National Health Service

Paul Maynard Excerpts

Wednesday 21st January 2015 Commons Chamber

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

It is intriguing to follow the hon. Member for Rochester and Strood (Mark Reckless). I will leave my intrigue at that point and focus on the debate rather than him.

It is a shame that the shadow Secretary of State has left the Chamber, as I was about to say something relatively pleasant and polite about him—he will not hear it now. When he came up to Lancaster and Fleetwood a few weeks ago he joined me in praising my local A and E department, which had seen 97% of patients within four hours, the fifth best performance in the country that week. That is a superb achievement given the complex health economy in Blackpool. It is very rare that we are at the top of a league table for the right reasons in Blackpool, whether that is for football or for health care, so I welcome that.

It was interesting to note a more hidden and nuanced message in what the shadow Secretary of State had to say. The medical director of Blackpool Victoria says that between April and September 2014, 36% of those arriving at A and E did not need to be there. They could have received their diagnosis or treatment somewhere else, and the cost to the hospital was calculated at £842,000. The message I draw from that is that we still have an immense amount of work to do to ensure that people know where to go for the right treatment at the right time. It is, of course, incumbent on us to ensure that those alternatives are resourced, that people know where to go and that people have confidence in the alternatives.

We have not spoken enough today about pharmacies. Pharmacy trade bodies and the industry put so much into lobbying Members on both sides of the House, but I think it will require another decade or so of intensive lobbying of MPs before we finally get the message that it is far better to have first recourse to the local pharmacist to see whether one needs to go further in seeking appropriate health care. I rely on regular repeat prescriptions for my epilepsy, and I have saved myself many a GP visit by asking a question at my local pharmacy. We are overlooking the most basic corner-of-our-street access point for primary health care, and we should not forget it.

I want to praise another Member of a different political party from mine, and he is sitting on the Government Front Bench: the Minister of State has already been praised today for his approach to mental health care. It is warmly welcomed, particularly in a town such as Blackpool. Our new 74-bed harbour unit is about to open on the edge of the town. It has been long-awaited, and is much-needed following some of the appalling standards of care at the Parkwood unit over the past decade.

The Minister will know that he faces great challenges. I could easily have come here today and read out a number of immensely tragic cases involving young people not getting the appropriate mental health care. He still faces a battle with the profession, because clinicians differ over their assessment of this issue. I see far too many young people with some learning disorder who are somewhere on the autistic spectrum, where the clinician refuses to accept that they can both have a learning disorder and a mental health problem. They fall into that gap and are batted backwards and forwards between different providers. There must be a battle in the medical profession over how to reconcile those two different forms of clinical diagnosis.

Another point I want to raise—I have far more than I will be able to get into my remaining four minutes—was mentioned by my right hon. Friend the Member for Chelmsford (Mr Burns). I was struck by the shadow Secretary of State’s sudden enthusiasm for the walk-in centre in Jarrow—his instant commitment that it would be saved were Labour ever to come to power. We then heard from my right hon. Friend that these things are sometimes trickier than that—that there is more nuance, perhaps. We in this Chamber often think we know it all—don’t we? We think we know everything there is to know and that we can learn nothing from anybody else about anything in our constituency—that we are the sole experts of what is right. Occasionally it would be nice to listen to the clinicians. There might actually be a clinical argument for why a particular unit has to open, close or reconfigure, but all too often debates on the reconfiguration of services become a political football—which is exactly what my right hon. Friend was saying.

A good example is the stroke unit in Blackpool. It has been a controversial addition because it was designed to serve the entire north-west. Patients were coming down the M6 from south Cumbria, past four or five other hospitals, to get higher quality treatment in Blackpool. As the hon. Member for Oldham East and Saddleworth (Debbie Abrahams) chuntered during the Secretary of State’s speech, the important point is that it was about outcomes. People were going to have a better chance of survival if they went to the stroke unit in Blackpool rather than their local A and E. Yet when that was debated, it was very hard to tease out the medical arguments in favour of this innovation, because all too often we were more concerned about focusing on saving bricks and mortar in our own backyards rather than on what is actually best.

[Steve Baker]

Does my hon. Friend agree that the two brands in the NHS that the public really understand above all are A and E and GPs, and all the time we are talking about A and E we are getting away from the fact that sometimes care is better provided in a specialist stroke or heart centre?

[Paul Maynard]

My hon. Friend makes an important point, which is that so many different terms are used and answers given in this Chamber and elsewhere about where patients need to go. What they actually want is reassurance and confidence that when they go somewhere they will get the right treatment at the right time that solves their problem. They do not want it to be overcomplicated, and neither do we.

