Oral Answers to Questions

Rachel Maclean Excerpts

Tuesday 26th March 2019 Commons Chamber

[Matt Hancock]

We are having constructive discussions—I am delighted that finally Vertex has agreed to participate in them; the parties have committed to providing the data needed for an objective assessment of the drugs in question, and I look forward to the discussions proceeding effectively.

[Rachel Maclean (Redditch) (Con)]

A constituent of mine came to see me in my surgery. He had been born with cystic fibrosis and told me what a transformative effect the drug had had on him. He was lucky enough to be accepted on the trial, but he says we need to raise awareness because millions of people are not getting the drug. What response can the Secretary of State give to him and fellow sufferers?

[Matt Hancock]

My hon. Friend’s constituent is absolutely right about raising awareness of the issue and the need for these drugs. I know the impact that cystic fibrosis can have on people and of the hope that these drugs will save lives. We have made a significant offer to the pharmaceutical company, Vertex, to allow these drugs to be provided in the UK, and I very much hope we can come to an agreement.

NHS Menopause Services

Rachel Maclean Excerpts

Wednesday 13th February 2019 Commons Chamber

[Rachel Maclean (Redditch) (Con)]

I thank the Members who have stayed behind for this important debate.

Every woman will experience the menopause at some stage in her life. When she does, she will embark on a journey that will throw up some of the most pernicious taboos that still exist in our society. The toxic combination of ageism and sexism that exist around the menopause, piled on top of the often debilitating symptoms, can cause mental health problems, relationship difficulties, problems at work, anxiety and depression, and much more. While menopause is a natural stage of life and ought to herald new freedoms and opportunities, for too many, it turns out to be the opposite. I know this from the menopause work that I have been doing in my constituency, including a Menopause Café, where we get together to drink tea and coffee, eat cake and talk about the menopause.

[Eddie Hughes (Walsall North) (Con)]

To speak from my own perspective, I organised a Menopause Café in my constituency in the Stan Ball Centre, and I was delighted to see a number of women from right across the constituency. Quite a broad range of age groups came to that event, so I will be arranging more in future.

[Rachel Maclean]

I thank my hon. Friend so much, both for his work locally and for supporting me in this work in the Chamber and the House. He is an absolutely fantastic campaigner for the menopause and for women.

Psychologically, none of us likes to be reminded that we are growing old. For women, however, the menopause provides irrefutable evidence that our biological clock has ticked. While men can, and do, continue to reproduce into their old age, we cannot. With that loss, we face a grieving process. Our species has evolved to reproduce itself, and women’s bodies have evolved to carry out childbirth and child-rearing. Aeons of our cultural norms have been built upon that basic and irrefutable fact. Despite advances in all areas of medicine, I do not see men being able to conceive children or breastfeed any time soon, so the loss of those capabilities comes weighted with deep-seated and unexpected emotions. At the same time that we are attempting to grapple with those emotions, we find ourselves beset with a huge laundry list of symptoms and facing at best, indifference and ignorance, and at worst, downright hostility, mockery and discrimination while we attempt to help ourselves.

[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Lady on securing the debate. Like the hon. Member for Walsall North (Eddie Hughes), I have much interest in this, not only because it involves health issues that I am responsible for, but because sometimes things are pretty close to home. Does the hon. Lady not agree that the support that is needed for women who are going through tremendous changes in their bodies is not readily and sustainably available at GP surgeries, and that funding needs to be allocated to support groups, like the ones that the hon. Lady and the hon. Gentleman referred to, to ensure that the mental and physical health of ladies going through the menopause is readily available? That is very important.

--- Later in debate ---

[Rachel Maclean]

I thank the hon. Gentleman very much for making that valid point. I will talk about some of those issues, and he makes the really good point that these issues also affects men who are living with women as they go through the menopause.

I became a campaigner for the menopause by accident. For me, the start of the menopause came as I took my seat in this place. I attributed the almost constant migraines, the exhaustion, stress, insomnia, and the more than usual irritation with my ever-stoic husband, down to the new job, and the fact that my parliamentary accommodation was just over the bridge from Big Ben. I was probably the only Member to rejoice when Big Ben ceased to chime all through the night, because believe me, I heard every single bong.

It was only when I started to seek treatment for the unbearable migraines that I discovered the link with the menopause, and I started on a process that led me to understand that, very sadly, I was far from alone. I hesitated before speaking out about this personal issue, because I feared that in this place I would be regarded negatively by some colleagues or gain an unwarranted stigma attached to me as a menopause campaigner. However, when I realised how many women are affected by this issue and how many fail to get the help they need, I realised that it fell to me to speak out—to speak for people who cannot be here. And if I did not do it, who would?

