The National Health Service

Philip Dunne Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Mr Philip Dunne (Ludlow) (Con)]

It is a particular honour to follow the right hon. Member for Cynon Valley (Ann Clwyd) and to hear of her recent experience, which highlights her continued diligence in serving her constituents after 35 years in this House. I am also pleased to follow my hon. Friend the Member for Wimbledon (Stephen Hammond), who has just left his place. He was one of the four successors that there have been to my post in the Department of Health and Social Care since I left it less than two years ago. As a result, he has covered many issues that I want to focus on today, which offsets the fact that I have only four minutes left for my remarks.

I am particularly pleased that this Queen’s Speech has had a significant focus on health. It has been a while since the first Conservative Government came in and enacted the Health and Social Care Act 2012. There is legislative capacity in the Queen’s Speech and in the period that will hopefully follow to allow the Department to put through its legislation. The measures on social care are so vital for many of us. With many of our adult and children’s social care providers running into a brick wall on funding, it is becoming increasingly urgent that we find solutions to the social care issue. It is particularly satisfying to see that mental health has its rightful place in the Queen’s Speech. Implementing the long-term plan is the key plank of the legislation, and the legislative capacity gives the Department the opportunity to ensure that it can fulfil the promise of the long-term plan with any statutory obstacles removed through legislation, as necessary.

I will touch on two specific measures, beginning with the health service safety investigations body, which my hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin) was so instrumental in supporting through the Public Administration and Constitutional Affairs Committee. This is a world-first body introducing a statutory underpinning to health safety and providing a safe space in legislation so that people can have confidence that its investigations will remain confidential in appropriate circumstances. I very much welcome that, having started that process myself.

Secondly, the medicines and medical devices Bill will provide an opportunity for innovation to come to the fore. The Secretary of State has a particular enthusiasm for technology and introducing a modern, 21st-century digital era into the NHS, which is long overdue. I anticipate that the Bill will provide significant capacity to beef up the accelerated access collaborative to allow productivity through technology to be adopted across the NHS. We have had some excellent work from Professor Eric Topol highlighting how the introduction of artificial intelligence, particularly in diagnostics, can greatly increase the productivity of the NHS workforce, on whom the demands being placed by our demographics are increasing all the time.

On workforce, I am very proud that in the time I was at the Department we increased the percentage of doctors and nurses in training by 25%, and I was delighted to hear the Secretary of State refer to the record number of GPs in training, but we have to sort out the pensions issue, which has been affecting many senior clinicians in general practice and in our hospitals. The measures announced earlier this year are only a stopgap. I was in a GP surgery last week. One of the practitioners works half time, another three quarters time; they cannot afford to work full time because of the tax implications for their pensions.

On nurses, the continuous professional development offer of an extra £1,000 per nurse is vital. When I was going round hospitals, the matrons in every ward I went to said that this problem was making it more difficult for staff to progress through the career structure, so that offer is very welcome.

I will make one final point on workforce. Shrewsbury and Telford Hospital is not one of the trusts receiving the extra and very welcome capital investment, but that is because it got it 18 months ago, and I am delighted that decision has gone through. This week, it hired 179 nurses from India to fill vacancies. When we allocate capital, we need to think about encouraging training opportunities for clinicians where the capital is being deployed.

Oral Answers to Questions

Philip Dunne Excerpts

Tuesday 18th June 2019 Commons Chamber

[Caroline Dinenage]

I am grateful to the hon. Gentleman because it was he who introduced me to Lorna Fillingham and the amazing Changing Places campaigners in the first place. It is really down to their incredible work that we have seen the growth of this very important issue. There are about 38 Changing Places facilities on NHS England estates at the moment, but the £2 million pot will definitely help to improve that number significantly.

[Mr Philip Dunne (Ludlow) (Con)]

10. What steps he is taking to improve the retention of NHS staff.

[The Minister for Health (Stephen Hammond)]

The interim people plan sets out how the NHS will become a great employer with the culture and leadership needed to retain staff. NHS programmes to retain its highly talented staff are already having an impact. There are now more nurses working in the NHS than at any other time in its 70-year history. In addition, about 1 million NHS workers will benefit from the new Agenda for Change pay and contract deal.

[Mr Dunne]

I welcome the recent announcement of a consultation on NHS pensions arrangements for senior personnel. I hope that that will look at the taper impact, which raises the effective tax rate to an unacceptably high level. Retention of key personnel is critical across the Shropshire health economy, as well as in other parts of the country. Can my hon. Friend reassure me that senior-level changes in Shrewsbury and Telford Hospital NHS Trust’s management will not delay the Secretary of State’s consideration of the Independent Reconfiguration Panel’s report on proposed acute hospital reconfiguration?

[Stephen Hammond]

I thank my right hon. Friend for his welcome for the pensions proposals and the consultation. The Department has received initial advice from the Independent Reconfiguration Panel on the Future Fit hospital reconfiguration. The Secretary of State is currently considering that. He will respond to the IRP’s advice in due course, and I will ensure that he informs my right hon. Friend.

Healthcare (International Arrangements) Bill (Changed to Healthcare (European Economic Area and Switzerland Arrangements) Bill)

Philip Dunne Excerpts

Ping Pong: House of Commons
Tuesday 26th March 2019 Commons Chamber

[Julie Cooper (Burnley) (Lab)]

I rise to support the Lords amendments before us. I thank all the Members who have worked on the Bill at various stages and the staff of the House, who have provided invaluable support. I also put on record my particular thanks to my hon. Friend the Member for Ellesmere Port and Neston (Justin Madders) for his great work during the Bill’s earlier stages. I also thank those in the lords for their exceptional work on this Bill. Thanks to their endeavours, we now have a Bill that is fit for purpose. I am pleased that the Government have decided to listen to our noble friends and give full support to the amended Bill, which marks a welcome, if rather belated, climbdown by the Government.

