Healthcare Optimisation Plan: Kirklees

Paula Sherriff Excerpts

Tuesday 12th December 2017 Westminster Hall

[Paula Sherriff (Dewsbury) (Lab)]

I beg to move,

That this House has considered the healthcare optimisation plan, Kirklees.

It is a pleasure to serve under your chairmanship, as always, Mr Hollobone. As is now widely acknowledged, our NHS is under ever-increasing pressure, and budgets are stretched beyond capacity in almost every part of the country. In my area of Kirklees, we face unprecedented cuts and challenges. Both of the local hospitals that serve my constituency have been subjected to downgrades and the closure of vital services.

The financial challenge in health services across Kirklees is unprecedented. There are reports that deficits are forecast to reach record levels by the end of this financial year. Sadly, that is mirrored across the country as a result of the Government’s onslaught of cuts to our public services. To be frank, our NHS is being starved of money to the point at which lives are being put in danger, and financial decisions are being given priority over clinical judgments. Every day, we see the pressure that the NHS is under. Hospital waiting times are up, it is harder than ever to get a GP appointment, ambulance waits are increasing, and hospital wards are seriously understaffed. As the weather turns to freezing, we are all fearful of a repeat of last year’s winter pressures, when people were dying on hospital trolleys, waiting to be seen.

Only this week, the highly respected Lord Kerslake resigned his post as chair of King’s College Hospital board, claiming that NHS funding desperately needs a rethink and that the demands for savings are unrealistic. That came on the back of comments from NHS England’s chairman and its former national medical director, following their disappointment that sufficient money was not made available in last month’s Budget.

The chairman, Professor Sir Malcolm Grant, said:

“We can no longer avoid the difficult debate about what it is possible to deliver for patients with the money available.”

Professor Sir Bruce Keogh added his personal view:

“Budget plugs some, but”

definitely

“not all, of NHS funding gap”,

which would

“force a debate about what the public can and can’t expect from the NHS”.

He added that it was:

“Worrying that longer waits seem likely/unavoidable.”

In the face of such financial pressures, the two clinical commissioning groups covering my constituency, North Kirklees and Greater Huddersfield, have recently released plans to introduce what they refer to as a health optimisation programme, which would restrict access to elective surgery for those who smoke or who are obese. Make no mistake, whatever title is given to the scheme, it is nothing more than a thinly hidden attempt at rationing healthcare for those in need. Smokers would be given six months to quit, and for those who are considered to be obese—measured by a body mass index of more than 30—the requirement would be to lose 10% of their body weight within 12 months.

[Thelma Walker (Colne Valley) (Lab)]

Does my hon. Friend agree with me that the use of BMI to classify whether someone is obese is, frankly, laughable? Does she agree that Greater Huddersfield CCG needs to look at an alternative measure that would not put Huddersfield Giants prop forward Sebastine Ikahihifo, whose BMI is 32.3, in that category?

[Paula Sherriff]

I thank my hon. Friend and neighbour for her very valid intervention. I was just about to say that BMI is very subjective. As we are all aware, some high-performance athletes or bodybuilders have a BMI higher than 30 but are at the peak of health.

Obviously I agree that any moves to aid weight loss and stop people smoking are a good thing, but not at the expense of excluding people from NHS treatment. If the CCGs were so determined to achieve better outcomes in those areas, they would invest in better smoking cessation services and weight-loss programmes, but the reality is that in recent years those services have been among the ones to suffer cuts.

Given the budget restrictions and taking into account the views of the professionals, who advise that there is little if any evidence in support of any improved outcomes as a consequence of such measures, I can only draw the conclusion that the proposals to ration surgery are nothing more than a cost-saving exercise. The CCGs argue vehemently against that view, but North Kirklees CCG admits that health optimisation is one of 21 cost-saving measures identified to meet the existing financial challenge that might see its deficit rise well beyond predicted levels by the end of the financial year. At best, it seems to be an ill-conceived plan that has not been thought through correctly.

As anyone involved in healthcare knows, the providers and commissioners in any area often form a hectic Venn diagram. That is no different in the borough of Kirklees where my constituency lies. The two hospital trusts that serve my constituency are overseen by four CCGs. Of those, only three are considering and proposing to implement a health optimisation programme. That means, in effect, not only a postcode lottery but a waiting list for elective surgery—a smoker from Wakefield might be allowed on to the list while his or her equivalent in Dewsbury, some nine miles away, would be forced to wait six months before even being considered for surgery. That would be completely unjust, unfair and morally wrong. The irony is that those same two patients would have their surgery in the same hospital.

When reading further into the small print of how health optimisation would work, I became even more alarmed. The decision on whether people can be referred for treatment would lie initially with their GP. He or she is able to make the decision on whether to refer or to put the patient on the health optimisation programme. Patients put on the programme would have six months to quit smoking or 12 months to lose weight. After that time they would be referred to a specialist who would decide if they qualified for treatment. My understanding is that that means, in effect, people could lose 10% of their body weight in the hope of receiving a knee or hip replacement, for example, only to be told that they do not qualify for the surgery. Not only that, but one month from the end of the programme, patients are asked if they still wish to be referred. That is where louder alarm bells started to ring for me. It is absolutely clear that the decision on whether to operate, or whether the patient needs surgery, must be made by the relevant surgeon and not by people who do not have all the facts in front of them.