I am pleased to say that this campaign, as we have just seen, has been universally welcomed by Members from across this House, including in particular, my hon. Friend the Member for Walsall North (Eddie Hughes), my hon. Friend the Member for Banbury (Victoria Prentis), who has just left the Chamber, my hon. Friends the Members for North West Cambridgeshire (Mr Vara) and for Selby and Ainsty (Nigel Adams), and the hon. Member for East Lothian (Martin Whitfield).

Outside our four walls, this debate is being followed with a keen interest, and I thank everybody—I know that they are watching and that they are heartened to see that this issue is receiving the attention that it deserves, although there is much more to be done. There are too many people for me to mention them all personally, but I particularly thank Dr Louise Newson—the menopause doctor—for her advice and knowledge on this matter. She operates a specialist menopause clinic in Stratford-upon-Avon and is an expert in this field. Her help has been invaluable.

Almost all women will be affected by the menopause at some point in their life. Most will experience symptoms between the ages of 45 and 55, but early menopause can also occur. For one in 100 women, this natural ageing process can begin before the age of 40, and early onset menopause occurs in one in 1,000 women under 30. In other words, it is very common, yet many are told they are too young to be menopausal, which is clearly wrong.

The duration and severity of symptoms vary from woman to woman. Generally, symptoms start a few months or years before periods stop—this is known as the perimenopause—and can persist for some time afterwards. On average, symptoms last for four years after the last period, but about one in 10 women experience them for up to 12 years. About eight in 10 women will have additional symptoms for some time before and after their periods stop, including hot flushes, night sweats, difficulty sleeping, palpitations, poor concentration, memory problems, low mood, anxiety and depression.

The common symptoms are numerous and varied. Every woman’s experience is unique. For example, I never experienced hot flushes or night sweats, but I certainly did experience other symptoms, and that was a problem for me, because I did not realise I was menopausal. That is the case for many other women. I remember considering whether I could even continue my job, and I know from correspondence I have received that countless other women struggle to manage the menopause however it affects their lives. A survey from West Midlands police showed that 21% of policewomen had given up work due to their menopausal symptoms.

Of course, the menopause does not affect just women. Every man in the country either lives with, works with or is related to a woman, and employers are affected and will continue to be affected.

[Eddie Hughes]

It is vital that men understand the symptoms and the challenges women face during this time of their lives and that they offer support, not just at home but in the workplace.

[Rachel Maclean]

I thank my hon. Friend again for that really good point. In fact, menopausal women are the fastest-growing demographic in the workforce. It is vital, therefore, that employers step up and produce menopause policies to help women going through this process.

There are many ways in which society can better support menopausal women, but we must look also for ways in which menopausal women can better help themselves. Of course, education can help. We can raise awareness of these issues in numerous ways—for example, through sex and relationships education in schools. We teach young girls about reproduction and periods, about contraception and relationships, and we ought at that stage to educate them about what happens in the menopause.

Employers also have an important part to play and can introduce supportive policies in the workplace, and I am pleased that many large employers are starting to lead the way in this respect. The best known local employer I have worked with is the West Midlands police, who are introducing creative and groundbreaking policies. Having spoken to women who have worked with them to introduce those policies, I know they faced considerable barriers when they first started to bring these conversations into the workplace—this very traditional, male-dominated environment—and yet they persisted, and now they find that their events and support groups are oversubscribed and that men really want to help and get involved to support their female colleagues.

[Jim Shannon]

I mentioned in my earlier intervention the importance of access to GP surgeries. Every lady who has this problem goes to her doctor. That is a fact. At that stage, there is an opportunity to address the issue. I hope that the Minister will respond to this point—she always does respond very positively—because there needs to be some extra assistance in GP surgeries to help the ladies whenever they present with these problems.

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[Rachel Maclean]

I completely agree with the hon. Gentleman. I have heard that point from so many women who have written to me, and I know that many of the women watching right now will have had the experience going to their GP and not getting the necessary support.

I will now talk about what I think the Government, the NHS and GPs can do to better support women experiencing, and sometimes struggling to cope with, the menopause. Central to the treatment available is hormone replacement therapy—or HRT, as it is commonly known. In essence, by addressing the hormonal imbalance resulting from the ageing process, HRT can address a wide variety of different symptoms experienced by menopausal women, and this is explicitly confirmed in National Institute for Health and Care Excellence guidelines on the menopause. It is recommended to treat vasomotor, psychological and urogenital symptoms, as well as altered sexual function resulting from ageing.

Despite these guidelines having been published in November 2015—three years ago—only 10% of women are actually taking HRT. Time and again, I hear about women who have been turned away from their GPs—as the hon. Member for Strangford (Jim Shannon) mentioned a moment ago—and not given this effective medicine, on spurious grounds. They are told, for example, that because their periods have not stopped they are not menopausal. However, it is suitable to prescribe the medicine at that point. It is not expensive, it is safe, and it has a transformative effect.