We have heard a lot of criticisms of this Government’s health reforms—they seem to be very unpopular on the Opposition Benches in particular—but let me highlight two that have been very good. One of them goes back to my younger days—when I had a finer figure, perhaps. My first proper job—Opposition Members will not like this—was as a health policy officer in the Conservative research department in 1999, so I listened with delight to the right hon. Member for Holborn and St Pancras (Frank Dobson) telling me all about the wonders of his time, because I scrutinised it quite carefully on a daily basis. I used to get a monthly present from the Association of Community Health Councils for England and Wales in the form of the London “Casualty Watch”, a monthly census of trolley waits in London accident and emergency departments. It was a pretty thick document. The census detailed page after page of trolley waits of more than 24 hours, and it was a shocking indictment of how Labour was running the NHS at that time.

That situation led to one of the Labour Government’s most shameful decisions: to abolish community health councils. I know that many Labour Members are embarrassed about that even now. One of the great things about our health reforms is that we have brought back Healthwatch, which has proved to be a thorn in the side of local health providers, of Members of Parliament and of the Government. We have brought back the ability of ordinary patients to affect the nature of the care in their communities. That is happening right now in Blackpool, and it is making a difference. I am delighted about that.

Another positive element involves putting public health matters into the local council. As I have said, Blackpool faces immense public health challenges, but putting Dr Rajpura, our local director of public health, into the council has been a tremendous success. It has helped to pull together all the disparate strands within the town as we face those challenges. Again, this has happened only as a result of our health reforms.

Another example that I want briefly to mention is the fact that some of our local nurses at the hospital have spun out their rehabilitation service into a community interest company called Spiral, which is now winning awards for the quality of its patient care. I am concerned that, if Labour were to reverse all these changes, the good things we have achieved would be washed away and lost, and the people who would suffer would be my constituents, including those who have turned to Spiral for their rehabilitation. That is my real concern.

Augmentative and Alternative Communication Services

Paul Maynard Excerpts

Thursday 6th June 2013 Commons Chamber

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

It is a pleasure to speak in this debate on this very important issue. I mean no disrespect to you, Mr Deputy Speaker, but it is a shame that Mr Speaker is not in the Chair, because he has been a great champion of speech, language and communication needs down the years. It is worth quoting his key comment from the Bercow report:

“'Communication is crucial. Recognising that is right in terms of equity for those in need and right in the national interest as we all wish to cut the costs of failure”.

Nowhere is that clearer than with augmentative and assistive communication. As that is rather a mouthful, I shall refer to it as AAC.

AAC is a series of aids, some complex and some not so complex, that assist those with neurological conditions that make it hard for them to express themselves. I was delighted when I received a commitment from the Prime Minister during Prime Minister’s questions in March that, as a result of the new commissioning landscape in the NHS, it would be available to more children and adults. I welcome that, and my aim is to ensure that it can actually happen.

I have a personal interest in this subject; it is not something I acquired when I was elected. I attended Hebden Green special school at the age of just three or four, and many of my fellow pupils would have benefited from these complex aids. It gives me real pleasure that one of my pupils, Alexis Egerton, recently gained a PhD thanks to utilising a complex powered aid—an example of how AAC can change people’s lives.

I am grateful to the Minister for the time he was able to spend yesterday meeting me and representatives from Communication Matters and the ACE Centre. I apologise for detaining him further today with a variation on the same theme. It is worth focusing on how the users of the aids feel about how the system currently works. Toby Hewson is an AAC user. He said:

“I cannot express adequately how frustrating it is for people with disabilities to have to battle with the system in the way we are forced to do...like a game of pass-the-parcel, people like me are sidelined and marginalised until we are exhausted.”

That is just an indication of the frustration so many people, and their families, feel about a system that has not yet worked properly for them.

I would be misleading the House and unfair to the Government if I did not make it clear that a great deal of progress has been made, not least through the Bercow report, the work of communication champion Jean Gross and the decision to ensure that most of the commissioning will occur at a national level. I hope that the Minister can act like a statin in the arteries of NHS England to allow what is good to occur, and for policy to be implemented in the way that I am sure everybody in the Department of Health wants it to be implemented.

However, I would also be misleading the House if I did not express some of the concerns about how policy is being implemented. The issue can be as fundamental as the funding mechanism deployed. I am sure that we would all agree that NHS England has to start from somewhere in deciding how much money it will allocate to this type of provision. I am reminded of the farmer leaning over a fence who is asked by a walker, “How do I get to Blackpool?” He replies, “Well, I wouldn’t start from here.” I would not start from where NHS England is starting, because it intends to use historical budgets, which might sound perfectly sensible—perfectly obvious perhaps—but if all that involves is ringing up a local hospital manager and asking how much he spends on AAC, when he might not even know what AAC is, I do not think it a particularly satisfactory starting point.