I ask Members to picture this scenario: Mrs Smith has been told that she has to lose 3 stone before she can be referred to a specialist regarding the pain in her knee. She tries to lose weight but finds it incredibly difficult, not least because her knee pain prevents her from exercising. Mainly being housebound affects her mental health, causing depression, which in turn leads to comfort eating. She tries to attend the weight management group that she was referred to but becomes disheartened and embarrassed when each week her weight either stays the same or increases, so she stops going. After 11 months she receives a letter asking her if she still wants a referral to an orthopaedic specialist to look at her knee. She knows that her weight has actually increased so she ignores the letter, because the thought of having to face up to her weight gain is far too humiliating. The pain in her knee is now excruciating, but she dare not face the surgeon when she feels such a failure. That could be a very real outcome if the plans are implemented. The NHS might save money and waiting lists could look far better, but what about the human cost? I implore the Minister to think about just that—the human cost.

A list of exceptions in the rationing proposals include: conditions that are immediately life threatening; patients who require emergency surgery or have a clinically urgent need where undue delay would cause clinical risk of harm; and patients undergoing surgery for cancer. Nowhere do the proposals mention any measure of the patient’s quality of life. I have heard stories from constituents who have had to give up work because their mobility has become so restricted while waiting for knee or hip operations, or whose weight has increased to levels of obesity simply because they cannot walk or exercise like they used to. How does naming and shaming those people on a rationing list improve their quality of life?

I also ask the Minister where the rationing ends. Is there a plan to stop providing surgery and treatment for, perhaps, people who play rugby, or teenagers who break their leg horse riding? Would we say, “No, you can’t have surgery, because your own actions led to this”? What about people who drink alcohol moderately? Would we say, “You cannot have treatment for your liver sclerosis because this is a lifestyle choice”? Is this the start of the beginning of a much bigger rationing programme?

In preparation for the health optimisation programme, Greater Huddersfield and North Kirklees CCGs stated that they had carried out a public engagement exercise. On research, I found the questions that they had asked, which included: “Please tell us how we could encourage people in Kirklees to live a healthy lifestyle?”; “Please tell us what support you think should be available to help people lose weight and stop smoking before their surgery?”; “When and how do you think that support should be provided?”; and, “Please use this space to provide any additional comments you have about supporting people to lose weight or stop smoking?”. Nowhere did the questions ask for opinions on whether people should be excluded from surgery because they are overweight or smoke. The CCGs’ failure to be up front and honest about their proposals can only indicate their embarrassment at having to implement such a scheme simply as a result of budget restraints.

Statistics show that approximately 30% of the population of Kirklees either smoke or have a BMI of more than 30, so almost one in every three people in my constituency could be turned down for elective surgery. North Kirklees and Greater Huddersfield CCGs acknowledge that there is not enough existing provision to support people being put on to the health optimisation programme, whether in smoking cessation services or weight-loss programmes. In the health optimisation programme proposal, the CCGs state that they will undertake a tender exercise for a

“‘Zero Value - Activity based’ contract with additional providers”.

What that means is anyone’s guess, but I strongly suspect that no new money will be made available, given the financial position of our local NHS services.

The plans have so many pitfalls that they simply must not be implemented, and the Minister can be sure that I will fight them every step of the way. Clinical commissioning groups should not face such intolerable choices. I do not believe that anyone delivering healthcare entered the profession to make cuts or to restrict people from receiving treatment that they desperately need to improve their quality of life. I therefore call on the CCGs to halt their plans to introduce the health optimisation programme for all the reasons that I have listed and many more. I ask the Government to listen to the experts, including the Royal College of Surgeons, to put an end to the draconian cuts and to provide us with a fully funded healthcare system that is accessible to all.

I would like to finish with a quote that I have used many times before, both in this Chamber and away from it. Nye Bevan, the founder of our great national health service, said that the NHS will last as long as there are folk left with the faith to fight for it. I will never lose faith or stop fighting. I hope that the Minister will say the same.

[Mr Philip Hollobone (in the Chair)]

The debate can last until 5.30 pm. There is one Member who wishes to speak, and before the debate ends, Paula Sherriff will have three minutes to make her concluding remarks. The guideline limits on speeches are ten minutes for Her Majesty’s Opposition and ten minutes for the Minister, but I expect that they will be able to speak a little longer. I call Rachael Maskell.

--- Later in debate ---

[Mr Dunne]

I do not accept that. It is important that we use all the tools at our disposal to encourage the public to lead healthy lives where possible. These measures form part of the suite of measures that are necessary to bring that about.

