Induced Abortion

Neil Parish Excerpts

Wednesday 31st October 2012 Westminster Hall

[Nadine Dorries]

My hon. Friend is absolutely right. It is the almost ghettoisation of pro-life and pro-choice that has over the years prevented rational and reasonable discussion of abortion.

I am attacked by both pro-life and pro-choice, because I support abortion up to a certain point but I want independent counselling to be provided to women who seek abortion and I would like the upper limit to be reduced. So I fall foul of both camps. It is important that MPs such as my hon. Friend come forward—he has views that encompass both sides of the argument—as they can be more rational in their presentation.

I have applied to the Backbench Business Committee for a debate on a votable motion next May. Of course, a Back-Bench vote does not amend legislation. If the result of the vote endorses a reduction to 20 weeks, however, it will inform the Government that perhaps it is time to bring the 1967 Act back to the House on Government time.

[Neil Parish (Tiverton and Honiton) (Con)]

I too congratulate my hon. Friend on securing this debate. Does she agree that, since the 1967 Act, medical science has advanced so much that there is now a real need to reduce to 20 weeks the limit for the termination of pregnancies? I would prefer to see the limit much lower.

[Nadine Dorries]

Later in my speech, I will address the evidence for that.

After the forthcoming debate allocated by the Backbench Business Committee, if there is a positive vote, if the debate is strongly attended and if Parliament expresses a strong feeling, that will send a strong message to the Government to bring the 1967 Act back to the House.

In 1990, the 1967 Act was amended to reduce the upper limit from 28 weeks to 24 weeks. I hope there will be a fuller debate in May, but in the meantime, following today’s debate, I will write to the Royal College of Obstetricians and Gynaecologists guideline committee, enclosing a copy of the Hansard of our speeches today, and ask it to look again. 1990 was a long time ago. As my hon. Friend the Member for Tiverton and Honiton (Neil Parish) said, things have progressed and science has moved on.

If the RCOG guidelines committee advised, based on the evidence available at the time, that the upper limit should be 24 weeks—

Community Hospitals

Neil Parish Excerpts

Thursday 6th September 2012 Commons Chamber

[Neil Parish (Tiverton and Honiton) (Con)]

I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing this debate and thank her for doing so. She brings her experience as a doctor, her common sense and some really solid views to the Chamber, and we should listen to her even more.

I think it was my hon. Friend the Member for Hexham (Guy Opperman) who described our new Minister as Boadicea. I would welcome her down to Tiverton for a visit to our hospital, but I would rather she took the knives off the chariot as she comes through—we would then be delighted to see her.

I think it was my hon. Friend the Member for Penrith and The Border (Rory Stewart) who made the point about rural constituencies. I am sure that his is bigger than mine, but my constituency covers some 400 square miles. We should remember that community hospitals—I have them in Tiverton, Honiton and Seaton—are essential. We also have, like it or not, an ageing population, both among those living in the area and among those who would love to retire there. Devon is a beautiful county and I very much welcome retired people who come there, but the facilities are of course needed. The point has been made by other hon. Members, but the issue is not just the treatment that elderly patients require; it is also about the time it takes to get to a hospital and the need to get there quite quickly. Distance is a problem for many rural patients, especially elderly patients. I would love to have more bus services, but we cannot have them in rural areas, given the sheer lack of numbers of people who travel by bus. It is essential for us to keep our community hospitals running.

I want to talk about one particular hospital and about its management. Dr Frank O’Kelly runs a clinical practice and commissioning service in Tiverton. He works closely with the hospital and is convinced that we need to get much closer to the people when providing services. I will give a bit of history of Tiverton hospital. Until 2006 it was run by a small community-based PCT in mid-Devon with no acute trust. It was at its most productive at this time and was hailed as one of the best in the country. I must declare an interest as in 2008 my granddaughter was born in Tiverton hospital. Since then it has been run by NHS Devon very much from north Devon, and it is not being used to its full potential. That is where Dr O’Kelly has some good ideas.