It is more frustrating still given the work done on levels of need by the communication champion—available to NHS England—and further reports since from the University of Manchester. We know the level of provision and unmet need: 0.014% of the population currently use a powered aid, but total need is 0.05%. I am sure that the Minister can do the maths. It is about 3.5 times what is currently being funded. I am not making the predictable everyday point that more must be spent—far from it—but I want NHS England to begin from a sensible starting point when making its decisions.

[Mr Gordon Marsden (Blackpool South) (Lab)]

I am grateful to the hon. Gentleman, my constituency neighbour, for giving way. I warmly commend his work to bring this matter to public attention. He and I have constituents at Highfurlong school and other special schools in Blackpool where these issues are very important. I have had correspondence from two constituents involved with the school. I know that Governments are not always keen on ring-fenced budgets. Does he agree, however, that NHS England should take account of the technology to come, rather than relying on past practice?

[Paul Maynard]

Indeed. We disagree on many things, but on that issue the hon. Gentleman and I can agree. In Highfurlong, we have an excellent provider of specialist communication provision, so I hope he shares my concern at the proposals, which look to be coming from the local council, that could result in Highfurlong being shut. It causes me great concern, as it does many parents in his constituency and mine, so I hope he will join me in ensuring that Highfurlong is not threatened in the way it might be.

The funding decisions being made have consequences for the proposed hub-and-spoke model. I would welcome a commitment from the Minister that clinical commissioning groups should not interpret the existence of specialist hubs as a justification for winding down their investment in local spokes. That, to me, is crucial, if only because of the issue of complexity. The hon. Member for Blackpool South (Mr Marsden) alluded to that.

[Dr Sarah Wollaston (Totnes) (Con)]

Does my hon. Friend agree with me and my constituents with children using these important assisted technologies that what matters is not just providing the equipment, but the cost of providing training and support, without which children and adults cannot benefit fully from these important technologies?

[Paul Maynard]

I thank my hon. Friend for that perceptive contribution. The concern is that NHS England’s budget for AAC will not be sufficient for training. The only way that the hub-and-spoke model can work effectively is if the hub can train up more people in the spokes to deliver the more complex tools. Complexity is at the heart of the problem in the structure. AAC is one of five areas for which complex disability equipment is to be commissioned nationally—incidentally, another is artificial eyes, the national centre for which is based in my constituency. It would be remiss of me not to congratulate that centre during an Adjournment debate on a parallel issue. As I was saying, though, complexity is the key: it determines whether a patient is treated at the hub or at the spoke.

A stroke patient will receive a relatively straightforward medical diagnosis—it might be a devastating incident in their personal life, but its medical nature is relatively simple. None the less, what will restore the power of communication to someone who has lost it will be a complex piece of kit, yet under the current rules, as I understand them, it would be commissioned in the spoke. If the skills are not there to utilise that piece of equipment, that stroke patient will not benefit, so complexity of need has to be balanced by the complexity of the product being supplied. That is crucial.

The other issue on which I want to draw out the Minister is the concerns of worried providers in the voluntary sector about their ability to bid for commissions from NHS England. There has been a long-running battle over whether AAC should be based in the education or the health sector. It is now clear that it will be based in the health sector, but one of the key elements of what NHS England seeks to commission is an educational component in a multi-disciplinary team. That component is most often found in organisations such as the ACE Centre, the Dame Hannah Rogers Trust, near the constituency of my hon. Friend the Member for Totnes (Dr Wollaston), or the Percy Hedley school, up in the constituency of the hon. Member for Blaydon (Mr Anderson). They all have immense expertise, yet they greatly fear that the mood music emanating from NHS England suggests that they will be unable to bid for such provision, because of an understanding that it must be supplied by an NHS provider. That seems strange, given all that the Government have said down the years about trying to ensure a broader spectrum of provision—that more civil society organisations can provide such services. I hope the Minister can provide some reassurance on that.

I would also like a commitment from the Minister—this is another fundamental aspect—that this really is a health issue and no longer just an education issue. I hear far too many heartbreaking stories of children who are equipped with complex equipment when in school but, because it is funded by the Department for Education, lose it when they leave. It is not just a piece of kit they are losing; it is their ability to express themselves as fully formed adults. That is why it is so important that this becomes a health issue, not just an education issue.

