Accident and Emergency Departments
Nick de Bois Excerpts(11 years, 5 months ago)
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Nick de Bois (Enfield North) (Con)
I am not sure I can keep up with the pace of the hon. Member for Lewisham West and Penge (Jim Dowd), but I am delighted to follow him and I have some sympathy with one of his points. I felt compelled to write to the NHS medical director, Sir Bruce Keogh, having seen his comments about the role of politicians.
Nick de Bois
It is true. As my hon. Friend says from a sedentary position, the Evening Standard claimed, “Nick de Bois 2, Sir Bruce Keogh 1”, so I hope I wrote on behalf of all Members. The medical profession is at the root of this issue. If it wants to win arguments based on evidence, so be it, it can win those arguments against politicians, but it also has to win the hearts and minds of the people it serves. That is why we should not be taking lectures on the role of MPs and democrats.
I would like, unapologetically, to talk about my hospital, which has been introduced briefly by my neighbour, the hon. Member for Edmonton (Mr Love). As a hospital facing threats of change—not all good by any means—Chase Farm hospital must predate almost every Member present in the Chamber, perhaps with the exception of the hon. Member for Islington North (Jeremy Corbyn). Going back to the early 1990s, it was promised the proceeds from the disposal of the Highlands hospital. As my hon. Friend the Member for Newark (Patrick Mercer) said, the story I am telling crosses more than one Government, so I will try to tell it in a non-partisan way because my interest is in getting the best for my constituents.
After my constituents were let down by the promise of investment from the sale of Highlands hospital—now a pleasant residential area—no money was forthcoming, and in 1999 an administrative merger between Barnet and Chase Farm hospitals was proposed, which we were assured would lead to no clinical changes and have advantages. The effect of the merger was that the healthy balance sheet of Chase Farm was sucked dry to support a hospital that was bleeding payments—the hon. Member for Lewisham West and Penge may identify with that. Again, my constituents were let down.
Just before May 2005 we were told that we would have £80 million investment in our district general hospital. Sadly, that investment did not materialise, and shortly afterwards, in 2006, a programme of downgrade—reconfiguration, as it is known—was started, particularly in our maternity and A and E units. That was confirmed in 2008, but judicial review by the local council held it up. Hopes were just beginning to rise, and with the change of Government those hopes were raised again from the moratorium. I have said this before on the Floor of the House but I will repeat it for the avoidance of doubt: my constituents were utterly let down by the Secretary of State when we were again downgraded.
Hon. Members will therefore understand why my constituents—I am sure this resonates with hon. Members on both sides of the House and their constituents—and the public the acute hospitals serve are so sceptical when they are on the receiving end of advice and recommendations. It is a question of trust and transparency.
Like every hon. Member, I understand the full implications of the strategic drive for, and some of the benefits of, centralisation. However, I oppose the reconfiguration because of the inconsistency in what we have been told. There has been a clinical case for change, and a clinical and safety case for change, and yet in 2011, the Care Quality Commission said that Chase Farm hospital was running up to standards.
At that point, the PFI situation emerged. The PFI deal sealed for North Middlesex hospital—a neighbouring hospital in the south of the constituency—meant an investment of £129 million over 31 years, meaning a total repayment of £640 million. That £2 million a month comes off the operational budget. On 22 November, the then Secretary of State was quoted in the very reliable Daily Mail as saying that the recent downgrade was partly because of unsustainable PFI debt.
One reason often cited for the proposed downgrade of my hospital is that GPs support it. Three hospitals—Barnet, North Middlesex and Chase Farm—were part of the downgrade plan, and GPs from Haringey, Barnet and Enfield were asked about the proposals. The vote was organised like a communist meeting. If we ask people in Haringey or Barnet whether they have a problem with the downgrade in Chase Farm, I suspect they will say no if it benefits their hospital. The figures show that only 44% of Enfield GPs approved, but of 129 GPs asked, only 48 responded, so only a positive 16% recorded their support. I hope the Minister asks her officials to reflect on that point.
I oppose the reconfiguration but recognise that I need to fight for the best possible deal for Enfield. It is therefore important to examine the so-called pre-conditions of implementation of the strategy that we were promised —we were guaranteed that they would be put in place.
Mr Burrowes
I commend my hon. Friend for his continuous efforts, although perhaps he should take his seat since he has given way.
Mr Burrowes
My hon. Friend has continuously stood up, not just in the House but in his constituency, against the closure of the A and E in Chase Farm and for securing health improvement in Enfield. He has secured a cross-party delegation meeting with the Secretary of State, at which we want an assurance that the £10.6 million being invested in primary care in Enfield ensures we get effective primary care improvements before the reconfiguration.
Nick de Bois
That goes back to my point—it is a question of trust. It is vital that that promise is delivered, but it is already some four years since the change was envisaged, and very little has been put in. It is therefore right that we press the case for implementation and delivery on the ground if the strategic review goes ahead.
I welcome the opportunity to meet the Secretary of State—I hasten to add that a cross-party delegation will meet him—but I have some questions to put to the Minister on the Floor of the House. Is she aware of the growing health inequalities in the borough, which have increased since the original 2008 assessment? According to the latest census, the population is far removed from the original assessment—there are 40,000 more people.
Angie Bray (Ealing Central and Acton) (Con)
I am listening carefully to my hon. Friend’s remarks. Does he feel at this stage that he is pushing at an open door or a closed door?
Nick de Bois
I am sitting next to my hon. Friend, who shares a great interest in this subject, and I think she has been reading my notes. With a new Secretary of State and with such interest across the country, Chase Farm does not feel as if it is alone any more. There is a momentum and an opportunity to examine new issues, so I hope I am pushing at an open door. On cost and on how we treat patients, we need to be bold and innovative. For example, we should be examining the impact of telehealth care on our acute centres. Such things will drive not just costs, but better health care. Can they have an impact on whether we retain more services at our acute centre in A and E, while more people are being treated in the primary sector?
I think that my constituents look at the Lewisham solution almost with envy. We should be able to at least guarantee to our constituents—[Interruption.] Bear with me here. As a minimum in Enfield, we would like to see 24/7 access to a doctor because the proposal for our urgent care centre is 12 hours. I think people need that comfort. I am not playing politics with Lewisham and I am not saying that the situation there is satisfactory—the hon. Member for Lewisham East (Heidi Alexander) knows well my position on that. However, I am saying how we look at it from Enfield. I hope the Minister will consider innovative ways, looking for providers be they from clinical commissioning groups or with direction from the centre, in which we can offer 24/7 doctor-led care to my constituents after years and years of frustration.
Mike Gapes (Ilford South) (Lab/Co-op)
It is a pleasure to follow the hon. Member for Enfield North (Nick de Bois). He and I have something in common. He said that he had been let down by the Secretary of State after 2010. Sadly, I have to say that my constituents and I, and my neighbour, the hon. Member for Ilford North (Mr Scott)—unfortunately, he cannot be here today, but he asked me to mention the fact that he has been in Committee—also felt let down because of a decision that was taken. Eight Members of Parliament from north-east London campaigned together on a cross-party basis to save the A and E at King George hospital, yet in 2011 the Government announced that, after the previous decision, they were going to go ahead with a recommendation to close the A and E and the maternity unit at King George hospital in Ilford. There will be no more births there at the end of March. We will no longer have children born in Ilford, unless they are born in the back of taxis or cars that are trying to get through traffic jams to take them to Queen’s hospital Romford. However, I want to concentrate on the A and E.