As we prepare to leave the European Union, it is vital that the Government are able to respond to the widest range of possible EU-exit outcomes in relation to reciprocal healthcare. So many people are reliant on the continuation of reciprocal arrangements and the Government are quite right to seek to secure such arrangements as we leave the EU. The Opposition have supported the principle of this Bill from the outset. but our concerns have been around the scope and the wide-ranging powers that were originally proposed. We were not happy to give the Government a blank cheque to enter into any number of health agreements, with anyone anywhere in world, with no requirement to report back to Parliament, and with little or no opportunity for parliamentary scrutiny. These amendments have addressed our concerns, and I again thank those in the lords for their work.

Turning to amendments 1, 2, 8, 10 and 18 to 20, I want to stress to the House the scale of the issue before us, as pointed out by my hon. Friend the Member for Huddersfield (Mr Sheerman), who is no longer in his seat. Under the existing arrangements, 190,000 UK state pensioners and their dependants who live abroad, principally in Ireland, Spain, France and Cyprus, enjoy the benefits of reciprocal health agreements. The current arrangements also provide full access through the EHIC to healthcare and emergency treatment for UK residents who visit the EU on holiday, to study or to work. The same protections are extended on a reciprocal basis to EU nationals who reside in the UK or who seek to visit. For the sake of those people, I am glad that the Government have come to their senses. These arrangements, which give full peace of mind for healthcare, must be protected.

I remind the House of the evidence given by representatives of Kidney Care UK. We heard that 29,000 people in the UK are dependent on dialysis, which involves three five-hour sessions per week to ensure survival. Under the current arrangements, if those people choose to holiday in the EU, they can easily pre-book slots for dialysis, with Kidney Care UK saying that that

“means that people are able to go away with the confidence that they will be able to be supported and receive the treatment they need.”––[Official Report, Healthcare (International Arrangements) Public Bill Committee, 27 November 2018; c. 12, Q39.]

That also means that they and their families are able to get a much-needed break. Kidney Care UK also made the point that

“it is easier to go away for two weeks in Europe and take a break in that way than it is to get two weeks in a UK unit”––[Official Report, Healthcare (International Arrangements) Public Bill Committee, 27 November 2018; c. 14, Q43.]

Perhaps there is a learning point for us there.

Based on that evidence, the Minister concluded at the time that without a continuation of these arrangements it would be more or less impossible for sufferers of kidney disease to travel. I totally agree, and I am delighted that the Government appreciate the urgency of the situation in which we find ourselves and are giving their full support to this amended Bill. That is important because we may yet leave the EU with no deal, and there will be many British citizens listening nervously to this debate because they have already booked holidays—some of them will be departing at the weekend or in the coming weeks. However, they can now be reassured that the legislation will pass without further delay.

I reassure Baroness Chisholm that the main Opposition priority is always to ensure that those who need care get it. Further to that, we are right in the first instance to protect the rights that UK citizens already enjoy. In short, we must protect our rights to reciprocal healthcare in Europe before we seek to acquire global healthcare provision. Similarly, those UK citizens who have retired to the EU will be relieved to know that treatment for chronic health conditions and ongoing health support will continue to be provided for them, as it is now, without interruption.

If that was not the case because the Bill was unable to receive Royal Assent in a timely fashion, there would have been much understandable consternation and anger among UK citizens currently residing in the EU. A significant proportion of these citizens are pensioners, and they would have been personally liable for healthcare costs after exit day unless a new agreement with the EU or new bilateral agreements with member states were in place. We must also consider the fact that if there is an interruption in provision, many British expats would have no alternative but to return to the UK, which would of course add to the pressures on our already overstretched NHS.

At every stage, both here and in the other place, concerns have been raised about what those in the lords described as the breathtaking powers sought in this Bill. Lords amendments 3 to 7 serve in part to restrict the powers to those that are clearly defined and to those that are necessary for the purpose of protecting reciprocal health arrangements. In amendment 3, just removing the words “for example” assists in terms of essential accountability issues by restricting the powers of the Secretary of State to those regulations specifically listed. The powers listed remain extensive, and the lords was assured that they give the Government everything they need to take forward the negotiations on reciprocal healthcare. We welcome amendments 5 and 6, which ensure that the power to deliver functions is conferred only to a public authority. We are happy that the powers conferred by clause 2 should also be subject to a five-year sunset clause.

We support amendment 11, which provides an important and necessary requirement to consult with the devolved authorities, namely the Scottish Parliament, the Welsh Assembly and the Northern Ireland Assembly. We fully support the vital role that the devolved Administrations play in delivering reciprocal healthcare arrangements, and we welcome the memorandum of understanding that has already been achieved.

Amendment 12, which requires the Secretary of State to report on repayments made under this Bill, is also welcome. This amendment reasonably calls for annual reports to be published after the end of each financial year as soon as is reasonably practicable. It is anticipated that these reports will include details of both expenditure and income. This will facilitate transparency on the Government’s use of public money. I am especially pleased that the Minister has withdrawn his former opposition to that procedure.

On a wider point, in connection with repayments, it is important that we do not overlook the fact that many hospital trusts are struggling to recoup moneys owed under current EU arrangements. Indeed, some costs are never recovered. The UK recovers less than £50 million a year for the cost of treating European patients, while paying £675 million for the care of Britons in Europe.

[Mr Philip Dunne (Ludlow) (Con)]

The hon. Lady is pointing out the disparity in payments between the UK and the EU. Recognising that there are considerably more EU users of the NHS than UK users of health services on the continent, why is it that the Labour party, in the past, criticised the NHS and the Department of Health and Social Care for trying to recover sums due from EU citizens for taking advantage of our health service?

[Julie Cooper]

I think the objections raised by the Labour party in the past were based on the methodology used and the potential abuse of personal data, but we would fully support an efficient system to recover moneys owed to the UK.

--- Later in debate ---

[Kevin Foster]

I meant it more as a comment. I accept the Lords amendments. To be blunt, given the pressure of time and the need to get the Bill on the statute book to give people certainty about their healthcare arrangements, if these amendments achieve consensus with Opposition Front Benchers and the other place, I am more than happy to support them.

