Mental Health and NHS Performance

Neil Carmichael Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I actually agree with the hon. Lady’s broad point about the importance of the social care system and its interconnectedness with the NHS. As she well knows—her party’s manifesto reflected this as well—in 2010 we faced a very challenging economic situation, and both parties recognised the need for cuts in public spending. What changed in 2015, however, at least in the Conservative party’s manifesto, was the recognition that we needed to increase funding for the social care system, and with the changes announced by the Secretary of State for Communities and Local Government in December, all local authorities can now increase funding for social care in real terms. I hope that we can start to turn things around.

[Neil Carmichael (Stroud) (Con)]

With the recent Education Committee report on children in care in mind, I welcome the Prime Minister’s refocus on mental health and the Secretary of State’s continued support for action. What practical steps does he have in mind, given our finding that local integration, effective relationships and the teaching of personal, social and health and economic education all help to produce good outcomes?

[Mr Hunt]

My hon. Friend is absolutely right—obviously his role on the Select Committee gives him a particular insight—but we do not want to rush to a solution, which is why we have said that we will produce a Green Paper before the end of the year. It is a complex area. Other hon. Members have alluded to the risk of medicalising problems, given that, as we know, all young people at school experience periods of stress, anxiety and worry that are not necessarily diagnosable mental health conditions and which we would not want to make out to be such. This is about thinking through a smart way to improve resilience training and self-help and to educate schools so that they can spot when something is just a temporary thing in the run-up to exams, or whatever, and when it could be something a lot more serious, such as obsessive compulsive disorder, an eating disorder or something else that needs more immediate help. We have today started a big education programme with schools, but we want to go further.

Meningitis B Vaccine

Neil Carmichael Excerpts

Monday 25th April 2016 Westminster Hall

[Geoffrey Clifton-Brown]

I entirely agree. I will ask the Minister to clarify this, because when I sat down she said sotto voce that it is one year, but my information is that, from when it started, it was for all those under two months of age on 1 September 2015, with a one-off catch-up programme for babies born between 1 May 2015 and 30 June 2015—those who were three or four months of age when the programme was launched. Therefore, while by now it may have nearly spread to one year, that was not the case when it was introduced. We should consider rolling it out definitely to those who are one year old today and preferably to those a little older as well.

I turn to the Department of Health’s cost-effectiveness methodology for immunisation programmes and procurement—the so-called CEMIPP, which is a dreadful acronym. The Minister will tell us that that looks at the life-cost issues, but those who contract meningitis and suffer long-term effects face not just the £30,000 to £40,000 of costs my hon. Friend the Member for Bury North (Mr Nuttall) mentioned, but considerable lifelong costs afterwards. The discounting rates, as hon. Friends have said, are particularly mean in that respect, so to look at the issue in the round we must look seriously at the cost to the public purse of not vaccinating. That route could show us more clearly that a roll-out to a larger cohort would be cost-effective.

[Neil Carmichael (Stroud) (Con)]

Meningitis Now is headquartered in my constituency. To follow on from my hon. Friend’s point, should we not think that prevention is better than cure? That should be the overall strapline to the debate.

[Geoffrey Clifton-Brown]

My hon. Friend is right. I pay tribute to the charity based in his constituency and to the other meningitis charity, because they have been campaigning for many years on meningitis B and all the other strains.

The point about rolling out the vaccine to the cohorts—I urge the Minister to go further than that—is that my understanding is that once someone is vaccinated for meningitis B with Bexsero, they are covered for life. Therefore, if more cohorts are covered by the roll-out, more of the population will be covered and the entire population will become less susceptible.

--- Later in debate ---

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow my hon. Friend the Member for North Devon (Peter Heaton-Jones), and I apologise to my hon. Friend the Member for Bath (Ben Howlett) for missing his opening statement, because of a statement in the main Chamber.

I start by thanking all the families who gave evidence to the Petitions Committee and the Health Committee. Through their very brave and dignified testimony, they have done more to raise awareness and save lives than any Government-led awareness campaign could possibly hope to achieve.

