Breast Cancer Screening

Stephen Lloyd Excerpts

Wednesday 2nd May 2018 Commons Chamber

[Mr Hunt]

My right hon. Friend is testing my clinical knowledge here; there will be other people in the Chamber who are better able to answer that question. I am ready to be corrected by eminent experts on this, but my understanding is that, in relation to women in their 70s, for every 1,000 women there are around 12 cancers, and of those 12 cancers, around three are potentially life-threatening.

[Stephen Lloyd (Eastbourne) (LD)]

Let us be clear that this is an utterly desperate situation. We know that some women may well have died who might not have done had they been identified. However, I would like to pay tribute to the Secretary of State’s statement. It was transparent, it ’fessed up and it made clear what the Department of Health and Social Care will be doing to remedy the situation. I appreciate that. What will the Department do to raise awareness of breast cancer screening among women who are not currently registered with a GP?

[Mr Hunt]

That is an important question. We have the Be Clear on Cancer campaign, which is a national advertising campaign but, as my hon. Friend the Member for Lewes (Maria Caulfield) said, it is important for people to recognise that, if we are going to protect them from cancer, they will have to take an active and proactive role in detecting any cancers they might have. Important though the screening service might be, they cannot rely on the screening service, because their own experience of how their own body is functioning is the most important detection method of all.

Bowel Cancer Screening

Stephen Lloyd Excerpts

Tuesday 1st May 2018 Westminster Hall

[Nick Thomas-Symonds]

I absolutely agree with my hon. Friend and I pass on my condolences to him, even though the loss of his father was some time ago.

Along with my father Jeff, my wife Rebecca and my mother’s many friends, I supported her through three arduous rounds of chemotherapy, helping her to achieve her goal of living long enough to meet her grandson, my son William, who was born some three months after she was diagnosed. Owing to the care and treatment she received, her inspirational bravery and her sheer determination, she lived not only to see him born but to see him reach his first birthday in September 2017, and to see her beloved granddaughters, Matilda and Florence, reach the ages of eight and five—precious moments that are now my precious memories.

For families dealing with cancer, time is everything. Those who are diagnosed with bowel cancer have the best chance of surviving—and of surviving for much longer—if they are diagnosed at the earliest stage. This is why screening is so important.

[Stephen Lloyd (Eastbourne) (LD)]

I thank the hon. Gentleman for securing this important debate. I offer him my condolences on his dear mother’s death. He will be aware of the enormous public petition—it has received 446,000 signatures—that was started all those years ago by Lauren Backler, who also lost her mother. I have supported that campaign for a long time. Does he agree that the evidence is clear that we should be screening at the age of 50, so it is surely time for an end to shilly-shallying from the Department of Health and Social Care? Will the Minister agree to at least pilot screening for bowel cancer at 50? It is obvious that the evidence from such a pilot would be irrefutable.

[Nick Thomas-Symonds]

rose—

Oral Answers to Questions

Stephen Lloyd Excerpts

Tuesday 20th March 2018 Commons Chamber

[Mr Hunt]

I have met the management team for my hon. Friend’s trust and he has talked to me on many, many occasions about that. I hope that he will have a positive answer, and if it is, that will be in no small part thanks to his campaigning.

[Stephen Lloyd (Eastbourne) (LD)]

Bowel cancer remains a major killer in the UK. The National Institute for Health and Care Excellence recognises the new FIT—faecal immunochemical test—to be a far more effective bowel screening process, but there remains a lack of clarity about when it is going to be rolled out nationally. Will the Minister provide that clarity today so that people can be saved down the line?

[Steve Brine]

The UK National Screening Committee has recommended that FIT be the primary screening test for bowel cancer, and NHS England remains absolutely committed to implementing it in 2018-19. We expect to make a decision very shortly on when that will be.

Oral Answers to Questions

Stephen Lloyd Excerpts

Tuesday 6th February 2018 Commons Chamber

[Caroline Dinenage]

Independent living schemes can keep people living healthier, more independent lives for much longer and provide the comradeship and camaraderie that keep people active and healthier. My hon. Friend is right to raise their importance, and the Government very much support them.

[Stephen Lloyd (Eastbourne) (LD)]

With reference to the integration of health and social care, the Minister may be aware that I have two outstanding respite and rehab homes in Eastbourne called Milton Grange and Firwood House. They are both under threat of closure by the county council, which says that central Government are not giving it enough money. Those homes serve a crucial purpose in supporting the local hospital. Will the Minister agree to meet me and representatives from the county council to work out a way to find the funds to keep both those vital homes open?

[Caroline Dinenage]

The hon. Gentleman is absolutely right to stand up for the good-quality respite in his local area. The Care Act 2014 requires local authorities to shape local markets and ensure that they give a sustainable, high-quality local offer. I would be more than happy to meet him to discuss that further.

Social Care

Stephen Lloyd Excerpts

Thursday 7th December 2017 Commons Chamber

[Jackie Doyle-Price]

I welcome the spirit in which the hon. Gentleman makes his comments. It is fair to say that we are hearing exactly the same sort of plea from local authorities, which are at the front end of dealing with this problem. He is absolutely right that we need to separate the short-term pressures from the long term, and we ought to be able to have a more sensible conversation on the long-term pressures. Yes, let us save the politics for the short term and have consensus for the long term.

[Stephen Lloyd (Eastbourne) (LD)]

I appreciate the opportunity to speak, Mr Deputy Speaker, as I missed the beginning of the Minister’s statement—my apologies. I concur totally with what a number of colleagues have said about the issues in the here and now. At the minute, there are significant issues for a lot of councils and a lot of care homes that cannot wait for a few years. The here and now must therefore be the priority.