This afternoon, a risk summit is being held between Barking, Havering and Redbridge University Hospitals NHS Trust and the commissioners to consider the implications of the absolutely damning Care Quality Commission inspection, one of a series of inspections of Queen’s hospital, which was published on 30 January, which is last Wednesday. Among other things, the report stated:
“The accident and emergency department…has not met most of the national quality indicators as a result of extensive delays in the care of patients. Five percent of patients who need to be admitted to the hospital are waiting for more than 11 hours in the department. The Trust should be aiming to transfer 95% of patients who are being admitted to wards within four hours of their arrival.”
Many patients are waiting much longer than four hours, and 5% are waiting for more than 11 hours. That was from an inspection in December. The report also says that there is
“poor care for patients in the ‘Majors’ area”
and that the
“environment is unsuitable for patients to be nursed in for long periods of time,”
because of a
“lack of privacy/dignity, no washing facilities, no storage space for personal belongings and no bedside tables.”
I could go on—there are complaints about other A and E services and facilities at Queen’s hospital.
Queen’s is a new, PFI-built hospital that was designed for 90,000 admissions. Last year it had 132,000, as my right hon. Friend the Member for Barking (Margaret Hodge) mentioned in an intervention. It is in a joint trust with the King George hospital in Ilford, which has fewer admissions, but there was a proposal—the then Secretary of State and his Health Minister said this was the intention—to close the A and E at King George hospital in about two years from October 2011. Patients would then have had to go to the A and E at the already over-pressed and stressed Queen’s hospital. Frankly, that policy was always insane and foolish. We fought against the first such proposals in 2006—the misnamed “Fit for the Future” proposals—right the way through, in cross-party unity with neighbouring MPs, under the last Government. We managed to get implementation halted for reconsideration and review, but sadly this Government have given the go-ahead to closure of the King George A and E unit.
Nick de Bois
I hope the hon. Gentleman will benefit from the time he gains by giving way to me. He is right about the documents—as he will recall, we had “Healthy hospitals”, which was the last thing being sought. Let me remind him that we have another thing in common: the merry-go-round of chief executives, from my former chief executive to his hospital’s chief executive. It worries me that the administrators are in control, not the people or the politicians.
Mike Gapes
I do not personally blame Averil Dongworth, the new chief executive at Barking, Havering and Redbridge University Hospitals NHS Trust, for the current situation. She has not been there long enough. There are a number of predecessors who were party to the proposal. I also blame Ruth Carnall and the people in NHS London who were behind the original proposals. They and Heather Mullin, along with others in the NHS in London, have been determined for six or seven years to close the A and E unit at King George regardless of the petitions, the protests or the fact that the public overwhelmingly rejected their proposal, even in their rigged consultation.
Mr Thomas
There certainly seems to be little obvious sign of any bare-knuckle fighting on the Prime Minister’s part to stop the closure of Lewisham A and E or, indeed, the other eight departments set for closure in London.
I want to concentrate the rest of my speech on the plans at North West London Hospitals NHS Trust. As the hon. Member for Ealing Central and Acton said, there are plans to shut Ealing, Charing Cross, Hammersmith—it is good to see my hon. Friend the Member for Hammersmith (Mr Slaughter) here—and Central Middlesex A and E departments. My constituency is served by Northwick Park hospital A and E department, and my constituents are worried about the pressure that the closure of the four other A and E departments in the area will put on Northwick Park when all the extra people turn up there needing treatment.
Clinical teams at the north-west London trust have noted that the strategy behind the proposed closure of the four A and E departments assumes that thousands of people can be persuaded not to go to A and E but instead to use their GPs and other community services. I am a little sceptical about the idea that that will work, not least because the numbers using Northwick Park A and E are already significantly greater than before the 2010 election.
One element of the strategy, to prevent the possibility of patients who shift to Northwick Park not getting the services they need, is, as I said, to use community services. The decision to downgrade the Alexandra Avenue polyclinic, a walk-in service open 8 am to 8 pm, 365 days a year in the south Harrow part of my constituency, to just Saturday and Sunday opening, 9 am to 3 pm, has led to greater use of Northwick Park hospital A and E, as a number of doctors have said. So the decision to close that polyclinic, supported, incidentally, by the Conservative party in Harrow, seems particularly surprising, given the appetite for community services to solve the problem of lots of people potentially going to Northwick Park A and E.
Nick de Bois
To put this in context, it is clear, having read Hansard, that both this Government and the previous Government supported reconfiguration on the basis of more people being served in the community, and that is probably not a bad thing. However, it is not just a question of having the infrastructure, the buildings and the clinical staff, but of imploring people to make a cultural change. One cannot do that easily and quickly, particularly between generations. So although both this and the previous Government agree that reconfiguration is important, my concern is that they have not taken the people with them.
Mr Thomas
On that very specific point, I agree with the hon. Gentleman. What feels different about the context in which we are having this debate is the sheer number of A and E departments whose closure is envisaged.
If the hon. Gentleman and others will forgive me, I will return to the issue of Alexandra Avenue polyclinic and how it helped to divert people from using the A and E department at Northwick Park. I urge the new Harrow clinical commissioning group to reopen Alexandra Avenue as a proper walk-in service, or to find an alternative site for such a facility in order to reduce the pressure on Northwick Park. The last figures that I saw showed that in fewer than 12 months, from April 2011 to February 2012, the number of people waiting more than four hours at Northwick Park and Central Middlesex hospitals’ A and E departments had risen to more than 9,000. A total of 9,137 people in that 10-month period had waited more than four hours for treatment. What is far from clear is whether there is a clear clinical strategy across London that has the confidence of doctors and of the public—that point was raised by the hon. Member for Enfield North (Nick de Bois)—to really drive down the pressure on A and E departments in the future.
Already, too many people in London have had to wait in ambulances for longer than 30 minutes; that happened to 42,248 people in 2011-12, a rise of almost 50% on the previous year. Some 10,000 people had to wait more than 45 minutes to get into the A and E departments across London; they were sitting in the ambulance waiting. As my hon. Friend the Member for Mitcham and Morden (Siobhain McDonagh) said, the UK Statistics Authority has pointed out that the Prime Minister has broken his promise to protect NHS spending. It is clear that the NHS in London is under unprecedented pressure, because of the Conservative party’s squeeze on NHS funding. A Prime Minister who once promised to stop A and E closures is allowing nine to go ahead across London. Once again, that old adage is being proved true, “Same old Conservatives. You can’t trust the Tories with the NHS.”
South London Healthcare NHS Trust
Nick de Bois Excerpts(11 years, 5 months ago)
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Mr Hunt
First, let me say to the hon. Gentleman that this is a reconfiguration. However, the normal processes for reconfigurations have been suspended because of legislation that was passed by the Government who were in power until 2010 and whom he supported.