The Tiverton patient-centred care project has been reviewing since February 2012 what is happening and what is to be done to improve the situation at Tiverton hospital, yet it is still not delivering any practical help. There is no doubt that openness and transparency have been the basis of the project, with all the papers published, and five lay members attend the meetings that Dr O’Kelly organises. The league of friends has been hugely supportive, and with Exeter university devised its own questionnaire for the public. The NHS questionnaire achieved about 800 returns while the league of friends survey produced 3,000. Dr Kelly’s idea is to get local people interested in how this service is delivered.

I would like the Minister to know the key points that Dr Kelly wants to raise. The idea for Tiverton could be rolled out across the country. His plan is that the whole hospital is recommissioned and a single accountable provider brought in to run the hospital and community services. This could be NHS, private or a social enterprise. The provider would need to have as its only focus the community service and tailoring it to maximise capability.

Ultimately, clinicians and organisations running facilities come and go, but the population whom they serve do not. The population are left with time-limited results of those changes, depending on the length of tenure of the organisations. So to refer again to Dr Frank O’Kelly, his advice to the politicians would be to give the population much more power so that commissioners and providers are reminded who the customer really is. For a community hospital, this could take the form of a community governing body to which the providers and commissioners were accountable. I want to emphasise that local people need to have a much more genuine say in how their hospital is run so that they do not feel that they are caught up in a bureaucratic web and cannot put their views forward.

Tiverton community hospital is an excellent facility. It is pretty new and it could be used to deliver a great deal more local services to patients who need them. So Minister, please, if you have time, come to Tiverton and see what we are trying to do.

EU Working Time Directive (NHS)

Neil Parish Excerpts

Thursday 26th April 2012 Westminster Hall

[Charlotte Leslie]

My hon. Friend raises a good point that will be of great interest as things progress. In a culture in which litigation against the NHS is becoming more and more common, what will happen if patients feel that their safety has been compromised because of the lack of training received by their doctors? The European directive raises all sorts of issues about patients’ rightful expectations of those who treat them.

[Neil Parish (Tiverton and Honiton) (Con)]

I thank my hon. Friend for the excellent speech that she is delivering. This, of course, is the social chapter that Tony Blair signed up to in 1997 kicking in, and I suggest that the Government might want to get us out of that legislation. I feel that irrespective of what length of time doctors might work, it is down to them to negotiate that with hospitals, rather than have it imposed by a directive. That is the biggest problem; things must be done by negotiation and not by directive.

[Charlotte Leslie]

Again, I agree with my hon. Friend. One of the most destructive things is that the directive puts a cap on excellence. If people want to put in extra time to become excellent in their field and be a world-leading expert, they will not be allowed to because someone in Brussels and the new deal says no. That worries me tremendously in terms of our competitiveness with the rest of the world. We have some of the world’s leading experts in many fields of medicine, but America and Australia do not have such restrictions and they will pull away because we simply will not see talent coming through. Worse than that, a country that says to bright, talented young people who are going into a service occupation to serve the public, “We are going to put a cap on your endeavour” is a country of which none of us would want to be part. The precedent that that sets is absolutely diabolical.

Let me come to an issue that is much more difficult. It is easy to sit and point to problems, but some things are much more difficult, especially, as hon. Members have said, when they involve the dreaded E-word—Europe. What can we do? There is no doubt that there is a massive consensus across the medical profession that something needs to be done. The Royal College of Surgeons, the Royal College of Physicians, the NHS Confederation and NHS employers all say that they have massive concerns about the country’s health service. However, an interesting omission from that list is the British Medical Association, which seems absolutely content. It wants to keep the opt-out, but it seems absolutely content with the SiMAP and Jaeger rules that are playing havoc with our hospitals and with situations that are driving many junior doctors to despair and sick notes. I guess that it negotiated the new deal, but it is odd and disappointing that, on this issue, it seems so unrepresentative of so many fields of the profession.