Back in 2015, when these guidelines were introduced, they were heralded as a great step forward, but that, sadly, has not materialised. Many attribute the problem to a 2002 study which found some causation between HRT and breast cancer, but the 2015 NICE guidelines are crystal clear: for the vast majority of women, the benefits of HRT greatly outweigh any risks. The guidelines state explicitly that it does not increase the risk of developing cardiovascular disease, that there is no association between developing type 2 diabetes and taking HRT, and that there is no evidence to suggest an increased risk of developing dementia. In fact, evidence suggests the contrary.

Even in individual cases in which cardiovascular concerns may discourage the prescription of HRT, oestrogen in the form of a skin patch or gel is available, and carries no risk of clots. That is the form of HRT that I am taking, and, combined with migraine treatment, it is helping me enormously. In fact, evidence shows that HRT lowers the risk of heart attacks by 50% and the risk of osteoporosis by 50%, and that the risk of depression is also reduced. Moreover, women on HRT are less likely to put on weight, because weight increases during the menopause. It is therefore clear that HRT brings public health benefits.

HRT with oestrogen alone is associated with no change in the risk of developing breast cancer. Body-identical progesterone does not carry a risk of breast cancer for the first five years, and even after that point the risk is very low. The risk of developing breast cancer is much higher in women who drink just a couple of glasses of wine every day, or who are overweight.

Sadly, despite all that evidence, the media have misreported and whipped up fear about HRT for a number of years, and many people, including women and healthcare professionals, are still misinformed as a result. The issue is further augmented by the fact that very few GPs and nurses receive enough training, undergraduate or postgraduate education about the menopause. That has led to a general lack of awareness and misinformation in the medical community. It is clear that many GPs are not following the NICE guidelines.

That negligence is a problem, because many women are being sent away with no support, or are being mistakenly treated for misdiagnosed conditions such as depression and anxiety. Research that Dr Louise Newson has undertaken and shared with me shows that it is common for GPs to prescribe, for example, risperidone or diazepam rather than HRT. Of the thousands of menopausal women whom she surveyed, some 66%—a truly staggering figure—had been given antidepressants rather than HRT. Those expensive and addictive medicines are, of course, effective in treating certain conditions, but in menopause cases there is no evidence that they improve low mood or anxiety. Both types of HRT, oestrogen and progesterone, cost the NHS about £4 a month, so they are low-cost in comparison with antidepressants. They are highly effective, and pose a very low risk.

The benefits of HRT are clear, the size of the issue is unavoidable, and the action that needs to be taken is simple. The health service must give better training to GPs and other health workers, and must increase their awareness of the benefits of HRT in treating the menopause. The myths must be dispelled, and I hope that many millions more women will then see the benefit. Society, including men and employers, will also see the benefit, and the health service should benefit as well. Women who take HRT are less likely to attend GP surgeries, and effective HRT treatment removes the need for unnecessary referrals to specialists such as cardiologists or psychologists. That would undoubtedly relieve pressure on those already burdened specialisms. Medicine and diagnostic costs would be also reduced.

A few weeks ago, I held a productive roundtable discussion about this issue with the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Thurrock (Jackie Doyle-Price). I am pleased that the Department will be considering what more it can do to support menopausal women. I was encouraged by my hon. Friend’s commitment and her pledge to engage in further work with us. However, I implore the Department to prioritise that work, because it affects every woman.

I am keen to hear the Minister’s remarks, and I look forward to working closely with her. Women across the UK, including in my constituency, are struggling and being denied help. That is so wrong when there is a cheap, effective and low-risk treatment already available. I am glad we have started to break the stigma in this place and I thank all who have supported me in this campaign.

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[Caroline Dinenage]

The hon. Gentleman is an enlightened man. The work that we did at the very first roundtable led to an evidence review that was published in 2017, which talked about raising awareness and about the effects on women’s economic participation. The review led to the Women’s Business Council developing a toolkit to enable employers to support their employees more effectively, and I think we can all agree that that can be nothing but a good thing.

[Rachel Maclean]

I thank the Minister both for the measures she is outlining and for the work that she did originally. Is she aware that the menopause used to be called the silent passage? The work that she and the others in the Chamber tonight are doing is helping to bring some sound to this passage, which can only be a benefit for every member of society.

[Caroline Dinenage]

My hon. Friend is right. I had not heard that description before, but it sums up what we are talking about.

The toolkit that the Women’s Business Council produced when I was in the Government Equalities Office sets out positive action that employers can take around flexible working and improving awareness and understanding around the menopause. It also provides practical and often simple adjustments that employers can make. We also support actions taken by individual organisations to raise awareness. My hon. Friend mentioned some wonderful examples of such work, including at West Midlands police and the Bank of England. I pay tribute to them and encourage more employers to think about what more they can do to support women through the menopause.

