Cerebral Palsy: Adult Care Transition
Paul Maynard Excerpts(1 year, 1 month ago)
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Paul Maynard (Blackpool North and Cleveleys) (Con)
It is a pleasure to have the chance to participate in a debate on cerebral palsy. I tend to be quite sparing in the opportunities I take to discuss this matter in this Chamber. I restrict myself to one opportunity per Parliament, so this is my effort for this particular part of the decade. So many and varied are the issues that could be covered that I could hold a debate on cerebral palsy every week of the year.
Cerebral palsy is one of the least well-understood conditions around—the incidence among the general population is the same as for Parkinson’s or motor neurone disease—and I think that it is partly because of that, and partly because of its broad spectrum of impairment, that it does not have the same profile in the public consciousness. Nor did it have, until recently, a condition-specific charity. Now, at least, I can thank Action Cerebral Palsy and the Adult Cerebral Palsy Hub for their actions and support for the all-party parliamentary group on cerebral palsy, which I chair, as well as the Cauldwell Children charity, which not only sponsors our APPG but, perhaps more importantly, supports tens of thousands of families up and down the country whose children often have quite complex special educational needs.
In this place, we often discuss issues around the transition from childhood into adulthood, so the Government recognise what a crucial stage that is in someone’s personal development. We consider it with regard to care leavers, for whom support has been extended to the age of 25, as well as to the introduction of education, health and care plans, which have also been extended to the age of 25. I think that we need to apply the same philosophy to cerebral palsy.
I mentioned earlier the broad spectrum of impairment, which is, I think, part of the problem in the way in which both Government and society as a whole deal with the condition. Eighty per cent. of those with cerebral palsy have some form of spastic motor impairment, but that is so broad that it ranges from the likes of me, who can function fine 98% or 99% of the time, to those with dyskinetic forms such as the twisting and repetitive movements known as dystonia, the slower movements known as athetosis, and irregular, unpredictable movements known as chorea, so planning for the inclusion of those with cerebral palsy in the adult world has to be, by definition, an individualised process.
The existing legislative framework is disconnected and fragmentary, and does not account for cerebral palsy as a condition in its own right. Indeed, all too often, I feel that it is bedevilled by ignorance on the part even of medical experts at times, and by a lack of common sense from providers. As those of us with cerebral palsy leave full-time education, we encounter a much less structured world where preconceptions about our abilities seem to be so much greater and, invariably, utterly misguided.
People watching the debate on their TVs will assume that I am drunk. That always happens; every time I stand up in this place and appear on TV, I get an email saying, “Why were you drunk when you appeared in the Chamber?” I personally find that quite ironic because I am actually allergic to alcohol as it is a trigger for my epilepsy. It is perhaps a good thing to have a Member of Parliament who is allergic to alcohol and can always speak and, indeed, vote with a clear mind—if only we could all manage that. Preconceptions about cerebral palsy are rife, day in, day out. I stress once again for the record that cerebral palsy is not an intellectual disability—it never has been; it never will be.
Help and advice for individuals during their transition into adulthood are all too scarce. During the course of the APPG’s inquiry into this issue, I have been consistently struck and, indeed, depressed by how policy and practice, as well as day-to-day experience, have not moved on since my own passage through education and early adult life. Indeed, the online community Cerebral Palsy Adult Advice UK made the following submission to the APPG’s inquiry:
“We have been totally overwhelmed by the number of adults joining our group looking for help because they have no idea where to start… we have been inundated by members seeking help—help that we are not equipped to direct them to, because it simply doesn’t exist.”
One young person with CP told us:
“I have to be the educator and adviser—there is still too much ignorance at every turn and an immediate assumption of my mental incapacity”.
This all leads to thwarted ambitions. The all-too-human desire to make the best of ourselves can be very hard to fulfil, given the hurdles that so many with CP face. People often ask me how I feel about what I must be missing out on in life. I get that question so often, and it really angers me. How could I have any conception of what I am missing out on? This is my lived reality day in, day out; I do not know any different. I do not feel I am missing out. I do not feel that there is any detriment to my life experience, but people always make that assumption.
There has to be a fundamental re-design of the services, rights and processes involved in the transition to adulthood. The consequence of not doing so is a failing at both an individual and systemic level of what is needed to support, equip and prepare young people with cerebral palsy as they move into adulthood and a lack of understanding of the day-to-day challenges that they will experience. Every young person with cerebral palsy must have in place a road map for their transition to adulthood that includes their education, health and care needs.
Like any good APPG report, mine has come up with a 10-point plan—I often wish we had 11 points or nine, just for a bit of variety, but there we are. As we have a Minister from the Department of Health and Social Care, my hon. Friend the Member for Faversham and Mid Kent (Helen Whately), here today, I will restrict myself to the health points. I recognise that a special educational needs and disabilities review is under way, which will consider the other points that I will not raise today.
