Medicines and Medical Devices Safety Review

Philip Hollobone Excerpts

Wednesday 21st February 2018 Commons Chamber

[Mr Hunt]

I am happy to do so, but this review is obviously separate from the things that are happening in Scotland. However, we will certainly look at all those issues.

[Mr Philip Hollobone (Kettering) (Con)]

This is the first chance I have had to thank the Secretary of State for visiting Kettering General Hospital last week, and I do so now. It is a laudable and oft-stated ambition that the NHS should be the world’s safest healthcare system. Are we there yet? If not, when will we be?

[Mr Hunt]

International experts from the Commonwealth Fund in New York say that we are the safest healthcare system in the world, but that gives me pause for thought because there is still so much avoidable harm and death in our system right now. If we are the safest, that says that healthcare everywhere needs to improve.

NHS Staff: Oxfordshire

Philip Hollobone Excerpts

Tuesday 20th February 2018 Westminster Hall

[Layla Moran]

Not at all; I thank the hon. Gentleman for his helpful intervention. He is right to foreshadow what is coming later. The more times we make the point, the better, because it is the crux of the issue in Oxfordshire. On the pay cap, when will we see the timetable for the pay review? We need to ensure that the basic cost of living at least is covered. I will come on to housing later.

I am glad about the renewed focus on social care in the Department since the reshuffle, but I sincerely hope that it extends beyond just a name change. Staffing levels for the sector are even worse than in nursing in Oxfordshire. One of the more surprising facts I have learned in recent months has been about how many social care staff are leaving the service locally to fill positions in the retail sector created by the opening of the shiny new Westgate centre in Oxford. Pay is at a similar level, but the work is less stressful, so the people doing those vital social care jobs are deciding that they would rather do something else and take the easier path.

It is not just pay that we are talking about; Oxfordshire pays well for such jobs in comparison with other parts of the country. Our area still struggles to recruit and keep people. The recently published Care Quality Commission report for Oxfordshire found that

“The system in Oxfordshire was particularly challenged by the issues of workforce retention and recruitment across all professions and staff grades”,

and that “countless” concerns had been expressed about recruitment and retention, and their impact on developing a skilled and sustainable workforce.

The report goes on to highlight the need to do more to increase professional development. We must ensure that budgets are available for continuous professional development within the NHS, allowing existing staff to train, develop and build their career over time. Without such opportunities, it is little wonder that they move on. That has been raised vociferously by nursing leads as another key factor in the retention crisis. I will be interested to hear what the Minister has to say about CPD and whether the budget for that will be increased.

Then there is overall funding. At the election, all political parties pledged more, but it was not enough. Rather than just talking about how much, I want to talk about how we can be honest with the public about how to pay for more funding, if we are all agreed that that is needed. In the short term, my party would like to see a ring-fenced penny in the pound on income tax, providing a £6 billion cash injection. In the longer term, and as a replacement for national insurance, on the basis of wide consultation, we advocate a dedicated health and social care tax. The advantage of that would be that people could see in their pay packets exactly what we were paying for.

We also want an NHS and care convention to bring together all political parties and stakeholders, so we stop using the NHS and social care as the political football it was during the election. Recently a letter on the issue backed by nearly 100 MPs was sent to the Prime Minister, but I was saddened to see that it was not taken up. I therefore urge the Minister not only to continue to ask the Prime Minister and the Treasury for more money for the NHS but, critically, to back something along the lines of a cross-party NHS and care convention, so that we can take the NHS out of the hands of political pundits and put it back into the hands of patients, where it belongs.

I have talked about what I would like to see from the Government: an open and generous offer to EU citizens; a decent pay rise; better funding, which is not kicked about as much; improved working conditions; and action on bursaries and training for nurses. But, to come to the point made so eloquently earlier, that will not cut the mustard for Oxfordshire, because our biggest issue by far is the prohibitive cost of housing in the county.

I will share an email I received from one of my constituents in Kidlington who works for the NHS. She contacted me to say that she feels as though she will never be able to afford a house of her own:

“I work for the NHS and although it comes with fantastic benefits and, I hope, great security it doesn’t pay like those who would be doing the same job as me as an office manager, in the private sector.

