NHS Efficiency

Paul Bristow Excerpts

Tuesday 2nd November 2021 Westminster Hall

[Sir Gary Streeter (in the Chair)]

Before we begin, I encourage Members to wear masks when they are not speaking, in line with current Government and House of Commons Commission guidance.

[Paul Bristow (Peterborough) (Con)]

I beg to move,

That this House has considered NHS efficiency.

It is a pleasure to serve under your chairmanship, Sir Gary. I draw Members’ attention to my entry in the Register of Members’ Financial Interests.

Our NHS is in my DNA. Both of my parents were nurses and worked in the NHS for most of their working lives. It was the NHS that brought my family to Peterborough when I was just five years old, and I have worked in NHS policy for 20 years. My commitment to our NHS and its principles is clear. Few things inspire as much national pride as our national health service, and I want to keep it that way.

The NHS has lost its ranking as the best healthcare system in a study of 11 rich countries by an influential US think tank. Most worryingly of all, it fell to ninth when it came to healthcare outcomes. We must do something about this. We must ensure that the record investment that we are putting into our NHS is spent well. I suggest that that money should come with some very specific key performance indicators that would ensure that it is not wasted.

I feel strongly that the money should be in the gift of Ministers in the Department of Health and Social Care, who are accountable to Parliament, rather than NHS England or NHS Improvement. Like the Department for Levelling Up, Housing and Communities would do with a local authority that does not run a balanced budget or provide statutory services, the Department of Health and Social Care should be able to intervene directly, or at least provide incentives. Recipients would not get their share of the extra cash unless they addressed the challenge of access to care and improved outcomes.

I am keen to help Ministers. I almost feel thwarted, because progress on many of the things that I spoke about at the party conference last month have started to be reflected in Government announcements. That is obviously a good thing, but extra money must come with strengthened incentives to do the right thing and, quite honestly, consequences for not doing the right thing.

The first area in which we need to make progress is local NHS management. Local government has had to make a series of savings in recent years. Armies of local government managers all doing the same jobs in neighbouring local authorities have been an easy target for those defending the interests of taxpayers. However, local authorities have done rather a good job of sharing senior officers. For instance, the chief executive of Peterborough City Council is also the chief executive of Cambridgeshire County Council. As a former Hammersmith and Fulham councillor, I also remember the 2011 tri-borough shared services agreement in west London, between Westminster, Kensington and Chelsea, and Hammersmith and Fulham, which saved over £33 million in just four years. Labour-controlled Hammersmith and Fulham petulantly took their toys home a couple of years later, but the bi-borough arrangement is still saving the taxpayer millions, and this practice is replicated across the country.

That practice is unheard of in our NHS, but why is that? There are no reasons why NHS trusts and new integrated care systems cannot share officers and back-office functions. Let us do away with every NHS trust having its own specific CEO, finance director, human resources director, estates director or diversity director. It is not controversial to ask our NHS to learn from local government. If certain localities cannot make those management savings, are unwilling to share back-office functions, cannot look to make savings, why would we give them the extra cash? I suggest a KPI on a reduction in management costs and back-office costs. I think it would be warmly welcomed by the taxpayer and those in our NHS who know that money is wasted.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I draw colleagues’ attention to my declaration of interest as a practising NHS doctor. Does my hon. Friend agree that one of the challenges is attracting good expertise, perhaps from the business world, into the NHS and that that sometimes costs money and resources? While he is wishing, correctly, to make savings in back-office costs, we should not be too prescriptive because we need to make sure the best people are coming into the NHS, both from within and without, to deliver the productivity gains he desires.

[Paul Bristow]

That is a characteristically well-made point by my hon. Friend. In the current system, NHS chief executives spend 18 months in one trust, then travel to another, spend 18 months there and then travel to another. That is no time at all to get to grips with the challenges that these organisations face. We absolutely need people from the private sector to come in and do these jobs. If they were doing these jobs on a larger scale, that would be welcome. I am specifically requesting that we look to local government, where people have come in and transformed services. I suggest we do the same in our NHS.

