Epilepsy Services

Priti Patel Excerpts

Tuesday 12th October 2010 Westminster Hall

[Priti Patel (Witham) (Con)]

I pay tribute to my hon. Friend the Member for Blackpool North and Cleveleys (Paul Maynard) for securing this debate, and for his tremendous personal account of the condition of epilepsy, and how it has impacted on his life and his journey to Westminster and becoming a Member. I thank my hon. Friend the Member for South Thanet (Laura Sandys) for being frank and for providing powerful insights into the work and role of general practitioners in her constituency. Clearly, they are making a difference.

My contribution to this debate is about the structure of the NHS, especially in the light of the fact that significant and welcome Government reforms are coming soon. In Witham, the number of administrators and bureaucrats in the local primary care trust—Mid Essex PCT—has increased fourfold in the past 10 years. In this debate, we are talking about general practitioners, commissioning, the postcode lottery in terms of services, nurses, access to care, real care provision on site and the ability to deal with epilepsy. I am sure that the Minister agrees that epilepsy services could be served so much better by getting rid of a lot of the waste and bureaucracy. This is an opportunity to redirect the resources to ensure that epilepsy is given the right kind of local care provision and to ensure that GPs who are commissioning services are dedicated the right kind of resources and professional expertise that are so desperately needed out there.

One of my constituents is here listening to the debate. It is self-evident, from looking at my local PCT, that provision is hit and miss. It comes back to data, which we have heard a great deal about this morning. There is not enough data out there. I struggle with that notion when I hear locally about the bureaucracy in my PCT, which has been so vast that one wonders what it has been doing to secure data in the past decade. I plead with the Minister to ensure that all the resources out there are redirected to the right purposes to serve local epilepsy sufferers in the right way.

My hon. Friend the Member for South Thanet mentioned stigma, but I should like to talk about quality of life and referrals to specialists. I have heard from my constituent who is here this morning about how epilepsy can prevent people from getting back into work. In respect of anybody who is up and able and wants to be an active citizen and contribute to their local economy, or even make a difference in some service, it seems self-evident that we desperately need local services and agencies working together to break down the barriers of stigma; to work constructively to enhance the quality of life of epilepsy sufferers; and to be more accommodating and understanding of the needs of people going into the workplace, without being patronising, enabling them and supporting them perhaps even to develop careers in the field or profession in which they choose to work.

The Government have an opportunity to consider generic substitution in the round, without coming to any rash conclusions. We are talking about savings, in this era of the comprehensive spending review, but this is about understanding that epilepsy is a subjective condition that affects individuals differently, not about a one-size-fits-all approach in respect of the drugs and prescribing regimes. This is a plea to the Minister to ensure that the right decision is made on behalf of sufferers.

--- Later in debate ---

[Paul Burstow]

I am grateful to the hon. Lady for raising that point. In the proposed quality and outcomes framework for 2011-12, NICE has recommended a new indicator to encourage more GPs to talk to women with epilepsy about the drug risk during pregnancy. I hope that that will focus on the point that the hon. Lady has rightly raised.

Patients should be able to check up on local services right down to the performance of individual consultant teams, so that they can, if necessary, vote with their feet. That not only gives patients more control, but it exerts pressure on different parts of the NHS to make continuous improvements. On a professional level, it is important to ensure that there is better recording and sharing of information about services.

My hon. Friend the Member for Southport and the hon. Member for Pontypridd (Owen Smith) talked about the lack of information about neurological services at local level. I can tell them that the Department has developed a reference data set for local commissioners to use. That will give them a standard set of information to request from local providers about the different stages of care for someone with a neurological condition. Reference has been made to a dearth of data. I can tell hon. Members that there are data relating to the primary reasons for hospital admissions, readmission rates, average lengths of stay, out-patients, first to review rates and programme spend for neurology through the payment by result rates. All that information is on NHS Comparators, which is part of the NHS website. It is an online tool that presents all that information in a way that is accessible not just to professionals, but to the third sector. One of the challenges that I pose to hon. Members and to organisations with an interest in this field is to make more use of NHS Comparators, because it is a valuable tool for challenging commissioners and holding them to account and for ensuring that there is competitive localism—a real sense of comparing one area to another to ensure that we drive up standards and learn from the best.

[Priti Patel]

We have heard in the debate that epilepsy is a very subjective condition—it affects people in many different ways. We have also heard about the data challenges, and the Minister has kindly given us some insight into what comparators are out there. The fact is, though, that if someone is a sufferer, is on their own and is in desperate need of care and access to information, hearing about data comparisons is not necessarily of practical help. What practical measures exist for sufferers and for organisations that can give genuine support and guidance to epilepsy sufferers?

[Paul Burstow]

The hon. Lady makes a very important point. I was talking about using the data to improve standards, but we also need to ensure that, through NHS information prescriptions, we provide better and more timely information to people. Further work is also necessary in that area.

A message that comes through strongly is that commissioning is key to better epilepsy care. We believe that placing decision making much closer to the patient through general practice consortiums will unlock new opportunities and lead to more sensitive and responsive decision making about care and treatment pathways. Some patient groups and some hon. Members in this debate have expressed concern about the experience and knowledge of GP commissioners in designing epilepsy services. Let me say a little more about that.

The NHS commissioning board will have a vital role to play in supporting consortiums. It will set commissioning guidelines based on clinically approved standards developed by the National Institute for Health and Clinical Excellence. In addition, the long-term conditions delivery support team will work closely with new directors of commissioning, their commissioning boards and GP consortiums to build skills and awareness. For example, the team has already developed a new commissioning pack, bringing together information that commissioners will need to design good epilepsy services.

My hon. Friend the Member for Southport has asked me, within about four days of the close of consultation on the White Paper, to describe in full and complete detail every aspect of the new accountability regime for the new system. I will not do that in the debate today, because that would not do justice to the 5,000 respondents to the consultation. The Department is in the process of properly considering the responses to the consultation and we shall give a considered and proper response. What we have done so far is set out clearly the direction of travel and reform. I think that my hon. Friend has conflated two or three things in his test of accountability: professional accountability, accountability to the public and accountability to other organisations. We will make clear, when we set out the next steps to the reforms that we have proposed in the White Paper, precisely how each part of the accountability conundrum that he posed is properly addressed.