In relation to the remarks of the right hon. Member for Carshalton and Wallington, who sadly has not stayed for the rest of the debate, this is about making sure that people who go to hospital to access emergency care are not suddenly faced with a bill for the full cost as if they were completely uninsured.

We have arrangements with Australia and New Zealand that are not at the same level as we have with other EU countries, but they could potentially be developed. I do not want to see that aspiration lost, because we want our young people to have the opportunity to travel and work abroad where appropriate. In many countries, as the hon. Member for Central Ayrshire (Dr Whitford) rightly said, people who work will start earning rights under that country’s social insurance system, which would trump the Bill.

[Mr Dunne]

My hon. Friend is generous in giving way. In talking about other Commonwealth nations to which we would like to extend such arrangements, does he agree that the dominions of the Channel Islands, which do not currently have reciprocal status with the UK, should not be ignored and should be a matter of importance once the EU arrangements have been completed?

[Kevin Foster]

As always, I thank my right hon. Friend for his incisive intervention. The Channel Islands might use our currency and, in many ways, fly our flag, but people forget they have a very different constitutional status and are not part of the European Union. For some visitors, it can be a surprise that there is not a reciprocal agreement. There is a reciprocal arrangement with Gibraltar, for example, and it makes eminent sense to try to have such an arrangement between the UK and the Channel Islands, not least given the strong cultural links and the fact that many families split their time between the mainland and the islands.

Looking across the Commonwealth more widely, it might make sense to have arrangements with countries such as Canada and Jamaica in the long run, based on the fact that they have comparable systems of healthcare provision. That is perhaps where the oft-cited example of the United States starts to fall apart, because it is one of the handful of modern, developed countries that do not have a guaranteed system of universal healthcare free at the point of need rather than a system based on insurance schemes for which people may pay.

It is welcome to have ambition, and the Bill is clear about where we are going. I have no problems with the Lords amendments, which are welcome, and I am happy to support them. I am conscious that we are looking to move the debate forward, but I wanted to get those thoughts on the record.

[Dr Whitford]

Obviously, the Bill itself is quite small. It does not extend or protect continuing reciprocal healthcare rights; it is simply an enabling Bill that gives the Secretary of State powers to try to do that. It enables him to pay for overseas treatment in the EEA and Switzerland. We have heard how the Lords removed the powers to extend that worldwide and increase the scope, as well as limiting some of the Henry VIII powers.

The Bill will allow the Secretary of State and his team to negotiate healthcare agreements with the EEA and Switzerland as a group through the EU system or, failing that, to make bilateral agreements. Unfortunately, that would mean having bilateral agreements with 31 countries, which would inevitably be more complex, more bureaucratic and more expensive.

Clause 4 allows data exchange, which most Members would recognise is absolutely critical not just for collecting payments or swapping money, but for accessing medical health records if someone goes for treatment in another country. It is important that that will be handled only by an authorised person who is part of a statutory body—a public body.

I welcome the new clause in Lords amendment 11, which says that the devolved Governments must be consulted, because it is the three devolved Governments who deliver healthcare in Wales, Northern Ireland and Scotland. It is critical that they are involved in any agreements.

This legislation is needed whether there is a deal or no deal. As came out of the points of order exchange earlier, the withdrawal agreement would extend through the transition period, but we have all seen how the last three years have melted away like snow off a dyke. The next 20 months will also disappear, so legislation is required for the long-term protection of those who already live in Europe and want to stay there, particularly those who have been there only a few years and do not have five years-worth of residency rights in the country they have chosen to settle in. After the Bill is passed, it is therefore important that the Government hope to negotiate the continuation of reciprocal healthcare.

The problem is that reciprocal healthcare is not a free-standing thing on its own; it is there simply to enable freedom of movement. People cannot exercise their freedom of movement rights if they simply cannot afford healthcare where they choose to live, work, love, settle or retire. We have had the right over the past few decades to retire and settle anywhere. People are well aware of my husband’s situation as a German citizen who lives here and has spent virtually all his adult life working in our health system. That was certainly his first concern after the Brexit vote, and I am sure it is a concern for all 5 million people who have either settled here from Europe or settled in Europe from the UK.

The problem is that, as the Government reject freedom of movement and talk merely about a mobility framework, any reciprocal arrangement is likely to be proportional to that mobility framework, as is described in the impact assessment. The Government are not offering visas of over a year for unskilled workers. They are demanding that people be high skilled, possibly that they earn more than £30,000 a year and that they are economically active and are contributors. Will pensioners still be able to retire elsewhere, since they are not necessarily contributors in a major sense and are certainly not necessarily economically active?

People highlight the difference between what the UK has to pay into the European system and what we get back from Europe. A lot of that difference is quite simply because of the number of UK pensioners who choose to retire to sunnier climes—who can blame them?—and the general lack of obsession with retiring to the drizzle and moving in the other direction. Living in Scotland, I can vouch for that. Who would choose to leave the south of France and come to live in the mist, fog and drizzle? That is why the number of European pensioners retiring to the UK is considerably smaller than the number of UK pensioners who retire to the south of Spain and the south of France. That is simple logic.

[Mr Dunne]

Would the hon. Lady account for the massive diaspora of Scots all around the world as a comment on the mist and greyness of Scotland’s location? Why does she think so many Scots live abroad?

[Dr Whitford]

The right hon. Gentleman probably would not like me to get into the clearances of the 17th and 18th centuries when people were burnt out of their villages and put on boats, or when people were transported for criminal activities. There are all sorts of reasons why Scots have ended up all over the world, and they are not all about the weather.

Services for People with Autism

Philip Dunne Excerpts

Thursday 21st March 2019 Commons Chamber

[Huw Merriman]

A few years ago, Ambitious about Autism produced a big report looking looked at that specifically. I am fortunate to have in my constituency an organisation called Little Gate Farm, which takes people who have finished their education and makes them work-ready. However, it requires employers to give them a chance, and I am always writing to employers urging them to do so.

