Junior Doctors Contracts

Nicholas Dakin Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

I think many people inside and outside the medical profession are deeply upset that that is happening. I really enjoyed my visit to my hon. Friend’s constituency, and we will continue to invest in his local health services. I think that his constituents will be upset by the fact that the pay and conditions many of them have for working at weekends go nowhere near what is being offered to junior doctors under the new contract. In that sense, it is totally disproportionate to withdraw emergency care, which is such an extreme measure and has never happened before.

[Nic Dakin (Scunthorpe) (Lab)]

I welcome the Secretary of State’s recognition that junior doctors are the backbone of the NHS and his expression of willingness to talk about the implementation of the contract. Those words are great, but I urge him to take actions to match them and take the opportunity of the cross-party initiative to pilot this contract. If he does not do that and ploughs on regardless, he will jeopardise patient safety.

[Mr Hunt]

I welcome any genuine attempt to try to resolve this issue, but Health Education England has said that it does not believe that that cross-party approach is workable. As I have said to the hon. Gentleman before, having pilots of seven-day care and new junior doctor contracts would mean that we took too long to deliver a key manifesto promise.

Junior Doctors Contracts

Nicholas Dakin Excerpts

Monday 18th April 2016 Commons Chamber

[Mr Hunt]

We do have that power by law. The letter we put out in defence against the legal action that has been taken against the Government explains very clearly why and how we have that power. It is all written there for the hon. Gentleman to see. I assure him that, on something as contentious and difficult as this, we take every care to make sure that we are acting within the law.

[Nic Dakin (Scunthorpe) (Lab)]

If I were Secretary of State for Health, I would feel personally responsible for this unprecedented action taking place on my watch, and I would do everything I could to build bridges to make sure it did not happen and that patients were not threatened in the way we all fear. What is the Secretary of State doing to build trust between himself and the NHS workforce?

[Mr Hunt]

I will tell the hon. Gentleman one of the things we are doing, which is turning around the hospital in his own constituency, which is no longer in special measures because the quality of care has improved dramatically. What else are we doing? Over three years, there have been 75 meetings, 73 concessions and three different independent processes. We have tried everything to get a negotiated outcome, but in the end we have to do the thing that is right for patients.

Community Pharmacies

Nicholas Dakin Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Derek Thomas]

I welcome that intervention, but I am concerned that the hon. Lady might have read my speech, and I have not yet put it on my Facebook page. In my constituency, I have several community pharmacists, and I am not sure that I have too many. It is simply that my patch is large and includes areas of social deprivation, which has an inherent impact on health. A car journey from the north to the south of my constituency takes an hour. The journey from the most westerly point to the most southerly point takes an hour and nine minutes. In a rural area such as mine, community pharmacists provide invaluable access to the NHS and invaluable support to vulnerable people.

To follow on from the hon. Lady’s helpful intervention, over and above their obvious healthcare roles, I see community pharmacies’ input into society as comparable to that of post offices, police community support officers, libraries, local churches or chapels, local pubs, village shops and our postmen and women. They all play an important part in local communities. They are the glue that holds communities together, the people and organisations that know when things are not as they should be, and the people who look out for our elderly, the sick and the vulnerable. Although it is difficult to put a price on the work they do, without those people and institutions, society would be a poorer place and the added strain on public services would be significant. It is perverse that we judge reducing support for services such as community pharmacists to be a saving.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate the hon. Gentleman on securing this timely debate. It is a pleasure to serve under your chairmanship, Mr Streeter. The loss of pharmacists’ expertise and experience and their knowledge of the people who come in and out could be enormous if pharmacies such as the Whitworth family pharmacy in my constituency are forced to close as a result of this initiative.

[Derek Thomas]

I think we all share those concerns. I am pleased to have secured this debate, so as to give people an opportunity to share their experiences in their own constituencies.

Reform of community pharmacies is not something that we can afford to get wrong. Many of the community pharmacies in my constituency are independent businesses that have been established for decades. A wrong move by the Government now might make those community resources unviable. We all know that community pharmacists provide important services, including the safe dispensing of medicines. They are often the first port of call for people with minor ailments and health concerns, and are a key support for elderly and vulnerable patients in the community.

