Child and Adolescent Mental Health Services

Sarah Newton Excerpts

Monday 2nd February 2015 Commons Chamber

[Norman Lamb]

I would be happy to provide as much information as possible—I have no need to keep anything secret and I would like to assist as much as I can. Again, I caution that children and young people turning up in police cells has been happening, quietly and unnoticed, for a very long time, but the truth is that the numbers are coming down. That is good, but I want it to stop altogether.

[Sarah Newton (Truro and Falmouth) (Con)]

The Minister has been supportive of my work to secure specialist adolescent mental health services in Cornwall. When he next comes to Cornwall, will he meet me and local commissioners to see how we can benefit from new money and plans that have been communicated today?

[Norman Lamb]

If the diary allows I am certainly up for that, and I pay tribute to the hon. Lady for the work she has done in her county in trying to improve children’s mental health services. We must do that across the country, and there are many examples of real and significant improvements.

NHS Major Incidents

Sarah Newton Excerpts

Wednesday 28th January 2015 Commons Chamber

[Mr Hunt]

I have great respect for the hon. Lady, so I hope she will understand this: when people are worried about political influence over operational guidance, I do not then issue some political guidance. The only thing that I, as Health Secretary, say in respect of instructions going out is that patient safety must always be the priority, and that is what I have said time after time. But then the actual decision about whether to declare a major incident must be taken by people locally. Julie Moore, the chief executive of UHB, is fantastic and absolutely able to make those decisions, and those decisions should not be second-guessed by politicians.

[Sarah Newton (Truro and Falmouth) (Con)]

Does my right hon. Friend agree that it is really important to let NHS England’s local teams—in our case the Devon and Cornwall area team—make decisions with local leaders of hospitals? So many people in the north of Cornwall live closer to Derriford in Devon than they do to Treliske in my constituency. It is only right that NHS England staff closest to the clinicians make those decisions.

[Mr Hunt]

That is absolutely right, but Members on the two sides of the House hold different views. We believe in devolving power locally and we want local decision-making. We accept that that might mean that sometimes services are slightly different in one part of the country compared with another, but the benefit is that we do get that local knowledge. In the past few weeks, I have spoken to South Western ambulance service, which had particular pressures over Christmas, to ask whether there is anything we can do from the centre. What I want to ensure is that the decisions that keep my hon. Friend’s constituents safe are made locally, because they are likely to be better than any that I could make in Whitehall.

National Health Service

Sarah Newton Excerpts

Wednesday 21st January 2015 Commons Chamber

[Andy Burnham]

I said that I am going to make progress.

Today’s Age UK survey finds that the number of over-65s receiving care has fallen by 380,000 under this Government. Half of the 1 million people who struggle to wash or bathe now get no help at all. Two thirds of the 250,000 people who struggle to feed themselves every day are now left to fend for themselves. There are over 100,000 fewer day care places and over 50,000 fewer people getting meals on wheels. Age UK says:

“Our state-funded social care system is in calamitous, quite rapid decline.”

But worse, it is dragging down the NHS.

[Sarah Newton (Truro and Falmouth) (Con)]

Will the right hon. Gentleman give way on that point?

[Andy Burnham]

In a moment. I said that I had given way for the last time, but I will do so once more for the hon. Lady.

Record numbers of very frail, elderly people are arriving at A and E due to a lack of support in their own homes. Between 2009-10 and 2012-13, there was a 48.1% increase in the number of people aged over 90 being admitted to A and E via blue-light ambulance—in other words, 100,000 very frail, very frightened people in the backs of ambulances going round our towns and cities to be dropped off at a busy A and E. That is what is happening on this Government’s watch.

[Sarah Newton]

Today’s Age UK report contains aggregated England data. Does the right hon. Gentleman not agree that all over our country there are councils integrating social care with the NHS, and, indeed, increasing their social care budgets? Does he not recognise the good work that is going on in the integration pilots in Cornwall, for example?

[Andy Burnham]

I have repeatedly praised Torbay council in the hon. Lady’s part of the world, which was the well regarded pioneer of integrated care. Yes, there are examples of councils around the country trying to do the right thing, but let me make two points: first, the Torbay model has been broken apart by the Health and Social Care Act; and, secondly, councils are trying, but they have been battered by the massive cuts to their budgets about which Age UK is warning today, and which are setting back the cause of integration.

The reality is that elderly people are going into A and E and getting trapped there. As I have already mentioned, there is the sad case of an elderly women in Lincoln who spent an entire calendar year in hospital because a care home place could not be found. That is simply wrong on every level, and it is unsustainable in human and financial terms. The collapse of social care is a root cause of the current A and E crisis because it has led to increased pressure at the entrance door of the hospital, and to the exit door becoming blocked.

For those who still get some support, 15-minute visits are becoming the norm. Richard Hawkes, chairman of the Care and Support Alliance, has said that A and E

“is forced to pick up the pieces when people become isolated, can’t live on their own and slip into crisis.”

My last question to the Secretary of State is: does he agree with Richard Hawkes that cuts to social care have contributed to the extra 600,000 people who now attend A and E every year?

