Immigrants (NHS Treatment)

Sarah Wollaston Excerpts

Monday 25th March 2013 Commons Chamber

[Mr Hunt]

The Government are not going to take any lessons in overblown rhetoric when Labour Members talked about this problem for 13 years and did absolutely nothing about it. What was missing from the right hon. Gentleman’s remarks was a proper apology for Labour’s total failure to control our borders during a period in office that saw a quadrupling of net migration. We do not know how many people are residing in this country illegally, but in January the London School of Economics published a report stating that it could be nearly 900,000 people, in which case the cost will not be a few millions but many, many times that. In 13 years, Labour did not change eligibility for access to free NHS services and did nothing to improve the collection of proper dues from people coming from outside the European Union.

The £20 million figure that the Prime Minister’s spokesman used this morning is the amount of uncollected debt that is owed to the NHS by foreign nationals. If the right hon. Gentleman had listened to my response, he would know that we believe—of course it is impossible to get exact figures on this because of the total mess that the previous Government created—that we identify less than half the people who should be paying for NHS care and collect less than half the money that should be collected.

Of course we will work with very closely with Scotland, Wales and Northern Ireland to ensure a co-ordinated approach. If the right hon. Gentleman had listened to what I said, he would have heard that the exemption for emergency care and for public health issues will remain in place, which is extremely important.

Let me finish by talking about A and E issues. The reality is that the LSE estimates that about 70% of those living illegally in the UK live in London, where A and Es happen to face some of the biggest pressures. University College London Hospitals NHS Foundation Trust opened a new A and E only in the past few years and it was built for a capacity of 65,000 people a year, but it is now seeing 120,000 a year. If the right hon. Gentleman’s Government had done something about this rather than talk about it, A and Es across London would not be facing the pressure they are now facing.

[Dr Sarah Wollaston (Totnes) (Con)]

Will the Secretary of State publish the names of those trusts that are abjectly failing to identify and recover charges from those who are not entitled to free care?

[Mr Hunt]

My hon. Friend makes a reasonable point. Part of the problem is that when we should be identifying someone as a foreign national who should pay for their NHS care, that does not happen a lot of the time because of the incentives in the system. Under the NHS improvement initiative, which is taking place in London at present—it is worth looking at that closely, because it has a lot of promise—there is a centralised collection of debt from foreign nationals who owe the NHS so that that does not become the responsibility of individual hospitals, which is something that is putting them off registering people as eligible for their NHS care.

Accountability and Transparency in the NHS

Sarah Wollaston Excerpts

Thursday 14th March 2013 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I want to start by thanking the vast majority of staff in the NHS, who go to work every day motivated to serve their patients and deliver world-class care.

We should not think that we can just return to the halcyon, storm-free days of the 1970s, when NHS care was perfect. Before I started medical school, I worked as a nursing auxiliary, which would now be called a health care assistant, in what was then known as a geriatric hospital. I have no wish to return to the days of vast, mixed wards and a rather authoritarian approach to care. I would far rather the NHS of today than that of the 1970s.

However, the mantra that the NHS is the envy of the world sometimes gets in the way of providing decent feedback and criticism when things go wrong—and after listening to the words of the right hon. Member for Cynon Valley (Ann Clwyd), who could say that things do not go wrong? The failures at Mid Staffs, and the fact that more than 1,000 people died in a single hospital, are truly shocking. Robert Francis told the Health Committee that he had spent three years of his life “listening in horror”—how shocking! It is hard to imagine any other institution or organisation where death on that scale would not have led to prosecutions, yet too often in the NHS it is not prosecutions that follow but promotions, just as it was in this case.

It has, unfortunately, become something of a heresy to criticise the NHS, and my comments are not to be interpreted as criticising the vast majority of staff, but rather as a means of considering how we can help those staff and their patients. It is vital that NHS staff are free and feel safe to raise concerns. This week, at a meeting in the House that I was chairing, Robert Francis spoke about “complaints being a gift”, but that is not the experience of staff or patients within the NHS.

The Health Committee conducted an inquiry into complaints and litigation in the NHS that reported in June 2011, and I wish to read from the chilling evidence that we heard from Nicola Monte. She spoke of her experience of being barrier-nursed in Stafford, and said that a nurse came into her room and berated her saying, “I have been off sick because of you complaining about me. Do you realise the suffering you have caused me?” Too often, staff end up feeling that they are victims because—as they know—they are often scapegoated for what are system failures, often by management. That runs throughout the NHS; the response to complaints is defensive and dismissive and that must change if we are to implement what Robert Francis rightly recommends as a new culture change of openness, transparency and candour within the NHS.

I hope, however, that no one will think that introducing a statutory duty of candour can be a single approach. That will not work without a culture change that supports and welcomes complaints as a “gift” to identify problems and improve care. I hope the Government will implement in full the recommendations made by Robert Francis so that complainants are regarded not as the problem but as part of the solution.