Junior Doctors’ Contract Negotiations

Nicholas Dakin Excerpts

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

I agree with my hon. Friend. I am afraid that this is a mark of the way in which the Labour party has changed. I suspect that a Labour party of a different era—one that was more responsible in how it dealt with industrial disputes—would have understood on whose side it should be acting at this point.

[Nic Dakin (Scunthorpe) (Lab)]

This is a Conservative Government, but to have a strike of this kind on any Government’s watch is a disgrace and a failure. I quite like the Minister actually, but he has only ever laid the blame for this elsewhere. Surely, the Government should be evaluating their own performance and saying, “We can do better than this and we should ensure that this does not happen,” even at the eleventh hour.

[Ben Gummer]

The hon. Gentleman tempts me with kindness, and I repay the compliment. However, having been involved in this process for some months now, I have found it incredibly frustrating. Up to the end of November, every time we asked the BMA to come and talk to us, it refused, despite personal entreaties. And when it did talk to us, we often found that we had nailed down an agreement only to find it slipping out of our fingers the next day in front of the media. This has been a hugely frustrating and difficult process for everyone concerned—not only for us but for the junior doctors, who have been left confounded and confused by the whole thing.

NHS Trusts: Finances

Nicholas Dakin Excerpts

Monday 1st February 2016 Commons Chamber

[Ben Gummer]

The reality, as my hon. Friend recounts in relation to his own constituency, is that satisfaction in the NHS is at near-record levels, and that dissatisfaction in the NHS is at record lows. We rank No. 1 in the Commonwealth Fund rankings of hospital and health systems across the world. Far from the picture painted by Opposition Members, the fact is that people feel the NHS is getting better. There is increasing proof that the NHS is safe in the hands of the Conservative party, and it will continue to be so for the next five years.

[Nic Dakin (Scunthorpe) (Lab)]

The health economy in north Lincolnshire has been severely challenged for a number of years. When I meet the chief executive and others from the North Lincolnshire and Goole NHS Hospitals Foundation Trust, I get the impression that they are trying run up a finance escalator that is flying down towards them. What can the Government do to help in these circumstances?

[Ben Gummer]

I recognise the problems that the hon. Gentleman has identified at Northern Lincolnshire and Goole Hospitals NHS Foundation Trust and in north Lincolnshire. NHS Improvement is looking at them in detail at the moment. I hope that by working with the trust’s existing management, we will see an improvement over the next year. That is the point of what NHS Improvement is trying to do. I reassure the hon. Gentleman that if Jim Mackey produces the kind of results that he produced in his own hospital trust, his constituents will see NHS outcomes of a quality that has so far eluded them.

William Mead: 111 Helpline

Nicholas Dakin Excerpts

Tuesday 26th January 2016 Commons Chamber

[Mr Hunt]

I do agree that we need more clinicians in primary care. We also need to invest in secondary care, which is why the hon. Lady has a new A&E centre opening in Hull, which I am sure she welcomes. We need more clinicians in primary care so that we can deal with these issues more quickly, before people need hospital care and to spot conditions such as sepsis. This Government are investing £10 billion in the NHS annually in real terms in order to step up the improvement in the services that we offer.

[Nic Dakin (Scunthorpe) (Lab)]

So will the Secretary of State put a higher proportion of clinicians in 111?

[Mr Hunt]

We will certainly look at whether we need to have more clinicians in 111. We do have clinicians available in 111. My own view is that it is the separation of the out-of-hours services and the 111 service that is at the heart of the problem that we are looking to deal with, but as part of the review we will look at the availability of clinicians in 111.

Cancer Drugs

Nicholas Dakin Excerpts

Tuesday 19th January 2016 Westminster Hall

[Nic Dakin (Scunthorpe) (Lab)]

As ever, Mr Streeter, it is a pleasure to serve under your chairmanship. I congratulate the hon. Member for Mid Derbyshire (Pauline Latham) on securing a debate on this important subject; she has tirelessly raised the issue of access to cancer treatments since she entered the House. She was right to describe the Cancer Drugs Fund as having moved from being a temporary measure to being a mainstay, and therein lies much of the challenge we face today. In that respect, the hon. Member for Solihull (Julian Knight) was right to remind us of the many good things the fund has done, and the hon. Member for Strangford (Jim Shannon) was right to emphasise the increased number of people with cancer and the need for cancer treatment.