The evidence is clear: on NHS 111, on walk-in centres, on GP services, on social care—this is a mess of the Government’s making. I am sure that the text of the Secretary of State’s speech is full of the usual spin and self-serving excuses, but he must not sit down until he answers directly the four questions I have put to him, not for my benefit, but so that he does not insult the intelligence of the people watching. He is in charge, not me. People are looking to him for answers and solutions, so let me give him some in the time I have left.

As I have said, let us get nurses back on the end of the phones at NHS 111, and let us have a review of the 111 service. I hear that contracts are about to be signed—for instance, to take a contract off an ambulance service—and they will extend this flawed model of care. Will the Secretary of State intervene to stop those contracts being signed until there has been a proper review?

Will the Secretary of State review the plan to relax ambulance response times in the pilot? That is surely the wrong response during this very difficult winter. Is he absolutely convinced that now is the right time to experiment with relaxing established standards? Does it not make sense to delay it until a quieter time of the year, and not to do it in the most troubled ambulance service in the country?

On walk-in centres, would not one of the simplest things the Secretary of State could do to stop the A and E situation getting worse be to commit to halt any further closures? We know that walk-in centres in Jarrow, Nuneaton and Chelmsford are under threat. Would it not help everybody if he just removed that threat today? On GP services, has he considered putting a GP in every A and E?

--- Later in debate ---

[Kevin Barron (Rother Valley) (Lab)]

It is a pleasure to speak in the debate, and to follow the hon. Member for Norwich North (Chloe Smith).

My hon. Friend the Member for Dudley North (Ian Austin) mentioned private health insurance. In America, 80% of the population have great health care through private health insurance, but for the many people who cannot afford any private health insurance and rely on charity, it degrades very steeply. My parents used to have to rely on charity in the 1930s in this country. If any so-called political party is talking about returning to health insurance, I have to say that people will get what they can afford and the bulk of people will get very little. What Nigel Farage said the other day was completely consistent with UKIP’s 2010 manifesto— I have a copy of it.

I want to talk briefly about the pressures on accident and emergency. It is no coincidence that when the economy is being run more “efficiently”, as I think the hon. Member for Norwich North put it, through cuts and austerity, there will be an effect on services. Figures from an Age UK report that came out this week show that despite rising demand from growing numbers of people in need of support, the amount spent on social care services for older people has fallen nationally by £1.1 billion, or 14.4%, since 2011, even accounting for additional funding from the NHS, and by a total of £1.4 billion, or 17.7%, since 2005-06. That is quite a large cut.

According to the Health and Social Care Information Centre, between 2010-11 and 2013, the number of older people receiving home care fell by 31%, from 542,000 to 370,000; the number of day care places plummeted by 66.9%, from 178,000 to 59,000; and the number of older people receiving vital equipment and adaptations to help them remain safely at home dropped by 41.6%. This is the austerity that the people on the Government Benches say our economy needs.

[Sarah Newton]

rose—

[Kevin Barron]

In a few minutes—let me get to my third page, and I will gladly give way.

Spending on home care has dropped since 2011 by 19.4%, from £2.2 billion to £1.8 billion, while the amount spent on day care has fallen even more dramatically, by 30%, from £378 million to £264 million.

[Sarah Newton]

I read the Age UK report with great interest, but the data, which the hon. Gentleman has cited, is aggregated information from across England. Not all local authorities are cutting social care. Some really good local authorities are coping with the reductions in funding from central Government, prioritising the needs of the most vulnerable people in their communities and finding innovative ways of working with the NHS and the voluntary sector to improve the self-reported well-being of the people they serve. It is not the blanket situation across the UK that he describes.

--- Later in debate ---

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

The NHS across the UK, including urgent and emergency care services, is facing enormous challenges. By the end of this Parliament, there will be nearly 1 million more over-65s than there were at its start, which means substantially more patients with more complex health needs, but such pressures are not unique to England. All hon. Members need to think very carefully about how we pursue the debate on the challenges and pressures that the NHS is facing. Patients and the NHS do not need or want cynicism and party point scoring. My right hon. Friend the Member for Chelmsford (Mr Burns) and my hon. Friend the Member for Cambridge (Dr Huppert) were absolutely correct to make that point.

[Sarah Newton]

Does my right hon. Friend agree that the pioneer programme in Cornwall is really leading the way, with the provisional results showing a 41% reduction in A and E and in-patient visits?

[Norman Lamb]

My hon. Friend makes a very good point. The Cornwall pioneer programme is doing the most amazing work making innovative change, involving Age UK alongside local doctors, and it is delivering real results.

Why does the Labour party make constant claims that the NHS in England is in crisis, when the position is so much worse in Wales, where Labour is in power?

Contaminated Blood

Sarah Newton Excerpts

Thursday 15th January 2015 Commons Chamber

[Sarah Newton (Truro and Falmouth) (Con)]

I am grateful to my colleagues inside and outside Parliament for working so effectively with the victims of blood contamination and raising these matters so effectively. Without their support, I would not be here—I would not have found out about this issue—so I am grateful to them. I also wish to recognise the work of my hon. Friend the Member for Guildford (Anne Milton) while she was Health Minister. I know also that the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), takes a great interest in this very important subject, and I am particularly pleased that the Prime Minister has indicated that he now wants to take action. I am sure that the work of the Minister and the all-party group will be listened to very carefully by the Prime Minister as they come together to find out what further action can be taken.

