NHS Winter Crisis

Pat McFadden Excerpts

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

I congratulate my hon. Friend on her campaigning role in holding the Government to account for delivering on the capital injection of £29 million that we promised to the Worcestershire trust, of which the Alex is a key part. I reiterate to her that she should not rest until it has the money.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

The cancellation of thousands of elective surgery appointments simply shows that the Tories are doing what they have always done, which is forcing people to wait longer for their operations and rationing healthcare in that way. How will the Minister deal with the backlog that will be created in future months because of all the operations that have been put off?

[Mr Dunne]

I have to say that I am disappointed with the right hon. Gentleman. He was a Minister in the previous Labour Government, and in each quarter for which I have the figures, which go back to 2000, between 10,000 and 20-something thousand procedures were deferred or cancelled. This problem has affected this country’s health service every year, going back to the beginning of recorded data.

Deafness and Hearing Loss

Pat McFadden Excerpts

Thursday 30th November 2017 Westminster Hall

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

I begin by echoing the tribute paid to my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) for securing this debate. As we have heard, there are a number of dimensions and aspects to deafness, but I want to focus on one issue: the criteria for receiving cochlear implants under the NHS. My argument today is simple: the criteria should be reviewed so that it is easier to get an implant. That would transform the lives of those who need this technology, and improve the lives of their families and loved ones. It would be a prudent investment, because it would obviate the need for more expenditure further down the line as a consequence of people not receiving the implants they desperately need.

I will tell the story of my constituent, Lamina Lloyd. Until last year, Lamina had a flourishing career as the manager of a local citizens advice bureau. However, Lamina has Meniere’s disease, which has resulted in progressive hearing loss—so much so that last year she had to give up work. She has two children who themselves have additional needs. She can no longer hear her children, who have to act as her ears. She describes her family as having gone from being an outdoor family to one that rarely leaves the house. Lamina is an intelligent, capable person, but hearing loss has meant the end of her career, a diminishment in the quality of her family life, and increasing isolation.

To try to alleviate her condition, Lamina wears the most powerful hearing aids available, turned up to maximum volume, but they make little difference and give her frequent ear infections and headaches from their feedback and squealing noises. She can no longer hear music or follow conversations, yet she has been in a battle—that is the only word for it—for the past two years to try to get a cochlear implant. She falls just 5 dB short, which is no more than a whisper, of the 90 dB hearing loss threshold for consideration for an implant. That threshold is one of the strictest in the western world. It is estimated that only 5% of those who could benefit from the technology get access to it in the UK.

Lamina describes her condition as being too deaf to hear, yet not deaf enough to get the help that could make a huge difference to her life. Her hearing has deteriorated even further in recent months, and she has an appointment to be assessed at the Queen Elizabeth Hospital in Birmingham in two weeks’ time, but she and many others in her position have serious reservations about how the assessments are made. The Bamford-Kowal-Bench test uses short sentences in lab conditions. It does not replicate normal conversation or real-world conditions. Lamina and many others feel that that tool is not fit for the purpose of properly measuring hearing ability and hearing loss.

Even if Lamina is approved for an implant, why has it taken so long? Why do we put people and their families through such pain before giving them the help that could be life changing? My hon. Friend the Member for Poplar and Limehouse raised those issues in an Adjournment debate earlier this year, and briefly at the beginning of his speech today. He was told earlier this year that the National Institute for Health and Care Excellence was launching a consultation on the relevant guidelines. That has not happened. The guidelines have been in place since 2009, but technology and costs have moved on a great deal since then.

I wish to ask the Minister a few questions. If he cannot respond to them all today, I would be very happy for him to consult with colleagues and write to me, and other Members participating in the debate, with a more considered response. First, why has the NICE consultation, which we were promised would be launched this summer, not yet been launched, and when will it be? Secondly, does he agree that Lamina’s case and many similar cases around the country show that there is an overwhelming argument for revising those criteria?

Thirdly, whatever hearing loss threshold is picked, does the Minister agree that the hearing loss test needs to be done in real-world conditions that approximate to how people actually live their lives and conduct conversations, and so on? Fourthly, and perhaps most fundamentally, why does it take so long for people to get an implant? Why is it such a battle? The NHS is there for those who need it; it should not be an organisation that people have to battle with to get the treatment that they need. Had my constituent been helped earlier, she might still be in a job. She would not need to rely on the state for financial support, and her family would not have had to go through the huge difficulties that they have all been through together over the last couple of years.

It is time for a step change in the urgency with which the issue of cochlear implants is treated. The guidelines must be revised. NICE needs to move on that soon, so that the suffering of my constituent Lamina Lloyd, and the many people around the country who are in a similar position, can be alleviated.

[Jim Fitzpatrick]

On a point of order, Mr McCabe. I asked my staff to monitor the transmission of the sign language. It is not being broadcast; the cameras do not meet the interpreters. Westminster Hall debates do not have subtitles, unlike in the main Chamber. Obviously I would very much appreciate it if you took that matter back to the Panel of Chairs and discussed it in due course.

Clinical Negligence Claims

Pat McFadden Excerpts

Wednesday 9th March 2016 Westminster Hall

[Sir Edward Garnier]

I will not give way.

That this debate takes place only a week before the Budget underlies that point. I further accept that the vast majority of patients who visit a GP, an NHS surgery or a hospital leave satisfied with their treatment and the outcome, but very occasionally something goes wrong. In just over 3% of those cases an error caused by a negligent decision or act of omission by a clinician leads to a claim being made by the injured person against the NHS. Such cases can include, for example, birth injuries or misdiagnosed or mistreated illnesses. Of course, those are not deliberate actions by ill-motivated doctors or nurses, but negligent ones that lead to adverse consequences for the patient.

What does 3% mean numerically? In 2011-12, the NHS reported just under 420,000 so-called “adverse incidents causing harm”, of which 13,500, or just over 3.2%, resulted in a clinical negligence claim. In the following year, there were just over 458,000 such incidents and 16,000 claims, or about 3.5%. In 2013-14, there were just over 470,000 incidents and just under 18,500 claims, or 3.9%. In the great scheme of things, those numbers are small, but they represent permanently damaged or shortened lives, pain, suffering, heartache and anguish.

Of course, they also represent monetary expense to the claimant and the NHS. We should therefore aim to ensure justice and proper compensation for the claimant who has been injured, and protect the taxpayer from excessive and unnecessary expense in legal and medical experts’ fees.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

Will the right hon. and learned Gentleman give way?

[Sir Edward Garnier]

I regret that I cannot; this is a half-hour debate, and I am afraid we are rather pushed for time.

It is uncontroversial to state—and the common law expects this—that damages should, as far as they can, put the injured party back where they were before the incident. We need a system that does not prevent the bringing of justified claims and encourages excellence and proportionality in the conduct of each claim, as well as in the conduct of the defence. An efficiently and expertly brought claim saves money, as it leads to the real issues being considered within a suitable timeframe. It allows the defendant to focus more quickly on what they need to do to satisfy the claim and not waste time and money on irrelevant or hopeless points.