I particularly welcome the Secretary of State’s announcement that gagging clauses are to be outlawed with immediate effect throughout the NHS but—I hope he will not mind my saying this—that must extend to the top of the system. Would the Secretary of State feel it appropriate for David Nicholson’s secretary to have the following clause in his or her contract:

“That they should avoid associating themselves with recommendations critical or embarrassing to the NHS commissioning board”?

I think we would find that wholly unacceptable, yet, if I may refer Members to the ministerial code of conduct, the Secretary of State’s Parliamentary Private Secretary, who is not a member of the Government, has exactly that clause within his contract. That is something we have to change because the culture of the NHS must extend from the Department of Health to the nursing auxiliary—or health care assistant—at the bedside, and to patients so that they and those around them feel safe and able to raise complaints.

[Mr Cash]

Is my hon. Friend aware that Public Concern at Work, to which I referred in my witness statement on Stafford hospital, has played a big role in highlighting whistleblowing and has set up a commission to look at that issue? The outlawing of gagging clauses should apply not only on severance, but also—emphatically—when people are in post so that they can be properly protected when acting in the public interest.

[Dr Wollaston]

I absolutely agree. This is about starting to identify the culture and values of the people we employ in the NHS, and making it clear that not only does everyone in the NHS have a duty to bring forward concerns, but that those concerns will be welcomed and acted on. I would like everyone in the NHS to have an individual to whom they can go and feel safe in raising their concerns. I thank my hon. Friend for raising that point.

My hon. Friend the Member for Reading East (Mr Wilson) has told me that he does not feel that he has been gagged, which is great, but there is still an important point of principle: as a PPS, he is not able to speak in this debate. We want everyone, from the very top of the NHS and the Department of Health, right through to the bottom of the system, to feel that they are fully free to raise any concerns they have, wherever they may be.

After the Bristol heart scandal, whistleblower Stephen Bolsin was asked how we could prevent this from ever happening again. He said:

“Never lose sight of the patient.”

His whistleblowing cost him his career. He first raised the alarm in 1989. His work over six years to raise his concerns remains one of the single most important improvements in clinical outcomes in the NHS—that is how important whistleblowers are to our system. Yet the scandals keep happening. Would it not be a tragedy if, five years from now, we were still saying, “We need to put patients at the heart of everything we do in the NHS”? It is time to make that happen.

Social Care Funding

Sarah Wollaston Excerpts

Monday 11th February 2013 Commons Chamber

[Mr Hunt]

I am afraid that what the hon. Lady says sums up the attitude of the Opposition; they thought it was wishful thinking to try to solve this problem, whereas we are getting on with a solution. We do not have those financial products available at the moment, but the whole point of these structures is that we will help to create a market in which it is possible to have them. The point of the cap is to allow the hon. Lady’s constituents, even people on lower incomes, to plan and make provision, not only for costs of more than £75,000, but for any costs they have up to £75,000. In combination with that, we are increasing the threshold for Government support from £23,000 to £123,000.

[Dr Sarah Wollaston (Totnes) (Con)]

I warmly welcome today’s statement, particularly the rise in the asset threshold, as I well remember my former patients’ shock when they realised that for anything over £23,250 they would have to meet their entire costs. However, may I ask the Secretary of State to look again at the impact there will be on rural local authorities, for example, Devon’s, which has the fifth oldest population in England?

[Mr Hunt]

I will certainly do that, and I am grateful for my hon. Friend’s comments. I would just say that it is in some of those areas with the highest proportion of older people that the impact of the current lottery in care provision is so dramatic and needs addressing so quickly. I therefore hope that her constituents will welcome the certainty in these proposals, but I will certainly look at and identify whether any particular issues are raised in rural areas.

NHS Funding

Sarah Wollaston Excerpts

Wednesday 12th December 2012 Commons Chamber

[Andy Burnham]

I hear reports from ambulance services all over the country that they simply cannot hand over patients at the door of A and E departments and are having to queue outside. Consequently, large swathes of the country are being left without adequate ambulance cover. That is unacceptable, especially as we go into winter and temperatures drop. We need to see some evidence that the Government have a grip on these things. I have been told that large parts of my constituency have occasionally been left without adequate ambulance cover. We must have answers on these matters today.

[Dr Sarah Wollaston (Totnes) (Con)]

I am very disappointed to hear the right hon. Gentleman talk down the NHS. As he has just acknowledged, before the election the NHS knew that it was facing an unprecedented efficiency challenge. He will also know that under Labour productivity in the NHS fell continuously. I wonder whether—[Interruption.] Okay, but for almost every year—

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. The hon. Lady needs to ask a sharp and punchy question as an intervention, and very quickly.

[Dr Wollaston]

Will the right hon. Gentleman acknowledge the NHS’s achievement in making a productivity gain?