Let me give some examples. One young lad was obsessed with washing cars. We matched him up with a garage, and that is exactly what he does. Someone else was given a job in a bookkeeping firm. The big challenge there is ensuring that that young person takes time off, because they have become so used to the routine. The initiative has become so successful that people are throwing themselves into work. We must do all that we can, as Members of Parliament, to pair and support people.

My right hon. Friend the Member for Chesham and Amersham says that we in the APPG

“will hold the Government’s feet to the fire to see those recommendations reflected in the new strategy.

Our need to act is clear. Too many people”—

as we have just discussed—

“still have to wait too long for a diagnosis—more than three years in some parts of the country. Getting a diagnosis can be a crucial milestone, helping to unlock vital support. Delays in being diagnosed can result in people developing more significant needs, or mental health problems.

National guidance from the health watchdog NICE state clearly that children or adults suspected of being on the autism spectrum should start their diagnostic assessment within three months of being referred to their local autism team. But we know there is a postcode lottery in waiting times for appointments, with many parts of the country falling far short of the three-month target. Alongside the National Autistic Society, we have been pushing progress on this issue in this very chamber for several years. Valuable research”—

carried out by the right hon. Member for North Norfolk (Norman Lamb)—

“on behalf of the APPGA shone a further spotlight on these long waits and called for a mandatory minimum waiting time standard. I am pleased to have him on board again leading our inquiry on health and mental health, which heard evidence last week.

We also know that autistic people too often don’t get the physical and mental health care they need. They face high levels of health inequality, and evidence suggests that people may die early as a result, which has been highlighted by Autistica. It’s vital that all health and care staff receive autism training to ensure that our health service meets their needs and makes the changes and adjustments that it needs to—a key part of the Autism Act. I welcome the Government’s current proposals on mandatory training in autism and learning disability to all health and care staff following the dogged campaigning of Paula McGowan, a mother who tragically lost her son Oliver. It’s vital that this proposal is taken forward and that its impact is monitored. I hope the Minister will devote some time to make sure that this programme makes a difference.

I also welcome the inclusion of autism, alongside learning disability, as one of the four clinical priorities in the NHS 10-year plan to improve health services. This is a great step towards ensuring that the NHS supports autistic people as well as it supports everyone else. It sets out actions to reduce children’s diagnosis waiting times, reduce the number of autistic people inappropriately under section in mental health hospitals, and making sure that reasonable adjustments are put in place. But we need more details on how these, and other commitments in the Plan will be delivered (and how they will be funded). I would appreciate if the Minister could update the House on when we can expect to see this much-needed detail.

I am pleased to see the Government already thinking ambitiously about the future of the strategy. I warmly welcome the Government’s commitment to extending the autism strategy to include children and young people, as well as adults, for the first time.”

[Mr Philip Dunne (Ludlow) (Con)]

My hon. Friend is making an exceptionally powerful speech, and I applaud his role as chairman of the all-party group. It is particularly impressive that he has been able to pick up the role in this debate of my right hon. Friend the Member for Chesham and Amersham (Dame Cheryl Gillan) in her absence.

Returning to the question of education, my hon. Friend touched on the subject of young people a moment ago. Does he agree that the Government’s recent announcement of an additional 37 schools across the country to provide special needs support for people, including those on the autistic spectrum, is a welcome recognition of the challenges presented to our education system by the increasing prevalence, regrettably, of autism across our communities?

I would like to highlight one story in my constituency that points out the need for such schools. It involves a mother of two autistic children, both of whom have to be schooled over 100 miles away from Ludlow, in the heart of my constituency, where she lives. She has campaigned with a local charity and not-for-profit group to open a new school—Overton school, just outside Ludlow, which is currently awaiting its Ofsted accreditation—partly so that other families who have to deal with the same circumstances will not have to travel 100 miles to visit their children.

[Huw Merriman]

My right hon. Friend is absolutely right, and I know how much he campaigns to deliver the solution he talks about because I am fortunate enough to share an office with him. He is a great champion of his constituents, and it is welcome news that more schools will be funded. The Minister will have heard his powerful pitch for his constituency. I can also reassure all Members that I am only temporarily sitting in for my right hon. Friend the Member for Chesham and Amersham; she will continue to be the chairman of the all-party group. I will now make progress, as I know others wish to speak.

My right hon. Friend the Member for Chesham and Amersham continues:

“For many families of autistic children, securing the right support for their child at school is a very difficult task—much harder than it should be. I am sure we have all been contacted by constituents who are struggling to get the school provision and support their autistic children need—this may be a place at a specialist school, or support to enable them to thrive and make progress in a mainstream school…

There’s one other very important issue that I want to draw to the attention of the House and the Minister. That is the continued inclusion of autism in the Mental Health Act as a mental disorder.

What this means is that autistic people and those with a learning disability—particularly those who have behaviour that is described as ‘challenging’—can be detained under the Act when they do not have a treatable mental illness. When this is twinned with a lack of appropriate support, particularly crisis support, to prevent someone being admitted to hospital, we see the numbers of autistic people in these hospitals increase.”

I would like the Government to address that challenge and issue.

I will conclude—I have failed to deliver my right hon. Friend’s entire speech, but she will be delighted that we have had a debate about this and raised awareness, so I finish on the following note. She says:

“Autistic people—children and adults—need the right support, at the right time, in their local communities. The wider community needs to have a much better understanding of what autism is and how it affects people. There are things that all of us can do to make our society a more inclusive place for everyone—in World Autism Awareness Week and beyond”,

that should be our goal.

NHS 10-Year Plan

Philip Dunne Excerpts

Tuesday 19th February 2019 Commons Chamber

[Stephen Hammond]

My hon. Friend is right that we need targeted support, which is why we have looked not only at increasing the recruitment of nurses but at the retention packages that might be offered, particularly for certain specialties—she mentioned mental health nurses. We have looked at the possibility of issuing golden hellos, and we have looked at targeted support for childcare and travel.