I will not go over all the salient points from the findings of the inquiries and the all-party group as they have already been discussed. One of the most important roles of a Member of Parliament, and one that I take very seriously, is to give a voice to the voiceless. In my brief contribution today, I want to do just that for one of my constituents. In a letter to me, she said:

“I would be incredibly grateful if you had the opportunity to express my hurt and disappointment and help strengthen the case for better treatment of others. My name being spoken publicly terrifies me, especially as I in the past have been subject to such ill treatment by the NHS and the court system.”

My constituent contracted hep C as a result of a blood transfusion shortly after giving birth to her son. Sadly, her hep C was not detected until 2004. She has received some help from the Skipton Fund. I do not have time to catalogue the sequence of poor treatment that she has received and her continuing fear for herself and her children. She says:

“At this point in time, none of my three children has been checked for hep C. It is a bridge, they say, they don’t yet want to face. I worry…To try and quantify how this has affected my life would be near impossible. Perhaps with this inquiry, the Government will make sure that those affected have what’s left of their futures made easier.”

Today, in this place, we must make sure we do that.

A and E (Major Incidents)

Sarah Newton Excerpts

Wednesday 7th January 2015 Commons Chamber

[Mr Hunt]

I am aware of those proposals, which we will obviously look at carefully. I am also aware that there are big pressures in the A and E department at Medway, but there are also other, more profound issues to do with the leadership at the hospital. The hon. Gentleman should rest assured that we are taking every step possible to try to turn things around.

[Sarah Newton (Truro and Falmouth) (Con)]

I recently spent a shift at the Royal Cornwall hospital’s A and E department and saw at first hand the fantastic work it is doing. Does my right hon. Friend agree with the clinical team and with Mr Virr, who leads the department so well, that people need to remember that A and Es are for life and limb emergency treatment on the day and that they should consider the excellent alternatives, such as minor injuries departments and out-of-hours GP services, before automatically going to A and E?

[Mr Hunt]

I commend my hon. Friend for her tremendous interest in the Royal Cornwall hospital and for her campaigning to support its efforts. I spoke with the chief executive earlier this week about the particular challenges with discharging patients. I also spoke with the deputy chief executive of the South Western Ambulance Service NHS Foundation Trust about the dramatic increase in 999 calls this winter. My hon. Friend is absolutely right that the public can help us by ensuring that they use alternatives to A and E wherever possible.

UK Ebola Preparedness

Sarah Newton Excerpts

Monday 5th January 2015 Commons Chamber

[Mr Hunt]

The right hon. Gentleman is absolutely right. Peter Piot is a remarkable man who came to Downing street to advise the Prime Minister and me early in the development of the Ebola crisis. He is well worth listening to on this subject.

The right hon. Gentleman also makes a good point in that the global response to Ebola was far from adequate. The World Health Organisation has some important lessons to learn, and tomorrow my right hon. Friend the Secretary of State for International Development and I will meet Margaret Chan, when we will no doubt talk about those lessons. In an era of globalised travel, it is important that we have a much faster and more effective response when we have outbreaks of deadly viruses.

[Sarah Newton (Truro and Falmouth) (Con)]

Will my right hon. Friend join me in thanking the staff of the Royal Cornwall hospital who treated someone returning from Sierra Leone with great professionalism, caring and compassion? Will he reassure me and those staff that, as well as those arriving back from west Africa by plane or train, those arriving back into our ports by ship are effectively screened?

[Mr Hunt]

I am happy to pass on my thanks to the staff of the Royal Cornwall—in fact, I spoke to someone from that hospital this morning and I know that they are very focused on this issue, as are all NHS hospitals. We have introduced information at all ports and, where necessary, screening. My hon. Friend makes an important point—it is never actually possible to put every single person through a screening process. We are one of the most open economies in the world and people constantly come in and out of the UK. We depend on public knowledge, so that people who have been to the affected areas know to present themselves to get immediate assistance if they develop any feverish symptoms.

NHS (Five Year Forward View)

Sarah Newton Excerpts

Monday 1st December 2014 Commons Chamber

[Mr Speaker]

Order. I am keen to accommodate as many colleagues as possible on this extremely important set of issues, but may I appeal to colleagues to exercise a certain self-denying ordinance, whether they are speaking from the Back Bench or the Front Bench?

[Sarah Newton (Truro and Falmouth) (Con)]

I welcome today’s announcement of the national sepsis prevention campaign, which will make a such a difference to people in Cornwall and all around the UK. Will my right hon. Friend continue to work with the all-party group and the UK Sepsis Trust to implement the sepsis six, which it is estimated will save 12,500 lives and £2 billion for the NHS every year?

[Mr Hunt]

Yes, I will. I have to say to the House that the importance of being better at tackling sepsis was brought home to me personally by two moving meetings with Scott Morrish, the father of Sam Morrish, who was from the west country—perhaps near my hon. Friend’s constituency. His son’s tragic death from sepsis was avoidable, so this is an absolute priority for me in the next couple of months.

