Adult Social Care: Long-term Funding
Sarah Wollaston Excerpts(6 years, 5 months ago)
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Mr Clive Betts (Sheffield South East) (Lab)
I begin by thanking the Backbench Business Committee for allocating time today for me to present the Housing, Communities and Local Government Committee and Health and Social Care Committee joint report on long-term funding of adult social care.
In 2017, the then Communities and Local Government Committee undertook a lengthy inquiry into adult social care. We concluded that spending on social care would need to rise significantly in the coming years, and that after successive failed attempts at reform, political parties across the spectrum needed to be involved in the process of reaching a solution. With that in mind, we returned to the issue in a joint inquiry with the Health and Social Care Committee, aiming to identify funding reforms that would be supported by the public and politicians, and to feed its findings into the Green Paper. I thank all members of both Committees for the constructive role they have played, and particularly the Chair of the Health and Social Care Committee, who is so knowledgeable on these matters and with whom it has been a genuine pleasure to work on this inquiry.
To find out the public’s views on how social care should be funded, we commissioned a citizens’ assembly, which I understand is the first held by the UK Parliament. Following a process of learning, deliberating and decision making, which took place over two weekends in April and May, a representative sample of nearly 50 members of the public was asked how best to fund social care. We have listened carefully to the assembly members’ views. They have been vital in informing our thinking, and are reflected throughout our report. We have taken the unusual step of specifically addressing our recommendations to both sides of the political divide, asking that both Government and Opposition Front Benchers accept them.
What are the challenges facing social care and what funding is required to address them? The critical state of social care and the very serious consequences for people who receive care, and those who do not, and their unpaid carers and families, as well as the NHS, is well documented. The evidence was clear that the combination of rising demand and costs combined with reductions in funding to local authorities has placed the social care system under very great and unsustainable strain.
Despite the welcome additional funding provided by the Government in recent years, local authorities face a funding gap of around £2.5 billion in 2020. This has been confirmed by the National Audit Office, the King’s Fund and the Nuffield Trust, as well as the Local Government Association. The consequences are extremely serious and widespread, leading to people going without the care they need, and the time and quality of care not being sufficient for many who receive it, leading to unpaid carers having to step into the breach and placing significant pressures on care providers and the care workforce.
A witness to the inquiry, Sir Andrew Dilnot, chair of the 2011 Dilnot commission, told us that the system was consequently now at risk of “fairly significant disaster”, which were very strong words indeed. We concluded that considerable extra funding in the order of many billions of pounds would be needed in the coming years for the following reasons.
We need to fill the funding gap that I just referred to and we then need to provide additional funding to meet future demand. The personal social services research unit at the London School of Economics projects that spending on both social services for older people and younger adults will more than double by 2014, even without the improvements to the service that we suggest. It is also important to meet the care needs of a wider group of people—not just those whose needs are critical or substantial, but those who have moderate needs that are currently largely unmet. Age UK estimates that around 1 million who need care currently do not get it. Finally, and very importantly, we need to ensure that the care provided is good care from a stable, well-paid and well-trained workforce and viable care providers.
The difficult question for the Government and the Opposition to grapple with is where the additional funding for adult social care and social care for people of a working age with disabilities should come from, what it should be spent on, and how the care should be delivered. On care provision, we are strongly of the view that the responsibility for the delivery of social care should continue to rest with local councils at a local level. Social care provision should not, however, be seen in isolation. There is a need for better integration at a local level particularly within the NHS, as well as housing services. After all, most people receiving care get it in their homes. Integration should be seen not as a matter of bureaucratic convenience, but as a way of improving the care that individuals receive. The integrated care partnerships and health and wellbeing boards have an important role to play in that.
Our citizens’ assembly members expressed strong support for a social care system that, like the NHS, is free at the point of use. We acknowledge that this would increase costs substantially and be unlikely to be affordable immediately. We believe, however, that it is an ultimate objective for the personal care element of social care to be delivered free to everyone who needs it, and that accommodation costs should continue to be paid on a means-tested basis. This direction of travel should begin with the extension of free personal care to those deemed to have critical needs.