I have two points to make on that. The first is negative and I would like the Minister to take it back to the Chancellor. I call on the Government to make a public commitment to fund the back-pay bill for sleep-in carers. I do not know how many colleagues know about this issue, but if it is not sorted very soon, a number of very reputable charities and organisations are likely to go bust. On a positive note, I wonder whether the Minister has read the recent BMJ report that indicated how exercise can be a significant miracle cure for older people. May I meet the Minister to share the report with her?

[Jackie Doyle-Price]

I would be happy to meet the hon. Gentleman; I am always looking for solutions. He is absolutely right that if we can look after our own wellbeing—both physical and mental—more effectively, the need for care will diminish. That is another reason why we need to have this public debate. Like the hon. Member for Birmingham, Erdington (Jack Dromey), the hon. Gentleman has mentioned sleep-ins. It is a big issue, but we are working closely with the sector to make sure that we can address it.

Deafness and Hearing Loss

Stephen Lloyd Excerpts

Thursday 30th November 2017 Westminster Hall

[Stephen Lloyd (Eastbourne) (LD)]

It is a privilege to serve under your chairmanship, Mr McCabe. I join other hon. Members in congratulating the hon. Member for Poplar and Limehouse (Jim Fitzpatrick) on securing the debate. I was chair of the all-party parliamentary group on deafness, but was rudely interrupted in 2015 when something else happened. It is a pleasure to be back and to serve as vice-chair of the APPG under the hon. Gentleman’s excellent chairmanship.

I commend the previous speakers’ comments about cochlear implants. I remember 20 or 30 years ago, when they really began to take off. The difference between now and then is absolutely huge. That overlaps with what the hon. Member for Rochester and Strood (Kelly Tolhurst) described of her mother’s experience. I thank her for that moving speech. Her mum will be proud of her, I am absolutely sure of that. I can relate to a lot of the things that her mum went through. I have been deaf for about 50 years of my life.

Cochlear implants have made a huge difference and the improvement is absolutely massive. The Minister is from the Department of Health—he is an old colleague from coalition days; it is good to see him—and I ask him to explore how cochlear implants can be ever more available, because they do much more now and they do it much earlier. They are a game-changer. For many years after they first came out, a long, long time ago, they really did not make that much of a difference. There was vigorous opposition from a lot of the British Sign Language community, and I understand why. That has changed a great deal over the years and cochlear implants are now, in many ways, the future for transforming deafness. I never really believed it in the old days, but now I do, because of the advances.

I would like to cover a few areas, a couple from the UK Council on Deafness angle and a couple specifically because we have a Health Minister here. British Sign Language is a different language. I am hard of hearing and have been since having measles when I was six. Sometimes, people might say to me, “Stephen, are you a member of the deaf community?” and I would say, “No, I am a member of the hearing community. I just don’t hear very well.” That is an important point, because they are completely different. The deaf community is a community. The BSL community is a completely different community, with cultural norms and a different language. BSL is not even a direct translation of my speech; it is different. Sometimes people do not understand that. They would say to me, “Why don’t you learn BSL?” and I would say, “Because I am a member of the hearing community, I just don’t hear very well, and it is a different language.” I am very supportive of profoundly deaf people trying to get BSL as a recognised language, as has happened, I believe, in Holyrood in Scotland.

I remember just before 2015 having meetings with a number of people down from Scotland and we were watching that development with great interest. Once it happens in one legislative House, it is very hard for other legislative Houses not to follow, so I say good luck with that up in Scotland, because it is a game-changer. It will happen eventually in Westminster. When it does, it is not just a label. When a nation says that a language is a statutory language, it means it is accessible and that public bodies have to provide information in that language, and that will make a huge difference for a lot of profoundly deaf people. I will tell hon. Members why and give one very good example.

I have been involved for many years in politics around deafness as a trustee of this or a patron of that, or what have you. I knew a lot of people who are profoundly deaf working in that area, including from the British Deaf Association. I just came from a statement this morning in which the Secretary of State for the Department for Work and Pensions mentioned that about 50% of disabled people are out of work. I tell you what, Mr McCabe, it is a hell of a lot higher than that for the profoundly deaf. I do not have the figures because no one really finds them. The DWP—it used to drive me crazy when I was here before—will not slice the different disabilities up. It just says “problems with deafness and problems with visual impairment”, which completely denies the separateness of deafness. Off the bat, though, I would say that profoundly deaf people have an unemployment rate of around 70%, which is just ridiculous. How can we possibly have 100,000 people—if not more—of adult working age and have such barriers that 70% are unemployed? It is a blooming outrage! Now that I am back in the House, which is wonderful for the people of Eastbourne—I thank them—I am determined to lobby hard to make BSL an accepted language.

I am also keen to join the hon. Member for Poplar and Limehouse in lobbying on Access to Work. The Government have done a great thing with Access to Work—I think it was John Major’s Government that started it. Access to Work is a good thing which has made a huge difference to a lot of people, and I am a big supporter or it, but there is a challenge. It has made a great difference for people who are in work and acquire a disability through illness, a catastrophic incident or what have you—it has been fantastic in helping them to stay in work. I want it to be improved, particularly in the small and medium-sized enterprises sector, so that SMEs understand that they can employ people with disabilities. Access to Work provides a lot of the money that will buy an induction loop, put in a ramp, or do whatever is necessary to help an employer take on a disabled person. That is really important. Corporates kind of get it—they are huge, and they have massive human resources departments and pots of money, so they try to do their best. It is much harder for an SME employing three people. If I were the director of a plumber working seven days a week, and someone with disability came to see me, it would be so much easier to say, “No, no,” and find an excuse not to employ them. Access to Work often provides the money that allows the SME to take on that disabled person.