Oral Answers to Questions

Sarah Newton Excerpts

Tuesday 25th November 2014 Commons Chamber

[Mr Hunt]

I am happy to arrange a meeting between either me or one of my Ministers and members of the APPG to discuss the matter. I stress that we recognise how important those specialised services are. We want to get the benefits of nationally co-ordinated commissioning with the local integrated care that CCGs are in the driving seat to deliver. That is why we are having this discussion.

[Sarah Newton (Truro and Falmouth) (Con)]

T2. Public Health in Cornwall has estimated that 300 people in Cornwall might die from the cold this winter because they are living in cold homes. Last week the Government introduced the first proper fuel poverty strategy to eradicate that totally unacceptable situation by 2030. Will my right hon. Friend join me in praising the work being done in Cornwall by a partnership of over 30 organisations in the Winter Wellness programme to ensure that people stay warm and well this winter?

[Mr Speaker]

Order. On both sides of the House the questions have been too long. It is not fair on other Members who are waiting to contribute. Please cut it out.

Sepsis (Preventable Deaths)

Sarah Newton Excerpts

Tuesday 14th October 2014 Westminster Hall

[Sarah Newton (Truro and Falmouth) (Con)]

It is a great pleasure to serve under your chairmanship, Sir Edward, and it is a great honour to raise such an important issue with one of the Ministers with some responsibility for sepsis.

Before I outline the detail of my argument, I will share the scale of the challenge caused by sepsis. It is no exaggeration to say that sepsis is a hidden killer that claims more than 37,000 lives across the UK annually. Sepsis accounts for a third of the UK’s critical care expenditure, and it is the leading cause of death from infection here in the UK and across the world, but it can be stopped. An average constituency in the UK will have 140 cases of severe sepsis each year, resulting in more than 50 deaths. Simple interventions could cut those deaths by more than 50%. Timely interventions across the NHS could save 12,500 lives and £170 million each year with minimal budgetary requirements. Scotland and Wales have adopted the “sepsis six” and have better outcomes for patients than England.

So what is sepsis? Sepsis is a time-critical condition that can lead to organ damage, multi-organ failure, septic shock and, eventually, death. Sepsis is caused by the body’s immune response to a bacterial or fungal infection. It commonly originates in the lungs, bowels, skin, soft tissues or urinary tract. Rarer sources include the lining of the brain, liver or indwelling devices such as catheters. In a patient with sepsis, changes in circulation reduce the blood supply to major organs such as the kidneys, liver, lungs and brain, causing them to begin failing. Although most dangerous in those with impaired immune systems, sepsis can cause death in young and otherwise healthy people.

In my role as co-chair of the all-party group on sepsis, I have had the great pleasure of working with the UK Sepsis Trust, which is a registered charity comprising ex-patients and people bereaved by sepsis. In addition to raising awareness and providing support to members of the public affected by sepsis, the trust supports the actions and campaigns of its associated voluntary professional body, the UK Sepsis Group. Health professionals led by Dr Ron Daniels of the UK Sepsis Trust have identified simple, timely interventions and procedures, labelled the “sepsis six,” as a standard of care for sepsis patients when delivered within one hour. Early sepsis treatment is cost-effective, reducing hospital and expensive critical-care bed days for patients, and will save thousands of lives.

[Mr Jim Cunningham (Coventry South) (Lab)]

I am finding this information illuminating. I did not realise that 12,500 people a year are dying of sepsis. Will the hon. Lady indicate whether that figure is increasing or decreasing?

[Sarah Newton]

I thank the hon. Gentleman for his helpful intervention. The figures are, of course, estimates, but they are well founded estimates from clinical leads. As I will say later, the problem is that sepsis is poorly recorded, especially within acute trusts. We do not currently have a full picture of the number of people who are dying of sepsis. Often, the cause of death is registered as a result of sepsis, rather than from sepsis itself. Without the collection, mapping and use of accurate data, it is difficult to target interventions where they are most needed. The information I have been given is based on good, up-to-date evidence from clinical experts.

The hon. Gentleman is right to say that the scale of the challenge that we face is shocking. That is why I decided to work with the UK Sepsis Trust to set up the all-party group on sepsis in November 2013, following a successful reception for world sepsis day, and many parliamentarians on both sides of the House have been involved. At the same time, the Parliamentary and Health Service Ombudsman published her first report on the treatment of a particular condition. The ombudsman felt so strongly that we were not addressing sepsis in hospitals that she undertook research and published a report. That report, “Time to act. Severe sepsis: rapid diagnosis and treatment saves lives”, was truly groundbreaking, and it highlighted the number of preventable sepsis deaths and advocated swifter sepsis diagnosis and treatment across the NHS to reduce the numbers.

In June 2014, the all-party group launched a report, “The state of sepsis in the NHS”, which addressed the reliable collection of data on sepsis deaths in England and the wide variation in the adoption of the ombudsman’s recommendations across the country The report, however, noted progress, which we further discussed one month ago at our reception on world sepsis day. We noted that the National Institute for Health and Care Excellence will produce a bespoke clinical guideline on sepsis by 2016. NHS England is engaged and has launched a level 2 alert for sepsis, and it is discussing the possibility of a national commissioning lever. The Public Administration Committee recently held a one-off inquiry on sepsis, and it pushed the Government to act more holistically and make more rapid progress on implementing the ombudsman’s recommendations. Like me, the Committee was frustrated with the amount of time it has taken NICE to develop its guideline.

