Coeliac Disease and Prescriptions
Debate between Nicholas Dakin and Lord Beamish(8 years, 1 month ago)
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Mr Jones
That is the main point. What some CCGs are doing is a false economy, because one hospital admission will cost more than the annual cost of prescriptions for an individual who adheres to a gluten-free diet.
Another person living with coeliac disease, Janice, who is a constituent of mine, wrote to me saying:
“I strongly believe that these plans will cause more expense to the government when coeliac patients can’t afford shop priced gluten-free foods and don’t stick to their diet and end up with cancer of the bowels”,
as well as other conditions. She went on:
“I am a pensioner and find it increasingly hard to afford luxuries like biscuits and cakes. If I have to add gluten free bread, pasta and cereals to my shopping list this will cause more stress. I cannot have any form of gluten, even in small doses, as I am violently ill.”
As well as a failure to consider the evidence before making decisions to withdraw gluten-free prescriptions, there is also evidence of a lack of public consultation by CCGs. Coeliac UK has been doing a good job of holding CCGs to account. One example it provided is of Trevor, who told Coeliac UK that he has never received confirmation in writing that the policy had changed; he was informed only when Coeliac UK told him. He was diagnosed 10 years ago and has only ever had bread on prescription. He is unable to work and has ongoing medical problems. His nearest shop is a Co-op, which does not stock gluten-free products, and the nearest shop that does is some six miles away. That creates problems for people such as him.
The CCGs that have already removed access to prescriptions for gluten-free products have not outlined or implemented policies that offer alternatives to safeguard patients, such as access to specialist dietary or nutritional advice. When a coeliac patient is taken out of a CCG’s responsibility because their gluten-free food prescription has been withdrawn, that CCG can no longer monitor them or determine the changed policy’s impact on that patient’s health. This is an important factor, and I am concerned that it has not been taken into account by a number of CCGs.
In areas where gluten-free products are not prescribed, there is now no opportunity to encourage dietary adherence nor a prevention strategy for long-term management of people with coeliac disease. Effectively, patients who suffer the condition in these areas will be offered no support by the NHS. Although CCGs are engaged with local authorities and wellbeing boards to explore alternatives, none has yet been put in place.
The NHS has a good track record of involving the public in consultation, but the lack of consultation on the decision to withdraw prescriptions for gluten-free products is a disgrace, added to the fact that charities such as Coeliac UK are not consulted before such decisions are made.
Nic Dakin (Scunthorpe) (Lab)
I congratulate my hon. Friend on securing this debate. The point he is making is direct and correct. The nine-year-old daughter of my constituent, Helen Frost, has coeliac disease and Helen is worried that prescriptions for gluten-free products may be taken away. The uncertainty is adding stress to a situation that is already difficult to manage.
Mr Jones
That is not even taken into consideration, as my hon. Friend says.
My concern is that cutting prescriptions for gluten-free products is a simple and easy target for CCGs under financial pressure. The entire prescription cost to the NHS in 2014 was £26.8 million or 0.27% of the total prescription budget—£194 per patient. The procurement system that the NHS has in place is not working. The market for gluten-free products in the UK in 2014 was some £211 million, but the annual NHS budget was around £27 million or 13% of that total market. I do not know why the NHS cannot negotiate contracts with some commercial companies. Failure in procurement will clearly have an impact.
I turn to the issue of pharmacists. Back when we had primary care trusts, some pharmacy-led supply pilot schemes were set up in a handful of regions in England. When a patient was diagnosed with coeliac disease, the pharmacy-led scheme allowed patients to access gluten-free food and to manage their coeliac disease. However, with the establishment of CCGs, that seems to have gone out of the window—except in Scotland, which has a national gluten-free food service: a pharmacy-led scheme based on pilots in the UK.
Will the Minister seriously consider introducing such a scheme in England? It would save time and money and be a better way of managing people with coeliac disease. It is worth noting that the annual cost of gluten-free food is lower than the annual cost of items that the NHS provides that cost less over the counter—for example, paracetamol and so on. I beg the Minister to consider that, if properly done, what I suggest would save money.