Ministers have said that they are working urgently with Europe for a solution. I have no doubt that that is true, and I appreciate the complexity of the situation. However, I am beginning to think that waiting for a solution to come out of Europe is like waiting for Godot. As hon. Members will know, this debate has been revolving around the European Commission and the European Parliament for almost a decade. It has come back again, and people are still trying to agree on what they are going to discuss. They have until September this year to agree that, but given past history, I have no faith whatsoever that an agreement is on the cards, let alone any results, and the precedent that has been set is not encouraging. While that farce has been going on in Europe, the clock has been ticking every day. Every day, patients’ lives are put at risk; every year, new generations of doctors enter a system that does not serve them, their patients, or the country.

What can we do? First, we should look at what we want. As I have said, no one wants a return to the bad old days when junior doctors were working ridiculous hours and were too tired to function, and patient safety was put at risk. The professions say that they want flexibility. For example, the Royal College of Surgeons has said that a working week of up to 65 hours, with a bit of flexibility, would be extremely good, and that will differ from discipline to discipline. Anaesthetists may want something slightly different from the surgeons, but the point is that our professionals know what they are talking about and what they are doing, and they deserve the flexibility to drive their services as they see fit. The Government have taken seriously the agenda to put professionals in the driving seat. We want flexibility, not arbitrary limits on times.

What can we do? My hon. Friend the Member for Daventry (Chris Heaton-Harris) has already mentioned what some other countries do. In the Netherlands, for example, doctors are classed as autonomous workers, because they earn more than three times the average wage in that country. We can look at such a classification, although that might be a complicated solution.

Neuroblastoma

Neil Parish Excerpts

Tuesday 5th July 2011 Westminster Hall

[Neil Parish (Tiverton and Honiton) (Con)]

It is a great pleasure to speak under your chairmanship, Ms Osborne. I thank Mr Speaker for granting me this debate on primary care trust funding for neuroblastoma. I am delighted to welcome the Minister with responsibility for care services and look forward to hearing his response to these grave matters.

Neuroblastoma is a rare solid tumour cancer that tragically occurs in very young children and infants, primarily under the age of five years. It accounts for 17% of cancer deaths in children. Only 100 children are diagnosed with neuroblastoma each year in the UK. That is a blessing in itself, but it is of little comfort to the parents coping with the emotional strain of knowing that their child must face the long, hard battle against cancer.

The disease is caused by the development of cancerous cells in neural crest nerve cells, which play a key role in the development of the sympathetic nervous system. Most neuroblastomas begin in the abdomen or adrenal gland, next to the spinal cord or in the chest. In nearly 70% of children diagnosed, the disease has metastasised, which means that it has spread to other parts of the body. That makes it a particularly hard cancer to treat. The disease commonly spreads to the bones, and it can cause pain and difficulty in walking. Occasionally, it can affect the spinal cord, causing numbness, weakness and loss of movement in the lower part of the body.

The symptoms depend on where the cancer starts and whether it has spread to other parts of the body. Initial symptoms can seem as innocent as tiredness, fever and loss of appetite. The vagueness of those symptoms makes neuroblastoma hard to diagnose in the early stages. Because neuroblastoma usually develops in the abdomen, the most common symptom is a lump in the stomach, which can make the child’s tummy swell, causing pain and great discomfort.

The disease is treated through a variety of means, including surgery, chemotherapy and stem cell replacement. However, even after those treatments, high-risk neuroblastoma remains a major cause of death due to malignancy—patients have a two-year survival rate of approximately 20%. On top of that, the majority of high-risk neuroblastoma patients will experience disease relapse.