Some parts of the NHS have taken a pioneering approach to sepsis. I am proud to speak up for nurse Susan Bracefield, who has done excellent work in establishing an integrated sepsis pathway for children in the south-west, which I am sure will save lives through early detection and rapid treatment.

[Mr Cunningham]

It was remiss of me not to congratulate the hon. Lady on securing this debate. Is there any specific reason for the variation across the country? Can she identify what those reasons are?

[Sarah Newton]

I thank the hon. Gentleman for his kind words. I encourage him to visit the all-party group’s website, where he will find our report, which addresses each region of the NHS. I made a freedom of information request to every trust across the UK asking a series of questions about the identification, recording and treatment of sepsis in their area. The report shows stark regional variations in England. As in all matters, it is a question of leadership. Good leaders who identify and recognise that sepsis is a problem galvanise their colleagues into taking action. I have seen that in the south-west, particularly in the work led by Susan Bracefield on a paediatric pathway. Sadly, otherwise fit and healthy young children can quickly succumb to sepsis, with tragic consequences that none of us wants to see.

The all-party group’s report highlights the variations across the UK. Clearly more needs to be done, and this debate is about what more we can do about sepsis. It is important that we have education programmes for everyone involved in the health care environment. Sepsis is not only the responsibility of the acute trusts. We need early diagnosis by general practitioners, carers and ambulance staff. Everyone who comes into contact with people in the caring environment must be able rapidly to diagnose the early symptoms of sepsis and ensure that people get the appropriate treatment. That first hour is absolutely critical.

We need some sort of national commissioning lever to get things going. The commissioning for quality and innovation payment framework could be a good approach, and I am interested to hear what the Minister will say about that point. Public Health England also needs to develop a robust public awareness campaign. Terrific success has been achieved on stroke, through the work done to help people identify the early symptoms of stroke so they get to hospital or to their doctor quickly; health outcomes for stroke victims have improved in the UK. We should take a similar approach to sepsis, informing and educating the public about its symptoms, so that they seek medical help urgently.

Health Education England has a key role to play in disseminating education to health care professionals. Ron Daniels and the UK Sepsis Trust have done a huge amount of work with the royal colleges to consider training modules for people throughout the health service, and they need support to disseminate them widely. We also need a national registry of sepsis deaths and survivors to understand the longer-term impact. That will require resources, and exemplar sites will need to be developed and accredited to highlight best practice across the UK. Some parts of the country, such as Nottingham, are doing excellent work, and other parts of the NHS can learn from what their colleagues are implementing elsewhere in the country.

The Government could take a more joined-up approach to the issue. Three or four Ministers have some responsibility for sepsis in their portfolio. We need an approach that brings things together and a lead Minister to co-ordinate the work of their colleagues, and we need to sign up to the world sepsis declaration to reduce sepsis deaths by 2020. We need to make it a UK effort, but it is also a global effort; sepsis is a huge hidden killer around the world. Finally, we must consider how we can use commissioning within the NHS to drive forward the improvements that we all want.

Sepsis deaths can be reduced further. There are proven things that can be done, including implementing the sepsis six, that would have a huge effect on reducing avoidable deaths in the UK and would save the NHS considerable money. Sepsis is not only heart-breaking for families who have to watch otherwise healthy and fit young people, or people of any age, succumb rapidly to undiagnosed cases; it is traumatic for NHS staff who, due to a lack of education, sometimes feel powerless to give their patients the care they need or prevent those avoidable deaths.

We have made progress in the past 12 months. As one of the co-chairs of the all-party parliamentary group, I have been heartened by the extent to which the NHS has engaged with us on the issue. We must not lose that momentum. We must ensure that the issue continues to get the urgent attention that it needs.

Often, in debates on sepsis, we link in the issue of antibiotic resistance. Some very mixed messages can be sent out, particularly to people in general practice: they must prescribe fewer antibiotics to prevent antibiotic resistance, but they must prescribe antibiotics to prevent sepsis. However, I do not think that the issue is contradictory at all. As we deal with antibiotic resistance, we must understand that it and sepsis are intricately related. The two messages are actually aligned, as both campaigns encourage better and more appropriate antibiotic use.

I hope that in responding to this debate, the Minister will be able to address the specific challenges that I have set out and reassure me and all the parliamentarians with whom I am working that the issue remains of great importance to the Government and that the work of the ombudsman, the UK Sepsis Trust and parliamentarians through the all-party parliamentary group will be built on with great urgency in the months ahead.

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

It is a great pleasure to serve under your chairmanship, Sir Edward. I congratulate my hon. Friend the Member for Truro and Falmouth (Sarah Newton) on securing this debate, and I thank her for bringing this issue to the House. I also thank the hon. Member for Coventry South (Mr Cunningham) for his helpful and supportive interventions. This is a chance to discuss an important issue. I know that the lack of colleagues here today is not a sign of disinterest; it is merely because the House is on a one-line Whip. I pay tribute to my hon. Friend for her campaigning work on the issue and her co-chairmanship of the all-party parliamentary group on sepsis, which is doing important work to raise the profile of this urgent condition.