My final query is rather technical—I beg the Minister’s forgiveness, but this goes back to acting like a statin in NHS England. A clinical reference group has been set up, but it has yet to meet—it is in a form of limbo, as it were. There is yet greater uncertainty, not merely because it has not met, but because the gentleman who chairs it, one Dr Thursfield, is shortly to retire from his academic post at the University of Birmingham. There is grave concern that his uncertain status in the clinical reference group is imperilling its ability to meet, take decisions and do its job. Alexis Egerton—the gentleman I mentioned earlier—was disappointed not to be appointed as a patient representative on the clinical reference group. I have known Alexis since my youngest days. He did his PhD on the funding of AAC provision, and it would be immensely valuable to the Government and the nation as a whole if we could find a way to allow him to play a role in that.

Finally—I want to ensure that the Minister has time to respond fully—will he bear in mind that the right to have a voice is a fundamental human right? We have an opportunity in this place to represent our constituents. If, in doing so, we give a voice to some who hitherto did not have one, we will have spent a useful half-hour in this debate. I look forward to hearing the Minister’s response.

[Cathy Jamieson (Kilmarnock and Loudoun) (Lab/Co-op)]

On a point of order, Mr Deputy Speaker. I apologise to hon. Members for having to raise this point of order at the end of a passionate speech in an important debate. I seek your guidance, Mr Deputy Speaker. Today I had a telephone call from someone in the press asking me to comment on a parliamentary question I had asked and for which they had the answer. Unfortunately I was not party to that answer, as it had not been delivered to me. When I contacted the Table Office, it could not elucidate either. I was, however, able to obtain a scanned copy from the press. Would you agree, Mr Deputy Speaker, that this is not the way to conduct business and ensure that Members are appropriately briefed?

A and E Departments

Paul Maynard Excerpts

Tuesday 21st May 2013 Commons Chamber

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

One million more patients a year are going through A and E departments and an increasing number of family doctors are progressively opting out of out-of-hours care. Why does the Secretary of State think that the King’s Fund can see the correlation but the Labour party cannot?

[Mr Hunt]

Because, I am afraid, the Labour party is completely failing to take responsibility for some catastrophically bad decisions that it made when it was in power. Labour Members might want to talk not only to people such as the King’s Fund, but to their own constituents, who say that traditional family doctoring is something they would like to see return.

Health and Social Care

Paul Maynard Excerpts

Monday 13th May 2013 Commons Chamber

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

It is a pleasure to speak in this section of the debate on the Queen’s Speech.

It is three years, almost to the day, since I made my maiden speech, in the very same section of the debate on the Queen’s Speech—health and social care—and a lot has changed in those three years, especially on the Government Benches, in terms of policy. Listening to the Opposition speeches, however, and indeed to some from the Government Benches, it seemed to me that a lot had not changed. I think back to 1997, when the Conservative party experienced an appalling and traumatic defeat. How did it react? For a short while, we thought that the voters had got it wrong, that we could keep thrashing away at the same old themes and that very soon the voters would repent of their folly and everything would be all right, we would be carried back, shoulder high, into power. Of course, it did not happen; it took us 13 years and three election defeats to realise that singing the same old tune, time and time again, did not deliver the promised nirvana.

When I listen to Opposition Members, I feel as if I am listening to the Conservative party of 1997, only now it is the Labour party of 2013: unwilling to change, going back to what makes it feel comfortable, bashing the tobacco companies—perhaps quite rightly, but there needs to be a much stronger evidence base than disliking global capital, for heaven’s sake! Time and again, I listen to Labour Members and think, “Theirs is not a party that is ready for power”, because I am not hearing a new analysis or new arguments; I am just hearing the same old grudges, although I might except the hon. Member for Barrow and Furness (John Woodcock), who is one of Labour’s more thoughtful Members—that is quite rare on the Labour Benches.

I was delighted to have the Leader of the Opposition in Cleveleys for the local election campaign. On this occasion, he kindly wrote to tell me in advance—the first time he had done that, despite having made several visits—so I thank him for that small courtesy, if for nothing else. He gathered in the shopping centre in the centre of Cleveleys, with his little pallet, which he stepped on to. Labour bussed in all the councillors it could from Blackpool, because there are hardly any Labour activists in Cleveleys, and he just stood around, and my spy, who was there, tells me that no one paid him the slightest attention—he was looked upon as rather a curiosity, while people walked by eager to get on with their shopping and get their bargains. What happened? The political compass needle in Cleveleys barely shifted compared with 2009. If Labour cannot win back Lancashire—a county it controlled from 1981 to 2009—it is not in a position to gain power, in my view. That is why it is doubly important that Conservative Members do not get overly seduced by what UKIP is doing, but focus on what matters and what we were elected to do.