My situation is that I have been working for NHS nearly 9 years now. I want to move out and I live in Kidlington. To have a slight chance I would have to do shared ownership. Although not ideal it is a great stepping stone, and you have to start somewhere. However, if I was to look outside Kidlington, the Bicester area where there is up and coming new builds, the prices are still out of my range. It is disheartening to be rejected, especially when you are literally outside the affordability, yet you have worked, paid taxes and generally contributed to society.”

That is a damning indictment, and the despair is shared by so many public sector workers across Oxfordshire. A 2017 study by Lloyds bank listed Oxford as the most expensive city in which to live in the UK, with the average house price now 11 times average earnings. The recent CQC report on Oxfordshire found that staff at every level cited cost of living and housing as barriers to staff recruitment and retention.

There have been some steps in the right direction. As the Minster will know, in March 2016 the OUH trust launched a scheme in which new nursing recruits were offered a cash incentive equivalent to their first month’s rent and a deposit. I have no doubt that the council, the NHS and other organisations in other parts of the county, as we have heard, are doing everything they can—I am not here to bash them—but the fact is that the new houses to be built will not fix the problem. At best, the models show that house prices may flatline over time, but the definition of affordable as 80% of the value of incredibly expensive houses is still nowhere near enough to tackle the problem for public sector workers.

I can propose a solution. I would like to see some kind of Oxfordshire housing allowance for public sector workers given to local NHS staff to help them meet the extremely high cost of living and to tackle our recruitment crisis. Unison’s Oxfordshire health branch has called for the reintroduction of an Oxford weighting to help staff with living costs in the area, in line with the NHS weighting already paid to staff in London. I prefer not to do that, simply because “more pay” can be seen as “more valued”, which is not what that is meant to be. I would prefer to see the introduction of a specific payment for housing—a specific payment for a specific problem.

I am open to exploring all options, and I am very keen to hear what fellow Oxfordshire MPs and others think. Without an Oxfordshire housing allowance in some form, we will always struggle to recruit the NHS staff we require. Moreover, we need to start doing something now.

To conclude, the Government can and must take a role collaboratively with stakeholders to recognise the unique situations and challenges that we face in Oxfordshire. If we do nothing, we risk the rationing of care and treatments and, rightly, a backlash from our constituents. God forbid that anything should happen to a single patient as a result of any of the issues I have described today. It is our duty to tackle the problems head on and to ensure that we recruit and retain the staff whom patients deserve and our local NHS desperately needs.

[Mr Philip Hollobone (in the Chair)]

The debate can last until 1 o’clock. I will call the Front-Bench spokespeople at 12.30 pm, so other Members have 10 or so minutes each. I call Victoria Prentis.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 6th February 2018 Commons Chamber

[Mr Hunt]

Let me reassure the right hon. and learned Lady that we do not wash our hands of any trusts that go into special measures. The point of the special measures regime is to highlight where Government intervention is necessary. I know the right hon. and learned Lady will agree that a huge amount of very fine treatment happens at King’s every single day, but it is having profound issues in relation to the management of its finances and some of its waiting times, which is why we are doing everything we can to support it.

[Mr Philip Hollobone (Kettering) (Con)]

With a high delayed-discharge rate of 10%, Kettering General Hospital, which is in special measures, has 60 patients on any one day who have completed their treatment and await their transfer into the community. Northamptonshire County Council has been given millions of pounds, via the better care fund, but it is simply not up to the job. What can be done in those circumstances?

[Mr Hunt]

I am well aware of the pressures at Kettering. It is a very busy hospital, and it has undergone a number of changes of management. However, I can reassure my hon. Friend that a big improvement package is there to support it and that we want to take it out of special measures as soon as possible.

NHS Winter Crisis

Philip Hollobone Excerpts

Monday 5th February 2018 Commons Chamber

[Stephen Barclay]

The hon. Gentleman’s trust has received an additional £1.6 million, so it is simply factually incorrect to say that its budget has been cut.

[Mr Philip Hollobone (Kettering) (Con)]

May I thank my hon. Friend the hospitals Minister for the extra £2.6 million given to Kettering General Hospital to help it to cope with winter pressures this year; and, through him, my I congratulate the NHS on this year undertaking the most comprehensive flu vaccination programme in Europe and the largest in this country’s history?

[Stephen Barclay]

My hon. Friend is an assiduous campaigner for his constituency, and he is absolutely right to highlight both the progress made and the importance of the prevention offered through the increased number of vaccinations. I hope many more people next year will continue to take up the vaccination, including Members of this House.