[Mr Philip Dunne (Ludlow) (Con)]

My hon. Friend has been generous in giving way. I welcome the workforce implementation plan, and I welcome the fact that Baroness Harding, the chair of NHS Improvement, will be taking this work forward. Will my hon. Friend ensure that Baroness Harding looks at the retention of senior, experienced general practitioners under the general practice forward view? That issue has been raised in a number of areas. We are losing too many of them too early in their career, and the situation is similar with experienced consultants in our hospitals. A contributing factor is the annual allowance for pension contributions, where tax payments take away the extra gross income staff receive as they progress through their later years. Will my hon. Friend pick that up with the Treasury?

[Stephen Hammond]

I have listened carefully to my right hon. Friend’s intervention, and he will be pleased to know that discussions with the Treasury are ongoing about certain potential incentives to senior serving staff.

The plan is not just about numbers; it focuses on getting the right people with the right skills in the right place, ensuring that our dedicated staff are supported, valued and empowered to do their best. It has clear commitments to tackle bullying, discrimination and violence, and a programme of work to sustain the physical and mental health of staff who work under pressure every day and every night.

Diabetes

Philip Dunne Excerpts

Wednesday 9th January 2019 Westminster Hall

[Sir John Hayes]

I was going to refer to the achievements of the deputy leader of the Labour party, the hon. Member for West Bromwich East (Tom Watson), later in my speech, but my hon. Friend obliges me to highlight them earlier than I had planned. He is a model example of someone who, having contracted type 2 diabetes, adjusted their lifestyle and diet, lost large amounts of weight, and fought back against—indeed, fought off—type 2 diabetes, exactly as my hon. Friend suggests. Many other hon. Members, including some in the Chamber today, are living with diabetes. Remarkably, our Prime Minister not only manages to hold down her job with immense dedication and determination, but manages type 1 diabetes simultaneously. I spoke about every family and every constituency, but many Members of this House have personal experience of dealing with both type 1 and type 2 diabetes.

During the debate, I will focus on three areas in which we can make real progress: the human and financial cost of diabetes; how education and technology can enable self-management and improve outcomes for both type 1 and type 2; and how, in the case of type 2 diabetes, intervention on societal and individual levels can prevent the onset and mitigate the effects of such a serious problem.

To prevent just a fraction of the complications arising from diabetes would have a big impact on the national health service, generating significant savings as well as fundamentally reducing pain and distress for individuals. Every week in England, over 160 lower-limb amputations result directly from the effects of diabetes, so the ability to provide high-quality diabetic foot care is of particular concern. The recently published NHS long-term plan makes a renewed commitment to the diabetes transformation fund, and I know that that will be welcomed by the whole diabetes community.

I hope that the Minister will set out what steps the Government are taking to encourage the use of education and technology to better support people in self-managing their diabetes, as that will reduce the burden of diabetes both on the individual and on the NHS. A few years ago, a family came to my constituency surgery, with a tiny, wonderful little girl. She was just about to start school. She had already been diagnosed as a type 1 diabetic. That little girl, Faith Robinson, was wearing technology that allowed her glucose to be monitored and insulin to be administered to her—that was absolutely necessary because she was so young. The family came to me with a request, which I will pass on to the Minister so that he can work with colleagues across Government to ensure that this happens routinely for all constituents who need it. They asked that Faith receive one-to-one support at school to manage that technology. The little girl was under five, and needed people at the school she was about to attend to understand the condition and how to deal with the challenges that she faced.

I estimate that there are constituents across the country in similar circumstances, with very young sufferers who need that kind of care and support. I invite the Minister not necessarily to comment today—I do not want to catch him out; that is not my intention—but to reflect on that and to say more about what can be done for that little girl, who I was able to help in that circumstance, and for many others like her.

[Mr Philip Dunne (Ludlow) (Con)]

I not only congratulate my right hon. Friend on securing the debate but thank him for allowing me to intervene on that point. My second daughter was two and a half when she was diagnosed as an insulin-dependent type 1 diabetic. I very much empathise with the story that he has just told us about his constituent. My daughter was barely able to describe her feelings because she was only just talking at the time, which was really quite challenging for the clinicians treating her, as she was unable to describe the impact of treatment and how she felt.

I agree with my right hon. Friend that the introduction of technology—both a result and part of the significant research efforts in this country by charities and the Medical Research Council—is leading to opportunities in treatment provision, in particular the flash glucose monitoring device, which I know the Government will introduce across the country in a more even way than in the past. That is very welcome, but it remains subject to clinical guidance. I urge the Minister to look at that guidance and the attributes required for people to have access to those devices, because they remain quite restricted.

[Sir John Hayes]

With the insight and acumen that characterised my right hon. Friend’s ministerial career, he has identified a point that I was going to make later. With his permission, I will amplify that in my speech. I was aware of his personal circumstances and of his expertise as a result of having a daughter with diabetes. He will recognise that the average sufferer spends about three hours a year with a healthcare professional. Self-management is therefore critical and, in turn, technology is essential to such self-management. We cannot expect a healthcare professional to be on call every time someone needs support or the kind of treatment that is routine for someone such as my right hon. Friend’s young daughter. I entirely endorse his remarks. The Minister will have heard them and will respond accordingly.

In essence, I want a world in which all people with diabetes have access to the right information, advice and training, not just at the point of diagnosis but throughout their lives. People will say, “Well, of course, we all want the very best, and we all want the ideal,” but if we do not aim for the very best, we will get something very much less than that, so I make no apologies for being definitive in my determination to aim for that ideal. It is critical that we as parliamentarians should look to more distant horizons than sometimes the prevailing powers in Government—as I know from my long experience of that—would encourage us to do. Such debates as this allow us to do that in a cross-party way, for this is not about party political knockabout but about something much more fundamental.