It is wonderful to be in a debate in which we are airing the positive benefits of vaccination, which has undoubtedly been one of the greatest achievements of modern science. We stand on the brink of eradicating polio from the world, and it is worth pausing to thank all those who have been involved in the development of vaccination over the years.

[Neil Carmichael]

At this point, I would like to salute Dr Edward Jenner, who worked on a smallpox vaccination and was based in my constituency. That underlines the importance of vaccination, and that work then is directly linked to the work of Meningitis Now.

[Dr Wollaston]

I thank my hon. Friend. In fact, I will take us back even further by mentioning Ben Franklin, who said that

“an Ounce of Prevention is worth a Pound of Cure.”

He was referring to fire services in Philadelphia, of course, but the principle still stands.

In paying tribute to all who have brought us to where we are today, we should remind ourselves that vaccination is becoming increasingly complex to develop. Bexsero is being developed through reverse antigen mining and is extraordinarily expensive. That is why we have to consider cost-effectiveness, because in a system where finances are limited, what might be displaced if a new intervention is funded? In other words, we in this House and beyond have a responsibility to ensure that the money we spend can save as many lives as possible, and to consider that in the round.

That is why it is important to take account of the work of the Joint Committee on Vaccination and Immunisation in making its incredibly difficult decisions and judgments. It is absolutely important that we allow the JCVI to carry out its work without undue political interference. The role of this House is, of course, to raise awareness and to hold the Government to account for the way in which—and the framework under which—the JCVI operates. However, our role must never be to lean directly on members of that committee in the very difficult decisions that they make. I pay tribute to the JCVI—to Professor Andrew Pollard and his team—for their work. Their decisions are extraordinarily difficult, and they need to apply the science with a combination of judgment and sensitivity. It is absolutely right that we regularly review the criteria that they are able to take into account.

I thank the Minister for her letter today confirming that the cost-effectiveness methodology for immunisation programmes and procurements working group, or CEMIPP—it may need a catchier title—is going to publish its work in full. Perhaps she will say whether she has now received that report. It is absolutely important that the principle of transparency applies, so that we can all be clear about the decision-making process.

I support Members who have said that we should review the so-called discounting rate if it means that, as my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) has pointed out, by the time someone is in their 20s, effectively no account is taken of them. It clearly seems reasonable that we apply the same principle that is applied to public health decision making in the NICE methodology, with its lower discount rate, so that we can take full account of that situation. It is also right for the House to reflect on views beyond this place by thinking, for example, about the social costs. I do not wish to repeat the many important points that have been made about that today.

The JCVI’s independence is absolutely vital. We in this House are not in a position to make judgments about the effectiveness and safety of vaccination. We have to rely on experts, and we are very grateful to them for their work. However, one thing that we have to do is hold the Secretary of State to account for implementing the decisions of the JCVI in a timely manner and for the time that it takes to carry out the negotiations on the cost of vaccines.

I would like to make a further point, which I do not think Members have brought up today. The level of variation in the roll-out of existing vaccinations needs to be looked at. During the Health Committee’s current inquiry into public health, we have been hearing evidence about the difficulty that public health professionals and directors of public health have in being able to access the data and information that they need to tell them where the gaps are in the roll-out of vaccination. Perhaps the Minister will update the House on where we are in that regard, because it clearly cannot make sense that artificial barriers have sprung up between those who are responsible for implementing the programme and those who are delivering it on the ground. It would be helpful to have an update on that issue.

It is also absolutely right that the House holds the Minister to account on what is being done to follow up the work that is happening on sepsis. As she will know, early diagnosis is critical. Although we want to focus on the number of cases that we can prevent, we cannot prevent them all, so we must also focus on early diagnosis and intervention and on ensuring that we have the right pathways in hospitals, so that the time it takes from the moment someone enters a hospital until they receive life-saving antibiotic therapy is kept to a minimum. Perhaps the Minister will update us on that.