The APPG recommends that each child and young person with cerebral palsy and their family must have a dedicated lead professional to act as an advocate, co-ordinator and support from the point of diagnosis through to the completion of their transition to adulthood. Each integrated care system must enhance the empowerment of young people living with CP by creating dedicated budgets for the individual to access the necessary resources and services from the public, independent and voluntary sectors to prevent the deterioration of their health and wellbeing in adulthood.
Every integrated care system in England should create new regional hubs of specialisms for those living with CP hosting multidisciplinary teams, bringing together experts from the public, independent and voluntary sectors. These hubs would have a specific focus on upskilling, training and recruiting specialist therapists and clinical practitioners.
The Government should make available investment in high-quality healthcare, therapy and education to unleash the potential of young people with CP, which, in turn, will reduce future costs in adulthood incurred by those living with the condition.
Dedicated healthcare transition care pathways for young people with cerebral palsy, alongside a dedicated adult service for the condition, should be in place in all nations of the UK. I have always been struck that I had no medical follow-up after the age of about 13, with no more physio and no intervention, yet that was the point at which my body was growing the fastest and my muscles and limbs were outgrowing the ability of my brain to develop them properly. Right when I needed it most, I had the least intervention of all. I only began returning to a proper form of physio three years ago, which has made an immense difference, not necessarily visibly but to my core body strength and my ability to do things that we need to do in daily life. That is why it is really important that we do a much better job at identifying people with CP, to monitor their development throughout their lives. I welcome the fact that the cerebral palsy integrated pathway is being upscaled to create cerebral palsy registers in every part of the UK. That has to be a good thing, but we must build on it and utilise that information now that it is being collected.
An estimated one in four children and young people with cerebral palsy will be non-verbal and require the use of assistive technology and alternative and augmentative communication strategies throughout their life. Preliminary research findings from Ireland have found that, while assistive technology—or ATech, as it is called—is valued, it also carries a “challenging and lengthy” funding process and high rates of abandonment without proper assessment or training. This is an issue that I have done a great deal of work on with Ministers during my time in this place, and I recognise that ATech is something that is now really embedded in the Government’s approach. I welcome the work done in the UK by bodies such as the Ace Centre to make us a world leader when it comes to ATech; I am pleased to also chair that APPG, but I will save that for what I suspect will be a future Adjournment debate. I am grateful to the disability Minister, my hon. Friend the Member for Corby (Tom Pursglove), for his engagement and support and for recognising the role ATech can play in the workplace.
All the strategies I have outlined are lifelines for young people with cerebral palsy who have challenges with motor function and verbal communication. Effective and timely access to appropriate equipment and training in the use of technology, which should start in infancy for all those who will require it, will enable the young person to engage fully within their social environment, home and school or further education community, and in the workplace. Families with young people with cerebral palsy have given testimonials to the APPG that they require expertise and support from professionals who understand how the interrelated comorbidities of cerebral palsy impact on each area of their son or daughter’s life. Parents have described the sense of exhaustion that they are driven to by having to explain their child’s condition to multiple agencies over and over again, and facing long delays for decisions to be taken and funding agreed on.
The most common proposed solution from parents and carers of young people with cerebral palsy is the creation of one-stop-shop regional centres, bringing together expert professionals: doctors, therapists, orthotists and dieticians, dentists, nurses, educationalists, and indeed anyone we can think of to collaborate and meet the holistic needs of the individual with cerebral palsy. For example, changes or deterioration in tone and postural stability related to growth may result in orthopaedic issues. Those may in turn lead to a need for changes in seating, wheelchairs and hoists, which may in turn affect access to augmentative and alternative communication or AT devices.
In its submission to the APPG, University College London Hospitals NHS Foundation Trust called for inequalities in health services for those living with cerebral palsy throughout the UK to be addressed by making it a statutory obligation for each integrated care board to provide a multidisciplinary service for people with cerebral palsy living in their area. I concur with that suggestion—indeed, I desperately await being drawn out of the hat for a private Member’s Bill one year, which I will use to put that suggestion forward as a Bill, because it sounds like just the sort of thing that would have a chance at going through. In the meantime, policymakers must put in place urgent and ongoing measurements of the capacity of local areas and integrated care boards to deliver the level of support that young people with complex cerebral palsy within their areas require, including appropriate access to doctors, healthcare and therapists.
I recognise that I have read out a very long shopping list today, but that is partly because we are starting from a much lower point than so many other conditions. Therefore, perhaps predictably in an Adjournment debate, I ask the Minister to please meet me and Action Cerebral Palsy to discuss all those issues—and more, I have no doubt. Cerebral palsy should not be seen as a condition where the prognosis is gloomy and the existence is depressing, but rather as a condition, however severe, where the individual living with it can, with help, live a productive and fulfilling life. That is what we anticipate and aim for for all our children; it should be no different for those children living with cerebral palsy. I thank the Minister for listening today, and look forward to hearing her response.