Let me say at the outset that the information and case studies in the reports by the all-party parliamentary group and the parliamentary ombudsman make for sobering reading. I extend my regret and sympathy to the families affected by these preventable deaths, particularly the family of Sam Morrish. Every preventable death is a tragedy from which we must learn. I pay tribute to the important campaigning work of his family and others to improve sepsis care and treatment across the NHS.

We entirely accept that more can and should be done to address sepsis, paying particular attention to the points raised in the reports by the ombudsman and the all-party group. I am grateful to my hon. Friend for sharing the key points of her speech in advance. I will do my best to deal with all of them in the time available, but I hope that she will indulge me. If the clock beats me, I will write to her and deal with them all clearly in writing.

Colleagues should be in no doubt that the Department takes its responsibilities on sepsis very seriously indeed. In fact, sepsis is one of the few issues on which three departmental ministerial colleagues each have a specific responsibility for overseeing action. I take my hon. Friend’s point about the need for co-ordination, and I will pass it on. The Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), covers sepsis management in hospitals, and the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), has responsibility for sepsis management in the community. In the House of Lords, Lord Howe covers sepsis management in hospitals.

Although I am standing in for my hon. Friend the Member for Central Suffolk and North Ipswich, who is indisposed this morning, coincidentally, only last week, when we went to the US to visit pioneering clinical innovators in the life sciences, one issue that we discussed was the early detection of sepsis through greater use of digital technology in community health care. Early diagnosis in that first hour is crucial. It is one of many areas in which investing in new technology, particularly data technology, provides a much higher chance of early intervention and thus of preventing complex and costly downstream complications. Point-of-care diagnostics are a crucial part of that, and I am mindful of that in my work on innovation.

Hon. Members will appreciate that although the Department is accountable to Parliament for health care, the delivery of that care is the responsibility of NHS England, the executive non-departmental public body responsible for overseeing the running of the NHS; Ministers no longer run the NHS. NHS England works with NHS staff, patients, stakeholders and the public to improve health outcomes for people in England. We hold NHS England to account through the mandate, which sets out its priorities. I am glad to say that sepsis is incorporated in the patient safety and premature mortality provisions of the mandate.

We all agree that we will have the greatest impact by focusing our efforts on improving the clinical management of sepsis by health care providers and ensuring a consistently high standard in sepsis care across the whole system. We are doing so through a range of initiatives, including better education and training in recognising the warning signs of sepsis; ensuring that trends in sepsis are monitored —that is where data become important—raising the profile of sepsis in the community; and ensuring collaborative working across the whole system.

In the period between the publication of the ombudsman’s report in September last year and of the all-party parliamentary group’s report in June this year, we made significant progress. For example, we have mandated that Health Education England must include sepsis in its work to improve the training and education of health care professionals. We have also ensured that sepsis is included as a key patient safety priority in the NHS business plan for 2015-16.

The NHS outcomes framework sets out the indicators that are used to hold the NHS to account for the outcomes that it delivers through commissioning health services. Sepsis is captured in the overarching indicator measuring potential years of life lost from causes considered “amenable to health care”—a clumsy phrase, but it is a statement of the importance attached to the condition. Reducing the number of deaths from sepsis is specifically included in that indicator.

NHS England is considering the range of commissioning levers that it will put in place for 2015-16. The commissioning for quality and innovation payments framework is one option. I cannot comment further at this point as internal discussions are ongoing, but we are conscious of the interest in a specific lever on sepsis.

NHS England has also initiated work to develop a consistent methodology for a robust, retrospective case-note review of deaths in hospital. That is part of further work to develop the NHS outcomes framework, which will offer a way of establishing much more accurately how many deaths are attributed to sepsis, identifying any shortcomings in sepsis care management and feeding any improvements into local practice. That work is expected to be completed by 2016 and rolled out thereafter.

Regarding paediatric care, a children’s sepsis summit is planned for tomorrow—15 October—as I am sure my hon. Friend is aware. It will bring together a range of national experts and key personnel from the south-west, particularly those involved in the review of the tragic case of Sam Morrish, to share learning and to set the direction for further work on the timely recognition and treatment of children with sepsis.

Furthermore, NHS England has developed a webinar series to promote greater awareness among clinicians of the actions to be taken to treat patients who are critically ill. Sepsis clearly features in this “deteriorating patient as a medical emergency” campaign; the first webinar in the series covered sepsis and was held on 17 September.

Regarding the timely recognition of sepsis, we fully endorse the work carried out by NHS England’s surgical services patient safety expert group, its children and young people patient safety expert group and the safety board of the Royal College of Physicians to roll out the “sepsis six” guidelines, to which my hon. Friend referred and which were produced in collaboration with Dr Ron Daniels. That has led to the development of a series of clinical toolkits for health professionals, which were launched by the UK Sepsis Trust.

To support the implementation of existing resources and guidance on sepsis, such as the sepsis six and the paediatric sepsis six, NHS England issued a stage 2 patient safety alert. I am advised that that alert has been cascaded to all trusts, social care providers, community providers and, via area teams, to GPs and public health directors in all local authorities.