In my maiden speech three years ago, I stressed the importance of the dignity of patients in our health care system, and I have stressed it ever since. We are now starting to see progress on that, not least thanks to the activism of the right hon. Member for Cynon Valley (Ann Clwyd) and the role she now plays, but more importantly thanks to the rhetoric around what we recognise as being important. On my way here today from Euston, I was standing on an underground train behind a young trainee nurse. In her arms was a thick folder bearing one title: “dignity”. That message is starting to get through to NHS staff, in particular.

Although we can all recite cases from constituents of cases of care that they felt were below standards, we must balance that with the recognition that nurses are the glue that holds the NHS together and that we talk them down at our peril. For every nurse who might not have ensured that somebody was adequately fed or had their fingernails clipped or their conversation in the morning, there is another for whom nursing is a vocation. We have to recognise that. Nursing is a vocation. Occasionally, it is a very difficult vocation. The system can be testing, trying and infuriating for many, but nurses are there because they want to care for their patients. Perhaps the secret to health policy lies in allowing our health care professionals to express that vocation, not to smother it beneath a system that does not allow that feeling of good will and desire to do good for our fellow patients to express itself.

The other thematic issue I want to come to is perhaps a little more controversial. We are all politicians, are we not, whether we like it or not? I am sure I would rather not be a politician, but I am a Member of Parliament and it comes with the territory. The moment anything is scheduled to close in our constituencies, there is an immense temptation to man the proverbial barricades. We issue a press release and set up a photo op outside the threatened location, but do we always pause to think what is in the best interests of our constituents, or do we think, “What will get me more votes?”

I am fortunate, as I have an excellent hospital in Blackpool, the Victoria. It has one of the premier stroke rehabilitation units in the north-west. When it opened, it started taking in-patients from as far away as the south lakes. I am not quite sure, but the area it covers might even stretch as far as Barrow—I know it goes as far as Kendal. That was quite controversial at the time, because it meant that a patient having a stroke would have to drive past about four hospitals to get to Blackpool. Some people thought, “Why can’t we go to our local hospital? It’s got wonderful facilities.” However, since the stroke unit at Blackpool opened, survival rates have increased for all patients in all groups, because of the excellence of its specialist care. That is a challenge for every Member of this House, no matter what our political parties. The easy answer—the easy campaign, the scare story, or what I call “campaigning in the conditional”—is not always in our long-term interests.

I ask myself how I would have reacted if the stroke unit had been in Lancaster rather than Blackpool. Would I have manned a barricade, gone on a march or set up a petition? I do not know; I hope I would not. I hope I would have trusted in the idea of outcomes. Although I recognise what the hon. Member for Barrow and Furness (John Woodcock) said about localism needing to mean something, I also recognise that clinicians, too, have a role. Where outcomes are unacceptably poor, something has to be done. However, we need to do a much better job of communicating to our electorate why the clinical evidence that suggests that a particular thing has to change is powerful evidence, because evidence is power and we need to convince those who are most concerned.

Oral Answers to Questions

Paul Maynard Excerpts

Tuesday 27th November 2012 Commons Chamber

[Anna Soubry]

No. I would urge the hon. Lady, if I may, to exercise care when claiming that this is a privatisation of the NHS. It certainly is not. GPs’ surgeries, such as those in her own constituency, have always been private businesses. A GP surgery in the hon. Lady’s own constituency, where, in my view, she has been engaged in considerable scaremongering, was put out to tender under rules introduced by the previous Labour Government. Indeed, it was the previous Government who brought in privatisation to the NHS on a scale that we had never seen before in this country. I am proud that it is this coalition that is making sure that the tariffs are fair and no longer favour the private sector.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

One way that the clinical commissioning groups can support the values of the NHS is to back the new social enterprises—forms of business enterprise—that are now delivering NHS services central to our health-care reforms. Is the Minister aware that my local clinical commissioning group wants to shut down a 60-bed rehabilitation unit provided by nurses and owned by a social enterprise called Spiral, without any adequate provision for a replacement? Will she meet me to discuss this worrying development?

[Anna Soubry]

Yes, of course I will meet my hon. Friend. I hold a ministerial surgery on Monday evenings and would be grateful if he came along to one, but I would be happy to meet him in any event. These are local decisions that will be made by local commissioners, but they should always commission in the interests and to the benefit of the people whom they serve.

Adult Social Care

Paul Maynard Excerpts

Monday 16th July 2012 Commons Chamber

[Liz Kendall]

In reality, the number of days on which a hospital bed is occupied by someone who could have been discharged has risen by 18% since this time last year, and by a staggering 29% in the last 18 months. These delays now cost the NHS £18.5 million every single month, and more than a third are due to cuts in social care. The number of delayed discharges from social care has risen by 11% in the last month alone.

