NHS Workforce: England

Paul Girvan Excerpts

Wednesday 17th July 2019 Westminster Hall

[Derek Thomas]

I said that in humour, which is why I talked about my own skill—or lack of. It is a curious thing, though, to hear people talking about the crisis in staffing when so many of them are in this place.

On a more important note, we are in a tricky situation with the challenges around the apprenticeship levy. In Cornwall, we hope to train 200 nurses using the apprenticeship levy over the next two years—that would address the shortage—but we have to recognise that funding is needed and I know that the Minister is looking at that now.

[Paul Girvan (South Antrim) (DUP)]

Will the hon. Gentleman give way?

[Derek Thomas]

I will when I have finished this point. Whatever the solution, we must recognise the added pressure on existing staff.

[Paul Girvan]

On that point, it is all very well getting nurses into and through training, but in Northern Ireland the NHS is haemorrhaging nurses who are not leaving the profession, but going into agency work, getting paid two and a half times more than they were and working the hours that they want. Not only is workforce planning impossible when people can just work when they want, but we lose continuity of care in wards.

[Derek Thomas]

I appreciate that valuable intervention. I had a conversation with the former Secretary of State for Health about how, when the student loan was introduced, there might have been a way in which students had all their loan written off if they gave seven years’ service to the NHS. The advantage of that, to be honest, is that people who had done seven years after qualifying would probably have settled down by then, entered into a home purchase and perhaps had family, so they would have been, first, less likely to clear off to another country and, secondly, kind of tied into the NHS where they were.

In part, that addresses the problem the hon. Gentleman raises. Yesterday, I met a newly qualified nurse from the south-west who found that on Christmas day she was the leading NHS nurse, supported only by agency staff. That must stick in the back of NHS staff’s throat, when they know that extra pay is available to agency staff. Efforts have been made to address that, and there must be ways to do so, but that is what we are getting at today—the workforce challenge.

If we have a workforce challenge, other things will happen, such as agencies springing up and the demand for them. We have to get to a place where working for the NHS as a nurse employed by the local trust is the best and most rewarding place to be, and appreciated by all. We simply do not say often enough how great such people are. We can do so many things locally and nationally to rebuild value, trust and appreciation in those people. The challenge for Health Education England is to look at how we fund local innovative ideas, ensuring there is enough money, as well as flexible support, to find solutions. I discussed that with Simon Stevens, and he seemed alert to the challenge.

As I said, I met nurses from the south-west yesterday, and they were concerned about safety on wards and retention of nurses. We have this bizarre circle spiralling downhill: if nurses do not feel safe, they go to do something that might not be nursing. Unfortunately, in places of low unemployment, lots of other work and employment opportunities are available, often paying more.

Solutions are possible. In Cornwall, I have found that people often do not know what is available. The Royal Cornwall Hospitals NHS Trust and other trusts in Cornwall, my local college and I got together to work on an event in the college called “Work for the NHS+”, which included 15 or more different parts of the NHS, as well as some from social care. They came along to tell students and the general public what the employment opportunities were, the pay and training that could be expected, and what kind of career paths were available. In Cornwall, as in many other parts of the country, there are some fantastic members of staff and people in the NHS and social care who can inspire others. This might sound ridiculous in a debate on shortages on a ward, but when we have such individuals, we must find opportunities to get them in front of people who are thinking about which career they should choose.

I do not know much about the other challenging problem raised by the nurses yesterday, but it is right to mention it. They said that although more nurses are training, training placement opportunities are fewer. They suggested that part of nurse training now is off the ward—obviously that has happened before, but they were concerned about whether that virtual training or simulators were the same. I know that the Minister will take seriously all opportunities to get nurses trained in the best possible way, so I will not dwell on a subject that I do not know much about.

I mentioned the issue to do with podiatry, which is a real problem in the south-west. We must find ways to help professionals, whatever they do, whether therapy, physio or all the things that people to do to ensure that we stay well and do not end up in hospital. Podiatry is one of those. We must ensure that people get the training, that they can afford to do so, and that they can have a great career in the NHS or with local authorities. We need to talk to universities about exactly why they are not attracting the kind of numbers they need to justify the courses.

I should have declared an interest at the beginning: I chair the vascular and venous disease all-party parliamentary group. One thing I am being told loud and clear—I have done a lot on this—is that because we have taken the nursing bursary away from older students, they find it difficult to go on the courses that I am describing. That will have a real impact on the numbers of nurses available to do those important jobs. If we do not address that issue, in a place such as Cornwall, where diabetes is a significant problem, the pressure on urgent care will be enormous—if it is not already.

