Capsticks Report and NHS Whistleblowing

Rosie Cooper Excerpts

Wednesday 13th July 2016 Westminster Hall

[Rosie Cooper (West Lancashire) (Lab)]

I beg to move,

That this House has considered whistleblowing in the NHS and the Capsticks report into Liverpool Community Health NHS Trust.

It is a pleasure to serve under your chairmanship today, Mrs Main. On 22 March 2016, the “Quality, safety and management assurance review at Liverpool Community Health NHS Trust” report by Capsticks solicitors was publicly released, following a serious and substantial investigation and examination of the litany of failures, misuse of power, intimidation of staff and patient harm that was allowed to go unchecked and unchallenged at Liverpool Community Health in the four years to April 2014. Some 43 individuals gave evidence to the review over 24 weeks, and almost 900 documents, spanning more than 19,000 pages, were reviewed.

The findings are clear: from 2010 to 2014, the trust’s pursuit of foundation status was its sole priority. The review compares LCH to Mid Staffs on the basis of the brutal tunnel vision that led to an unsafe drive for savings at all costs, compromised the quality of patient care, fostered bullying and harassment of staff on an industrial scale, and made possible the culture of concealment and denial at board level. The report’s findings are even more damning, given that all this took place after Mid Staffs and the publication of the initial Francis report. It demonstrates that, in pockets of the NHS, the events at Mid Staffordshire have changed little if anything at all. It prompts the question, to what extent is this happening in other trusts up and down the country?

The report paints a stark and harrowing picture of far-reaching failure, driven from the very top of the organisations where individuals have escaped the consequences of their actions to date. Sadly, the same cannot be said for the patients and staff of the organisation, which abjectly failed them.

I do not intend to go through the Capsticks report in great detail, as it is publicly available for people to read. Instead, I want to add background detail and put a human face to the words it contains. I want to talk about my experience of what can only be described as the very worst of the national health service.

I got involved in LCH simply because my father was admitted to ward 2A—a GP-led community ward at the Royal Liverpool hospital, run by LCH. The quality of my dad’s care was not great, and despite meeting managers and eventually a doctor, I remained unhappy with the care and remarked that I would speak to the Care Quality Commission. I was very surprised that staff members encouraged me to do so. It was the bravery of the ward staff, who spoke out about the horrific situation at LCH, that led to three years’ work to expose the true situation. And we are not there yet. No whistleblower has come to harm in this investigation, because I took the heat.

Once staff felt able to confide in me, many other people from across the various services with equally horrendous experiences of patient care, mismanagement and staff mistreatment spoke out, too. The Capsticks report enabled their voices to be heard, but it was limited because it was a governance review, not a clinical review. I am seeking investigations by a range of regulatory and professional bodies—including NHS Improvement, the Care Quality Commission, the General Medical Council, the Nursing and Midwifery Council, the Royal College of Nursing, the Health and Care Professions Council, the Chartered Institute of Personnel and Development, the Chartered Institute of Public Finance and Accountancy, and the Health and Safety Executive—into the failures at LCH as an organisation and by individuals.

However, one fundamental question remains unanswered. We still do not know the full extent of the harm caused by LCH. Justice demands a public inquiry, or at least an inquiry in public. We cannot try to hide what went on. A refusal to undertake a clinical assessment of the harm would be an admission that Mid Staffs and the Francis inquiry have changed absolutely nothing, and that the lives lost unnecessarily and prematurely in the care of the NHS had no value. Is that really the state of our NHS in 2016?

Despite the information that I have presented, detailing the extent of failures at LCH, there remains a determination among some members of the NHS senior management to minimise the LCH revelations. They are of the view that the Capsticks report should not have been commissioned, and that the dismantling of the organisation will bring scrutiny of the entire system’s failures to an end. It will not. I promised those who put their trust in me that I would not let that happen. I will keep at this until we have the whole truth and those who are responsible are held to account. The Minister might reflect on why those in senior positions who knew something did not believe that the duty of candour applied to them, and why there seemed to be no consequences.

The Capsticks report paints a stark picture of far-reaching failure that emanated from the top of the organisation, where the pursuit of foundation trust status had consequences for patients and staff at LCH, and financial considerations rode roughshod over the quality of care. A combination of driving down recurring costs and minimising expenditure on front-line services meant that the trust could create the impression of a healthy financial organisation, enabling it to become an FT. All its key performance indicators were financial. No one seemed to notice that all reference to quality disappeared.

Efficiency savings are usually 2% to 4% a year in the NHS. At LCH, there were several services for which the initial cost improvement programme proposed a 50% planned reduction in the overall budget within a single financial year. Those ludicrous budget cuts were described by the interim chief executive as “erratic”—“dangerous” is the word I would use. Those cuts could be driven through because there was a lack of a clear, transparent and robust quality impact assessment process to support the cost improvement programme. The situation was compounded by the executive team’s deception of the trust’s board in the implementation of the cost improvement programme.

The Capsticks report shows no evidence that the board had any discussions about the impact of the CIP on staff and their ability to deliver safe and effective healthcare to patients. Between 2011 and 2014, more than £20 million was stripped out of front-line services. In the district nursing service, there was an underspend of £2.8 million, which meant that some areas were left to run at 50% of safe staffing levels. Stressed nurses worked unpaid long after their shift had finished to ensure that patients received essential treatment and medication. Working alone without alarms, they had to go into houses where there were drugs and guns, having been told by their managers, “That’s your job.”

In 2014, the deluded former chief executive wrote to me that the trust had reduced grade 3 pressure sores by more than 30%, and benchmarked against best practice. The reality was that the number of patients with avoidable, agonising pressure sores, which reach right down to the bone, rose sixfold as nurses frantically scuttled round the city trying to catch up. Staff were put in harm’s way. One nurse was held hostage at knifepoint by the relative of a patient she was visiting, and was seriously sexually assaulted. The attacker was given a custodial sentence.

Clinical governance between 2010 and early 2012 was the responsibility of the director of finance. He had never previously worked in the NHS and had no clinical experience, yet he was responsible for reporting serious untoward incidents to the board. I have been told that even the person in charge of nurse prescribing had no clinical background: he was a fitness instructor.

The incident initially reported to the director of finance was relayed to the chief exec, the human resources director, the medical director, and the director of operations and chief nurse. The executive nurse promised a “root cause analysis”. This never happened; nor was there a proper investigation, which was a breach of trust policy. No one seemed to notice. The director of finance stated as part of the Salmon process that the director of operations and executive nurse, and the health and safety reporting system

“both downplayed the seriousness of the incident.”

The minutes of the board meeting on 23 September 2014, at which the report of the interim chief executive and interim nursing director was presented, state that “CG”—Craig Gradden, the medical director—

“confirmed that it had been reported in the ‘Weekly Meeting of Harm’, but had not been reported to the Board, as it had been risk rated too low”.

So sexual assault of a nurse was risk-rated too low to be reported to the board—it was rated lower than a stolen personal computer or the parking problems at Burlington House.

Questioning the credibility of the medical director, he Capsticks report states:

“We also do not as a review team accept the comments made to us that the serious nature of the incident was not known at the time. Our reading of the Datix entry on this incident clearly indicates the nature and seriousness of the incident.”