Any changes that the Government intend to impose should not be retrospective—that is a basic rule of fairness —and must be even-handed. The Treasury must be an umpire and not a partisan ally of the Department of Health, because in the long run a poor set of reforms will lead to greater expense, not less, and a lessening of public trust in the NHS and the Department. Given that the Department of Health is managing the consultation and is the most common defendant in clinical negligence claims, it is difficult—despite, I hope, the construction of very high Chinese walls—to think of this as a wholly disinterested exercise.

It is easy to say—although it is not so easy to accomplish this—that the best way to reduce the number of clinical negligence claims against the NHS is to reduce the incidence of medical negligence. That is no doubt a statement of the blindingly obvious, but it may occasionally get forgotten as the Government look for ways to cut expenditure. Let us start by improving the training and decision making of those in the NHS who are statistically most likely to do things that lead to clinical negligence claims.

Let us also remember that the Legal Aid, Sentencing and Punishment of Offenders Act 2012 automatically cut the costs and expenses paid out by the NHS Litigation Authority by about a third, and that for claims worth less than £25,000 those savings come to 39% of the costs budget, or £71 million a year. In the NHSLA’s annual report of 2014-15, the chairman asserts that more than a third of the NHSLA’s spending was received by the legal profession, and most was paid to claimant lawyers. In fact, the report shows that the NHSLA’s operating costs amounted to £2.64 billion, of which £291.9 million, or 11%, was paid to claimant lawyers and £103.2 million, or 4%, to defence lawyers.

The report’s figures suggest that 15% of the LA’s spending is paid to lawyers, but there is no breakdown of what that number includes. The report indicates the LA’s net operating costs reduced from £3.373 billion to £2.641 billion between 2013-14 and 2014-15—a reduction of £732 million. It also says that claims reported to the LA reduced from 11,945 in 2013-14 to 11,497 in 2014-15—a reduction of 3.7%. The amounts paid out in damages reduced from £840.7 million in 2013-14 to £774.4 million in 2014-15—a reduction of 7.9%.The NHS has therefore achieved significant reductions in expenditure. The NHSLA also reports an increase in sums paid to claimant lawyers for costs and disbursements from £259 million to £292 million between 2013-14 and 2014-15. The average cost per case increased from £16,852 to £17,735—an increase of 5.2%.

There is inadequate analysis of those figures, and the report is, to that extent, misleading. The NHSLA claims to have

“saved over £1.2 billion…in rejecting claims which had no merit.”

However, as claims without merit always fail, those savings are illusory. It cannot claim to have saved money it would never have spent. The authority also claims that £38.6 million was saved by taking a significant number of cases to trial, but it does not say how much was spent unsuccessfully contesting cases at trial or settling cases soon before trial.

The NHSLA refers to the levels of costs recovered by claimant lawyers without distinguishing between costs and expenses. It compares the level of costs incurred by different sides without noting that the burden of proof requires claimants to undertake much more work than defendants. APIL says that nearly half of what the NHSLA says it pays out in legal costs to claimants’ lawyers are accounted for by success fees on conditional fee agreements, after the event insurance premiums, court fees and expert witnesses’ fees. Much of that could be saved if the NHSLA were better at its job of settling the claims it ought to realise it will lose on liability from or close to the outset.

That said, not all medical negligence claims are straightforward, but proving what went wrong is not made easier for a claimant’s lawyer when the NHS holds all the information and is reluctant to disclose it. On far too many occasions, cases that could have been settled more quickly, cheaply and satisfactorily are not, because the NHSLA withholds information, does not respond in good time to requests for information, or simply fails to apply its collective mind to the best way of dealing with the complaint. I have lost count of the number of times that I, as a constituency Member of Parliament, have corresponded with a hospital, insurance company or some large institution, private or public, that, when faced with a complaint, has buried its head in the sand and hoped that it will go away.

Most complainants just want someone to take responsibility and say sorry, and are not after money or revenge. That applies to the bereaved parents of stillborn babies as much as it does to the adult children of an elderly patient who died after a fall from a hospital bed, or who lay for days in agony because of untreated bed sores. The defensive failure to apologise often causes more heartache than the negligence itself and causes claimants to believe that they have to sue to get justice.

In addition, the NHSLA too often engages in unproductive trench warfare: it must not be seen to be giving ground, so the order goes out: “Deny, defend, delay!” Cases that could have been resolved months and sometimes years earlier end up being settled at the door of the court, or lost after a trial, by which time advocates’ brief fees have to be added to all the other costs that have piled up unnecessarily since the complaint was first raised. If ever there was a need for a patient to heal himself, it is the NHSLA in its refusal to free itself from the indefensible, or to see the wood for the trees. Rather than too often denying, defending and delaying in the wrong cases, it should assess, admit and apologise in the right cases.

An example of that is in the failure to look for and to release medical records. Requests for records should be met under the Data Protection Act 1998 within 40 days, and under Government guidelines for healthcare organisations within 21 days. Far too often both deadlines are missed, and not by a whisker, but by a country mile. It can often take more than six months for claimant lawyers to get patients’ records from GPs and hospitals and, with a limitation period of three years to bring a claim, pressure mounts to issue proceedings to protect the claim. It is not unheard of for long-delayed medical records to show that the claim is unwinnable, so it is dropped—but why not send out the records within a month and save the time, the expense and the anguish?

The NHS is a hydra-headed organisation and, when dealing with medical negligence claims, that can lead not to the proper use of decision-making powers at the most local level, but to procrastination, duplication and more expense. Some NHS trusts have in-house legal departments and when they receive a claim pass it directly to the NHSLA; some hold on to them and pass them on much later. My informants from the legal profession tell me that trusts’ legal teams are far less settlement-minded and tend to use every point, good, bad and indifferent, to string the claimant along. If a case gets towards trial, the NHSLA instructs outside lawyers. Why not make it a matter of policy for all claims to be handed straight over to the NHSLA, and thus minimise, even if not abolish, delay and unnecessary costs?

Finally, I want to urge the Government to reconsider their proposal that all clinical negligence cases up to a value of £250,000 should be low-value claims. First, in any view, £0.25 million is not a low-value claim either to the claimant or to the taxpayer, not least when one considers how many there are every year.

Secondly, to take just one example, hundreds of babies are left brain-damaged every year because the NHS has treated them negligently either before or after birth and, sadly, some of them die soon after birth. A claim brought by the parents of a child who has died aged a few hours, days or weeks will not of itself lead to a large award of damages, but the evidential route to determining where liability lies for the acts or omissions that led to that premature death can be highly complex in investigation and assessment. The same legal costs may be incurred in proving a claim, whether it is of low or of high value.