My second point is on innovation and new ways of working. Innovation is the way an organisation develops. It should be a constant process—trying to do things better, improving outcomes for patients and trying to be more productive. Across the NHS there are those that innovate with new technology, those that adopt new pathways and service delivery, and clinicians who want to train and learn new techniques. However, the NHS can be poor at spreading best practice at pace and scale. Like any bureaucracy, it can be slow at looking at new ways of working.

There have been attempts to address this. We spent millions funding organisations such as Getting It Right First Time—GIRFT—under Professor Tim Briggs, which is a national programme designed to improve the treatment and care of patients and collect best practice. We created the National Institute for Health and Care Excellence—NICE—which, when it was created, was considered to be a model for the world to emulate on determining the cost-effectiveness of technologies and drugs. NICE also produces quality standards that set out priority areas for quality improvement in health and social care. After all this work has been done and all this money has been spent, many parts of our NHS just ignore it. They say things such as, “This can’t possibly apply to us,” or, “This is merely guidance, and we don’t need to do this here.”

The use of insulin pumps and implantable cardiac defibrillators or vascular technologies should not depend on where someone lives, but it does. The solution is certainly not to reduce GIRFT’s budget from £22 million to £10.8 million, but that is what has happened. GIRFT should be empowered to develop best practices in primary and community care, and we should look at the GIRFT model of hot emergency and cold elective centres to help us power through the backlog.

What is the solution? How do we make outliers adopt best practice and do the right thing? A KPI, and perhaps even GIRFT or NICE, can help us with technology and pathway adoption, which could transform productivity, powering us through the backlog. Backed up with an incentive such as a generous and workable best practice tariff, a KPI could focus attention. If outliers persist in a practice that has been shown to be outdated and to follow pathways that do not lead to optimum outcomes, why would we give them the extra money?

On capacity, staffing is recognised to be a risk factor in delivery for our NHS. The money is there, but it takes a long time to train a doctor, GP or nurse. That is why every hour of a medical professional’s time is valuable. We have to make sure that they are doing what they are paid for and what they went into medicine to do.

[Dr Luke Evans (Bosworth) (Con)]

My hon. Friend is making a fantastic speech. Does he agree that every hour of a clinician’s time is valuable? The average clinician loses about 10% of their workload simply chasing up letters, following up blood tests or trying to find scans, which is a complete nonsense in our current system. It could easily be ironed out by joining up simple IT between primary and secondary care. Is that a KPI my hon. Friend could support?

[Paul Bristow]

My hon. Friend is a champion of efficiency in the NHS and in his profession, and he makes such points regularly in the meetings of the Select Committee on Health and Social Care. Perhaps he has already read my speech, because I think that the winter access fund is an excellent start. It will address what many GPs have rightly complained about for some time, which is the amount of time they spend on fitness notes and chasing appointments, as well as something that I only realised when I met GPs in my constituency. I want to give a quick shout out to the super Dr Neil Modha and his team at the Thistlemoor surgery, who are doing a fantastic job in a very challenging catchment area. What I realised was how much time GPs spend providing medical records to insurance companies and other bodies, which just is not their job.

We need clinicians to practise at the top of their licence. We need GPs seeing ill patients, not prescribing things a nurse could easily do. Nurse-led prescribing has been around for a long time, but it has not been rolled out across as many areas as it should. We need a revolution in physician associate and nurse-led prescribing, which will free up the time for GPs and consultants to do what they need to do.

That same waste of clinician time happens in secondary care. We need surgeons using their skills in the cath lab or the operating theatre. They should not be in theatre only one day a week; they need to be there multiple days a week, every week. I hope surgical hubs and other initiatives will help, but I fear that without a strict KPI on clinician time on highest-skill, highest-value activity—and I am not opposed to backing that up with financial incentives—we will not make the savings in clinicians’ time that we need. Only with such a KPI, together with an effort to demonstrate how valued our clinicians are, will we ensure that their valuable time is not wasted. If an integrated care system or the management structure at an NHS trust cannot or will not do that, we should make it dependent on the extra cash.