The Government have backed the five year forward view. Opposition Members raised the issue of finances. We have committed to a real-terms increase in funding through the spending review period. Most recently, in the Budget only last month, we committed an additional £2.8 billion on top of the £8 billion real-terms increase by 2020. We are providing significant extra resource, but we recognise that different areas of the country will face different challenges and so will develop different approaches to how they use their resources most effectively in patients’ interests. That will inevitably involve making difficult decisions. It is right that we trust local NHS organisations, clinically led, to make those decisions, rather than second-guessing them centrally.

Having said that, we have set certain expectations of the system, one of which is that blanket bans on treatments are completely unacceptable and incompatible with the NHS constitution. That is why I refute the challenge from Opposition Members to say whether or not we are imposing rationing on the NHS. The local management responsible for the NHS in their areas have to respect the constitution and should not introduce blanket bans, but they do have to look at ways to provide care for their populations in a manner that lives within the budgets they have been provided with.

[Paula Sherriff]

I have listened to the Minister carefully. Can he explain why he feels it is acceptable that someone in Wakefield could have surgery, while someone nine miles away in Dewsbury could not? They might both be smokers, and the surgery would be carried out by the same surgeon, probably in the same hospital. Are we not in danger of going into a very big postcode lottery once again?

[Mr Dunne]

The hon. Lady made that point in her remarks, and I will try to address it. She can pick me up on that again.

[Mr Dunne]

I will come on to that. We are talking primarily about what is happening in North Kirklees and Greater Huddersfield CCG areas, which have not yet implemented this policy. I will explain why I do not think that that should be the case.

On the healthcare optimisation plan, I take the gentle chiding from the hon. Member for Ellesmere Port and Neston (Justin Madders) about the way in which the NHS describes proposals. I have some sympathy with what he says about the way in which language is used, but this is a plan to encourage greater public health among the population of North Kirklees and Greater Huddersfield CCG areas, for which they are responsible. I talked to the CCGs in preparation for the debate and was advised that they do not see this as a blanket ban on treatment. I have emphasised to them that they should not do so and that there should not be a blanket ban on treatment.

I will describe the proposals, as I understand them. They have been developed by the CCGs since autumn 2016, and the objective is that patients who are overweight with a body mass index of 30 or above will have 12 months to lose at least 10% of their overall weight or to reduce their BMI to less than 30, while patients who smoke will be encouraged to take up to six months to quit smoking before undergoing routine surgery. Those who quit smoking for four weeks or achieve their target weight loss will be able to be referred for surgery under the policy.

The development of the plan coincided with the UK’s childhood obesity strategy and the proposed introduction of the soft drinks industry levy, reflecting the Government’s commitment to tackling the major public health problems affecting large sections of society. The hon. Member for Dewsbury and the hon. Member for York Central recognised the need to address the obesity crisis in this country. I am grateful for their support and that of the Opposition spokesman, the hon. Member for Ellesmere Port and Neston. I think we are united in recognising that something has to be done about this. I hope they support the proposals that the Government have made for the obesity strategy and the considerable progress we have made in reducing smoking since 2010. Hon. Members have made the point that the policy should not be at the expense of treatment if treatment is urgent or, if there is no treatment, it might lead to degradation of the health condition of the patient subject to the policy.

[Paula Sherriff]

I thank the Minister for his generosity in giving way. Does he agree that the decision must be made by a surgeon? That is so important, because they are highly trained and are surely the ones who can come to a decision on whether the patient can wait.

[Mr Dunne]

I will come on to that. The short answer is that I agree that the relevant clinicians should make those decisions.

Going back to where the CCGs are in this process, as I said earlier, they have not yet introduced the proposal. They have been working with the local population and with Healthwatch Kirklees, and have held a number of engagement events with local authorities and interested stakeholders to try to understand the reaction of those parties to the proposal. An engagement event was conducted in March and April of this year, and one with Kirklees Council in August and September of this year.

The CCGs have listened and responded to some of the points made. They have made several changes to their original proposals, including exempting children from the programme. They also recognise the limitations—amusingly identified by hon. Members in their contributions—of using BMI as a measure of body weight. Therefore, for example, people with high muscle mass should be excluded from the BMI calculation for the reasons that were well explained earlier in the debate.

The CCGs are including safeguards in the proposals, and they intend that, in exceptional circumstances, normal individual funding request processes will continue to apply. Hon. Members have criticised that as imposing an undue obligation on the individual to seek that route to secure treatment. That is effectively an appeal mechanism that applies across the NHS and is a well-worn and well-understood path for clinicians to support individual funding requests for patients where needed, which we should continue.

Both the hon. Member for Dewsbury and the hon. Member for York Central used the expression “lives at risk”. I would gently say that there is absolutely no intention that policies such as this should lead to lives being at risk. They are about trying to put individuals in a position where their own circumstances would lead to better outcomes from the proposed surgery. The hon. Ladies have called for evidence supporting the proposition —it was raised by the hon. Member for York Central when we met at the end of last month. I have asked for that evidence. A number of research papers support the propositions made by the CCG, in particular on the question whether obesity at the time of surgery is associated with a wide range of problems. Sustaining weight loss is the key. Rapid weight loss followed by rapid weight gain clearly do not help the patient, but the evidence from the research papers provided to me is that maintained weight loss or cessation of smoking undoubtedly and clearly have clinical benefits for the patient. There is evidence to support that.