Last week, our general district hospital—the only one in Cornwall—closed to the public, because a spate or outbreak of vomiting and diarrhoea put a lot of people from nursing homes and others into hospital. In that situation, the system rallied and did some amazing work to cope, ensuring that no one who needed care was failed, but it was also an example of why we need to work equally hard, if not harder, to ensure that at the best of times and the worst of times people get the best healthcare available.

The NHS in Great Britain is the envy of the world. We need to be careful always to remember how fantastic our system is. Last week, my brother and his wife came back from Cambodia with stories of trying to get healthcare there—they have two young children—and that reminded me of how fantastic our health service is, as are all those who work in it.

NHS Whistleblowers

Paul Girvan Excerpts

Wednesday 18th July 2018 Westminster Hall

[Patricia Gibson (North Ayrshire and Arran) (SNP)]

I thank my hon. Friend the Member for Central Ayrshire (Dr Whitford) for bringing forward this important debate. I think we all agree that when malpractice and failure in our NHS threaten the public interest, and when concerned staff do not have the confidence to speak up and share their concerns, our public services are threatened across the board. Of course, that does not apply just to the NHS—we know it has happened in other sectors.

My hon. Friend, who focused on the NHS, pointed to recent examples that underline the need for staff who raise concerns to be protected. Indeed, almost all the official reports and the inquiries that have followed have shown that co-workers had seen the dangers but had been too afraid to raise the alarm, or had raised it with the wrong person or in the wrong way. We need only cast our minds back to the Clapham rail disaster, the Zeebrugge ferry disaster and the empire of Robert Maxwell—in all those cases and others, people already had concerns, but they were either unable or unwilling to come forward, for whatever reason.

[Paul Girvan (South Antrim) (DUP)]

Numerous NHS staff have indicated to me their unwillingness to come forward because they believe there is a culture of bullying in the NHS. If they make a complaint, they are targeted. Even though complainants want to remain totally anonymous, that does not seem to happen. I know one doctor, in particular, who raised an issue and who feels he has been sidelined from promotion and everything else because of the stance he took against his peers.

[Patricia Gibson]

Sadly, we have heard that point several times during the debate. We hear it far too often. The culture must change.

We have focused on the NHS, which we all understand is an important public service. If the public cannot trust and have faith in the NHS, we are in a sorry state indeed. I am sure my hon. Friend the Member for Central Ayrshire would tell us that the reason we need to ensure there are robust mechanisms in place to protect whistleblowers is that, ultimately, whistleblowing is about saving lives.

We will never know whether safer whistleblowing, with protection for those who raised concerns, would have halted the activities of Ian Paterson in the NHS and the private sector, given that concerns about his surgical procedures and his desire to carry out harmful and unnecessary mastectomies had apparently been circulating since 2003. Professor Ian Kennedy, who reviewed Paterson’s practice, put it like this:

“Whistleblowers do not fare well in the NHS. This is one of the major indictments of management in the NHS: that it is inwards-looking, over-defensive, and prone to destroy, by a variety of means, those who suggest that the Emperor has no clothes…It is a blight on the NHS and is one of the principal areas where lessons must be learned.”

As the hon. Member for Stirling (Stephen Kerr) reminded us, where provisions to further protect whistleblowers are required, they should be put in place.

It has been reported that up to 10 doctors who worked with Paterson are under investigation by the GMC, apparently for failing to act on concerns. I make no comment about that, but one has to ask how it is possible that there is a culture in which fellow medics can even be suspected of failing to act on such concerns. How on earth could such an ethos ever develop and, apparently, thrive? That monster has lurked in the NHS, and that culture has to be changed. As the hon. Member for Hartlepool (Mike Hill) said, it is changing, but not as quickly as we would like.

As my hon. Friend the Member for Central Ayrshire outlined, the Scottish Government have implemented a number of measures to help protect whistleblowers and ensure they feel confident to speak out. Extra legal protections are now in place for student doctors and other postgraduate trainees who speak up if they are unfairly treated by their training body. However, as she pointed out, those are—and must be—quite separate from standard employment issues.

Importantly, the Scottish Government have committed to the function of the independent national whistleblowing officer for NHS Scotland being held by the Scottish public services ombudsman, creating a mechanism for independent external review where an individual has a concern about the handling of their whistleblowing case. That will be in place by the end of 2018. Importantly, the intention is to ensure that whistleblowing cases are concluded in a reasonable timescale. We heard from the hon. Member for Stirling about a case that dragged on for many years, which is far too long. That is simply not acceptable.