The chief executive, Bernie Cuthel, told Capsticks that she was not aware of the severity of the incident, but she managed to send the nurse a handwritten note.

The incident was not reported to the Health and Safety Executive either, presumably because the trust knew that it would be found wanting, as it had no proper lone-worker policy and staff did not have any alarms. Why did staff have no alarms? Because they cost too much money. The trust even charged the nurse who was assaulted for access to the internal investigation records. How the LCH executive directors reacted to that incident demonstrated the utter inhumanity of those shameless individuals. Only under the new leadership has the incident been properly investigated.

There are other failures right across the organisation, where finance was given priority over the quality of care. At one point, the trust’s in-patient services had 33 vacancies and an 11% staff sickness rate. How were they expected to maintain high standards of care? One nurse told me that she was left with one healthcare assistant to look after 18 ill patients, and when a senior manager arrived, his only comment was about the noticeboard.

Poor, ill and often elderly patients were expected to run around the city trying to get appointments to see district nurses. GPs gave me many examples, including that of one lady who, after a hysterectomy, needed an infected wound dressed. She was forced to go daily to different treatment centres in different parts of the city by taxi, because she was not fit to catch a bus; it cost her more than her income for the week. In another case, a patient was left waiting for four months for a health assessment, leaving their lung cancer undiagnosed and eventually inoperable. The equipment service was in disarray: I have seen photographs of wheelchairs for the use of patients stored in a gents toilet.

In prison healthcare services, which the trust ran before 2015, the abject failure of oversight by the board was shocking—shocking in the extreme. The service, including meds management, still requires thorough investigation. Basic health checks for new prisoners to assess their risk of suicide were not carried out, with tragic consequences. The prisons ombudsman was ignored, and the coroner now recognises organisational failure.

Staff, as well as patients, paid the price. Where there was resistance to the planned cost improvements and their consequences, the human resources function was used not to support staff but to enforce, leading to a culture of bullying and harassment. The community dental service faced a cut of £2.7 million, or 49% of its overall budget—a reduction of 50 whole-time equivalent staff. When the clinical directors tried to point out the risks to patient care, they were suspended on concocted grounds and faced disciplinary action in an effort to silence them. There are many more examples.

My first awareness of the bullying culture at LCH was in the intermediate care bed-based unit where my father was admitted. I was told by whistleblowers that nurses in the service who spoke out were bullied, and that three senior members of staff were on suspension without even having been given reasons for their suspension, although that later changed, after challenge, to redeployment in a non-clinical role for no given reason. These matters remained unresolved for more than a year, until the new team arrived. People had been moved out of the way.

Driving home one night after a day of managerial mayhem, one nurse with a family and decades of service to the NHS in a role she loved, pulled her car to the side of the road and seriously contemplated suicide. Another nurse, in the prison service, received foul racist texts from his senior manager. He was appalled and told her so. Little did he realise that that would be the end of his NHS career. He was suspended for more than a year, then sacked and reported to the Nursing and Midwifery Council, although eventually cleared. The manager was not even disciplined.

Management failings went unchallenged. In one particularly shocking case, a whistleblower has alleged that a prisoner with dementia was placed in a tumble dryer at HMP Liverpool for the amusement of prison and health staff. It is alleged that when he tried to get out, it was a nurse who pushed him back in.

The report’s description of scoping meetings is illuminating:

“people…described the culture and atmosphere as being designed to find personal fault and that the presence of a representative from Human Resources at these meetings, which in our view is most unusual, further exacerbated that feeling.”

Staff knew it was dangerous to speak up.

Staff availing themselves of occupational health psychological services were limited to six weeks’ support, but so great was the threat of harm to them, that some were still receiving help for more than a year. The number and severity of these cases was drawn to the attention of LCH executives by the trust providing the services, because they were outside the provider contract and required extra resource. Even that did not make a difference.

The report offers us an insight into the scale of the HR problems that existed: 332 known employee relations cases, including eight cases of bullying and harassment, 111 disciplinary cases, 26 grievances, one whistleblowing, 20 capability cases and 166 sickness sanctions—all that in a small community trust. The view of the interim chief executive offers some insight into those figures:

“When coming across grievances that were in the system, some of them were two or three years out and not resolved. I came across individual members of staff who had been on suspension for up to nine or ten months and the full time officers couldn’t even tell me why they were suspended.”

The mechanisms to protect staff, such as JNCC—joint negotiation and consultative committee—meetings, did not function effectively; they actually gave false assurance. The meetings were attended by the board chair and considered bullying cases regularly, but nothing changed because managers were used to enforce the directives of the executives, and for people who did not do as they were told, there were consequences. Even the ACAS report talked of employees being “fitted up”.

There were cliques, and someone whose face fitted would be invited to join the Friday night Prosecco club, also known as the “Montrose mafia”. When someone was suspended or fired or resigned from the stress of it all, a member of the clique would be moved into the position, without proper process, in order to deliver “the programme”, which also meant overlooking the shortcomings of the executives, which were many. I was always astounded that everyone knew that Helen Lockett did her LCH on-call duty from Bristol. She was not even in Liverpool. Safe? I don’t think so. As one staff member interviewed by the Capsticks team said:

“In fact it’s probably the most un-healthy organisation I’ve ever worked in by some distance at that time. Just because those key individuals…forgot what we were actually…here to do.”

On 5 February 2014, I asked the Prime Minister to forensically examine the history of HR practice, disciplinary action and subsequent payoffs. He said he would happily do so, I believe in good faith, because he thought the CQC could do that, which it turns out it cannot. I ask the Minister, when the HR department is used as a weapon to enforce the rule of a trust, rather than the law of the land, who is policing it?

A vast amount of taxpayers’ money is wasted on paying for lawyers and subsequent compensation for victims as careers and lives are destroyed. The Department of Health and professional bodies such as CIPD surely should act. The evidence of a pervasive culture of bullying and harassment at LCH reinforces Capsticks’ opinion that the executive team were “out of their depth.”

We might think that an executive team that slashed £20 million from front-line services, causing patient and staff harm, would guard every penny. We would be wrong. They spent more than £350,000 on drumming up support for their application for foundation trust status. They spent more than £1 million on a programme management office of external consultants to tell them how to save money. At the trust’s annual meeting in 2013, the same year the board slashed £7 million from front-line services, its leadership team still managed to find enough money to hire jugglers, unicyclists, stilt-walkers and a life-sized elephant to greet guests—I am not kidding. In the same period, the chief executive’s pay increased by nearly a third, from £95,000 to around £130,000 a year.

In 2014, when the CQC at long last began to expose the extent of the leadership failures at LCH, the trust board’s first reaction was to spend £11,000 on a crisis communications consultant. In January 2014, as I pressed hard and still harder for answers and immediate changes for staff and patients, board members spent almost £1,000 on legal advice in an attempt to browbeat me and prevent parliamentary and public scrutiny of the goings-on at LCH.

I mentioned that the executives downgraded the risk rating of the serious sexual assault of a nurse. That was not a one-off: there were other instances in which they were willing to hide failure. The Capsticks report says:

“when risks were escalated upwards, they were either ignored or watered down by those in more senior positions to make them look less significant than they were, without any clear rationale for doing so.”