I will come back to the point raised earlier on by the hon. Member for Dewsbury and the hon. Member for York Central, but I absolutely recognise that the clinician primarily responsible for the care, whether that is the GP or the secondary clinician, should have discretion to ensure that a referral is made, should a non-referral of a patient or a delayed procedure outweigh any benefits from a period of improving health and reducing risk factors prior to a routine operation. We will encourage the CCGs to ensure that that is in their final proposals, once those are made.

--- Later in debate ---

[Paula Sherriff]

I thank the Minister for his considered response. Like the vast majority of MPs in the House from all parties, I care deeply about the NHS. However, I am getting slightly fed up with the platitudes that we hear day in, day out from the Government regarding their putting extra funding in. The NHS is in crisis, and I say that as someone who worked in the health service for nearly 13 years immediately before becoming an MP. I hear it from ex-colleagues of different political persuasions nearly every single day.

I maintain that the concept of the health optimisation plan in Kirklees, and undoubtedly those elsewhere, is deeply flawed. I plead with the Minister to use his influence to engage with the CCGs and to encourage them to go with option 4. I think we all agree that stopping smoking and losing weight is a good thing—my goodness, I could follow some of that advice—but not at the expense of people being in pain and potentially affecting their mental health, or of having a postcode lottery. I discussed the Wakefield-Dewsbury case with the Minister. That is happening, and it will happen because of the false borders to which my hon. Friend the Member for York Central (Rachael Maskell) rightly alluded.

My mum suffers from severe rheumatoid arthritis and has had it since childhood. She is 73 on Friday. A few years ago she started taking a drug that gives her a quality of life that she never had—she started using it as a guinea pig and has continued to use it. It used to take her hours every day to open her hand. She was in so much pain. I once found her at the top of the stairs and she could not go down them. She was crying.

She said to me on the phone one day that she is terrified that the Government will stop her receiving those drugs, because they are not cheap. I told her not to be silly. She knows that her quality of life would severely deteriorate once again if they did, and that she would probably be in a wheelchair. I am not sure I could say that to her now, because this plan is rationing, plain and simple. I cannot have that conversation and tell her that the Government will not stop her receiving the drugs because they are expensive.

I want the Minister think about that in the wider context. She is a 73-year-old woman. Is her life, and those of all the people affected, worth less than ours? We would not stand for our healthcare being rationed. I certainly would not.

Autism Community: Mental Health and Suicide

Paula Sherriff Excerpts

Thursday 30th November 2017 Commons Chamber

[Dr Lisa Cameron (East Kilbride, Strathaven and Lesmahagow) (SNP)]

I beg to move,

That this House has considered the support available for autistic people experiencing mental health problems; calls on the Government to ensure that the NICE-recommended indicator for autism in GP registers is included in the Quality and Outcomes Framework; and further calls on the Government to ensure NHS England works closely with the autism community to develop effective and research-based mental health pathway.

I thank everyone across the House, no matter what side of the Chamber they sit on, who supported the application for this important debate to the Backbench Business Committee. It is truly a cross-party endeavour to raise the profile of this issue, awareness of mental health issues within the autism community, difficulties about access to services, the importance of funding adequate support, and the progress we all must make across the UK for this population.

I thank the many autism charities, mental health charities and research groups that have reached out to me over the past few weeks.

[Paula Sherriff (Dewsbury) (Lab)]

Will the hon. Lady join me in thanking the Whole Autism Family, a charity run by Anne-Marie and Martin Kilgallon in my constituency, who have two autistic boys and who do so much to support other families, who can find it difficult to access medical and other healthcare?

[Dr Cameron]

I thank the hon. Lady for her important words. The bedrock of much of the work undertaken across the UK is such small charities, often run by those who have personal experience and know what works and what needs to be done.

The level of interest in the debate shows the importance of the issue. It is important to so many across the UK, including charities such as those already mentioned. Many charities have contacted me with important recommendations, including Autistica, the National Autistic Society, the Royal College of Psychiatrists and the British Psychological Society.

--- Later in debate ---

[Mrs Trevelyan]

I absolutely agree. I work closely in my constituency with the families who are supporting their autistic children. Clearly, dealing with strangers, with the unfamiliar, and with group dynamics is possibly one of the most difficult things to ask an autistic young person—or indeed an older person—to take on.

We have for too long neglected the research into mental health therapies for our autistic community, even though that tops the list of research priorities if we ask those in that sector. I very much hope that the Government will look to support those who are doing this work. In our manifesto, we said that we

“will address the need for better treatments across the whole spectrum of mental health conditions”—

by—

“making the UK the leading research and technology economy in the world for mental health, bringing together public, private and charitable investment.”