As my hon. Friend the Member for Central Ayrshire pointed out, we are building a consistent approach in Scotland. Staff will have access to an independent external body that can review their case and bring it to a clear, final and fair conclusion. I urge the Minister to study the improvements in Scotland carefully to ensure that the system in England is as robust as it can be and as supportive as possible to whistleblowers who raise genuine concerns. Of course, that is not to suggest that Scotland has nothing left to learn. We all must continue to be very vigilant, as the hon. Member for Stirling pointed out.

Gagging clauses have been used to suppress, or potentially suppress, information about patient care, which can lead to failings being repeated. I think we would all agree that that is completely unacceptable. My hon. Friend gave us a timely reminder—if we needed reminding —about the tragedy of Mid Staffordshire, which led to the deaths of as many as 1,200 patients. That must not be allowed to happen again.

Such malpractice and failings can thrive only in a culture where people are afraid to speak out and where fear and secrecy reign, as the hon. Member for Hartlepool reminded us. We have learned from Mid Staffordshire, but we must go on learning from it. I urge the Minister to be ever vigilant and watchful. Of course, genuine concerns have to be raised responsibly, but they must be raised. The NHS as an institution must encourage that, as the hon. Members for Stirling and for Hartlepool set out.

A whistleblower must be seen not as a problem but as someone who genuinely seeks to improve how things are done. Every Member who spoke alluded to that. That requires a culture change in the many corridors and management offices of our health system, which will take time. We are getting there, but we are not there yet. We must never be complacent. Openness and transparency are key to ongoing learning and improvement, and such a culture will give patients the confidence they need. I am keen to hear the Minister’s response to those concerns.

Access to Orkambi

Paul Girvan Excerpts

Tuesday 17th July 2018 Commons Chamber

[Mr Lewis]

Of course I agree entirely. It must be very frustrating for Holly and her family to find themselves in this situation. There really is no excuse for delaying the beginning of a review. Members know full well how long these reviews can take, so let us get on with it. I think we are united in a belief that this is absolutely essential as part of the lessons that we need to learn from this situation.

[Paul Girvan (South Antrim) (DUP)]

The hon. Gentleman alluded to having spoken to families of people who were on a large cocktail of drugs and the costs associated with that. Let us not say that it is just down to costs; I appreciate that NICE might well be using the wrong process. This cocktail of drugs adds up to a significant cost, and there can be a dramatic saving if they can come off some of those drugs, as well as losing the side-effects that come with them.

[Mr Lewis]

I agree entirely. We sometimes spend vast amounts of public money reacting to a problem, and the rhetoric is all about prevention and early intervention, but we end up doing the opposite. This is a very good example of that.

Fortified Flour

Paul Girvan Excerpts

Wednesday 16th May 2018 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

I, too, congratulate the hon. Member for Pontypridd (Owen Smith) on bringing this debate to Westminster Hall. I congratulate him on presenting his case so well, as he did at the awareness day that some of us were able to get down to. As the Democratic Unionist party spokesperson for health, I am aware of this issue and very supportive of the fortification of flour.

All the speeches we have heard were tremendous. I commend my right hon. Friend the Member for Belfast North (Nigel Dodds) for telling a very personal story. Personal stories in these debates always carry substantial weight. His was a story that he and his wife have walked, and although we might have known something about this issue, we have heard a whole lot more. I commend him on that and assure him of our support. He knows that it has always been there for him, but on days when we tell personal stories we feel it a bit more.

When my parliamentary aide was pregnant, we got a surprise. In the mornings when she was under a little pressure, instead of shouts of “coffee” coming from her desk she would ask for water. By the time of her second baby, we all knew what “no coffee” meant—baby on board. You can imagine the apprehension I felt, Mr Hanson, on a Friday morning when I said to the staff in the office, “Girls, who’s for coffee?” If they said no, I knew they did not want coffee, but was there anything they wanted to tell me? That, however, is by the way. Why did my aide do that? It is simple: she told me, “Coffee makes the baby’s heart beat faster, so I need to stay away from it.” I wanted to make a contribution to the debate because she has lived through this.