Wider work to further the sepsis agenda includes initiatives to combat antimicrobial resistance more generally. While some might argue that there is a tension between limiting the inappropriate use of antibiotics to reduce the incidence of antimicrobial resistance and the provision of early antibiotics in cases of suspected sepsis, we would argue that those activities are complementary and do not cut across each other. The key issue is the appropriate use of antibiotics, which is common to both agendas, as each requires the appropriate use of antibiotics for the right patients at the right time.

It is also important to note that we have strengthened and updated a key resource on the appropriate use of antibiotics. This guidance, called “Start smart—then focus”, was originally published in 2011. We are currently consulting on an update, which is due to be published shortly. The resource has been updated to refer explicitly to sepsis and to draw particular attention to the need to act promptly

“between the onset of sepsis-related hypotension and the administration of appropriate antibiotics”.

Equally importantly, it focuses on the need to initiate effective antibiotic treatment

“within one hour of diagnosis in patients with life-threatening infections”.

It also sets out clear guidelines on the need to review the clinical diagnosis within 48 to 72 hours and to make a clear plan of action when additional information becomes available, such as new microbiological, radiographic or clinical data.

Let me turn to another point raised by my hon. Friend in the all-party group’s report, which is the need to establish robust pathways to deal with sepsis. That is an absolutely key objective, which NHS England has been developing in conjunction with the UK Sepsis Trust. The action includes the development and publication of toolkits for acute medical units and emergency departments. The toolkits, which were published in September, identified organisational standards for the acute management of sepsis in both locations.

I understand that the UK Sepsis Trust is working with NHS England to establish sepsis exemplar sites and to recognise publicly those providers that excel at the processes and behaviours that improve the early detection, diagnosis and delivery of interventions to patients. The sepsis exemplar standard initiative is to be welcomed, as it encourages joined-up thinking between health care units, which will help to strengthen further the provision of seamless care for critically ill patients.

The programme is expected to include three phases. The first phase is the accreditation of excellent emergency departments, which will identify departments with traditionally strong links with primary care, pre-hospital systems, acute admission units and critical care, and which have demonstrated willingness and drive to improve sepsis care and an engagement with sepsis-related audits, changing improvement strategies and improving data collection.

The second phase is the accreditation of further health care units. Following the pilot testing for emergency department standards, and building on lessons learned in creating those standards it will involve the development of accreditation plans for other health care units, such as ambulance trusts, in-hospital critical care outreach or sepsis teams and acute medical units prior to expansion in other areas. The final phase is the assigning of exemplar unit status as part of our commitment to demonstrate best practice.

I turn to the National Institute for Health and Care Excellence, which my hon. Friend mentioned and for which I have ministerial responsibility. Of course, we recognise that we need to support NHS colleagues in addressing sepsis with the provision of comprehensive and up-to-date guidelines, so in April we asked NICE to develop such guidelines to aid the recognition, diagnosis and management of severe sepsis. These guidelines are under development and will be comprehensive and thorough. They are scheduled to be published no later than July 2016, but I very much hope they will be published earlier than that.

[Sarah Newton]

At the Public Administration Committee hearing, frustrations were demonstrated by Committee members, which I certainly share, about the fact that a “90% good” NICE guideline would begin to save lives and that the time that NICE is taking to get this guideline 100% right is allowing preventable deaths to continue. I urge my hon. Friend the Minister to go back to NICE and say that, while it is important that whatever it does is excellent and should be based on the best available evidence, in the meantime the delays in developing guidance are costing lives.

NHS Funding (Ageing)

Sarah Newton Excerpts

Tuesday 25th March 2014 Westminster Hall

[Dr Coffey]

I agree with my hon. Friend. Funnily enough, I do not think that the formula was strong enough in reflecting the demands of age. It could have gone a lot further. The sparsity challenges are also a constant issue for those of us who represent rural seats. There is no doubt that a patient’s health care experience is somewhat diminished when a cardiac check-up means a 200-mile round trip. I realise that we cannot have a cardiac hospital within five or 10 miles of everybody—that might be the case in London, but I will not get into the London health funding debate. There is no doubt, however, that such trips are not helpful with regard to the patient experience. The funding formula has had negative consequences. We have seen a more rapid reconfiguration and regionalisation of services. The quality of care for patients has been affected and there are funding challenges. The problem is particularly acute where there is a high proportion of elderly patients. That is not good enough.

[Sarah Newton (Truro and Falmouth) (Con)]

My hon. Friend is making a powerful case for patient care in rural communities and I wholeheartedly agree with her. Does she agree that the market forces factor is having a negative impact on rural communities in poorer parts of the country where average incomes are much lower? People within the NHS and the care system are often paid national wages, but the funding formula discounts for local wages.

[Dr Coffey]

My hon. Friend makes an interesting point. I have not gone into that level of detail and do not have that level of understanding, but she makes an important contribution to the debate. Local clinical commissioning group and NHS trusts must contend with that challenge and should make that point to the board of NHS England.