I thank my hon. Friend for raising this important issue. The menopause is about valuing people, equality and rights. We have shown we can make progress on such issues elsewhere, and we must and will do the same here.

Question put and agreed to.

Oral Answers to Questions

Rachel Maclean Excerpts

Tuesday 15th January 2019 Commons Chamber

[Stephen Hammond]

The hon. Lady is right: we want to see more nurses in the NHS. That is why we have provided funding to increase nurse training places by 25% and why the long-term plan will have a detailed workforce implementation plan. She talked about the bursary, but since that was replaced nurses on current training schemes are typically 25% better off. Alongside that, additional funds support learning.

[Rachel Maclean (Redditch) (Con)]

I welcome the fact that my local trust has 94 more nurses than in 2010. What is the Minister doing to ensure greater retention of nurses at my local hospitals, so that they have their own nurses instead of relying so much on agency nurses?

NHS: Staffing Levels

Rachel Maclean Excerpts

Tuesday 11th December 2018 Westminster Hall

[Rachel Maclean (Redditch) (Con)]

It is a pleasure to serve under your chairmanship, Mr Hollobone, and I congratulate the hon. Member for Batley and Spen (Tracy Brabin) on having secured this important debate. I have a little bit of a family connection to the NHS, as I am the daughter of a GP, but it is an honour to follow colleagues of all parties who have direct experience of working in the NHS. I welcome their having shared that experience with us.

Staffing levels in the NHS are an important issue, which affects my local NHS trust in Worcestershire as well. I am in close contact with that trust and with staff at the Alexandra hospital in Redditch, and I very much hear that concern; I hear it from my constituents all the time. I agree that it is essential that we increase the NHS workforce at all levels, from nurses to consultants and, particularly, GPs. We are now in a situation in which demand is rising fast: the population is growing, it is ageing, and people are living longer. That is partly due to the success of our fantastic NHS, and the doctors and nurses who work within it, but it does create one of the biggest problems that the NHS faces.

I must have met every Minister in the Department of Health and Social Care over the past few months, and I am looking forward to meeting the Secretary of State later today, when I will be pressing for more details about a welcome capital investment in breast cancer services at the Alexandra hospital and across Worcestershire. There has also been more investment in my local hospital, to keep the frailty unit open and open a new urgent care centre. However, all those services have to be staffed, and we need the stability and security of knowing they will continue to be there, serving my constituents. I welcome those changes, but in previous meetings, I have consistently pressed the issue of staffing levels. I am encouraged that the Government are focused on meeting these challenges and providing the NHS with the workforce we need it to have.

At the moment, one of the biggest recruitment drives in the NHS’s history is taking place. It is intended to increase the number of doctors and nurses trained in the NHS by 25%—an increase of 1,500 places a year. Steps such as those will play a crucial role in supporting the future NHS workforce, but as Members have highlighted, the immediate pressures are still here and must be addressed now. Nowhere is this issue more acute than in general practice, and I often write to constituents who have complained about the waiting times for seeing their GP. Since becoming the MP for Redditch in 2017, I have pushed for change; I am pleased that the Government are listening and now intend to hire 5,000 more GPs and 5,000 additional GP staff by 2020.

I also welcome the fact that the Home Office has exempted doctors and nurses from the tier 2 visa quota system for non-EEA skilled migrant workers. That will enable the NHS to recruit more quickly and widely, especially considering that NHS recruitment demands account for 40% of tier 2 places. I welcome the fact that the Prime Minister and the Secretary of State for Health and Social Care have said time and again that we must get the message out that we want EU nationals to stay in this country, and we need them in our NHS. That has been unilaterally guaranteed by this country, with or without a deal, so please let us get that message out to our wonderful NHS staff.

There are positive steps, and the progress that has already been made should be welcomed. In my county of Worcestershire, the total number of staff employed rose by almost 7% between August 2013 and August of this year, to over 5,000. [Interruption.]

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On resuming—

[Rachel Maclean]

I believe I was noting the positive progress in Worcestershire. The total number of staff employed rose by 7% to more than 5,000 between August 2013 and August this year, and the number of doctors has increased by 5% . The number of nurses has gone up by nearly 8%. There are now nearly 1,400 nurses working in Worcestershire acute hospitals. I have been to the wards, and spoken to the nurses at the Alex who tell me about the positive recruitment days that they have held at the University of Worcestershire. I very much welcome that work, and I hope that it will continue to bear fruit.