Oral Answers to Questions
Paul Maynard Excerpts(1 year, 3 months ago)
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Steve Barclay
First, that is exactly what the women’s health strategy is doing through designing women’s health hubs. It is exactly why we are appointing a wider portfolio of roles into primary care. The hon. Lady says that Labour has a plan, but Labour’s plan is to divert £7 billion out of primary care property, which will not improve services for women and will actually impede the ability to deliver exactly the sort of services she is calling for.
Paul Maynard (Blackpool North and Cleveleys) (Con)
Thornton Cleveleys will see a 17% increase in new patients registering for primary care in the next five years, exceeding the physical capacity. Cost-effective solutions have been found, but the obstacle is the integrated care board, which keeps changing its mind as to whether money is or is not available. The clock is ticking on the need for this new capacity. Will the primary care Minister meet me to resolve this impasse and get the ICB to sort its act out?
Steve Barclay
My hon. Friend brings welcome transparency to the issue. The Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Harborough (Neil O’Brien) was listening intently, and is nodding his head about meeting him to discuss it.
Cystic Fibrosis: Prescription Charge Exemption
Paul Maynard Excerpts(2 years, 3 months ago)
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Mr Virendra Sharma (in the Chair)
Before we begin, I remind Members to observe social distancing and wear masks.
Paul Maynard (Blackpool North and Cleveleys) (Con)
I beg to move,
That this House has considered prescription charge exemption and cystic fibrosis.
It is a pleasure to serve under your chairmanship, Mr Sharma, and to open this debate on a matter that I know is of very great interest to a significant number of people in the country. I am very grateful to all those who have emailed me over the past few days since the debate was announced, not least those who contributed via the Chamber engagement programme that the House of Commons runs. Their comments and insights have certainly deepened my understanding, and I hope that their contributions will enrich the debate in particular. I am also grateful to the Cystic Fibrosis Trust for its members’ contributions, and for the support and briefings that it has given me.
I am sure that hon. Members here today are more than aware of cystic fibrosis. It is one of the few serious, life-threatening, chronic conditions for which people are still required to pay prescription charges. The Cystic Fibrosis Trust estimates that there are around 2,500 people in England who did not qualify for free prescriptions and are faced with a lifelong financial burden. Indeed, the Cystic Fibrosis Trust calculates that there are now more adults than children with cystic fibrosis.
This issue has concerned me not just over the past few weeks but for 25 years, since I was first diagnosed with epilepsy. The consultant told me, somewhat bizarrely, that one upside of the diagnosis was that at least I would now get free prescriptions. I said, “What?” That was news to me; I was not even aware such a thing existed. I had not required medication for my cerebral palsy, and had been a relatively healthy teenager. It had never occurred to me.
At the same time as I had the good fortune to be diagnosed with epilepsy, I had an even weightier burden to carry: I was the health policy officer for the Conservative party, as we languished in opposition. It was a slightly odd time, I have to say—perhaps that gives hope to those opposite that all things change in time. I not only had to deal with the somewhat bizarre queries of Ann Widdecombe at 6 am when I rang her up, but got to see all the briefings and lobbying that came across my desk. One of the early ones was from the Cystic Fibrosis Trust, telling me about the particular predicament that its members were in: not being entitled to free prescriptions. I thought to myself, “How perverse! They have a lifelong, life-limiting, chronic condition for which they cannot get prescriptions, yet, for my epilepsy, which is chronic and can have devastating consequences, I do get free prescriptions.”
It is not just a case, like mine, of taking some five tablets over the course of the day to manage epilepsy. As Gayle told me,
“My daughter takes more than 50 tablets a day to treat the condition. When you compare this to other serious lifelong conditions that are exempt from prescription charges it is impossible to understand why CF is not included and this outdated decision needs to be rectified”.
The lack of an exemption leads to some perverse situations. As Sarah told me,
“Thankfully I developed diabetes, which is a horrible thing to be grateful for. As a result of getting another health condition which comes with more challenges for my health, it meant I was exempt from paying all prescription charges”.
Go back to that first word that she used: “Thankfully”. What a bizarre thing to have to say with regard to diabetes.
At this point, I should pay tribute to someone who is not here today: Bob Russell, the former Member for Colchester, whom older Members here will know well. He campaigned non-stop on this issue. It is worth cycling back to what he said in 2013, the last time that we debated this issue in the House. He said:
“Those with long-term conditions do not choose to be ill. They face a daily routine of various types of medication and physiotherapy to maintain any quality of life.”—[Official Report, 10 July 2013; Vol. 566, c. 511.]
Those words are as true today as they were back in 2013—and back in 2003, 1993, 1983 and all the other many times that this issue has been discussed.
When I first researched this issue 25 years ago, I was even more surprised by the fact that the exemption list was based on a list of conditions that had not been reviewed since as far back as 1968—before man had made it to the moon—with the exception of the addition of cancer in 2008. My contention to the Minister today is a simple one. It is the one I urged my right hon. Friend the Member for North Somerset (Dr Fox), when he was shadow Health Secretary, to pose to the then Health Secretary Alan Milburn in 1999. Why has the list not been reviewed since 1968? People live with cystic fibrosis well into adulthood these days, which was not the case in 1968. Why can we not review matters and take modern medicine into account? In particular, why is it fair for me to get free prescriptions when they cannot?