I will let the House into a vast secret. I say this with authority, because I used to be a consultant in this area for years. If a business employs disabled people, they get lower churn.

[Matt Western (Warwick and Leamington) (Lab)]

rose—

[Stephen Lloyd]

I have seen that in call centres, in businesses and in numerous other areas. I used to be very involved with the Federation of Small Businesses, and I am sure I will be again now I am back. Lower churn is really important for businesses if a lot of their spend goes on employing people. At a later date, I will explain why it leads to lower churn, but it does.

[Matt Western]

Will the hon. Gentleman give way?

[Stephen Lloyd]

Yes, certainly—sorry.

[Matt Western]

The hon. Gentleman is talking about the challenges that SMEs have in employing people with such impairments. Does he agree that it is difficult for many people who suffer from deafness or failing hearing to progress within organisations because of the cap? It is therefore almost self-enforcing that those people are pressed into part-time working.

--- Later in debate ---

[Stephen Lloyd]

That is a very good example. I have no hearing on my left, so I could not hear the hon. Gentleman trying to intervene. Jim knows to punch me.

The hon. Gentleman is right. There are issues to do with Access to Work. As it has expanded and cost a lot more money over the years, the Government—I am not chucking stones, as I know how challenging it is to work within the Budget envelope—have introduced more and more caps. Rather than focusing on different ways of capping Access to Work, I would like the DWP—the Minister can go back and tell his colleagues—to focus on better and more creative ways to use the money. I know from years of experience—colleagues will have to take my word for it—that the majority of disabled people who get into a job, are properly managed and have the right support, stay there for years. That costs much less money than constantly having to re-employ. I thank the hon. Gentleman for the intervention.

I want to talk about two key areas that are specific to the Minister’s brief. One of the things I fought for last time I was here—I am going to do so now as the Minister is in Health—was an automatic invitation for a hearing aid screening whenever someone hits pension age. That would be at 65 or 66, although that was under the coalition—I think retirement age is 150 now. That is significant because something like 50% of people over the age of 65, heading up to 60% as they get older, begin to get age-onset hearing loss. My hearing loss is not age-onset, although I am old enough now—it was measles, as I said—and the hon. Member for Poplar and Limehouse is far too young, so his cannot possibly be age-onset. The thing with hearing loss is that the vast majority of people ignore it for 15 years because it is not a sexy disability. The hon. Member for Rochester and Strood flagged that up, and it is true. People start losing their hearing, they do not admit to it, their husband or wife goes potty, the volume is turned up massively on the television, and eventually their kids drag them to the audiology department, if it is still open—we will come to that—in their mid-70s.

The problem with that—there is significant data to prove this, which I will happily share with the Minister another time—is that the longer someone takes to get a hearing aid, the lower the chance of it working. The difference between a 75-year-old and a 65-year-old in acuity terms is enormous. Hearing aids are not like glasses. If I cannot see properly, I put glasses on and I have 20:20 vision. Hearing aids do not replace lost sound; all they do is amplify the residual hearing. Let me try to explain that to colleagues very quickly. Imagine a radio with a battery that is running down. If the volume is turned up, it makes a lot more sound, but it is very discordant. That is what hearing aids do.

I was pressing very hard for the Department of Health to run a pilot so that all people who get to pensionable age receive an invite to audiology or wherever—it could be a pharmacy, for that matter—to have a hearing test. My rationale for that, which was supported by pretty much every group that could possibly be imagined, including NICE, was that if people get in early, they are forced to accept they are losing their hearing. They get a hearing aid, and ipso facto it is much easier to get used to. My view, which is shared by many others, is that that would be a huge advantage, not least in reducing the levels of dementia. We have discovered that dementia is linked to social isolation, and old people who are deaf or hard of hearing tend to isolate.

The Department of Health agreed in principle to run a pilot. It took me a long time to get that agreement, because the Department did not want to do it. It knew that I was right and all those extra hearing aids were going to cost a lot more money. Then there was a tragedy, colleagues: I lost the election. I was not there to nag like hell, and it sort of disappeared and was put on the back burner. I am delighted to see that my old colleague is now the Minister. I am sure that, now I have put that on the table, he will move heaven and earth to develop it into a pilot. It will make a huge difference to hundreds of thousands of people—I am deadly serious—so I encourage that.

It is easy to cut hearing aids, because it is mostly old people who use them. They are not organised and are not going to complain like hell; they are isolated, anyway. As I said, they are in their mid-70s by the time they go to audiology departments. I am really pretty angry that a lot of CCGs are getting away with beginning to trim audiology services because there are not enough people fighting their corner. I know that CCGs are independent, but the Minister and I also know that there are protocols. In his response, I ask that he make a commitment that CCGs will be told how important audiology and hearing aids are. They must not use the austerity challenges they face to cut audiology. On that note, I again thank the hon. Member for Poplar and Limehouse for securing this debate.

--- Later in debate ---

[Sir Mike Penning]

Governments need to be kicked and beaten up when they get things wrong and praised when they get things right. I was proud that a Conservative Government brought in Access to Work, which is massively important. There will always be examples of abuse in the system and so on, but that does not give the Government carte blanche to say, “No, the only way this can work is with a cap,” particularly if the evidence does not show that a cap will work. The Minister will have looked twice when he came into the Chamber and realised what this debate would mostly be about, which is not his responsibility but the DWP’s. I am more than happy to go across to my old Department and sit with my old officials and explain to them exactly where the evidence is in their cupboards.

Let me touch briefly on two other areas, and then on one thing that has not been touched on at all. I do not understand why, in the 21st century, a recognised language is not recognised in the House or across the country. I really do not understand why, all these years after I made a point of order in the main Chamber in 2005 to complain that a hearing loop was not available for my constituents when they were in the House—even when it was installed, it did not work properly—this is the first time a debate has been signed for our constituents. People will always go on about how that must cost more money. The cost is minimal compared with the benefit to our constituents of being part of the democratic process.