It saddens me, then, that a young constituent of mine, named Sam Daubany-Nunn, is being denied funding by his local primary care trust to receive vital treatment in Germany that might well be curative. Sam was diagnosed with neuroblastoma at the age of 16 in July 2008. Such a diagnosis is quite unusual in someone as old as that. At the time, Sam was undertaking his GCSEs at Colyton grammar school. He went through eight hours of surgery, gruelling high-dose chemotherapy, a stem cell transplant and radiotherapy. Fortunately, he responded well to his treatment and, despite his illness, he excelled at school, achieving high grades in every subject. He went on to pursue his studies at sixth-form level. I met Sam and his family in Seaton in my constituency. They live in Uplyme, right on the border between Dorset and Devon. That is why Dorset PCT is in the dock today.

Sadly, Sam became ill again in October 2010 and the family were informed that he had relapsed and that the neuroblastoma had come back. Sam went through six further courses of chemotherapy, two cycles of metaiodobenzylguanidine treatment at University college London and another stem cell transplant.

Following that, a new treatment was added to the front-line protocol in the UK for all new children diagnosed. That new treatment is a targeted cancer therapy called monoclonal antibody therapy. Monoclonal antibodies are made in a laboratory and introduced to the body intravenously. They attach themselves to areas on the cancer cells. In this case, the antibodies bind to a protein called GD2 on the surface of neuroblastoma cells. Those antibodies operate as markers for the patient’s own immune system, encouraging it to attack and destroy cancerous cells. Without those markers, the immune system would not attack cancerous cells, as those tumours are part of the body.

I was pleased to receive a letter from my right hon. Friend the Secretary of State for Health in response to a point that I raised with my right hon. Friend the Leader of the House at business questions. The letter informed me that UK patients now get access to that treatment via the Cancer Research UK-supported European trial and that there is now wide clinical agreement that all children with high-risk neuroblastoma who might benefit should have access to monoclonal antibody treatment, as it increases survival rates to about 70%. That is extremely important. However, that clinical trial, led by Dr Penelope Brock from Great Ormond Street hospital, is not available in this country for relapsed cases—it is available for newly diagnosed cases only—and five or six patients a year would not meet the strict criteria for the trial.

A second trial is being established with wider eligibility criteria, and it will include those children who, like Sam, have relapsed, but it will not be available until January 2012. That is an unworkable time frame for neuroblastoma sufferers who cannot wait for the UK trials to start. That is certainly the case for Sam. As a result, some parents have opted to take their children for treatment in Germany, which is piloting the new trial that will be available across England in 2012. That has been paid for by their local primary care trust after an individual funding request. However, Dorset primary care trust, near my constituency, has refused to support the funding request in Sam’s case. His family have been raising funds to pay the €80,000—a very big sum—that the treatment in Germany costs. Indeed, they have remortgaged their house. Hon. Members will understand that not everyone can take that action, which is why I am raising this matter with the Minister today in the House.

Sam’s case is not isolated. After raising neuroblastoma funding in both the House and the media, I was contacted by a father whose son, Adam, suffers from neuroblastoma. Like my constituent, he is not eligible for the clinical trials in the UK and he made an individual funding request to Surrey primary care trust, which, like my constituent’s, was rejected. I understand that Adam’s father is now in contact with his local MP. I wish him and his family well and hope that he can receive the treatment that he needs.

That contrasts with the decision made by NHS Northamptonshire’s individual funding request department in an almost identical case involving a constituent of my hon. Friend the Member for Wellingborough (Mr Bone). I will take this opportunity to thank my hon. Friend for all the assistance that he has given me in this regard. A young boy named Zach, whose case my hon. Friend has previously debated in Westminster Hall and who, like Sam, was not eligible for the clinical trial, was offered funding for monoclonal antibody treatment in Germany. In its letter to the family, the individual funding request department made this clear:

“Given the timescales involved NHS Northamptonshire does not wish further obstacles to stand in the way of treatment and we have agreed that if necessary the cost of monoclonal antibody treatment in Germany would be covered by NHS Northamptonshire.”