As Anna told me:
“The exemption list was introduced in 1968 when children born CF were not expected to live to their teens. Now more than ever, with the life-changing personalised medicines that are available to the majority of CF patients, life expectancy will be massively increased. Therefore, CF should be reconsidered for exemption as most patients will now be living relatively normal lives.”
Ruth Jones (Newport West) (Lab)
I thank the hon. Member for giving way; he is making a powerful speech. As a former physiotherapist who used to treat children and young people with cystic fibrosis, I know exactly the point he is making. Living in to adulthood is fantastic and brilliant, but people are being penalised. Is it not right that those people should not have to worry about having to take medication? It should be a right.
Paul Maynard
The hon. Lady is exactly right, and I will demonstrate why with a few examples from people with CF. For those living with CF, medication, physio and general health all have to be considered when planning the simplest activity. Being unwell frequently interferes with work and education. As Sam says:
“Due to the nature of the illness I have been unable to work full time after previously trying. Prescriptions is another cost I have to pay despite barely getting any financial support from the government. To me it shows a lack of understanding the fact the medication ultimately contributes to us staying alive and gives us the best chance of trying to contribute to society.”
We could easily be having a debate about other long-term conditions, such as asthma, which are not included either. I could point to transplant patients, a category that would not have existed in 1968 but who rely on drugs to sustain their lives. If any Scottish National party or Plaid Cymru Members were present, they might have cited the example of prescription charge regimes in Wales and Scotland. Opposition Members might bring up the claims and calls of the wider Prescription Charges Coalition. I will leave it to them to make those points; those views are not necessarily shared by Government Members.
I want to focus, laser-like, on this single issue. We have seen in today’s newspapers the success that such an approach can have. The long campaign on hormone replacement therapy by the hon. Member for Swansea East (Carolyn Harris) finally got some good news. It is clear that we need to undertake a thoroughgoing review, setting out what conditions have been brought into scope since the Medicines Act 1968, through advances in medical science. Those might be conditions that did not, or could not, have existed in 1968, or conditions where life has now been further prolonged.
I am sure I can predict some elements in the Minister’s reply, because they were made by former Labour Ministers and in 2013. I am sure we will hear of the wonders of prescription prepayment certificates at just £2 a week—what could be better value? That is less than the price of a cup of coffee at Costa. But many living with a long-term medical condition such as CF can be economically disadvantaged by their condition, by prescription charges and by paying for the annual prepayment certificate, which costs £108. That adds to their financial burden.
According to the Cystic Fibrosis Trust, about one in 10 people with CF—just under 1,000 in the case of that survey—received emergency grants of about £150 from the trust in 2020-21. More than half of those grants were awarded for daily living costs, such as food. As Tracy told me:
“A few years ago I had to take redundancy due to ill health…I had previously paid for a prepaid prescription certificate but could not afford to renew it when it ran out. After 3 months without medication, I was in a poor state of health, constantly coughing, very weak, unable to lie down or even sleep sat up due to the accumulation of mucus in my lungs. After 4 nights without sleep I saw my GP who gave me a prescription for a strong course of antibiotics and steroid tablets. We had to miss a payment on a household bill so that I could pay for my prescription. The first course of antibiotics didn’t clear the infection, so I needed a further one. I had to borrow money from a family member to pay for it…Eventually, I was able to claim PIP which allowed me to pay for my own prescriptions again. I consider myself lucky to have someone who was able to help me out when they saw how ill I was.”
There is also a serious risk that those who incur prescription charges for their CF may not take their essential medicines, particularly if they are experiencing financial hardship, or in higher education on a limited income. Over a third of those who replied to the Cystic Fibrosis Trust survey said that they had not taken medication because of the cost of prescriptions. As Anna told me:
“During university I didn’t take my medication simply because I couldn’t afford the fees. The blunt fact here is that people with CF take anywhere from 10-30 different medications a month. People with CF have been charged an insane amount of money when there is a system in place meant to protect people with long-term health conditions from being financially penalised—however they are being kept from the exemption list.”
The cost to the Government of righting what I believe to be a moral wrong is £270,000. As a former Minister, I know that that sort of money can often be found with a good rootle down the back of the ministerial sofa—a bit of jingling of the coins. However, there must be darker, deeper and slightly odder reasons why successive Governments—of all colours, and I look across the Chamber as I say that—have refused to review the 1968 list, despite all the pressure and reasonable arguments to do so. I cannot begin to imagine why Ministers are saying no.
If anyone wonders what this change might mean for CF patients, they should listen to Mario:
“My partner would then feel supported by the government rather than left on her own. The relationship to her medicine would change from financial to purely medical. Support, hope and fairness is the minimum we ought to give to people with life-threatening long-term conditions such as cystic fibrosis.”