That included the suppression of a report into district nursing services because its findings were so catastrophic and told the truth. Having requested documents under freedom of information, I have evidence that the nursing director and clinical director signed off the CIP plan that states that they believed those plans to be clinically safe. All the evidence says that those plans were not safe at all.

In hiding their failures, the executives regularly deceived the non-exec directors, as the Capsticks report highlights:

“There were repeated failures by the Executive Directors to be open and transparent with the wider Board, which is ultimately responsible for the care and welfare of its staff. This included not sharing with the Board details of a serious assault carried out on a health care professional and not sharing with the Board the results of a survey of staff views and opinions undertaken by the Staff Side which amongst other things highlighted that 96% of respondents believed bullying was a moderate or worse problem at the Trust.”

The trust chair was present at staff side meetings.

The non-exec directors on the board are also culpable for their failings. The fact that the board was deceived by executive directors should not detract from the catalogue of errors that the non-executives made in fulfilling their duties. Instead of providing the most basic challenge and oversight, the chair of the trust and her fellow non-executive directors were in denial. They were more concerned with protecting their reputation than with protecting patient safety and staff welfare. The chair was reported on many occasions, usually in response to me, as saying:

“The board has complete confidence in the chief executive and her team.”

What is so concerning is the directors’ sheer lack of awareness—never mind acceptance—that they had failed. Capsticks says that its

“detailed review of the public minutes of Board meetings from 2011 until April 2014 do not show that Non-Executive Directors on the Board collectively and individually held the Executive Directors to account. Indeed our extensive review of these minutes shows little evidence of scrutiny and challenge.”

There was an over-reliance by the board on external consultancy reports for assurance on its performance—although ironically, the board ignored the finding of a 2012 report on governance by Deloitte that stated that

“there was an inconsistent level of challenge from Non-Executive Directors on quality”.

They heard only what they wanted to hear.

Paragraph 9.36 of the Capsticks report states:

“The Board and its Committees for their part failed to understand the impact of such a significant Cost Improvement Programme on the quality and staffing of front line services and did not provide the required level of proactive oversight, too willing in our view to accept Executive Director assurance of a process which was largely at variance with that set out in national guidance.”

In paragraph 13.36 of its report, Capsticks comments that

“the Board ignored one of key findings of the Francis Inquiry…which identified ‘an unhealthy and dangerous culture’ as a pervading cause of the failures at Mid Staffordshire NHS Foundation Trust.”

Had any of the opportunities been taken, the subsequent sequence of failures could have been broken. The board could have done something. It should have done something. It did not, and patients and staff came to harm. I do not believe that the non-execs accept to this day their responsibility for the damage that they caused in failing the patients and staff at LCH.

Perhaps equally concerning for the Minister is that the extensive regulatory framework that exists, in the expectation of stopping events such as Mid-Staffs and now LCH, fell down on the job. Nurses who contacted the NMC were simply referred to protocols—although the NMC is currently engaged in resolving some of these issues. This was not the RCN and the other unions’ finest hour. Most absent of all were the NHS Trust Development Authority, which is now called NHS Improvement, and Liverpool and South Sefton clinical commissioning groups.

The clinical commissioning groups in particular have a duty—I quote from NHS England’s rules—to

“make their own assessment of cost improvements and be satisfied that services are safe for patients with no reduction in quality.”

In the case of Liverpool clinical commissioning group, there is no evidence that LCH’s savings plans received even the most basic checks to ensure that they were safe and would not lead to patient and staff harm. For a clinical commissioning group that is responsible for almost £0.75 billion of NHS spending and the future reorganisation of health services in Liverpool, that dereliction of responsibility is deeply disturbing and must prompt the questions, “Is it up to the job?” and “Where else is its eye off the ball?”

The CQC’s previous assessments of the trust did not reveal the bullying or the seriousness of the situation, although after I contacted it, it did produce the first regulatory evidence that all was not well. It also protected the whistleblowers, for which I thank Ann Ford. The lack of any discernible action by the CQC four months after it received the Capsticks report is not good enough. The lack of accountability remains deeply troubling.

The Trust Development Authority in the end removed the chief executive, the executive nurse and the human resources director from their posts following a review by Sir Ian Carruthers. I was led to believe that because of the information that I had provided and the Carruthers review, those individuals had been sacked. That was untrue. The TDA also left the failing non-exec directors in place on the board, and that hindered the trust’s recovery. If the board was failing and the executives had to go, why leave half the board there to hinder the people brought in to make it better?

I am still astounded that I was told that the chief exec had been fired when the truth, elicited by freedom of information, says that she was given a reference and that Manchester mental health trust was asked to mentor her without being told about the full circumstances. Effectively, she had been moved from one job—because she was doing badly—to be mentored at Manchester mental health trust. Currently, she remains safely holed-up in a senior executive role at Betsi Cadwaladr University Health Board, still earning about £106,000. I am told by the Care Quality Commission that her flight across the borders within the United Kingdom prevents it from taking any action.

Gary Andrews, the former director of finance and a non-clinical clinical governance lead, has been given a senior managerial role in NHS England’s vanguard programme. Craig Gradden, LCH’s former medical director, is employed as a medical consultant in Sefton. Helen Lockett, Liverpool Community Health’s former director of nursing, who I was told had been sacked, got a £25,000 pay-off and a reference. Only the 18-month interim order issued by the NMC while she is under investigation stops her practising. Who referred her to the NMC? Was it the system? No, it was me.

Michelle Porteous, the HR director, was allowed to leave unchallenged and was seen to spend her last days at the shredding machine—no one stopped her. Although outside the remit of the NHS and its regulators, the former chair of the trust continues to work with the health service through her management of a charitable company called Health@Work, which sells health and safety advice, training in emotional intelligence, spotting signs and symptoms of poor mental health in staff members and techniques to manage stress. I will say no more.

The Prime Minister said he did not want failures recycled around the NHS, but here we have a regulator doing just that: not investigating, not disciplining and not taking the appropriate sanction, just recycling. Accountability and the interests of patients and NHS staff require action, so I ask the Minister whether the fit and proper person test, introduced to prevent NHS leaders responsible for serious mismanagement from assuming similar roles in the NHS, is fit for the job.

Before I come to my last point, it would be remiss of me not to mention the progress that has been made by LCH in the two years since April 2014. The trust has turned an important corner, through investment in safe staffing levels, a new approach that values clinical leadership, clear action to put quality and patient safety first and a new culture of openness and honesty. To have come so far in such a relatively short period of time is a credit to the frontline staff in LCH and the new leadership it has been given.

Most importantly, while the Capsticks review has shone a light into the dark recesses of the goings on at Liverpool Community Health in those four terrible years before the system acted, it does not, and cannot, document all the harm caused to patients. The Capsticks report finds that it is reasonable to conclude that between 2010 and 2014, patients received sub-optimal care. It is therefore a sad and undeniable fact that there will be people on Merseyside today who have lost loved ones, or seen them suffer, or suffered themselves, who do not know that their anguish was avoidable and caused by the failures of leadership at the trust.

In the interests of truth and justice, we cannot allow that to continue. I therefore look to the Minister for assurances that preferably a public inquiry, and at least an independent clinical review, into patient harm associated with the leadership failings at Liverpool Community Health NHS Trust between 2010 and 2014 will be conducted without further delay and that nothing is hidden. It must be made public. I am very aware that very senior people are really angry that this is coming out.