Now for the important question: where should the funding come from? Given the scale of the additional funding that is likely to be needed, which I have explained, we recommend that a combination of different fundraising measures are needed at local and national levels. At a local level, there should be a continuation for the foreseeable future of the existing local government revenue streams. We recommend that, in 2020, this funding is enhanced through using the additional revenue from 75% business rate retention, rather than the Government’s proposal to use the money to replace grants such as the public health grant. In the medium term, we recommend a reform of the council tax valuations and bands to bring them up to date. As other funding streams develop, the contribution from council tax and business rates to social care funding could fall, allowing councils to better fund other important services.
However, local government funding will only ever be one part of the solution for social care, given the scale of the challenge. It is clear that extra revenue will also need to be raised nationally to be spent on local provision. The citizens’ assembly was strongly in favour of any extra taxation being earmarked, wanting the clear assurance that the money raised would be spent on social care. We therefore recommend that an additional earmarked contribution, described as a “social care premium”, should be introduced, to which employers, as well as employees, would contribute. For fairness, it would be paid on earnings above a threshold and with the current national insurance limit lifted. We suggest that this premium could either be as an additional element to national insurance, which would ensure the accountability desired by the public and the citizens’ assembly, to be placed in an appropriately named and dedicated fund, and regularly and independently audited, or be paid into independent insurance funds, similar to the German model.
We strongly believe that a funding solution must fall fairly between generations and therefore recommend that those aged under 40 should be exempt from the social care premium, and that it should also be paid by those who are still working after the age of 65. We also recommend that a specified additional amount of inheritance tax should be levied on all estates above a certain threshold and capped at a percentage of the total value. This is intended to avoid the catastrophic costs for some individuals, who currently have to lose the vast majority of their assets, including their homes, to pay for care costs. It would pool the risk and spread the burden more fairly, a key recommendation of the citizens’ assembly. My view is that, if everyone who can afford it pays something, no one should have to lose everything.
After successive attempts at reform, the forthcoming social care Green Paper must be the catalyst for achieving a fair, long-term and sustainable settlement. It also ought to recognise the care needs of those of working age with disabilities, as well as the care needs of the elderly. To ensure that, we recommend that our work should now be taken forward by a cross-party parliamentary commission.
I say, on behalf of both Select Committees, to Government and Opposition Front Benchers that if we, on a cross-party, cross-Committee basis, can unanimously reach difficult decisions and make clear recommendations, can they not do the same? Use our proposals as a basis for building the wider consensus that we need to create a long-term, sustainable funding solution for those who need care now and in the future.
Dr Sarah Wollaston (Totnes) (Con)
I thank my co-Chair for the dedicated work that he has put into this joint report, as well as all members of both Committees and our wonderful supporting Committee teams. Like him, I thank not only all those who took part in the citizens’ assembly and those who advised and supported them, but the very many people, and their loved ones, who depend on social care, who wrote to us and whom we visited on our Committee visit. They told us moving stories about the level of unmet need and the consequences, both for themselves and their families.
The situation could not be more stark. As we approach the 70th anniversary of the NHS next week, would my hon. Friend say more about the impact on the NHS if we fail to address the unmet need in social care?
Mr Betts
I thank the hon. Lady, the Chair of the Health Committee—I think on this occasion, my hon. Friend, because we have worked on a friendly basis on this inquiry. She is absolutely right. One of the important recommendations is about trying to extend the scope of care provision to include those with moderate needs. If we provide care for them, it is quite likely that we will stop them getting into the substantial and critical phase and ending up in hospital in the first place. In terms of the NHS, it is about stopping people getting into hospital by getting them proper care and having care available for people in hospital, so that they do not have delayed discharges. In those two ways, that can be beneficial. Of course, we can also join up services. Can the NHS district nurse who goes into someone’s home and looks at their needs not assess their care needs at the same time? Can we not get that sort of joined-up approach?