Finally, much of this is dependent on greater transparency. I was very pleased to hear the Secretary of State for Health and Social Care say this morning to the Health and Social Care Committee that we are going to be able to see more data relating to the performance of GP practices, but that needs to happen with ICSs as well. In the past, clinical commissioning groups in this country could be guilty of hiding commissioning policies, rationing hip and knee surgeries to those with a body mass index of below 30—or even 25 in a handful of cases—on page 145 of a 278-page document on a website that no one ever reads.

NHS England is just as guilty of doing that with national service specifications and commissioning policies, and politicians have very few means of challenging that as politics has been taken out of the NHS. We need to open up the windows and let the light in. Accountability and transparency have always been the way to improve performance and efficiency, so let us have the Ofsted-style rating for ICSs and other NHS bodies. Let us know who does well and who does not. Together with clear KPIs, transparency and accountability, we can ensure that the record cash injection, which my constituents applauded, is spent well. The NHS is a source of national pride, but its performance post-pandemic can and should improve. I offer Ministers a few ideas—a few acorns—for how we might do that.

--- Later in debate ---

[Paul Bristow]

I am impressed by the Minister’s response. She talked a lot about how the NHS will improve efficiency and productivity post pandemic. I remind her of the plea that I made at the very end of my speech: the key to this issue is transparency and accountability. If we do not open the windows and let the light in, the Government’s ambitions will not be realised, and money will be wasted through other means. Let us try to create an NHS that is as transparent as possible and accountable to Ministers, then we might be able to see some of the changes that the Minister talked about in her speech.

Question put and agreed to.

NHS England Funding: Announcement to Media

Paul Bristow Excerpts

Monday 25th October 2021 Commons Chamber

[Edward Argar]

The hon. Lady will know that, while her local clinical commissioning group—her local health system—may well be considering various options, it has not put any particular option forward to me in that context. I look forward to seeing her letter, but I am certainly happy to meet her if that pre-empts my reply.

[Paul Bristow (Peterborough) (Con)]

My constituents in Peterborough will be thrilled with the £5.9 billion to clear the backlog and the extra cash for diagnostic services, but they will also be keen that that money is spent well. Will the Minister ensure that many more clinicians practise at the top of their licence doing the things that we need them to do, rather than spend their time doing things that clerical staff and more junior colleagues would be better placed doing?

[Edward Argar]

We need to make sure that our NHS workforce, which is diverse in terms of its skills and background, is able to work where those skills are most effectively deployed to deliver the best outcomes for patients. My hon. Friend is absolutely right: where are there are administrative tasks, which I do not in any way denigrate, that are better performed by an administrator than a clinician, we should be looking to deliver that.

Baby Loss Awareness Week

Paul Bristow Excerpts

Thursday 23rd September 2021 Commons Chamber

[James Sunderland (Bracknell) (Con)]

I will admit to being in two minds about speaking in this important debate. As a biological male, I cannot, of course, get pregnant. What do I know, really? Can I feel it? Do I have a right to be here? Do my experiences carry any legitimacy against the amazing stories that we have heard today? Of course the answer is yes, but there is a conflict. This is difficult territory for all of us, but not least for men. We need to destigmatise this conundrum. The fact that something is difficult does not mean that we should not do it or talk about it, so I really hope that I hold it together for the next five minutes or so.

For me, baby loss is about many things. It is about bereavement at the loss of any child, big or small. It is about the devastation that is left behind. It is about the hopes that are dashed, and the misery. It is about love. It is about the agony of miscarriage, however that child is conceived. It is about those trying for children—those who desperately want children. And it is about those going through in vitro fertilisation or intrauterine insemination, with the physical and emotional nightmare that that brings; people mortgage their house and their hopes, take out loans and bankrupt themselves, against the mirage of science. It is great when it works, but the agony of infertility is very real for so many people. This debate is also about those who might never have children and those who do not have children.