Or listen to Donna:
“CF patients have enough problems to face, we should do anything we can to help. CF drugs may be expensive, but lung transplants cost even more.”
I will leave the final words to Sharon, another survey contributor:
“I would have more money available to pay for life’s other essentials. It would be pleasing to see the end of an injustice as I have no choice but to take this life lengthening medication and shouldn’t be required to pay for it when if I had been born with another condition, I wouldn’t have to.”
I hope that the Minister listens to those pleas and reasonable questions, and sets out the Government’s agenda to right what I believe to be a wrong.
Paul Maynard
I thank all those who have participated, particularly my hon. Friend the Member for Ashfield (Lee Anderson). We are all grateful to him for not just speaking on a personal basis, but illuminating a debate far better than I could from my more dry, academic analysis. I thank him for his personal contribution, and I thank all hon. Members for a constructive debate. I recognise the point that the Minister made; making a commitment on the hoof at the Dispatch Box can be career-limiting. I know that myself, as I reflect on what I once said on rail and aviation, which I suspect led to my defenestration. Saving High Speed 2 can be terminal for a career, perhaps. None the less, I hope he will take the issue back to Lord Kamall, and that he might encourage him to meet me and other interested Members to hear what the Gentleman whose brief it is thinks of the matter.
Edward Argar
I am happy to reassure my hon. Friend that I will certainly convey his request for a meeting to my noble Friend.
Paul Maynard
We have something concrete on which to conclude the debate.
Question put and agreed to.
Resolved,
That this House has considered prescription charge exemption and cystic fibrosis.
Covid-19 Update
Paul Maynard Excerpts(2 years, 4 months ago)
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Sajid Javid
There will be two ways to access high-risk events, be it a nightclub or larger events. The main way will be to take a lateral flow test and get a negative result, which would need to be registered through the NHS website and the proof could be through the pass or a text message result, for example. There will be an exemption from that for someone who is double-vaccinated. The proof of vaccination can also be given through the letter process.
Paul Maynard (Blackpool North and Cleveleys) (Con)
A constituent of mine has both anaphylaxis and urticaria. She has been told that she cannot be medically vaccinated. Amid all the talk about second doses and third doses, she cannot access even her first dose. What assurances can the Secretary of State give her regarding access to non-invasive forms of vaccination?
Sajid Javid
My hon. Friend asks a very important question. The rules around the need to be vaccinated, whether for passes or otherwise, do not apply to anyone who is medically exempt. Many people have received exemption certificates directly from their GP. That is the best route. Some individuals have called 111 and received advice. If I can be of direct assistance to my hon. Friend, then of course I will help.
Covid-19 Update
Paul Maynard Excerpts(2 years, 4 months ago)
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Paul Maynard (Blackpool North and Cleveleys) (Con)
For what reason is the Department of Health and Social Care making an announcement on extensions to the red list, rather than the Department for Transport, as has been the case previously?
Sajid Javid
Departments across Government work together on the pandemic, and that means that my Department works very closely with the Department for Transport.
Oral Answers to Questions
Paul Maynard Excerpts(2 years, 10 months ago)
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Matt Hancock
That is not something that has yet come across my desk, but I will make sure that the relevant Minister writes to the hon. Gentleman with as much detail as we know.
Paul Maynard (Blackpool North and Cleveleys) (Con)
Matt Hancock
What my hon. Friend says is absolutely right. Of course if someone puts a defibrillator on private land, access to it should naturally be open to anybody who needs it. I will look into the exact legal status, but let us set aside the legal status for a minute. If there is a defibrillator on private land that could save somebody’s life, the landowner should of course allow access to it for anybody who needs it.
Oral Answers to Questions
Paul Maynard Excerpts(3 years, 2 months ago)
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Jo Churchill
I thank the hon. Lady for her question. I would also like to point out that, in her area, 93% of cases are being tracked and people are being spoken to, which highlights the great work that is being done on the ground locally in that area. We are providing support, and I would urge her constituent to reach out to the council, because it is important that we give people the support they need in order to isolate. As I say, she will be hearing more on that subject from the Chancellor during the Budget next week.
Paul Maynard (Blackpool North and Cleveleys) (Con)
The Parliamentary Under-Secretary of State for Health and Social Care (Jo Churchill)
We are currently considering the best future arrangements for Public Health England’s important health improvement functions. We have been engaging with key stakeholders throughout the process and will be setting out further details of our approach in due course. We are excited about creating the national institute for health protection to ensure additional capacity so that we have future capability and a laser-like focus on areas of health inequality.
Paul Maynard [V]
I very much welcome the plans to reform Public Health England’s health protection functions, and I note with interest the Secretary of State’s new powers of direction in some public areas, such as obesity. Blackpool has some of the most severe public health challenges in the country. Further discussions about the health promotion functions of Public Health England were promised when the NIHP was announced, so can the Minister say now how other areas of public health promotion that are not referred to in the White Paper will be addressed?