NHS Blood Cancer Care

Philip Hollobone Excerpts

Wednesday 17th January 2018 Westminster Hall

[Henry Smith]

The hon. Gentleman is again absolutely correct. The stem cell register is vital to our addressing this condition going forward and beating blood cancer in the future. We would all do well to echo his message.

[Mr Philip Hollobone (Kettering) (Con)]

I congratulate my hon. Friend on the tremendous work he is doing with the APPG and also on his superb speech, which I am following closely. One of my constituents, Mr Gaziano, has written to me to say that he suffers from an incurable form of blood cancer called chronic lymphocytic leukaemia, which is apparently the most common form of leukaemia among adults. He makes the same point about the lack of support. Apparently, 66% of people with that type of leukaemia live with anxiety, 50% with stress and 34% with depression, but they are not getting the psychological support from their healthcare teams that they need.

[Henry Smith]

My hon. Friend is absolutely right. I am sorry to hear of his constituent’s experience. He anticipates remarks I will make later, with regard to psychological support for people with chronic, longer-term conditions and the watch and wait approach, as it is sometimes called, for dealing with some forms of blood cancer, particularly in adults.

The Government and NHS England need to address, as a matter of urgency, the specific needs of blood cancer patients and take immediate steps to improve their care. Something that may seem as simple as the terminology surrounding blood cancer can have an effect on ensuring support for patients. As I said, there are 137 different types of blood cancer—we have heard a number of different examples already—including various strands of leukaemia, lymphoma and myeloma. In each of those, one common word is missing: cancer. The lack of that important word when telling somebody they have one of those forms of blood cancer runs the risk of their not fully comprehending the gravity of their condition. The APPG’s report found that clinicians and patients said that the increasing use of the overarching term “blood cancer” has helped patients who have been diagnosed recently to gain a greater understanding, not only of how the disease is part of a wider clinical area but that there is an entire community of health professionals, charities, and patient groups to help them.

I am grateful to all those who took the time to respond to our web consultation and answer the questions, including those on early diagnosis. After analysing the responses, the APPG’s report outlines three main audience groups where increased awareness could benefit patient outcomes. The first is the general public. While greater awareness of the symptoms would lead to people seeking medical intervention sooner, I also appreciate the words of caution from some in the medical profession, who reiterate that this must be handled carefully to avoid undue concern, particularly given the commonality of the symptoms. There is agreement that blood cancer awareness is far behind that of other common cancers, as we have heard.

The second group is GPs. Recognising and diagnosing blood cancer symptoms can be difficult, and many patients reported frustration at having to see their GP a number of times before their blood cancer was diagnosed, as we have heard. The third—as I turn to the Minister—is cancer policy makers. We heard that blood cancer was not always at the forefront of their minds. As such, we seek the extension of policies and initiatives designed to ensure broad benefit to patients with solid cancer tumours to those with blood cancer.

Much of the work on blood cancer awareness is undertaken by the charity sector. To that end, I pay tribute to the Spot Leukaemia campaign organised by Leukaemia CARE, which I am pleased to say was supported by my local community through Crawley Town football club, which made the cause its charity of the day at a game just last September. I ask the Minister for his assurance that the Department of Health and Social Care will engage with such campaigns, to ensure that the full power of his Department and the NHS can be used not only to work in partnership with such charities but to give greater consideration to non-solid tumour cancers when developing policy.

If blood cancers are taken into greater account, it will lead to improvements in the patient experience. As we heard in an earlier intervention, the patient experience of those with blood cancer differs from those with other cancers. The sad reality is that some patients with some chronic blood cancers will never be cured. They will instead require treatment for the rest of their lives, with the cancer managed as a long-term condition. Patients who have had access to a clinical nurse specialist have been clear on the role that a CNS has in the patient experience. Indeed, respondents to the APPG’s report were clear that access to a named CNS was the single most important factor that improved their experience.

Again, the charity sector is working to support patients in this area. By April, the Anthony Nolan charity will have funded nine CNS posts in stem cell transplant centres across the UK. These specialists provide support for patients, including assistance in getting back to work or school, as well as dealing with the physical and emotional aspects of a stem cell transplant—a potentially curative treatment for blood cancer, as we heard in an intervention, for which I am grateful.