Only if we can achieve the ideal will people be well placed to gain confidence and to cope as the Prime Minister does—as I have described—and as the deputy leader of the Labour party does. They can manage their condition and do not have their lives inhibited by it, and so believe that their opportunities are unaffected by the condition.

To ensure the early uptake of education, it must be provided in a useful format: digitally and through every kind of agency, whether that is schools working with health professionals, or local authorities, which have a responsibility for public health following the Health and Social Care Act 2012, stepping up to the mark too. I shall say a little more about the co-ordination of that, although the Minister is already aware of my concerns. It is about ensuring that our public health effort on diabetes is co-ordinated, consistent and collaborative. That is vital, for reasons already mentioned by colleagues in interventions.

I welcome the commitment in the NHS long-term plan, as I said, to expand the support on offer for people with type 1 and type 2 diabetes, including through the provision of structured education.

--- Later in debate ---

[Sir John Hayes]

I agree entirely with my right hon. Friend. In the modern idiom, we need to be technology-neutral about that, because the field is changing rapidly. As new technology comes on stream and improves, we need to be sufficiently responsive to and flexible about those changes to ensure that people get the very best, latest technology available to them, for the reasons he gave.

The limits on self-management by the restrictions on technology inhibit people’s wellbeing, confidence and, thereby, opportunities. I want to ensure that the provision of technology is consistent throughout the country. There are suggestions that such provision is patchy, that some places are better than others and that some of our constituencies are not getting all that they deserve. The Minister will not want that, because he is an extremely diligent and resourceful Minister—I know that from previous experience—and I want him to tell us how he will ensure that the technology is appraised properly, is delivered consistently and, accordingly, will change lives beneficially.

[Mr Dunne]

My right hon. Friend is being generous with his time. May I elaborate a little more on that specific point to give an indication to the Minister of the specifics that might cause difficulty between different clinical commissioning group areas? In my experience, those who are allowed to have clinical access to a glucose monitoring device already need to have their blood sugar levels under control—in single digits, below nine. For many people, however, the monitoring device is the one thing that gives them the ability to get better control of their blood sugar glucose levels. Therefore, if they do not get access to it until they are under control, it does not have the immediate benefit to their lifestyles that it would if the regime were slightly more permissive in the allocation of the devices.

[Sir John Hayes]

My right hon. Friend makes a very shrewd point about cause and effect. In Scotland, for example, both the processes leading to allocation and the actual allocation of technology are much more routine, as he suggests should be the case. I hope the Minister will tell us today or subsequently how he will ensure that that becomes true for the whole of our kingdom—that the very principles set out by my right hon. Friend become embedded in the way in which we approach technology, ensuring that it is allocated according to need.

We all agree that the resources should be targeted to secure optimal outcomes for the 4.6 million people who have been diagnosed with the condition. In addition to those diagnosed, however, one in three adults in the UK has pre-diabetes and might be at risk of developing type 2 diabetes if they do not change their lifestyle—a point made by a number of Members in interventions. About three in five cases of type 2 diabetes can be prevented or delayed. A focus on preventing the onset of diabetes should be of paramount importance. G. K. Chesterton said:

“It isn’t that they can’t see the solution. It is that they can’t see the problem.”

By seeing the problem, the solution will be implicit, because many more people will never develop type 2 diabetes if they make those adjustments to their lifestyle.

There is a dilemma, though: is it better that 50,000 people get a perfect solution and are prevented from having diabetes, or that 5 million people reduce their risk marginally? Let me set that out more clearly. Is it better that a small number of people achieve what the deputy leader of the Labour party, the hon. Member for West Bromwich East, has done—losing immense amounts of weight, changing their lifestyle and completely revising their diet? Or is it better that a very much larger number of people make a smaller change, lose less weight and change their lifestyle more marginally, but by so doing significantly reduce their risk of developing type 2 diabetes?

That is a challenge in health education; it affects many aspects of the health service’s work. It probably means that, rather than seeing this issue purely from a clinical perspective, we have to democratise the diabetes debate, spread the word much more widely and get many more people to lose a couple of inches off their waist, to lose a stone or half a stone. That effect would be immense in reducing the risk of diabetes, not for tens of thousands but for millions of people.

If the figures I have brought forward are so—I have cited them only because I have learnt them from Diabetes UK and others who have helped me to prepare for this debate—we would change the lives of very large numbers of constituents in a way they would be able to manage, understand, comprehend and act upon reasonably quickly. I want the Minister to reflect on the dilemma I have described; it may not be quite so much of an either/or as I have painted it, but we need a democratic debate about that, which is part of the reason I have brought this debate to the House. Certainly we need an open and grown-up conversation about some of those measures and how we go about tackling what I have described as a crisis.

I do not want to speak forever, Mr Robertson—I know you and others in the Chamber will be disappointed to hear me say that. That will cause disappointment and even alarm among some, but I want others to contribute the debate. However, I have a couple of other points to make so I will move on—having taken a number of interventions already, I hope colleagues will bear with me.

I have been fascinated to read about research funded by Diabetes UK that proves that remission is possible. I would like to take the time to congratulate the hon. Member for West Bromwich East once again and to say that I hope many more people will recognise that remission is a real possibility for them by making changes in what they do.

Part of the issue is how lives more generally have changed. My father cycled five miles to work and five miles home every day, but now most people do not do that. Once many more people worked in manual jobs—my father had a physique like Charles Atlas, but the nearest I have come to Charles Atlas is reading an atlas. Part of the problem is the way we live now; far fewer people exercise implicitly in the way he did, and it seems that junk food is more appealing to many people than eating fresh, healthy produce—indeed, that has been recognised by successive Governments as significant for health outcomes.

Evidence shows the best way to reduce the risk of diabetes is through a healthy diet, being physically active and reducing weight. That can be facilitated through societal approaches and targeted individual interventions. Technology, including digital services to support lifestyle changes, is increasingly critical in diabetes prevention. To be sustainable, methods to prevent type 2 diabetes should focus on individual behaviour change, not just short-term activity levels.