It is vital to maintain the morale of our staff, and I welcome what my hon. Friend the Member for Lewes (Maria Caulfield) said regarding flexible working. It is important that we look at the issues in the round. As a former employer myself, I know how important it is to get every aspect of the employment offer right. I welcome the new contract deals that will result in a 6.5% pay rise for more than 1 million NHS workers this year. That means that those on the lowest salaries in the NHS will see some of the largest proportionate pay rises. Many nurses and healthcare assistants will enjoy pay increases of at least 25%. We must get the pay offer right to ensure that we encourage our NHS staff both to enter the profession and to stay.

I thank the Minister for attending the debate. I want to hear more about the strategy. I welcome the progress that has been made, and I implore him to continue, steadfast, in that pursuit.

Budget Resolutions

Rachel Maclean Excerpts

Tuesday 30th October 2018 Commons Chamber

[Rachel Maclean (Redditch) (Con)]

It is, of course, a pleasure to follow the hon. Member for Lincoln (Karen Lee), but unlike her, I choose to welcome the Budget, which will deliver genuine benefits to my constituents in Redditch.

First, I welcome the overall framework of this Budget—the fact that the money being spent for my constituents comes from growth in the economy. It comes from jobs and lower taxes, which means that my constituents will have more money in their pockets.

I am glad to see the shadow Chancellor back in his place. He referred to leafy Surrey, and we are very proud of our leaves in Redditch, but I doubt that that was what he had in mind. This is a Budget for middle England. My constituents come from all walks of life, and we cannot get much more middle England than somewhere like Redditch. We welcome the £20.5 billion to be spent on health up to 2023-24, a massive increase of 3.4% every year.

Members will know that I have spoken often about the acute trust that services my constituents—or rather, that lets them down on a regular basis, unfortunately. This matter is dear to my heart because the trust is one of the worst performing in the country. As the local MP, I inherited a flawed process that involved the removal of services from our local hospital, the Alex, before the trust as a whole was ready to take them on. We are coming to the end of that painful process and seeing more money being put into our local trust, with £16 million already delivered to it, but I want that trust to hurry up and get itself out of special measures. I consistently advocate that and lobby for it. I am meeting the trust and urging it to submit its business case so that it can give my constituents the good services they need and deserve.

To sound a note of positivity, there is capital investment in that hospital and a new urgent centre for the Alex. These steps are to be welcomed, but there is more to do, so I welcome the fact that money is coming into our NHS more generally.

I want to pick up in particular on the fact that we are focusing on technological investments in the NHS more widely. I would like the Health Secretary to come to Worcester and Redditch to see what we are doing there with the innovative bed capacity app. That is helping the flow-through of patients, which will of course help more patients to be seen more quickly at the front door.

The Government have made up to £10 billion more available for social care in the three years up to 2019-20. There are lots of pressures in Worcestershire in adult and children’s social care. There is rising demand in children’s social care. I note that local authorities are able to make bids for a fund, and I would like Worcestershire to be able to do so, as it has rising need and demand.

As the daughter of a dementia sufferer, adult social care is close to my heart, and I have seen how much pressure there is on that service. The number of people over the age of 85 needing 24-hour care in England is projected to almost double to 446,000 by 2035, so I welcome the fact that there will be a long-term solution in place following the Green Paper on health and social care.

Many colleagues have touched on mental health, and I am going to touch on one specific aspect, about which I have already spoken in the Chamber: the menopause. We had a fantastic debate on that subject not long ago in this very place, and it was a real pleasure to be supported by colleagues from all across the House. I pay particular tribute my hon. Friend the Member for Selby and Ainsty (Nigel Adams), who responded to the debate for the Government. In fact, two male MPs spoke, and they put a real focus on the issue of mental health at the time of the menopause. That focus is really welcomed by women up and down the country.

I would like to make a plea for some of the additional mental health funding to be used for issues relating to the menopause, because that is a time when women battle with mental health issues. Surely if two men in this Chamber can talk about the menopause, businesses and other organisations up and down the country can do so as well. I want to put on record my thanks to my male colleagues from all parties who have pledged to support me further on this so that we can stop the stigma of the menopause and stop it being a taboo subject. We need to raise awareness, because this affects people’s mums, wives and partners, and the women they work with. It is good that we are raising awareness around this critical issue.

There were a number of welcome announcements in the Budget, and I want to focus on the air ambulance service. I have been privileged to meet a wonderful woman called Jenny Ashman, who is a volunteer from Inkberrow in my constituency. She is known locally as “Jenny from the chopper”, because she has raised nearly £2 million for the midlands air ambulance services, and I am sure that she will be jumping for joy at the announcement of £10 million for the air ambulance services up and down the country.

There is a lot to welcome in this Budget, but as time is short, I shall finish by saying that the Budget speaks to the aspirations of middle England. It is a practical Budget that puts more money back into the pockets of my constituents in Redditch. We are seeing tax cuts for 30 million people, which will mean that they have more money to spend. That will put money back into the economy.