For instance, in a case of delayed cancer diagnosis, the same expert evidence may be required where a patient’s life expectancy has been reduced by two years and the award is £30,000, or where life expectancy is reduced by 50 years and the case is worth £500,000. Those worst affected will be the most vulnerable—the elderly, those on low income and people with disabilities.

On 13 January, in answer to my written questions Nos 21040 and 21037, the Minister accepted, unsurprisingly, that there is no exact correlation between the value and complexity of clinical negligence claims, and it must therefore follow that to impose an artificial limit on the amount of costs recoverable by the claimant based only on the quantum of damages could lead to injustice, especially when the NHSLA will not be equally constrained.

Already claimant law firms reject 90% of inquiries in this field and the proposed fixed-fee regime for cases of up to £250,000 will simply dissuade firms from assisting even more claimants. As one experienced Queen’s bench master who specialises in such cases recently said, further research is

“essential in order properly to understand the impact on access to justice of the existing system of funding before implementing any further changes.”

A fixed-costs system for claims under £250,000 would affect 95% of cases and make many meritorious claims unviable for patients, undermining the legal and the medical systems. That would not be in the interests of justice, of medicine, of the economy or of the country, and we need to think again. The Minister is a thoughtful man, and I am sure he will want to give a thoughtful response, today and subsequently.

--- Later in debate ---

[Ben Gummer]

I will turn to access to justice. I do not entirely accept the hon. Gentleman’s interpretation of the judge’s words.

In our proposed reforms, I intend to change the balance for the NHS Litigation Authority and for claimant lawyers to ensure that we get to a single version of the truth as early in the process as possible. I accept in its entirety my right hon. and learned Friend’s interpretation of the NHSLA’s performance in past years. I do so on the basis that many claimants have been immensely frustrated—as have the clinicians involved—by the length of time that trusts and the LA have had to respond to claims, the length of time it often takes to reach a resolution and the fact that there is often too much defence, delay and prevarication. At the same time, I have full confidence in the NHSLA’s current management, because I have seen a real determination to get to grips with the problems it inherited and change the authority into something far more fit for purpose.

I accept my right hon. and learned Friend’s contention that we need to change what happens with the NHSLA, but I posit that the existing costs regime encourages some claimant lawyers to stack costs in the early stage of a claim process rather than get to what we need to do: to establish a version of the truth agreed between all parties. I am not arguing that that is a deliberate and malicious intention, but that is how the system is constructed at the moment. Therefore, in attempting to reform how costs are settled between the NHSLA and claimants, we want to incentivise learning right at the beginning of the process, to ensure that it is as rapid as possible and that, if claimants have a fair claim, they receive justice and compensation as quickly as possible. Our interests are therefore entirely aligned.

That is why I say to claimant lawyers—I have said this privately to them on several occasions—that this is a genuine consultation. We are seeking to find out how best to reform a system that we all accept is not right. I therefore warn them against peremptory lobbying of Members of Parliament about a scheme that has not yet been determined. This is a genuine consultation, in which we will accept all their views, but they cannot—I hope they will not—proceed on a basis that could lay them open to accusations of pleading for special interests rather than trying to contribute to the consultation.

[Mr McFadden]

The right hon. and learned Member for Harborough (Sir Edward Garnier) said that law firms currently reject 90% of cases brought to them because the burden of proof is high. I therefore do not think that we should portray this as a field of many frivolous claims. With that degree of rejection by law firms as background, will the Minister tell the House how the Government came to their figure for estimated savings for the new regime of £80 million? Where will those savings come from?

[Ben Gummer]

I hope that I in no way suggested that any of the claims brought forward were frivolous. I am saying that the way in which the current system is constructed loads costs at the beginning, and that does not help get us to a fair and equitable solution as quickly as possible. I am merely positing, but I believe there is fault on both sides. It is not necessarily the fault of either organisation; it is the fault of the system as a whole, which does not encourage good behaviours. The result is that we are not extracting learning as quickly as possible from litigation; we are not using claims, when unfortunately they are brought, to ensure that we improve medical practice; and, frankly, we are not using the early stage of complaints sufficiently well to ensure that claims are not brought.

I entirely agree with my right hon. and learned Friend that almost all complainants are not after a financial reward; they just want someone to say sorry and to accept responsibility for what happened. If we can achieve that far quicker in a learning culture, we will do something remarkable, not just for them, but for the many people who will follow. In answer to the right hon. Member for Wolverhampton South East (Mr McFadden), the estimate of savings proposed in the initial consultation document was part of the spending review round, and it was done through the usual modelling processes employed by the Treasury and the NHSLA, which understands the value of claims coming through.

My right hon. and learned Friend asked about the £250,000 limit. That limit was not arbitrary, but drawn from the original intentions of Lord Justice Jackson’s review on civil litigation costs in 2010, with which I know he is well acquainted. In that review, Lord Justice Jackson pressed for fixed recoverable costs in the lower reaches of the multi-track up to £250,000. That was in relation to personal injury claims, but, in trying to draw a line somewhere, we felt that that was an appropriate place, given his recommendation to do so. That is, however, subject to consultation. We want to hear the full range of views about where the limit should be placed. My right hon. and learned Friend’s contribution will be an important part of that consultation, and I and officials will take note of it.

My right hon. and learned Friend spoke of the Chinese walls and why the Department of Health is bringing forward this review. He is well aware of the usual practice that Departments bring forward proposals that relate to their areas of responsibility. The Ministry of Justice did so in previous reforms in which it had a financial interest, just as the Department of Health is doing here. I hope that, in our open approach, we will be able to explain that our primary concern is around changing the culture of the NHS and making sure that we are driving down claims for good reasons—that there are fewer of them because we are improving clinical practice—rather than just trying to deny people access to justice, which is the opposite of one of the intentions of the review.

The hon. Member for Torfaen (Nick Thomas-Symonds) is entirely right to say that we should ensure that we make justice as open as possible. The litmus test of the reform will be that, if people feel that, despite everything we are doing to make the NHS a better organisation—listening to complaints, learning from mistakes and providing restitution early—they still wish to bring forward a claim, it will be easy to do and no unreasonable barriers will be placed in their way.

Vaccine Damage Payments Act

Pat McFadden Excerpts

Tuesday 24th March 2015 Westminster Hall

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

I will not detain the House for long. I want briefly to raise the case of my constituent Stacey Jones, who suffered life-altering changes to her health following the administration of the HPV vaccine six or seven years ago. For Stacey it has meant seizures and mood swings—severe continuing problems that require treatment to this day. I pay tribute to her brave mother, Julie Jones, who has fought to have her daughter’s condition recognised. She brought it to my attention and that of Ministers and the local medical profession, and she has tried to put the plight of young women such as Stacey on the agenda.