[Stephen Lloyd]

I thank the right hon. Gentleman for kicking off about the induction loop years ago, because I could not function as an MP in the Chamber without it.

[Sir Mike Penning]

The things I do for everybody in this House. It was genuinely embarrassing. I remember it vividly. I said to the Speaker, Michael Martin, “My constituents have come to see this world heritage site and their Parliament at work. I took them on a tour, and frankly they got hardly any benefit apart from visuals, because they couldn’t understand or hear a word I was saying.” I seem to remember that there was the comment, from a sedentary position, “Well, they didn’t miss very much,” but I was trying to get across a point. This is the mother of Parliaments, and as we have heard from colleagues, we are way behind the loop again. I am sorry to use that terrible pun, but we are really behind. I hope that we will have a lurch forward. I have noticed all the Clerks coming in, and have heard that the Speaker will be reported to, and all that, and that is great, but it is absolutely useless unless someone actually does something. Then we can move on. I know this is a trial, but signing should be transmitted live.

Secondly, there should be a GCSE. I find it fascinating: we can see all the different courses that our young people do in schools and colleges, yet they are excluded in this way. If people do not want any more GCSEs, we could drop one of the ones that would not get used anywhere near as much as this. It would make people aware. In my constituency, people who are not deaf or hard of hearing have said to me that they want to be able to communicate like this; they want to do these courses as well. They want to have a GCSE, so that they can chat away with their mates in that sort of way. That is a simple thing, and I cannot see huge cost implications, so it should be moved on, as we have heard this afternoon.

Finally, I will touch on people whose hearing has been impaired by industrial injuries. That has not been mentioned at all in the debate, but not because people think it should not be. It is just one of those issues. People cannot see this type of industrial injury. It is not like the industrial injuries that my hon. Friend the Member for Poplar and Limehouse and I saw in our former jobs as firemen. There is something very wrong about how we measure industrial injuries, and hearing impairment industrial injuries in particular. So many people who have a hearing impairment do not admit it to themselves, their wives and their loved ones, even though their wives and loved ones are probably aware that there is an issue. They certainly do not talk about it to their employer or previous employers.

I can talk about this, because my eardrum is perforated. I did not know about that until I started to miss conversations that I thought I should be picking up. You just do not think there is something wrong. However, when I was a Minister at the Ministry of Defence, I had to have a medical before I was allowed to go into operational fields, and it was obvious that I had a perforated eardrum. It was almost certainly from live firing when I was in the armed forces—the specialists told me that—although it was not picked up then. That is not so important to me, but where industrial injuries are common, it is massively important that there be a level playing field on decibel levels. Completely different levels are used for hearing damage in the armed forces and what I call civvy street, and that cannot be right.

We must encourage people to come forward, not so much so that they can get compensation, but because, as we heard earlier, if we can pick this up earlier, it saves the state and everyone a lot of money, and also makes life much better for that person, who can start to accept the disability that they have and continue to live a happy life.

[Ms Karen Buck in the Chair]

Maternity Safety Strategy

Stephen Lloyd Excerpts

Tuesday 28th November 2017 Commons Chamber

[Mr Hunt]

First, may I apologise to my hon. Friend, because I should have mentioned her in my statement as someone who has spoken very passionately and movingly on this topic in the House? I will take away her point about specialist coroners, because we are now going to have specialist investigators, which we have never had before. I would make one other point. I hope she does not think I am doing down her former profession, but really when people go to the law, we have failed. If we get this right—if we can be more open, honest and transparent with families earlier on—it will, I hope, mean many fewer legal cases, although I am sure that the lawyers will always find work elsewhere.

[Stephen Lloyd (Eastbourne) (LD)]

I welcome the Secretary of State’s statement, like many others in the Chamber. He talked several times about learning lessons. As he knows, a recent report has highlighted that in my own trust, the East Sussex Healthcare NHS Trust, there were 19 stillbirths last year, which is a far higher percentage than in the rest of the UK. In the spirit of learning lessons, will he agree to someone in the Department of Health examining why that is the case?

[Mr Hunt]

I absolutely undertake to look into that case and ensure a proper investigation into what is happening. The hon. Gentleman is right; in the end, we need to be much more open about this data, so I commend the trust for sharing the data publicly. Until we access such data, we will not know where the issues are that we need to solve.

NHS Shared Business Services

Stephen Lloyd Excerpts

Tuesday 27th June 2017 Commons Chamber

[Mr Hunt]

My hon. Friend is exactly right. Of course we welcome the fact that no patient harm has been identified to date. We have to wait until the process of the third clinical review is completed on at-risk patients’ records, which will happen by the end of December. She is absolutely right to say that SBS is no longer performing this contract; it has been taken in-house. Other parts of the SBS contract not related to what we are discussing today were given to another supplier.

[Stephen Lloyd (Eastbourne) (LD)]

Does the Secretary of State agree that this is a very straightforward case? It shows a woeful lack of transparency, is a good example of why so many of us have concerns about too much private sector involvement in the NHS and, bluntly, there is a conflict of interest for the Secretary of State.

[Mr Hunt]

I acknowledged in my statement that there is, or was, a potential conflict of interest when the contract with SBS was in operation, and the National Audit Office talks about that today. In reality, as the National Audit Office confirms, patient safety was always our overriding priority in all the decisions we took. I suggest to the hon. Gentleman, as I do to the shadow Health Secretary, that he would have taken exactly the same decisions had he been in my shoes.

