The National Health Service
Phillip Lee Excerpts(5 years ago)
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Matt Hancock
There speaks the voice of Scotland. As we have put record amounts of funding into the NHS in England, that funding proportionately flows through the Barnett formula to Scotland, but the Scottish Government have refused to increase NHS funding in Scotland. I wish that they would increase it as quickly as we have in England, where we have seen a faster increase in the numbers of doctors and nurses than in Scotland.
Dr Phillip Lee (Bracknell) (LD)
Will the Secretary of State help me by pointing me towards an online resource that provides the evidence base for his decisions on the locations of A&E departments and the like? Any medical professional will say that we need a regional and, dare I say, national plan in order to make sure that access to emergency care is equal for every citizen in England and Wales.
Matt Hancock
The hon. Gentleman makes an important point that capital investment needs to be strategic, and the new health infrastructure plan, which I was discussing at the Health and Social Care Committee yesterday, is intended to put in place that long-term plan for capital investment, and we are building 40 new hospitals over the next decade. It may be fair to say that I got some flak from Labour Members for proposing 10 years’ worth of new hospitals, because they said that only the first part of the health infrastructure plan—the so-called HIP 1—should be announced. I do not think that that is true, however, because we need a long-term approach to capital investment, with 40 new hospitals over the next decade.
NHS and Social Care Commission
Phillip Lee Excerpts(8 years, 9 months ago)
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Dr Phillip Lee (Bracknell) (Con)
It is a pleasure to follow the hon. Member for Leicester West (Liz Kendall) and other colleagues who have spoken. I congratulate the right hon. Member for North Norfolk (Norman Lamb) on securing the debate.
I broadly support the call for some cross-party engagement to try to secure the future for the national health service, although I will come on to clarify that in my speech. The right hon. Gentleman may encounter some difficulties in seeking cross-party support for financing the NHS, not least because of some of the contributions so far. There are some profound challenges to financing health and social care, primarily because of the challenges that we, and all western societies, face with an ageing population. I remember the Intergenerational Foundation launch here in Parliament a few years ago. Only the former Member for Dulwich and I turned up. At the time, the subject was not much discussed, but I note that it is now increasingly being discussed. We are beginning to do the maths and realise that we cannot afford the current settlement for financing health and social care and that we will have to discuss it at some length. The problem is that one ends up talking about broadly different political philosophies and approaches. Some people, I suspect more on the Conservative Benches, will want to emphasise the need for personal responsibility; others, I suspect more on the Opposition Benches, will want to emphasise collectivisation and the like. That is why I suggest that discussing the financial settlement is possibly a road to nowhere.
I think there is scope, however, for discussion on the structural organisation of the health service: where our hospitals are located and what each individual hospital does. In a week when we have had yet another dreadful failure of the system with the 111 line and out-of-hours services, it is beholden on us to start to discuss what is offered in the out-of-hours arena: how the services are structured and where patients should go to seek the appropriate care for themselves or their children.
The context has been set out by other colleagues. We know that we have a problem of increasing demand, which is driven mainly by ageing, obesity and the welcome advances in surgical practice, technology and drugs. There is also a problem with the health-seeking behaviour of different generations. In my own clinical practice, I am seeing the passing of the stoic wartime generation. Their attitude towards health, and to symptoms of pain and suffering, is noticeably different from that of their children and that will bring increasing demand on healthcare services. If we consider that together with the large cohort who were born between 1945 and 1955, we have an equation that results in a significant deficit.
On the subject of deficits, since I have been here I have seen many faceless NHS bureaucrats come up with numbers relating to likely demand and shortfall. They are always wrong; the figures are usually underestimated. I said at the time that the £20 billion challenge in the previous Parliament was an underestimate of likely demand and here we are talking about £30 billion. What is next: £40 billion? I am glad that a shadow Minister for mental health has been appointed and that people are waking up to the importance of mental health because demands for mental health services in particular will increase the £30 billion figure.
On hospital structure, essentially we have 19th and 20th century buildings trying to deliver 21st century care. Medical and management staff are trying to do their best within this infrastructure, but to be blunt it is not possible to deliver the very best care in all hospitals and in all locations.
Dr Philippa Whitford
Is it not also, to some extent, a failure to engage with the public so that they understand how much 21st century medicine has changed? People who have a heart attack are not going to their local casualty department. They are being taken to a heart unit where they will have an angio and an angioplasty. People do not understand that the big boxy paramedic ambulance has everything that an old A&E used to have.
Dr Lee
The hon. Lady is right. Tomorrow I will be working as a doctor. I am very proud to be working as a doctor. I have been very public and open about it throughout my time here and I will continue to practise medicine for the foreseeable future. I encourage her to face down her internal critics, as well as those rather ill-informed external critics in the Scottish Daily Mail. I actually stood for election calling for the closure of my local hospital. I did not want my constituents going to an ill-equipped hospital, or thinking that it provided care that it did not. I have sought to educate my local electorate about the need for a 24-hour angio suite and for a 24-hour stroke unit.
We have made some progress on reconfiguration, particularly on stroke care. In London and in Greater Manchester, stroke services have been consolidated. That is why people are now surviving and survival rates for strokes are improving. Patients are taken to appropriate units and appropriately cared for. The appropriate intervention can be applied within the appropriate time. Sadly, that is not possible across the country. It is available only in areas where difficult decisions about reconfiguration have been taken. On oncology, there is a widespread belief that cancer outcomes are all to do with late diagnosis in primary care. Forgive me, but that is not necessarily the whole story. It is the quality of cancer care when patients reach the hospital—any delay in receiving radiotherapy and so on—that is having a profound impact on cancer outcomes. If we consolidated oncology services into fewer sites, we would get better clinical outcomes.
On out-of-hours care, when I turned up here I said that I would scrap out-of-hours care as it is currently constituted. Most people looked at me and thought, “Are you slightly nuts?” The answer is no. Having done many, many, many sessions in the primary care out-of-hours arena, I realised that there was the potential to delay the care of the acutely unwell in a way that could have an adverse impact and, in extremis, lead to someone’s death. I suspect, without knowing the details, that the case we heard about in the urgent question on Tuesday was such an example. I do not believe it is clinically possible to properly assess a sick child via a telephone. We can go some way towards doing it with an adult, because—guess what?—an adult can express themselves more accurately. With a child, we have to see them and touch them, and, in particular, we have to see the mother’s response towards the child, to assess how acutely unwell they are.