I support those words wholeheartedly and hope that the Minister will be encouraging and will help us to do much more.

Thirdly, let me mention NHS data gathering—this is an issue that comes up in any number of NHS-related debates, but it is critical in this one. GPs are so often the first port of call for those with mental ill health. Going to a GP can be really, really difficult for autistic people. It is an environment with unfamiliar lighting, sounds and rules that cannot be escaped. The hon. Lady’s example of a bell going off is a classic one. It is the unfamiliarity and the pitch of the unexpected sound. There is a lack of understanding by neuro-typicals about what certain pitches of sound can do to those who have hyper-sensitivities. To an autistic young boy or girl, it can be like a bomb going off. We need to consider the impact of such things on those with these heightened sensitivities, especially when they are in a strange place and already in a state of anxiety. Strip lighting in public spaces is another thing that creates enormous tension.

[Paula Sherriff]

The hon. Lady is making an incredibly powerful speech. Some supermarkets, including Sainsbury’s, do an autism hour—every month, I think—which is great, as it provides literature in store for people, and staff also gain a better understanding. If a child or young person is having a meltdown, people should not think automatically that they are naughty but consider that they might be experiencing difficulties relating to their autism.

[Mrs Trevelyan]

The hon. Lady is exactly right. I have experienced many times the meltdown of a small child in a supermarket aisle and had people either offer a word of support or—usually—criticise me for being a bad parent. The line I always used was, “You tell me when you have an autistic child and take them shopping, and I’ll tell you what the problem is”. It is very difficult to understand. We need to provide places of calm. Cinemas do it, and we can do it too. I ask that the Minister take this forward and take on the challenge of getting those quality and outcomes frameworks to work so that our GPs can provide the support that people need.

Oral Answers to Questions

Paula Sherriff Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Hunt]

My hon. Friend makes an important point. We have no plans for legislative changes, but we do want to see closer working between NHS Improvement and NHS England on the ground, so that people working in constituencies and areas such as his get only one set of instructions. We are making good progress.

[Paula Sherriff (Dewsbury) (Lab)]

T7. I have repeatedly asked the Secretary of State, and I ask him yet again, whether he will visit my area to see for himself the damaging impacts that the downgrades and closures of local hospital services in Dewsbury and Huddersfield will have on my constituents.

[Mr Hunt]

I am very happy to accept the hon. Lady’s invitation to visit her area, which I will do, but what I know I will see when I go there is that 8,300 more people are being treated within four hours at her local hospital, where there are 42 more doctors and 56 more nurses than in 2010.

Abortion Act 1967: 50th Anniversary

Paula Sherriff Excerpts

Monday 6th November 2017 Commons Chamber

[Diana Johnson (Kingston upon Hull North) (Lab)]

Fifty years ago, the noble Lord Steel and thousands of brave campaigners brought about a momentous change in women’s reproductive rights. It is hard to overstate the benefits that their campaign brought to women. Abortion has gone from being a leading cause of maternal mortality, shockingly responsible for 14% of maternal deaths—a fact that organisations such as the Society for the Protection of Unborn Children do not address when they call for the abolition of the 1967 Act—to being the most common medical or surgical procedure in the UK, one that a third of women will have had by the time they reach 45. We used to be a country where an estimated 87,000 to 100,000 illegal abortions took place every year and where unwanted pregnancies changed the lives of desperate women. Now, 200,000 women a year can access safe, free and legal services on the NHS.

The 1967 Act was a landmark piece of legislation. For a time, it made Britain one of the world leaders in reproductive rights, when this Parliament introduced a humane piece of law. I am disappointed that no Minister from the Department of Health or the Government Equalities Office has attended any of the events marking the enactment of this piece of legislation. I am also disappointed that Ministers have chosen to award funding raised from the tampon tax to Life, which argues for restricting women’s choices on reproductive rights, when so many wonderful charities could have benefited and used the money to empower women and support their choices.

[Paula Sherriff (Dewsbury) (Lab)]

I thank my hon. Friend for securing this important debate. When I debated with the pro-life charity Life on the radio recently, I was told that if a women it was helping went on to decide to have a termination, it would withdraw support, including housing, from that women. Does she agree that that is incredibly concerning?

[Diana Johnson]

Yes, that is incredibly concerning and I think it is a really bad decision of the Government to award money from the tampon tax to that organisation.

As this House tonight rightly marks the milestone of the Abortion Act, we should also reflect on whether the Act is still fit for purpose. The Abortion Act was never intended to be the end of the campaign for women’s reproductive rights. That point was put succinctly by the late Madeleine Simms, a former campaigner at the Abortion Law Reform Association and one of the architects of the original law. She said:

“The 1967 Abortion Act was a half-way house. It handed the abortion decision to the medical profession. The next stage is to hand this very personal decision to the woman herself.”