Oral Answers to Questions

Neil Carmichael Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Ben Gummer]

Yes.

[Neil Carmichael (Stroud) (Con)]

7. What steps he is taking to increase access to GPs’ surgeries.

[The Secretary of State for Health (Mr Jeremy Hunt)]

The Government have committed to make sure GPs can be accessed when needed seven days a week, ensuring that people are able to access primary medical care when they need to.

This is already being rolled out through the GP access fund, which will enable 18 million patients to benefit from improved access to their local GP, including extended hours, telephone or Skype consultations.

[Neil Carmichael]

Does the Secretary of State agree that the news he brings will be of great comfort to elderly people in particular, but in addition the signposting of people towards GPs rather than acute hospitals will be very important and a very useful addition to our policy?

[Mr Hunt]

My hon. Friend makes an important point. It is partly the availability of services seven days a week, which we need to provide because illnesses do not happen on only five days a week and we need to respond to changing consumer expectations; but it is also about the signposting. That is absolutely critical, so that people know where to go and do not overburden A&E departments, which should be there for real emergencies.

Oral Answers to Questions

Neil Carmichael Excerpts

Tuesday 21st October 2014 Commons Chamber

[Mr Hunt]

There is pressure throughout the NHS because there are nearly 1 million more over-65s than there were four years ago, which puts pressure on GPs, as it does on any department or hospital providing elective care. However, this is not just about getting an appointment; it is also about ensuring that GPs have personal responsibility for the patients on their list and are accountable for the care of some of the most vulnerable people. We have brought back named GPs with personal responsibility for over-75s, and I hope the hon. Gentleman welcomes our going further and bringing it back for everyone.

[Neil Carmichael (Stroud) (Con)]

T4. Meningitis Now, based in my constituency, is a keen supporter of the Men B vaccination for infants. Given the Joint Committee on Vaccination and Immunisation’s recommendation that it start, will the Minister update us on how the roll-out is progressing?

[Jane Ellison]

My hon. Friend is right to highlight this important issue. As he knows, the Department is negotiating with the manufacturer to purchase the vaccine at a cost-effective price, and he will understand that we need to ensure that NHS funds are used as effectively as possible. We are keen to see a positive conclusion to the negotiations as soon as possible so that plans for the Men B immunisation programme can be finalised.

Community Hospitals

Neil Carmichael Excerpts

Wednesday 3rd September 2014 Westminster Hall

[Neil Carmichael (Stroud) (Con)]

It is a great pleasure to serve under your chairmanship, Mr Owen, and to speak in a debate instigated by my hon. Friend the Member for Dover (Charlie Elphicke), because it is such an important subject, in particular in my constituency. It is also a great pleasure to be present for the first performance of the new Minister—I congratulate him on his appointment.

Approximately 10 years ago, our hospital in Stroud was under threat, in essence because the previous Labour Government were obsessed with “big is better”, rather than small and local. The whole town and the wider community rallied together to ensure that their love of their hospital was understood and the fundamental case for keeping it open was made. Today, it is still open—quite right too.

At the same time, the Stroud maternity unit was under threat for much the same reasons. It also received a huge amount of support locally. It, too, is still open—again, quite right too. If I do nothing else, it would be to pledge my total support for those two institutions, as well as the Vale community hospital in Dursley, because it really matters to people that such hospitals—our community hospitals—are protected and allowed to thrive. That is a key priority for me in my constituency.

When I was first elected, it was a great pleasure to dig the first hole for the building of the Vale community hospital. It is now thriving, with 20 beds, and providing an increasing number of valuable services to my constituents.

That is the overall package that we have in the Stroud valleys and vale; it is one that we want to build on, to protect and to hand over to our successors, children and grandchildren in future. It is the core of our health care.