Some patients will be put on a watch and wait programme, as I mentioned earlier. That literally means that a patient’s blood cancer is monitored, and it can sometimes take years for it to reach a point where treatment can start. The very nature of such a scenario will place unbelievable pressures and strain not only on the patient fighting that cancer, but on their family, friends and wider support network.

Tailored psychological support, which I am grateful to my hon. Friend the Member for Kettering (Mr Hollobone) for mentioning, needs to be made available for patients—particularly those on a watch and wait regime.

King’s College Hospital

Philip Hollobone Excerpts

Tuesday 16th January 2018 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

The good news for our next speaker is that she has an extra 10 minutes for her debate, because we can move straight on.

[Helen Hayes (Dulwich and West Norwood) (Lab)]

I beg to move,

That this House has considered King’s College Hospital finances.

It is a pleasure to serve under your chairmanship, Mr Hollobone. I am pleased to have secured this debate on the finances at the King’s College Hospital NHS Foundation Trust, which I have been seeking for some months. It has been clear to me that the trust has been heading towards a crisis, which came to a head shortly before Christmas, when NHS Improvement took the trust into financial special measures. The debate is therefore timely.

To date, the Government have responded to the crisis at King’s as if the problem has arisen suddenly in the short term. I want to use this debate today to set out clearly the causes of the problems at King’s, which can be traced back to 2010 and 2013. I also want to ask the Minister to take seriously the complexity of the current situation at King’s and to take action now to allow it to stabilise and rebuild. There is ample evidence of a crisis across the whole of our NHS this winter, and I want to emphasise that the situation at King’s is a warning sign for the NHS that the Government must heed.

My relationship with King’s goes back 20 years. I have been a surgical patient and an out-patient at the hospital. I gave birth to my children there. Both were delivered by the same amazing midwife, whose name we chose as a middle name for our second daughter. My mum worked at King’s for 10 years until she retired. The situation at King’s is as personal and as important to me and my family as it is to tens of thousands of my constituents.

King’s is an extraordinary hospital. As a major teaching and research hospital, it undertakes world-leading work across more specialisms than any other hospital, including liver transplants, maxillofacial surgery, foetal medicine, neurosurgery, neonatal intensive care, cardiology and sexual health. As a major trauma centre, the emergency department saves the lives of critically ill and injured patients every single day. The work of its trauma surgeons is pioneering. Together with the specialist nurses, anaesthetists and other clinical staff, they were at the frontline of treating critically injured victims of the Westminster and London Bridge terror attacks and the Grenfell Tower fire.

In south London, we are enormously proud of King’s specialisms and its major trauma centre, but it is also our district and general hospital, where people have antenatal scans, give birth, have their appendix removed, have hips and knees replaced, have broken limbs fixed, have cataracts removed, recover from strokes, and receive help to manage diabetes, sickle cell disease and many other health conditions. King’s has a very special place in our community. I pay tribute to the extraordinary skill, commitment, dedication and care of the 15,000 staff at King’s. I have spoken to many staff in recent weeks. All of them, including the consultant with 32 years of experience I met yesterday, say that things have never been tougher. I want to put on the record my gratitude for everything they continue to do.

My constituents are desperately concerned about the plight the hospital currently faces. King’s has been on a journey over the past 20 years. Back in 1998, when I was an in-patient, it was a struggling, failing hospital, where patients were treated in overcrowded conditions and waited on trolleys in accident and emergency. Years of Labour investment transformed it, so that by 2010 it was meeting all of its main clinical targets, had recruited many more staff, and was consistently achieving a small financial surplus each year.

I am concerned that, despite the incredibly hard work of the brilliant staff at King’s College Hospital, that journey has come full circle—the days that we thought had been left behind at King’s have now returned. The hospital is regularly more than 100% full, with meeting rooms and storage space being used for beds; it has been consistently failing to meet the four-hour waiting time target in A&E, or the 18-week referral-to-treatment target; and it is not meeting its key cancer targets.