It was remiss of me not to thank the staff, as the hon. Lady did, and I will name Laura and Tamsin. The work they did on this was exceptional. To produce a report of this quality in the time available was absolutely first-class, and we should congratulate them on it.
Childhood Obesity Strategy: Chapter 2
Sarah Wollaston Excerpts(6 years, 5 months ago)
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Mr Speaker
Order It is unsurprising that there is significant interest in this matter, but in order to facilitate timely progress to the ministerial statement, and indeed to the subsequent debate which I can advise the House is heavily subscribed, there will need to be a premium on economy from Back and Front Benches alike, as will now be brilliantly exemplified by the Chair of the Select Committee on Health, Dr Sarah Wollaston.
Dr Sarah Wollaston (Totnes) (Con)
I warmly welcome the second chapter of the childhood obesity plan, which takes us so much further in a number of areas. Can my hon. Friend the Minister set out the timescale for these consultations and confirm that the responses will be considered in a timely manner, treating this with the urgency it deserves?
Steve Brine
Yes, and may I thank the Chair of the Select Committee for the work she has done on this? Ever since we came into Parliament together she has been championing this issue—long before it was fashionable, I might add—and she has really led the line with her Select Committee inquiry on it, to which I and other Ministers joining me on the Front Bench today, including the Minister for Digital and the Creative Industries, my hon. Friend the Member for Stourbridge (Margot James), gave evidence. With most, if not all, of the consultations we are not hanging about; they will be getting under way this year.
Oral Answers to Questions
Sarah Wollaston Excerpts(6 years, 6 months ago)
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Dr Sarah Wollaston (Totnes) (Con)
Further to the point made by the hon. Member for Dudley North (Ian Austin), we know that the UK is a world leader in research into rare conditions, but that does not always translate into timely access to those treatments. The Secretary of State will know that there are many CFTR—cystic fibrosis transmembrane conductance regulator—treatments in the pipeline that could benefit people who are living with cystic fibrosis. Will he meet me to see how we can ensure that those are available in a timely manner for the people who desperately need them?
Mr Hunt
Of course I am happy to meet my hon. Friend. I recognise that this is one of the things that we are not good at at the moment. We have fantastic research, with amazing new drugs developed in this country, but our uptake can be painfully slow, and that is of course something that we want to put right.
NHS Long-Term Plan
Sarah Wollaston Excerpts(6 years, 6 months ago)
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Mr Hunt
Thank you, Mr Speaker. The hon. Gentleman said just now that there is
“no such thing as a Brexit dividend”.
I have heard lots of other people say that from a sedentary position. But what did their leader say on 26 February? These were his exact words:
“and we will use the funds returned from Brussels after Brexit to invest in our public services and the jobs of the future”.
So who is right: is it the hon. Gentleman or his leader?
After paying the Brexit divorce bill this Conservative Government will use the contributions that would have gone to Brussels to fund our NHS—that is what the British people voted for. But the main reason we are able to announce today’s rise, one of the biggest ever single rises in the history of the NHS, is not the Brexit dividend but the deficit reduction dividend, the jobs dividend, the “putting the economy back on its feet” dividend, after the wreck left behind by the Labour party. Every measure we have taken to put the economy back on its feet has been opposed by the Labour party, but without those measures there would be no NHS dividend today; with the Conservatives you don’t just get a strong NHS, you get the strong economy to pay for it.
In the next few weeks, as Labour scrabbles around to raise its offer on the NHS, we will no doubt hear that it is offering more for the NHS, but when the Labour party comes forward with that offer, the British people will know that the only reason it has done so is that a Conservative Government shamed it into doing so with an offer far more generous than anything Labour was prepared to contemplate.