I want to turn to why the abortion law needs reforming. Britain’s abortion laws are governed not just by that 50-year-old Act, but by the 88-year-old Infant Life (Preservation) Act 1929 and the 156-year-old Offences Against the Person Act 1861. Taken together, this is the oldest legal framework for any healthcare procedure in the UK. It is a framework that, astonishingly, still treats the act of abortion as inherently criminal and punishable by life imprisonment. As I have mentioned, one third of women, and the healthcare professionals who support them, are stigmatised by these laws. As Madeleine Simms highlighted, the 1967 Act did not give women authority over their own abortions; it merely handed that authority to the medical profession, subject to the consent of two doctors. No other medical procedure requires the sign-off of two doctors, and nor does that requirement exist in most other countries in which abortion is legal.

While other healthcare areas have moved towards more patient-centred provision, with a better doctor-patient relationship, the provisions of the 1967 Act are, despite the best efforts of healthcare professionals, holding back similar progress in reproductive healthcare. Furthermore, as Professor Lesley Regan of the Royal College of Obstetricians and Gynaecologists said:

“No other medical procedure in the UK is so out of step with clinical and technological developments”.

Since 2014, the majority of abortions in England and Wales have been carried out medically, using pills. The 1967 Act was not designed with medical abortions in mind; it was passed when the overwhelming majority of abortions were carried out through surgical techniques.

I regret the fact that, in the 50 years since the Abortion Act was passed, Parliament has mostly shied away from debating issues such as those I have just set out. In March, the House of Commons heard the First Reading of my ten-minute rule Bill on the decriminalisation of abortion in England and Wales. In the 50 years before I introduced the Bill, previous MPs had introduced 11 Bills to amend our abortion laws—seven were private Members’ Bills and four were, like mine, ten-minute rule Bills. All 11 attempted to restrict abortion in some way; not a single one was about improving provision or better supporting women. It seems peculiar that for a procedure so common—one that affects a third of women—the overwhelming parliamentary focus has been on ways to restrict the practice. Had this procedure affected a third of men, it is hard to imagine that we would have debated it in the same way.

--- Later in debate ---

[Jackie Doyle-Price]

At the risk of being really controversial, I think there are lots of elements of counselling for women that are seriously lacking. That possibly reflects the fact that decisions about the welfare of women have generally been taken by men. It is great that there are now lots more women in this House able to influence exactly that.

[Paula Sherriff]

Does the Minister agree that it is imperative that we offer women choice in the decisions they take about their body? Will she give an undertaking this evening to investigate why the Government thought it was appropriate to award the largest sum from the tampon tax fund to an anti-choice organisation?

[Jackie Doyle-Price]

I understand that the hon. Lady feels strongly about this issue, and nobody can doubt her passion and commitment to women’s welfare. My understanding of the grant she referred to is that it went strictly towards the support of women who chose to go through with the birth. I am happy to look at that further. I am not entirely sure it was the largest donation, but I am happy to look into that. However, the hon. Lady is right when she says there should be genuine choice. We do not want anyone to feel that they cannot have an abortion, any more than we want them to feel that they have to have one. We really want women to be able to make informed choices and to feel empowered to have the child, if that is what they would like to do. The important thing is that we empower women. That is the whole purpose of what we are trying to do here—to empower women and allow them to make choices that are safe for them.

Since the Act was passed, there have been regular calls from all sides of the debate for changes to the legislation, and the hon. Member for Kingston upon Hull North has outlined her views clearly today. As she said, this Government and previous ones have always viewed legislative change as a matter for the House to take a view on, and there are no plans to change that.

The Act was last amended in 1991 by the Human Fertilisation and Embryology Act 1990. This reduced the time limit for most abortions from 28 weeks to 24 weeks. No time limit applies where there is a substantial risk that the child will suffer from a serious handicap or that the pregnancy would cause grave permanent injury to the physical or mental health of the mother or put her life at risk. So amendments are possible, and it is ultimately Parliament that decides the circumstances under which abortion can be legally undertaken. The Government will always ensure that regulation works to make that as safe as possible.

The hon. Lady outlined clearly her belief that abortion should be decriminalised, and the Government will no doubt take a view as and when she brings forward her Bill, as indeed will the rest of the House. It is true that any abortions conducted outside the grounds in the 1967 Act currently remain a criminal offence, and there is no intention for that issue to be dealt with by anything other than a free vote.

Turning to the impact of the Act in practice, it is important that we remember that, in the years before the Act, abortion was, indeed, the leading cause of maternal mortality in England and Wales. For example, the first confidential inquiry into maternal deaths in 1952, reported 153 deaths from abortion alone. The most recent confidential inquiry report found there were 81 reported deaths in 2012-14 for all direct causes of maternal mortality, such as obstetric complications, interventions and omissions. So since the Act came into force, women in Great Britain have had access to legal and safe abortion services.

NHS Pay

Paula Sherriff Excerpts

Wednesday 13th September 2017 Commons Chamber

[Paula Sherriff (Dewsbury) (Lab)]

I start by saying it was a joy to be in the Chamber to listen to the maiden speech by my hon. Friend the Member for Portsmouth South (Stephen Morgan). I am confident he will be a strong advocate for his area. I would also like to take this opportunity to recognise my hon. Friend the Member for Leicester South (Jonathan Ashworth). NHS workers must take some reassurance in knowing that they have a champion in him.

