NHS Winter Crisis

Debate between Philip Dunne and Paula Sherriff

Monday 8th January 2018 Commons Chamber

[Mr Dunne]

Cumbria is one of the parts of the country that has had persistent challenges in the delivery of healthcare. I am pleased that decisions have been taken over the past year or so, including those about investing in improving cancer facilities in Carlisle that my hon. Friend referred to, which we hope will address long-standing issues that have not been addressed under successive Governments.

[Paula Sherriff (Dewsbury) (Lab)]

Despite the best efforts of NHS staff, patients in my area routinely waited over 12 hours just to be seen at hospital. We have heard from my hon. Friends about patients having to sleep on the floor. Will the Minister therefore take this opportunity to say that he will halt all further downgrades and closures of services in my area at Huddersfield Royal Infirmary and Dewsbury and District Hospital until a full assessment of capacity has been undertaken?

[Mr Dunne]

A significant amount of funding—some £3.4 million—was made available to the hon. Lady’s area. Reconfiguration proposals are being driven by the STP process. It is down to local authority leaders and local NHS leaders and clinicians to determine what is the best configuration of services in their area.

Healthcare Optimisation Plan: Kirklees

Debate between Philip Dunne and Paula Sherriff

Tuesday 12th December 2017 Westminster Hall

[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.

Oral Answers to Questions

Debate between Philip Dunne and Paula Sherriff

Tuesday 4th July 2017 Commons Chamber

[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

Debate between Philip Dunne and Paula Sherriff

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.

Oral Answers to Questions

Debate between Philip Dunne and Paula Sherriff

Tuesday 11th October 2016 Commons Chamber

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

My hon. Friend is right to highlight the fact that the London ambulance service is in special measures and has been for some time. I visited it this summer and am pleased to confirm that some £63 million of additional funding has been provided to the ambulance service since April 2015. The service is starting to make significant inroads in increasing the number of paramedics who are available on call, with some 250 more being added over the last couple of years.

[Paula Sherriff (Dewsbury) (Lab)]

T2. Last October, the then Health Minister, the right hon. Member for North East Bedfordshire (Alistair Burt), confirmed that my constituency fell far below the national average in terms of NHS dental provision. In fact, it is one of the worst in the country. Unfortunately, nothing has changed since then. Does the Secretary of State believe it is acceptable that my constituents, including many children, are unable to get an NHS dentist?

Mid Yorkshire Hospitals NHS Trust

Debate between Philip Dunne and Paula Sherriff

Thursday 21st July 2016 Commons Chamber

[Mr Dunne]

I will come on to what we are doing nationally to try to make sure we have an adequate number of trained professional clinicians to meet the needs around the country.

It is important to recognise that while nationally some standards are set for safe staffing ratios, which were referred to by the hon. Member for Dewsbury, these are not a hard-and-fast rule and never have been. They are guidance rather than statutory requirements, and this position has not changed. Trusts have to use their judgment and focus on quality of care, patient safety and efficiency, taking into account local factors such as case mix rather than just numbers and staffing ratios. It is not a case of meeting a particular staffing ratio or getting to a particular figure and thinking that the matter is resolved. There must be enough staff—as both hon. Members are saying—to meet the needs of the patients, and it is a matter for the clinicians on the spot to make a judgment on that.

Nationally, demands on our staff across the NHS are rising, and more patients are being cared for than ever before. That is as true of Mid Yorkshire as it is of anywhere else in the NHS. Last year, across the Mid Yorkshire Hospitals NHS Trust, 232,966 patients were seen, compared with 194,119 in 2009-2010. That is an increase of more than 15% over the past six years. There were also some 4,685 more diagnostic tests carried out in May this year than in May 2010. Activity levels are therefore rising considerably.

[Paula Sherriff]

I thank the Minister for his constructive tone in responding to the debate. Does he acknowledge that the significant increase in the tendencies is partly down to a crisis in primary care in the area? That sector is struggling to attract GPs and practice nurses, and people are therefore sometimes attending A&E inappropriately, instead of being seen in primary care.

[Mr Dunne]

It is well recognised across the country that the tendencies in A&E include a significant proportion of people who should not be there and who should be being dealt with elsewhere in the system. The reasons for that are legion; it is not all down to pressures on GPs. Much of it is down to members of the public increasingly seeing their hospital as the place to go. We have a big educational job to do across the country on that, and it behoves all of us to help to relieve the pressure on A&E by encouraging patients to get their health needs seen to in the most appropriate place, whether through a pharmacy or a GP, or through other community services.

I want to touch on the question of funding. It is not all about money, but money plays a part. As a result of the funding settlement that we have secured for NHS England, the Wakefield clinical commissioning group will receive £488.8 million in 2016-17—the current fiscal year—which represents a cash increase of just over 3% compared with the previous year. In cash terms, that is a £21.7 million increase—a significant increase compared with previous years. For North Kirklees, the other CCG that commissions the work of the trust, there was also an increase in the current year to £237.1 million, representing a 2.49% increase compared with 2015-16, or just a shade under £12 million. That increase is substantially greater than the deficit reported by the Mid Yorkshire trust for last year. Of course, the commissioning funds do not all go to the trust, but the health economy in the area has received a significant cash injection.