Almost every mother I have ever known, as soon as they have that pregnancy test, has made changes to their lifestyle. They do it automatically, and in many cases right away, for the sake of the baby. They stop having alcohol and start on vitamins, reduce caffeine and increase their fruit and veg. By doing that, they naturally create—to use an Ulsterism—a better wee home for their child, which is what the mother is trying to achieve.

This is a personal story from my aide. They are told by the doctor to take folic acid, and of course they do, because it is important, but the problem is that ladies who have been on contraceptive pills find their folic acid store completely depleted. If they have not taken folic acid before pregnancy, it may be too late. With approximately 40% of UK pregnancies estimated to be unplanned, that is certainly an issue, so we look to the Minister for a good response. I mean this respectfully: larger ladies who have a higher body mass index should be taking more folic acid than the usual pregnancy dose. That is not talked about widely, but it is important to put on record how important folic acid is for anyone who is pregnant, and perhaps those showing signs more than others.

I read an excerpt from the NHS Choices website regarding flour and folic acid that made things very clear to me. It describes how a randomised controlled trial from 1991 first indicated that taking 4 mg of folic acid during pregnancy—10 times the current recommended dose—could prevent about 80% of neural tube defects. On the basis of that trial, it was concluded that such defects are due to a vitamin deficiency that needs correcting before pregnancy. However, it said that, despite campaigns, a study of nearly half a million women in England showed that less than a third took folic acid supplements before pregnancy. That tells me clearly that action is needed, and it is needed now.

[Paul Girvan (South Antrim) (DUP)]

On adding folic acid to flour, we have potentially been putting fluoride into water, and that has virtually no health benefits. That has only dental benefits, which are about lifestyle choice, and that is different from those suffering because they are not getting folic acid through their diet. It is great that this issue has been brought forward, and we should look to put folic acid into flour and ensure that everyone gets it, because there are no negative sides to that.

[Jim Shannon]

I wholeheartedly agree with my hon. Friend. We are already putting additives into many products we eat, to our benefit, and that is what we should be doing.

To return to taking folic acid supplements before pregnancy, of the half a million women in England surveyed, less than a third did so. The figures varied by age, with the highest use in women aged 35 to 39, of whom 38% took it before pregnancy, compared with only 13% of those aged 20 to 24 and 7% of those under 20. There was also a marked ethnic variation, with 35% of white women taking it compared with 20% of south Asian women and 18% of Afro-Caribbean women.

Just under two thirds of all women took supplements in early pregnancy, but the researchers say that that is already too late. The current strategy of encouraging women to take folic acid before pregnancy is inadequate and, in particular, putting younger women and minority groups at a disadvantage. People always talk about stats, but the fact of the matter is that they tell a story—and these stats tell a clear story. When women take folic acid before and during pregnancy, it makes a difference. However, there is clearly either no knowledge or not enough information about it. We look to the Minister and the Government to step forward and do what is right.

I would also like to mention that whenever people come to my office for benefit claims and I see what medication they are on, as we need to do—it must be the same for everybody’s offices—I find it surprising how many are, for different reasons, in receipt of folic acid. That is because folic acid helps to get their bodies back into kilter. That is important: folic acid has benefits not just for those who are pregnant but for those who are in ill health.

While I understand the Government’s reluctance to become a nanny state who enforce rather than guide, we should remember that flour fortification is not new. To white flour, the UK adds calcium, iron, thiamine and niacin to replace the nutrients stripped and discarded when the bran and germ are removed from the wheat grain. That was introduced after world war two to help improve the nation’s heath. We did it then for that purpose, so why in 2018 can we not do it for the purposes we are presenting to the House today? I do not agree with the nanny state argument. Sometimes, Governments have to take the initiative and do things that are important.

Today, milling is even more efficient at stripping the nourishing layers from the endosperm, which means that even less natural folate is left in white flour than there was when replacing other lost B vitamins was deemed necessary. There is, therefore, a greater need today for folic acid than there was in the past—even after world war two, when that was seen to be important.

I will conclude, because I am conscious of the timescale you gave us, Mr Hanson. The Government must consider this issue. I give my full support to the hon. Member for Pontypridd for bringing the debate forward, and to my right hon. Friend the Member for Belfast North and other speakers. We have all come here with the same message, in an attempt to highlight this issue to the Government. Anything we can do to bring healthy babies into this world should be done without any delay. This seems to be a cost-effective way of helping mothers and their babies from the earliest opportunity. I am fond of the Minister, and he knows that. I look to him for a substantial response—no pressure whatsoever—on what we have proposed, with reasons.