Instead of burying their heads in the sand, Ministers should be taking action. Labour has called for £700 million from last year’s NHS underspend to be ring-fenced for social care immediately, and I was delighted to learn that the all-party group on local government today called for those funds to be used for that purpose, rather than being absorbed back into the Treasury coffers. I hope that, when the Minister responds, he will tell us whether he agrees.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

I congratulate the hon. Lady on giving way at long last. It is nice of her to do so, and we are most grateful. Given that she began by saying that she wanted to see a consensual, non-partisan approach to the issue, can she explain why we have just heard a party political diatribe? I find that very disappointing.

[Liz Kendall]

I was stating the facts about the care crisis, which have been made clear not by me but by organisations representing older and disabled people, by local councils and by the NHS. It is the Government’s denial of the existence of the care crisis and their insistence that there is enough money in the system that I am seeking to correct.

As I have said, the Government have failed to recognise, let alone tackle, the care crisis, and they have failed to face up to the difficult decisions that we need for the future. Their progress report on funding merely says that the Government support the principles of Andrew Dilnot’s commission on the funding of long-term care and support. They now claim that it is only right for Dilnot’s proposals to be considered as part of the spending review. That was not their view two years ago, when they made a clear promise in their NHS White Paper to legislate on a new legal and financial framework in the current parliamentary Session. Now we have only a draft Bill to reform social care law alone. At best that means that there will be no change in funding before the next general election, and at worst it means no change at all if the Government return to power.

--- Later in debate ---

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

I shall be very brief then, Mr Speaker. I have just two minutes.

When we talk about social care, we tend to spend most of our time discussing the elderly. I want to say a few words about young disabled people, however, who benefit from social care, and who need to have a voice in this debate. I chair the all-party group on young disabled people, and we have been discussing many of the key issues. Last week, we discussed housing, for example. I welcome the money proposed in the White Paper for improving housing for the disabled, but may I sound a note of caution? At present, too many wheelchair-adapted houses are not going to those who need them—people in wheelchairs. It is all very well constructing these houses, but we must get the allocation policy right, too.

I welcome the transition funding, but I have a plea to make on that. There is a concern that there is a cliff-edge at the age of 18. For many families it is, as it were, a gradual cliff-edge. Things start to decline at 14, so the care package they get at 18 might not be the appropriate one they need as an adult. May I ask the Minister to look at that issue closely?

I welcome the introduction of portability, as that is crucial. I know that the Opposition brought similar measures in when in government, but we are taking this further. It is far more important for younger disabled people than it is for those who are elderly. We talk a lot in this Chamber about social mobility. One of the main hurdles for young disabled people who wish to go to university is the great fear that when they get there they will not have the same social care package as they had when they were at home with their parents. That is the main fear they face; it is what keeps them at home and means that they do not take full advantage of the educational opportunities on offer. I will stop there.

Young Offender Institutions (Speech and Language Therapy)

Paul Maynard Excerpts

Thursday 28th June 2012 Commons Chamber

[Seema Malhotra (Feltham and Heston) (Lab/Co-op)]

I am grateful to the House for the opportunity to speak today on this important topic and thank many hon. Members for their supportive comments this week and for sharing their own perspectives. I wish to raise several points in my contribution, which I hope the Minister will be able to address. If he cannot answer today, I would be grateful if he would ensure that he writes to me with answers or, if the questions relate to areas that are not his direct responsibility, agrees to forward them to the Minister responsible.

This debate was triggered by my recent visit to Feltham young offender institution and, indeed, my interest in youth justice as a member of the Justice Committee. Speech, language and communications needs have become an increasing area of policy focus. An inability to communicate effectively has a tremendous impact on the ability to learn, hold down a job and have a stable family life. I am pleased that the all-party group on speech and language difficulties, which was convened by my hon. Friend the Member for Swansea West (Geraint Davies), is undertaking an inquiry into the links between SLCN and social disadvantage.

The Marmot review of health inequalities in 2010 identified communications skills as being necessary for school readiness, and a Department for Education research report last year showed a clear association between social disadvantage and SLCN among primary school children. It stated:

“More of the low attainers were boys, more were eligible for free school meals and more had English as an additional language.”

Speech, language and communication needs are characterised by difficulties in understanding complex language, in explaining oneself clearly and logically and in responding appropriately to specific social settings. The Bercow report described those needs as including

“difficulties with fluency, forming sounds and words, formulating sentences, understanding what others say and using language socially.”

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

The hon. Lady mentions the impact of many forms of communication delay. Does she agree that one of the most dangerous forms is when young offenders, upon release, do not understand the terms of their release and are called back to prison because they do not understand what they cannot do, such as cross a road to reach a grandmother, for example? Does she agree also that that is why speech therapy is so important in our young offender institutions—to make sure that individuals understand what is happening to them?