I pay tribute to my hon. Friend the Member for Dumfries and Galloway (Mr Brown) for his work in obtaining the debate, and more broadly on the issue. Although the subject is compensation, I want to put a broader question to the Minister. Does she agree that it cannot be right for young women and their families, such as Stacey and her mother, to be regarded simply as collateral damage for the vaccine programme? That is how the families feel. In a sense, that is a question for my hon. Friend the Member for Liverpool, Wavertree (Luciana Berger) as well as for the Minister, because there is an election coming and I am not sure whether the Minister or my hon. Friend will occupy the Government Front Bench in a couple of months. I hope that they both agree that it cannot be right for young women such as Stacey to be regarded as collateral damage of a vaccine programme. If so, how do we change the view of such families, who feel that the Department of Health simply brushes aside their concerns, does not acknowledge them and does not take them seriously?

The health problems that those young women are suffering from are real, but they feel that they are being ignored. I ask the Minister and my hon. Friend the Member for Liverpool, Wavertree, to address in their summing-up speeches the question of not just compensation, but the attitude shown to such families, who feel that they are being ignored, so that their plight is taken more seriously whether or not they are entitled to compensation under the law.

NHS Specialised Services

Pat McFadden Excerpts

Thursday 15th January 2015 Westminster Hall

[Mr Jamie Reed (Copeland) (Lab)]

It is a pleasure to serve under your chairmanship, I think for the first time, Sir David, although you do look an awful lot like someone we used to call Mr Amess. I extend my genuine thanks to the hon. Member for St Austell and Newquay (Stephen Gilbert), whom I congratulate on securing this debate and on raising these issues in such detail. That is extremely important.

I pay tribute to all hon. Members who have spoken today. I single out my hon. Friend the Member for Luton North (Kelvin Hopkins), who made a superb contribution. He will be pleased to know that a Labour Government would increase spending on the NHS, more so than any other party. I am keen to give my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick) the engagement that he seeks at a time of his convenience. I commend my hon. Friend the Member for Alyn and Deeside (Mark Tami) for his compelling personal testimony. Every contribution has been very important. I also pay tribute to the Backbench Business Committee for ensuring that this and other important debates go ahead.

[Mr Peter Bone in the Chair]

Tens of thousands of people across the country rely on specialised health services. Far from being for the very rarest conditions, those with relatively common illnesses and diseases regularly depend upon specialised services. Those conditions and services include, but are by no means limited to, epilepsy, haemophilia, many cancers, HIV and cystic fibrosis. The list also includes fertility treatments such as in vitro fertilisation. The hon. Member for St Austell and Newquay gave a much more detailed list. The issue not only covers a wide range of conditions but accounts for £14.6 billion of the NHS budget, meaning that more than £1 in every £7 spent by the NHS is on specialised health care.

How those services are commissioned and provided is not a peripheral issue. It has a meaningful impact on the health and well-being of many thousands of families throughout the country. As we have heard today, we represent many constituents who require such specialised services. That is why it is right that these issues are debated in detail.

What is of real concern to those of us who use the NHS is the ability to access high-quality care and services. While access is available, many will not be concerned by the commissioning process, but widespread changes to the process could damage services and therefore patient care. The fundamental issues being debated today are the proposed co-commissioning of specialised services and, as has been mentioned, the proposed tariff change for these services. Each presents challenges that the Government must address. I am sure that the Minister will speak at length about how it is now the responsibility of NHS England, but Government must share responsibility for services and their performance. The public and the House expect it.

The Health and Social Care Act 2012 made NHS England the sole national commissioner for prescribed specialised services. The intended effect was to ensure that access and services were uniformly available across the country. It was meant to ensure that all patients would have access to available treatments. The rationale behind the change was that local funding and commissioning of specialised services had led to variable access and quality for patients.

National service specifications ensure that all patients, no matter where they live, have access to the same standard of care. They are currently underpinned by national access policies, expert advisory groups and national accountability for services. The proposed changes that we are discussing and the adoption of co-commissioning could pose a risk to those national standards. Many stakeholders have expressed concerns that specialised services are not easy to plan for on a local level. The Specialised Healthcare Alliance has said that

“given the highly variable incidence of rare and complex conditions, individual CCG allocations will not be aligned with actual need in-year.”

The Government should give assurances to hon. Members, stakeholders and patients about plans to change how such services are commissioned. For example, where will the budget rest? Will it be divided between NHS England and local clinical commissioning groups? Will clinical commissioning groups have any degree of autonomy in decisions about which services to commission in their locality? Why does the Minister believe that the changes will not result, as hon. Members have said they will, in a postcode lottery of services where patients in one area will have no access to some services on which they rely, but other patients will?

On 30 September last year, NHS England published its commissioning intentions 2015-16 for prescribed specialised services. Section 11 states clearly that NHS England has recommended to the prescribed services advisory group that renal dialysis should no longer be commissioned by NHS England and should instead be commissioned by CCGs. The National Kidney Foundation and its members have expressed deep concerns about the change. Patients are anxious about how the changes will affect services that keep them alive. There are 52 centres at present, each with a number of CCGs. How would those arrangements change as a result of the new commissioning framework?

The Cystic Fibrosis Trust has also echoed similar concerns. It is worried that the result of the changes could be

“ a lack of accountability and wide differences in provision of care across the country.”

Will the Minister reassure those stakeholder groups that that will not be the case as a result of the proposals?

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

I apologise that I could not be here for most of this debate, but among the conditions that my hon. Friend is mentioning, I urge him and the Minister not to forget sickle-cell anaemia. Sufferers feel that there is a damaging variability in the quality of treatment available throughout the country and feel that a move away from national commissioning to local-only commissioning might exacerbate that problem.

[Mr Reed]

I thank my right hon. Friend for that intervention. He will be pleased to learn that other hon. Members have made that point as well. Sickle-cell anaemia and the needs of people with that condition must be at the forefront of commissioning intentions and guidance.

It is absolutely clear that there is widespread opposition to the changes among key stakeholders. When the Specialised Healthcare Alliance conducted a survey of patient organisations, expert clinicians and industry representatives, asking for their views on specialised commissioning, 90% of respondents preferred their services to remain part of specialised commissioning. Co-operation between NHS England and CCGs should be welcomed in order to ensure best outcomes for patients, but wherever there is a risk that provision could suffer, NHS England must clearly retain sole responsibility for such services.

Patient care is central to the debate, as it is to all health debates. CCGs could not accurately predict the demand on some key services across a small population, so they are not in a position accurately to commission those services. Many CCGs are already overwhelmed; are they truly capable of doing what is being proposed? The ability to commission effectively will inevitably differ from CCG to CCG, which runs contrary to the initial intentions behind specialised commissioning.

Another concern is the speed with which the proposed changes will be implemented. NHS England plans to begin implementing co-commissioning arrangements in April this year, but it has yet to confirm which services will be co-commissioned. Such fog is damaging for patients and medical professionals alike. The Government and NHS England must be clear about their intentions to allow for proper planning and effective service provision. Perhaps the lessons of the 111 fiasco, for which the Minister was in no way responsible—the service was rolled out even though Ministers knew it was not ready—should now be heeded. These are real concerns expressed by those who will be most affected by the changes, and I hope that the Minister will reflect on that.