Back in April 2018, my young niece succumbed to a very serious illness. It was not long before her second birthday, and she would have been five today. I have not spoken about that publicly, and I do not really want to do so now, but I can tell the House that bereavement at the loss of a child is devastating, and I was not the parent. Grief works in so many ways; it is so difficult. Aside from the inherent loss of a beautiful and innocent child, it is about what is left behind. It is about birthdays, Christmases, the friends and boyfriends that never materialise, grandchildren and children, and it is also about the parents who grieve—and it lasts forever. Politically, this is actually very easy to deal with: we need to throw the kitchen sink at it. I note that the Minister is in her place. Money should be no object when it comes to this kind of thing.

My niece died just across the river in the fantastic Evelina Hospital. It is a brilliant facility, and I commend the staff who work there. What an amazing machine. It is so state of the art that it looks like a spaceship, and the people are just brilliant. I thank them and all the staff across the country doing that very difficult job. However, we must invest in more of these facilities. We have to give all our children the best possible care. It is only money, at the end of the day. There can be no greater prize than bringing a child into the world, or saving a life, or prolonging life, so let us give all our children the best possible chance.

We need to talk about this issue, as we are now, however difficult that might be. Of course, baby loss is also about losing a baby through miscarriage. These are not just embryos; they are people. They are lives. They are the embodiment of hopes and dreams for so many people. They are actually little versions of ourselves. Yes, nature can have a way of taking its own decisions, and that is fine, but miscarriage is devastating for all parents, grandparents, families and so many people who have direct involvement in it. I can only imagine the horror. My heart goes out in particular to women who have to give birth to a baby that once had a heartbeat. I cannot imagine how difficult that must be. We need to empathise and sympathise and just be there, to love and to feel for them.

For women who cannot get pregnant and who do not get pregnant, it is about the pain, the loss, the endless cycle of hope each month, and the devastation as her period starts all over again. This is tricky, tricky stuff. It is also about the sister who churns out children like rounds from a machine gun with complete impunity—with no effort at all. Perhaps even worse, it is about the sanctimonious friend or sister-in-law who can do the same. It is about the doubt and the worry. It is about the compounded misery, month on month. Again, our hearts must go out to the people who are so badly affected. It is about the hours crouched over toilets in cubicles, with negative pregnancy tests, bereft at yet again coming on. The list goes on, and it is real and it is happening today in this country to so many of us.

It is also about the agony of putting on a brave face afterwards. It is about going back into the world—going back into the office—as if nothing has happened. It is tough stuff. Then there are the tests, the invasion, the prodding, the poking and the examinations for those who want to find out why they cannot conceive—being on a slab, feeling like a total failure.

And what about men? Well, here we go. I was that man in the day, doing unnatural things in cubicles in clinics across London. I was that man carrying precious cargo on the tube in odd-shaped containers. I could deal with the alcohol bans for three months at a time, although that was difficult, but the loss of caffeine was really tough.

[Paul Bristow (Peterborough) (Con)]

I commend my hon. Friend for having the courage to tell his story. I, too, have been through the experience of IVF. Does he agree that one of the worst things about going through that battle of fertility is people innocently asking, “When are you and your partner going to start a family? When are you going to have children? You don’t want to leave it too late.” A risk in all this is the lack of awareness that infertility is very common.

[James Sunderland]

I thank my good friend for his intervention. He is absolutely right. You often do not want to say anything, but you feel as though you should. You ask why you have not got children, and why others are having children and you are not. There is the expectation of one’s grandparents. It is a difficult business.