Hospital Car Parking Charges

Stephen Lloyd Excerpts

Monday 1st September 2014 Commons Chamber

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

rose—

[Stephen Lloyd (Eastbourne) (LD)]

rose—

--- Later in debate ---

[Jackie Doyle-Price]

Absolutely. This comes back to the issue of challenging trusts as to whether the car parking charges are fair. We have had push-back from a number of trust managers who say that it costs money to operate and maintain the car parks, partly because of some of the PFI contracts that have been mentioned. It is simply not good enough, however, for hospital trusts to pass on costs to staff and vulnerable patients when they need to be more challenging about how they manage their finances and not simply take from the patients. Nor is it enough for trusts to argue that charges are reasonable for their area. That is like writing an open cheque and allowing London hospitals to levy extremely high charges. It simply is not good enough. There is, in effect, a parking lottery in the NHS, with some patients able to access health care without any charge for parking their car, while others pay extremely handsomely for the privilege. I find that scenario completely incompatible with an NHS that should be free at the point of use.

I was shocked to discover that 74% of hospitals make more than £500,000 a year from their car parks, and even more shocked that more than 40% raise more than £1 million. I recognise that there are many reservations about the removal of car parking charges because of the amount of revenue received, but I do not buy it: I think there is lots more that hospital trusts can do to replenish any gaps that might occur in their revenue as a result of removing car parking charges.

I want to refer to my own local trust of Basildon in that regard. Some will know that Basildon has a very troubled history. It was one of the hospitals that went into special measures following the inquiry into Mid Staffordshire and it has had very high death rates. In the past year, however, since a change of leadership in the hospital trust, it has made massive advances, and it was the first to come out of special measures.

One of the things that the new chief executive has done is to recruit 200 new nurses, and in doing so she has managed to cut the pay bill because she is no longer relying on agency staff. We can all find other ways of replenishing the money that might be lost as a result of reducing car parking charges—not least, I might add, through some patients getting better quicker because they will get more visits from their families. That makes perfect sense to me.

[Stephen Lloyd]

I thank my hon. Friend for giving way and for facilitating this very important debate. One area she has not yet touched on is the impact on built-up areas such as the one surrounding Eastbourne district general hospital. The car parking charges at the DGH are really quite high, so instead of using the car park people are parking around and about, which is making it very difficult for residents. If it is done badly, it is bad for residents—

[Madam Deputy Speaker (Dame Dawn Primarolo)]

Order. Short means not many words. A large number of Members are waiting to speak. The hon. Member for Thurrock (Jackie Doyle-Price) has now been on her feet for 17 minutes. This is going to be a severely curtailed debate and Members will get only a minute or two unless we can start making some progress. Remember that interventions must be short if there are to be any more. I wonder whether the hon. Lady would consider, in respect to her colleagues who wish to speak, drawing her remarks to a close.

Obstetric and Paediatric Services (East Sussex)

Stephen Lloyd Excerpts

Thursday 18th April 2013 Commons Chamber

[Stephen Lloyd (Eastbourne) (LD)]

Let me begin by thanking Mr. Speaker for allowing the debate, and by welcoming the Minister.

Unfortunately, it is an extremely challenging situation for my constituency that brings me here today: the imminent downgrading of the obstetrics and maternity department and the ending of in-patient paediatric services at my local hospital, Eastbourne district general hospital, which is managed by East Sussex Healthcare NHS Trust.

ESHT, as I will now call it, attempted to downgrade maternity services once before, in 2007, but East Sussex county council’s health overview and scrutiny committee, or HOSC, had severe reservations and duly referred the plans to the then Secretary of State, the right hon. Member for Kingston upon Hull West and Hessle (Alan Johnson), who referred the proposals to the independent reconfiguration panel, or IRP.

As the Minister will be all too aware, the IRP is the independent expert on NHS service change and advises the Secretary of State for Health on contested reconfiguration proposals in England. In 2008, it finally published its recommendations, which were that consultant-led maternity, special care baby, in-patient gynaecology and related services must be retained on both sites—at Eastbourne district general hospital and Conquest hospital at Hastings.

The IRP felt that the trust did not make a clear case for safer and more sustainable services for the people of East Sussex and specifically that the proposals reduced accessibility compared with current service provision and that the journey from the DGH to the Conquest hospital posed a risk of incidents for women, especially during unexpected transfers.

Despite clear guidance from the IRP on how the hospital trust must remedy the problem, four years later a report from the national clinical advisory team, or NCAT, has deemed maternity services in East Sussex unsafe. That has given ESHT the opportunity to downgrade Eastbourne’s maternity from a consultant-led department to a midwife-led department almost immediately and, because safety is involved, without consultation. The trust managers have achieved exactly what they failed to achieve all those years ago. Is that a coincidence? I think not.

Let me be clear that I do not contest the findings of that report. How can I? I am not a clinician. However, I am extremely angry that we have found ourselves back where we were, with my hospital losing its consultant-led maternity services. We are back to the point at which we fought and won all those years ago, only now it seems it was a pyrrhic victory and that in fact we have lost. Eastbourne is to forgo its consultant-led maternity after all. Frankly, I think that is outrageous—absolutely outrageous.

Eastbourne is the fastest growing town in East Sussex. Our fastest growing demographic is 25 to 45, the age at which most people have children. The road connections between Eastbourne DGH and the Conquest hospital in Hastings are appalling—that was highlighted by the IRP report five years ago and they are still dreadful.

Where does the responsibility for that grotesque shambles lie? In the opinion of the cross-party “Save the DGH” campaign team, of the Under-Secretary of State for Transport, my hon. Friend the Member for Lewes (Norman Baker)—I am delighted to welcome his support today and although I know he cannot speak in the debate, I appreciate his presence in the Chamber—and of many tens of thousands of people across Eastbourne and the surrounding area, as well as in my opinion, the responsibility lies squarely with the current leadership of the trust and, specifically, at the feet of the chief executive, Mr Grayson, and the chairman, Mr Welling.