I have been dismayed to hear the negativity coming from the other side of the House. The Opposition have no answers to the problems facing our country. We remember the legacy that was left by their Government when they crashed the economy, and the note from their Treasury Minister that there was no money left. That was the legacy that we inherited, yet all they have come up with in the intervening time is a plan that would cost every man, woman and child in this country £3,500. They would load £1 trillion of debt on to our hard-working citizens, and they are still blind to the misery that they inflicted on my constituents. Their comments are outdated and patronising. People should come to Redditch. They would see that, although my constituents are not rich, they are rich in spirit. They come from all walks of life, and they will welcome this Budget.

Oral Answers to Questions

Rachel Maclean Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Rachel Maclean (Redditch) (Con)]

I am hearing deeply concerning reports about ambulance waits outside Worcestershire Acute Hospitals NHS Trust, and the Minister is aware of these concerns. We welcome the capital funding that is going into this trust, but will he meet me to discuss what more can be done to improve patient handover, which is concerning for my constituents?

[Stephen Barclay]

As my hon. Friend says, there is significant capital investment into Worcestershire, as well as a major programme of improvements addressing variation in ambulances, but of course I am also happy to meet her to discuss the matter.

Dangerous Waste and Body Parts Disposal: NHS

Rachel Maclean Excerpts

Tuesday 9th October 2018 Commons Chamber

[Stephen Barclay]

The first financial penalty it has suffered is the prompt action we took over the weekend, with 15 NHS trusts cancelling those contracts and moving across. There is a clear financial penalty in that loss of business. As for fines, that is a matter of legal process, through the Environment Agency, in the normal way. That is not an NHS matter. The focus for the NHS is on maintaining continuity of service.

[Rachel Maclean (Redditch) (Con)]

The Minister will be aware that my constituents want to be assured that their operations in Redditch and Worcester will be able to continue as normal. Can he give them that assurance?

[Stephen Barclay]

Yes, I can.

NHS Trusts: Accountability

Rachel Maclean Excerpts

Tuesday 10th July 2018 Commons Chamber

[Sir Mike Penning]

My hon. Friend brings great expertise to the debate, and I thank her for joining us. She is absolutely right. I declare an interest: my mother was a nurse in the days of “sister” and “matron”. Then there were nurse managers and other managers—all of a sudden, we went that way, but we seem to be coming back again. We can change the name on the Titanic, but it is still the Titanic: a manager is a manager, no matter what title we put on them.

It seems to me that we are not reducing the number of managers. I vividly remember that there were 11 primary care trusts in the Dacorum area of my constituency. Then the number reduced to two—one, actually, because there was only one director of finance. When we looked at the head count, the cost analysis, which should have massively reduced, it had actually gone up.

I want clinicians to be involved in the day-to-day care of my constituents, but I am not convinced that a GP should chair a clinical commissioning group, especially given that in most cases they do not seem to be full time in the role. What qualifications do they bring? I know that GP practices are much more business-orientated now than ever before, but they employ practice managers—the partners do not run things.

More recently, there has been an understandable concern in my constituency about the proposed closure of one of the facilities called Nascot Lawn; it is not in my constituency, but was playing a vital role in looking after the most vulnerable children in my community. Brilliantly, the families and loved ones came together to challenge the closure. They got the MPs on board and we were involved. I then scratched my head and said, “Hold on a second, I remember being told that Nascot Lawn was going to provide the respite care for my constituents when they closed a place called Woolmer Drive.” Woolmer Drive was a desperately needed respite centre where young people could go, and where their carers and loved ones could spend a bit of time. So not only did Woolmer Drive close, which meant that patients had to go to Nascot Lawn, but Nascot Lawn was closing. That was challenged, but there was very, very little consultation.

I will talk about consultations in quite a lot of depth. Frankly, most consultations are a sham. The decisions are made before they consult. They make the decision to close, put it in their budgetary regime and then consult. They then come out and say, “We’ve listened to the consultation and we are going to ignore you.” So what is the point of the consultation?

[Rachel Maclean (Redditch) (Con)]

My right hon. Friend echoes our experience in Worcestershire. The Minister will know the deep concern my constituents have about Worcestershire Acute Hospitals NHS Trust. Exactly the same thing happened before I came to this place. Services were taken away from the hospital and people were told, “You’re being consulted.” All that happened was that services were removed. It was part of a plan, I understand that, but the idea that it was a consultation is really for the birds.

[Sir Mike Penning]

It is a tick-box exercise. Most of the time trusts cannot even get that right. In this particular case—I will come on to another case in a moment—we challenged it. We judicially reviewed it not once, but twice. But why should members of the public have to come together to raise money to judicially review such decisions? There is currently no other process with proper discussion and involvement of patients, which challenges the decisions we hear day in, day out.

