Breast Implants
Steve Brine Excerpts(12 years, 4 months ago)
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Steve Brine (Winchester) (Con)
I welcome the Secretary of State’s statement. As he knows, I co-chair the all-party group on breast cancer and we will want to monitor how women are treated by the NHS and private providers, and we will certainly feed that into the Department. For women who have fought breast cancer and been through the trauma of reconstructive surgery, this will bring it all back and be tremendously upsetting. Does the Secretary of State therefore agree that speed is of the essence in respect of replacement surgery where it is wanted, so that those women can again put this nightmare behind them?
Mr Lansley
I am grateful to my hon. Friend and I completely recognise the points he makes. As he will know, the overwhelming majority of the approximately 3,000 women who had PIP implants through the NHS will have had them as breast reconstruction surgery following mastectomy. From day one, we were clear that we wanted all those women to be able to get advice, investigation and remedy, and removal and replacement, should they wish. If the NHS was responsible for the original operation, we will be responsible for the replacement with new implants, if that is what is wanted.
The NHS is very clear about this issue in the advice that was presented. I welcome the fact that my professional colleagues in the associations are making it clear that, through the NHS, replacement procedures for these women should be possible rapidly, but it should not prejudice the availability of urgent referral for cancer, which will continue to be an operational requirement in the NHS.
National Health Service
Steve Brine Excerpts(12 years, 6 months ago)
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Debbie Abrahams
No, I am sorry; I am not going to give way.
We should compare our health care management costs with those in the United States, where they run at over 20%. We need to be very careful about what we are talking about.
Stephen Pound (Ealing North) (Lab)
There are few areas of our work in this House that may be described, honestly and without hysteria, as matters of life and death. The national health service is so utterly central to our existence, our future and the hopes of our country that it is no surprise that the emotions it engenders are as strong as those that have been witnessed on the Floor of the House this afternoon.
I have to tell the Secretary of State that he has a problem. He is a man of great charm, he is widely liked and he is popular, yet he has not sealed the deal on his disintegration, disaggregation and atomisation of the national health service. He has not been able to persuade the Royal College of General Practitioners, which tells us that three quarters of its members oppose it. He has not been able to persuade Professor Malcolm Grant, his own choice to run the commissioning board, who describes the plan as “completely unintelligible”. The Secretary of State wishes to persuade the nation that it is appropriate, at this time of all times, to spend about £3 billion on reorganisation—money that could be far better spent dealing with the dental abscess of the hon. Member for Southport (John Pugh) and all the other problems that face us.
The hon. Member for Truro and Falmouth (Sarah Newton) spoke for many in the House when she prayed for a depoliticisation of this issue. The reality is that the national health service was born amid the gun smoke of political opposition; it was born opposed entirely by one political party in this House and supported by another. Of the supporters—
Stephen Pound
Hold on a moment, I am just having a rant.
Of the supporters, let us give credit—because there once was a time when we could give credit to a decent, humane, sensible, consistent bunch of men and women—to the Liberals of those days and to Beveridge for the work that he did. Above all, let us never forget the transcendent genius of a south Wales miner’s son who left school at the age of 14, Aneurin Bevan, who gave us our national—I emphasise “national”—health service.
Stephen Pound
May I thank the hon. Gentleman? I do not know how anyone persuaded him to bowl me that patsy ball that I can immediately crack to the boundary. He is absolutely right. Dr Hill, the radio doctor, opposed the national health service. Aneurin Bevan said that he had had to
“stuff their mouths with gold”.
Of course the producer interest opposed the beginning of the national health service because it was about the consumers—that was its major difference. Of course the vested interests opposed the creation of the national health service—that is no surprise. But that was then.
The national health service was born in compromise. I was born in July 1948, as was the NHS. For many years I was suspected to have been the first child ever born on the NHS, in Queen Charlotte’s hospital, but somebody in Salford beat me to it.
Ovarian Cancer
Steve Brine Excerpts(12 years, 7 months ago)
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Mr Steve Brine (Winchester) (Con)
It is a pleasure to follow such a powerful speech. I pay tribute to my hon. Friend the Member for Pudsey (Stuart Andrew). We have worked together before, and he is getting quite a reputation for calling good debates in this place. I pay tribute to him for bringing this issue before us.
Like my hon. Friend, I come to the House with many experiences, which have shaped my life thus far. Cancer—not just ovarian cancer—has touched my life many times, and I have fought it many times. So far, it has won more times than I have, and such experiences shape the work that I do in the House.