Let us be clear: last year’s delisting of drugs from the Cancer Drugs Fund was a retrograde step for many cancer patients across the country. The decision affected many thousands of patients, and I am sorry to report, as the chair of the all-party group on pancreatic cancer, that that included hundreds of pancreatic cancer patients, because the pancreatic cancer drug Abraxane was removed from the CDF on 4 November.

Pancreatic cancer has the worst survival rate of any of the 21 most common cancers, with less than 5% of patients surviving five years or longer. That survival rate has barely changed over the last 40 years. Sadly, as my hon. Friend the Member for Torfaen (Nick Thomas-Symonds) emphasised, pancreatic cancer is often diagnosed late, with about 80% of diagnoses taking place when the disease has spread to another part of the body. Patients diagnosed when the disease is metastatic live, on average, for just two to six more months.

Trials have shown that Abraxane, when used in combination with the standard chemotherapy drug gemcitabine, can extend eligible patients’ lives by an average of about two months more than gemcitabine alone. However, it is important to note that some patients live for significantly longer than two months, with some on the trials living for more than two years, and with a significant increase in the number surviving for more than one year. Clearly, when the average survival rate is between two and six months, even an extra two months’ survival gain represents a relatively large amount of time for patients to spend with their loved ones, and the value of that was indicated earlier.

That survival gain is why Abraxane is now in use around the world. From Germany to the USA, and from Austria to Australia, it is making a small but tangible difference to patients. It is worth noting that Scotland and Wales have also approved Abraxane for use on the NHS. Yet, in England, as of 4 November, it is no longer available to new patients, creating a devastating postcode lottery, as the hon. Member for Strangford said.

There has been a significant outcry from members of the public—people such as my constituent Maggie Watts who lost her husband, Kevin, to pancreatic cancer in 2009, and the 102,000 people who signed her petition on Change.org calling for Abraxane to be put back on the CDF list.

Why was Abraxane removed? Unlike some other drugs, it was not removed because of cost. Instead, it was decreed that it did not meet the minimum clinical effectiveness threshold when that was raised in 2015. In short, it was removed because the CDF scoring system did not take account of relative survival gain. The scorecard CDF panel members must complete requires them to give a score of zero to a drug that gives an average of less than three months’ life extension. Despite there being few treatments for pancreatic cancer, the system also did not recognise that this cancer has an unmet need in terms of treatment options. Abraxane is the first significant new treatment for nearly two decades, but the scoring system was inflexible, so the drug scored low.

That is the issue: we cannot just compare a new treatment for, say, breast cancer, where the average five-year survival rate is more than 80%, and where there are many effective treatments, with a new drug for a cancer such as pancreatic cancer, which has the lowest survival rate and few treatment options. Put simply, where a cost-benefit analysis takes place in a system with a finite budget, and where drugs for cancers with relatively high survival rates are scored on the same basis as drugs with the lowest survival rates, that system will always work against new drugs for cancers such as pancreatic cancer.

That brings us to the NICE consultation on how the CDF will be used in the future, which the all-party group will be submitting its views on. If a NICE committee defines a drug as an end-of-life drug, it can approve it at a higher cost threshold than other drugs. That is extremely important for cancer drugs and especially for pancreatic cancer drugs. However, the consultation document suggests only minor changes to the end-of-life three-month threshold, which, as hon. Members will gather from my earlier comments, is vital for cancers such as pancreatic cancer. This is where the issue of relative survival gain needs to be properly addressed.

Another way to have addressed issues affecting cancers with the worst survival rates would have been to introduce a system of patient and clinician engagement for pre-defined end-of-life drugs. That system is being used successfully in Scotland. Introducing it here would mean that NICE had to engage more with clinicians and patients to establish what extra benefits certain drugs might bring. NICE committees would then have to give due weight to that PACE evidence, in addition to the clinical and cost-effectiveness data they usually review. Without PACE, Abraxane would not be available in Scotland. The system could make a big difference to patients in England if it were introduced for certain pre-defined cancer types, such as rare cancers—the hon. Member for Mid Derbyshire mentioned the failure we have seen in that respect—and cancers of unmet need with the lowest survival rates.