The problem, with all best intentions, is that with a telephone service these types of incidents are always going to happen. It was no different with NHS Direct; the medical profession used to get very frustrated with that, and 111 is the same. The symptoms of sepsis can be the symptoms of many things, so if we tighten the protocols we end up flooding the service with more and more people worried that their child has sepsis when, actually, it is not that common.
I would revisit the whole out-of-hours settlement. We could get away with having fewer doctors during antisocial hours primarily looking after the housebound and those who are terminally ill. The list of patients who could be visited by said doctor would be compiled by GP practices in that region. Patients would not get a visit unless the GP practice has said they are entitled to a visit because of a diagnosis of being either terminally ill or housebound. In future, I would put the resources into urgent care centres. For now, I would put one in each casualty to sift through. I would make sure it was a doctor. Forgive me, but doctors are taught to triage and to diagnose. No other healthcare professionals are taught in the same way. The best thing to do is to put one’s most experienced and qualified person at the front end, because then proper triage can take place.
Dr Tania Mathias (Twickenham) (Con)
In my constituency, the borough has a brilliant GP-led out-of-hours system that I would invite the Secretary of State to considering rolling out. I appreciate the idea of a commission, but we already have the vanguards and out-of-hours services, such as the one being led from Teddington memorial hospital, which I believe set the right standards. What can a commission do that we cannot do without one?
Dr Lee
I thank my hon. Friend for her intervention because it allows me to elaborate. A couple of years ago, I had a meeting with the right hon. Member for Leigh (Andy Burnham)—all the polls were saying that the Opposition would win the election, so I thought I would have a meeting with him in advance. I said, “Look, Andy, you’re going to have a problem. We’ve got all these hospitals. We know some of them are not fit for purpose. We know we’ve probably got too many because of how healthcare has changed. Some 80% of care delivered in the NHS is for chronic conditions. Why don’t you have a cross-party commission so that all the parties can share the political pain of deciding which hospitals should be retained as acute hospitals, delivering the 24-hour stroke and angiography suites, the surgical interventions and the like, and then have more community hospitals, with urgent care centres attached”—the hub-and-spoke model. At the time, he looked at me and said, “Well, maybe”, and made no commitment.
My point was that it was extremely difficult for colleagues in marginal seats to come out and say what I said in my constituency, which was that the current local hospital settlement was not in the best interests of my constituents. It is very hard to do that in a marginal seat, be it Labour, Conservative or whatever, so, with a cross-party commission, we could all share the pain.
All the royal colleges, particularly the paediatricians and obstetricians, know that staffing in some district general hospitals is not ideal. It is extremely difficult to provide the level of care we know we can deliver. How do we get to that point? A couple of years ago, I thought that having all the parties and independent experts in a room would be one way of going from approximately 200 to 100 such hospitals in England and Wales. That is the sort of scale change I am talking about. I hope that that answers the question from my hon. Friend the Member for Twickenham (Dr Mathias).
Dr Philippa Whitford
In my constituency, we have hospitals that have grown organically and are not far apart, but we have also seen an increase in the number of modern community hospitals—what people would have called cottage hospitals. The hon. Gentleman says that many of our patients require the management of chronic diseases. We need to take that closer to the public. It is the highly specialised things that should be centralised. The public would accept that, provided they do not get the sense of their hospital disappearing and provided they are aware that other services are coming closer to them.
Dr Lee
Again, I agree with the hon. Lady—we are making a habit of this. I held a series of public meetings at which people were initially against my position, but when they understood that I was trying to provide more services closer to home, but that this might mean their having to travel a bit further for acute care, they accepted it and became broadly supportive.
I am under no illusions about the difficulty of all this, but if there is one goal we should all seek in the NHS, it is better clinical outcomes. At the moment, clinical outcomes are not as good as they should be. The much-trumpeted Commonwealth Fund report made that clear. Part of the problem—perhaps a significant part—is where the care is currently being delivered. The junior doctors strikes, which have just been paused; the consultant contracts; the nursing contracts to come—all these would be made easier with a structure in place that is more easily staffed. It would be easier to avoid husband-and-wife doctor teams being split if we had bigger hospitals with bigger staff pools to provide the cover.
We need to concentrate first on the structure of healthcare, and social care—I am conscious I have not spoken about social care, but of course it should be integrated; it is so obvious. But let us concentrate on the structure of healthcare first, as part of a cross-party approach, and then perhaps we can have a debate about finance. I suggest to the right hon. Member for North Norfolk, however, that finance might be a harder nut to crack than the hospitals, on which I think there is a broad consensus that we are all in it for the same outcomes: people recovering from their illnesses; people being treated appropriately when they have operations; and ultimately everybody, irrespective of means, leading long, health lives.
Space Policy
Phillip Lee Excerpts(8 years, 10 months ago)
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Dr Phillip Lee (Bracknell) (Con)
It is a privilege to follow the hon. Member for Central Ayrshire (Dr Whitford). In fact, I am beginning to question why we are not in the same party, because every time she speaks I find myself agreeing wholeheartedly with her on a variety of different issues.
The hon. Lady will not know that, in my maiden speech in 2010, to some colleagues’ surprise I spoke about the UK space industry. In fact, I was advised by some wise owls in these parts that I should not speak about the space industry, because I would be ridiculed as the spaceman of the House of Commons.
A year or so later, I secured an Adjournment debate in this Chamber, in which I discussed the rather esoteric subject of microgravity. During my speech, I spoke about the value of protein crystal investigation, the potential for doing a variety of biotechnological and medical experiments in space, and how that could advance our knowledge base. Major Tim Peake is doing all those experiments now. I like to think that that Adjournment debate led in part to the Government’s decision to invest in the European Space Agency’s European Programme for Life and Physical Sciences. That investment led to Tim Peake, whose field of expertise is microgravity, travelling on the rocket to the international space station.