Another thing I have heard said about NHS funding is, “Whatever the Conservatives offer, we’ll match and do more,” but the trouble is that the opposite is true, because under this Government NHS spending in England is up 20% in the past five-year period, but in Wales it is up just 14%. That is to say that for every extra pound per head invested in England, in Wales it is just 84p, which is why people are 70% more likely to wait too long in A&Es in Wales. The right response to this statement would be for Labour to say that every additional penny though the Barnett formula will go into the NHS in Wales, but we did not hear that pledge.
The hon. Gentleman also talked about social care, and this matters. I fully agree with him that we need to have a strong plan for social care and that it needs to go side by side with the NHS plan, and we have made some important commitments to the social care sector today. But if he is going to criticise social care cuts, he might at least ask why austerity happened. It was not, as he continually suggests, because of an ideological mission to shrink the state, but to save our economy and create jobs so that we could reinvest in public services. The evidence for that is shown today, with the first ever five-year NHS funding plan, to go alongside a 10-year plan. This is a Conservative Government putting the NHS first and shooting to pieces his phoney arguments about Conservative values.
Dr Sarah Wollaston (Totnes) (Con)
I recognise and thank the Secretary of State for his tireless efforts in making the case for this funding uplift and for a long-term plan. Will he now go further and set out whether, as a result of the extra funding, we will see an end to capital-to-revenue transfers? Will he also set out the role of transformation funding, because we all know that that is essential to get the best from the resources that we are going to add?
Mr Hunt
My hon. Friend asks two important questions. As she knows, we have committed to phase out capital-to-revenue funding, because if we are to make the NHS sustainable in the long run, we urgently need to make capital investment in estates, technology and a whole range of new machinery, including cancer-diagnostic machinery and so on, and we will not be able to do that if we continually have to raid capital funds for day-to-day running costs. That was one of the main reasons why we decided that we had to put revenue funding on a more sustainable footing. My hon. Friend is absolutely right about that.
Transformation funding is also important, because when the five year forward view was published, pressures in secondary care and the acute sector meant that a lot of transformation funding was sucked into the hospital sector and we were not able to focus on the really important prevention work that can transform services in the long run. I am very sympathetic to the idea that we need, if not a formal ring fence, a pretty strong ring fence for transformation funding, so that the really exciting progress that we see in some parts of the country can start to spread everywhere.
Education (Student Support)
Sarah Wollaston Excerpts(6 years, 7 months ago)
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Stephen Barclay
I have given way quite a lot, so I will make a little progress.
In addressing the Opposition’s points, we have moved slightly outside the scope of the SI before the House, which concerns postgraduates, into a discussion about undergraduates, and the Chair of the Health Committee, my hon. Friend the Member for Totnes (Dr Wollaston), made the point that the postgraduate market has certain features that are distinct from the undergraduate market. In certain disciplines, such as mental health and learning and disability, some older applicants may be more risk averse about taking on a student loan, depending on when they did their first degree. If it was before 1998, they probably will not have a student loan, but let us not forget that the Labour party introduced tuition fees, so many who studied after 1998 will have a loan.
Working in conjunction with colleagues in the Department for Education, and taking some of the lessons about targeted support that have been learned in teaching, we intend to offer £10,000 golden hellos to postgraduate students in specific hard-to-recruit disciplines—mental health, learning and disability, and district nursing—to reflect the fact that those disciplines often have particular recruitment difficulties. That £9.1 million package will be supplemented by a further £900,000 to mitigate a particular challenge with recruiting in any geographical areas. For example, if an area such as Cornwall suddenly found itself having difficulty in recruiting speech and language therapy recruits, a targeted measure—perhaps at a different quantum from £10,000—could be implemented in order to reflect those geographical issues.
Dr Sarah Wollaston (Totnes) (Con)
I thank the Minister for meeting me to discuss the concerns raised by the Health Committee in our nursing workforce inquiry. As he has stated, applicants for learning disability and mental health nursing tend to be older, and those applicants are more likely to stay. They are particularly affected, so I am grateful to the Minister for listening to our concerns. Putting the needs of patients first by allowing for these targeted extra packages is very welcome.