Jo Churchill
I thank my hon. Friend for his question, and I recognise the challenges that Blackpool faces. I read with interest the Blackpool town prospectus, which highlights the public health challenges, and I am looking forward to talking to the clinical commissioning group lead about them later this week. We remain convinced that place-based approaches will have the best results, where we can target interventions in the right way when they are needed. I think my hon. Friend is alluding to other areas such as work, housing and so on. Discussions are going on with other Departments, but those specific initiatives are for those Departments themselves. As the details of the national institute for health protection are outlined, these things will become clearer. I know my hon. Friend cares deeply about his constituents and their health, and I look forward to working with him and others in the future.
Defending Public Services
Paul Maynard Excerpts(7 years, 11 months ago)
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Paul Maynard (Blackpool North and Cleveleys) (Con)
I genuinely believe and have no doubt that the hon. Lady is committed to the NHS and I share her desire for a wider public debate, but does she agree that, to have a meaningful debate and to add value to her critique, she needs to set out what she sees as the financial requirements of the NHS, otherwise such a debate will not be very helpful?
Heidi Alexander
I am grateful to the hon. Gentleman for his intervention, but he will just have to watch this space.
As I was saying, the truth is that the cash crisis in the NHS is the fault not of migrants, but of Ministers. Cuts to nurse training places during the last Parliament have created workforce shortages and led to a reliance on expensive agency staff. Cuts to social care have left older people without the help and support they need to remain independent at home, putting huge pressure on NHS services. The underfunding of GPs has left too many people unable to get timely appointments, which means they are often left with nowhere to turn but A&E. The financial crisis is a massive headache for NHS accountants, but we all know it can mean life or death for patients. Waiting time targets, which exist to ensure swift access to care, have been missed so often that failure has become the norm.
Paul Maynard (Blackpool North and Cleveleys) (Con)
It is a pleasure to be called to speak in this debate on the Gracious Speech. There is always a theme in these debates on the Queen’s Speech—a list of goals that are not present, a list of what should have been in there that was not, and what people do not like about it and what they do like about it. What has saddened me is that the common theme from the Opposition is that they do not think that there is much in the Queen’s Speech, and yet, as we have just heard, there are 21 separate Bills. There is quite a lot in there.
It takes me back to 2010, when I first became an MP, because this Queen’s Speech is all about why I wanted to come into politics in the first place. Looking back to 2010, I see that on my website I described myself as the fresh-faced MP for Blackpool North and Cleveleys. That is no longer true—I look in the mirror now and see that the lines are slightly deeper, the eyes slightly more sunken; I am on the wrong side of 40—but one thing has not changed: my belief that I got into politics to stand up for the people who are directly under the state’s care who have no one to stand up for them. They include the patients in hospital, whom we discussed in opening today’s debate; the young people in care waiting to be fostered or adopted, who the Prison Reform Trust told us today are over-represented in the youth justice system, not just by a small amount but by an absolutely massive amount; and the prisoners in our prisons who are not being educated properly or rehabilitated, which has a direct impact on the number of victims there will be if we do not reduce reoffending. Getting that right has to be the right thing to do.
Jim Shannon (Strangford) (DUP)
Does the hon. Gentleman share my concern about the radicalisation, both Islamist and neo-Nazi, that takes place in prisons? Is there not a need for the Government to tackle that? People are going into prison with some sort of innocence in terms of religious belief and coming out with a radical opinion. There has to be something done.
Paul Maynard
I thank the hon. Gentleman for making that point. He tempts me to indulge in a nine-minute disquisition on how we balance the presence of faith in our prison system with the need to safeguard against radicalisation. I agree with him broadly, but I do not want to go down that path, tempting though it may be. I would much rather focus on the fact that what brings all this together—standing up for those who have no one else to stand up for them—is this idea of life chances, which is the theme behind the Queen’s Speech.
The Whip should listen carefully now: although I hate the phrase “life chances”, he should not write that down in his little black book, because to my mind what we are really talking about is social justice. Like Ruth Davidson, I am proud to say I am a John Major Conservative. I believe in equality of opportunity. I do not believe in equality of outcome because it cannot be guaranteed, but I do believe that part of achieving social justice is taking ownership of the consequences of our policies. We have to have some regard for the outcomes.
That can be hard to justify when we look only at globalised national statistics. They do not give us the granular narrative detail of individual lives. Many times in this Chamber we have debated how we measure child poverty, what the best indicators are, what they mean, and how we tackle child poverty. We can disagree constructively on what those indicators are and how we utilise them, but I believe we need to go down another level. A good example is an article I urge everyone to read that appeared in The Atlantic magazine last month about the proportion of Americans who, if landed with an unexpected bill for $400, would not be able to meet it out of their earnings. Shockingly, some 47% of Americans would not be able to pay that bill for $400 without recourse to either borrowing from others or payday lending. I shudder to think what the figure is in this country. No doubt a sociology department somewhere is preparing a research funding request as we speak to find out that information. We need to burrow down so much more into the detail to get a true understanding of how to improve life chances.