The space industry has hardly any presence in my constituency, so why did I decide to talk about it in my maiden speech in 2010, and why did I subsequently take up the House’s time to talk about microgravity in an Adjournment debate? It was because, as the hon. Member for Central Ayrshire has already eloquently pointed out, there is something about space and the exploration thereof, particularly manned exploration and flights, that is truly inspirational to everybody. Whenever I visit schools during their science, technology, engineering and maths week, invariably I see pictures there of planets and rockets. There is something about space and the exploration of it that inspires young people. When engineers were asked why they had done an engineering degree at university, up to 40% of them said that they had done so because of the exploration of space and that their interest had first been stimulated by images from space.
I made my maiden speech in an Opposition day debate on industry. I thought it was important to talk about the space industry, not only because I think that the future of this great country is wedded to the success of science and technology and that that will increasingly become the case, but because the space industry is, in and of itself, so inspirational and such a great success that it needs as much support as possible from Governments, of whichever colour. The previous Labour Government did some very good work and UK space policy made some significant advances as a result. I hope and expect that this Government will follow suit.
When I made my maiden speech, the estimated size of the space industry was £6.8 billion, but the figure now is £11.6 billion. That increase has happened in five or six years. The space industry has grown so successfully during that time that we would struggle without the tangible value it provides.
I have been vice-chairman of the parliamentary space committee pretty much ever since I made my maiden speech, and I have often experienced pushback when I talk about the value of manned space flights. As the hon. Lady has said, there is a sense that somehow space is for others, not for Britain, that the exploration of space is very expensive and that we should be concentrating on other things. However, let us remember that for every dollar the US Government spent on the Apollo space programme, there was a remarkable $13 dollar return on their investment.
The returns were not just financial. In December 1968, a very famous photograph was taken by Bill Anders on Apollo 8—the so-called “Earthrise” photograph. The value of that photograph cannot be calculated in financial terms alone. Imagine where the environmental lobby would be if it did not have a photograph of the earth as seen from the moon. Imagine how those astronauts felt when they put up a hand and hid the earth with their thumb. Our perception of this wonderful planet was changed by that investment by the US Government. Of course, it was driven by a race with the Soviet Union, but the return was not just financial. We recognised the fragility of this planet and how fortunate we are.
I would argue that, in the process of the achievement of putting the first man on the moon in July 1969, man rediscovered the value of exploration. Now we face the next challenge, which is to place a person on the surface of Mars—perhaps it should be a woman. Increasingly, women are deployed in fighter jets because of their ability to withstand G-force, so perhaps it will be a woman who first stands on Mars. I think that Britain should be part of that. The cost may seem large, but we should consider it in proportion to the rest of the money we spend as a nation and, indeed, as a world. If we are not prepared to explore space, push back our boundaries of knowledge and discover things that we did not realise we were going to discover, then what on earth are we about as a species?
Space is an exciting subject and I cannot think of another subject that is so truly inspirational. British Governments, of whichever colour, should play a greater part in it and recognise that they have a role to play in mitigating risk and that private investment alone will not bring it about. If we do that, this country will have a very bright future indeed.
Patrick Grady (Glasgow North) (SNP)
I think this is the first time I have been called to speak in the Chamber without there being a formal time limit on speeches, but I will do my best not to go to infinity and beyond. I thank my co-sponsors of the motion, and the Backbench Business Committee for giving us the time to have this debate at relatively short notice. As my hon. Friend the Member for Central Ayrshire (Dr Whitford) has said, the debate has come at an opportune moment, the day before Major Tim Peake makes his spacewalk.
Adjournment debates secured by the hon. Member for Bracknell (Dr Lee) notwithstanding, I understand that this is the first time since a 2005 Westminster Hall debate that the House as a whole has considered space policy, so this debate is very timely indeed. It is great to hear that today’s important deliberations have been recognised by good wishes from Captain Kirk and Mr Sulu themselves. Indeed, our very own chief Trekkie, my right hon. Friend the Member for Gordon (Alex Salmond), who usually occupies the spot on which I am standing, has sent us his best wishes as well. On space issues, there is a close link between the inspiration provided by both science fiction and science fact. Perhaps I will come back to that later.
It is also appropriate to finish the week in which the English votes for English laws procedures were used for the first time by discussing matters about which there can be no question but that Scottish National party Members have a mandate to speak and vote on. Later today we will discuss the House of Lords, which is reserved. Schedule 5, part II, section L6 of the Scotland Act 1998 proudly and clearly reserves to the Parliament of the United Kingdom,
“Regulation of activities in outer space.”
If a Starman waiting in the sky read that, he might think it was quite a claim or question whether Parliament really has the power to regulate the infinite majesty of all creation, although I am sure some Members think that it does. However, the explanatory notes to the legislation make it clear that the reservation applies specifically to matters regulated by the Outer Space Act 1986.
The 1986 Act gave effect to a number of international treaties on the exploration and, for want of a better word, the exploitation—I will touch on that later—of outer space. The principles behind the treaties are hugely important, particularly those in the 1967 United Nations outer space treaty:
“The exploration and use of outer space…shall be carried out for the benefit and in the interests of all countries…and shall be the province of all mankind”,
and:
“Outer space, including the Moon and other celestial bodies, is not subject to national appropriation by claim of sovereignty, by means of use or occupation, or by any other means.”
My hon. Friend the Member for Central Ayrshire spoke powerfully about the role played throughout the cold war by the development of the international space station, which demonstrated that global co-operation was possible even at a time of significant political tension. The ISS has been described as the most complex international scientific and engineering project in history. It is the largest structure that humans have ever put into space. It can be seen on a clear night if not quite with the naked eye, except perhaps through the Prestwick hole, then certainly through binoculars or a home telescope. It was the result of collaboration between five different space agencies, representing 15 countries. It has been permanently occupied since 2 November 2000, or just over 15 years, which is a truly remarkable achievement.
It will be interesting to hear whether the Minister will recommit the Government to such principles of space law today. In particular, will he offer any reflections on the possible impact of recent legislation passed in the United States recognising the right of US citizens to own any resources they obtain from asteroids? A number of academics and observers have expressed concern about that, especially if other countries begin to follow suit. Indeed, Gbenga Oduntan, a senior lecturer in international commercial law at the University of Kent, has said that the US Space Act 2015 represents
“a full-frontal attack on settled principles of space law”,
and is
“nothing but a classic rendition of the ‘he who dares wins’ philosophy of the Wild West.”