In the next few minutes, I will not rehearse the arguments we have heard or repeat the statistics that my hon. Friend set out, but I will reinforce some of the things that have been said. Clearly, the most effective way of promoting awareness and understanding of the symptoms of ovarian cancer is to raise its public profile, and I hope that this debate will, if nothing else, go some way towards doing that.
I am a member of the all-party group and I pay great tribute to Target Ovarian Cancer and cancer charities generally, which do such an excellent job on this issue. I, too, have been struck by how effective they are as a lobby and by how powerful they are; the fact that so many Members are here today and that so many are interested in this issue is testament to that.
I thought that I would give Members a few reflections on my role as co-chair of the all-party group on breast cancer. I hope that is not insensitive; it is meant to be helpful, because there are really powerful lessons to be learned from the fight against breast cancer, and I hope that they can help women with ovarian cancer.
Thirty years ago, the breast cancer survival rate in this country was barely 50%; today, it is more than 80%. My goodness, that is testament to the effort that has been made. There have been many debates in the House, which have played a tiny role. There has also been funding, and large amounts of research and expertise have been applied to the issue. Awareness, too, has been critical. Similarly, there have been new treatments and a screening programme. All those things have made a difference, and they have all been essential to the significant progress we have achieved.
What has been key, however, has been the number of women who have been prepared to stand up and put their personal experiences on the record to keep breast cancer high on the nation’s agenda. Obviously, there have also been some high-profile deaths. There are so many to list, but what struck me, and it is often quoted, was when Linda McCartney lost her fight against the disease. So many women had grown up with the McCartneys, and her death did so much to place breast cancer on the agenda.
Breast cancer ambassadors continue to play a crucial role in raising awareness by sharing their personal experiences and promoting cancer campaigns in their local areas, as well as nationally, through the national media and through this place. That really brings home issues of which people might otherwise have remained unaware. It was not always the case that women immediately thought a lump might mean breast cancer; that was due to a huge amount of hard work and a huge number of awareness campaigns. The ambassadors really filled the gap effectively, and I hope we can see more of that in the fight against ovarian cancer.
As a member of the all-party group on ovarian cancer, I know that some representatives of the charities might be thinking that the lack of survivors makes fighting this disease more difficult, but that is a reason to try harder, not to give up. The lack of survivors means that people such as the hon. Member for Slough (Fiona Mactaggart) and other Members who take part in debates such as this are more important than ever in raising the issue and in keeping it high on the political agenda, and we will raise it again and again.
The high number of fundraising and public awareness drives promoted by the Department that the Minister represents, as well as politicians’ willingness seriously to grapple with the issue, have meant that the fight against breast cancer has retained its high profile, to the benefit of tens of thousands of women and their friends and families. Governments have produced very effective awareness campaigns over the years to encourage women regularly to check themselves and to ensure they know what they are looking for. The TLC—touch, look, check—campaign by Breakthrough Breast Cancer, which Target Ovarian Cancer works closely with, has been incredibly effective, and TLC day is part of breast cancer awareness month, which is this month. That is another exceptionally powerful way of reminding the public of that issue and of raising awareness of the fight against breast cancer.
Such simple messages, which can be spread through the champions I mentioned, can be used successfully and powerfully in the fight against ovarian cancer. We can send a bold message that women can fight the disease and beat it, and the hon. Member for Slough is wonderful living proof of that.
Many large national studies with large research grants were carried out in years gone by in the fight against breast cancer, and we need greater commitment and funding for research grants from the Government and charitable bodies at national level in fighting ovarian cancer. By demonstrating the commitment that exists in the research community to provide the wherewithal for large studies, huge strides can be made in bringing ovarian cancer to political and public attention. Perhaps the Minister can shed some light on his Department’s proposals on the future funding and commissioning of studies on the disease. Any information that he can share with us would be much appreciated.
Notwithstanding the connection between the familial forms of breast and ovarian cancer, which share the same defective genes to some extent, the age profile of the women affected is broadly similar, although, as the hon. Member for Upper Bann (David Simpson) rightly said, a striking number of younger women are affected by ovarian cancer. In that respect, I received the briefing from the Teenage Cancer Trust, which was very powerful.
It is not inconceivable that the same women who take on board the messaging about breast cancer symptoms will be open to messaging about ovarian cancer. We are always told, so it must be true, that women are much more receptive to health messages than men. That is absolutely right, so we have an important opportunity to make significant and potentially life-saving progress.