The trust special administrator, Matthew Kershaw, looked extensively at whether there was an option within South London Healthcare NHS Trust to solve the problem. He invited expressions of interest from other people who might run the hospitals in the group, but nobody was able to come forward with a proposal that would solve the problem within the geographical confines of the trust. Indeed, nobody—not the Labour party, nor any of the people who oppose these changes—has come forward with a proposal that would not impact on neighbouring health care economies.
The hon. Gentleman spoke about choice. Choice is not just about the number of hospitals that one could go to, but about the number of good hospitals that one could go to. Nowhere in south London currently meets the London-wide clinical quality standards. As a result of my decision today, the whole of south-east London will meet those standards and it will have some of the highest quality care in London for people who use A and E and maternity services.
On the cost of the process, £5.5 million is the cost of failure—the total failure of the last Government to address this issue when they could have done, rather than bequeath the highest deficit anywhere in the NHS.
Nick de Bois (Enfield North) (Con)
The Secretary of State recognises that Lewisham is the victim of an unfair decision as a result of failed PFI and failed finance, which were not of his making. He will recognise the striking similarities with Chase Farm hospital, which has also been downgraded because of the appalling PFI arrangements at neighbouring hospitals. He knows that I utterly oppose that decision. Given the present concerns, particularly with regard to implementation, will he meet me and a cross-party delegation to look closely at these matters?
Mr Hunt
I recognise how hard my hon. Friend has campaigned on behalf of his constituents and how deeply they feel about these issues. He knows that the decision has been made. We want to get the safe implementation of that decision absolutely right and I would be more than happy to meet him to discuss how we can best ensure that that happens.
Dementia
Nick de Bois Excerpts(11 years, 6 months ago)
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Hazel Blears
The hon. Gentleman is absolutely right. In fact, the recent all-party group inquiry into diagnosis revealed exactly that situation, which is a real concern. Many GPs are uncomfortable about making a diagnosis of dementia. They sometimes feel that such a diagnosis is pointless if the necessary drug treatments or wraparound care and support services are not available. Increasing the confidence of GPs at that point to enable them to make a diagnosis is of fundamental importance.
The figures on diagnosis are quite stunning. Only half the GPs questioned said that they had sufficient training in this area, and a third of them believed that a lack of access to drug treatments was a barrier to early diagnosis. Almost a third were not confident about making a diagnosis of dementia, and only a third felt that they had had enough training to go through the diagnosis process. Unless we tackle that, we will not get the increase in diagnosis that the Prime Minister and all of us want.
Nick de Bois (Enfield North) (Con)
I have listened carefully to what the right hon. Lady has said. She mentioned that Belfast had a high rate of diagnosis, at 70%. The figure in my constituency is around 36%. During her inquiry, was there any attempt to establish why best practice or prevailing factors could not be transferred and learned across the spectrum, in order to improve the situation?
Hazel Blears
Yes, there was. The all-party group had an interesting presentation from the Scottish Health Department. Diagnosis rates in Scotland are very high indeed, and we learned that the highly organised, managed and focused system there was driving up diagnosis. It is driven, to some extent, from the centre, and I know that that is not always popular these days, but the drive from the centre out to the GPs is really making a difference. I think that there is room for us to adopt a more driven process—it need not necessarily be more centralised—in which GPs are more accountable and in which they report back on rates of diagnosis. There is much more that we can do in that regard.
Diagnosis is a problem, but once a diagnosis has been made, the availability of support in the community becomes relevant. There are many problems in that area. Our inquiry revealed that many carers felt that nothing happened after the diagnosis, because there was no help or support available. In my area in Salford, we are lucky. We have one of the 10 national demonstration projects established under the national dementia strategy in 2009, and we are developing some really innovative services in the community. I should perhaps declare an interest: my mum attends the centre two days a week, and I sit on the strategic board that drives the process there. I have seen that when people are really committed to such projects, they can make a huge difference.
Our centre is the result of a partnership between the local authority and the Humphrey Booth charity, which has existed in Salford since the year 1600. It is a marvellous example of people working together. The centre is known as the Poppy centre, and its facilities include a dementia singing group, on a Wednesday, which attracts 150 people. That is an incredible resource. The centre also offers day centre services, art work, music, personal tailored care, a dementia café for when friends and family drop in, living history, hairdressing and hand massage. It is a wonderful place, staffed by brilliant people.
NHS Funding
Nick de Bois Excerpts(11 years, 7 months ago)
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Heidi Alexander (Lewisham East) (Lab)
It is a pleasure to follow the measured and thoughtful speech that the hon. Member for Stevenage (Stephen McPartland) has just given. May I also put on the record my tribute to my right hon. Friend the Member for Cynon Valley (Ann Clwyd) and the vital work she is doing, at what must be an incredibly difficult time for her, on putting the importance of care and compassion back at the heart of our NHS?
I wish to focus on the current threats to NHS services in south-east London. My right hon. Friend the Member for Lewisham, Deptford (Dame Joan Ruddock) has already spoken about the threats to Lewisham hospital and the plans on the table, and I am going to treat the House to my own concerns about that matter. We are rightly debating national expenditure levels on the NHS today, but the harsh reality in Lewisham is that my constituents are confronted with the fact that their local accident and emergency and maternity departments may have to close in order to deal with financial pressures elsewhere in the NHS.
The Government can claim all they like that they are investing in the health service, but it does not feel that way in Lewisham. Last Friday, along with local doctors, my right hon. Friend the Member for Lewisham, Deptford and my hon. Friend the Member for Lewisham West and Penge (Jim Dowd), I presented a petition against the closure of Lewisham’s A and E and maternity departments to No. 10 Downing street. As has been said already, in five weeks the petition has been signed by more than 32,000 people. The proposed changes at Lewisham hospital are not only unwanted, but arguably unsafe and unjustified.
Lewisham is a busy hospital. More than 120,000 people visit the A and E each year and last year more than 4,000 babies were born there. Lewisham is a place where average life expectancies for both men and women are below national averages. Sadly, it is a place where sometimes, admittedly infrequently, a stab victim will walk into the A and E from the streets and a place where many teenage girls will give birth to their babies.
The A and E and maternity departments at Lewisham hospital are a matter of life and death for many of my constituents. I am therefore not surprised that more than 32,000 people signed the petition to keep a full A and E and full maternity service there; I am also not surprised that more than 100 local GPs, including the chair of the new clinical commissioning group and the head of every single clinical group at the hospital, have written to the Prime Minister to express their concern about the proposals.
The question for the Minister today is: will the Government listen? Will the special administrator to the South London Healthcare NHS Trust, a man appointed to sort out financial problems in neighbouring hospitals, think again about his plans for Lewisham when he draws up his final recommendations to the Secretary of State for Health?
I do not think that anyone can be under any illusion about the degree of local opposition to closing the A and E and maternity departments at Lewisham. I recognise that trying to balance the books at the South London Healthcare NHS Trust is a hard job, but asking a hospital that is not even part of the trust to pay such a heavy price seems patently unfair.