Space should be for exploration, not for exploitation in any sense that excludes anyone from the benefits it can provide, or what the motion calls
“scientific, cultural and technological opportunities”.
In drafting the motion, we were very careful to list those aspects of space exploration and opportunity before mentioning the economic impact of the space industry. Indeed, UKspace, the trade association, has said that the Government must
“ensure its positioning maintains the balance between economic growth, excellent science and the inspiration of young people”.
As we have heard, we have certainly lived through an inspiring era of space exploration. In recent years, there has been huge interest in the Philae lander and the Rosetta mission, the evidence of water on Mars and the New Horizons fly-by of Pluto. I was particularly struck by NASA’s use of the “children will never know” hashtag when images were first beamed back from Pluto. The new generation of children will never know a day when they could not see images of Pluto in such great detail. Sadly, children born today will also never know the thrill of the space shuttle, which certainly inspired me when I was growing up. I remember watching the final launch of Atlantis back in 2011, and thinking about all the other things then going on in the world.
Patrick Grady
That is a fair point. It is important to recognise the huge achievement of all the astronauts of various heritages and from various parts of the United Kingdom. There is certainly no intention to play trumps.
Patrick Grady
A measurement of picos—[Laughter.] My hon. Friend may be able to enlighten us later, if she catches your eye, Madam Deputy Speaker.
Like any academic discipline, research in space science and technology costs money and requires certainty. I am happy to back calls from researchers for greater transparency in the relationship between the UK Space Agency and research councils on funding decisions. It would be useful to hear from the Minister how the Government are engaging with research departments at the cutting edge of this important technology. Much of this technology has an impact on our daily lives, especially in the west, where we rely on satellite technology for everything from weather forecasting to our mobile phones.
We have spoken of the inspiration that space exploration can provide, so it is important that Governments in the UK and Scotland continue to support science and technological education, as well as initiatives such as dark sky parks. In boasting of our satellite technology industries, we must also remain vigilant about the risk of space debris, as my hon. Friend the Member for Central Ayrshire mentioned. Too many of our oceans and geological ecosystems are poisoned by the unthinking results of attempts at technological progress, and the same must not be allowed to happen in near or outer space.
Those of us on social media will have seen the internet activity about NASA’s recruitment of a planetary defence officer recently. That is not as outlandish or as “outspacious” as it might sound. It is not simply about the risk of asteroids—I know that former Members who are no longer with us used to champion that issue—but about the risk of near-Earth objects too. If the satellites we put into space are not properly managed and regulated, there is a risk that they will crash into population centres.
Patrick Grady
That is a helpful contribution that demonstrates the point that we are making about the importance of the space industry, not only to the economy but to the greater collective good.
I spoke of the relation between science fiction and science fact. NASA recently collaborated successfully in the production of the movie, “The Martian”, which is about a man stranded on the planet after a mission goes wrong. It is based on a realistic understanding of the technologies and science that would be involved in a mission to the red planet.
I have spent the little free time I have had over the past 18 months reading through Kim Stanley Robinson’s Mars trilogy, which is rightly described as a “future history”. It was written in the 1990s with exceptional clarity and foresight. It was forensically researched, to the extent that after reading it for several hours, one can easily look out of the window and expect to see a Martian landscape unfolding. The trilogy is also a well-observed study of human societies and the possibilities open to mankind in building an economy and polity from scratch. There is much to commend in, and much to learn from, how science fiction authors have used the inspiration of space exploration to reflect on our current earthbound condition.
This is a valuable opportunity for debate, and I look forward to hearing further contributions from Members and a response from the Minister, particularly on the questions of ensuring the neutrality of and common access to space, support for education and science, the preservation of dark skies and the minimisation of space debris. We have talked about nationalities and laying claims. Scotland lays claim to one astronaut so far—Brian Binnie, who was brought up in Aberdeen and Stirling, and has test piloted a number of private space flights. Let us hope that the inspiration from the many space missions, which are growing in number, and not least Major Tim Peake’s, will encourage more young people to pursue careers in the sector and that, before long, we will see more astronauts from Scotland and across the UK who will have the opportunity to contribute to the good of humanity, to explore strange new worlds and, if Hansard will allow a split infinitive, to boldly go where no one has gone before.
Dr Lee
I do not know whether the hon. Gentleman remembers this, but he was one of the few Members of the House who attended my Adjournment debate on microgravity. Prior to that I had been contacted primarily from America by Boeing and various other companies on the subject. They pointed out that the microgravity research industry had a potential $100 billion of growth. The hon. Gentleman is right to point out the future potential for the space industry.
Jim Shannon
I do remember that. It was one of those Adjournment debates that I am known to attend, and I remember intervening along those lines. It was three or four years ago.
Something else that I enjoyed, and that I think was positive, took place last week when Tim Peake was able to make radio contact with young people in a school. The inspiration that that gave to those young people was fantastic, as was the fact that it happened. Those young people were inspired, and they had a photograph and a TV show that showed him in their school making direct contact. I know it was a bit rehearsed, but it was exciting for us to watch. How much more exciting must it have been for the children, both male and female, to have that ambition and inspirational drive to try to be the next Tim Peake in space? As we seek to obtain secure jobs for the future, we need more such encouraging developments, and this has been a welcome opportunity to contribute to a debate on an issue of great importance to the future of our country and its economy.
In conclusion, the new national space policy, the Deregulation Act, and the space innovation and growth strategy are all signs that we are heading in the right direction. The positivity that comes through this debate will be noted not just in this Chamber by MPs, but outside the House and further afield. We can play our part in space travel and policy in future, and I hope that off the back of this debate we can maintain momentum and ensure that those plans turn into real delivery for the “better together” space industry and future economy of the United Kingdom of Great Britain and Northern Ireland.
Mental Health
Phillip Lee Excerpts(8 years, 11 months ago)
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Dr Phillip Lee (Bracknell) (Con)
I congratulate colleagues on their contributions and welcome familiar faces from past mental health debates.