On the proposed tariff changes, in November 2014, NHS England and Monitor published a consultation notice on the national tariff payment system 2015-16. The consultation notice included a proposal for a 50:50 gain and loss share arrangement between NHS England and providers of acute prescribed services, meaning that for any service whose value exceeds national base levels, providers would receive payment only for the national base plus 50% of the difference, whereas on any service costing less than national base levels, the commissioner could save 50% of the difference between the actual value and the national base. That will give commissioners a financial incentive to restrict access to treatments for non-clinical reasons, which I find unacceptable.

Given the financial difficulties facing many CCGs throughout the country, that incentive might proving damaging and counterproductive in some cases. Will the Minister commit to undertaking an impact assessment on the tariff change and publish that assessment? If the tariff change has any detrimental impact on patient care, it cannot continue. I hope that when he responds to the debate, he will tell us whether he accepts that view. Will he also consider the views of the specialist hospital network? There is potential to do real damage to such hospitals: not only to the service that they provide, but to their research and development work as well, as my hon. Friend the Member for Luton North mentioned.

The Government’s engagement with stakeholders on health policy throughout this Parliament has been woeful. At best, it has been characterised by a refusal to engage in discussions about what is best for services, professionals and patients; at worst, by wilful ignorance of what experts, clinicians and patients need. A “carry on regardless” attitude has permeated most Government policy across all Departments, but nowhere is it more prevalent than within the national health service. The proposals represent the end of “no decision about me without me”. Stakeholder after stakeholder is calling on the Government to rethink their plans for the commissioning of specialised services.

The 2012 Act is seemingly never-ending; it appears to be changing yet again. The NHS has been plunged into never-ending reorganisation. It is an object lesson in bad law. Again, in fairness to the Minister, that happened before he arrived in post. Let us try to restore consensus on this issue and give commissioners the comfort, certainty and predictability that they and patients deserve. Let us put patients first and stop what could be a retrograde step. I look forward to the Minister’s response.

Sickle Cell Anaemia

Pat McFadden Excerpts

Wednesday 10th December 2014 Westminster Hall

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

It is a pleasure to debate this matter under your chairmanship, Mr Owen. Sickle cell anaemia affects an estimated 12,000 to 15,000 people in the UK and around 400 people in the west midlands, where my constituency lies. The associated condition, thalassaemia, affects around 1,000 people, although hundreds of thousands more in our country carry the trait for these conditions. They mainly, but not exclusively, affect the Afro-Caribbean community.

Sickle cell anaemia is the most common genetically inherited condition in the UK. Roughly one baby every day is born with the condition in our country. There is no known cure and for those who have it, the symptoms can vary from relatively mild, infrequent pain to much more serious episodes of crisis, frequent hospital admissions, strokes, often in very young people, organ damage and reduced life span. At the heart of the debate about treatment for the condition lies one simple question: why, with all the progress that has been made—there has been progress—is there still such variability in the treatment for sufferers, leading to enormous and debilitating pain, unnecessary and expensive hospital admissions and damaging consequences for the families of those who suffer from sickle cell anaemia?

Some hospitals and some specialist care units do a fantastic job, but patients with sickle cell anaemia do not want islands of excellence. They want an excellent system that offers high quality integrated care that minimises hospital admissions, manages pain treatment and enhances quality of life wherever they live in the country. The experience of patients, as told to me and to others, is that we are still a long way from having a system in place that delivers that standard of care wherever people live.

I pay tribute to the work of the Wolverhampton sickle cell care and social activity centre based in Bilston in my constituency and to the other patient-led groups around the country, to the Sickle Cell Society, which is the national organisation that speaks up for sufferers, and to the work of the all-party group on sickle cell and thalassaemia, which is chaired by my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott).

[Jim Shannon (Strangford) (DUP)]

The right hon. Gentleman and the House know that people are living longer. On average, people live into their 80s or thereabouts, but life expectancy for those with sickle cell anaemia is 40 to 50, which is better than it was. Can the Minister and the NHS do more with private pharmaceutical companies to try to find a method of prolonging their life? It may not be as good as 80, but it could certainly better than 40 to 50.

[Mr McFadden]

That is a very good point. Shortened life span is one effect of the condition, and there is certainly more to do on the research and treatment fronts.

Organisations such as those I mentioned are doing a tremendous job in explaining what the condition means for sufferers, calling for more attention to it, and pressing for better training for NHS staff and a more rounded way of providing treatment. I have had extensive contact over the past seven years or so with the Wolverhampton sickle cell care group. It provides hugely needed and valuable support for sufferers, which may be anything from helping patients to deal with different governmental agencies and helping their families through crises when they have to be admitted to hospital, to a broader advocacy role. The group praises many NHS staff locally, but their biggest and most consistent complaint is about lack of understanding of the condition among GPs, A and E staff and some other NHS staff, leading to pain and delay for sufferers and bad consequences for their families.

The group told me about Sharon, a single parent of two children under the age of 10 who has full sickle cell disease and is in frequent crisis. Every time she is admitted to hospital, there is a desperate scramble among friends and relatives to ensure care for her children. There is no proper system in place to support her children, and the stress on her and her family is enormous. She discharges herself from hospital early, often before proper treatment is complete, because she has to look after her children, so the whole pattern soon begins again. Is there not a better way to manage Sharon’s pain than through frequent hospital admissions and incomplete treatment? If she does have to be admitted, should there not be a better system of support for her children?

The group also told me about a local man in his 40s who has gone for years without treatment for bleeding at the back of his eyes as a result of sickle cell disease. His sight is now at risk, but earlier treatment might have brought about a different outcome.

The Sickle Cell Society told me about a patient who was costing the NHS a fortune through repeated hospital admissions, exacerbated by the fact that her children slept in the one bed in her flat and she did not have a bed. Eventually, the charity was able to help her to buy her a bed and that made a huge difference. The cost of her hospital admissions could have paid for a hundred beds.

We will never reach the stage where no patient with sickle cell anaemia needs to be admitted to hospital, but getting the care right has the potential to reduce hospital admissions, making the condition easier to manage for the patient and saving the NHS a considerable amount of money. The fact that there is no cure does not mean that good professional care cannot make a difference.

That brings me to the national picture and the peer review of specialist care carried out by the west midlands quality review service and the UK Forum on Haemoglobin Disorders, which was published last year. The review visited 29 hospitals and reviewed the care provided. The aim of the care standards that have been developed is quite simple: there should be specialist haemoglobinopathy teams based in hospitals, backed up by a local haemoglobinopathy team. In other words, the system should have both the expertise to offer the best care and properly connect primary and hospital care. That is a good aim, but the reality is much more varied and therein is one of main causes of frustration for sickle cell disease sufferers and the organisations that speak out for them.