I want to be absolutely clear with the Minister that the causes of the problems at King’s have roots that go back to events in 2010 and 2013, which could have been predicted by the Government and Monitor, and which absolutely should have been prevented. I draw the Minister’s attention to four key issues. First, the rate of funding increase for the NHS was significantly cut from 2010, from 3% to 4% under the previous Labour Governments to 1% under the Tory-Lib Dem coalition Government. There was therefore no way that the funding was ever going to keep pace with inflation, let alone increases in drug and treatment costs and increasing demand. The fact that we are all living longer is a positive thing, but since older people use health services far more than younger groups in the population, it creates an entirely foreseeable increase in the need for health services. That can be managed and minimised when good-quality social care is available to everyone who needs it, but over the same period £6 billion has been taken out of social care. At the Princess Royal University Hospital, which is part of the King’s trust, 20% of older patients are clinically fit for discharge but have nowhere to go—a direct example of the extra burdens that the Government’s inadequate approach to social care is having on the NHS. The false economy cuts are simply adding to the pressures in our NHS, as people who should be able to maintain their health at home with good support end up requiring acute care.

The second key issue affecting King’s is a result of the 2013 decision for it to take on two hospitals—the Princess Royal University Hospital and Orpington Hospital—from the failing South London Healthcare Trust. Following that decision, the Government and Monitor should have insisted on a review period to ensure that the new expanded trust had the right level of support and resources to run the hospitals, but they did not do so. From that moment on, the finances of the new trust deteriorated rapidly. The situation at the Princess Royal was far more complex than anticipated, but there was no review of funding in the light of new and more detailed information about the level of investment required. That 2013 decision fundamentally destabilised the finances of the trust.

The third issue is the challenge of the competing responsibilities of emergency care, including the trauma centre and elective surgery. The King’s trauma centre generates its own demand, which increases year on year, but the funding for emergency medicine is by way of a block grant. There is no increase in funding that is in any way responsive to that demand. It cannot be right that, when King’s staff step up to the plate in response to terror attacks or the Grenfell Tower fire, there is no additional funding to cover the costs of the additional work. Elective surgery is paid for by procedure, so when the demands of emergency admissions, whether because of an increase in flu cases, or a major incident, force elective operations to be cancelled, there is loss of income in addition to an increase in costs. That creates knock-on financial consequences for the trust as a whole.

Fourthly, the limited capital funding since 2010 has meant that staff at King’s have not been able to plan strategically for the facilities the hospital needs to cope with increasing demand. The King’s College Hospital site at Denmark Hill is very constrained for a major hospital, and it has been developed piecemeal over many years. Large parts of the hospital estate are no longer fit for purpose, and additional ward space is urgently needed. King’s will open a new state-of-the-art critical care unit later this year, the largest in the country, but the trust has not been able to expand its general ward capacity, which will potentially result in additional pressures as patients leaving critical care compete with emergency admissions and elective surgery patients for insufficient beds.

The four challenges I have described have been evident for some time, but the Government’s approach, rather than to undertake a review of the finances and agree a sustainable funding settlement, has been to set more and more unrealistic targets for financial savings; to refuse King’s the sustainability and transformation funding that other hospitals have been awarded; and to fine King’s for being in a challenging financial situation.

Since 2015, at the behest of Monitor and later NHS Improvement, vast sums of money that could have been spent on patient care have been spent on management consultants. At one stage the trust was paying a single firm of management consultants more than £1 million pounds a month. The trust has been asked to make punishing savings when it has no control over the demand for its services or some of its costs, but the management consultants have not been judged on their ability to deliver sustainable, lasting improvements—theirs has been a one-way street of throwing good money after bad.

It is absolutely the case that the Government have known about the financial situation at King’s for some considerable time, yet on top of an already unmanageable financial situation, the Government proposed completely unrealistic control totals, in essence setting the hospital an unachievable target for making savings, then punishing it with financial penalties for failing to do so. Since last year, King’s has been under enhanced regulatory oversight by NHS Improvement, technically a similar situation to being in financial special measures, with NHSI staff permanently in the hospital and a high level of scrutiny.

Over the past three years King’s has made savings of more than £200 million, more than twice the average level of savings of trusts across the country over that same period. King’s has done that while maintaining standards of care that are on the whole very good. The Government have known about the financial situation at King’s for three years, the Government have been directly involved with the situation at King’s, and the Government are culpable, yet instead of taking responsibility for the situation and acting to ensure that King’s has the resources it needs, the Government have required King’s to do the impossible and punished the trust when it has been unable to deliver.