On one occasion, I was eating a piece of white toast in the kitchen and this mad, deranged woman grabbed it from me and said, “Don’t.” On another occasion, I was on exercises with my regiment, with the whole unit on parade—I was there with the brigadier on a big visit—and my phone rang. It was my wife, and she said, “Come home, honey; I’m ovulating.” Those words would put the fear of God into any man. But the worst thing of all is the Brazil nuts, chopped up with breakfast—absolutely horrible things. To this day, I have post-traumatic stress disorder from that.

NHS Update

Paul Bristow Excerpts

Wednesday 21st July 2021 Commons Chamber

[Helen Whately]

I agree that pay for our NHS workforce is clearly very important. That is why we are considering the recommendations of the pay review body and we will make an announcement on pay in due course.

[Paul Bristow (Peterborough) (Con) [V]]

I hugely welcome the Minister’s statement today, particularly the news about the autism strategy, but as we look beyond the pandemic, there is real concern from charities and patient groups that many patients have missed being diagnosed with some very serious conditions due to lockdown and covid restrictions. GPs have a crucial role in dealing with this issue. Will the Minister set out the steps that her Department is taking to provide an extra 50 million GP appointments a year?

[Helen Whately]

My hon. Friend makes a really important point. We have seen people not come forward for treatment during the pandemic and it is worth reiterating that if anyone is worried about their health, it is really important to seek that help and get a diagnosis or seek treatment. We are working to increase the number of appointments available in primary care. One thing we have also seen during the pandemic is that GPs have increased remote working and virtual appointments. We know that many people need to be able to see a GP in person, but there are also opportunities to combine GPs being able to offer services in person and virtually in a way that is good, hopefully, for GPs and patients.

Health and Care Bill

Paul Bristow Excerpts

2nd reading
Wednesday 14th July 2021 Commons Chamber

[Paul Bristow (Peterborough) (Con)]

I draw the House’s attention to my declaration in the Register of Members’ Financial Interests.

I want to focus on two main areas of the debate: the role of patients in accountability and transparency; and tariffs—the way in which we pay for procedures and care. I support the Bill, but I hope that we have the means to address the deep-rooted cultural issue of regarding patients’ views as less valuable than those who work in our national health service. Before I was elected, I was often involved in advocacy campaigns. Patient groups would want to challenge NHS England’s commissioning policies or service specifications. These policies govern the technologies and procedures that are used to treat conditions, but the patient groups would find the decision-making processes totally impenetrable, as would the clinicians and health policy experts advising them. What chance do individual patients and relatives have to make their voices heard?

The same impenetrability applies to clinical commissioning groups. Patient access to established procedures and technologies is blocked by local policies, but people have to be dedicated to find these policies on convoluted websites or page 178 of a 256-page document. For example, CCGs regularly restrict patient access to hip and knee procedures for patients with a body mass index of over 30. Extraordinarily, some CCGs allow procedures only for patients who have a BMI of less than 25. I would confidently predict that that would disqualify the vast majority of hon. and right hon. Members, and we should call it out for what it is, which is rationing.

Such rationing was routine before covid created massive backlogs in NHS waiting lists in some CCGs. Transparency and openness is the solution to these problems. A formal role for patients on ICS boards, a formal role for patients in the development of commissioning policies and creating a national appeals board for challenging commissioning decisions are all ideas that I hope Ministers might consider as the Bill progresses.

Finally, on tariffs, national tariffs are not perfect but they do incentivise providers to treat as many patients as they possibly can. The Bill states:

“NHS England must publish…‘the NHS payment scheme’”—

a document “containing rules for determining” the prices to be paid in future, including, for example, for hip and knee procedures. Tariffs have led to hip and knee procedures and other procedures being done at volume and at scale, certainly, at least, when commissioners agree to pay for them. High volumes of elective procedures have been a good thing and the current elective backlog is probably the biggest challenge that the NHS faces coming out of the pandemic, so whatever ends up in that document, it needs to be clear, transparent and provide incentives for high-volume procedures to be carried out at pace and at scale.