I come back to the formula. I said in response to my hon. Friend the Member for Warrington South (David Mowat) that the focus on age may have slightly increased, but that it did not go far enough. The correlation between age and per capita funding increased only marginally between the old formula and the partially adopted current formula. South Sefton receives 40% more per capita than Ipswich and east Suffolk, but it has 50,000 fewer pensioners and a lower proportion of pensioners. Life expectancy in my part of Suffolk is considerably higher than in others, which is good, but that does not necessarily mean that people, in particular the elderly, do not have complex health needs that need addressing. At the moment, the formula continues to discriminate against the elderly and even further against people in rural areas.

--- Later in debate ---

[Dr Poulter]

It may be helpful if I outline the way the new formula works and how some of the weighting has changed, which will help to address the point my hon. Friend has just made and shed more light on the direction of travel that is under way.

The new formula uses a new indicator to recognise how health inequality should be reflected, which is based on the standardised mortality rate for those aged under 75. Previously, adjustment has been made on the basis of a measure of disability-free life expectancy. The new indicator is technically better, in that it can pick up pockets of deprivation within more affluent areas. The formula focuses much more on real population need, rather than taking a blanket approach across the population.

The new formula moves to the more powerful method of using individual rather than small area utilisation data—this is fundamental to the formula—to derive estimates of need. The main factors in the model are age, gender and 150 morbidity measures from the diagnoses of admissions to hospitals. That picks up on the point that my hon. Friend just raised. The formula looks at the pressure of long-term illness. Those 150 morbidity measures will pick that up. The increased need for health care in deprived areas is captured in the base formula by directly taking account of much of the increased need in deprived groups. In addition, further adjustments are made for factors such as the claimant rate for key benefits. That ensures that the model captures increased need that is linked to deprivation but is not linked to earlier utilisation of hospital services.

The new formula reflects more up-to-date data on population growth and measures population based on registered GP lists, rather than population projections based on the census. I am sure we can all recognise that where there has been growth in a population or changes are happening at local level, basing the formula on up-to-date GP lists is a much more accurate way of reflecting the health care needs of the local population than basing it on a 10-yearly census.

The new formula also reflects the responsibilities of CCGs rather than PCTs, as my hon. Friend outlined in her contribution. CCGs are not responsible for specialist services or primary care, although of course NHS England is now also taking over responsibility for the GP contract, as she will be aware. As a consequence, it is important to stress that the new formula for allocating funds to CCGs follows the advice provided by ACRA. A strong element of the allocation is focused on age. The primacy of age, an ageing population and the needs of older patients are very much built in, as are the needs of patients with long-term conditions. There is still a strong weighting for deprivation.

[Sarah Newton]

How does my hon. Friend the Minister feel that the market forces factor is reflected in the new formula?

[Dr Poulter]

These are obviously factors that NHS England will keep under review and take advice on from ACRA, but importantly, the new funding formula is not based on census data every 10 years but on real-time information coming in from GP practices. It looks at the health care needs of local populations, at deprivation, at areas where there are groups of patients with multiple medical co-morbidities. We know that as people live longer and our NHS is more successful, that will of course throw up new challenges. People are living longer not just with one long-term condition, but sometimes with two, three or four. Someone with dementia may also have heart disease, diabetes and a whole host of other conditions. A much more accurate reflection of real-time patient information is used to help set and adjust the formula for future years, and I think we would all welcome that. It is all part of having an independently set formula, rather than one based on the whims of a particular Government.

Almost two thirds of total NHS funding, as we are aware, now goes to clinical commissioning groups, which have the clinical expertise and local knowledge to best commission health services according to local needs and priorities. We are very proud that, as part of our reforms in 2012, we ensured a clinically led NHS at local level. Doctors and nurses are now making decisions for patients, which is already leading to improved services not just in Suffolk but throughout the country, because it is ensuring that the money from the increased budget that we are giving the NHS is being spent in a way that focuses on the needs of patients.

The Government have been able to ensure real-terms growth in funding until 2015-16, despite the stark financial challenges that we face as a country, and we should be very proud of the fact that we are continuing to put more money into the NHS. That means that NHS funding in England will be almost £15 billion higher in cash terms in 2015-16 than it was in 2010-11, and spending will rise from £100.4 billion in 2010-11 to £115.1 billion in 2015-16. Importantly, transforming care and delivering more personalised care under the integrated health fund—the £3.8 billion fund that my right hon. Friend the Chancellor of the Exchequer set up last year—is an important part of ensuring that that money is spent not just more efficiently, but in a more patient-centred way, particularly for patients with long-term conditions, both in Suffolk and in other parts of the country where there are many older patients.

In concluding, I want to highlight the fact that although, as we have already discussed, every CCG is receiving an increase in funding, the three CCGs in Suffolk in particular have seen funding growth. Ipswich and East Suffolk CCG’s funding allocation will increase by 2.85% in 2014-15 and by 2.19% in 2015-16 to reach £412.4 million in that year. As a result of the new funding formula that has been put in place, Suffolk is doing well, as are many other parts of the country.

Having a formula that is independently set according to clinical need and population information, and that is up to date and accurate, puts us in a much better place properly to look after the needs of patients, be they young or old, in the years ahead. That formula and the Government’s bold decision to ensure that it is independently set puts us in a strong position to deliver high-quality care for older people. That, together with the £3.8 billion integration fund, means that we will radically transform and improve the way in which we deliver care.