I also ask the Minister to include, as part of any review, an independent investigation into the adequacy of the actions taken at the same time by NHS Improvement—TDA as it was—NHS England, Liverpool CCG, South Sefton CCG, Southport and Formby CCG and their predecessor organisations to assess and address safety concerns at LCH. That needs to reflect the health system’s future challenges, where accountability and governance will not just affect one organisation but a whole region, area or system. It is only through that course of action that we can provide the assurances necessary to those harmed that that will never be allowed happen again.

In finishing, I ask the Minister—obviously not today—to look at the TDA assessment programme for the break-up of LCH because, for example, Bridgewater, a trust that does not have a CQC rating, is pitching for LCH business against other organisations that do have CQC ratings. That is patently unfair. Also, in the private sector we would not allow a business to poach former members of staff—it is almost insider trading—but that clearly is going on in this process. We must establish whether former members of staff declare their conflict of interest and whether we are protecting NHS organisations from that kind of insider trading.

I am sure that the Minister is aware of how deeply angry and upsetting this is, not just for me—having spent three years looking at it and working hard at it—but for each and every single member of staff who, right now, trusts him to deliver. They were too frightened to go to their execs and they were let down by the system. They were not sure that they could whistleblow in safety—that is why I did it. The system has let people down so badly. No one has been hurt because I did what I did in that way, but that is not right, either. People need to be able to speak freely on behalf of their organisations, their patients and their staff. This is not 21st century health politics.

--- Later in debate ---

[Rosie Cooper]

May I quickly thank the Minister for his genuine, honest approach? But hearts were dropping—I have been getting texts—during his response about the CQC and HR. All they can do is require improvement—that does not stop this and does not change it. The TDA was supposed to look after boards and it did not spot this failing board.

Oral Answers to Questions

Rosie Cooper Excerpts

Tuesday 22nd March 2016 Commons Chamber

[The Minister for Community and Social Care (Alistair Burt)]

This work is already in hand through the British Heart Foundation. I should like to add that last week the Chancellor announced another £1 million to make public access defibrillators and CPR training more widely available in communities across England. Coupled with last year’s funding of £1 million, that means that there are now over 690 more publicly accessible defibrillators in communities across England. That mapping work is important, however, and my hon. Friend is right to raise it.

[Rosie Cooper (West Lancashire) (Lab)]

I believe that the Capsticks governance review, published today, will show that serious harm was caused to patients and staff, that there was a culture of bullying and harassment even after the Francis inquiry, and that Liverpool Community Health NHS Trust is the community equivalent of Mid Staffs. In the spirit of openness and transparency, will the Secretary of State instigate a public inquiry to establish the full extent of the harm caused to patients and staff?

[Ben Gummer]

May I commend the hon. Lady for the brave stance that she has taken on this difficult issue? I will certainly take her concerns seriously. I want to read the report now that it has been delivered, and will speak to her at the earliest possible opportunity to establish how the Government and local commissioners can take things forward. It is imperative that the NHS has the best possible culture for how staff are treated and heard. I hope she will look at the announcement made by my right hon. Friend the Secretary of State about ensuring that people have the freedom to speak up and safe spaces in which to blow the whistle.

Oral Answers to Questions

Rosie Cooper Excerpts

Tuesday 9th February 2016 Commons Chamber

[Alistair Burt]

I hope so. I appreciate my right hon. Friend’s visit to my office yesterday with members of that surgery and NHS representatives. The £1.4 million released from PMS in Essex will be reinvested in the CCG area, but it is important that there is an opportunity for all practices to bid for that money so that some of the work already done under PMS gets the chance, if it is vital and still needed, to continue, which certainly includes services that are rated “outstanding”.

[Rosie Cooper (West Lancashire) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

Significant progress has been made in our negotiations with the British Medical Association on a new contract for junior doctors, but agreement has not been reached on the issue of Saturday pay, despite previous assurances from the BMA that it would negotiate on that point. So, regrettably, 2,884 operations have been cancelled ahead of tomorrow’s industrial action, which will affect all non-emergency services. I urge the BMA to put the interests of patients first and to reconsider its refusal to negotiate.

[Rosie Cooper]

At Prime Minister’s questions in February 2014, I raised with the Prime Minister my very serious concerns about the dangerous bullying culture at Liverpool Community Health NHS Trust. I understand that the Capsticks inquiry into parts of that is now complete, so will the Secretary of State, in the spirit of honouring his stated commitment to openness and transparency, ensure that that report is made available, perhaps via the NHS Trust Development Authority, if necessary, to the public trust board on 23 February?

[Mr Hunt]

I will happily look into that matter. The Under-Secretary of State for Health, my hon. Friend the Member for Ipswich (Ben Gummer), has held a round table on bullying and harassment. I thank the hon. Lady for raising the issue, because over the past decade—none of us should be proud of this—the number of NHS staff who say they are suffering from bullying and harassment has gone up from 14% to 22%. If we are going to deliver safer care, we have to make it easier for doctors and nurses on the frontline to speak out without worrying about being bullied or harassed.

NHS (Government Spending)

Rosie Cooper Excerpts

Wednesday 28th January 2015 Commons Chamber

[Dr Poulter]

To take the intervention in the spirit in which it was intended, I recognise that the hon. Gentleman is committed to our NHS, as are Members on this side of the House. That commitment to and investment in the NHS has been made clear by the fact that we have increased NHS spending by £12.7 billion during this Parliament.

Opposition Members have also incorrectly asserted that our long-term economic plan is taking Britain back to the 1930s, but the latest forecast from the independent Office for Budget Responsibility shows that our plans would reduce total Government spending as a share of GDP from some 40% today to 35.2% by the end of the next Parliament in 2020—the same levels of public spending as were proposed under Labour in 2002, when the right hon. Members for Doncaster North (Edward Miliband) and for Morley and Outwood (Ed Balls) were in the Treasury. If it was appropriate to set public spending at that level under Labour when they were in government, they need to explain why it is somehow wrong for a Conservative-led or coalition Government to plan for a similar level of public expenditure in the future—something that the Labour party has completely failed to do to date.

[Rosie Cooper (West Lancashire) (Lab)]

The Minister referred to the goodbye note from my right hon. Friend the Member for Birmingham, Hodge Hill (Mr Byrne). Would the Minister’s goodbye note say, “Good luck, there’s no NHS”?

[Dr Poulter]

Such drivel, frankly, is beneath the hon. Lady. We have made considerable additional investment in the NHS. Comparisons between an NHS run by a coalition Government in England and the NHS in Wales bear up very well for the NHS in England.

NHS Major Incidents

Rosie Cooper Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

I have been to East Surrey hospital, which is a good example. It, too, has had its share of problems with care, but it has addressed them head on. Standards in the hospital are getting better, and it is encouraging to see that refreshing openness and honesty. We have put more investment into the NHS. Welsh patients are angry, because they can see that openness and transparency about results, combined with strong financial support, not cuts from central Government, lead to better service. Rather than try to create a political weapon in England, Labour should act where they can do something about it—in Wales.