Stephen Barclay
I am grateful for that support from the Chair of the Health Committee. Having spent four years on the Committee myself, I know the value that members of Select Committees bring to the House. The Health Committee, particularly under her chairmanship, is hugely valued in the Department. The mitigation package that has been put before the House tonight reflects the constructive engagement that we have had with the Committee. We realise the importance of having consistency between undergraduates and postgraduates, and of expanding the supply of places, but it is also important to recognise that there might be specific areas in which there are recruitment challenges, and that targeted action to mitigate those challenges is appropriate.
Robert Halfon
My hon. Friend is right. My hope is that, rather than 50% of all students just going to university, one day 50% of all students will be doing degree apprenticeships in all subjects, but especially in the subjects we need, particularly in coding, healthcare, science, engineering and nursing.
Dr Wollaston
I welcome my right hon. Friend’s work as Chair of the Select Committee on Education. Does he agree that we are losing too many healthcare assistants because in the past there have not been the opportunities for them to progress? These regulations are an important way to retain such a valued part of our workforce.
Robert Halfon
As so often, my hon. Friend is a mind reader. I will address her point, but of course she is right.
These jobs should not be limited to degree level; we should ensure there are apprenticeships in healthcare professions from level 3. We must have sufficient progression for those already working in the sector. The nursing associate role is a positive step that will provide opportunities for healthcare assistants to progress within the sector. From there, they could train to become registered nurses, if they wish.
Oral Answers to Questions
Sarah Wollaston Excerpts(6 years, 7 months ago)
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Mr Hunt
That is a wise suggestion, and it is exactly the direction of our thinking in the social care Green Paper, which will have a significant chapter on housing. Integration is not just about integrating health and social care; it is also about other services offered by local authorities. I commend, too, the hon. Gentleman’s local authority of Redbridge: it is No. 1 in the country for user satisfaction with the social care system and No. 4 for carer satisfaction.
Dr Sarah Wollaston (Totnes) (Con)
One of the most pressing issues for those who depend on social care is resolution of the back-pay issue for sleep-in shifts. Will the Secretary of State update the House with his own estimate of the liability? The independent sector puts this liability collectively at around £400 million. Will he also update us on the progress being made, because he will know that many sectors are handing back their contracts and withdrawing?
Mr Hunt
I thank my hon. Friend for raising this serious issue, and I can reassure her that a lot of work has been going on inside the Government to work out how to resolve the issue. A court case is due that may have a material impact on those numbers, but we are continuing to work very hard and fully understand the fragility of the current market situation.
Mr Speaker
I have been enjoying listening to my colleagues so much that I inadvertently lost track of time, but it seems only right that the final question should go to the Chair of the Health Committee—I call Dr Sarah Wollaston.
Dr Sarah Wollaston (Totnes) (Con)
Thank you, Mr Speaker. Will the Secretary of State commit to publishing the progress report on sugar reduction and the next steps strategy on the reformulation programme, so that the Health Committee can examine that when Public Health England appears before us on 22 May?
Learning Disabilities Mortality Review
Sarah Wollaston Excerpts(6 years, 7 months ago)
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Caroline Dinenage
The hon. Lady is right that this issue was identified a few years ago. The report was commissioned in 2015 and has been in the making since then. There was a Care Quality Commission report in 2016 which concluded that bereaved families do not often experience openness and transparency. Everything we have done up until this point—the mortality review, the learning from deaths programme and all the other things we have put in place with regard to the transforming care programme and annual health checks—is geared towards addressing this very issue.
Dr Sarah Wollaston (Totnes) (Con)
The learning disabilities mortality review programme sets out the stark and unacceptable health inequalities faced by those with learning disability, and I welcome the steps the Minister has set out today. May I press her further, however, on the point about workforce shortfall? What is she going to do not only about recruitment, but about retention of the vital workforce in both health and social care?