I know the Minister has been in post for only a few months and I am sure he receives many demands for things to be provided by the NHS, but I am also sure his officials have briefed him on the principles of the NHS: that it is a comprehensive service available to all with access to NHS services based on clinical need, not individual ability to pay, and that it aspires to put patients at the heart of everything it does. This issue is about limiting choice because of cost.
In conclusion, the issue needs urgent intervention. It is not fair to individuals and there is a postcode lottery. A pharmacy-led system could be delivered better and more effectively. At the of the day, the people affected have no choice but to have a gluten-free diet. We should not ration care for some of the most vulnerable in our society.
Mental Health
Debate between Nicholas Dakin and Lord Beamish(11 years, 7 months ago)
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Mr Jones
My hon. Friend makes a good point. The starting point should be the medical history of those individuals. Someone at the Department for Work and Pensions has said that it is not possible to identify such individuals, but that is complete nonsense. The process my hon. Friend has just suggested should be the starting point.
Professor Harrington’s review of the process put forward the idea of mental function champions. The Government spun that idea out a bit, as though it was the big answer to the problem, and I actually fell for it at the beginning, thinking that those people would be the ones who would carry out the assessments. That was not the case, however; they are there to give advice to the Atos assessors. We still have assessors with no mental health qualifications.
Representatives of the charity Mental Health Matters, a good advocacy charity in the north-east, have just met Atos to ask about the champions, and a number of questions have been raised. Atos would not tell them how the champions were recruited, and there is no indication that they need any formal qualifications. I understand that they are given a two-day Atos in-service training course, but they do not interact with any of the royal colleges or other outside bodies. Remarkably, they are also not accountable to the DWP. I put it to the Minister that he needs to tell the DWP that this must be looked at again. The process is not only causing a lot of heartache and difficulty for many of our constituents; it is actually not a good use of public money. People are failing the tests and going to appeal. At least one of my constituents has been affected in that way. They sometimes go through the process and end up in a residential hospital for a month, which must cost more than the amount of benefit that might have been saved.
We also need tailor-made programmes for people with mental illness. We should consider a separate work stream that could include voluntary work, given that many people with mental illness find the transition back into work through voluntary work easier than being thrown straight back in. We also need a pool of employers who understand and are sympathetic towards people with mental illness. There is an idea that such people can just join the normal job market and that employers will just accept that they might not turn up for work for a day or a week because they are not feeling well, but that is not the case. Those people will not keep their jobs for very long.
Nic Dakin (Scunthorpe) (Lab)
I was at a recent meeting of the Mind support group in Scunthorpe, and I was concerned to hear people saying that they were anxious about taking on voluntary work because of the impact it could have on their benefits and their access to other services. Does my hon. Friend think that that issue needs to be looked at?
Mr Jones
Yes, it does. If there were a separate work stream for those individuals, of which the voluntary sector was a part, we could use the voluntary sector to get people back into the world of work. I agree with my hon. Friend, however, that they should not be penalised for doing so through loss of benefits.
I also want to talk about the old issue of the NHS reorganisation. It provides some great opportunities for doing things differently, and there should be an opportunity for local providers to bring in the third sector. I have one problem with that, however. I am president of the local Mind, which has just received a contract to provide certain services, and the process it has to go through is very difficult. I am not suggesting for a minute that such organisations should not be performance managed, because there are some large contracts involved, but we need an easier system for applying for the contracts. We also need to ensure that when bodies are competing for the contracts, people can access the services.
Another area of concern is the increased waiting lists for IAPT services. I know that the world has changed since 1 April, and people who lobby on behalf of mental health services are going to have to change their lobbying tactics. It is important to ensure that commissioning groups have an understanding of mental illness and of the importance of IAPT services.