Winterbourne View Hospital and the Transforming Care Programme

Paul Bristow Excerpts

Thursday 10th June 2021 Westminster Hall

[Paul Bristow (Peterborough) (Con) [V]]

It is a pleasure to serve under your chairmanship, Ms McVey. I direct Members to my entry in the Register of Members’ Financial Interests. I congratulate the hon. Member for Worsley and Eccles South (Barbara Keeley) on securing this important debate.

The circumstances of the Winterbourne View scandal have already been described, so I do not want to repeat that history, but I share others’ shock and outrage at the way in which some of the most vulnerable patients in our healthcare system have been treated in assessment and treatment units. Those attitudes and that kind of abuse should be historical; the shameful thing is that they are still with us a decade later. Ten years after the NHS should have changed for good, new scandals keep emerging.

Across the system, the levels of physical and chemical restraint remain disturbingly high. The CQC report is the latest to recommend change, and the Government’s response is needed urgently. Although there has been a welcome emphasis on moving patients into other settings, we know that there are more than 2,000 people with a learning disability or autism in assessment and treatment units right now, and about 200 of them are children.

Progress has been slow. Admissions are not falling, and those patients are still staying in ATUs for an average of five and a half years. We have yet to build enough support in the community. The building the right support programme is a catalogue of missed targets, and I hope the Minister can tell us why. We should have done more, and we should have more confidence in the targets set by NHS England’s long-term plan.

The record to date is not encouraging. Until the cross-governmental action plan is published, as promised, scepticism will prevail. We have heard why families are worried. There are two aspects of current care that particularly trouble me. The first is the widespread use of anti-psychotic medication. Drugged-up patients are no doubt easier to manage, but it can take years to wean them off those drugs, and even then the consequences continue.

The second aspect, which can be read about in The Daily Telegraph today, is “do not resuscitate” notices. I put that matter to the Secretary of State for Health and Social Care at the Select Committee meeting today. What we are really talking about here is a culture—a culture in which the needs of those with learning difficulties or autistic people are sometimes treated as not important. As many hon. Members have said, these people are able to live fulfilled lives. They are human beings, with plenty to live for. It is hard to accept the idea that a “do not resuscitate” notice could be placed on the record of Sonia Deleon, who very sadly died. When they looked at why she would not be resuscitated, it simply said the words “learning disabilities”. That is unacceptable.

Our pride in the NHS should not blind us to its failings. It has systematically failed people with learning difficulties and autistic people. Their trauma is real. The damage is lasting. I have confidence that we now have a Government who are going to take their commitments on social care seriously and, as many Members have said, that includes those in the working-age population and not just those who are old. This action must finally happen.

Dementia Action Week

Paul Bristow Excerpts

Thursday 27th May 2021 Commons Chamber

[Paul Bristow (Peterborough) (Con) [V]]

Like many other hon. Friends, my family has also been touched by dementia. My grandmother spent her final days in a care home and suffered from Alzheimer’s disease. The woman who looked after me when I was a small child was taken from us, but her story was not a sad one: she lived a long life, had regular visits from her family, and, crucially, was loved. My mother was also a nurse and a deputy sister caring for those with Alzheimer’s disease, and my father was a care home manager in Peterborough, providing love, care, and a home to those with dementia. The condition is a progressive one and brutally attacks people’s ability to think and communicate. It takes away who you are. It is an evil condition, but I am thrilled that the Minister has such a strong commitment to finding a cure.

As many other hon. Members have remarked, the Government’s promise to double funding for dementia research and speed up progress in clinical trials is incredibly welcome. The dementia moonshot could be a game-changer and now is the time to deliver on that pledge. As Alzheimer’s Research says, the UK is well placed to capitalise on research. We have a vibrant, diverse research ecosystem thanks to a variety of research and funding sources. This, together with the reform of the social care system, has to be a national priority.