It has been made clear to me by many employees of the trust over a number of years that the trust was determined to push through these downgrades, regardless of the recommendations of the IRP. That was obvious for all to see when the chief executive, Mr Grayson, who, when he was asked about the reconfiguration at a HOSC meeting only last month, stated:

“I think it is fair to say the health and social care system in East Sussex failed women and babies in East Sussex when it failed to deliver a change to services in 2008 which, I feel, would have made them safer…we could have done something safer in 2007/08...we need to keep that at the front of our minds as we move into the next period.”

These words do not sound like a senior manager dedicated to implementing a solution that the IRP said was not only sustainable, had the recommendations been properly followed, but in the best interests of the safety of local mums and babies. Or does the Minister disagree with my proposition?

Let me move to the current proposals. The main incidents that led to the safety issues, according to the NCAT report, were problems related to staffing. For instance, emergency measures were required in September 2012 owing to the vacancies for middle-grade doctors and the absence of two consultants, as well as midwifery absences running at about 13%. However, on drilling down into the data, I discovered that the absence of one of the two consultants was due to retirement, and approximately half the midwifery absences were due to maternity leave, all of which, obviously, would have been known in advance. Importantly, other than that, the turnover of midwives was reported as low. This clearly shows an acute lack of planning and poor senior leadership. Staff pregnancy is not a secret, and retirement tends, in my experience, to have a pretty clear lead-in period.

I have brought up these very concerns and others with the Care Quality Commission, having met one of its directors only this week in Westminster. I can safely say that the CQC will in future pay even closer attention to the trust and in particular to the district general hospital.

It is with regret that I also have to tell the House that I have not been hugely impressed with the Department of Health over the issue of my local hospital. The Department has been slow to reply to my letters on what are, naturally, incredibly important concerns to my constituents. For instance, I wrote to the Secretary of State twice on 15 March when the shock news about consultant-led maternity services being switched to Conquest was announced. That will be five weeks ago tomorrow, and I have yet to receive a reply.

This is not the first time I have taken issue with the Department. Immediately before the maternity and paediatric downgrade, the hospital trust also removed emergency orthopaedics and emergency and highest risk elective general surgery from Eastbourne district general hospital. I and colleagues from the Save the DGH team were eventually able to meet the Secretary of State. We made it clear to him that the proposals to remove orthopaedics and general surgery from Eastbourne DGH did not meet all the Government’s four reconfiguration tests. I showed him the meeting papers which clearly state that our local GP commissioners did not support the move. The Minister then agreed to write to NHS South of England to investigate this further, and I received a reply from the Secretary of State a month later, in which he states:

“NHS South of England . . . is satisfied the proposals to reconfigure health services in East Sussex meet the requirements under the four tests.”

In the view of Eastbourne, Hailsham and Seaford clinical commissioning group, emergency general surgery and emergency orthopaedics should be sited at Eastbourne DGH, so clearly those two views contradict each other. I find that extraordinary.

Added to this, we conducted surveys of local GPs and consultants which showed that more than 90% of DGH consultants and 42 local GPs were opposed to the plans, and more than 36,000 people signed a petition against the proposals in only 18 days, which gives a strong indication of the strength of local feeling.

Alarmingly, the Secretary of State also informed me at our meeting that the issue had not even come on to his radar, despite his office confirming some weeks previously that it had received 5,506 letters in three months from people in Eastbourne and the surrounding area. These were individually enveloped letters, yet the Secretary of State was not made aware of them or of the issue. I find that extraordinary.

That brings me to my next key point. I would like to know who in the management structure of the health service or at the Department, both now and prior to the recent changes, is responsible for ensuring that trusts properly implement IRP recommendations, as it is clear in my view and that of others that the trust never sincerely implemented the series of recommendations made by the IRP, which were to maintain two sustainable and consultant-led maternity units. This obvious lack of commitment properly to implement the IRP recommendations was made crystal clear, as I said earlier in my speech, by the trust’s chief executive, Mr Grayson, when he gave evidence to HOSC only last month.

Consequently, I would like the Minister to arrange for me and the cross-party Save the DGH campaign team, which is ably led by the tenacious campaigner for our local hospital, Liz Walke, to meet his officials because we need to establish clear lines of communication with the Department. The people of Eastbourne are being failed, and to address that we need to ensure co-operation at the highest level.

Let me explain how the people of Eastbourne are being failed and what those failings will mean for local mums and babies. First, the proposed changes mean Eastbourne will be the largest discrete town in the UK without essential core services. Secondly, Eastbourne will have the worst population access factor in the UK. The PAF has been validated as a measure of the access to nearest facilities according to the size of population—as I am sure the Minister knows, it is the distance in miles multiplied by the population in thousands.

Thirdly, the NCAT report confirmed that 36% of first-time mothers and 20% of mothers having a second or subsequent baby are referred to a doctor during their pregnancy. Although I accept that expectant mothers will be screened and those found to be at increased risk will be directed to have their babies at a consultant-led unit in Hastings or Brighton, the original IRP report concluded that the risk to mothers was unquantifiable, and the very nature of birth means that there will be examples of mothers who have been screened with no problems detected going on to experience complications. With around 2,000 births in Eastbourne last year, that is an awful lot of pregnant mothers having to be shipped, by blue-light services, across to Conquest hospital.