Ensuring that we have the right number of nurses —I shall start with nurses—is a vital move towards achieving the Government’s objective of having a fully seven-day NHS by 2020. Nationally, we already have 11,800 more nurses, midwives and health visitors than we did in May 2010. The number of nurse training places has increased by 14% over the past three years alone, with further increases planned in the current year. More than 50,000 nurses are currently in professional training, which includes working and learning in hospitals through placements. However, the current funding system means that two out of every three people who apply to a university to do a nursing degree are not accepted for training. That is one of several reasons why trusts such as Mid Yorkshire find it difficult to recruit.

In 2014, the last full year for which I have statistics, universities were forced to turn down 37,000 nursing applicants. As a result, the NHS suffers from a limited supply of nurses and must rely on expensive agency staff and overseas workers, as referred to earlier. That is one reason why, earlier today, the Government announced their response to the public consultation on plans to place trainee nurses in the same system as all other students, including teachers and doctors. That response has been placed in the Library.

[Mr Dunne]

I will come to how we will respond when I conclude my remarks, but the right hon. Lady is quite right to point out that the problem is not unique to this particular trust and must be seen in a regional context.

[Paula Sherriff]

I also thank the Minister for his generosity. I just want him to know that the public meeting unfortunately did not go ahead owing to the tragic death of our colleague from Batley and Spen. However, given the staffing crisis and the fact that Mid Yorkshire is still undergoing a significant downgrade programme that will see Dewsbury hospital reduced to a minor injuries unit and many patients having to go to Pinderfields Hospital in Wakefield, will the Minister please reconsider the plans?

[Mr Dunne]

The short answer is yes. I intend to honour a commitment to meet the local trust—I would be happy to facilitate a meeting for the local MPs as well—to talk about the reconfiguration plans that are afoot.

I am conscious that I am in the unusual position of winding up an Adjournment debate at this stage of the parliamentary calendar and in danger of running out of time, so I will turn to the reconfiguration plans before I conclude.

We have to look at staffing issues, wherever they are, and at all the nursing specialisations in the hospital that were referred to earlier in the context of the wider reconfiguration of services currently going on within the trust and the sustainability transformation plans within the region later this year. The reconfiguration is driven by the need to address long-term systemic problems, some of which I touched on earlier. The current service changes were agreed back in 2013 and were supported by the Secretary of State in 2014 following the advice of the Independent Reconfiguration Panel.

Implementation of the agreed service changes at the trust is a matter for the local NHS, which is undertaking detailed work to assess fully the benefits and risks of bringing the changes forward. The process will look primarily at safety and quality, as well as capacity across the system, and will take local stakeholder views into account. Local commissioners will make the decisions about precisely what is to happen, and it is for the local NHS to keep all service change under review in line with its role in ensuring that the services provided are high quality, safe and sustainable. Staffing levels at the trust, particularly in nursing, remain a concern, and are regularly identified by the trust’s regulators and commissioners.

The trust has taken some action to address those concerns, including recruitment of additional nurses and non-qualified support staff as well as strengthening safe staffing policies and increasing board level scrutiny. Clearly, that has not solved the problem, as we have heard so graphically this evening, and more needs to be done.

The trust believes that benefits could be realised in bringing forward implementation of the service changes with improved clinical safety, efficiency and patient flow. I am aware that concerns are being expressed about the knock-on effects of the proposal for changes nearby in Calderdale, of which the hon. Ladies will be aware, and that is currently under consultation.

Change at each of these trusts should not be looked at in isolation, particularly in an area such as this with so many interdependencies and challenging geography and local public transport. Following the meeting of my predecessor, my right hon. Friend the Member for Ipswich (Ben Gummer), with the hon. Member for Dewsbury (Paula Sherriff) and the late hon. Member for Batley and Spen (Jo Cox) earlier this year, he agreed to facilitate a meeting in September with the regulators—NHS Improvement, the CQC and the NHS providers and commissioners. I will undertake to ensure that that meeting goes ahead.

Question put and agreed to.

Shipbuilding on the Clyde

Debate between Philip Dunne and Paula Sherriff

Monday 25th April 2016 Commons Chamber

[Mr Dunne]

My hon. Friend is right to highlight the gear box work for David Brown, which, as I said earlier, has secured long-lead contracts last month. The benefit of the Royal Navy shipbuilding programme is not confined to Scotland; it affects constituencies right across this country, which is just as it should be. When contracts are placed, we will seek to highlight to hon. Members the work we will be providing in their constituencies for their constituents.

[Paula Sherriff (Dewsbury) (Lab)]

Amid the politics, perhaps the House could remember the estimated 800 families for whom, with their livelihoods at risk, this is a very worrying time. Will the Minister confirm that the promised investment in upgrading the shipyards will still go ahead?

[Mr Dunne]

I hope that some of the remarks I made earlier will provide some reassurance to the families of those who work on the Clyde. Part of the contracts we have already signed with BAE Systems will help to provide shore test facilities both on the Clyde and through the supply chain, so some investment is going into facilities. The overall level of facilities investment will be part of the overall contract, so I cannot update the hon. Lady further at this point.