Caroline Dinenage
My hon. Friend is absolutely right that the workforce in our health and social care system is absolutely fundamental to the way we look after people in our country. We must be able to attract, recruit, retain and bring back into the system people who have left it. We are currently compiling a workforce strategy jointly between Skills for Care and Health Education England, and it will be reporting later in the year.
Breast Cancer Screening
Sarah Wollaston Excerpts(6 years, 7 months ago)
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Mr Hunt
I thank the hon. Gentleman for his constructive tone, and I want to reassure him that each and every case will be looked at in detail. The sad truth is that we cannot establish whether not being invited to a screen might have been critical for someone without looking at their individual case notes, and in some cases, sadly, establishing a link will mean looking at the medical case notes of someone who has died.
It is important to explain that the reason for these estimates, which are much broader than we would like, is that there is no clinical consensus about the efficacy of breast screening for older women. As I understand it, that is because the incidences of cancers among older women are higher, but a higher proportion of them are not malignant or life-threatening, which makes it particularly difficult. It is also the case that breast cancer treatment has improved dramatically in recent years and so it is less important than it was to pick up breast cancer early. None the less, we believe it will have made a difference to some women, which is why it is such a serious issue.
The evaluations of the AgeX trial, which brought this to light at the start of the year, have been continued by Oxford University throughout the trial period. I am not aware of any evaluations shared with the Department that could have brought this problem to light, but obviously the inquiry will look into that. We need to find ways to improve oversight, and modern IT systems can greatly improve safety and reliability—in fact it was during the upgrading of the IT system that this problem was brought to light.
I will share with the hon. Gentleman the advice the Department received from Public Health England in January, which was the first time we were alerted to the issue, and we will certainly provide any extra resources the NHS needs to undertake additional cancer screening. One of our biggest priorities is that women between the ages of 50 and 70, when the screens are of their highest clinical value, do not find their regular screens delayed by the extra screening we do to put this problem right. He is right that one thing that has come to light is the regional variation in how the programme is operated. It was previously operated by the old primary care trusts, under the supervision of strategic health authorities, and then brought under the remit of Public Health England, but the regional variations have continued for a long time, so this problem will be worse in some parts of the country than in others. I undertake to keep the House fully informed.
Dr Sarah Wollaston (Totnes) (Con)
I thank the Secretary of State for the commitments and actions he has set out. Colleagues across the House will be thinking of the hundreds of thousands of women not called for their final screening test. They now need consistent, high-quality, evidence-based guidance so that they can make an informed choice about whether to take up the offer of screening. There is much material available setting out pictorially and clearly how they can weigh up the risks and benefits. Will he assure the House not only that a helpline will be in place but that it will be backed up with high-quality material available directly to patients and their GPs, many of whom will be directly counselling women following this news?
Social Care
Sarah Wollaston Excerpts(6 years, 7 months ago)
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Kelvin Hopkins
I am always in favour of improving the way we do things, and technology is of course important.
Dr Sarah Wollaston (Totnes) (Con)
Does the hon. Gentleman agree that, given that some funding decisions and challenges are very difficult, and given the amount of money that is needed, we should adopt a cross-party approach, looking at all the options, building consensus, explaining the position to the public and ensuring that this arrangement is delivered?
Kelvin Hopkins
In fact, the royal commission did cover funding. Over the last 20 years and more, I have spoken to many audiences, and have asked them, “What would you prefer—to have your house taken away from you, or Granny’s house taken away, or to pay slightly more tax?” The unanimous view was in favour of a slightly increased level of taxation to pay for long-term care. Everyone is going to get old. I am easily the oldest person in the Chamber. I am not planning to go into long-term care any time soon, but on the other hand I am closer to it than the other Members who are present. However, I will not speak about myself.