Think about the connection between social isolation and ill health—the number of lonely elderly people in my constituency who probably do not speak to anyone day in, day out, and the younger people with serious health conditions who may feel socially isolated. Social isolation is the key predictor of future ill health and therefore future demand on the health service. That has to be taken into account. Think also of children. I visit many primary schools and I know that in the more deprived parts of my constituency there is a major problem with the number of children arriving at school aged four who are untoileted. Think of the burden that places on the staff in toilet training them, taking them away from the educational aspects of their job.
Another wider issue for older children perhaps, those who are eligible for free school meals, is how many of them are not fed properly during the school holidays. I know the hon. Member for Washington and Sunderland West (Mrs Hodgson) is deeply concerned about that. Although all that is difficult to measure, it gives a different dimension to the story of life chances from the national global figures for whether child poverty is going up or down in any particular set of years we all focus on. We need to be much more creative in our approach.
I had hoped that by talking for an extra five minutes, my hon. Friend the Minister for Culture and the Digital Economy would have returned to his seat to hear what I am about to say about Department for Culture, Media and Sport issues. I know he has to wind up the debate and I was hoping to help him. He published an excellent culture White Paper just before the Queen’s Speech—the first since Jenny Lee’s ground-breaking document in the 1960s. The key element of the latest White Paper is about broadening participation. I had not really thought about it in those terms, but I was invited by a constituent, James Nash, to a concert by the National Youth Orchestra at the Liverpool Philharmonic hall a few weeks ago. James plays trumpet at grade 8 —grade 8 is a requirement to play in the National Youth Orchestra. He is very proud of his participation and thoroughly enjoying the experience. He went to a local comprehensive and is very musically talented so this is a fantastic opportunity for him, yet that orchestra is a charity, supported by the Arts Council.
I had the pleasure of hearing Thornton Cleveleys Brass Band the Sunday before last. For the first time ever, it has won a regional division of its national brass band competition at the fourth tier, I gather, of brass bands. It will soon compete in Cheltenham in the national competition. That band is looking for funds and it will be going to the Arts Council, which now supports brass bands thanks, I believe, to the Minister’s intervention. That broadens participation by so many young people who enter music through the local brass band.
There are many ways in which culture is broadening horizons, but unfortunately in Lancashire there is one way in which those horizons are narrowing rapidly—through the very sad decision by Lancashire County Council to close so many of our local libraries. Almost half of Lancashire’s libraries are being shut. I am losing Cleveleys library, which has a children’s centre attached, and Thornton library, which is just over the constituency boundary but I feel I have a share in it with my hon. Friend the Member for Wyre and Preston North (Mr Wallace). We all recognise that councils have to make savings. What I find so frustrating is that when others have come up with solutions to help to keep libraries open and make the savings, Lancashire County Council will not sit down and listen.
Wyre Borough Council wants to convert all Wyre’s libraries into a community interest company, thereby forgoing many of the business rates and other associated costs that make them so expensive to run for the county council. By doing that, it can save the money the county council wants to save and keep every single library open, but shockingly the county council will not even sit down and talk about it. The hon. Member for West Ham (Lyn Brown) rightly praised councils that innovate. Please could she have a word with Lancashire to persuade the council to innovate? Many other councils of all stripes have rethought how they do library provision. Why can Lancashire not do the same? Does it want to make a cheap political point? I desperately hope not, because that would be a tragedy.
I remember back in 2008 the right hon. Member for Leigh (Andy Burnham) taking the visionary step of calling a public inquiry because Wirral Metropolitan Borough Council had chosen to close so many of its libraries. I attended that public inquiry. I know he is not here, but I very much hope that my hon. Friend the Minister for Culture and the Digital Economy will agree to meet me to discuss whether Lancashire’s plans are enough to justify another public inquiry under the terms of the Public Libraries and Museums Act 1964. The council has an obligation to provide a “comprehensive and fair” service. My concern is that what Lancashire is planning is not fair—I know that is a subjective term—and it is certainly not comprehensive.
My constituents, who have been accustomed to going to Thornton and Cleveleys libraries will now have to go further afield, to Fleetwood and Poulton, shortly after seeing all their bus connections to such areas slashed by the county council. That is doubly frustrating. I urge Ministers at least to arrange for me to have a conversation with my hon. Friend the Minister for Culture and the Digital Economy to discuss those issues.
On a wider point, whenever I come here, I desperately try to believe that all of us are here for the right reasons—we all want to make things better for the people we represent in our constituencies. Some of us hide it better than others, perhaps, by our conduct in this place. Some are more bolshie, some are ruder, some cat-call me from a sedentary position and some chunter away, but I always try to find something positive in what the other person is saying, and I urge all Members to try to do that.
Whatever we think of the phrase “life chances”, the issues that it covers are surely the reason why we came here today. I urge all Members to look for the positives in what this Government are trying to do. I know that the Opposition have to scrutinise us, but I hope they will open their hearts occasionally to find the good stuff that we are doing and help us to do it better still, rather than just criticising us for being anti-public sector, anti-everyone and anti-everything.