The plans for Lewisham are based on inaccurate data and flawed assumptions. The size and nature of the caseload at Lewisham’s A and E have been misunderstood. The estimated additional journey times to neighbouring hospitals have been woefully underestimated, yet the speed with which it will be possible to reduce the need for hospital care seems to be hopelessly optimistic and based more on wishful thinking than on hard fact.
Those are not the only problems with the proposals. I also cannot see how the current plans make financial sense. In the past week, we have had—even though the Government dispute this—independent verification that there has been a real terms reduction in spending on the NHS in the past few years. Surely it then becomes all the more important that every pound spent is spent wisely and well. How can it be wise to sell off more than half the Lewisham site for £17 million only to have to reinvest £55 million in reconfiguring the remaining buildings on that site to do different types of work? Why sell off the existing buildings, only to shell out money at other hospitals to increase capacity to enable other parts of the NHS to do the work that Lewisham is already doing very well?
The 4,000 babies who are born to Lewisham mothers every year will have to be born somewhere. Where? There is no free capacity in the system at the moment, so that will require investment. Where are the people who use Lewisham’s A and E going to go? We have all seen the reports of more and more ambulances queuing outside hospitals, with patients waiting to be taken into A and E but being kept in the ambulance because of a lack of space.
It is asserted that in Lewisham, if the proposal to close the A and E went ahead, only one in four people would have to go to other A and Es, while the other 77% would still be treated in the urgent care centre that would remain. That figure is fanciful. The emergency doctors at the hospital say to me, based on their analysis of patient numbers and the nature of the work that they do, that just 30% of people could still be treated at the urgent care centre.
I accept that the NHS cannot be preserved in aspic and I understand that it must change to meet the demands and challenges of the 21st century. However, those changes must be driven by patients’ health needs, not an accountant’s bottom line. That is not what is happening.
Nick de Bois (Enfield North) (Con)
The hon. Lady may be aware that we have had a long fight against the downgrading of my hospital, Chase Farm. Many people think that that fight is over, but I do not. With the new demographic figures and population increases in London, it is important that we continue to press authorities and Ministers to take these things into account, even at this late stage, because where people go is even more of a priority than she assessed it was before the figures came out.
Heidi Alexander
The hon. Gentleman is completely right. Lewisham’s population is growing, and has increased by 10% in the past 10 years. All the indicators suggest that London’s population will continue to grow. It is a diverse population with varied health needs, so it is imperative that people in our capital city can access high-quality services close to home.
In conclusion, before the election, the Prime Minister told us that he would cut the deficit and not the NHS. In 2007, he promised a bare-knuckle fight over the future of services at Lewisham hospital. How times have changed. He has broken his promises on NHS spending and he has broken his promises about Lewisham hospital. If anyone needs proof that the Government cannot to be trusted with the NHS, they need look no further.
Oral Answers to Questions
Nick de Bois Excerpts(11 years, 9 months ago)
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Mr Jeremy Hunt
I should like to reassure the right hon. Gentleman that I take a close personal interest in all reconfigurations because they tend to end up on my desk. In this case, I encourage him to take part in the consultation for Trafford general, which will go on until the end of the month, but I remind him that the Government have put in place four important tests for any major reconfiguration. We must be satisfied that those tests are passed before we approve any reconfiguration, and those include the support of local doctors.
Nick de Bois (Enfield North) (Con)
T6. As breast cancer action month comes to an end, recent research by Breast Cancer Campaign has shown that 76% of women would like more information about breast cancer signs and symptoms. What steps are the Government taking to encourage early diagnosis of breast cancer?
Anna Soubry
Achieving early diagnosis of symptomatic cancer is key to our ambition to save an additional 5,000 lives a year by 2014-15. As I explained in an earlier answer, we are providing more than £450 million in funding over the spending review period to support early diagnosis. From January to mid March 2013, we will be running a regional pilot of our previously tested local campaign on breast cancer symptoms in women over 70. We are targeting those women because that is an area where, unfortunately, survival rates are particularly poor.
Pseudoxanthoma Elasticum
Nick de Bois Excerpts(11 years, 9 months ago)
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Nick de Bois (Enfield North) (Con)
I am grateful for this opportunity to debate pseudoxanthoma elasticum, which is a hereditary disorder that can lead to the normal elastic fibres of the skin, eyes and cardiovascular system gradually becoming calcified, causing characteristic symptoms. I welcome the Minister to the Dispatch Box with his new responsibilities, and am grateful that my hon. Friend the Member for Burton (Andrew Griffiths), who also has an interest in this matter, has joined me in this important debate.
It is estimated that about one in 25,000 people in the world have PXE. That could mean that up to 2,500 people in the UK have the condition. Clearly, it is a rare condition, but it is potentially devastating, because approximately 60% of PXE sufferers will develop eye problems, and many experience the loss of central vision. Therefore, 1,300 people may go blind—it generally happens from their 40s onwards, but we know that it can happen to people as young as 9 years old, because any injury to the head can lead to the onset of a bleed in the eye, resulting in the sudden loss of central vision.
I should take this opportunity to thank Elspeth Lax who runs the PXE support group which has championed many individual cases in the UK, where there is a frustrating lack of knowledge among the wider medical community, including among cardiologists, ophthalmologists and general practitioners. The level of knowledge is hit and miss.
Although there is a knowledge vacuum, it is far smaller than it was 30 years ago, when Mrs Lax was told, on diagnosis, that she would go blind, and that she should give up work and not have any children. To date, her support group has looked after 567 patients in the UK, the youngest of whom was born with skin markings in six places. That is rare, but, as I said, my concern is that PXE patients can go on to lose their central vision at any time.
I am also grateful to PXE International. Its Facebook page has allowed me to engage with UK citizens and others from around the world, and to contrast UK health care management with that of other countries. PXE sufferers affectionately call themselves “PiXiEs”—the community name is used among sufferers, indicating their good humour and stoicism as they explore and expand their knowledge. It might interest the House to know that, such is the following created since the announcement of the debate, we are being watched in America over the internet.
The debate was prompted by the case this summer of Dawn Thomas, the wife of Lance Corporal Thomas, a constituent of my hon. Friend the Member for Burton, who will speak later in the debate. She was initially denied funding for anti-vascular endothelial growth factor medications, which are otherwise and forthwith called anti-VEGFs, which slow sight loss by stopping blood vessels that inhibit sight forming or growing. The primary care trust eventually conceded on funding the treatment, but my hon. Friend will deal with that later.
My interest was spurred because, as the Minister well knows, I have a continuing and long-standing interest in matters health, as evidenced by my support for health reform, and I am currently co-chair of the all-party parliamentary group on primary care and public health. I should also remind the House that my wife was diagnosed with the condition at age 7, although she is fortunately not seeking treatment for sight deterioration. I appreciate the opportunity to put that on the record.