We recently learned that, by their 10th birthday, the average child in the UK has consumed 18 years’ worth of sugar. That means they consume 2,800 more sugar cubes per year than recommended levels. The current food chain has become badly distorted. Basic knowledge that my parents’ generation took for granted about how to buy, cook, prepare and store food has steadily but alarming declined.

We have allowed soulless supermarkets to drive needless overconsumption of packaged, processed, passive, perturbing products, and it is time that the greed and carelessness of corporate multinational food retailers gave way to a better model. It is not a coincidence, it is something considerably more than that; as local food retailers have declined—people knew from whom they were buying, understood what they were buying and where it came from—the consumption of processed, packaged ready meals has grown. We need to rebalance the food chain in favour of locally produced, healthy produce and to re-educate people about how to buy, cook, eat and enjoy it.

Oral Answers to Questions

Philip Dunne Excerpts

Tuesday 27th November 2018 Commons Chamber

[Matt Hancock]

I have a huge amount of sympathy for the hon. Lady’s point. We did act to ensure that the parties came together. The offer has been made and the response from the company has frankly not been good enough. It needs to come to the table; the ball is in its court.

[Mr Philip Dunne (Ludlow) (Con)]

T5. Does the Minister agree that last week’s success by Shrewsbury and Telford Hospital NHS Trust management in securing sufficient qualified clinicians to keep the A&E and Telford’s Princess Royal Hospital open 24/7, rather than closing it overnight, is a positive first step on the journey out of special measures?

[The Minister for Health (Stephen Hammond)]

My hon. Friend is right. I welcome the trust’s recent announcement that it now has enough middle-grade doctors and nurses to keep the Prince Royal Hospital’s A&E open 24/7. It has been receiving some excellent support from NHS Improvement, and I hope that it will achieve similar success in improving the quality of care as that support continues.

Gosport Independent Panel

Philip Dunne Excerpts

Wednesday 21st November 2018 Commons Chamber

[Mr Speaker]

Order. I always listen to all of my colleagues with equal doses of respect and affection, but I am moved to observe as we approach the festive season that it would probably be a good idea for the right hon. Member for New Forest West (Sir Desmond Swayne) to send copies of his textbook on succinct questions as Christmas presents to all colleagues.

[Mr Philip Dunne (Ludlow) (Con)]

I join the cross-party support for my right hon. Friend’s statement and add my voice in commending the dedication and commitment of Bishop James Jones, who, I am pleased to say, is I think in the Chamber listening to the Government response to his report.

I am a great supporter of the National Guardian’s Office and the “freedom to speak up” guardians; in fact I am such a strong supporter that I wear its lanyard around my neck and have done ever since I was in the Health Department. But a number of people who make complaints either do not yet have sufficient confidence in these guardians or feel that their complaints are not properly addressed. There are however good examples of best practice, where some chief executives of trusts have a regular, routine meeting with guardians to make sure that complaints are brought directly to their attention. Will my right hon. Friend work with the senior leaders across the NHS and the National Guardian’s Office to ensure that best practice is used so we can give the most possible confidence to people with concerns about safety?

[Matt Hancock]

Yes, absolutely I am happy to do that, and I am happy to commend my hon. Friend’s lanyard, too. Ultimately culture change and having a good culture comes down to the leadership within the NHS and individual trusts. It has struck me in the four months that I have been doing this job that the trusts that have the best results in terms of outcomes for patients, waiting times and waiting lists and finances are also those that are hot on this subject; they listen to complaints and act on them, because they know that that is the way to improve their organisation. I want to see that sort of best practice right across the board.

Healthcare (International Arrangements) Bill

Philip Dunne Excerpts

Wednesday 14th November 2018 Commons Chamber

[The Minister for Health (Stephen Barclay)]

With the leave of the House, I thank everyone who has spoken in the debate. This is a short and sensible Bill, which will ensure that the Government have the appropriate legal framework to give effect to a deal in relation to reciprocal healthcare arrangements, which so many of us, both here and abroad, enjoy. I am grateful for the support in principle for the Bill from both sides of the House, including from the Opposition Benches.

The level of interest in and the contributions to the debate demonstrate that it is clearly in the interests of the British public to ensure that reciprocal healthcare arrangements similar to those currently in place continue when we leave the EU. A number of questions have been raised in the debate, which I will endeavour to answer in my closing remarks. However, as my opposite number, the hon. Member for Ellesmere Port and Neston (Justin Madders), pointed out, we will have an opportunity in Committee to scrutinise those questions in more detail. He raised a number of very pertinent points, which I will be keen to explore with him.

I would like to reiterate the offer I made in a recent letter to all Members of the House to have meetings with me and the team of officials working on the Bill if they want to explore the Bill in more detail. I recognise—this point was picked up by my hon. Friend the Member for North Thanet (Sir Roger Gale)—that this issue genuinely concerns constituents of Members on both sides of the House. I am keen to engage with Opposition Members, the Chair of the Health Committee and other colleagues on the detailed issues they may wish to raise on behalf of constituents.

[Mr Philip Dunne (Ludlow) (Con)]

I am grateful to my hon. Friend, and I would like to take advantage of his offer, but I would also like to highlight another issue. I do not wish to extend the competence of the Bill unduly, but it is an opportunity for us to look at the reciprocal health agreements we have with the overseas territories, as mentioned by my hon. Friend the Member for Chichester (Gillian Keegan), and particularly with United Kingdom dependent territories—I am thinking here of the Channel Islands. Under the previous Labour Government, the reciprocal health agreement with Jersey was ripped up and terminated in 2009. Under the coalition agreement in 2011, it was reinstated. However, at present, there is no reciprocal health agreement with Guernsey, which is also responsible for Alderney and Sark. I ask the Minister to consider that during the passage of the Bill.

[Stephen Barclay]

I am grateful to my hon. Friend for raising that. Understandably, much of the debate today has focused on the EU element of the Bill, but he is quite right to recognise that the reciprocal element extends beyond the EU and particularly to Crown dependencies, overseas territories and countries such as Australia, New Zealand and elsewhere. I am very happy to have those discussions with him.