As I have mentioned many times in this House, my constituency lies between two hospitals: Dewsbury and District hospital, which has recently seen a significant downgrade; and Huddersfield Royal Infirmary, which is earmarked for future downgrade and closure. Sadly, and probably as a consequence of these NHS cuts, I receive a large number of hospital complaints from constituents covering a variety of different issues. There is, however, one common theme in all the letters and emails: no one wants to point the finger of blame at NHS staff, because they can see how hard they are working, often in unsafe conditions mainly due to chronic understaffing.

In March this year, it was reported that there were over 30,000 vacant full-time positions across the NHS. There are nearly 200 vacancies at just one of my local hospital trusts alone. This means that in many hospital wards across the country, staff are having to do the work of two or even three people. We have all heard the stories of NHS staff working 12 hour shifts without food, water or even toilet breaks, where staff are close to breaking point mentally because of the undue stresses of their everyday working life. Yet they are consistently ignored when they ask for what should be their basic right: a decent pay rise to reflect the work that they put in on a daily basis in circumstances some of us in this House can only imagine in our worst nightmares. They are, frankly, heroes.

As we have heard from many of my colleagues today, NHS workers have reported having to: cut back on food shopping; miss meals in order to feed their children; use debt services, taking out payday loans or even approaching loan sharks; and even resort to food banks when the money runs out at the end of the month. Many are leaving the profession to take alternative work in different sectors. Some tell me they choose to work in supermarkets, where the pay is broadly similar but without the stresses and strains of working in a stretched industry where many workers are left feeling undervalued and burnt out from trying to keep up with the unprecedented demand for care. Many worry about the future of their registration, given the pressures they are having to work under.

By undervaluing our NHS workers to this extent, the Government are presiding over what could be the worst staffing crisis ever seen in the NHS since its inception in 1948. NHS bursaries have been slashed, and we hear that nurse staff recruitment from EU countries is down 96% on last year, mainly because of uncertainty over Brexit. In addition, a huge proportion of the existing workforce is due for retirement in the early 2020s. Instead of looking for solutions to this problem, the Government have chosen to inflict a seven-year, real-terms pay cut on our NHS staff. Yesterday, they came out and offered nothing more than a sticking plaster, with no offer of new money, saying that one group of public sector workers were more valued than another, and a vague promise that maybe in the future there could be a little bit more money made available, but no details on for whom or how much.

Those of us on the Labour Benches know how those on the Government Benches feel about our public sector heroes. We heard that loud and clear in June this year when they voted to keep the public sector pay cap and then cheered in celebration at their “triumph”. That will stay with me for the rest of my life. These are people who often put their lives on hold for us and put their lives at risk for us. They clearly deserve a pay rise to reflect their dedication and commitment.

Access to NHS Dentists

Paula Sherriff Excerpts

Tuesday 12th September 2017 Commons Chamber

[Judith Cummins (Bradford South) (Lab)]

In today’s NHS, the word “crisis” is sadly all too commonplace. Week in, week out, crisis grips our NHS. We see it played out across our front pages: in our money-strapped and creaking social care system, in our overflowing A&Es, and in the ever longer delays in accessing even basic procedures such as knee and hip replacements. For health professionals right across this country, it must be beyond frustrating that where the Government are concerned, it takes nothing less than a full-blown crisis before a Minister is willing to sit up and take notice.

What we see unfolding in NHS dental practices in communities right across this country is yet another crisis. The British Dental Association agrees. A BBC investigation last week revealed that of 2,500 dental practices listed on the NHS Choices website, half were not willing to accept new adult NHS patients—half of all practices.

[Paula Sherriff (Dewsbury) (Lab)]

I have raised with the Minister and his predecessors for over two years now the terrible dental services in Dewsbury, and we have not yet reached any resolution. Does my hon. Friend agree that while looking at this issue we must try to achieve a resolution for the whole of West Yorkshire?

[Judith Cummins]

Absolutely.

More disturbingly, 40% of practices were unwilling to take children as NHS patients. Millions of people each and every year are being left without access to an NHS dentist. The human cost of this crisis is huge. Families, parents and young children are suffering horrific, lifelong and extreme damage to their teeth and to their oral health. Stories of people resorting to pulling out their own teeth are increasingly commonplace. Images of young children—toddlers—with mouths full of rotten teeth are less and less of a rarity.

Adult Social Care Funding

Paula Sherriff Excerpts

Thursday 6th July 2017 Commons Chamber

[Steve Brine]

Yes, I do. As I said, this inspection regime is a good thing. It is important for families and for people in the system, but it is also important for the staff—they want to know that they are benchmarked as giving the best possible care. It is as important for the staff as it is for the punters, for want of a better word.

[Paula Sherriff (Dewsbury) (Lab)]

rose—

[Tom Pursglove (Corby) (Con)]

rose—

[Mr Speaker]

I call Paula Sherriff.