--- Later in debate ---

[Sir Mike Penning]

It is all well and good saying that there should be, perhaps in legislation, but unless people have the confidence that their career is not going to be curtailed, or unless they are close to retirement and are not going to put their pension at risk, they are not going to blow the whistle. What really upsets me is that although I was sent to this House to represent people and for them to be able to tell me, in confidence, anything that they needed to, so that between the two of us we could discuss how to take it forward—often without using their name, but if necessary we can—that is not happening. That really worries me an awful lot.

To go back to Nascot Lawn, we went to a judicial review. We have done that before in our part of the world. The judge sided with the patients, but all that happened—it was about process, of course—was that it went back to the CCG, which turned around and said, “We will consult slightly differently. We will address what the court said, and by the way, we are going to go ahead and do it.” It is a sham, and we should be honest about that in the House.

When we tried to prevent our acute hospital from being closed—I pay tribute to my community for that—we did everything in the world. We got a coffin on a trolley, and thousands of us pushed it from my A&E that was going to close to the nearest one at Watford hospital, which it was proposed people should go to, in order to show just how much passion there was. We managed to get the money together to go to judicial review—a lot of money; in excess of £60,000—and the judge said, “You have a moral case. You have an ethical case. I agree with you, but you don’t have a case in law because all the powers are with the trust and the PCT”, as it was then. I ask the Minister: how can it be right that people must be so concerned, not just in my constituency but elsewhere?

Lastly on this part of my speech, let me talk again about what happened when we lost our A&E. I have raised this in the House before, so the Minister knows what I am talking about. To go back a bit further, St Albans, Hemel Hempstead and Watford are covered by West Herts, and at one time all three had A&Es. We are a massively growing population. The largest town in Hertfordshire is Hemel, which will have a projected 20,000 new homes in the next 20 years. St Albans is expanding, and so is Watford. There was a consultation, but the public were ignored. The A&E was closed and made into an elective surgery facility in St Albans. The public promises to the people of St Albans were that Hemel’s A&E would look after them. It is not a particularly long ride—it is clearly not in St Albans town centre, but that was going to be that. However, a few years on, those responsible said, “Let’s shut Hemel’s A&E and move it to Watford, because that can look after West Herts,” so the promises went out the window. The public went mad in St Albans and in our area. They were all on the streets, and what did we get? An urgent care centre, some out-patient services and a fracture clinic. Really and truly, that is all that is left in Hemel.

[Rachel Maclean]

My right hon. Friend is generous in giving way a second time. Again, the parallels with Redditch are interesting. Does he agree that the problem for the public comes when they see that their town is growing and they feel that trusts have not planned for the future? That is exactly what we have in Redditch as well, because it is a new town and it is growing, and people do not understand how the future demand will be catered for in the trust’s plans.

[Sir Mike Penning]

That is absolutely what I hear every day in my constituency. I also hear, “What are you going to do about it, Mr MP? Get off your backside and do something about it!” I am doing everything I possibly can—I am meeting Secretaries of State and trusts—but what happens? I get ignored, because I have no powers at all; it is all in the hands of bureaucrats.

Education (Student Support)

Rachel Maclean Excerpts

Wednesday 9th May 2018 Commons Chamber

[Angela Rayner]

I absolutely agree that we have to make sure that we target interventions and make sure that they work, but part of the reason I have brought the motion before the House today is that the interventions are simply not working. Since 2017, we have 700 fewer students training to be nurses, so the impact is absolutely clear, and I hope that Government Members will support our motion.

Some universities are even looking at closing down specialist courses entirely. If today’s regulations pass, there is every reason to believe that this will get worse. Nearly two thirds of postgraduate nursing students are over 25, more than a quarter are from ethnic minorities and 80% are women, so the impact of today’s regulations will surely be even worse than the previous cuts. Even if the Government are determined to make the change, there are good reasons not to make it now. This policy would move postgraduate nursing students over to the main student finance system, which means dealing with the Student Loans Company.

There is every reason to believe that the Student Loans Company is not yet ready. In recent weeks, the Government have been dealing with an error by the company that has led to 793 nurses being hit with unexpected demands to repay accidental overpayments they were unaware of. The Government’s response was a hardship fund of up to £1,000 per student, yet the Minister for Universities, Science, Research and Innovation, the hon. Member for East Surrey (Mr Gyimah), admitted in a written answer to my hon. Friend the Member for Blackpool South (Gordon Marsden) that the majority of students were overpaid by more than £1,000 and will be left short. Perhaps when he responds, the Minister will tell us how he can possibly expect nursing students affected by this policy to have any faith in the system they will be stuck in.