There is another factor in all this. In my constituency, there were three local authority care homes where the residents were happy, the staff were wonderful, and the healthcare professionals treasured them. All those homes were closed, and the land was sold off. Now we see the private care sector in constant difficulty. Given the collapse of Southern Cross and the ongoing threats to the future of many more homes, I believe that at some point the state will have to step in to ensure that care continues to be provided. Indeed, the Minister conceded that point: she said that we would have to step in and solve the problem. Why not set up a national care service now, and start to bring care homes back into the public sector as we did in 1948? I am not old enough to remember Nye Bevan’s speech in the House in which he proposed the establishment of the national health service, but I was inspired by him when I was at school, and my policies developed as a result.
Another scandal has been reported recently, namely the practice of effectively using self-funders to subsidise publicly funded residential care. Contracts with cash-strapped councils are squeezed, and charges for self-funders are increased to compensate. In one case, the charge for a care home resident who had been state-funded and then became self-funding was multiplied by several times. Most worryingly, there have been reports of inadequate care in homes across the country, which was mentioned by my hon. Friend the Member for Worsley and Eccles South. When care is provided by homes in the private sector that are squeezed for funding and have to make profits, it is inevitable that care standards will eventually be cut. It is clear that long-term care should not be in the profit-driven private sector, but should be a true public service, in the public sector. I commend today’s motion and all that has been said by many hon. Members on both sides of the House, but we have to move towards a national care service, based on exactly the same principles as the national health service.
Surgical Mesh
Sarah Wollaston Excerpts(6 years, 8 months ago)
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Dr Sarah Wollaston (Totnes) (Con)
I pay tribute to the many women, including those in my constituency, who have come forward to discuss deeply personal and painful accounts of serious complications following mesh surgery, sometimes with life-changing and lifelong consequences for them and their families. I also thank the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) who, as always, has set out the background to the issue so eloquently. She has been such a campaigner on behalf of victims, and I really thank her for what she is doing. I will not repeat much of the background that she set out, but I will highlight a few points to which I hope the Minister will respond in her closing remarks.
As we have heard, NHS Digital has published a review of patients who have undergone urogynaecological procedures for prolapse or stress urinary incontinence, including those where mesh, tape or equivalents were used. However, as the hon. Lady pointed out, the review does not cover all procedures, nor does it include the men who have been affected. We know that 100,516 women underwent these procedures between 2008 and 2016, of which 27,016 cases involved mesh for prolapse. Although the numbers are falling, I am afraid that this is just a snapshot.
Mr Seely
I congratulate the hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) on calling this important debate. Are the figures accurate? I have been told that some of the figures do not include people who are treated abroad and come here having developed complications, or people who have been to private clinics. The numbers that we have may therefore not be accurate, perhaps underestimating the true total.
Dr Wollaston
I was about to come to that very point. Crucially, many of the women I have met have been treated in the private sector. In this House, we should be concerned about all our constituents, not only those who are treated in the NHS. Of course, it is the NHS that often then bears the burden of managing complications, but we must have a much more accurate picture.
I support the call from the Royal College of Obstetricians and Gynaecologists and from the British Society of Urogynaecology for mandatory prospective data collection, using the BSU’s database. That is a well-established method of collecting outcome data. Retrospective snapshots are no substitute for collecting data as we go forward or, most importantly, for being able to track it in the long term. Although the majority of complications that happen after 30 days happen in the first year, many of the women I have met developed complications far later than that. I particularly want to emphasise to the Minister how important it is that we have access to shared databases not just here in the UK, but across Europe. Will the Minister tell us whether the Government will be seeking for us to remain part of the European Database on Medical Devices—EUDAMED—so that we not only get an accurate picture of what is happening here in the UK, where our population is smaller, but can compare our data with the whole European Union?