[Andy Burnham]

The hon. Lady just made another untrue statement. She talks about talking down the NHS, but productivity has not fallen. I am sorry, but let us have some honesty. We are not just going to sit here and take one statement after another—

NHS Commissioning Board (Mandate)

Sarah Wollaston Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

Let me say to the hon. Gentleman that we have 17,000 fewer managers than when his party was in power. We also have 3,500 more doctors and there are more clinical staff in the NHS today than when his party left office, so I think the record speaks for itself. There is not a climate of fear—I reject that. There is an understanding that the NHS is under a lot of pressure, with an ageing population and more people using and needing its services every year. That is why today’s package is so important to support the NHS in delivering what the public need.

[Dr Sarah Wollaston (Totnes) (Con)]

At long last, the NHS will be operationally independent, and genuinely clinically led. I welcome the mandate: it is an excellent and ambitious target for the NHS. Will the Secretary of State reassure the House that, in these challenging times, efficiencies made in the NHS will be genuinely reinvested in patient services?

[Mr Hunt]

My hon. Friend, as a GP, will recognise from the mandate that a lot of the improvements that we need in the NHS are in primary care. The budget for the NHS is protected, but demand for services is going up, so we need to make these changes. I will give her one example where I think that this is particularly important. The number of hours it will save GPs if the majority of prescriptions are ordered online, which does not happen at the moment, could transform life for more than 8,000 GP surgeries up and down the country.

Regional Pay (NHS)

Sarah Wollaston Excerpts

Wednesday 7th November 2012 Commons Chamber

[John Pugh]

I do not think that that is the case, or that the right hon. Gentleman thinks so, but he ruined my punchline, which goes like this: if the South West consortium is even more schizophrenic than the Government on this, it must be made to come to its senses.

[Dr Sarah Wollaston (Totnes) (Con)]

I ask the hon. Gentleman please to withdraw his comment about this being a schizophrenic response. It is really unfortunate when people use the term “schizophrenic” to refer to very important decisions, because it minimises the impact of schizophrenia on sufferers. May I ask him to rephrase his comment?

[John Pugh]

I cannot take it off the record, but I do take the point that the hon. Lady has made.

--- Later in debate ---

[Alison Seabeck (Plymouth, Moor View) (Lab)]

It is a pleasure to follow the hon. Member for Aberconwy (Guto Bebb), who very openly mulled over some of the problems posed by regional pay.

The unfairness, irrationality and economic illiteracy of the proposal made by the south-west cartel, as highlighted by the hon. Member for Southport (John Pugh), who is no longer in his place, are stunning. The upshot of the documents that have been leaked to the public has been an outcry in my region. I, too, have received hundreds of e-mails and letters from local people who are concerned about what they see as an unfounded and unfair attack on hard-working Plymouth families.

The south-west proposals are tacitly supported by the Government. When questioned in the House, they washed their hands of any responsibility for the action being taken by the 20 trusts in my region. Why is that? Is there something about the south-west? Did the Government believe that the south-west would be supine because there are lots of Government MPs in the region? Did they think they would try regional pay in the south-west and put their toe in the water and perhaps that nobody would notice—after all, it is a long way from London? Did they think, “We now have regional pay in the south-west. It’s a good idea, so we’ll roll it out in the rest of the country”? The response from people across the party divide in the south-west, including those working in the NHS, has put the proposal firmly in its place. We will not accept it or take it lying down.

[Dr Wollaston]

Does the hon. Lady agree that there are concerns in the south-west that regional pay will impact on the ability to recruit in certain key specialties?

[Alison Seabeck]

The hon. Lady speaks from a wealth of experience of working in the NHS. She is absolutely right on that point, which I will make more of later in my speech.

The public have a right to know what the Government’s position is, but as with so much else, confusion reigns. The Deputy Prime Minister has said at times that he is not in favour of regional pay, but it will be interesting to see how he votes today. The Chancellor of the Exchequer is clearly in favour, but the Prime Minister says nothing. The Secretary of State for Health has not helped to clarify matters today. The amendment, which is in the name of the Chief Secretary to the Treasury, is interesting. It states that the Government will not go down the route of regional pay

“unless there is strong evidence and a rational case for proceeding”.

How will the Government consult and gather the evidence to decide whether there is a rational case for regional pay? When will the Minister make the evidence available to Members of the House?

The Government must understand that the proposal is causing huge concern. The debate is not just about public sector pay restraint. Labour Members have accepted that there needs to be restraint in the public sector. We are not saying that that should not happen in times of austerity, but there is a need for equal pay for equal work. It is wrong if a nurse in Plymouth, working the same hours, doing the same job and providing the same high-quality care, is paid less than her counterpart in a hospital in Peterborough or Preston.

Induced Abortion

Sarah Wollaston Excerpts

Wednesday 31st October 2012 Westminster Hall

[Nadine Dorries]

I will address that point in a moment. I will not give way any more, as I know that lots of people want to speak.

I want to make it clear that my proposal to reduce the upper limit does not include babies with foetal abnormalities or, sadly, disabilities. That is a discussion to be held, as I have said, between parents and doctors. Abortion is available up until birth for foetal abnormalities. My proposal applies to abortions for social reasons.