The Government must now take responsibility for the situation and ensure that the King’s College Hospital NHS Foundation Trust is not allowed to fail any further. I therefore ask the Minister to do the following: to undertake a full review of the finances at King’s, starting with an analysis of what is required to deliver safe and effective care across all areas of treatment and responsibility; to make a commitment that financial special measures will not mean just forcing through the proposed control totals, which simply cannot be met without jeopardising patient care; to guarantee that there will be no threat to any of the services provided at King’s on which my constituents and residents in the wider south London and the south-east area rely; to agree a capital funding settlement to enable King’s master plan for Denmark Hill to be implemented, so as to deliver the space and facilities the hospital needs now and for the future; to guarantee that financial special measures will not mean an increase in the interest rate that King’s is charged on its deficit; and to revise the funding formula so that King’s is not hit financially when it steps up to respond to major incidents and London-wide emergencies.

I will end with this: King’s is a special trust and some attributes of it are unique, but the pressures and challenges it faces can be found in NHS hospitals up and down the country. Until the Government recognise that and choose to make a long-term commitment to fund the NHS to provide the services our ageing population needs and to stop the outflow of NHS funds into private profits, our NHS is not safe in their hands.

[Several hon. Members rose—]

[Mr Philip Hollobone (in the Chair)]

Order. The debate may last until 6.15 pm. The hon. Lady has three minutes at the end of the debate to sum up the contributions. We have oodles of time, so we do not need to worry.

--- Later in debate ---

[Mr Philip Hollobone (in the Chair)]

Order. If the Minister could finish his remarks no later than 12 minutes past six, it would give Helen Hayes three minutes to sum up the debate.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 19th December 2017 Commons Chamber

[Mr Dunne]

The right hon. Gentleman will be aware that centralising cardiac services in particular into acute cardiac hospitals is having a significant impact on improving access to treatment by reducing the time it takes to get diagnostic tests and initial treatment, and is therefore saving lives. Specialisation is working in London and in other parts of the country where it is being applied. I am sure that he would welcome the recent allocation to Kingston Hospital of up to £1.3 million to help with winter pressures.

[Mr Philip Hollobone (Kettering) (Con)]

The Minister visited Kettering General Hospital earlier this year and saw for himself that a record number of patients are being treated with increasingly world-class treatments. Will he confirm that the hospital will get £2.6 million to cope with winter pressures this year?

[Mr Dunne]

My hon. Friend never fails to highlight the success of Kettering General Hospital. I am delighted to confirm that £2.6 million will be available for that hospital this winter. We are working hard with the hospital management, through the special measures regime, to improve performance in that trust.

Healthcare Optimisation Plan: Kirklees

Philip Hollobone Excerpts

Tuesday 12th December 2017 Westminster Hall

[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.

Hormone Pregnancy Tests

Philip Hollobone Excerpts

Thursday 16th November 2017 Commons Chamber

[Steve Brine]

No, I do not. I will write to the hon. Lady about that, but I can tell her that issues relating to the historical regulatory process were outside the scope and remit of this review.

[Mr Philip Hollobone (Kettering) (Con)]

I come to this having had no constituency involvement in this issue at all, but I have been listening to the exchanges this morning and it is quite clear that the level of concern on both sides of the House is sufficient for the Government to call a debate on the matter in Government time, so that all these issues can be properly explored.

[Steve Brine]

All I can say is that, right on cue, the Leader of the House has arrived and is sitting right next to me, and I suspect that she has heard my hon. Friend’s request.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 14th November 2017 Commons Chamber

[Mr Dunne]

I am grateful to my hon. Friend for giving me the opportunity to reaffirm the commitment of the NHS, from the centre through to every organisation for which EU citizens are working, that these people are welcome here. My right hon. Friend the Secretary of State for Exiting the European Union yesterday made it very clear that we are looking to have a simple, straightforward and cheap means for those who are here at the point of departure to be able to register to stay here. We want to encourage all those who are working for our NHS, wherever they come from, to continue doing so.

[Mr Philip Hollobone (Kettering) (Con)]

During his visit to the hospital in April, the Minister will have seen that Kettering General has a long and proud record of recruiting medical staff from outside the EU, and in numbers. Is it not the case that the NHS has always recruited from outside the EU and will continue to do so after Brexit?

[Mr Dunne]

My hon. Friend is right to say that there has been a long-standing tradition of this country welcoming professionals from outside, through various waves of migration that go back several decades. It is important to point out to him that the Secretary of State announced a year ago a 25% increase in the number of doctors in training in this country and earlier this autumn a 25% increase in the number of nurses to be trained in this country, so that we become less reliant on overseas clinicians at a time of a shortage of some 2 million worldwide.