NHS Bursary

Nicholas Dakin Excerpts

Monday 11th January 2016 Westminster Hall

[Paul Scully]

Absolutely.

[Nic Dakin (Scunthorpe) (Lab)]

The hon. Gentleman is spelling out the case clearly. He will recognise that the introduction of fees for the teacher training year has led to a decrease in the number of people coming forward for teacher training. Perhaps that is a lesson that needs to be learned for student nurses.

[Paul Scully]

I thank the hon. Gentleman for that intervention.

I will bring my comments to an end with a few questions. The system needs to change. Not everyone agrees with me, but a number of people, even people who want to keep a sense of the bursary system, believe that the bursary system is not perfect by any stretch of the imagination. The petition, and the discussion around it, is the beginning of the process feeding into that change. Even those who are not happy with the proposed loan structure can help to shape the system over the next few months—in reality, it will have to be ready for the academic year after next—so that it is ready for students applying for the 2017-18 academic year. Whatever the final structure, student nurses must understand what they are applying for, how they will be funded and what the repercussions will be for repayments. We have a few months to work on it and to raise issues with Ministers.

I have a few specific questions for the Minister that come from the petition. How will specialist courses remain viable under the change? Podiatry, for example, tends to be undersubscribed—places on podiatry courses have to go through clearing year in, year out—so it is important that we consider how we can have viable courses for the services that we need.

Will trusts, especially foundation trusts—foundation trusts have proved that they can work through their own budgets by virtue of being given foundation status—be given the freedom to help repay student loans as part of a pay package, as was suggested by the Council of Deans of Health? As a result of that, what more can we do to retain nurses in the NHS after graduation, perhaps through contract agreements, rather than seeing them move abroad? Will there be enough placements to take on the proposed increase in the number of trainees? We spoke about that a little earlier.

--- Later in debate ---

[Wes Streeting]

I am grateful to my hon. Friend for raising that point, which I did not raise in the earlier Adjournment debate. Since that debate took place I have seen an article by Crystal Oldman in Independent Nurse magazine, which expressed concern about our ability to recruit nurses into community-based settings. If we are trying to prevent patients from presenting at accident and emergency, which is important to alleviate waiting times and the burden on A&E departments, it is vital that people can access timely care and support in the community. I do not believe the Government have fully considered that, but I look forward to hearing the Minister’s response.

In my Adjournment debate I also asked the Government whether they thought it was fair that students from the most deprived backgrounds should have their grants taken away while some of the wealthiest people in our society received tax cuts. I am not surprised that I did not receive an answer to that question, but it is a fair one. A lot of people wonder how, in straitened times, it is possible for the Government to find money for tax cuts for the wealthiest, but we cannot find money to ensure that people who perform vital functions in the NHS receive the support they need to get them through their training.

I asked the Minister in that debate how much debt the Government expect to write off because those indebted by the reforms are unable to pay their debts in full. That question was not answered. However, we know that in the case of the tuition fees brought in by the coalition Government, the current Government expect that the majority of students will see their debts written off, at cost to the taxpayer, further down the line.

I wonder about the Chancellor. Following him on economic policy at the moment is a bit like following a drunk driver: one minute he tells us that things are fantastic, and then the next minute he tells us that something called “the global economy” might have an impact on our domestic economy. I am glad that he has finally got that point, but I do not believe that he is currently being straight with the House and the public about how he intends to “fix the roof”, whether the sun is shining or not. It will be no good if some poor Chancellor 30 years down the line has to find huge amounts of money for debt write-off. This Chancellor needs to be clearer about where the money is really coming from.

On that point, I asked in the Adjournment debate which Department—the Department of Health or the Department for Business, Innovation and Skills—would meet the cost of servicing the resource accounting and budgeting charge for student loan debt. That question was not answered, although I am sure the Treasury and both those Departments have a view. It seems that the Government have not reached a clear position, and they really ought to have done so before embarking on this course of action.

I also asked the Minister about the Barnett consequentials for health education budgets in Northern Ireland, Scotland and Wales. He told the House that it was a matter for Her Majesty’s Treasury, but I am afraid that we did not get any real detail about what the impact on those nations would be.