I intend to focus entirely on the deteriorating loss of central vision, not the complications arising from calcification, which include loss of skin elasticity and gastro bleeds. To do that, I shall highlight to the Minister four key points. First, notwithstanding what I have said, all PXE patients lead a normal, active and long life, if their sight is not compromised. No shortening of lifespan is attributed to PXE. Secondly, the treatment for the sight deterioration, which is similar but not identical to wet macular degeneration, can be treated by Avastin and Lucentis, as the drugs are known in this country. This treatment significantly enhances patients’ quality of life by preserving their sight, but, as he knows, Avastin is sometimes used “off licence” by primary care trusts—though I do not wish to go into that matter now. Treatment involves periodic injections into the eye and requires regular check-ups to detect any deterioration. It is not possible to predict the number of treatments a patient will need, but, according to the National Institute for Health and Clinical Excellence, the recommended cost of Lucentis is just short of £800 per treatment.
Thirdly, I and PXE patients believe that there is both a humane and an economic case for ensuring that Avastin and Lucentis are available on the NHS for PXE patients and—crucially—on a timely and pre-authorised basis. That would avoid greater cost to the state, if a person loses their sight. Fourthly, time is critical in getting treatment to prevent sight deterioration. Overall, my point is that, unfortunately, both the NHS process and the lack of information and awareness within the medical community put sight-saving treatment at risk. The condition is not widely understood. As a result, urgent treatment is often not delivered in a timely manner.
The Government have a crucial role in overcoming that problem by ensuring that all PXE patients are looked after, and given tests and treatment promptly. The benefit would be not only sight-saving treatment for patients but a longer-term economic saving to the NHS and wider economic value, because patients could continue to work and enjoy a full life. Currently, the patient pathway works against this goal. It might take a week or longer to see a general practitioner, then a letter has to be sent to a consultant, after which it might take between four and eight weeks to get an appointment. That might mean the loss of critical time.
After that, more time might be lost, if the PCT does not agree to fund Lucentis. Why? Even though it is used for eye injections to treat WMD, NICE has not approved Lucentis for PXE—it was not even considered as part of the appraisal. We therefore have this bizarre situation: there could be two people at the same hospital and requiring the same treatment, one with WMD and the other with PXE. The first could get the drugs without any special application to the PCT, while the patient with PXE, which is one of the rarest diseases I have come across, could not, simply because it was not licensed at the time. Soon, following the changes to commissioning, clinical commissioning groups will be making these decisions locally—a dangerously slow process—which is absurd, given that the drug has been authorised for age-related WMD.
Although many of the victims of this condition are in danger of losing their sight, most likely over the age of 40, in reality a blow to the head can cause a bleed, leading to loss of vision, quite possibly within days. Fast treatment is essential, and, because a blow to the head is often not the result of an emergency incident, gaining treatment at an early stage is unlikely. Sometimes it is only with the help of active support groups that people avoid losing their sight.
There is an important distinction between age-related wet macular degeneration and PXE, because although PXE can also strike at a young age, it is a genetic condition, not a degenerative condition. That is why it has been identified as a rare condition that we can treat. Patients therefore can and should be able to continue to lead long and productive lives, because not only is it the duty of the publicly funded NHS to provide such treatment, but it makes economic sense. The Royal National Institute of Blind People, for example, estimates that the annual cost to the public purse of supporting a person with loss of vision is somewhere in the region of £14,500. According to a 2009 report commissioned by the RNIB via Access Economics, that excludes the cost of informal care, which is often provided by family members and friends, as one would anticipate.
My message and my request for the Minister in this debate is this. Support for the case for anti-VEGFs being additionally licensed for PXE is crucial, and I do not believe it will be expensive. That is something that, I hope with the support of the Government, we may be able to pursue, so that we can avoid any frankly critical time being lost should a PCT or future CCG not understand or wish to authorise that. It is equally crucial that there should be support for greater awareness of PXE in the NHS among clinicians, as well as CCGs and their support groups, so that they understand the need for urgent treatment. It is perfectly understandable why a disease that, at best, will affect 2,500 people is not widely understood or at the top of the agenda. However, given the narrative that the House has just heard, I hope that what are proven drugs—which can so easily mitigate the potentially life-changing outcomes of this rare disease—can be made available on an on-demand basis.
The Minister of State, Department of Health (Norman Lamb)
I congratulate my hon. Friend the Member for Enfield North (Nick de Bois) on securing the debate. He told the House that his wife had been diagnosed with PXE, and I am sure that this is a matter of great personal concern to him. I am grateful to him for engaging with me and the Department before the debate. I am keen to ensure that we maintain a continuing discussion on this matter. We cannot answer all the questions in the debate today, and we cannot change the whole system or the way in which the NHS operates, but let us discuss the genuine problem that has been highlighted today.
I should also like to acknowledge the contribution from my hon. Friend the Member for Burton (Andrew Griffiths), who spoke movingly about his constituent’s situation. He drew our attention to the fact that, while losing one’s sight is a critical matter for an individual, the cost to society and to the Government demonstrates powerfully the case for treatment in those circumstances. I also want to pay tribute to Elspeth Lax for her tireless work. We owe people like her, and the support groups that offer support to hundreds of patients with many different conditions, an enormous debt of gratitude.
I completely take on board the importance of fast access to treatment. It is critical. Indeed, the NHS constitution makes the point that citizens have a right to a speedy decision, without delay. People need to exercise their rights under the constitution in cases such as these.
Nick de Bois
It is worth highlighting that, because of the shortcomings, many people suffering from this condition have resorted to paying for their drugs themselves privately, such is the urgency of their situation.
Norman Lamb
I completely understand that. The debate has focused on the effects of the condition on the eye, and these matters are of considerable concern to people with PXE.
There are no licensed eye treatments for PXE. People with PXE should be advised on healthy lifestyle measures, such as stopping smoking, adopting a healthy diet and taking physical exercise, to reduce the risk of complications. They should also be monitored regularly by a health care professional. As it is a genetic condition, patients who are considering having children should receive genetic counselling, and first-degree relatives should be screened. Because of the similarities between age-related macular degeneration and PXE in the eye, some clinicians may consider using treatments that are effective in AMD, including laser treatment and the drugs Avastin and Lucentis, which have already been mentioned. My understanding, however, is that PXE has a different cause and a different process, and patients with PXE might not respond to those treatments in exactly the same way.
Lucentis is considered by some clinicians to be effective in treating people whose eyes have been affected by PXE. I have also mentioned Avastin, but neither Lucentis nor Avastin are licensed by their manufacturer for use in the treatment of patients with PXE. The National Institute for Health and Clinical Excellence has appraised or is currently appraising the use of Lucentis in the treatment of other eye conditions such as wet age-related macular degeneration and other conditions—diabetic macular oedema and retinal vein occlusion, for example—but Lucentis is currently recommended in NICE technology appraisal guidance only as a treatment for wet AMD, subject to certain criteria.