This is obviously a massive subject, and it is impossible to cover it in three minutes. I am struck by the number of different specialties and different problems within mental health that have already been touched on, be it addiction, dementia, depression, stress-related illness, or eating disorders in the young—the list goes on and on. Sadly, all these things are increasing in frequency. Next week and over Christmas, I will be working as a doctor, and I can guarantee that I will be seeing people with mental health problems during that period. We have talked a lot about service provision; in fact, I think that every contribution so far has dealt with that.
We might want to reflect on our society and ask ourselves the difficult questions as to why we are seeing an increase in depression, stress-related illness, eating disorders and the like. I would say that it reflects what is sick in our society. There are the drivers towards excess consumption that we can afford neither financially nor physically. There is the breakdown of the family, with people not taking their parental responsibilities as seriously as they should on every occasion. There is the retreat of the Church, to be replaced by what, exactly? I am not sure that anything has come forward to replace the Church in providing from within communities, and not necessarily from Government, a community hub and support for people in distress. We should all reflect on that. We should spend a few weeks or a few months thinking about it, and ask ourselves how we can pass legislation here, how we can perhaps lead different lives as role models, and how we can encourage people to seek a life that is better in terms of the quality of life and also physical and mental health.
I want to mention something specifically with regard to forensic psychiatry. My constituency is proud to host the pre-eminent high-security hospital, Broadmoor. Broadmoor hospital is widely renowned internationally. It is being redeveloped over the next few years. This redevelopment was based on a Care Quality Commission report commissioned under the previous Labour Government, and the decision was made by the coalition Government. It provides £250 million for 210 to 220 new beds and is designed around new clinical models. Broadmoor is not a prison, but if its recidivism rate was replicated across the prison service, we would all be extremely happy. Its 420 nurses and 12 consultants do remarkably good work. It is challenging work dealing with some very difficult cases—the type of cases we see in our newspapers. I am very proud that that hospital is based in my constituency, and I am particularly proud of a society that places such emphasis on treating people as patients, not as criminals.
Access to Medical Treatments (Innovation) Bill (Money)
Phillip Lee Excerpts(9 years ago)
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Chris Heaton-Harris (Daventry) (Con)
I thank the Government for introducing, as is the convention of this place, the money resolution on my private Member’s Bill.
Several colleagues have expressed their concerns about the Bill, as the Opposition spokesman has just done. I must say to them, and to the Association of Medical Research Charities and other bodies, that many of the briefings seem to relate to the previous iteration of the Saatchi Bill that went through three Readings in the other place and have not been changed for this Bill, even though this Bill is massively different from that brought forward by Lord Saatchi in the House of Lords.
The Bill has two elements. It proposes that a database of innovation be established for only registered medical practitioners to use when they innovate or depart from standard medical practice. As we have already heard, doctors and surgeons say that they regularly innovate.
Dr Phillip Lee (Bracknell) (Con)
I would never question my hon. Friend’s intentions in this area, but the AMRC’s summary states:
“we do not see the need for this legislation and do not believe the Bill will achieve its aim of encouraging medical innovation.”
It goes on to say that
“this Bill…as it stands is unnecessary and may adversely impact on patients and medical research”.
That view is supported, among others, by Cancer Research UK, the British Heart Foundation and the Wellcome Trust. Does that not give him pause for thought before he proceeds with the Bill?
Chris Heaton-Harris
Yes, it does. I have talked to those organisations constantly from the conception of the idea of stealing these two ideas from the Saatchi Bill, and I will continue to talk to every organisation that wishes to talk to me about the Bill. If that was a bid to be on the Bill Committee to offer an alternative view and help me pick through the details of the legislation to ensure that it does what I intend it to do, I welcome my hon. Friend’s approach because a couple of people who would have added great value to the process and the Bill are not able to sit on the Committee.
I gave the example on Second Reading of a surgeon who had innovated and saved the life of his patient, but who was unable quickly to communicate that to his peers as there was no comprehensive means of doing so. The database has been called for by many of the medical colleges, as is acknowledged in the briefings that my hon. Friend will have read. The database is important in spreading the best innovations, because it will include not just the successes of any innovation, but its failures. That will allow best practice to spread quickly and for other registered medical practitioners to learn from any innovation. It will not be available for patients to access and will be held by the Health and Social Care Information Centre, as we have just heard, which is where the money resolution directs the money towards.
The database will not cover research and will not hamper recruitment to clinical trials. Nothing in the Bill will allow doctors to bypass any process or requirement that has been set by their trust in relation to undertaking innovative treatments in the NHS, including the requirement to ensure that commissioners will fund any treatment that is not provided by the NHS. As we all know, individual innovation is incredibly important, but it is not a suitable substitute for medical research, which usually tests the efficacy of treatments in a systematic way. I hope that successful innovations will lead to systematic research projects as the evidence builds around a particular specialty and that they will thereby encourage more clinical trials.
The second part of the Bill, which I fully acknowledge is much more controversial, will give registered medical practitioners a supplementary method of demonstrating that they have acted responsibly while innovating. It closely mirrors the existing legal test, the Bolam test, that is used when clinical negligence proceedings reach the court stage. It brings the test forward and enables doctors to use it to demonstrate that they have acted responsibly before they enter the courtroom. It does not change the common law.
Jimmy Savile (NHS Investigations)
Phillip Lee Excerpts(9 years, 8 months ago)
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Mr Hunt
Of course it is important that we learn the governance lessons, but the report is careful. It does not use the word “improper” in relation to the behaviour of Ministers or civil servants. It says that they acted reasonably. It raises some important questions, and I hope that the tone of my statement will reassure my hon. Friend that I do not seek to duck the fact that there are clearly questions about whether Ministers and civil servants behaved in the appropriate way. It is important that we learn the lessons from what went wrong.
Dr Phillip Lee (Bracknell) (Con)
I represent the constituency that is home to Broadmoor hospital, and I worked at Stoke Mandeville for two years in the early part of this century, so I have taken a deep personal interest in the investigation. I find it difficult to comprehend or accept that senior managers and clinicians were not aware of the allegations. I can find no mention in the Stoke Mandeville report of any clinician by name as yet. Can the Secretary of State assure me that looking to the future, named individuals will be given the responsibility to prevent this from happening, and if they fail there will be an impact on them, their career, their pension and the like?