Junior Doctors’ Contracts
Paul Maynard Excerpts(8 years, 6 months ago)
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Heidi Alexander
I will not give way, because I wish to make some progress.
The Health Secretary may claim that he is doing all he can to make the contract fair and safe, but the truth is that he is not. He may say that the overall pay envelope for junior doctors will stay the same, but he will not say who the losers will be. He may say that no junior doctor will work excessively long hours, but he will not tell us that he is removing the very safeguards that were designed to prevent that. He may even say that he has some support, but he will not read out the range of independent clinical voices who have condemned his approach.
Paul Maynard (Blackpool North and Cleveleys) (Con)
The hon. Lady is right to focus on the future contract, but does she recognise the inadequacies in the existing contract?
Heidi Alexander
I am not saying that the existing contract is perfect—I do not think that the British Medical Association would say that either. A few months ago, an alternative contract was being discussed, the work on which was led by the former Health Minister, the hon. Member for Central Suffolk and North Ipswich (Dr Poulter). The answer is not the contract that is on the table at the moment.
Paul Maynard (Blackpool North and Cleveleys) (Con)
Three minutes is never enough, but here I go. First, we have heard a lot about seven-day working and a seven-day NHS. That does not occur only within the hospital. I would like to restate the point made by my hon. Friend the Member for Totnes (Dr Wollaston) in the Westminster Hall debate on the e-petition that, most important of all, we need to look at how we can reduce in the first place unplanned admissions to hospital from the community. Secondly, I echo what the hon. Member for Central Ayrshire (Dr Whitford) said. We here have a responsibility not to exploit junior doctors and their willingness, sense of vocation and commitment to the NHS.
It is worth looking at some of the deficiencies of the 2003 contract. As I understand it, a doctor working 47 hours can be paid the same as one working 41 hours. That cannot be right. A doctor working daytime can be paid exactly the same as a doctor working only nights and late shifts. A doctor progressing to a post of greater responsibility might not get any extra pay for that. There are multiple flaws in the existing contract that need to be addressed as part of the growing trajectory towards improving terms and conditions each time we reassess the contract.
I recognise that there is a desire on all sides to get back round the table, and I strongly urge all sides to do that. I hope it can be done, but there is no contract that I can see lurking in the Minister’s bottom drawer waiting to be unveiled. In the report from the Doctors and Dentists Review Body three scenarios were set out. There are a further six, I understand, in circulation and in preparation by the NHS Employers organisation. There is so much to discuss, so many alternative scenarios, that it would be a dereliction of duty for all sides not to get back round the table.
We should note that in what has been proposed, by reducing the maximum number of hours to 72, there would be no more of the four nights in a row that some junior doctors have had to work, and no more seven consecutive nights on particular rota shifts. There is much that is positive in the contract, yet I recognise why there are concerns. I urge Dr Malawana who wrote to the Secretary of State to look again at what my right hon. Friend is seeking to achieve. There is clearly a willingness to discuss how to redefine daytime work, how to judge what we pay for Saturdays, how we change flexible pay premiums. There is so much that can still be discussed that we are missing an historic opportunity here to set in stone for another decade a much better contract and a much better set of criteria for fairer working practices for our very, very hardworking junior doctors.
Oral Answers to Questions
Paul Maynard Excerpts(8 years, 6 months ago)
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Mr Hunt
If the hon. Lady looks at what has happened with permanent full-time nursing staff, she will see that the numbers have gone up in our hospitals by 8,000 over the past two years, so there are alternatives. We need to do more to help the NHS in this respect, and I will be announcing something about that shortly.
Paul Maynard (Blackpool North and Cleveleys) (Con)
10. What plans he has to review renewal arrangements for the issuing of NHS medical exemption certificates.
The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)
Medical exemption certificates excluding patients with long-term conditions have been in place since the 1960s. The requirement to renew the certificate every five years has been in place since at least 2002 and we have no plans to review it.
Paul Maynard
The Minister will be aware that, over the summer, there has been media coverage of patients with ongoing and exempt conditions being penalised for not having an up-to-date exemption certificate. Because the renewal period is five years long, the NHS Business Services Authority’s address database gets out of date very quickly and many people have been penalised for inadvertently not renewing their certificate because the database held an out-of-date address for them. What more can be done to assist the authority and the patients, perhaps by introducing a shorter renewal period, and to ensure that this stops occurring?
George Freeman
I pay tribute to my hon. Friend, who has first-hand experience of this matter. It is true that people who are responsible for ensuring that they hold a certificate when claiming the exemption could be subject to genuine mistakes. That is why we responded to the feedback this summer and put measures in place so that if someone submits a valid medical exemption certificate within 60 days of a penalty charge notice, the penalty charge will be cancelled. It is also worth remembering that all patients on benefits or on the NHS low income scheme are exempt anyway, and that patients who require frequent prescriptions can enrol for a pre-payment certificate, which costs no more than £100 a year.