A study by the Centre for Sexual Health Research at the university of Southampton and the School of Social Policy, Sociology and Social Research at the university of Kent found that 41% of women who have second-trimester abortions do so because they were not sure about having an abortion and took a while to make up their mind to ask for one. I believe that one positive effect of reducing the limit to 20 weeks might be to focus the mind slightly sooner than 23 weeks. Because abortion is available until 24 weeks, there is a laxity, as people have a prolonged period to make up their mind. The research says that women took a long time to make up their mind. Maybe reducing the upper limit will help.

It is clear to me that we cannot allow the present situation in our hospitals to continue. In one room in a hospital, there might be a premature poorly baby born at 22 or 23 weeks at whom the NHS will throw everything it has to help it survive. In another room in the same hospital, a healthy baby will be aborted at 24 weeks. Dr Max Pemberton recently wrote in The Daily Telegraph that

“many doctors are uncomfortable with the current cut-off point. It is not something we openly discuss, because we know it is a highly emotive area. But privately, many doctors will express discomfort that the current legislation is inherently illogical and inconsistent. Any doctor who has found themselves in the neonatal intensive care unit of a hospital will be acutely aware of it. In the same hospital where doctors are trying to save a premature baby born at, say, 23 weeks, a woman down the corridor is legally allowed to undergo a late-stage abortion on a foetus of the same gestation. So on the one hand we throw considerable money and resources to try to save a baby’s life, while on the other we sanction its destruction.”

I have consistently made that argument for the past seven years. The medical profession cannot make two arguments. Doctors cannot say that a poorly baby’s life is worth trying to save from 20 or 21 weeks onwards while stating at the same time that there is no chance of life up to 24 weeks, so it is okay to abort up until that point. There is an inconsistency in retaining 24 weeks. Should there be a case to say that doctors should not try to save the life of a poorly baby born before 24 weeks’ gestation? Can hon. Members imagine the uproar if we said, “Okay, the RCOG has said that viability is 24 weeks, so we really shouldn’t be saving premature babies before 24 weeks”? We should say, “No, the point of viability is 24 weeks, so we should stop. Wipe out the neonatal units, wipe out the premature units. Viability is not consistent before 24 weeks.”

Doctors cannot have it both ways. They cannot say in the NHS, “We try to save babies from 20 weeks because they are viable,” and then say, “We abort at 24 weeks because they are not.” The two arguments cannot stand. That is an anomaly, and it must end.

[Dr Sarah Wollaston (Totnes) (Con)]

Will the hon. Lady give way?

[Nadine Dorries]

No. I have said that I will not give way any more. I must crack on, because lots of people want to speak.

Some people ask whether medical science in the area has moved on. Is there a difference between the science in 2008, when we had the vote, and the science today? The answer is that viability can never be proven. Until healthy women agree to allow healthy babies to be aborted at 20 weeks and we then try to save them, we can never actually know what viability is.

[Dr Wollaston]

Will the hon. Lady give way on that point?

[Nadine Dorries]

I will give way, but this is the last time.

[Dr Wollaston]

I thank the hon. Lady for giving way. On that point, we are not trying to save babies at 20 weeks. No babies survive at 20 weeks’ gestation. If she refers back to the British Medical Journal paper considering two periods of survival, the increase in survival of pre-term babies after the 2000 period was due entirely to babies born at 24 and 25 weeks. The absolute limit of survival is about 22 weeks; that is when we try to save them. Will she please stop suggesting that the NHS is capable of saving babies at 20 weeks? It is simply not true.

[Nadine Dorries]

Maybe the NHS should stop trying to save babies from 20 weeks. My neighbour 10 years ago was a 22-week survivor. Although she had slight problems, they did not prevent her from going to school and living a full and wonderful life. Babies do survive from 22 weeks, which is my argument for viability. If the RCOG wants to say that viability is at 24 weeks, it must look at the living babies born at 22 weeks and say, “That’s wrong.”

The only measure of viability that we have is the premature poorly baby—the baby who arrives early for a reason. Doctors must fight to deal with two complicated situations: whatever made the baby arrive prematurely, and the fact that it has arrived prematurely, which involves lung function and other things. I am afraid that a healthy aborted baby and a premature poorly baby cannot be compared, particularly not at 23 weeks.

I have been asked in numerous interviews, and only this week by Victoria Derbyshire during the filming of a “Panorama” programme, “How do you know that aborted babies are healthy babies?” For the record, between 96 and 97 out of every 100 babies are born healthy. The viability argument needs to be discussed in the context of what we do in our neonatal and premature baby units, and what we do in terms of abortion. The two must be compared.

I want to discuss sentience, because it is an argument for life. We know that a baby can feel pain in the womb before 20 weeks. If a woman’s stomach is poked post-20 weeks or earlier, it can wake up the baby. Thanks to Professor Stuart Campbell’s amazing and pioneering work with 3D imaging, we can see how a baby in the womb responds to stimuli, and thanks to the work of Professor Sunny Anand, we know exactly how a foetus responds, due to how it reacts to anaesthetic during in-utero operations.