Mr Hunt
The report clearly says that every trust must have a named director who is responsible for safeguarding. One can draw one’s own conclusions about whether senior management knew or not. The report was unable to find evidence that that was the case, but nor did it say that it was not the case. One comes away with the clear suspicion that senior management may not have wanted to hear the things that they were being told because of Savile’s importance in fund raising and possibly his celebrity status. That is what we must make sure never happens again.
Pancreatic Cancer
Phillip Lee Excerpts(10 years, 2 months ago)
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Nic Dakin
My right hon. Friend is absolutely right that the nub of the issue is how to get early diagnosis—the difficult-to-achieve holy grail.
In evidence to the all-party group a week after celebrating six years of survival, pancreatic cancer survivor Ali Stunt said:
“We need to focus on early diagnosis… Those of us who are diagnosed in time for surgery, which is what we want to achieve, have a tenfold increase in the chance of surviving five years… I was lucky. I was told that surgery was an option and that my operation would be booked in for a week’s time. I was told I needed chemotherapy and a week later was in my consultant oncologist’s office. I told him that I wanted to live to see my boys graduate. Following combination chemotherapy for 6 months and then chemo-radiotherapy, my scans were clear. Regular check-ups followed with scans and blood tests—all of which revealed ‘no evidence of disease’. My oncologist finally ‘signed me off’ in April 2013.
This is a story not often heard when pancreatic cancer is involved. These past 4 years since I founded Pancreatic Cancer Action I have met and got to know some fabulous people who have bravely fought and helped me raise awareness of this cruel disease. Not many of them are still alive, but all will have a special place in my heart. It is and always will be my mission to get more people diagnosed sooner—so more can have the same outcome as me.”
I first became aware of pancreatic cancer many years ago when my friend and colleague Martin Newbould became ill with it. Martin was an inspirational individual, a wonderful family man and an outstanding head of maths. More recently, my witty local newsagent Mick Emerson retired only to be diagnosed with pancreatic cancer soon after and then pass away. My friend Sir John Mason passed away just before the summer after a dignified battle against the disease, leaving a massive legacy of good work in the community. Having been ill for some time with an undiagnosed condition, John’s pancreatic cancer was, I understand, finally diagnosed after an emergency admission at Scunthorpe hospital’s A and E.
Currently, a staggering 48% of pancreatic cancer diagnoses are made by emergency admission, which is more than twice the total for other forms of cancer. That is important, as presentation via emergency admission is normally when the disease is more advanced and associated with much poorer survival rates than other routes to diagnosis. For example, one-year survival for patients presenting via emergency admission is just 9%, as opposed to 26% for those diagnosed as a result of GP referral. Over 40% of pancreatic cancer patients visit their GPs three times or more before even being referred to hospital. Some 16% have to visit their GP or hospital seven times or more before the correct diagnosis is made. By comparison, figures show that 75% of all cancer patients combined are referred to hospital after only one or two visits to their GPs.
Such data are only recently known as a result of the National Cancer Intelligence Network’s impressive work. It shows the power of data in helping us to tackle this disease. Further improvements in the collection and application of real-time data have the potential to transform medical practice in this area. Evidence given to the all-party group last week suggests that establishing a tool to collect patient data online would not be difficult to achieve. Such a robust IT system would radically improve data collection. Patients support their data being used for analysis and expect their data to be used to improve care for everyone else. London Cancer’s Dr Millar recommended that patient data be made freely available for use, within the law, for research in return for the free health care received under the NHS. Linking more GP data with that already received through secondary care and the research lab will help to improve early diagnosis in terms of the amount of data that can be analysed.
One issue highlighted throughout the all-party group’s inquiry was the disconnect between primary and secondary specialist care in achieving timely, effective treatment. Pancreatic cancer patients are not transferred quickly enough from primary to secondary care when time is of the essence if better outcomes are to be achieved. Most European countries do not have the same GP gateway as the UK; patients can see a specialist more quickly and clinical outcomes are better. One consultant surgeon and surgical oncologist told us:
“The patient turns up and the chap says, ‘Well it’s not reflux and I’m a reflux doctor. Back to your GP.’ So he goes back to the GP—more delay is coming. The GP says, ‘Well it isn’t reflux. Maybe now he has some back pain or something. We’ll try the spine doctor.’ So he goes to the spine surgeon. The spine surgeon says, ‘Well, it’s not spine pain. Back to your GP.’ This is the common scenario. The patient becomes a tennis ball.”
To get around this investigative ping-pong, it is worth seriously considering whether to allow GPs direct, easier access to CT scans, which would be much more likely to rule cancer in or out at an earlier stage than other investigative measures. One experienced GP told us:
“I think it’s about getting the right test, for the right patient, at the right time. Presently a hospital doctor who has had—no disrespect to my colleagues—two years’ medical experience can request a CT scan for a patient in hospital where I can’t.”
There is recognition that allowing GPs to refer patients directly for CT scans could accelerate diagnosis, but there is understandable concern about how it might work in practice.
Dr Phillip Lee (Bracknell) (Con)
Mr and Mrs Stella, constituents of mine who tragically lost their son Robert aged just 26, are sitting in the Public Gallery. I am a working doctor and fully understand how difficult it is to diagnose pancreatic cancer early because of the non-specificity of the symptoms. However, the solution might be in research. GPs require a test and to be able press a button and diagnose something from within the primary care setting. As the hon. Gentleman rightly points out, obtaining tests from primary care is difficult. Does he agree that once we have found such tests, which will come with time, primary care is where funding should be placed, so that earlier diagnosis is more achievable? Pancreatic cancer can be beaten, but to beat it we must diagnose it early.
Nic Dakin
I absolutely agree that the need is to find the tests and to have the wherewithal to allow them to take place.
I want to ask the Minister a few specific questions that she may pick up on in her response. Will the Government put in place pilots across the UK to experiment with direct GP referrals for CT scans to see how that might work and what impact it has on what actually happens—the positives and the negatives—so that we can learn from the experience? What actions can she take to boost awareness of pancreatic cancer signs and symptoms among GPs, to which the hon. Member for Birmingham, Yardley (John Hemming) referred earlier? Will the Department of Health consider pump-priming research into more recalcitrant cancers, such as pancreatic cancer, with ring-fenced grants where sustainable research has yet to be reached? As pancreatic cancer survival rates remain stubbornly low, will the Minister consider running specific awareness campaigns for the public through appropriate media?