[Rosie Cooper (West Lancashire) (Lab)]

I was recently told by staff in Aintree hospital on Merseyside that, in the interests of patients and patient safety, executives should have declared a major incident. Although the execs teetered on the brink, they feared the political consequences of making that decision rather than doing the right thing. What genuine help and advice can the Secretary of State give execs who face that situation on the front line and help them to do the right thing for patients?

[Mr Hunt]

If executives did not declare a major incident because they were worried about the political consequences, they were wrong, but I would have to be persuaded that they would do that, because every NHS executive I speak to wants to put patients first, with patient safety paramount. On the practical things that we are doing, there are 60 more doctors, and 41 more nurses since 2010, and £4.5 million to help them through this winter. We are doing a lot of practical things to help the NHS in the hon. Lady’s area through the winter.

Obstructive Sleep Apnoea

Rosie Cooper Excerpts

Tuesday 2nd September 2014 Westminster Hall

[Julie Hilling]

I thank the hon. Gentleman for that intervention. I absolutely agree that we need to do more and I will go on to talk about what the Government should be doing.

[Rosie Cooper (West Lancashire) (Lab)]

Before my hon. Friend gets to that, I congratulate her on securing the debate. Does she agree that with 80% of OSA cases not being diagnosed and the economic and social aspects of that being so dramatic—it costs so much to deal with strokes and heart attacks—we must do more to ensure that the National Institute for Health and Care Excellence regulations are implemented? The Government and the Department of Health cannot walk away from the health and social costs and the costs to the patient.

[Julie Hilling]

I thank my hon. Friend for that intervention. It feels as though she has looked at my speech, because I am going to cover in detail a number of the aspects that she has raised.

OSA can reduce a person’s ability to work and impair the quality of life of the person and their family. The story of Steve, one of my constituents in Bolton West, shows only too well what can happen when OSA is not diagnosed. When Steve was 36, he started to get lots of daytime sleepiness; indeed, he was sleeping all the time. He became very aggressive and went to his doctor, who treated him for depression. The first medication did nothing, and the second medication made him even more aggressive. He managed to maintain his job, but with great difficulty, often having to slope off for a sleep, and he was being threatened with dismissal. He did not have a relationship with his young daughter; between the ages of four and six years old, she had no relationship with her dad at all. He could not play with her or interact with her, except to snarl at her. Indeed, he did not have a relationship with his wife or anyone else at that time. The family went on holiday, but his wife said that she would never go away with him again because he slept the whole time. Eventually, he had to take sick leave from work, and for five months he never left his bed. He was so bad that his wife had to change the bedclothes around him. He had a constant headache and felt worthless as he was not contributing anything to society or his family. He could not eat properly and just could not function. He attempted suicide twice.

Steve was referred to a mental health consultant at Royal Bolton infirmary who immediately asked whether he had been tested for sleep apnoea and he was referred to Wythenshawe sleep clinic. There are three stages of sleep: a top layer, a lower layer and deep sleep. The sleep clinic discovered that every minute and 43 seconds, Steve went back to the top of the sleep cycle and was never getting into a deep sleep. He was given a continuous positive airway pressure—CPAP—machine. He went home, slept for 11 hours and was back at work the next day. Eight years later, he still uses the machine every night and has never looked back. It does have its downsides. He will not go abroad because he has a great fear of electricity cuts and he cannot sleep in the same room as his wife because of the noise of the machine, but he believes that that is a small price to pay for getting his life back. Steve feels like he suffered two years of torture. Let us not forget that sleep deprivation is listed as a proscribed method of torture. However, with a very low cost treatment, he can now function and live life to the full.

My friend’s sister, 52-year-old Jean, also had difficulty in getting her GP to take her issue seriously. She went to him because she was very tired all the time and kept falling asleep in work and on the bus home. She would go to bed and sleep all night, but wake up feeling just as drained and tired. After three visits, her GP started to take her problem seriously and, after running a number of tests with no result, referred her to Wigan infirmary. She got an appointment within three weeks, had her sleep monitored and then got a CPAP machine. It has not solved her problem completely, but it has much reduced the number of times she wakes up and she is able to enjoy life again.

[Julie Hilling]

I thank my hon. Friend for that intervention. She is right. We need to make both the public and medical practitioners aware. Also, we need to ensure that the services are in the right place. I will talk more about that in a moment, but first let me tell hon. Members about one more person. My office manager, Noelene, also surprised me by saying that she suffers from OSA; I never had any inkling that she did. She has an underactive thyroid and was extremely tired and forgetful. She would have no recollection of doing something or no memory of how she had got somewhere. She just blamed her thyroid, but her endocrinologist told her that her thyroid levels were fine and that she could not keep blaming everything on her thyroid. He referred her to his friend the sleep specialist. She collected a monitor that afternoon and less than four weeks later was given a CPAP machine. As the specialist said, if the mask works, it is OSA, and if not, it is something else and they will have to continue to investigate. She had problems with the mask initially and found it very uncomfortable but persevered. She could not get on with the full mask, because, as she said, a full mask and hot flushes are not a great combination, so she tried two other masks and now has a nose mask. Occasionally she does not use it, but immediately feels bad. She is now four years on from diagnosis and treatment.

I guess I am not surprised that I did not know that people had the condition, because snoring and falling asleep all over the place are still treated as a great joke, and the first reaction of most of us when we are told that we snore is immediately to deny it. The cost of undiagnosed sleep apnoea is enormous, however. Up to 80% of cases of OSA remain undiagnosed. Awareness of the condition is poor, and the risks associated with it are underestimated even by doctors. The British Lung Foundation led a three-year project to raise awareness of the condition and to campaign for the setting of quality standards for the treatment and care that OSA patients can expect. The OSA patients’ charter, published in 2012, was designed to do that, and it calls on the Government to prioritise OSA by increasing awareness, ensuring adequate data are collected for good service planning and investing more research into the condition.

Progress has been slow, however. The British Lung Foundation commissioned a report on the health economics of OSA, which will be published later this week, to demonstrate the economic and social arguments for greater focus on, and treatment of, the condition. The report finds that treating OSA can generate direct health benefits to OSA patients, and reduce costs incurred by the NHS, in comparison with not treating the condition. Currently, only 22% of OSA patients are treated across the UK, but increasing diagnosis and treatment rates to just 45% could yield an annual saving of £28 million to the NHS, as well as 20,000 quality-adjusted life years. That includes savings that result from reductions in road traffic accidents, heart attacks and strokes, as well as the positive impact on patients’ quality of life and improved survival rates over time. Other sources suggest that NHS expenditure on undiagnosed patients is estimated to be approximately twice that of people of the same age and the same gender. It is estimated that if everyone in the UK with moderate to severe OSA was treated, approximately 40,000 road traffic accidents could be prevented—accidents that not only affect sufferers of OSA, but cause injury and death to so many others.

The main treatment for OSA, continuous positive airway pressure, is very cost-effective. NICE usually values a treatment as cost-effective if it costs £20,000 to £30,000 per quality-adjusted life year gained, but the main treatment used for OSA costs the NHS only £5,000 per quality-adjusted life year gained. Because OSA is associated with other conditions such as heart disease, stroke and diabetes, some savings may also be made in the reduction of medication for those conditions. A Canadian study found that 38% of patients being treated for OSA reported a reduction in their intake of medicines to manage their other conditions.