The peer review process found instances of excellent joined-up practice. It found committed staff going the extra mile to deliver the best care, but it also found overstretch, patchiness, breakdowns in care pathways and an unacceptable degree of variability across the country. The report says:

“Cooperation between acute and community nursing teams was sometimes very good but this was not universal. The availability of social work and psychology support was variable”.

It continued:

“In many teams there were inadequate numbers of nursing staff for the number of patients, or in some cases no acute nurse specialist at all. Even where these posts were in place they often had a very high workload which included inappropriate tasks”

such as

“filling in benefit forms…with very poor cover arrangements.”

The peer review process also found that, particularly in non-haematology parts of the system, patients

“perceived they were viewed as ‘second class’ haematology patients.”

That point about how sickle cell patients view their own experience is critical. They often feel that they are treated either with a lack of understanding or, even worse, sometimes with suspicion when they try to explain their condition or arrive at A and E in need of urgent pain relief. Lack of understanding can lead not only to poor care, but to patients feeling they have not been treated with dignity and that their need for treatment is not respected.

I do not need to remind the Minister that the very principle of the NHS means there should be no such thing as first-class and second-class patients. I do not want to see anyone treated as, or feeling as though they have been treated as, a second-class citizen. The whole basis of the NHS, paid for collectively with treatment on the basis of need, is that everyone is a first-class citizen. If there are sufferers of a genetically inherited condition who do not feel they are being treated as such, that is not acceptable and something we should take very seriously indeed.

Another issue identified by the peer review process is poor quality of data. That leaves us unsure about the number of sufferers and unsure, beyond emergency admissions, about the resources devoted to treating the condition. How can we ensure that there is the right treatment if we do not know how many sufferers there are or where they are? What is the Minister doing to improve those clearly identifiable data problems?

The peer review made a number of good and important recommendations about access to specialist care, staffing levels, training, psychological support and managing the important transition between paediatric and adult care. Those issues are absolutely central to the experience of sickle cell patients. Can the Minister tell us this morning what is happening to those peer review recommendations? Will he undertake to go through them not in a general way, but point by point, and to give a progress report to the House if not today, then soon and in writing? Such a report would be welcomed by sufferers and would ensure that there was follow-up on these important recommendations.

Then there is, for patients, the basic cost of living with the condition. To live with sickle cell is to live with pain, and that often means frequent prescriptions. For some patients, the cost can be prohibitive. This is not just a matter of money, but of behaviour. If people do not use their pain relief efficiently because they cannot afford more, it can affect their condition. I appreciate the cost pressures on the NHS, but will the Minister agree to commission a departmental analysis on whether free prescriptions for sickle cell sufferers would cost money or lead to net savings because they would reduce avoidable hospital admissions?

What of how sickle cell care is to be delivered in the future? NHS England is currently the body responsible for commissioning care for rare diseases. That is sensible, because sufferers might be concentrated in different parts of the country and sometimes there may be few sufferers. However, a review is taking place into how that will be done in the future, the results of which are due next year. There are three possible models: continuing with national commissioning, co-commissioning with clinical commissioning groups locally, or leaving it all to CCGs. Given that concern already exists about the large variation in the quality of treatment, knowledge of the condition and the priority given to it, sickle cell organisations fear that a move to only local CCG commissioning will exacerbate the problems. Can the Minister ensure that the way treatment is organised in future is in line with the central aim of the peer review exercise—to deal with the variability of treatment issue—rather than its being organised in such a way as to make it more difficult? I repeat that our aim should be a system that makes the best the norm, rather than balkanising care and creating a lottery, depending on where sufferers live.

Sickle cell anaemia is an issue that deserves more attention than it has received and a greater priority in the delivery of high-quality health care. In some ways, it is less about knowing what the best care looks like and more about ensuring that it is delivered to the highest standard throughout the country, regardless of where patients live. The condition also requires some smart, joined-up thinking between different agencies. Repeated hospital admissions because of a lack of a bed to sleep on is not a smart way to deal with a condition such as sickle cell.

Sufferers have to put up with a life of pain, but good treatment, the right information and the right lifestyle can make an enormous difference. That treatment, information and help vary so much is not acceptable. Dignity and respect are essential for all NHS patients: sickle cell patients feeling they do not always get that should be a concern for us all. It is time we ensured that the best care is available to all sufferers, delivered by a system that understands the condition, fully respects the patient and allows sufferers to live as full a life as possible. I hope the Minister can respond to the issues I have raised today in a way that makes that more likely. On the issues for which he does not have immediate answers, I hope he will go back to the Department and press his officials to make sure the changes we know are needed happen.

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

It is a great pleasure to serve under your chairmanship, Mr Owen, and to respond to the right hon. Member for Wolverhampton South East (Mr McFadden), whom I congratulate on securing the debate. I hugely welcome the opportunity to discuss this issue.

Sickle cell anaemia is a really terrible condition and diagnosis for all those who are affected, but especially for our African and Afro-Caribbean communities. I want to start by acknowledging the work that the right hon. Gentleman has done for his constituency and his community, and I join him in paying tribute to the all-party parliamentary group on sickle cell and thalassaemia, chaired by the hon. Member for Hackney North and Stoke Newington (Ms Abbott). I also pay tribute to the Sickle Cell Society, the Wolverhampton sickle cell care and social activity centre and the patient groups. As with so many rare diseases, it is the advocacy of the few that in the end leads to changes in mainstream provision, and I am serious about paying tribute to that. The right hon. Member for Wolverhampton South East made a number of important points that I will try to deal with in detail. If I run out of time, perhaps he would allow me to follow them up in more detail in writing.

I stress that for those who have had a sickle cell diagnosis, it is a life-changing moment. All of us who are involved in policy making should not take our eyes off the personal suffering that patients—those with the diagnosis—and families and loved ones experience. Some 250,000 people in the UK carry the sickle cell trait, with about 15,000 affected by sickle cell anaemia, as the right hon. Gentleman knows. For those affected, it can mean a life of constant pain management, including, often, extensive periods of hospitalisation when the pain is bad, blood transfusion and red cell therapy, and tiredness, dizziness, palpitations, jaundice and gallstones. All those in combination mean that people are denied the quality of life that the rest of us take for granted.

However, as the hon. Member for Strangford (Jim Shannon) pointed out, the worst aspect of all is a substantially reduced life expectancy. Even today, sickle cell sufferers will, on average, survive until their 40s or 50s. Even though that is a massive improvement on the position 40 years ago, when the average life expectancy was only 14 years of age, it is still a shock when the rest of us are expecting to live very much longer than that. We can only pay tribute to the bravery shown by the people who have to deal with all the problems that this condition brings. However, bravery and resilience are not enough; we need to look at the way in which we support and treat people and bring on innovative care pathways and medicines. That is why we are continuing to invest in improving services, especially blood, bone marrow and stem cell services, which are vital for the condition.