As a member of the Health and Social Care Committee, I have heard some very uncomfortable stories about how those with dementia have had delays in diagnosis, difficulty in accessing care packages, and, ultimately, unhappy experiences at the end of their life. I agree with my hon. Friend the Member for Redcar (Jacob Young) that we need to adopt the same attitude to finding a cure for dementia as we have done to the wonderful combined effort that has gone into searching for a covid vaccine.

I wish to pay tribute to everyone at the Alzheimer’s Society in Peterborough and the Dementia Resource Centre in my constituency who do such wonderful and marvellous work.

Finally, I want to mention a meeting that I have had with the Alzheimer’s Society and the worrying rise in the prescribing of anti-psychotic medication to people with dementia during the covid-19 pandemic. A total of 6,195 over-65s in Peterborough and Cambridgeshire have a formal diagnosis of dementia. Figures from Cambridgeshire and Peterborough show that 656 dementia patients aged 65 and over were prescribed these anti-psychotic drugs, which is up from 619. I understand that the Department of Health and Social Care is monitoring the monthly data, but I hope that there will soon be some action to address this issue.

A Plan for the NHS and Social Care

Paul Bristow Excerpts

Wednesday 19th May 2021 Commons Chamber

[Paul Bristow (Peterborough) (Con)]

It is a pleasure to speak in this debate, and I refer Members’ attention to my entry in the Register of Members’ Financial Interests. I would like to take this opportunity to thank all those who work in our NHS and social care system in Peterborough. Both of my parents were nurses in Peterborough’s NHS, so I know first hand about how much the NHS means to the people of Peterborough.

Yesterday, the Health and Social Care Committee took evidence from Jonathan Freeman. Sadly, his mother Gillian died in January, after suffering for many years with dementia. His answers to my questions were powerful and worrying. The death of a parent is upsetting in any circumstances. Unfortunately, it was made far worse because of the difficulty in securing the right care for Gillian, or in fact any financial support. It took Mr Freeman two years to persuade her GP that there was a problem. When advanced dementia was properly diagnosed, he got his mother into a care home. That care home made mistakes and lacked the support for her dementia. He had to move her again. This new home was much better. It encouraged him to apply for funded nursing care to meet his mother’s needs. Years of savings were being rapidly depleted. A month of rental income from her house was paying for less than a week of her care.

To get the assessment, Mr Freeman told me:

“You would not believe how much nagging”

was needed and the

“delays we had”,

but he got there, and he was told his mother qualified. The assessor even told him that her funding would be backdated. The assessor left, six months passed and he pushed for answers. The assessor had registered the claim on the computer, but never filed the paperwork. He was assured it would be sorted out, but instead the clinical commissioning group secretly commissioned a peer-led review of the assessment. Someone who had never met his mother concluded she should get nothing.

“They would not tell me the reasons”

for that, he told me.

“They did not even tell me there was that panel”.

He appealed. They refused. No reasons were given.

Mr Freeman told me that

“I was a senior civil servant. I understand bureaucracies, but this was Kafkaesque.”

Gillian’s illness progressed. He did not want to go through that ridiculous process again, at least until he was certain it would succeed. By that stage, she was immobile and unable to eat by herself or even communicate. So he applied, and after further delay, everyone agreed with all of the assessments, apart from one—mobility. The CCG’s assessor argued that the wrong hoist had been used, but assured him that this would not be used as an excuse not to fund, but it was. He appealed. They refused, and again no reasons were given.

Mr Freeman had to sell his mother’s house to pay for her care. She was denied access to a continuing healthcare package despite the clear view of three expert assessors, and she died without receiving a penny. It was very clear to him that the CCG seized

“any possible excuse not to provide mum with the financial support that was her right”.

The CCG does not even monitor its performance for meeting the statutory criteria for appeals. It took an FOI request for the CCG to admit it.

The Queen’s Speech committed the Government to bringing forward proposals to reform social care, and we have heard scepticism today about that, but this Government deserve credit for making that promise, and there is no question—no question at all—but that reform is long overdue.

