hospital trusts, NHS clinical staff and personal budgets in social care. We have had two further hearings, for reports yet to be published, on discharging older people from hospital and specialised services.

I recommend those reports to those on the Government Front Bench—I have a few copies with me, just in case they do not wish to watch the football tonight. Taken together, they paint a bleak picture of a system under immense pressure, with commitments undelivered, a massive increase in complexity as a result of the Health and Social Care Act 2012 and, above all for the Public Accounts Committee, continuing poor data upon which to make decisions and manage performance, as well as a complete lack of clarity about accountability for delivery on the areas we have investigated.

The concerns outlined in our reports include: on staffing, that trusts have been set unrealistic efficiency targets, and that the shortage of nurses is expected to continue for the next three years; on funding, that the financial performance of trusts has deteriorated sharply, and that this trend is not sustainable; and that the data used to estimate trusts’ potential cost savings targets are seriously flawed.

[Melanie Onn (Great Grimsby) (Lab)]

Northern Lincolnshire and Goole NHS Foundation Trust has only just been taken out of special measures, but last week’s Care Quality Commission report highlights a concerning dip in standards at Diana, Princess of Wales hospital. The bosses have said that that is because they struggled to recruit quality staff. Does my hon. Friend agree that removing the NHS nursing bursary is long-term pain for short-term gain?

[Karin Smyth]

I agree with my hon. Friend. In fact, one of the reports I have with me is the one we published in December about the work of the Care Quality Commission and some of the concerns that have already been issued about the work it does to uncover issues such as the ones she has highlighted in her constituency.