While a research fellow at Oxford, Dr Anand became aware that many premature and early gestation babies died during in-utero operations due to shock induced by pain during the procedure. General thinking at the time, in the 1980s, was that no baby could experience pain before birth—that until birth, a baby was not sentient. In his pioneering work, Dr Anand developed anaesthesia to be delivered to foetuses. Thanks to that work, introduced at the John Radcliffe hospital, anaesthetising babies during in-utero operations is now standard procedure, and babies now live.

Dr Anand went on to continue his work and research in America. When I sat on the Science and Technology Committee, we considered abortion, and one of the members of that Committee—Evan Harris, the former Member for Oxford West and Abingdon, who lost his seat at the last election—described Professor Anand as a little doctor from Little Rock. Dr Anand did much of his further research in America, first at the university of Arkansas and now as the St Jude chair for critical care medicine and professor of paediatrics, anaesthesiology and neurobiology at the university of Tennessee health centre in Memphis.

My only point in relation to Evan Harris’s comments about Professor Anand is that Dr Anand is a gentle, polite academic who is well renowned and respected and has a successful career. To describe such a man as a little man from Little Rock, and to have binned and not considered the evidence on abortion that he presented to the Science and Technology Committee, was a travesty. I complained about it to the Clerks at the time, and I will continue to complain about it, as it tainted the report. If a foetus can feel pain stimuli, it is a sentient being. Anyone who feels, is. They exist. If one feels, one is a human being.

I move to the feminist argument. As the mother of three young adult daughters, I am a strong believer in a woman’s right to choose. Never, ever would I want to see a return to the bad old days of backstreet abortionists, or restricted access to early abortion. Do I champion this issue from the perspective of religion? No, I do not. I do not come to this from a religious perspective. I champion this from the perspective of compassion, humanity and civility. I believe in the right to choose, but, provocatively, I would like to throw this in: what about the female baby, post-20 weeks? I often hear the argument, “It is a woman’s right to choose.” What about healthy female babies who are aborted at 24 weeks?

I champion this issue because I believe passionately in the reduction of the upper limit. When I visit pregnancy crisis centres, I hear women who are undergoing counselling. Some actually say, “I would have preferred an option other than ending my baby’s life.” Well, there are other options. That is one of the reasons why I tabled the counselling amendment—there are always other options.

I would like to talk about the truth about abortion. It is not just articulate, clever women who abort; vulnerable women are coerced. They are the women who are seen by pregnancy crisis centres. Not every woman who has a late-term abortion for social reasons actually wants one. I was staggered to hear what one MP who came up to me the other day said. Her actual words were, “Every woman who wants an abortion knows exactly what she is doing.” Well, in her rather slick, well-educated Oxbridge world and her leafy shires I am sure they do, but what about the young Asian girl who was recently marched into a clinic in floods of tears by two family members? No one knew her age, but she was marched in by two family members for an abortion. Is that a one-off story? No. Speaking to abortion providers, that happens on a regular basis.

What about the young women who have waited to have their abortion because they did not want to have it, and who then found themselves being coerced by partners or others? One woman at a pregnancy crisis centre that I went to aborted at 24 weeks because she had been told by her partner and other family members that it would be beaten out of her if she did not. Not every women makes the decision because she went to university and marched up and down streets in Oxford and chanted about women’s rights. Lots of women are actually incredibly vulnerable. It seems to me as though many of the women who make the feminist “women’s right to choose” argument have no regard whatever for those women. In pushing one particular mantra and ideology, no consideration is taken of those women at all.

It is assumed, and I am told, that it is a woman’s right to choose, and that by wanting to limit from 24 weeks and by wanting to introduce counselling, what I am trying to do is limit a woman’s right to choose. Well, let me inform everybody that a woman’s right to choose is limited because the upper limit is at 24 weeks. To say that a woman’s right to choose is being limited is nonsense—it is already limited. It is limited because at 24 weeks it is felt that a baby is viable. I argue this: a baby’s life is viable before 24 weeks, so it is time to reduce the limit, because this is 2012, not 1990. I hope we live in a society that is civilised and compassionate, and which cares for vulnerable women who do not want to have abortions and are forced to do so. I hope that we would give as much consideration to those women as we do to the Oxbridge-educated, articulate women who change their job and want to have an abortion.

Some of the women who end up at pregnancy crisis centres do so because they are scarred and need counselling, which is not available to them, because they aborted at a very late stage. Those women are more likely to suffer mental health consequences than those who abort at an early stage. If we do not go for the viability argument; if we do not look at sentience and all the other arguments I have made; if we just decide to disregard the fact that in one hospital, there might be two babies, one being aborted at 23 weeks and another having her life saved at 20 and if we choose to ignore all that, let us just decide that we should be a little more considerate to the women who find themselves forced into a situation in which they have a late-term abortion.