If we look at the Royal College’s report, we find that people are going through the system saying they are quite happy when they get a diagnosis, but are then told they might have to wait up to a year for a talking therapy—that is just no good. What we need—again, this will save the NHS and the economy money—is a quick service such as the IAPT service. I know from people in my own constituency and others who have written to me that the wait is totally unacceptable. If we want to make this work, we have to make sure we have a joined-up service and that people who want a diagnosis get the support they need quickly. Otherwise, people will be stuck in this no man’s land between diagnosis and treatment.
Another area on which the new organisation needs to focus is local government. Local government now has an important role in health care through health education and protection. The Royal College of Psychiatrists is working with councils on a project to have champions at the local level. It is important for local councils to have councillors or chief officers who can champion the need for mental health services locally.
I welcome the debate. It is important to talk about these subjects, and the more we do, the better. To adopt an old BT phrase, “We need to talk”. If we talk about it—whether it be in schools, the workplace or here—we will erase the stigma of mental illness. That has to be the goal: mental illness being treated just like any other long-term condition. People should not be afraid of admitting to it and should not feel that they cannot be helped. We also need to recognise that in many cases—including, I have to say, my own—it can be strength rather than a weakness.
Local Government Finance Bill
Debate between Nicholas Dakin and Lord Beamish
Mr Jones
That is a very important point. That will limit the ability of my council in County Durham and my right hon. Friend’s authority to effect any change. That will lock in the unfair and disproportionate effects, which have been caused by no account having been taken of deprivation. We have just heard a Minister saying this Bill takes account of equality, but it must be the first Bill in history that supports a system by which the poorest in our society and those councils with the largest need—growing aged populations and increasing numbers of looked-after children, for example—will suffer the most.
Finance (No. 3) Bill
Debate between Nicholas Dakin and Lord Beamish(13 years, 7 months ago)
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Nic Dakin
I thank my hon. Friend for that intervention. She draws attention to the fact that people see banks closing and services becoming less available and more remote at the same time as large bonuses are being given out, with no apparent transparency and no clear criteria.
The Bill delivers a tax benefit for banks—a bonus for banks, rather than for UK plc—in the form of the £2.5 billion bank levy, which should be compared with the £3.5 billion bank bonus last year, and with £100 million being given back through cuts in corporation tax. At a time when the banks should be putting more in to atone for the situation we are in and to help the engine of the economy, the Government are allowing them to take more out. That does not seem fair to me, and it does not seem fair to the people I represent.
Mr Kevan Jones
Does my hon. Friend agree that it is an absolute disgrace not only that those involved directly in the big five banks are earning such bonuses, but that those who have earned a lot of money from the misery that has been caused over the past few years are also doing so, including those companies that offer advice, such as Goldman Sachs, whose average bonus is about £270,000 per individual?
Nic Dakin
My hon. Friend draws attention to another interesting area where we would wish the Government to apply their imagination and attention to try to get more money back for the taxpayer so that it can be invested in the economy, in public services and in growth, the engines that would drive us forward. This is a no-mandate Government. A year ago there was clearly no mandate for what they are doing. They are taking their approach to bankers’ bonuses even though there is a clear mandate from the population—one of the few that exists—for cracking on, getting on top of bankers’ bonuses and ensuring that they play their part in reinvigorating the British economy. Where there is a mandate, the Government fail to act and give a dividend to bankers instead of a tax. There is no mandate for the things the Government are doing, such as the NHS reorganisation.
Business of the House (Thursday)
Debate between Nicholas Dakin and Lord Beamish(14 years ago)
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Mr Jones
I do not want to intrude on the personal grief of the Liberal Democrat party. As with any other Member of the House, in the limited time available tomorrow, Liberal Democrats can try to catch the Speaker’s eye to make their points. I am sure that those who signed the pledge during the election but will vote in favour of the increase tomorrow will want to come to the House to explain why they have changed their minds. It is entirely open to individuals to do that.
Nic Dakin
I calculate that we have had about two and a half hours of debate, in which only three people have spoken, on an issue that might seem unimportant to people outside—whereas tomorrow we will have only twice as much time as that to debate something of great importance. I think that tells the story.