[Seema Malhotra]

I thank the hon. Gentleman for his contribution. He makes an important point about the inability to understand what is going on in the justice system through an inability sometimes to read and, certainly, to understand what is being said. An important part of the argument is that we need better speech and language therapy services in order to reduce reoffending.

Statistics from the Royal College of Speech and Language Therapists show that 10% of school-aged children and 1% of adults in the general UK population have speech, language and communication needs, but that 55% of children in deprived areas are affected by such needs. They suffer from a “word gap” of an estimated 30 million words when compared with children in wealthier households, and that limits their ability to use language to communicate effectively.

It is estimated that more than 60% of young offenders have speech, language and communication needs, and there is evidence of a vicious circle—of deprivation leading to reduced language development, leading in turn to communication difficulties. Children with speech and language difficulties are more likely to become frustrated at school, to play truant and to get involved with crime. Once they are involved, they struggle with the formalities of courts and of police interviews, and they come out worse because of it.

Oral Answers to Questions

Paul Maynard Excerpts

Tuesday 12th June 2012 Commons Chamber

[Paul Burstow]

I can certainly assure the hon. Gentleman that we are in earnest in making sure that we learn the lessons from this evaluation and work actively with the Thalidomide Trust to ensure that we implement the lessons in future schemes.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

My constituent Mr Joseph Bannon of Cleveleys, who is a thalidomide patient, has made clear to me the great importance of continuing the scheme. They are a declining group of people with increasing needs and any failure by the state to meet those needs would be absolutely unconscionable. Will the Minister reassure me that there is no prospect of that occurring under this Government?

[Paul Burstow]

What I can reassure the hon. Gentleman about is that the Government are carrying on with the evaluation. We are waiting for the evaluation of the second year to see how the scheme is working. The grant is not intended to meet all the additional costs that thalidomiders face. Aside from the grant, there are other sources of public funding and, of course, the funds that the Thalidomide Trust administers on behalf of those survivors of this catastrophe.

Epilepsy

Paul Maynard Excerpts

Tuesday 29th November 2011 Westminster Hall

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

It is a pleasure to serve under your chairmanship, Mr Scott. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing this important debate.

I am epileptic. I have nocturnal epilepsy. I have tonic-clonic seizures, which, as the hon. Gentleman explained, are the severest form of epilepsy and the form that we all associate with the condition. I am, at least for another fortnight, between the ages of 20 and 35. I am single and, for the avoidance of doubt, I should make it clear that I sleep alone. I am also male, for the avoidance of any further doubt, and it might surprise people outside this Chamber to learn that I work long hours in a stressful occupation—at least I think it is stressful. I therefore tick every box for being at risk of sudden unexpected death due to epilepsy. I go to bed every night knowing that there is an infinitesimally small chance that I might not wake up again. That is, of course, a great concern.

I realise that anyone with epilepsy has a 24 times greater chance of sudden death than the normal population. Those particularly at risk of SUDEP are 23 times more likely again to experience sudden death. That understandably preys on the mind, but what concerns me more than anything else is the fact that I did not learn of all the risks at the time of my diagnosis; I discovered them because I happened to Google my condition. I sat at my computer with a chill going over me, thinking, “My goodness, I never knew any of this could possibly occur.”

I know that that is a wider concern from meeting many people, including a constituent of mine, Avril Walker, who lost her son Christopher to SUDEP when he was aged 19. I have also met many families through Epilepsy Bereaved and Jane Hanna. They all say the same: they have a sense of anguish at the loss of a loved one, which is natural and entirely understandable, but many of them have a much greater sense of frustration that at the time of diagnosis no one explained the risks of SUDEP to them. If they had known, they could at least have sought to undertake mitigating activities to reduce their risk.

I know what those activities can involve. Before my diagnosis, when my epilepsy was not controlled, I managed to throw myself down the stairs. I woke up with my head in a fridge, a washing machine and an oven, which thankfully was not turned on. I threw myself out of bed and hit my head on my bedside cabinet, making a large gash only just above my eye. When I went to accident and emergency, I was told, “Oh, you’ve just been drinking too much.” The irony, of course, is that the treatment for my epilepsy involves the avoidance of any alcohol. That is what makes it so difficult to control: if any alcohol is used in any food that I inadvertently eat, I will have a seizure in the night.