I hope that the Backbench Business Committee grants the next debate on this issue next May. I hope that there will be a vote. I hope that, by then, enough information will have been put before hon. Members for them to decide that what they want to do is what the public want to do. I finish on this note: I am overwhelmed by the amount of support that I have received from members of the public in wanting to reduce the limit. The more this is debated, as it should be, the more public opinion will become informed, and the more MPs will realise that what they need to do in this place is carry out the will of their constituents, not follow their own political ideology.

Oral Answers to Questions

Sarah Wollaston Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

4. What his policy is on making available all information about the results of clinical trials to patients, doctors and medicine approval bodies.

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

The Government support transparency in publishing results of clinical trials, and they recognise that more can, and should, be done. In future, greater transparency and the disclosure of trial results will be achieved via the development of the European Union clinical trials register, which will make the summary results of trials conducted in the EU publicly available. Greater transparency can only serve to further public confidence in the safety of medicines, which is already robustly assured in the UK by the Medicines and Healthcare products Regulatory Agency. By law, the outcomes of clinical trials undertaken by companies must be reported to that regulator, including negative results.

[Mr Speaker]

Order. We are grateful to the Minister but some of these answers are simply too long. If they are drafted by officials, Ministers are responsible—[Interruption.] Order. I require no assistance at all from the Under-Secretary of State for Health (Anna Soubry). She should stick to her own duties, which I am sure she will discharge with great effect.

[Dr Wollaston]

I thank the Minister for his answer and for recognising that missing data from clinical trials distorts the evidence and prevents patients and their doctors from making informed decisions about treatment. Will the Minister meet a delegation of leading academics and doctors who remain concerned that not enough is being done to see how we can ensure that all historic and future data are released into the public domain?

[Norman Lamb]

My hon. Friend raises absolutely legitimate concerns, which have been raised by others, including Ben Goldacre. I am happy for my noble Friend Lord Howe or me to meet her and experts to discuss this important issue further.

Community Hospitals

Sarah Wollaston Excerpts

Thursday 6th September 2012 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

I beg to move.

That this House recognises and supports the contribution of community hospitals to the care of patients within the National Health Service; requests the Secretary of State for Health to commission a comprehensive database of community hospitals, their ownership and current roles; and believes that the assets of community hospitals should remain for the benefit of their community while allowing them greater freedom to explore different ownership models.

I warmly welcome my hon. Friend the Minister to her new role. She will know that there are more than 300 community hospitals in England. I used to work at one of the very smallest at Moretonhampstead in the heart of Dartmoor, so I know just how important community hospitals are, especially to isolated rural communities. I may have lost one, but I fortunately gained four, and I am happy to represent Brixham, South Hams, Dartmouth and Totnes.

Community hospitals vary in size and function—some are urban, some are rural, for instance—but they share a common theme: they are deeply rooted in their communities and provide an extraordinary level of support with volunteering and charitable giving through leagues of friends. The reason for that support is clear: people value their personalised approach and want to be treated closer to home. Community hospitals score well on things such as dignity, respect and nutrition. We should be treasuring and enhancing their role because although small is beautiful, unfortunately it can make them a tempting target for cuts.

The need for efficiencies in the health service is nothing new. I remember reading in 2009—before the general election—about the Nicholson challenge. We have known for some time that we have to make £20 billion of efficiency savings over the next four years—that is 4% efficiency gains year on year—but there is a misunderstanding about what this means. It is not about doing less of the same; it is about spending what we spend more efficiently and looking at the needs of our population. Over the next 20 years, the number of over-85s in our country will double.

[Nicola Blackwood (Oxford West and Abingdon) (Con)]

In my constituency, Abingdon community hospital has played a fascinating role in supporting the wider NHS in Oxfordshire. It has assisted with the problem of bed blocking by supporting early and late-stage rehab and preventing patients from needing acute beds. I do not think that community hospitals should face cuts, given the role they can play in easing pressures on acute hospitals. Does my hon. Friend agree?

[Dr Wollaston]

I agree absolutely. Their role in so-called step-down care and rehabilitation is vital, and I am glad to hear that it is happening well in Abingdon.

Seventy per cent. of the total spend on health and social care goes on people with long-term conditions. We should all understand that the burden of disease in England has completely changed—from tackling life-threatening emergencies to managing people with long-term, complex conditions.

[Miss Anne McIntosh (Thirsk and Malton) (Con)]

I congratulate my hon. Friend on securing this timely debate. She mentioned the growing elderly population, and nowhere is that more of an issue than in north Yorkshire. Does she agree that the Government—and this is a good opportunity for me to congratulate our new Minister, whom I hope will respond positively—should not be obsessed only with home care, which has its place, and that there will always be a place for community hospitals in our health care structure?

[Dr Wollaston]

I wish to make the case for reinvigorating community hospitals as hubs for delivering the right care at the right time and in the right place. Of course, the right place, where possible, will always involve helping people to be independent in their own homes, but community hospitals have a vital role, through both step-up and step-down care, in helping to maintain that independence.