Clinicians may prescribe any treatment, including an unlicensed treatment or a product not licensed for a particular condition, where they consider it to be the best available medicine to meet the clinical needs of their patients—it is for the judgment of the clinician—subject to their primary care organisation agreeing to fund the treatment. Primary care organisations, too, are legally obliged to provide funding so that treatments that have been positively appraised by NICE are available on the NHS. In the absence of relevant NICE guidance, these primary care organisations are responsible for making funding decisions based on an assessment of available evidence and on the basis of an individual patient’s circumstances.
Where a decision is taken not to fund a treatment, primary care organisations must have a process to allow for the possibility that an individual may have exceptional circumstances—I absolutely take the point that loss of sight needs to be taken very seriously into consideration—which justify access to treatment that is not available to the rest of the population. If doctors feel that there are exceptional clinical circumstances, they can request treatments that are not usually funded on behalf of their patients through an individual funding request. I recognise, as I have said, that time can be of the essence in these cases. In this situation, a special panel that includes clinicians would carefully consider individual cases against the latest medical evidence and decide whether the treatment could be approved.
Under the NHS constitution, patients have the right to expect local decisions about the funding of medicines and treatments to be made rationally and without delay following a proper consideration of the evidence. If new evidence arises to support the use of a treatment or if an individual’s clinical circumstances change, a new individual funding request can be made. To help organisations make these difficult decisions, the Department has issued a set of core principles, and primary care organisations are required to have in place clear and transparent arrangements for local decision making on funding of drugs and for considering exceptional funding requests.
I shall deal now with the general issue of the commissioning of services for people with rare conditions. This Government are committed to providing the best quality of care for people with rare conditions. When we took office in 2010, we endorsed the right in the NHS constitution that says no one should be left behind just because of the rarity of their condition. Lack of awareness is, of course, often a real problem. The importance we attach to services for people with rare conditions has been clearly demonstrated in the reforms set out in the Health and Social Care Act 2012, which my hon. Friend the Member for Enfield North was active in supporting during its passage through Parliament. As a result, specialised and highly specialised services, which are currently commissioned at both a national and regional level through a range of NHS organisations, will be brought together under one roof. From April 2013, the new NHS Commissioning Board will directly commission services for people with rare diseases on a national basis. The board will have a clear focus on specialised services organised around programmes of care. These new arrangements for the commissioning of specialised services provide a unique opportunity to do things more effectively and smarter than in the past, and will bring real benefits to patients with rare conditions, including to patients with PXE.
Moving to a national standard system of commissioning while maintaining a local focus managed through the board’s four regions and the local area teams will provide the geographic and speciality oversight that is needed for these services. The commissioning board will set out a detailed service specification for each of the services that it will commission directly. That will link national service knowledge and expertise with local contract knowledge of providers and pathways of care, cementing the new system together in the interests of patients. The benefits to patients with rare conditions are clear: a single national commissioning policy and better planning and co-ordination will result in improved consistency around the country.
The Government are also committed to increasing awareness—which I mentioned earlier—of very rare conditions such as PXE. That commitment has been demonstrated through the UK’s involvement in the development of the UK plan for rare diseases. We shared our views on the proposed plan earlier this year, launching our consultation on 29 February, rare disease day. The consultation document was produced jointly by the four nations of the United Kingdom, and the consultation closed on 25 May.
The consultation responses will inform the UK plan, which is being developed in response to the 2009 European Council recommendation on rare diseases. That recommendation, which was supported by the UK, asked every member state to develop a national plan or strategy for rare diseases by the end of 2013. My officials are currently working through all the consultation responses—there were more than 350, which demonstrates the level of interest—and are writing a summary of the responses. They expect to publish it later in the autumn, with the final plan being published next year.
This is the first time that the UK has developed a plan to tackle rare diseases. The plan will bring together a number of recommendations designed to improve the co-ordination of care and to lead to better outcomes for everyone with a rare disease, including people with PXE. However, a plan in isolation is clearly not enough. This plan will need buy-in from everyone in the system. With that in mind, my officials have been working closely with the newly formed NHS Commissioning Board to ensure that the plan has traction within the system, so that people know about it and understand its power.
In comparison with some other member states, the UK already has good systems for supporting and treating people with rare diseases through the provision of specialised services, but that does not mean that we cannot do better. For example, more co-ordinated care saves patients time, money and stress by avoiding the need for multiple visits to various clinics and hospitals, which has too often been people’s experience in the past. We are also considering how rare diseases can be better represented in training curricula. That is critical to raising the level of knowledge and capacity in the system.
People with rare diseases are likely to come into contact with professionals from a range of disciplines: from GPs through geneticists and researchers to nurses, surgeons, mental health teams and social care workers. It is for that reason that the UK plan for rare diseases will be targeted at the whole of the health and social care sectors. The final plan will set out a coherent and joined-up approach to tackling rare diseases. It will acknowledge existing developments, such as the contribution that expert centres can make to better diagnosis and treatment of rare diseases, while proposing a number of further developments, such as better information for patients so that they can be fully engaged and helped to understand and manage their conditions.
The plan will include recommendations, actions and examples of best practice for commissioners of specialised services, royal colleges, providers of information, and staff on the ground who deliver care to people with rare diseases. It will recognise that each nation of the UK has different health care systems, and it will be for each nation to implement it in accordance with its own priorities and patterns of service. In England, much of the implementation of the final plan will be for the new commissioning board in its role as a single national commissioner of specialised and highly specialised services.
I am grateful to my hon. Friends for raising this important issue. The value of a debate such as this is that it forces Ministers to focus on rare diseases to which we might not have devoted time otherwise. I shall be happy to continue to engage with the issue to ensure that patients with PXE are given the treatment and care that they deserve.
Question put and agreed to.
Life Sciences
Nick de Bois Excerpts(12 years, 7 months ago)
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Mr Lansley
I think that the hon. Gentleman is wrong about that. The MHRA operates, in scientific and expert terms, in an independent fashion. In so far as it is accountable, it is accountable to me as Secretary of State and to this House. It is not accountable to the pharmaceutical industry. If he is proposing a major transfer of costs from the pharmaceutical industry to the taxpayer, I am afraid that I do not agree with him.
Nick de Bois (Enfield North) (Con)
I warmly welcome the commitment to telehealth and the expansion of it over the next five years. Does the Secretary of State agree, however, that that represents a step change for patients? Will it be the responsibility of councils and stakeholders to demonstrate the value and benefits of telehealth to their patients, so that there is full buy-in?
Mr Lansley
I am grateful to my hon. Friend. The figures from the evaluation of the 6,000 or so patients who have participated in the three pilots in Cornwall, Kent and Newham suggest that if telehealth is appropriately and properly provided, there are benefits. There was a total reduction of 45% in mortality, about 21% in accident and emergency visits, about 15% in planned admissions and bed stays in hospital and about 8% in costs. Those are dramatic benefits, but the most important aspect is the empowerment that telehealth gives patients so that they can be at home and be confident about their care, rather than be prey to rapid crises leading to admission to hospital.
Oral Answers to Questions
Nick de Bois Excerpts(12 years, 8 months ago)
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Anne Milton
Yes, this is not only about resources, as my hon. Friend rightly says. Some 60% of adults are overweight or obese, and those figures are even higher in some areas. It is extremely important not only that any money is followed by that public health outcomes framework, but that it is effective. This is not something we can simply chuck money at, as the previous Government did.