The petition and this debate will have helped to raise pancreatic cancer up everyone’s agenda. I pay tribute to how Julie Hesmondhalgh—Hayley Cropper in “Coronation Street”—has helped to raise awareness of pancreatic cancer. I understand that she has been nominated for the best soap actress award at the TV Choice awards tonight. We wish her luck with that, because it will move pancreatic cancer yet further up the agenda. It is good to have her here today as part of the campaign. Julie points out:
“What the Coronation Street storyline did for pancreatic cancer awareness is phenomenal, but much more attention and funding is required. I worked with Maggie, along with many motivated people affected by pancreatic cancer and the charities Pancreatic Cancer Action and Pancreatic Cancer UK, to push the petition to the 100,000 signature milestone. This cancer desperately needs to be in the spotlight.”
She is absolutely right. The spotlight shines on it today. We need to seize this opportunity, this moment, this petition, this debate to up our game. Another 40 years cannot pass by without change. We need to set our stall out to make the same progress that we have made in prostate, breast and bowel cancer in the past 40 years for pancreatic cancer in the next 40 years. Nothing less is satisfactory. It is, as our parliamentary inquiry says, time to change the story.
Eric Ollerenshaw
I am grateful for that intervention, particularly as I will go on to mention the Recalcitrant Cancer Research Act—as usual, my hon. Friend has got in before me. He is on exactly the right lines in terms of what we are all thinking.
I have talked about good news and extra money. However, I am not sure whether that goes quite far enough. There is still no ring-fencing per se of money for research into pancreatic cancer, brain tumours and so on. Instead, applications will still have to be made for funding. They will be peer-reviewed and selected from similar applications for research into other cancer types.
The issue is that the reason given by Cancer Research UK for not awarding more funding for pancreatic cancer in the past has been that not enough quality applications have been received, so the doubling or trebling of funding set out in the strategy will happen only if more applications are made. For that to happen, we need more researchers in the field, whether established and respected researchers coming over from abroad, such as Professor Andrew Biankin from Australia, who has recently relocated to Glasgow—as usual, Scotland sets the trend—to carry on his pioneering work there, or new, young researchers starting out in their careers.
We are currently in a Catch-22 situation, however: new researchers do not generally want to enter the field, partly because it is deemed difficult to make advances in it—that puts them off as they fear it will hold back their careers, as the Department of Health’s written response to the e-petition mentioned—and partly because the funding is not there. But the funding is not there because not enough research applications are being made.
I firmly believe that we need to break that vicious circle and to pump-prime research into pancreatic cancer, making sure that we hit the minimum funding level required to gain critical mass. I also firmly believe that the Government can and should play a role in that.
Dr Phillip Lee
I have long lamented the fact that celebrity endorsements seem to increase the funding of research into particular illnesses and conditions disproportionately in terms of the impact that those conditions and illnesses are having on broader society. Does my hon. Friend agree that the Government might want to take into account the funding that certain conditions receive from private sources because they are deemed fashionable, so that greater Government funding can be given to those conditions that are seemingly less fashionable?
Eric Ollerenshaw
My hon. Friend makes an important point. It is difficult for Ministers and boards to make decisions about what is or is not fashionable. Nothing we are trying to do, in getting pancreatic cancer higher up the agenda, is aimed at taking away from the advances being made for other cancers. We all welcome those. We simply want fairer funding ourselves, and some recognition of the impact of this particular cancer. We are not asking to take away from anything else, but unfortunately we are asking the Minister for something extra.
I come now to the Recalcitrant Cancer Research Act, which my hon. Friend the Member for Peterborough (Mr Jackson) mentioned. It was passed in 2012 in the United States, and requires the director of the US National Cancer Institute to prepare a special strategy for recalcitrant cancers in the US. A recalcitrant cancer is defined as a cancer type with a five-year survival rate of less than 20% that kills more than 30,000 US citizens a year.
The result of the Act has been more focus on pancreatic and lung cancer research in the US, as well as a welcome increased focus on and awareness of those cancer types more generally. I would like the Minister to consider whether the British Government need to produce their own recalcitrant cancer research strategy, commissioned and produced either by the Department of Health or the National Institute for Health Research. Such a strategy should focus not just on pancreatic cancer but on other cancers of unmet need—those with low survival rates.
If a British strategy were to use the US definition of “recalcitrant”, it would cover pancreatic cancer, which has a survival rate of just under 4%; lung cancer, for which it is 10%; oesophageal cancer, for which it is 15%; brain tumours, for which it is 19%; and stomach cancer, for which it is 19%. That would help to give a focus.
NHS Investigations (Jimmy Savile)
Phillip Lee Excerpts(10 years, 4 months ago)
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Mr Hunt
I know that the hon. Gentleman has campaigned a lot on these issues. We have not ruled out anything, but we want first to draw together the lessons for the NHS and across Government as quickly as possible. One of the important benefits of the way in which we have proceeded so far is that, because it is an investigation and not a public inquiry, we can get to the truth relatively quickly. However, we will certainly look at the cross-governmental lessons.
Dr Phillip Lee (Bracknell) (Con)
As a former member of the medical staff at Stoke Mandeville hospital and now as the Member representing Broadmoor hospital, I have many questions, but let me concentrate on one. In appendix 2A part V, there is a letter about Broadmoor from Jimmy Savile to the Department of Health. It is headed “National Spinal Injuries Centre at Stoke Mandeville”, and it is signed “Dr Jimmy Savile”. Indeed, the content of the letter is deeply unprofessional and remarkable, and it was copied on to a series of people, including the then Secretary of State. Will my right hon. Friend assure me that each of these individuals has been investigated in respect of their response to this correspondence, as I cannot believe that people could have received it without being deeply concerned about this vile man’s involvement in a high-security hospital?