Will the Minister also say how clinical placements will be funded under the current loans system? He tells us that he has started discussions with Universities UK about that, but we would have expected the Government to have those discussions before embarking on a policy of this nature.

I also asked the Government whether they were at all concerned that applications from mature students might fall, given the detrimental impact that the coalition Government’s student finance reforms had on mature and part-time student numbers. The Minister did not give a reply, but we have heard in interventions this afternoon that that is a legitimate concern. We keep being told that all has been well since the coalition introduced the new tuition fees regime, and that student numbers in higher education are excellent. It is true that overall student numbers have gone up, but I do not think that there has been the necessary level of analysis about whether people are being deterred from applying. It is all very well saying that the numbers have gone up, but that does not tell me whether the regime deterred people from applying. However, we know for certain that it has had a particularly detrimental impact on the numbers of mature and part-time students. The issue of mature students ought to weigh heavily on the Government’s mind before they decide to proceed down this course on nursing bursaries, because it is clear that there will be big problems for the nursing profession if mature student numbers fall.

[Nic Dakin]

On that point, it is important for areas such as north Lincolnshire, which struggle to attract new graduates, to be able to grow our own graduates, and mature students are a major part of that. A fall in their number will particularly affect areas such as ours, which new graduates do not see as particularly attractive.

[Wes Streeting]

I absolutely agree with my hon. Friend, and I have another concern. In my Adjournment debate I asked the Minister to confirm whether mature students would be eligible to apply for a second loan, and he confirmed that they would be able to do so. However, that does not reassure me that the change to bursaries will not have a detrimental impact. If a mature student has already taken out a significant loan for a first undergraduate degree and still has some of that loan debt outstanding, given that they are closer to retirement than the stereotypical 18-year-old entrant, will they really want to take on additional debt? There are major question marks about that, and again, the Government ought to have done the research and analysis on it before embarking on this policy direction.

I am conscious of the time and the number of Members who wish to speak, so I turn finally to the question of process. This Thursday, a Delegated Legislation Committee will be convened to debate the abolition of student grants for all students, including the cohort we are talking about today. It is absolutely appalling that the Government are seeking to use the device of delegated legislation to put through such a major change to student finance. Whatever disagreements I had with previous Labour Governments about their higher education policy, at least they were courageous enough to bring their policies to the House of Commons, put them through the House of Lords, justify them and put them in the full light of scrutiny by right hon. and hon. Members.

This use of a Delegated Legislation Committee is part of a wider pattern of behaviour by this Government, who seek to ignore scrutiny. They seem to believe that a majority of 12 on a minority of the vote gives them carte blanche to do whatever they like. The level of public outcry, not to mention the concern expressed by Members from all parties in the House, means that the Government ought to behave far more transparently.

I asked the Minister in my adjournment debate to give the House an assurance that students studying nursing, midwifery and allied health subjects would not see their tuition fees and debts hiked up even further than has been suggested, but I was not answered. We know from newspaper speculation that the Government are considering increasing tuition fees above inflation, and we also know that the Cabinet Office is trying to find ways of avoiding a vote in both Houses, which is shameful.

Similarly, I asked the Minister to give the House an assurance that we would have a full debate and a vote if the Government chose to extend tuition fees to nursing, midwifery and allied health subject courses. The Minister told the House that he could not give us a definite answer to that question yet. I hope that he can do so this afternoon, and that he will confirm that we will have a full debate in the House of Commons and in the House of Lords, and that right hon. and hon. Members and noble peers will have the chance to make their voices heard and to put the issue to a vote.

Finally, I asked the Minister to commit to meeting student representatives to discuss their concerns, and he said that he was happy to do so. I spoke this weekend to one of the organisers of the protest, Danielle Tiplady, who has done a remarkable job in campaigning on this issue and in raising awareness among her colleagues. I hope the Minister will commit today to meeting her and other student representatives, so that he can hear at first hand the powerful testimony that we heard at the demonstration at the weekend.

We should all be concerned about the direction of this policy, and I am glad to see so many right hon. and hon. Members here this afternoon. Given that there are other debates taking place, including on Syria, which is a really big matter that concerns all of us, it is great that we have had such a big turnout this afternoon. I hope that helps to encourage the Government to think again.