What do we need to do? In July 2012, the Department of Health set up a working group on OSA to look at areas for improvement in care and services for the condition. However, the group was disbanded early in 2013 during the NHS restructure, and no one is responsible for taking forward the recommendations from the group’s work. The Department of Health should appoint a body to take forward those recommendations. In 2012, NICE was asked to produce a quality standard on sleep-disordered breathing. That has not been developed, and it should be taken forward as an immediate priority so that those with OSA know what to expect from their care.

Everyone who has symptoms of OSA should be diagnosed quickly and accurately, and they should receive the highest standard of care. That will help to reduce NHS costs and improve patients’ quality of life, and it could reduce the number of road traffic accidents that are caused by sleepy drivers. The level of risk of OSA varies across the UK depending on the prevalence of risk factors, and there is a mismatch between the geographical distribution of need and the regional distribution of services. Local commissioners must ensure sufficient availability of services in areas such as Bolton West that have a high estimated OSA prevalence. OSA screening and specialist referral should be introduced into the quality outcomes framework. Doing so would allow for more accurate data on the number of referrals being made from primary care and provide an immediate financial incentive for early intervention that would reduce costs and improve outcomes in the long term.

Finally, let me return to where I started on my journey of interest in OSA. Those who drive for a living, frequently on monotonous roads and motorways, are at risk of falling asleep at the wheel. Their lifestyle also puts them at increased risk of developing sleep apnoea. Those who fear that they have the disorder are often worried about seeking treatment, because they are concerned about losing their livelihood. I hope that the Minister will support the call of the sleep apnoea partnership group to expedite the treatment of vocational drivers so that they can be driving again within four weeks of referral.

[Rosie Cooper]

Before she reaches the end of her speech, will my hon. Friend emphasise that it makes absolutely no sense not to raise awareness of the condition, diagnose sufferers and provide treatment to improve the health of individuals, save the NHS money and reduce the number of sleep accidents? That is a no-brainer.

[Julie Hilling]

My hon. Friend has kindly done so for me. Clearly, OSA is a major issue, and one that is as serious in Bolton West as it is throughout the UK. The Minister assured me in February 2013 that a model care pathway and service specification to reduce variation in diagnosis and treatment would be developed, but we are still waiting. The time for talking is over. Research has been done and professional groups have informed the Government, so it is now time to take action. I will listen with great interest to the Minister’s response.

--- Later in debate ---

[Norman Lamb]

In accordance with the request of the hon. Member for Sheffield, Heeley (Meg Munn), I will write to the Health and Safety Executive. She made a good point, and I am happy to raise it directly with the HSE. Those are serious issues, and they deserve to be taken seriously.

The case studies provided by the hon. Member for Bolton West clearly demonstrated the benefit of accessing treatment, and the impact that treatment can have on someone’s life. I agree with the hon. Member for somewhere near Liverpool—

[Rosie Cooper]

West Lancashire.

[Norman Lamb]

I apologise; I agree with the hon. Member for West Lancashire (Rosie Cooper) that that is a no-brainer. As other hon. Members have said, we must raise awareness and understanding not only among the general public but among clinicians and general practitioners, because a problem with diagnosis may arise because a GP does not recognise the need for a referral. As the hon. Member for Strangford (Jim Shannon)—I think I have got his constituency right, at least—has said, we must work with the devolved Administrations and ensure that we raise awareness of the condition across the United Kingdom.

As the case studies demonstrate, OSA can have a huge impact on the quality of life of those who suffer from the condition and their families, which the example of Steve demonstrates so graphically. OSA can contribute to other long-term health conditions, such as high blood pressure, stroke, diabetes and, critically, mental health issues. The hon. Member for Bolton West made a point about Steve contemplating suicide, and we often forget about the close connection between many long-term conditions and the mental health issues that can go with them. People suffer depression because of an inability to escape their condition.

As we have heard, OSA can also lead to serious, even fatal, accidents. The statistic that there may be 40,000 preventable road traffic accidents is extraordinary. The issue is driver fatigue. Sleep apnoea sufferers are thought to be seven times more likely to cause crashes than drivers without the condition. The challenges posed by OSA should not be underestimated. In the UK it is thought that some 4% of middle-aged men and 2% of middle-aged women suffer from OSA, which in many cases requires lifetime treatment of the sort described by the hon. Lady. A further complication is that, as she describes, OSA is often left undiagnosed because people with the condition usually have no memory of some of the key symptoms, such as interrupted breathing during sleep, so they may be completely unaware that they have a problem unless a partner happens to raise it with them.

The NHS outcomes framework for 2014-15 sets out the Department’s priority areas for the NHS and includes reducing deaths from respiratory disease as a key indicator. Additionally, the mandate sets out the requirement for NHS England to improve outcomes in a range of areas, including preventing premature deaths from the biggest killers, which include respiratory illnesses, and supporting people with long-term physical conditions such as sleep apnoea. Incidentally, it will be interesting to see the economic impacts that the report will set out. I am happy to take that up with the national clinical director, too.

Our “Living Well for Longer” report, which was launched in April 2014, sets out what the health and care system will do to achieve the Government’s objective to be among the best in Europe at reducing levels of premature mortality. The report brings together in one place the national actions taken by the Department and the wider Government, NHS England and Public Health England on prevention, early diagnosis and treatment, focusing on the five big killers, including lung diseases, and showing how they will support local leadership and interventions.

Local clinical commissioning groups are responsible for assessing the needs of their local populations and for commissioning services to meet those needs. For patients with OSA, NHS England expects CCGs to take the NICE guidelines into account when deciding what services should be made available. NICE has recommended continuous positive airway pressure as a treatment option for adults with moderate or severe symptomatic OSA or hypopnoea syndrome, where certain clinical criteria are met. NHS commissioners are legally required by regulations to fund that treatment, where clinicians wish to use it.

Continuous positive airway pressure is currently the only technology recommended for OSA in NICE technology appraisal guidance. The hon. Lady mentioned a referral to NICE for a quality standard, and I am happy to write to NICE. She will understand that NICE is independent, and it is important to respect that independence, but I am happy to ask NICE where that issue is in the work stream of quality standards that are waiting to be addressed. That work will be completed by 2017, which is the long-stop date. I will check, and I am happy to write to her to confirm the position.

Although it is not always possible to prevent OSA, making certain lifestyle changes may reduce a person’s risk of developing it. Those changes include losing weight, limiting alcohol consumption and stopping smoking. The Government are acutely aware of the damage being done to the population’s health through smoking and harmful drinking, which is why we have set out clear ambitions for driving down the prevalence of smoking and reducing the incidence of alcohol-related disease in our tobacco control plan and our alcohol strategy respectively.

We have ensured that NHS health check, a key programme to address systematically the top seven causes of preventable mortality, includes identifying and helping people to take action to quit smoking, maintain a healthy body weight and reduce alcohol consumption. All those issues, of course, have an impact on a range of conditions, including vascular dementia and heart disease, but they are also relevant to sleep apnoea, and we ought to be doing more to address the issues that could prevent the condition.