It is great that the reforms that we introduced early on in the Parliament have enabled general practitioners to have more say in community health provision. It is absolutely right that CCGs are able to direct patients more effectively and more easily to local community hospitals. That is certainly happening in my patch, because our local doctors know and understand the value of our community hospitals. The reforms that we introduced to localise decision making, and to put clinicians in charge rather than managers, have made a big difference. We should continue in that direction of travel.

The key word is “signposting”, to ensure that the patient gets to the place where he or she should be, rather than automatically assume that a large, city-based hospital is the place to go. We need to make it clearer that community hospitals are there and should be used as often as possible. It is a matter of signposting. Unless we make that clearer, from time to time we will find ourselves wondering why there are queues in big trust hospitals and, possibly, empty beds in community hospitals. We need to do signposting.

[Richard Drax]

I am listening attentively to my hon. Friend’s excellent speech. Dare I say, reorganisation in the NHS is not something that I particularly want to address, but is it not common sense for trusts to look again at how best to use what they have, rather than to play with what they have inherited? Community hospitals should be incorporated with the district or acute hospitals to ensure that they all work together in their relative areas to look after the people living in those areas.

[Neil Carmichael]

I thank my hon. Friend for that helpful intervention. It is absolutely right that we need a holistic approach to the use of hospitals. Such an approach would be better informed and implemented if more information were available. That is the essence of my point, which will be helped precisely by what he was talking about, which is having more and better relationships between the different types of hospital.

May I say a few words about the investment that the coalition Government have managed to provide for our hospitals? I have already said that the Vale community hospital was built during the early years of my time as Member of Parliament. We have also seen huge improvement in the Stroud maternity unit, with significant investment in access, the entrance area and a complete revamp of corridors and facilities. As a result, it is a very attractive place for expectant mothers to go. The questions are, do we have enough expectant mothers, and do we have enough of them who want to go that particular unit? I am not going to add to the baby count myself, as I have three children already, but those are questions we need to address.

Stroud general hospital can now boast improved diagnostics and excellent out-patient services. That is good for those situations, which we often see, that involve someone needing to go into a hospital, but not necessarily to stay overnight. The recently opened out-patient facility is therefore a good example of valuable and useful investment.

I want to pay tribute to the leagues of friends in Stroud hospital and in Vale community hospital. In particular, I want to single out one individual, David Miller, who has contributed a massive amount to our hospital over many years. He should be recognised as a powerful force for augmenting investment in our hospitals through very good use of locally raised funds.

In essence, I am utterly and absolutely determined to ensure that our hospitals are supported properly—financially, locally and in every other way. Secondly, the key thing is to signpost the patient to the right place and to recognise the powerful role of community hospitals in promoting public health, dealing with care after major operations and enabling out-patient activity to work, all in conjunction with general practitioners across my patch. That is the message that the Government must hear; that is the theme that the Government must pursue; and it is certainly what I will do in the Stroud valleys and vale.

Oral Answers to Questions

Neil Carmichael Excerpts

Tuesday 26th November 2013 Commons Chamber

[Mr Hunt]

We will take no lessons in complacency from the party that did so little to sort out excess deaths in hospitals such as Mid Staffordshire, Morecambe bay, Basildon and Colchester, and many other hospitals. The truth is that, compared with when he was Health Secretary, we see nearly 2,000 more people every single day within the four-hour standard. We are doing much, much better: we have more A and E doctors, and the NHS is doing extremely well. I know that for him it is always politics first and patients second but, for once, he should be responsible and think about the people on the front line.

[Neil Carmichael (Stroud) (Con)]

T4. In contrast to the previous Government’s lack of focus, what have this Government done about hospital infection control, with particular reference to data management systems?

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

My hon. Friend makes an important point, and I hope that he will be reassured that under the current Government, clostridium difficile and MRSA rates are both about 50% lower than they were under the previous Government. We will continue to make sure that we reduce unacceptable hospital infections.

Oral Answers to Questions

Neil Carmichael Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Jane Ellison]

We are very aware of the discussions that have been going on in the other place and the amendments that have come forward, in which we have taken considerable interest. At this stage, we want to look at all the available evidence, because new information is coming through, before coming to a view. I take this opportunity to welcome the hon. Lady to her new post.