UK Rare Diseases Framework

Paul Bristow Excerpts

Wednesday 24th March 2021 Westminster Hall

[Paul Bristow (Peterborough) (Con) [V]]

It is a pleasure to serve under your chairmanship, Mrs Miller. I draw attention to my entry in the Register of Members’ Financial Interests.

NICE was established to determine cost-effectiveness, and it quickly became the best at this in the world. Given the pandemic, the importance of the life sciences sector to our country has never been clearer. If we want to retain our global reputation, however, NICE needs to alter the way it works. The rare diseases framework should be seen in this context. Its themes of pioneering research and being a global player are the right ones. I am encouraged that NICE recognises the challenges we face. That said, I am not yet convinced that NICE has got to the right place on the detail. Unless we get it right, we risk reducing the number of new medicines arriving to treat patients.

Within the framework, priority 4 is all about improving access to specialist treatments. The review has identified the need to change and update the discount rates, but less helpful are the suggestions in the current process review consultation on how we evaluate new health technologies. Essentially, there are two routes: the regular single technology appraisal process; and the highly specialised technology option, which is far more flexible. Medicines for rare diseases need that flexibility and the higher threshold for cost-effectiveness. If they do not meet the HST criteria, new technologies are stifled. NICE is risking needlessly complex and convoluted criteria that will not allow for transparency on why particular medicines are put into the programme. I hope it will register the concerns expressed by the ABPI and others.

The Medicines and Healthcare Products Regulatory Agency is talking about new pathways to licences. Such work needs to be joined up and supported by NICE’s processes. Early engagement is positive, but NICE must avoid premature decisions, including about the commercial aspects and pricing.

[Mrs Maria Miller (in the Chair)]

To ensure that we can get all Members in, the Minister has very generously given some of her time, so I hope that I can bring in every Member on the list.

Social Care Reform

Paul Bristow Excerpts

Thursday 18th March 2021 Westminster Hall

[Paul Bristow (Peterborough) (Con) [V]]

It is a pleasure to serve under your chairmanship, Dr Huq. I draw attention to my declaration in the Register of Members’ Financial Interests.

Before examining what needs to change, I want to acknowledge the work of staff in the sector. This has a personal element for me. My dad managed nursing homes and my mum was a deputy sister in a residential home caring for people with dementia. I know how hard staff work each and every day. Pay can be low and recognition can be lacking. Likewise, the care workers who support people in their own homes do so much. We only tend to see their importance in reverse, when the lack of a placement or support prevents hospital discharges.

We need to go much further in integrating our approach. Last month I helped launch a report by Look Ahead. Unlike most of the reports that land on our desks or in our inboxes, it called for reforms that would not cost money. In fact, taxpayers would save money. Look Ahead looked at one element of integration: supported housing. It estimated that nearly £1 billion could be saved each year by extending integrated mental health, social care and supported housing services across England. The report is a robust analysis of how supported housing keeps people with mental health problems out of institutionalised care. This means more than just savings. The online launch began with a video from service users, which had the hairs standing up on the back of my neck. One man told us how it was the first time he had ever had his own private shower. He said that it made him feel like a king. These are small, but incredibly significant and humanising differences.

We know that there is not enough money to sustain the social care system as things stand. Any way to make savings, while improving outcomes, must be seized. Yet, only a handful of NHS trusts and local authorities are adopting an integrated approach. In my view, this missed opportunity comes down to culture. I am not casting aspersions; the system just is not geared towards different organisations working together. Outcomes are what matters and the goal, for most, should be to help people to live as long as possible, independently, away from institutionalised care.

Lasting reform requires not only innovation and leadership by Government, but political courage on the part of the Opposition. If social care funding is left as a political football, we know who is being kicked around. Two decades have seen at least a dozen White Papers on social care reform. The right ambitions are easy to state; it takes legislation and political will to achieve them. As we emerge on the other side of the pandemic, the need for such services will only grow. The Prime Minister has given us a road map for leaving lockdown; a road map for integrated social care would be as profound as the creation of the NHS.