My opposite number, the hon. Member for Ellesmere Port and Neston, raised a number of points, one of which was the impact on people with long-term conditions. I agree that, without reciprocal healthcare, people with long-term conditions, including those who need dialysis, may find it harder to travel, which is the very essence of why the Bill is necessary, so that we can implement a reciprocal arrangement with the EU or, failing that, with individual member states to support the travel arrangements of those with long-term conditions.

The hon. Gentleman also questioned the £66 million figure that I referenced in my speech, and I am happy to point out that that was in relation to the 2016-17 value of claims made by the UK to EU member states. He also asked about cost recovery more generally and, since 2015, we have increased identified income for the NHS under reciprocal arrangements by 40%, and directly charged income has increased by 86% over the same period. I mentioned the increased focus on that to my hon. Friend the Member for Crawley (Henry Smith), which I hope gives a signal of intent as to the direction of travel on cost recovery.

The hon. Member for Ellesmere Port and Neston also mentioned the role of NHS Improvement, and I am happy to clarify that it is now working with more than 50 NHS trusts to improve their practices further, with a bespoke improvement team in place to provide on-the-ground support and challenge in identifying and sharing best practice.

The hon. Gentleman also mentioned an important point, and one that we will probably go into in more detail in Committee, on data. Again, the policy intent is continuity, rather than a change in our approach to data. Clause 4 expressly contains a safeguard for personal data, which can be processed only where necessary for limited purposes or funding arrangements. That covers, for example, where someone is injured while abroad, where personal data of a medical nature often needs to be shared to allow treatment to take place. At the same time, there are safeguards in the Bill, which I am sure we will explore.

My hon. Friend the Member for North Thanet expressed concern about cherry-picking, and I recognise his point. That is why we are looking for the reciprocal arrangements to continue, although even in the event of no deal and no bilateral deal, local arrangements often apply for healthcare, such as on the basis of long-term residency or previous employment. Those would be local factors, but obviously the policy intent is to have an arrangement with countries across the EU.

The hon. Member for Linlithgow and East Falkirk (Martyn Day) and my hon. Friend the Member for East Renfrewshire (Paul Masterton) spoke about the work of the devolved Assemblies and how we liaise with them. Indeed, I spoke with my Welsh counterpart just yesterday. In the other place, the Parliamentary Under-Secretary of State for Health has been working closely with the devolved Assemblies, as have colleagues and officials in our Department. How we work with the devolved Assemblies is a pertinent point, and we are keen to continue that active dialogue.

My hon. Friend the Member for Poole (Sir Robert Syms) correctly identified the importance of the EHIC card and of inward tourism to the UK. The point about continuity was reinforced by my hon. Friends the Members for Chichester (Gillian Keegan) and for Chelmsford (Vicky Ford) in their thoughtful contributions. It was also echoed by my hon. Friend the Member for Walsall North (Eddie Hughes) when he highlighted the importance of taking a practical approach to how these arrangements apply.

My hon. Friend the Member for Totnes (Dr Wollaston) raised a number of detailed points, and I am happy to have continued dialogue with her on them, although I hope she will draw some comfort from recent quotes and legislative developments in a number of EU27 states. For example, the French Minister for European Affairs said, “France will do as much for British citizens in France as the British authorities do for our citizens.” France has legislation under way. The Spanish Prime Minister said, “I appreciate, and thank very much, Prime Minister May’s commitment to safeguarding those rights. We will do the same with the 300,000 Britons who are in Spain.”

Again, I hope the fact that we actually pay out more to the EU than we currently receive, and the fact that both nations benefit from a reciprocal arrangement, gives an idea of the starting point of the discussions. Like my hon. Friend, I would welcome it if that were done across the EU27 as a whole.

My hon. Friend also raised the issue of dispute resolution, and the current arrangements between the UK and other member states require states to resolve differences, in the first instance, between themselves. That is the existing position that applies, but clearly it would be a matter for negotiation as to how a future UK-EU agreement might be governed. That is a cross-cutting issue; it is not one pertaining solely to this Bill.

It is clearly in the interests of the British public to ensure reciprocal healthcare, arrangements, similar to those currently in place, continue when we leave the EU, whether that happens through an agreement with the EU itself, as we very much want, or through individual arrangements with EU member states.

Oral Answers to Questions

Philip Dunne Excerpts

Tuesday 24th July 2018 Commons Chamber

[Steve Brine]

We are looking at the future of the cancer drugs fund as part of the new 10-year plan. There is a radiotherapy review at the moment, as the hon. Gentleman will be aware. Knowing him, he will be engaging with the review in his area. He talks about the latest radiotherapy and, of course, we have the new proton beam therapy treatment coming online in London and Manchester, for which children and patients are currently sent overseas. That is a great step forward, but there is an awful lot more to do, which is why the 10-year plan will have cancer at its heart.

[Mr Philip Dunne (Ludlow) (Con)]

18. What assessment he has made of the opportunity for artificial intelligence tools to improve the provision of healthcare.

[The Secretary of State for Health and Social Care (Matt Hancock)]

The Government believe that artificial intelligence and other digital technologies have the potential to transform health and care services. Our work on that includes investing over £400 million in tech transformation, which I announced last week. There is much more to do.

[Mr Dunne]

I also welcome my right hon. Friend to his new role. He will bring tremendous energy and enthusiasm, particularly into the information advantage that we know is needed to transform the NHS. Does he share my view that not only will this transform patient outcomes but we can use artificial intelligence to improve patient treatments? What are his initial views of the obstacles standing in the way of rapid uptake of such technologies?

[Matt Hancock]

There are huge opportunities for AI to improve patient outcomes and to make life easier for staff. In answer to the second part of my hon. Friend’s question, it is all about getting interoperable data rules and standards in place so that different systems can talk to each other in a secure, safe and innovative way.