With the Government finally embarking on their flagship review of higher education, they could have allowed this issue to be considered as part of the review before going ahead with this change today. Ministers have insisted that this change is necessary now to make how we fund training sustainable, yet there is little reason to believe that it will achieve this. The average NHS nurse earns just over £31,000 a year and the average graduate now leaves university with £50,000 of debt. A new nurse with a postgraduate qualification will take 86 years to repay their undergraduate debt on the average NHS salary—that is before we add interest—which is nearly triple the current repayment period before debt is written off, meaning they will not even begin to repay the debt. How many postgraduate students affected by this policy will repay any of, let alone all, their additional loan, and how much of that debt will simply be written off by the taxpayer in decades to come?

[Rachel Maclean (Redditch) (Con)]

Does the hon. Lady not agree it is completely wrong to talk about debt in the way she is—in this place—as though it is some sort of credit card debt? It completely misrepresents the situation for young people from disadvantaged backgrounds thinking about going to university. Her words will be putting them off.

[Angela Rayner]

I am not sure it is my words that are putting people off; I would say the thought of having £50,000 of debt hanging over them for a very long time is putting people off going into education.

--- Later in debate ---

[Rachel Maclean (Redditch) (Con)]

I will keep my remarks brief. It is a great pleasure to follow the hon. Member for Gedling (Vernon Coaker). I agree with him that we need a new long-term system that works and removes the cap from people who wish to study as nurses. The vice-chancellor of Oxford Brookes University, Alistair Fitt, has said that nursing bursaries “had to end” and were not a sustainable system. The cap on places was discouraging people who wished to enter the nursing profession, which is so important for all our constituencies.

In Worcestershire, we need more nurses, not fewer. I welcome the work that has been going on in a partnership between my NHS trust and the University of Worcester. I backed their calls for a medical school, and the work being done on the ground is already reducing nursing vacancy rates. They are down from 8.4% to 7.5%, and nursing turnover rates are down from 14% to 10% in the last year. That is a tribute to local professionals working hard to tackle the real problems in my area for the benefit of my constituents. I want to see more of that.

Under the new system under the regulations, postgraduate healthcare students will be 25% better off as they take part in their studies. These are new measures, and we need to back the Government. We should not vote for the Labour party’s motion to annul these Government regulations, which will help more people to enter the nursing profession at senior levels. We are talking about the senior leadership roles that we need in all our hospitals to deal with the needs of our population and their healthcare.

Finally—I said I would be brief, and I will be—we definitely need to stop the rhetoric about student debt, because it puts people off going to university. I refer Labour Members to the comments of Martin Lewis, a respected financial expert, who just last week said that it was completely wrong—[Interruption.]

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. The hon. Lady is making a serious speech. There should not be so much chuntering going on.

[Rachel Maclean]

Thank you, Madam Deputy Speaker.

Martin Lewis’s comments were, it is true, aimed at politicians on both sides of the House, but we have all heard the Labour party’s recent claims about student debt. The idea that that is the same thing as a debt has, in reality, put people from different backgrounds off studying at university. Student debt is not the same thing as a credit card debt. It is a graduate tax that people pay only when their income reaches a certain level, and that is the same for nursing students. We have to go forward with a sustainable solution.

[Dr Whitford]

Will the hon. Lady give way?

[Rachel Maclean]

I will not, because time is short.

Conservative Members will work to fight against the weaponisation for political ends of students and people who want to be students. We will open up more opportunities for everyone in this country to make a career in the NHS, if that is what they choose to do, and we will run the economy in a balanced way to support our precious NHS during this Parliament and in the years to come. I will not be voting for Labour’s motion tonight.

Question put.

The House proceeded to a Division.

[Madam Deputy Speaker (Mrs Eleanor Laing)]

I remind the House that the motion is subject to double-majority voting of the House, and of Members representing constituencies in England.

Oral Answers to Questions

Rachel Maclean Excerpts

Tuesday 8th May 2018 Commons Chamber

[Steve Brine]

I cannot comment on the individual case, but I can say that NHS England and we at the Department are working closely with the Stroke Association to develop a new national plan for stroke in England which we expect to publish this summer. The hon. Lady’s constituents and mine will benefit from the national policy narrative, but they will also benefit from some brilliant charities that work on the ground with constituents. Yesterday, I saw Chandlers Ford Stroke Support Group at the amazing Funtasia in my constituency. That group does a lot to support people in stroke as well.

[Rachel Maclean (Redditch) (Con)]

In Worcestershire, we are fortunate to have some excellent stroke services serving my constituents across the whole county. Does the Secretary of State agree that the most important aspect of any service is leadership? With that in mind, will he update the House on his progress in appointing a new chair for our trust to deliver stroke services and other services to Redditch?

[Steve Brine]

I am not close to that issue, but I am told that we have some excellent candidates, and I think that my hon. Friend will be pleased.