Through the responsibility deal, we are actively working with business to take voluntary action on calorie reduction and food labelling to help people make healthier eating choices. That is already delivering change and making a real difference. The Change4life social marketing campaign is encouraging individuals to make simple changes, such as reducing their calorie consumption and being more active. One of the key challenges in tackling OSA, as several hon. Members have said, is raising awareness of the condition. It can be difficult for sufferers to detect OSA themselves, and it often goes undiagnosed as a result. In fact, it is estimated that in this country up to 3% of adults across all age groups have undiagnosed OSA, which is an extraordinary number. There are then the associated accidents.

Surveys carried out by the British Lung Foundation in 2011 and 2014 to measure awareness of OSA show that awareness of the condition has risen significantly, which we should applaud. Awareness has especially risen among men, who are most at risk, and in areas with a high risk of OSA. I pay tribute to the British Lung Foundation, which has worked collaboratively with the hon. Member for Bolton West, and the important work of its obstructive sleep apnoea project that aims to improve diagnosis and raise awareness of the condition. The project’s successes include the largest survey of OSA sufferers ever undertaken, a UK-wide mapping tool of sleep services and prevalence of known OSA risk factors and a media campaign that reached at least 48 million people.

It was a privilege for me to attend the recent opening of the Breathe Easy North Norfolk group. Breathe Easy groups have the potential to be incredibly powerful, and they are run by their members with help and support from the British Lung Foundation. Breathe Easy groups provide support and information to people living with a lung condition, as well as those who look after them.

Those are all examples of highly valuable initiatives led by the British Lung Foundation that have a huge impact on the lives of a great number of OSA sufferers in the UK. The effects of sleep apnoea are potentially devastating, and the condition affects thousands of people in this country, many of whom are not aware of the problem even when they are feeling its effects. It is vital that the NHS continues to work hard not only to reduce the number of premature deaths from all respiratory illnesses, including OSA, but to support people with long-term conditions better, regardless of where they live. I assure the hon. Lady that the Government will continue to work hard to improve outcomes for all those in society who have, or are at risk of, a long-term condition such as sleep apnoea.

I reiterate the point made by other hon. Members that the analysis of the economic case demonstrates that much better preventive work ultimately saves money, as well as having a massive impact on individual lives. I strongly feel that we need a shift of emphasis to focus much more on prevention.

Hospital Car Parking Charges

Rosie Cooper Excerpts

Monday 1st September 2014 Commons Chamber

[Nic Dakin]

My hon. Friend makes a sound point. The hon. Member for Cleethorpes (Martin Vickers) and I represent rural areas as well, so the point is well made and well received.

[Rosie Cooper (West Lancashire) (Lab)]

Everybody in the House wants free car parking at hospitals now, but what does my hon. Friend think we can do in the interim to ensure that hospitals stop private car parking companies targeting the disabled and those who arrive in emergency situations? None of that will stop now without proper enforcement.

[Nic Dakin]

I very much agree with my hon. Friend. I am sure that the Minister and the shadow Minister will take that point on board and listen to the other points that have been made in the debate. That will put pressure on hospital trusts to respond positively to the point that she has made.

Francis Report

Rosie Cooper Excerpts

Wednesday 5th March 2014 Commons Chamber

[Andy Burnham]

I do support that campaign, because I think that we need transparency so that local people can see whether their hospitals have enough staff. I also support the full integration of health and social care into a single service—an even deeper integration than a pooled budget—because I believe that that is the only way in which we will build a service based on the individual. We need a system in which all the needs of one person are clear and the service can start in the home, rather than this fragmented world in which care in the home is being cut and older people are being left at ever greater risk of hospitalisation.

I find it worrying that Government Members seem to be in denial about what I have been saying, and that brings me to the central point that I want to make. I believe that the Government have mishandled their response to the Francis report, and I shall cite three examples in support of my claim. First and most obviously, the Government have failed fully to implement 88 of the report’s recommendations, as they have themselves acknowledged. Secondly, Stafford hospital has, in my view, been hung out to dry. Thirdly, by overtly politicising the whole issue of care failure, the Government have created a climate of fear throughout the NHS—the worst possible response to what Francis said.

It seems to me that the Government have missed the entire point of the Francis report. If we distil the report into a few words, it called for a culture change. A range of measures were proposed with the aim of achieving that change, including a duty of candour for individuals and organisations, regulation of health care assistants, and, crucially, moves to strengthen the patient voice at local level by giving Healthwatch more protection and prominence. Francis recommended that local authorities be required to pass centrally provided funds to local Healthwatch groups, but that recommendation was not accepted. Of the £43 million allocated by the Department last year, HealthWatch groups have received only £33 million, which leaves £10 million unaccounted for. The Patients Association has said that

“vital recommendations have not been accepted and…patient care could suffer as a result.”

We support measures that the Government are introducing in the Care Bill on the appointment of chief inspectors, but let us be clear: they were not recommendations of the Francis report, and, if we are not careful, they will risk reinforcing a much more top-down approach to regulation. The position is not helped, I might add, by the Secretary of State’s new habit of calling hospital chief executives directly himself. Indeed, one of the great ironies of the Government’s reorganisation is that it has left the NHS a more top-down organisation than it was before, with clinical commissioning groups yet to find their voice and NHS England calling all the shots.

Let me quote from the Nuffield Trust’s report, entitled “The Francis Report: one year on”. In his foreword to the report, Francis himself says:

“Perhaps of most concern are the reports suggesting a persistence of somewhat oppressive reactions to reports of problems in meeting financial and other corporate requirements. It is vital that national bodies exemplify in their own practice the change of cultural values which all seem to agree is needed in the health service.”

Robert Francis himself says that national bodies are still behaving in a top-down fashion—one year on.

[Rosie Cooper (West Lancashire) (Lab)]

What with NHS England, the NHS Trust Development Authority, the Care Quality Commission, Monitor, clinical commissioning groups and the Department of Health, is the NHS not in danger of having no clear lines of responsibility? There appears to be no clarity when it comes to who is enforcing good quality of care across the NHS. Is not the use of human resources practice to bully staff one example of something that may fall through the gaps between those various organisations?

[Andy Burnham]

My hon. Friend has raised an important point. People are confused about the new NHS, and confused about who has responsibility for what. The Government have created more organisations, not fewer; the NHS is more top-down than it was before; and that is not changing the culture. Robert Francis himself has said that the culture is not changing. The Government are utterly complacent if they think that they have got everything sorted out.

Dermatology Funding

Rosie Cooper Excerpts

Wednesday 4th December 2013 Westminster Hall

[Rosie Cooper (West Lancashire) (Lab)]

It is a pleasure to serve under your chairmanship for this afternoon’s debate, Mr Turner. I congratulate the hon. Member for Gainsborough (Sir Edward Leigh) on securing this important debate, which will be relevant to the 13 million people who present each year with skin problems, and their families.

I want to focus on psoriasis, on the often under-appreciated burdens that its sufferers bear, which go beyond the effect on their skin, and on the barriers to their getting the best care. On 1 November, I chaired a summit in west Lancashire, where seven of my constituents with psoriasis met the award-winning dermatology team at Ormskirk hospital, as well as some local GPs and the west Lancashire clinical commissioning group. I learned how psoriasis affects people, beyond the plaques on their skin, and the changes that we need to make to secure the high-quality care that my constituents and other psoriasis sufferers deserve.