Let me say something about what we are doing. In England, NHS Blood and Transplant provides blood for transfusion services. There is targeted donor recruitment, extended donation testing, and supplements, through a national frozen blood bank suitable for the long-term storage of blood for those with rare conditions. NHSBT’s therapeutic apheresis services provide a range of services to patients through NHS trusts from its six units situated across England, in Bristol, Liverpool, Oxford, Sheffield, Manchester and Leeds. Those units undertake procedures that provide direct treatment to patients with a range of medical conditions, as well as collecting stem cells from both patients and donors. Therapeutic apheresis treatments and services provide both life-saving and life-enhancing treatments for patients referred in sickle cell crisis or for ongoing sickle cell management. NHSBT is working with commissioners further to improve access to automated red cell exchange for sickle cell patients as part of those services.

One option for patients is a stem cell transplant, which requires genetically matched stem cell units, either from bone marrow donated by an adult donor or through stem cells harvested from cord blood. In the past four years, the Government have provided an additional £12 million of new money to help with transplant services. The Department of Health, working in partnership with NHSBT and the Anthony Nolan charity, has overseen the delivery of improvements way above what we originally anticipated.

The achievements include the following. More than 60% of black, Asian and minority ethnic patients are able to find a well matched donor now, compared with 40% at the beginning of the Parliament, and 258 more UK patients received a potentially curative stem cell transplant in 2013-14 than in 2010-11. The process for stem cell provision has been significantly streamlined, with single access searching in both England and Wales. I am delighted to say that there are now 60,000 young donors on the so-called fit panel, whose volunteers are eight times more likely to have donated stem cells than other registry volunteers.

Increasing use of UK-sourced cord blood to meet the needs of UK patients is crucial. This year, more than 25% of cord blood transplants will use donations from UK donors, costing about half the price of imported units. That compares with 10% in 2010. The time taken to provide stem cells from adult donors has improved. The right hon. Member for Wolverhampton South East knows that that is a crucial issue. Samples for confirmatory HLA—human leukocyte antigen—typing are provided from more than 80% of donors within 15 days now, compared with 35% in 2010.

The NHS and its key delivery partners are committed to continuing service improvement—I will say more about that in a moment—in collaboration with patients and patient group representatives, which is crucial. In the NHS today, if a child is diagnosed with sickle cell anaemia, they will be referred to a care team in a specialist sickle cell centre. Those are specialist units usually based, as the right hon. Gentleman knows, in large hospitals and staffed by front-line health care professionals with a high level of expertise in treating people with sickle cell anaemia. A detailed treatment and care plan, which outlines future medical care, is now drawn up for each patient, and parents are given information and support to help them to manage their child’s condition.

Due to the complexity of sickle cell anaemia, multidisciplinary teams are now assembled. Typically, they include paediatricians, haematologists, clinical psychologists, social workers and specialist nurses. The purpose of the care plan is to avoid sickle cell crises and to provide adequate pain relief when a crisis does occur, as well as reducing the risk of serious complications developing, such as infections, stroke and other associated symptoms of sickle cell anaemia.

Clearly, we want to see improvements in health care services for all types of patients. The right hon. Gentleman made that point well. The Government have committed to specific strategic plans in key areas. One of those plans is “The UK Strategy for Rare Diseases”, which covers sickle cell anaemia. The strategy sets out a shared UK vision for all those affected by rare diseases. It is owned by each country in the UK and commits them to more than 50 commitments. The strategy focuses on five areas: empowering patients, identifying and preventing rare diseases, diagnosis and earlier intervention, the role of research and, most importantly of all, co-ordination of care. As I have said, people suffering from long-term conditions are resilient, but that resilience can easily be undermined by the constant to-ing and fro-ing that occurs when a patient’s care pathway is not properly managed.

[Mr McFadden]

I thank the Minister for outlining the nature of the specialist care teams that are in place. He is right, but the critical point made by the report from the peer review exercise was that although that approach worked well in some places, it did not work as well in others. The specialists whom he talked about—the specialist consultants and specialist nursing staff—were not always there in sufficient numbers, and there is still something of a lottery, some might say, or at least unacceptable variability in the quality of treatment and the understanding of the condition, depending on where the patient lives. I therefore want to press the Minister on the recommendations from the peer review exercise, which were all about making the best the norm. What will he and the Department do to ensure that those recommendations are followed through on in that way?

[George Freeman]

The right hon. Gentleman makes a good point. I have my eye on the clock, and I will deal with it.

I conclude my opening remarks by saying that it is no longer acceptable to make the patient fit the pathway. We need to fit the pathway around the nature and progression of the disease in patients. These patients in particular have to see a wide range of professionals, and we need to look at that model. The final thing that I want to mention in terms of our strategic response is the genome project. We are funding 100,000 full genome sequences, to be put together with phenotypic data, with cancer and rare diseases as the initial focus. I am confident that that will quickly start to unlock some insights into possible preventions and new treatments.

The right hon. Gentleman made a number of important points, and I want to acknowledge them. If I cannot deal with all of them now, I will come back to him in writing. He made points about the lack of understanding among GPs across the system; the need for better care pathways to try to reduce hospital admissions; the importance of data underpinning our understanding of good outcomes, best and worst practice and variability; and the important insights in the report. I want to come back to his two specific requests. I would be delighted to ask the various organisations involved to give me a progress report on where they have got to in implementing the various measures, and I will obviously share that with him; perhaps we will have an opportunity to debate it. I will also happily ask NHS England and the National Institute for Health and Care Excellence to look at the health economics of free prescriptions in terms of short-term costs unlocking longer-term savings. I cannot prejudge the outcome of that, but I will happily look into the issue.

In the three minutes left to me, I want to touch on a couple of the specific points that the right hon. Gentleman made. How do we promote understanding and get sickle cell disease higher up the agenda? The 100,000 genomes project also includes a substantial investment in training in rare diseases for clinicians across the NHS as we launch our genetic medicines service. NHSBT and the Anthony Nolan charity continue to promote donations of blood and stem cells, but there is also the issue of the training that goes with that. The Department of Health is working with those key delivery partners to see what more can be done to improve not only donation, but the understanding of the condition and the training across the system.

The right hon. Gentleman asked what measures were being put in place to support care for people with long-term conditions. Our aim is to make the NHS among the best in Europe at supporting people with long-term conditions such as sickle cell disease. In the past, we have not done as well in that area as we would have liked. Through the mandate, we have asked NHS England to make measurable, tangible progress and commitments to supporting people with ongoing health problems to live healthily and independently. The NHS outcomes framework contains a range of improvement areas, and I will happily ask it to give me a progress report on that work.

NHS England is tasked with responding to the UK rare diseases strategy. Earlier this year, as the right hon. Gentleman will be aware, it issued a statement of intent that sets out how it intends to play its part in delivering that strategy; and in the recent NHS England “Five Year Forward View”, it has set out various commitments on exploring specialist centres for rare diseases to improve the co-ordination of care for patients in line with the strategy. I understand that NHS England will be looking to those specialist providers to develop networks of services, integrating different organisations and services around patients. As I said, I will happily ask for a progress report and share it with the right hon. Gentleman. Possibly we will have a chance to debate that in a format similar to this.