Mental Health

Nicholas Dakin Excerpts

Wednesday 9th December 2015 Commons Chamber

[Luciana Berger]

I do not think it is an either/or situation; it is about how we do both, and I will come on to that in the rest of my remarks.

We know that 75% of people who have mental health problems in working life first experienced symptoms in childhood or adolescence, yet only about 6% of the mental health budget is spent on child and adolescent mental health services. We need to do more to focus attention on children, young people and, crucially, prevention, and here we must look to our places of learning, our workplaces and our communities. We need schools and colleges that promote good mental health. We need to ensure that all children have access to high-quality social and emotional learning so that they acquire the skills to express how they feel and develop an understanding and awareness of good mental health. We were concerned to read the 2013 Ofsted report on personal, social, health and economic education, which stated that mental health education was often omitted from the curriculum owing to a lack of teacher training. The Government have funded the PSHE Association to publish guidance and lesson plans to support teaching about mental health, but how are the Government ensuring that schools are actually using it?

We need communities that promote good health and wellbeing. Poor housing, fuel poverty and neighbourhood factors, such as overcrowding, feeling unsafe and a lack of access to community facilities, can have a harmful impact on mental health. These, along with abuse, bullying, trauma, deprivation and isolation, are just some of the levers of mental distress in our communities that we must address.

[Nic Dakin (Scunthorpe) (Lab)]

I congratulate my hon. Friend on setting out such a strong case. Does she agree that the pressure on local government over the last few years has had a negative impact on community cohesion in relation to mental health and led to a growth in loneliness and other such things that spawn mental health problems?

[Luciana Berger]

My hon. Friend’s intervention brings me neatly on to my next remarks. I am enormously concerned about the impact of the Government’s deep cuts to local authority budgets over the past five years, of the additional £200 million in-year cuts to public health and of the cuts coming further down the line. I am concerned about their impact on our communities and the services that serve them, such as our libraries, drop-in centres, leisure centres, befriending services—my hon. Friend talked about loneliness—children’s centres, which support parents and young children, and citizens advice bureaux, which support people early on. They are the glue that support and keep our communities together, and I am concerned about what might happen over the next few years.

We need a social care system that is integrated with our physical and mental health services, and we will continue to push the Government to address the fragmentation across these systems. Billions have been slashed from social care budgets and the number of people receiving social care support for mental health has fallen by a quarter since 2009-10. This is seriously impacting on mental health trusts’ ability to discharge their patients. I hear that time and again when I visit mental health trusts across the country. They have patients they cannot move out because the social care is not available for them to move into.

We need workplaces that promote a good work-life balance and where mental health is recognised, understood and supported. Some 70 million working days are lost every year owing to stress, depression and other mental health conditions. Mental health problems cost employers in the UK £30 billion a year through lost production, recruitment and absence. As the chief executive of NHS England has rightly pointed out, the NHS has to get its own House in order. Across the health service, staff tell me they are concerned about their wellbeing and that of their colleagues. Longer hours, fewer resources, greater demands and an incredible amount of goodwill are creating a perfect storm within the NHS. The figures from the NHS staff survey show that the proportion of staff reporting work-related stress has increased from 29% in 2010 to 38% in 2014.

Junior Doctors Contract

Nicholas Dakin Excerpts

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

The Department has not yet had a chance to examine that report, but I have seen it. This all goes to emphasise that we should not be where we are. This matter can be settled. The Secretary of State’s door has been open for negotiations all the time. There is no reason why the junior doctors committee should not walk through that door, begin negotiations and end the risk to patients that is involved in strike action.

[Nic Dakin (Scunthorpe) (Lab)]

Why not just go straight to ACAS? From my constituents’ point of view, something has broken down and it needs fixing. Why not just get on with it?

[Alistair Burt]

Because of what happened the last time an independent body looked at this matter. After the negotiations broke down before, the Secretary of State sent the matter to an independent body, the Doctors and Dentists Review Body. The BMA took part in that and made its representations, but when the independent body reported, the BMA still did not do anything. Those recommendations form the basis on which negotiation can take place. If those negotiations are not successful, that is when conciliation can happen. That is exactly what the Secretary of State has offered. I hope the hon. Gentleman will support that and try to ensure that strike action does not take place.