Nick de Bois (Enfield North) (Con)
6. What steps he is taking to raise the standards of care provided by health care workers and care assistants.
The Secretary of State for Health (Mr Andrew Lansley)
I have commissioned Skills for Health and Skills for Care in partnership with employers, unions, regulators, educators and others to develop a code of conduct and minimum training standards for health care support workers and adult social care workers in England. This will give employers and patients confidence in the employment and standards of staffing at all levels. I expect the final report and recommendations by September 2012.
Nick de Bois
The Secretary of State knows that I believe in less, not more, regulation, but given the increasing role and responsibilities of health care assistants, particularly with the elderly, does he agree that the time has come both to recognise their increased responsibilities and to provide safeguards at a national level by requiring them to be on a national register?
Mr Lansley
My hon. Friend will know that health care and social care support workers do responsible jobs and that the responsibility for them lies principally with their employers and the staff who supervise them. We made provision in the White Paper we published last December for a process of assured voluntary registration. What I announced and referred to a moment ago will give a code of conduct and standards that will form a basis for an assured voluntary registration scheme in future.
Health and Social Care (Re-committed) Bill
Nick de Bois Excerpts(12 years, 10 months ago)
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Caroline Lucas
I thank the hon. Lady, but I do not agree that the two points that she makes are causally linked. Of course I do not want to see the abolition of nurses, but that does not mean that we should have to pay for our prescription charges. Either we want an NHS free at the point of delivery and with free eye tests and so forth or we do not. [Interruption.] Someone is speaking from a sedentary position, no doubt asking how we will pay for it. I will be very clear that there is massive potential in cracking down on tax evasion and avoidance, higher tax for the rich, higher corporate tax and so forth. We are essentially talking about political priorities. The priority that I represent—a great many more people are coming to this view—is that we should be willing to pay for the public services that we want.
Hon. Members may oppose amendment 48 on the basis that charging for prescription or for dental and eye care is an important way of raising revenue. In England, eligible patients pay a prescription charge of £7.20 an item. In Scotland the charge is £3 and Wales and Northern Ireland have abolished prescription charging altogether. England raised just £470 million through the charges in 2009-10, which was just 0.5% of the NHS resource budget.
Crucially, we should remember that income from charging in the NHS is not pure profit. There is a real cost to administering the plethora of exemptions and reduced charging rates for which different groups are eligible. For example, there are 11 different groups that are eligible for free dental care, 15 that are eligible for free sight tests and 12 that are eligible for free prescriptions. I hope that hon. Members will see the benefit of doing away with that convoluted and complex system, which provides little benefit in terms of income, and which goes directly against the NHS principles by significantly reducing people’s access to all forms of health care simply because of their inability to pay.
Much has been said by hon. Members on both sides of the House about the founding principles of the NHS, and it will continue to be said. However, I put it to hon. Members that amendment 48, more than any other, seeks to point out that much important NHS care and treatment is charged for, and that we need to go back to NHS services as they were envisaged by its architect, who has been referred to many times this afternoon. Hon. Members might recall that he resigned as Health Secretary as early as 1951, in protest at his Chancellor’s efforts to impose charges for prescriptions, dental treatment and eye care.
Amendment 1181 raises serious concerns about the way in which CCGs will be able to charge for services. Although the power to charge, under proposed new section 14Z3 to the National Health Service Act 2006, is intended to be of benefit to the health service, it is very disturbing. Its scope is unclear—I wrote to the Minister last week to ask for clarification—but the fact is that important limitations on how the Secretary of State can exercise that power would apparently not apply to CCGs. The measure could run a coach and horses through the principle of a free health service, and Parliament needs to be clear on its impact in practice.
It is extremely worrying that CCGs will be able to decide that certain specialist services—for example, for pregnant women or women who are breast feeding young children, or aftercare—are not appropriate as part of the health service. That would mean that the statutory guarantee that the NHS will be free will not apply, because CCGs can decide that certain services and facilities should not be provided as part of the NHS. If that happened, CCGs could use the charging power to decide to charge for supplying, for example, goods to pregnant women, or for instructing people how to use their rehabilitation equipment.
Amendment 1181 would ensure that that could not happen. Ministers might say, “CCGs are commissioners and not providers”. If so, why is a measure that allows CCGs to charge necessary in the first place? The amendment would make it absolutely clear that there is no way in which a CCG could charge for anything that is related to the basic core health service, such as hospitals, doctors, nurses or ambulances, whether they are acting under section 3 or proposed new section 3A of the 2006 Act. The amendment would also impose on CCGs the same limitation that is already imposed on the Secretary of State. Why was that omitted from the Bill?
It is right that raising funds under that power should not interfere with a CCG’s functions. However, the Bill says that raising funds should not interfere significantly, but what on earth does “significantly” mean in that context? How is it to be determined or measured? If companies such as UnitedHealth got hold of that power and reckoned they could make money out of it, they will be on to it in a flash. The very least that they should be required to do is demonstrate that dealing in land and supplying goods and the like will not take them away from fulfilling their commissioning role. I would prefer it if those giant profit-driven companies were nowhere near the health service, but while they are, we need far greater safeguards than currently exist.
Unfortunately, the previous Government gave overseas companies the legal route into the NHS, and this Government are seeking to smooth that route yet further. Hon. Members may recall that at Prime Minister’s questions on 18 May, the Prime Minister claimed that he had not heard of Mark Britnell, one of his health advisers, who was also a key adviser under Tony Blair, until he googled him the previous Sunday. The Prime Minister’s interest was stoked by a report of a speech that Britnell, global head of health care at KPMG, gave to a group of private health companies in New York last October. Dr Philip Hammond pointed out in Private Eye that according to a brochure summarising the conference, Britnell said:
“GPs will have to aggregate purchasing power and there will be a big opportunity for those companies that can facilitate this process…In future, the NHS will be a state insurance provider, not a state deliverer…The NHS will be shown no mercy and the best time to take advantage of this will be in the next couple of years.”
That is a shocking thing to say, and no wonder the Prime Minister was keen to distance himself from it, at least in public.
My last point is about the final proposal in amendment 1181, which would mean that:
“Income raised by a clinical commissioning group as a result of the exercise of powers under this section shall be specified in its annual accounts, referred to in its annual report under section 14Z13, and paid annually to the Secretary of State.”
Without the amendment, it is completely unclear what CCGs will do with the money that they raise and how, if at all, it will affect their budget allocations. I think it would be madness for Parliament to give CCGs the right to charge for supplying goods, dealing in land and providing instruction for the purposes of raising more funds for the NHS, and then not to require them to account for it in any way, and not to ensure that the funds find their way back to the public rather than the private purse. This part of my amendment seeks to ensure that that is done.