The South East Coast ambulance service, which gives an outstanding service, gave a range of travel times between 23 and 52 minutes. However, the total transfer time from Eastbourne’s freestanding midwifery-led unit to Hastings consultant obstetric unit is over 60 minutes, and one study showed averages of 90 minutes. The Minister will know that the total transfer time is the important one, rather than the blue-light travel time. It is the total time from the decision to transfer from the FMU to arrival in the receiving bed at the obstetrics unit, incorporating the time for the ambulance to arrive, park, load, travel and unload. Most importantly, it is the total “down time” during which a patient with an obstetric problem will not have access to skilled medical obstetric assistance.

Fourthly, even the NHS pregnancy book advises:

“You should also be aware that if something goes seriously wrong during your labour… it could be worse for you and your baby than if you were in hospital with access to specialised care.”

Let me give the Minister a scenario. A mother in her third pregnancy, which has been uncomplicated, arrives at the midwifery-led unit in Eastbourne, where she had planned to deliver. On arrival, she is found to be in early labour, her blood pressure is low and the baby’s heart rate is slow. The patient is transferred urgently by ambulance 20 miles east to the consultant-led unit at Hastings for delivery. We should remember that the average total transfer time from when that decision is taken to arrival is upwards of 90 minutes.

The baby is born in a frail condition and needs to be resuscitated by neonatal paediatric staff and helped to breathe on a ventilator. The baby will then need to be retrieved by the neonatal transfer team to the neonatal intensive care unit in Brighton, which is more than 30 miles to the west, bypassing the DGH. The mother will also require transfer to the post-natal unit in Brighton in order to be with her baby, and what about her family, husband or partner and the other children and grandparents? I look forward to the Minister telling me how that can possibly offer the mother or the baby a better or safer service.

I find this situation absolutely foolhardy and almost beyond belief. Eastbourne is a growing town that pulls together. We have rolled up our sleeves in the teeth of the financial economic downturn and we are bucking the economic trend: unemployment is down from this time last year, our town centre has secured a £70 million private regeneration investment and we have some of the best performing schools in Sussex. Simply put, Eastbourne is a wonderful place to live and bring up a family, yet—this beggars belief—it seems that our hospital is being salami-sliced, with downgrade after downgrade. It is just plain wrong. I urge the Minister to intervene before it is too late.

It is not only the downgrade of our maternity services that angers me; there is also the decision to close in-patient paediatrics at the DGH. By bundling everything under the “safety” umbrella, the trust has been able to bypass due process on the basis that NCAT recommends that maternity and paediatric services be co-located. In fact, horrifyingly, the NCAT report also states that all core services should be co-located on one site. Will the trust be able to bypass everything in future and downgrade the entire DGH to a cottage hospital at NCAT’s say so? It is absolutely absurd.

Lastly, I have issues about whether staff really can go public with their concerns; frankly, under the current regime they fear for their jobs. I have been contacted by staff from all the different levels in the hospital. All are courageously keeping me informed but, equally, they are profoundly fearful about going public. That puts me, their elected representative, in a very difficult position. I will not breach their confidentiality without permission and they do not give their identities for fear of the consequences, but the trust management is then able to pooh-pooh my concerns and public statements as not being based on fact. In fact, the contract of one of my NHS constituents states:

“If he or she discusses items under consideration by the Trust that he or she becomes aware of with ‘unauthorised persons’, this will result in disciplinary action which may involve dismissal”.

Minister, that not only prevents staff members from bringing their concerns to their democratically elected Member of Parliament, whom the trust determines to be an “unauthorised person”, but they are not even supposed to discuss concerns with their colleagues. Surely to God the Minister agrees that the position is completely unacceptable!

The Secretary of State said recently, and very publicly, that a culture of “openness and transparency” will be at the heart of trying to drive up NHS standards, by encouraging NHS staff to speak up when they have concerns. Well, we do not have a culture of openness and transparency within ESHT and the DGH. That is worrying.

Due to the failings of the local trust and the mismanagement of the situation that has led us to where we are, I, along with my hon. Friend the Member for Lewes (Norman Baker), whose constituents are also served by the hospital, have called for the resignation of the chief executive, Mr Grayson, and the chair, Mr Welling. Again, and in Parliament, I reiterate that call and ask that they step down in the interests of the people of Eastbourne and the surrounding area, so that they can be replaced with a more capable leadership team. The issue does not affect only Eastbourne, but the surrounding area. Last Saturday there was a march in Seaford, which is in my hon. Friend’s constituency. It was supported, across parties, by many local residents.

I also take this opportunity to thank my hon. Friend the Member for Wealden (Charles Hendry), who cannot be here today as he is elsewhere representing the Prime Minister as his trade envoy. His constituents are equally served by the DGH. He contacted me to give his express permission to relay to the House that he, too, wants to know how we reached a situation where these services were deemed to be unsafe. He is also keen for the full range of maternity services to be restored to the DGH as soon as possible.

In wrapping up, I take the opportunity to thank two local mums in particular. Selene Edwards and Amelia West, alongside the Save the DGH campaign group, are working hard to protect local services and in a matter of weeks have both set up Facebook groups with over 8,500 members between them. Such community involvement is bringing the town together to fight the changes.

I shall now conclude. The Minister is, of course, free to address any of the points I have raised, but I am particularly keen for her to address four key points. First, how have maternity services at the DGH been allowed to get to the current “unsafe” position despite the 2008 IRP recommendations being utterly emphatic that consultant-led maternity must remain on both sites? Secondly, were the 2008 IRP recommendations ever properly implemented by ESHT? My constituents and I have lost so much trust as a result of this sorry episode that we would insist, reasonably, that the whole process should be independently audited by medical experts. Was the 2008 IRP-recommended report ever properly implemented?