[Paula Sherriff]

You finally spotted me, Mr Speaker. Worryingly, Age UK recently described choosing a care home as “Russian roulette”. Does the Minister believe it is acceptable to force people to take these risks with their most loved ones?

[Steve Brine]

I did not quite catch the question, but I do not think the hon. Lady is easily overlooked in any forum. If she would like to write to me or speak to me afterwards, we will be able pick up that point.

Oral Answers to Questions

Paula Sherriff Excerpts

Tuesday 4th July 2017 Commons Chamber

[Steve Brine]

Rural communities are as important as any other. It is up to East Sussex County Council to come forward with a local tobacco control plan, and I know my hon. Friend will be taking a close interest in that, as she does in all matters when representing her constituents.

[Paula Sherriff (Dewsbury) (Lab)]

11. What steps he is taking to reduce the number of children admitted to hospital for dental surgery.

[The Minister of State, Department of Health (Mr Philip Dunne)]

Public Health England leads a wide-ranging programme to improve children’s oral health. Its oral health strategy, which was published last year, showed a marked improvement across the country in the proportion of children with no obvious tooth decay—it rose from 69% in 2008 to over 75% in 2015. NHS England is finalising plans for the “Starting Well” programme, which will operate in 13 high-needs areas to improve the oral health of under-fives.

[Paula Sherriff]

Prevention and early intervention are crucial, but no NHS dentists are accepting new patients in Dewsbury, which has the second-worst provision in the country. Children in Dewsbury have five times the national average level of tooth decay. I have asked for help on this for two years, but absolutely nothing has been done. Can you tell me why the dental health of children in Dewsbury is so unimportant to this Government?

[Mr Speaker]

I cannot, but I hope that the Minister can—preferably rather briefly.

Oral Answers to Questions

Paula Sherriff Excerpts

Tuesday 21st March 2017 Commons Chamber

[Mr Dunne]

The right hon. Gentleman is an acknowledged expert on diabetes. I have visited facilities around the world, including in Abu Dhabi, where Imperial College London has a joint venture with the diabetes centre there. The UK is an acknowledged expert, and we are launching the national diabetes prevention programme, which will roll out across 10 pilot sites for type 2 diabetes prevention work. I shall encourage the Prime Minister to consider the right hon. Gentleman’s proposal that we expand that work on other trade visits, certainly those for health, around the world.

[Paula Sherriff (Dewsbury) (Lab)]

5. What steps his Department is taking to reduce the number of mental health patients having to travel out of their local area for treatment.

[The Secretary of State for Health (Mr Jeremy Hunt)]

This Government were the first to set a national ambition to eliminate inappropriate out-of-area placements by 2020-21. By then, no adult, child or young person will be sent away from their local area to be treated for a general mental health condition.

[Paula Sherriff]

I thank the Secretary of State for his response. My 17-year-old constituent Jess needed an acute mental health bed. The nearest available was in Colchester. She was allowed to go home some weekends, but it meant an 800-mile trip for her mum. We can only imagine the emotional and financial hardship that that caused. The Secretary of State tells us that he is working on this matter, and I believe that he does want to improve things, but what progress has actually been made, as this is really, really not good enough for Jess and others?

[Mr Hunt]

I agree with the hon. Lady and she makes her case very powerfully. We need to make progress and we need to make it fast, particularly for young people, as their recovery can be very closely linked with the potential of their parents to come to visit them. Nearby places such as the Sheffield Health and Social Care Foundation Trust, which do not serve her constituents, have eliminated out-of-area placements and saved £2 million in the process. It is about spreading that best practice.

NHS Shared Business Services

Paula Sherriff Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

I wish I could give my hon. Friend the answer to that question. I think it is completely extraordinary that for such a long period it was not noticed that the data had gone missing. It was discovered towards the end of the SPS contract. There are lessons for the NHS—this relates very closely to what other hon. Members have said—about the dangers of over-reliance on paper rather than electronic systems, with which it is much easier to keep track of what is happening. [Interruption.] Let me say to the hon. Member for Leicester South (Jonathan Ashworth), who continues to make comments from a sedentary position, that when it comes to making the NHS electronic, people will compare his Government’s records and ours and will say which is better.

[Paula Sherriff (Dewsbury) (Lab)]

I am sure all Members will be able to identify with people with anxiety caused by waiting for test results or diagnoses—I certainly can—so does the Secretary of State concur that it is scant consolation to those 700,000-odd people to be told that their letters were not lost, but are residing in a warehouse somewhere?

[Mr Hunt]

It is a completely unacceptable lapse of efficiency, and this supplier is no longer performing that job for the NHS. Of course it causes many people frustration when the information they are waiting for does not reach their GP’s surgery. However, the most important thing, as the hon. Lady and I would agree, is the safety of patients. That is why our biggest priority has been not the administrative inconvenience, frustrating though it is, but making sure we understand whether any patients have actually been put at risk.