We should look at what community hospitals are capable of, because they are not just about in-patient beds: they provide a full range of diagnostics, minor injuries units, therapies—physiotherapy and occupational —and mental health care. In my constituency, people with cancer can access chemotherapy at Kingsbridge hospital, saving them a long roundtrip to Derriford hospital. Kingsbridge hospital—South Hams, I should say—supports a triangle centre helping people and their families living with cancer, while organisations such as Rowcroft hospice are looking to expand their care-at-home system through hubs in community hospitals and, at times, by utilising their beds and support. We can get so much more from community hospitals if we reinvigorate them.

We should not think of community hospitals as backwaters; they can be centres of great innovation. The nationally recognised Torbay pilot, which provides care based in the community, started at Brixham community hospital in my constituency and is now being considered for nationwide roll-out. That is a very good model.

[Guy Opperman (Hexham) (Con)]

I congratulate my hon. Friend on securing this important debate. She mentions the Torbay model, which is rightly a pilot and flagship for the integration of services, but does she envisage a situation in which not only are medical services integrated in one location but other emergency services can come together? The result could be enhanced training for people, such as firemen and policemen, who could qualify as paramedics and assistants to the medical services.

[Dr Wollaston]

Indeed I do, and there are many community hospitals that support first responders in the way my hon. Friend describes. That is an important role, and there is perhaps even an extended role in housing, where step-down housing can enable people to make the transition back to full independence. Indeed, there are many such roles.

What are the current barriers to providing the right care at the right time and in the right place? I would like the Minister to deal with five points. First, the biggest challenge we need to address is the tariff and tariff reform. She will know that most acute hospitals are paid through a system known as payment by results, which creates some perverse incentives, whereby acute hospitals want to hoover up as much activity as possible. Often, people are treated in an acute setting when they could be more appropriately cared for in a community hospital setting or at home. Can the Minister update the House on the progress we are making on reforming the tariff, by, say, working towards a “whole year of care” model or looking at other ways to remove the incentive in the system that means that people cannot be transferred into community hospitals or provided with the right care in the right place?

[Neil Carmichael (Stroud) (Con)]

I congratulate my hon. Friend on securing this debate and I entirely agree with her important point about the tariff and acute hospitals. I hope she agrees that it is also important to signpost patients to the right place, which, because we are talking about a caring issue, is in many cases a community hospital.

[Dr Wollaston]

I thank my hon. Friend for making that important point. Quite often patients are not aware of the full range of services available in their community hospitals. We can do far better in signposting them. It is also important that GPs understand and support those services and make referrals to the right place.

The second issue I would like the Minister to address is the community hospital estate. She will be aware that many community hospitals around the country are being pushed into ownership by NHS Property Services. However, there are examples around the country of community hospitals that are owned by their communities, for example, or by a social enterprise. If those hospitals are unable to have ownership of their premises, that can hold them back if they have ambitions to expand their roles in future. Obviously we want to reassure the public that these valuable community assets remain in public ownership, as it were, but we also want to ensure more flexibility in their ownership model. I would therefore be grateful if the Minister addressed that point.

Thirdly, there is an accountability issue. There are occasions where having multiple providers operating out of a community hospital can cause confusion. Situations can arise where, because everybody is responsible, nobody is responsible, and accountability can end up being shunted around the system. Does the Minister agree that it would make more sense to have a single body, or even individual, with overall responsibility for what happens to patients and the way in which care is organised in a community hospital?

Fourthly, I want to raise an important point that goes beyond community hospitals to the whole way in which we look at a primary care based system, namely the looming crisis in general practice numbers. For the first time we now have a vacancy rate for GPs of 12% in the south-west. On top of that, in about four or five years we will have a retirement bulge—I am afraid that I have not helped the situation—and we are also moving, quite rightly, from a three-year period for general practitioner training to a four-year period. All that coming together means that across the country, the south-west included, we will face a shortage of skilled practitioners both to deliver commissioning and to staff our community hospitals. We need their support. It would be a great shame if GPs who were enthusiastic about getting involved in commissioning and helping out in their community hospitals were unable to do so because of their clinical commitments. Can the Minister therefore update the House on how we are going to stop the problem, which has been going on for years, of too many medical students going into training in acute hospital specialties? We need more of them to go into general practice.

Finally, will the Minister support the Community Hospitals Association? It does a tremendous job. In 2008 it received a £20,000 grant to help set up a detailed database that documented not only where community hospitals are but what they do. At this time of change I hope she agrees that it is particularly important that we keep track of what they are doing. The CHA has also highlighted innovation and helped to spread best practice, so I hope that she will give it further support.

No debate about community hospitals would be complete without thanking the leagues of friends, which around the country have provided millions of pounds. They do not provide luxuries; we are talking about major building projects, equipment, funds for care, volunteers who come into the hospital—an extraordinary level of support. We could not manage without them in our community hospitals. I know that the whole House will want to join me in paying tribute to our leagues of friends.