Thirdly, how do the chief executive and chair of the trust still remain in post when they have presided over this debacle? Finally, I would like to request a meeting with the relevant senior Department of Health officials, so that clear lines of communication can be established with the Department to fix the problem for my local hospital before it is too late.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate my hon. Friend the Member for Eastbourne (Stephen Lloyd) on securing this debate. Given that no doubt many people in his constituency will, I hope, read all my speech and all the comments I make, it is very important that I make a number of matters very clear. As I am confident that he knows extremely well, this decision does not lie with the Department of Health. When he asks me a series of questions, which of course I am more than happy to answer, he must know, and those reading or listening to this speech must know, that these decisions are local decisions.

The coalition Government have taken the view that it is only right and proper that decisions of this nature regarding the provision of NHS services are made locally. My hon. Friend, quite properly, comes to this place to raise these matters on behalf of his constituents. I make no complaint at all about any Member of this place doing that, because, in many ways, it is our primary job. However, it is also absolutely imperative that when hon. Members, like my hon. Friend, come here and put forward a complaint on their constituents’ behalf, it is made clear where the decision-making process lies and where the responsibility lies—and it lies at a local level. That is why, in replying to his speech, I rely on information provided to me not by my officials in the Department, because they are not party to this decision, but by the various trusts, knowing the processes and understanding that this, as he must know, is a local matter.

I am told that the trust has been experiencing challenges in recruiting doctors for the specialties associated with obstetric and paediatric services. This has been followed by advice the trust has recently received from local clinicians and the national clinical advisory team. That advice, I am told, indicates that the trust’s current maternity and paediatric services cannot continue as they are. I am told that the current arrangements are unsustainable in terms of delivering a safe service to patients. I am sure that my hon. Friend has at heart a desire to ensure that all his constituents receive safe treatments and the safe delivery of their babies. That must be his, and indeed everybody’s, priority.

I am told that it is because of those factors—the shortage in recruitment and the safety of patients—that the trust has had to take urgent action, primarily on the grounds of patient safety. As my hon. Friend knows, the trust met in March and made a temporary decision—this is not a permanent decision.

[Stephen Lloyd]

Will the Minister give way?

[Anna Soubry]

In one moment, if I may, because the clock is against me and it is really important that I place on the record a proper and full response to my hon. Friend’s speech.

I am told that this is a temporary measure whereby the consultant-led obstetric service, neonatal services, including a special care baby unit, and in-patient paediatric and emergency gynaecology services will, in order to make sure that they are safe, be provided by Conquest hospital alone.

[Stephen Lloyd]

Will the Minister give way on that particular issue?

[Anna Soubry]

Briefly, yes.

[Stephen Lloyd]

I appreciate that. The Minister will be interested to know that I went to an extraordinary general meeting where the chair said that the measure would be temporary. I got a commitment that it would last for 18 months. I then publicised that and three days later I got a clarifying letter saying, “No, Mr Lloyd, we are saying that in 18 months we will consult on whether it is temporary.” I do not believe that it is temporary, and having the Minister support the idea that it will be temporary means that it is more likely to stay as such.

[Anna Soubry]

I get the point, but it is not a question of me supporting or believing in anything. I have been given information and am placing it before the House to ensure that the good people whom my hon. Friend represents have the full picture. It would be a serious allegation to suggest that the information with which I have been provided is false. I can say only what I have been told, which is that it is a temporary decision.

That is combined with the establishment of a stand-alone, midwifery-led maternity unit, alongside a short-stay paediatric assessment unit at Eastbourne district general hospital. This means that if a paediatric patient requires in-patient admission, they will be transferred to Hastings under the interim change.

As yet, no woman or child has been transferred to Conquest hospital. I understand that the project plans are in place for the delivery of the interim configuration of maternity and paediatric services, providing a single-site service at the Conquest hospital from 7 May.

My hon. Friend is fully aware that the trust has confirmed, as I have said, that this is a temporary change and, indeed, that a strategic and long-term solution will need to be agreed within 18 months. It is also important to remind hon. Members that I am told that the process will be led by local general practitioners and what we now call local clinical commissioning groups.

I am conscious that the clock is against me, but there is much I wish to say. I press on my hon. Friend that, as I have said, there are no specific proposals at the moment. I am informed that in order to develop a solution, the future of maternity and paediatric services is being considered as part of a separate, countywide programme called Sussex Together, which will bring together doctors, nurses and health professionals, in conjunction with local authority colleagues from across the county, so there is a real opportunity to improve health services and outcomes across organisational boundaries.

I will, of course, write to my hon. Friend to try to answer all his questions. I wish I had been given notice of them, because I could have answered them today, but I am precluded from doing so. At the moment there is no point in my meeting any of his good constituents who are leading the campaign, because there is nothing that we in the Department can do. As I have said, this is a local decision and it is temporary.

[Stephen Lloyd]

Will the Minister give way on that point?

[Anna Soubry]

No, I am afraid that I cannot take any more interventions, because I am keen to place the following on the record. The trust’s latest decision has been taken on urgent safety grounds as a temporary solution, and CCGs—clinicians, doctors and nurses—hope to and will find the long-term solution to the problem. In arriving at that solution, CCGs will want to assess proposals against the four tests that have already been outlined. Adhering to those tests and continuing to focus on the needs of the local population will ensure that proposed changes to services are locally led, not Government-driven or directed by Whitehall.

We hope that everyone will work together, including the local authority’s health and wellbeing board. Moreover, the health overview and scrutiny committee is a very important organisation that can refer proposals to the Secretary of State. It comprises democratically elected members and professionals, all of whom can ensure that the right thing is done.

[Stephen Lloyd]

Will the Minister give way?

[Anna Soubry]

No, I only have 10 seconds left. The committee has the power to refer proposals for changes to services to the Secretary of State—