I again pay tribute to the right hon. Gentleman’s leadership on this issue. I think that the advocacy of Members of Parliament and particularly those with high concentrations of patients who are especially heavily affected by this condition, along with that of patient groups and charities, will be seen in years to come to have played a major part in helping to drive new care pathways and the integration of research, medicine and care, so that patients who are suffering are given the support that they need.

Urgent and Emergency Care Review

Pat McFadden Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

No one has campaigned more assiduously than my hon. Friend for his local hospital, despite the incredible tragedies and difficulties that it has been through and the pressures that has created for the people of Stafford. He is absolutely right: if we are going to solve the problem, we must consider the system holistically and consider how different A and E departments can specialise services. We need much more of a hub-and-spoke system, rather than one where every A and E has to offer exactly the same menu of services. If we do that, we will save more lives and that has to be the right thing to do.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

Following Monitor’s report yesterday on the closure of walk-in centres, is it not the case that at the heart of the Government’s NHS reforms is a massive shift in power from the consumers—the patients—to the producers of services? When the Government’s slogan is, in effect, “All power to the producers”, it is not surprising that services have been reorganised in a way that does not benefit patients. May I suggest that instead of sticking up for the BMA, the Secretary of State starts to stick up for patients?

[Mr Hunt]

After what happened at Mid Staffs, we will not take any lessons on sticking up for patients—none whatsoever. We are taking the power out of the hands of the managers in PCTs and SHAs and putting it into the hands of doctors on the front line who are seeing patients every day. That is the best thing we can possibly do.

Accident and Emergency Departments

Pat McFadden Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

Quite a lot of the money will help ambulance services indirectly because it will be intended to reduce the number of blue light calls by, for example, providing primary care alternatives to A and E by better integrating health and social care economies, but the long-term change that we announced last week, which I think will make a real difference to ambulance trusts, involves IT. In this day and age it is crazy that an ambulance can answer a 999 call and go to someone’s home not knowing that they are a diabetic who has mild dementia and who had some falls last year. That information could be incredibly helpful to paramedics and we want to make sure that, with patients’ consent, they have it at their fingertips.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

The A and E at the Wolverhampton New Cross hospital is already under great pressure and earlier this year had its busiest day in history, but what really concerns local people are the possible implications of the closure of the A and E at Mid Staffs and the transfer of the work to New Cross. Can the Secretary of State confirm that if that goes ahead, New Cross hospital will have the resources in terms of capital and staff to make it work, because the alternative will be a second-class service for patients in both Wolverhampton and Staffordshire?

[Mr Hunt]

I thank the right hon. Gentleman for the interest and support that he shows for his local hospital. Of course, Mid Staffs has an extremely troubled history and it would be a derogation of my duties if I did not try to sort out the problems there once and for all, but we will not make any changes that have knock-on effects on neighbouring trusts without proper assessment and making sure that provisions are in place so that they can cope with any additional pressures. The final decision about what is going to be done has not been made, but I reassure the right hon. Gentleman on that point.

HPV Vaccine

Pat McFadden Excerpts

Tuesday 2nd July 2013 Commons Chamber

[Mike Freer]

The hon. Lady makes a good point. Herd immunity is valuable only for those who are sleeping within the herd. Those who have sex outside the herd are at risk, and that inequality needs to be addressed.

The best way to protect all males against HPV-related cancers and warts would be to offer the vaccine to all boys aged 12 to 13, as well as girls, as part of the school-based immunisation programme. The vaccine is most effective when given at this younger age, before people start having sex and before exposure to the strains of HPV. Other countries are starting to do that; the vaccine is available for boys in a number of other countries, including Australia and the United States. I firmly believe that we should follow suit.

If we do not have a widespread vaccination programme for boys, at least, and as a bare minimum, gay men should be offered the vaccine when they first present at a sexual health clinic as men who have sex with men. That would match the current policy on offering hepatitis B vaccinations to gay men. Given the expense of treating HPV-related cancers and warts, there is a strong cost-effectiveness argument for extending the availability of the HPV vaccine. If the inequality is not a powerful argument, the cost savings to the Department of Health must be.

The Joint Committee on Vaccination and Immunisation inquiry that began last year is welcome, although little is known of the progress it is making. If the JCVI looks into the cost-effectiveness of vaccination initiatives, it will find that the case to extend the programme to boys is irrefutable.

Each HPV vaccination for the three-dose programme costs £260. Compare that with the lifetime treatment and care cost of an HIV-positive man or woman at £280,000 a year, the £13,000 cost of treating anal cancer, the £11,500 cost of treating penile cancer, the £15,000 cost of treating for oropharyngeal cancer or the £13,600 cost of treating vulval and vaginal cancer transmitted by an infected male. In 2010, the cost of treating anogenital warts was £52.4 million.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

I congratulate the hon. Gentleman on securing the debate. If the Minister and the Department are considering reviewing the vaccine in the light of his speech, may I ask the Minister whether she will also consider another aspect of this—that is, the number of young women who have had a severe adverse reaction to the vaccine? My constituent, Stacey Jones, received the vaccine five years ago and since then she has struggled with memory loss, loss of concentration, mood swings and a need for continuing treatment by the neurology department at the Queen Elizabeth hospital in Birmingham. Does the Minister accept that it cannot be an acceptable price to pay for what might be an otherwise beneficial vaccine programme if some young women undergo such a severe reaction? Will the Minister and her officials look into this to see how many other young women are in that position and whether changes can be made to reduce the number of young women who have had such a reaction or even stop it altogether?

[Mike Freer]

I am grateful to the right hon. Gentleman for intervening on me to ask the Minister a question and I am sure that she will answer it in due course. He makes a valuable point, however. I, too, have a constituent who had an adverse reaction to the vaccine and who is believed to have myalgic encephalomyelitis as a result. Statistically, such reactions might only be small in number compared with the benefits of the widespread vaccination programme, but he makes a good point in that it is important that the Department of Health tracks them to see whether a pattern emerges over time.

A and E Departments

Pat McFadden Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

I do agree, but what hospitals say is that the issue is not the number of beds, but the people in them who are not being properly discharged into the social care system. I was at King’s College hospital last week, where I was told that the hospital had probably two wards full of people who could be discharged into the social care system but had not been. Breaking down those barriers—something that I am afraid the last Government did not get round to doing in 13 years—will be an important priority.

[Mr Pat McFadden (Wolverhampton South East) (Lab)]

The A and E department at Wolverhampton’s New Cross hospital recently saw a record 365 patients in one day. Those pressures will increase with the downgrading of Mid Staffordshire hospital. Does the Secretary of State agree that it will be deeply unfair to patients in both Wolverhampton and Staffordshire if the added burden on Wolverhampton’s New Cross A and E department is not met with increased resources from him, in terms of size and staff, to cope with the increased pressures?

[Mr Hunt]

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