Fortunately for my constituent, there has been a last-minute change of heart by Dorset primary care trust. I received a call last night from the chief executive of Dorset PCT, who informed me that it had reviewed Sam’s situation and concluded that his was a unique case and that it would be unfair not to support the request for funding. That is fantastic news, and I extend my thanks to Paul Sly, the chief executive of Dorset PCT, for his assistance and for reviewing the original decision. However, I cannot help but feel that this case may not have had such a happy ending had I not been contacted by Sam’s family, written to the chief executive of Dorset PCT, raised the matter in the House, written on the subject in the press and finally secured this debate today.

I emphasise that other families might not be able to raise the funds to go to Germany. It is essential that Samuel gets this treatment now; otherwise, his chances of survival will be hugely limited. That is why it is good to raise this matter. That raises the question of how two primary care trusts can come to two completely different conclusions and why some people should be denied potentially life-saving treatment in such an ad hoc manner. People should be treated fairly throughout the country, and although I realise that the PCTs probably have a great deal of autonomy, I urge the Minister to iron out the problems, if he can. We can then get to January and February next year, when monoclonal antibody treatment will be available in this country.

Finally, I want to read from the conclusion of the letter from Paul Sly, the chief executive of NHS Dorset and of NHS Bournemouth and Poole:

“Our local processes for individual treatment requests are set up to try to deal fairly with the vast majority of requests. However as we went through the request it became apparent that the only possible funding route for Samuel at this time was a referral to the National Cancer Drugs Fund. Unfortunately as the Fund only covers ‘drug costs’ they were unable to assist.

In the light of the above, we carried out a further review of Samuel’s situation and concluded it is unique for three reasons…the treatment will be available in the UK later this year…he meets the trial inclusion criteria…he has to have the treatment within a specified time frame and cannot wait for the UK trial to start”.

That is extremely important.

I have put the issue on record. I hope that the problems faced by Samuel Daubany-Nunn and his family will reach a good conclusion. I reiterate to the Minister that there are not many such cases in the country, but it is extremely important that people receive this treatment when they need it, otherwise their chances of survival are very limited. I therefore ask the Minister to look at the general process. I am certain that NHS Dorset will honour the position that it has taken in its letter, but I am naturally keen to ensure that the Daubany-Nunns get help with funding Samuel’s treatment, because they very much need it, and it is only fair that people are treated similarly throughout the country.

Oral Answers to Questions

Neil Parish Excerpts

Tuesday 26th April 2011 Commons Chamber

[Paul Burstow]

My right hon. Friend of course is more than happy to go to all sorts of places to talk to people about the health reforms. However, local government fully supports this particular proposal and sees it as a vital innovation for the involvement of local government in the health service. It will be transparent because it will be part of the local authority and will meet in open.

[Neil Parish (Tiverton and Honiton) (Con)]

11. What recent assessment he has made of progress by GP pathfinder consortia in delivering improvements in NHS services.

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

I am delighted that nearly 90% of the country is now covered by pathfinder consortia, including my hon. Friend’s constituency, where the eastern Devon consortia chairs board pathfinder is up and running. I know that one area on which these emerging consortia are focusing is providing better, more flexible services for patients in community settings. We are supporting all the pathfinders through the pathfinder learning network, which is already showing a wide range of examples of where clinician-led commissioning is delivering benefits for patients.

[Neil Parish]

I welcome the Secretary of State saying that the consortium in my constituency is up and running. Will he also take this opportunity to ensure that through these consortia patients can get better access to their doctors? Labour paid doctors a great deal more money, but patients actually got less access to their doctors.

[Mr Lansley]

That, indeed, will be one of the areas on which the quality and outcomes framework for individual GP practices will focus. In addition, however, through the commissioning outcomes framework for the NHS as a whole, one area in which we want to see continuing improvement in quality is patient experience and outcomes as reported by patients. GPs and their clinical colleagues will therefore be incentivised continuously to improve quality.