[Neil Carmichael (Stroud) (Con)]

2. What assessment he has made of the adequacy of provision of maternity services in Gloucestershire.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

On 12 November last year, I announced the allocation of a £25 million capital fund to the NHS to improve maternity services across the country, and that has supported improvements in 110 maternity care settings. I am pleased to say that, of that figure, Gloucestershire Hospitals NHS Foundation Trust was awarded £150,000 to refurbish the Stroud maternity unit.

[Neil Carmichael]

I thank the Minister for that encouraging answer. We now have 1,400 new midwives since 2010. Coupled with the very welcome recent investment in Stroud maternity unit, does he agree that this represents a real choice for expectant mothers and an excellent maternity service in general?

[Dr Poulter]

My hon. Friend is absolutely right to highlight the fact that when we came into Government there was a historical shortage of investment in maternity and midwifery care. We now have almost 1,400 more midwives in the work force, training commissions are being maintained at a record high, and we are continuing to invest in on-the-ground capital projects to support the birthing environment for women.

Accident and Emergency Departments

Neil Carmichael Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

I agree with the hon. Gentleman that consultant cover is not as good as it needs to be, and not just in A and E departments, but across NHS hospitals, so I hope that he will support me in moving forward with a seven-day NHS, which is a very big change and might be opposed by people working in the NHS. I am delighted that I can be assured of his support.

[Neil Carmichael (Stroud) (Con)]

Does the Secretary of State agree that putting patients first is at the heart of this and that that means, in part, ensuring that they can navigate the system and go to places such as the excellent Vale community hospital in Dursley where appropriate?

[Mr Hunt]

I am delighted to hear about the excellent Vale community hospital in Dursley. On my hon. Friend’s general point, we have not been good at persuading the public that there is anything between GP surgeries and A and E departments. The NHS has tried repeatedly to come up with walk-in centres and urgent care centres. Some have been successful, and some have not. At the heart of the challenge is the fact that the public want a 24/7 service for accidents and emergencies and urgent care. We have to ensure that they have it and that they understand where it is.

Hospital Mortality Rates

Neil Carmichael Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

It is important to recognise that even at the hospitals that we are talking about this afternoon, there is good care happening every single day. The way that we will reassure my hon. Friend’s constituents is by having an independent inspection system which has not existed before, where regulators are not leaned on by Ministers to say the right thing in the run-up to elections. It is only when his constituents have confidence in that regulatory system that they will know the truth about their own hospital, and we want them to get there as soon as possible.

[Neil Carmichael (Stroud) (Con)]

I welcome Sir Bruce’s report and the Secretary of State’s robust approach to it. Does my right hon. Friend agree that if we take away the right lessons from the statement and the questions on it, that will be the catalyst for a change of culture, enhancing transparency and accountability and introducing a new pace of response for the changes necessary to bring about higher standards in our hospitals?

[Mr Hunt]

We do need to draw those lessons, and the sad lesson from this afternoon is that that change in culture with respect to transparency and accountability does not extend to the Labour party. Voters will notice how unwilling Labour Members are to accept that things went wrong on their patch.

A and E Departments

Neil Carmichael Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

We have not had the final recommendation from the special administrator appointed by Monitor for what will happen at Mid Staffordshire hospital, but we will make absolutely sure that any changes made improve patient safety and care.

[Neil Carmichael (Stroud) (Con)]

Does the Secretary of State agree that the new role that GPs will play in commissioning will greatly assist the production of better community services and more integration with social care, all of which has been championed so frequently by the King’s Fund?

[Mr Hunt]

I completely agree with that. I pay tribute to my right hon. Friend the Member for South Cambridgeshire (Mr Lansley) for piloting those important reforms through the health service. I just hope that the Labour party, which claimed to support practice-based, clinically led commissioning, will see the error of its ways and understand that proper clinical commissioning holds the key to solving many of these problems.