Psoriasis is a terrible and lifelong condition. I have observed it through a personal connection, because after my mum died my father, who was 62, developed psoriasis. The Psoriasis Association tells me that the average member has been living with psoriasis for 32 years. The personal toll of living with the disease and its cumulative impact, which commits people to lifelong skin care, is enormous. The effects are felt beyond the individual and reach to people’s families, employment prospects and participation in society. The painful plaques are highly visible, which leads to rejection and stigma on top of everything else. Worse, 40% of people with severe psoriasis will develop psoriatic arthritis, which can lead to more pain as well as joint damage.

Psoriasis is also associated with mental health problems. It affects the skin and the joints, as well as people’s psychological well-being and life expectancy. Research has shown that the cumulative impact of psoriasis on people’s quality of life can be as significant as that of type 2 diabetes. One person in 10 with psoriasis considers suicide. I met such a person at the summit and it was heartbreaking to hear how the condition had affected her life. That is the most extreme end of the condition, but it shows the devastating impact that psoriasis can have on people’s lives.

Many positive things are happening for people with psoriasis, including the recent publication of the National Institute for Health and Care Excellence quality standard on psoriasis, which gives guidelines on treatment. The national standard constitutes progress, but the Psoriasis Association called it a

“minimum standard, not a gold standard”.

Psoriasis care is not always up to that standard. In some areas, even achieving the minimum standard is, sadly, an aspiration.

To an extent, the degree of understanding and appreciation of the full effects of psoriasis has a direct consequence on the funding of services. Despite the fact that 13 million people present with skin problems each year and that 15% of GPs’ time is spent managing patients with skin conditions, there is still a lack of understanding, even within the medical profession, about dermatology. I have been contacted by a consultant dermatologist who believes that dermatology has been neglected in medical schools and in GP training, so that GPs are often ill-equipped to deal with the variety, complexity and volume of cases. We need more specialist education for people such as GPs who look after patients when they are not in the care of the dermatology team.

--- Later in debate ---

On resuming—

[Rosie Cooper]

Figures provided to me show that 180 dermatology consultant posts in the UK are unfilled, out of a total of 830. In Ormskirk, the dermatology service struggles to attract doctors to fill full-time roles. It has a work load roughly equivalent to that of nearby St Helens, but whereas St Helens has seven consultants, Ormskirk has two. We also need specialist nursing capacity and more space in the department. Nearby services have several light-therapy machines, but Ormskirk has only one, so my constituents have to wait six or eight weeks for treatment—once they have had their referral, and on average there is an eight to 12-week wait just to be seen by a specialist. Ormskirk is an award-winning service, yet the team there do not have the resources they need.

A 2008 audit showed wide variations in treatment. Access to specialist treatments such as biologic drugs, specialist nurse support and psychological services is sporadic throughout the country. Access to psychological support is a major theme of the new quality standard for people with psoriasis, yet 80% of the 170 dermatology departments that responded to the 2013 BAD audit of services reported having no access whatever to psychological support for patients.

We know from research that early intervention and appropriate treatment for psoriasis will contribute to a person’s psychological well-being and ability to continue in the working environment. It really is not enough simply to treat the skin. I have seen pioneering dermatology services where patients have access to a resident psychologist as a routine part of their treatment. I want and need that level of support for my constituents. I hope that the Minister will encourage commissioners and dermatology services across the country to look at the evidence base and adopt that model.

That does not mean that we need to find a magical pot of new money; it means using existing tools to incentivise what works best. That could even save money in some cases. Commissioning groups are held to account through the outcomes indicator set; will the Minister encourage the National Institute for Health and Care Excellence to develop indicators covering dermatology? As in other areas, in dermatology we need better co-ordination between primary and secondary care; will the Minister encourage NICE to create a quality and outcomes framework indicator on dermatology, to incentivise that? Eventually, it would be great to see a best practice tariff or a national CQUIN—commissioning for quality and innovation—payment framework for psoriasis. At the moment, dermatology is such a Cinderella service that that seems ambitious, but we must aim for it. We need central clinical leadership to push dermatology up the agenda, to promote quality improvement and to reduce local variation.

Perhaps the Minister will tell us why, when other specialists are getting going with their strategic clinical networks and have plenty of clinical leadership from the centre, dermatology does not even have a national clinical director. From a response to a written question back in May, I learned that NHS England does not have a single person responsible for dermatology. Will she tell us whether that is still the case? We must recognise the burden that psoriasis places on people’s lives and ensure that dermatology services are properly joined up and properly funded. I hope that the Minister will task NHS England with making that happen.

Finally, will the Minister join me in congratulating the Psoriasis Association on a very successful psoriasis awareness week last month? The members have created a booklet, “I wish someone had told me…”, which is full of practical advice, and I recommend it to anyone suffering from the condition. We must all work together to provide a quality service for all patients with skin conditions, particularly psoriasis.

Oral Answers to Questions

Rosie Cooper Excerpts

Tuesday 26th November 2013 Commons Chamber

[Mr Hunt]

We have to make the GP profession attractive to younger GPs as well. The money we save from getting rid of seniority pay will go back into practices, but it should not be given to people just for length of service; it should be related to quality of service too, which will make the GP profession much more attractive.

[Rosie Cooper (West Lancashire) (Lab)]

5. What recent assessment he has made of ambulance handover times at accident and emergency departments.

[The Minister of State, Department of Health (Norman Lamb)]

Patient handover is a key part of delivering good emergency care. Systems are in place to ensure efficient handover, but we recognise that it sometimes takes longer than the recommended 15 minutes, particularly during peaks of demand. We are taking the issue of handover delay seriously, which is why we have introduced financial sanctions for unacceptable delay.

[Rosie Cooper]

Southport and Ormskirk hospital in my constituency has one of the longest handover times in the north-west, with ambulances queuing outside the hospital and patients lying on stretchers for hours. How does that offer the patient-centred care and dignity that the Government keep promising but failing to deliver? What can the Minister do to make it better for my constituents?

[Norman Lamb]

That sort of experience is not acceptable and has to be addressed, and I am sure the hon. Lady will welcome the encouraging news that the sanctions in the national contracts that clinical commissioning groups enter into with hospitals have resulted in a 38% reduction in delays, comparing the first two weeks of last November with the first two weeks of this November, which is the first period during which we measure winter pressures on handovers. That sign of a significant increase is to be welcomed.

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

My hon. Friend makes an important point, and I hope that he will be reassured that under the current Government, clostridium difficile and MRSA rates are both about 50% lower than they were under the previous Government. We will continue to make sure that we reduce unacceptable hospital infections.

[Rosie Cooper (West Lancashire) (Lab)]

T2. Following Francis and Keogh, and in creating a more open and accountable NHS, will the Secretary of State, in the spirit of total transparency that he favours, order foundation trusts to publish all their board papers, have exactly the same publishing requirements as non-FTs, and hold all their board meetings in public?

[Mr Jeremy Hunt]

I absolutely encourage that transparency. In fairness, the hon. Lady will accept that this Government have done more to improve transparency in the NHS than any Government have ever done. I would encourage all FTs to be transparent about their board meetings, but they are independent organisations, and we have learned—[Interruption.] Well, this was legislation that her Government introduced, and we have learned that it is important to give people autonomy and independence, because they deliver a better service for patients.