That brings me to the wider point about Brexit that is highlighted in the report of the Select Committee on Health on the implications of Brexit for medicines, devices and substances of human origin: the issue of access to clinical trials. It is encouraging that the Government have stated that they wish to remain a part of the European Medicines Agency or to have associate membership, but there are all sorts of aspects to forward clinical research on which it is essential that the Government campaign. They must campaign not just to maintain regulatory alignment and harmonisation, but to ensure that we can remain part of all research mechanisms and mechanisms for ensuring that we have the earliest possible awareness of any complications—not just from drugs but, as this situation has shown, from medical devices. I hope that the Minister will further outline the Government’s intention in that regard.
Sir Oliver Heald
My hon. Friend will remember that I spoke about my constituents in Letchworth during the debate in Westminster Hall. I am delighted that the audit has been done, but another constituent from Letchworth has been in touch with me since then. She has had ventral mesh rectopexy surgery and posterior mesh rectopexy surgery, which I understand are subsets of the mesh cases. Does my hon. Friend agree that if we were to look at a smaller group of people such as her across Europe, we would actually get quite a good picture of what is happening, given that we would be looking at data across a bigger area?
Dr Wollaston
My right hon. and learned Friend is absolutely right, and his point applies not only to medical devices. When it comes to relatively rare conditions, we need to look at the widest possible population base in order to detect any complications. It is also important to use the widest possible population base when detecting rare complications. I thank him for highlighting that.
If we are to have informed consent for women, it has to be based on high-quality, balanced and evidence-based information, and that has been lacking. We also need to be clear that if a medical device is altered in any way, it must be part of a clinical trial. That was entirely lacking in this situation. The types of device, including the size and thickness, were changed without anyone properly recording or following up on those changes. That has to be the key lesson for the future.
Owen Smith (Pontypridd) (Lab)
The hon. Lady is making an extremely important point. Does she agree that the issue here is that all one effectively has to prove for a follow-on device is its equivalence with the original device? There is therefore a fundamental flaw in how we license devices versus the far more rigorous way in which, for example, we license molecules.
Dr Wollaston
I absolutely agree. It strikes me that there has been a kind of wild west out there, with representatives saying, “Why don’t you try this one? This is probably going to be better”, without organisations setting up clinical trials from the start so that we could compare different devices, and without women giving properly informed consent that a different kind of device would be used. Lessons have to be learned not just for mesh surgery, but for other medical devices. Just because something sounds like it might be better, it does not mean to say that there will not be serious complications. Those complications may also happen at a late stage. We need databases such as EUDAMED so that we have access to the widest possible population base and clear device tracking.
Dr Wollaston
I do agree.
As I say, informed consent is essential, and that was lacking in very many cases. There are cavalier attitudes and assumptions that medical devices are somehow safer than medicines, but we know that that is simply not the case. We have to rigorously make sure that devices are all part of clinical trials, with long-term follow-up and tracking. Perhaps the Minister could update us on how we are getting on with the barcoding of devices, which clearly makes them over time. One of the tragedies is that many women are completely unaware that they have even had mesh inserted at all. That, again, has to be a lesson that we learn for the future about accurate documentation.
I hope that the Minister will comment on whether there are plans to introduce compensation for victims. As I said, many of the women I have met have had profound, life-changing injuries, and many are entitled to compensation.
Dr Huq
The hon. Lady mentions the physical injuries and physical pain, but does she agree that these women have also had great emotional pain and psychological suffering? Many are suicidal. The Minister would be well advised to introduce, within a future action plan, counselling services of some kind for these sufferers.
Dr Wollaston
I thank the hon. Lady for making that point. Yes, absolutely: the scars have been profound not only in physical terms but in the impact on how people feel about themselves. There is a great impact not only on them but on their families and their relationships.
On access to services, while we all welcome a tertiary service being set up for victims of urogynaecological mesh, there is concern about current waiting times for those who wish to have a referral to a tertiary centre, and about access to investigations, which need to be timely. When women come forward to report deeply personal and distressing experiences, it is important that they can be seen as rapidly as possible. I hope that the Minister will comment on that.