Cancer Targets

Paul Girvan Excerpts

Tuesday 1st May 2018 Westminster Hall

[Mr Baron]

I completely agree. Our inquiry into cancer inequalities in 2009 found that the NHS is as good as any other healthcare system internationally, if not better, at treating cancer once it is detected; the problem is that we do not detect it early enough and we never catch up. The line of international averages compared with UK averages shows that we are always behind, and there is little evidence that we are catching up. We get behind at that early one-year point, because we are not diagnosing as early as other healthcare systems, and no matter how good our treatment, we do not catch up. That is how we are losing those tens of thousands of lives, because we are not matching the European averages for survival rates.

[Paul Girvan (South Antrim) (DUP)]

Having been through treatment in the past, I appreciate that early diagnosis can, if dealt with correctly, save an absolute fortune. Everyone has heard the saying, “A stitch in time saves nine.” Unfortunately, leaving it too late, rather than intervening early, and having to treat the symptoms as they progress costs the health system a lot more money.

[Mr Baron]

I completely agree. I have not mentioned that aspect, because I have been focusing on patients, but the hon. Gentleman is absolutely right. If we were to diagnose earlier, the NHS could save a lot of money. We all know that, by and large, the more invasive the treatment, the more costly. Given how large the NHS is, too few health economists are trying to quantify this. When I ask my local CCG or cancer alliance, they do not know the cost savings associated with earlier diagnosis. That is a great shame.

 Orkambi and Cystic Fibrosis

Paul Girvan Excerpts

Monday 19th March 2018 Westminster Hall

[Paul Scully]

One thing I will say in favour of Vertex in this case is that, although the amount of people who suffer from this condition is fortunately restricted, the research and development still has to go in. It is not like developing the next ibuprofen or cancer drug, which will go out to millions of people; this would go out to 70,000 people in the world. In order to build that research and development budget in, Vertex needs to charge reasonable costs for the drug. None the less, those costs do need to be reasonable. That is why the negotiation needs to be absolutely above board, transparent and sensible for the sake of the sufferers, who, frankly, do not have time to wait for a prolonged negotiation.

[Paul Girvan (South Antrim) (DUP)]

So much emphasis is put on the cost of treatment, yet if we add together the costs of the cocktail of drugs that many sufferers are currently on, there probably would not be a big difference from the cost of the new drug.

[Paul Scully]

I will come back to that important point in just one second. We were talking about the campaign being brought together, and I want to pay tribute to the hon. Member for Dudley North (Ian Austin), who has done a fantastic job in raising the profile of cystic fibrosis. I am sorry that I was not able to be at the roundtable that he hosted—I was out of the country—but 41 Members were there who were keen to learn more about this. That is because of his efforts and the efforts of the petitioners, and that is absolutely to be welcomed.

--- Later in debate ---

[Paul Masterton]

My hon. Friend powerfully sums up why Vertex, the SMC, NHS Scotland, NHS England and NICE need to work together to find a way to make Orkambi available on the NHS as soon as possible, not just in Scotland but right across the United Kingdom. I understand that confidential talks are ongoing and I very much hope that there will be a positive conclusion; there is no reason to assume that an agreement cannot be reached. We have seen things happening right across Europe, and in the Netherlands a deal was struck fairly recently to allow the drug to be made available.

[Paul Girvan]

Big pharma has a strong lobby and there are those within the industry who would lose out if a drug such as this were to be licensed and used in the UK. They would fight tooth and nail to ensure that it did not get across the line. I ask the Minister: whenever a new drug is assessed, is consideration given to the fact that there are those who will not want it to see the light of day?

[Paul Masterton]

I suspect that the Minister has listened carefully to that intervention. I, too, will be interested to hear his response.

I finish by extending my hope that we are able to get the drug licensed for more children—the current license is for those aged 12 and over. In January, the European Commission extended the marketing authorisation for Orkambi to include children aged between six and 11 —just like those young people whose desperate grandparents took the time to contact me—and, just days ago, the Republic of Ireland became one of the first EU countries to make Orkambi available to children aged six and over. I hope, therefore, that Orkambi will not only become available on the NHS in the near future, but that Vertex will make a further submission to the SMC so that it can also be available to six to 11-year-olds.

Cystic fibrosis is a serious, life-limiting condition, and Orkambi can help to give people with the condition as long and healthy a life as possible. Both in Scotland and across the UK, there should be no unnecessary delay in extending access to it, either because of age or because of its availability on the NHS.