This is a call to arms to people listening to the debate. If you value your community hospital, let your GPs know, let your commissioners know, let HealthWatch know, let your local health and wellbeing boards know. If we want community hospitals to be treasured, as we all do in the House, we need to make that very clear.

[Several hon. Members]

rose—

--- Later in debate ---

[Dr Wollaston]

I thank the Minister for her reply.

Who could forget the passionate cry from the heart from my hon. Friend the Member for South Dorset (Richard Drax) and the invitation to take cake in Swanage hospital? How wonderful it was to hear an alternative vision for the future from my hon. Friend the Member for Hexham (Guy Opperman) and to hear how we could see community hospitals as the heart of community care provision. I hope that the commissioners in south Dorset will see the light and see that that is a much better alternative.

Many Members have contributed to the debate and I am grateful to them all. We heard from the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) and from my hon. Friend the Member for South East Cornwall (Sheryll Murray), particularly about the difficulties of rurality and transport. We heard likewise from the hon. Member for Southport (John Pugh). We want to tackle rural health inequalities and the speech made by my hon. Friend the Member for South East Cornwall clearly made the point that if we do not have transport, that contributes to health inequalities. We heard from my hon. Friends the Members for Bracknell (Dr Lee) and for Penrith and The Border (Rory Stewart) about the need for leadership and how we can deliver the right care at the right time and in the right place.

My hon. Friend the Member for West Worcestershire (Harriett Baldwin) made a knowledgeable contribution about different ownership models in her constituency. My hon. Friend the Member for Newton Abbot (Anne Marie Morris), whose constituency neighbours mine, paid tribute to the marvellous stroke service that operates out of her community hospital. She also spoke knowledgeably about the problems with PFI in the NHS that have dogged so many hospitals and burdened the NHS with unnecessary debt. My hon. Friend the Member for Halesowen and Rowley Regis (James Morris) spoke about the campaign to keep in-patient beds at Rowley and it is clearly disappointing that we will not be able to see more direct intervention on unnecessary closures in parts of the area.

It was good to hear the speech from the shadow Minister, the hon. Member for Denton and Reddish (Andrew Gwynne), but Labour Members are not so much abstaining as absenting themselves from the debate, which is clearly disappointing. I assure him that I fully understand that there must be reassurance for the future that community hospitals will always stay for the benefit of their local communities and that it is good to hear the Minister reiterate that very important point. If we are going to see the contribution from leagues of friends continuing for the future, they must have absolute confidence that those valuable community assets will always stay for the benefit of local communities.

I thank all Members for their contributions and pay tribute to all the staff and leagues of friends of our wonderful community hospitals.

Question put and agreed to.

Resolved,

That this House recognises and supports the contribution of community hospitals to the care of patients within the National Health Service; requests the Secretary of State for Health to commission a comprehensive database of community hospitals, their ownership and current roles; and believes that the assets of community hospitals should remain for the benefit of their community while allowing them greater freedom to explore different ownership models.

National Health Service

Sarah Wollaston Excerpts

Monday 16th July 2012 Commons Chamber

[Andy Burnham]

I will give way to the hon. Member for Totnes (Dr Wollaston) before I conclude.

[Dr Sarah Wollaston (Totnes) (Con)]

I hope that in his conclusion, the right hon. Gentleman will address a point raised by the King’s Fund. It said that the greatest policy failure of the previous Administration was the failure to tackle health inequalities. He says that he wishes to appeal the whole of the Health and Social Care Act 2012, but does he accept that shifting public health back to local authorities gives us one of the greatest opportunities to tackle health inequalities? Will he seriously put public health back where it was before and, by so doing, continue to fail to address health inequalities?

[Andy Burnham]

The hon. Lady mentions the Act, and I seem to remember that she called the Bill a hand grenade thrown into the health service. She seems to have changed her tune since then. We made huge progress on tackling smoking and improving the public health of this country, progress of which we are very proud. We can always say that we could have done more, but I remember putting through measures on smoking towards the end of our time in government that were opposed by those on the Government Front Bench. I am not sure how she could justify that.

The budget cut combined with the distraction of reorganisation means that six out of 10 hospitals in England are now off target for their efficiency savings. That brings me back to where we started: this is the wrong time to reorganise the national health service. In conclusion, the House cannot reverse tonight the damage of the NHS reorganisation, but we are not powerless. There are things we can do to help the NHS at one of the most dangerous moments it has faced. Our constituents will expect us to hold Ministers to account for promises made on rationing and reconfigurations. They will want us to do the right thing by NHS staff facing pay cuts and redundancy. Our constituents have a right to expect that one of the central pledges in the coalition agreement—not to cut the NHS—will be honoured. That is the simple call of our motion this evening which, we hope, can unite all sides of the House. A vote tonight for the motion would be a positive vote for an NHS under siege and a message of appreciation for NHS staff facing uncertain times. I commend the motion to the House.