Oral Answers to Questions
Phillip Lee Excerpts(10 years, 5 months ago)
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Norman Lamb
I agree, and that is why NHS England undertook the work to analyse exactly what the position is across the country. In fact it is very varied. There are some regions where it is fine, and others where it is not acceptable. I think we would all agree that it is completely unacceptable for children to be sent sometimes hundreds of miles away from home. When it publishes its report, it—[Interruption.] If the right hon. Member for Leigh (Andy Burnham) would just listen, when it publishes its report, it will be publishing an action plan of the steps it will take very soon to meet any shortfalls in provision.
Dr Phillip Lee (Bracknell) (Con)
Although I supported the Health and Social Care Bill at every stage, I have always harboured some concerns about the ability of GPs to commission mental health services. Mental health is a fast-growing problem and a challenge to the NHS for the future. What assurances can the Minister give me that GPs will receive the appropriate specialist guidance, if required?
Norman Lamb
I thank my hon. Friend for that question, and it is a legitimate one. A lot of work is being undertaken by NHS England and the national clinical director Geraldine Strathdee, a highly regarded individual, to strengthen the quality of commissioning of mental health services. It falls short in many areas at the moment and it is essential that it is improved.
Health
Phillip Lee Excerpts(10 years, 5 months ago)
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Dr Phillip Lee (Bracknell) (Con)
I shall take this opportunity in what is nominally the health debate on the Queen’s Speech to speak more broadly about the national health service. I welcome the fact that there is not much in the Queen’s Speech on health policy, because what we have done already under this Government needs to bed down.
I have always tried to build cross-party consensus in the Chamber. At no point have I sought to make any party political points in relation to health care, primarily because, as a clinician who still practises in the health service and who has an extensive network of friends from medical school who are all approaching consultancy, I have been aware of the challenges that the NHS faces and have therefore always believed that there needs to be an understanding across the Benches for us to find the appropriate solutions.
We need to get a grip of the NHS challenges that we face. Significant changes are afoot in our society—changes in attitude and behaviour, and patients’ expectations change as each generation passes away. A stoic wartime generation is being replaced by arguably much softer ones. Their experience of pain and their approach to suffering are different, in my clinical experience. Each generation is becoming more and more obese. As I have already said, the society we live in is ageing. There have been some poignant contributions to this debate. That is fine and I share the concerns, but let us not kid ourselves: more than 20% of the population is now aged over 60. The proportion of people paying tax compared with the proportion of people who have retired is diminishing. We cannot lose sight of that reality, and we need to recognise that change is inevitable.
There are some welcome advances in medicine—in drugs, technology and the application of that technology to the care of patients—but these have invariably been expensive. The National Institute for Health and Care Excellence does a pretty good job of the cost-benefit analysis, but we are now saying no to drugs that enhance people’s lives. We need to reflect on that.
The NHS was introduced in 1948 by Nye Bevan, who represented a constituency that I sought and, funnily enough, failed to take in 2005. At that time, the budget was £437 million, the equivalent of £9 billion in current money. We are approaching or may have touched above £110 billion per year. He said that there would be an initial expense when he introduced the service and that costs would then fall as the population became healthier. I am sorry—Mr Bevan might have been right to introduce the service, but he was wrong in thinking that the costs of that service would diminish with time. Clearly, they have not.
What is there to do? I would say there are four things. First, we need to find a way of reducing demand on the services. This morning I attended an induction as I am about to start working at an urgent care centre in my constituency. It was striking to note who was coming through the door. The demand is great and it is growing, and we need to deal with it.
Secondly, we must improve the physical structures in the system. Our hospitals are 19th and 20th-century buildings and we are trying, and at times failing, to deliver 21st-century care in those environments. We need to improve them and to do it fast. In order to secure an appropriate plan for our nation, I suggest that we need some sort of cross-party committee and cross-party understanding of where those acute hospitals will be in the future. We will have fewer of them, but we will have more community-based hospitals delivering chronic care. Let us not forget that over 80% of the NHS budget is now spent on chronic care. We need to make sure that that care is delivered closer to patients’ homes.
In the future we will have telemedicine, which will deliver care in patients’ homes. This is the reality. It is already being piloted in Scotland, with some very good outcomes.
Dr Lee
We need to recognise that, but with that will come changes in hospital infrastructure and, yes, extremely difficult politics. We have heard about the difficult politics in south-west London, west London and elsewhere. That will be replicated irrespective of who wins next year’s election. The problem is here and now and we need to deal with it. All parties should put skin in the game and make a decision on where those hospitals should be.
The third element is funding. This is the most emotive topic to discuss. Colleagues on the Labour Benches have proposed co-payments. From those on the Government Benches, there have been suggestions of health accounts and supplementary insurance schemes. There is a plethora of ways of funding health care—one only has to look abroad. In Norway people pay to see their GP; in Denmark they pay for their drugs at cost; in Germany there are supplementary insurance schemes; in France there are means tests, and the list goes on.
I have not 100% decided what I think would be the right thing in future in this country, but the debate is needed. I cannot see how we can go above 10% of GDP on health care spending and balance the books across the whole of Government. Perhaps there are people who think we should spend north of 10% on that—fine—and approaching almost 20% on welfare if we include pensions. We are approaching £1 billion a day expenditure on these two areas. I do not think that is sustainable, but I know that if it is to change we need a cross-party debate on the matter. It is not easy.
Finally, the political cycle does not help. We have heard how it helped the hon. Member for Burnley (Gordon Birtwistle) get elected at the last election, and I am sure this will be replicated on both sides of the House in future. There is no avoiding it. I have walked the walk in my constituency: I stood at the last election calling for the closure of my local hospital, because I know that if we consolidate services in my region, we get better outcomes. People live who otherwise would not live. People suffer less. I did not think it was appropriate for a clinician who had worked in the region in which he was seeking to represent a constituency to say otherwise. I thought it appropriate that I stood on that. I continue to stand on it and I continue to stand for the consolidation of acute services in my region and for chronic care to be offered locally to people.
In conclusion, this country is very privileged to inherit a health care system that is pretty good. It is approaching first class by global standards, but it is a legacy that we must protect. Our grandparents have given it to us and we need to protect it in future, which means that we need to be open-minded about the changes required. I think the solutions will come from more than one political party and more than one expert group, but the time is now and we all need to work together.