Amendment 1234 refers to the fact that once they managed to get into the CCGs, multinational health companies such as UnitedHealth would be allowed to do the actual commissioning, thus creating a very unhealthy form of what is effectively in-house outsourcing. I understand that they will be able to charge for the supply of goods if the Government do not accept the amendment. Parliament cannot trust companies whose primary duty is to their shareholders to be in charge of so much taxpayers’ money, nor should such companies be given the right that the Secretary of State currently holds to charge for the supply of goods or for land deals. We should make it clear that CCGs cannot agree among themselves that their functions will be carried out by one of their private company members. Commissioning is a public function that should be exercised in the public interest, and private companies such as UnitedHealth should not be entitled to charge for any it.
Nick de Bois (Enfield North) (Con)
I refer Members to my entry in the Register of Members’ Financial Interests. I wish to speak to amendments 1172 and 1173, in my name, which require the Secretary of State to collect haematopoietic stem cells. The issue is, of course, that of the collection of umbilical cord blood and cord bank policy, which was first raised in the last Parliament.
I pay particular tribute to the work of the all-party parliamentary group on stem cell transplantation for its work under the leadership of the hon. Member for Alyn and Deeside (Mark Tami), and to the enormous contribution and determination of my hon. Friend the Member for Enfield, Southgate (Mr Burrowes). My previous lack of knowledge of the subject was probably no different from that of many other people, but after giving my hon. Friend and neighbour a lift home on several occasions I became a speedy convert. Quite simply, the collection of cord blood can be life-saving. I pay tribute to the work of the Anthony Nolan trust in that regard.
In 1974 the Secretary of State was not obliged to facilitate stem cell transplantation from unrelated donors. Because the Governments of the day took that position, advances made took longer to achieve, which undoubtedly cost lives. The situation is different now: both the Government and the Opposition support expansion of the practice, and in particular of the more modern use of umbilical cord blood for such purposes. However, it would be fitting for the Minister now to make it clear in the Bill that this issue is important, to lock in the bipartisan support while it is strong, and to send a message to future Governments and civil servants that for as long as the Bill remains on the statute book, the issue is not to be lightly disregarded or de-prioritised at a future date.
The amendments involve no financial or political cost, but they are not merely symbolic. They could be described as an insurance policy against the risk of thoughtlessness or distraction on the part of future Governments—a risk that would ultimately cost lives.
Mr Burrowes
It will not surprise the House to learn that I strongly support what my hon. Friend has said about the importance that should be attached to the life-saving cause of collecting cord blood and transplantation. As he has said, the Government are wholly committed to investing in and improving collections and to transplantation, but is it not important for us to consider whether that should form part of the duty of the Secretary of State? Is it not a priority, given that one in five members of black and ethnic minorities cannot obtain a match for the purposes of the transplantations that are sorely needed for life-saving operations?
Nick de Bois
My hon. Friend raises a key point. If we were to make prospective parents aware of the possibility of donation, we could address the major deficit in the BME community.
Mr Burrowes
Is it not also important to ensure, through the Bill or other means, that commissioners are able to make the right decisions? Evidence of some commissioners questioning the economic value of proceeding with stem cell transplants was brought before the all-party group on stem cell transplantation. It is important that we pursue commissioning excellence.
Nick de Bois
I understand that the UK Stem Cell Strategic Forum recommended to the Government that there should be a regional centre of excellence, and I hope Ministers will let us know by letter if that policy is indeed being pursued, as I think it might deal with the issue that my hon. Friend raises.
Cord blood is a natural, safe, ethical and sustainable resource, and it offers many advantages over using traditional bone marrow transplants. We in this country should be proud that the NHS was one of the first bodies to recognise the potential importance of cord blood and significant breakthroughs were made in Britain. In 1996 an NHS cord bank was established, which is now working alongside the Anthony Nolan trust. At a time when the health service is mindful of the need to inform patients fully about their health care, the issue of the collection of a mother-baby’s cord blood does not seem to get the same degree of attention. The principles of full information and consent do not seem to apply to cord blood, which is, in general, treated as a waste product, unbeknown to parents, apart from in exceptional circumstances. By agreeing to my amendments, we can change that situation and the Government can demonstrate that they are giving a lead in the dissemination of information to expectant parents.
Last year academic research said that in order to have a truly effective operation we should strive to obtain 50,000 units of cord blood. I congratulate the Government, who have already committed £4 million to reach the first benchmark of 20,000 cord blood units. I commend the work of the Anthony Nolan trust and the NHS, which have also been sharing in building up to this target. Of course this is only the start, and I know that the Government have already expressed their commitment to helping to develop this very important work.
We have an opportunity for more lives to be saved, for valuable scientific research to be undertaken and for the UK to become a centre of excellence in cord blood. We can avoid the current situation whereby every day two people die waiting for a stem cell transplant, and 65,000 litres of cord blood are discarded every year. I welcome the Minister’s words of support and I appreciate the sentiments behind the Government’s thinking. I urge them to continue to get behind this valuable cause.
Rushanara Ali (Bethnal Green and Bow) (Lab)
I speak in support of amendment 1169, which seeks to strengthen the Secretary of State’s duty to reduce health inequalities. As presented in clause 3, the Secretary of State’s duty is insufficient to tackle the health inequalities in our society. The clause lacks strength, invites the Secretary of State to disregard its meaning and changes little in the way in which health inequalities will be tackled in the future. By supporting amendment 1169 we can ensure that the Secretary of State can be regularly and properly held to account for his duty to tackle health inequalities across England.
Tackling health inequalities is vital because this is, in many cases, a matter of life and death. The World Health Organisation’s Commission on Social Determinants of Health has said:
“Social justice…affects the way people live, their consequent chance of illness, and their risk of premature death. We watch in wonder as life expectancy and good health continue to increase in parts of the world and in alarm as they fail to improve in others.”
In our own country, Bevan’s dream for the NHS was for a service in which:
“No longer will wealth be an advantage nor poverty a disadvantage.”
Yet, despite the great strides that have been made there is much more to do, and the link between poverty and poor health remains.
Reform of Social Care
Nick de Bois Excerpts(13 years ago)
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Mr Lansley
The hon. Lady will know that we are continuously seeking to improve the standards of care that older people receive, and, in so doing, we sometimes have to tackle what are clearly serious abuses. In the wake of the Winterbourne View events, for example, we will bring forward a report to Parliament on standards and the means by which they are to be met. With regard to hospital care, it was I who asked the Care Quality Commission to undertake specific unannounced nurse-led inspections to look at dignity and nutrition. We will work continuously to ensure that we deliver the standards of care that people have a right to expect.
Nick de Bois (Enfield North) (Con)
My right hon. Friend might be aware that more than 100,000 people a year are not receiving the palliative care that they need. Can he assure the House that that will be a key priority, following the issue of this report?
Mr Lansley
My hon. Friend is right. I very much welcomed and encouraged the dialogue that took place between Andrew Dilnot’s team and Tom Hughes- Hallett’s team, and they have made complementary recommendations. My hon. Friend is absolutely right to say that, as far as end-of-life care is concerned, there is widespread unmet need. The disparity in the quality of care and the services provided in different parts of the country is staggering. Just as the Dilnot commission deals with care and support, we certainly aim to deliver greater consistency in eligibility and in the quality of care provided.