Thankfully, I adhere to my medicine. The diagnosis is so important because there is no greater impetus to adhere to medication than the knowledge of what might happen if one does not. The most sacrosanct thing in my life is ensuring that I have my medicine. I live what is essentially a double life—I am down here half the week and up in Blackpool the other half—so it can be quite difficult to ensure that I have the little packet of pills that I usually carry around with me. If I am without them, panic ensues and I have to rush down to the Victoria walk-in centre to get an extra prescription. May I complain to the Government about its being shut in a month’s time?

[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

I am listening with great interest to the hon. Gentleman’s personal experience; our debates are always enhanced by such contributions. Does he think that there is any particular reason why doctors are unwilling to tell people diagnosed with epilepsy about the risk of sudden death?

[Paul Maynard]

I thank the hon. Lady for that pertinent intervention. I was intending to come to that. I think that all doctors dislike dispensing bad news. It is perhaps the least fulfilling part of the job. I am sure that some of the doctors to whom I have spoken think that the moment of diagnosis is not necessarily the appropriate moment for a detailed discussion starting, “Oh, and by the way, you’re 23 times more likely to die now, so you need to do this, this and this.” However, it underlines the importance of epilepsy specialist nurses, who can have a more structured conversation one or two weeks later, after people have got over the shock of the diagnosis.

The diagnosis is a shock. When I was diagnosed in my early 20s, I had no idea when I went to the doctor’s that morning that he would tell me that I had epilepsy. I was stunned by the news. That might not have been the most appropriate time to say, “And by the way, you’ve got all this to deal with as well.” None the less, it is vital that that structured conversation occurs at some point soon after diagnosis, because it is possible to do things to mitigate the condition, even if it is just blunting the sharp corners of one’s bedside cabinet, lowering the height of the bed or fitting a child gate above the stairs. If one knows what is likely to occur, one can at least try to mitigate it.

It also underlines the dramatic importance of adhering to medication. Many of the young people who are most susceptible live what one might call chaotic lives. They do not always pick up their medication. If they are away at university, they are not under parental control and one cannot monitor their medicinal intake precisely. If they are aware of the risks, a degree of self-discipline might be brought into play to ensure that they stick to their medication regime. I have heard time and again that sudden deaths seem to occur particularly in a university setting. That concerns me. Self-discipline is necessary as early as possible, and the diagnosis and explanation process are fundamental.

When the worst occurs—tragically, it will occur, because one can never iron out the risks entirely—a much better post-death process is needed. It is natural for the family to be shocked, particularly if they were not expecting it and had not been made aware of the risk factors. There is a lack of awareness in the coroner service and among the police. There can be nothing worse than finding one’s child’s bedroom turned into a crime scene because police are not aware of the potential for sudden death from epilepsy. All that could be much better handled with instructions from on high. The coroner service in particular needs to make a list of national charities dealing with sudden death to which families can turn for help. That would be of great assistance, because many people simply do not know where to turn.

I beg the Minister to encourage the medical profession to ensure that some medical professional has a conversation either at diagnosis, if they feel it appropriate, or within a fortnight or so, to explain the risks. That alone would make a difference, rather than a conspiracy of silence that leaves those with epilepsy to find out about it for themselves. If that conversation occurs, at least people can try to take the actions necessary to protect themselves. That would make the most difference.

Oral Answers to Questions

Paul Maynard Excerpts

Tuesday 7th December 2010 Commons Chamber

[Paul Burstow]

First and foremost, the hon. Lady should welcome the fact that this will provide opportunities for the greater integration of services, and that is a key way in which we can deliver better outcomes for her constituents and others up and down the country.

[Paul Maynard (Blackpool North and Cleveleys) (Con)]

16. How many patients in psychiatric care died of natural causes in the last five years.

[The Minister of State, Department of Health (Paul Burstow)]

Information on the number of people in psychiatric care who died of natural causes is not available. However, information about patients detained under the Mental Health Act is collected by the Care Quality Commission. The most recent information, covering the period 2005 to 2008, shows that there were 1,392 deaths of detained patients, of which 1,123 were ascribed to natural causes.

[Paul Maynard]

I thank the Minister for that reply. Does he share my concern that, almost uniquely in psychiatric care the state has a large degree of control over an individual’s circumstances, yet, unlike in prison or police custody, deaths from natural causes do not have to be reported to the coroner or be the subject of an inquest? Does he not think that the time has now come to end that disparity and to shed some light on to the real reasons behind many of the deaths from natural causes in psychiatric care?

[Paul Burstow]

My hon. Friend might be interested to know that the Ministry of Justice is reviewing sections of the Coroners and Justice Act 2009 and how they will be implemented. That review will include the subject of how deaths are reported to coroners. In fact, the statutory requirements to report deaths of mental health patients to coroners are the same as those for other patients, and NHS providers must report deaths of service users that occur during, or as a result of, care or treatment that they are providing.