Obviously, there are still huge improvements to make in the fight against breast cancer, and that is even truer of the fight against ovarian cancer—particularly in terms of diagnosis and treatment. Like other Members, I urge the Minister to take action on ovarian cancer awareness as soon as possible. Currently, we are barely getting past first base. This is a silent killer, but it is also a silent national scandal. If we achieved what has been achieved in the fight against breast cancer in the past couple of decades through raising awareness, screening and better treatments, 3,000 of the 4,000 deaths a year from ovarian cancer might not occur. That might have saved the grandmother of my hon. Friend the Member for Pudsey, and it might have saved mine.
I ask the Minister please to ensure that the Government take swift action and make a start on dealing with this issue. At the moment, there is little DOH-led activity to improve awareness of symptoms among women and GPs, despite the fact that the Government have rightly committed themselves to saving the lives of 5,000 cancer sufferers a year as part of their excellent cancer strategy. I have worked closely with the Minister on the Health and Social Care Bill, and he knows that I am a huge supporter of that cancer strategy. With investment of £12 million in awareness work towards achieving that pledge, some might describe tackling ovarian cancer as low-hanging fruit.
The Minister said earlier in the year that the main focus for the Government’s national symptoms awareness campaign would be bowel cancer, but he also stated that new campaigns were being piloted on other cancers and their symptoms. I hope that he will update hon. Members on the progress that his Department has made in piloting the campaigns. Including ovarian cancer in the awareness budget will help the Government to meet their targets—I am sure of that—while enabling them to improve survival rates for those with ovarian cancer, which are among the worst in Europe at the moment. If they improve, the lives of many women can be saved.
Target Ovarian Cancer gave me an excellent booklet, “An MP’s guide to ovarian cancer”, shortly after I was elected, and it contains a lovely quotation from a lady whom I met at an ovarian cancer reception last year. Her name is Eilish Colclough—I always get it wrong when I attempt it—and she is a mother of five. We have seen her speak before, and she is fighting terminal ovarian cancer. She says:
“I look at myself as living not dying.”
Whenever she speaks, and whenever such patients, survivors, fighters and livers come to speak to the all-party groups that I am involved in, it is always infinitely more powerful than any Member or Minister. In my experience—and I have had a lot of it, as I have said—people with cancer are not just their cancer; they are everything else as well. I hope that we can find many more people such as Eilish—survivors—to give more proof of that, to help us fight ovarian cancer, and to drive down the number of women we lose to it.
Congenital Cardiac Services for Children
Steve Brine Excerpts(12 years, 10 months ago)
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Jason McCartney
My hon. Friend makes an important point. Many of those 14.5 million people are in rural areas, such as his North Yorkshire constituency. I will touch on that issue in relation to my Colne Valley constituency shortly.
I want to say a few words about the inconsistencies in the options. The Safe and Sustainable review has said consistently that centres should perform a minimum of 400 operations a year, and ideally 500. However, under option B, Bristol and Southampton would fail to achieve that number. The review’s projected figures show that they would perform 360 and 382 operations respectively. During the meeting in Leeds, campaigners were told that it was not viable to have three centres in the north of England because the figures would be 347 for Leeds and 381 for Newcastle. If option B is viable, why is it not viable to have three centres in the north of England? Would not a solution be to keep Leeds and Newcastle open, and to give them two years in which to achieve all the standards set out by the review?
Mr Steve Brine (Winchester) (Con)
That is precisely why the motion calls on the JCPCT to show maximum flexibility and not to restrict itself to the four options. The answer could be, “Yes we can.”
Jason McCartney
I agree that that is what we are looking for. The idea behind the motion is to ask for more flexibility.
I have talked about statistics and about the 500,000 names on the petition, but there are three compelling reasons why I am speaking in this debate—or perhaps I should say three young reasons. Those three young reasons all happen to be at one school in my Colne Valley constituency. I met three pupils at Linthwaite Clough school near Huddersfield, who back the campaign to save Yorkshire’s only children’s heart surgery unit because they owe their lives to it. George Sutcliffe is a 12-year-old who uses a wheelchair six days a week and attends the heart surgery unit in Leeds about once a month. Ben Pogson, who is 10, and Joel Bearder, who is just four, both underwent major heart surgery at the unit. Ben and Joel’s mums, Sam and Gaynor, have played leading roles in the campaign to save the unit, along with many others, and I praise their contributions. As well as those three pupils, one of the teachers at the school owes his life to the skill of the medical staff in Leeds. Richard Quarmby, a learning mentor at the school who will start his teacher training in September, had major surgery for his congenital heart condition at the Leeds heart surgery unit.
Those people owe their lives to the unit. They cite its wonderful staff and its proximity to Huddersfield as crucial. It takes less than an hour to get there. The unit gives fantastic family support and there is accommodation for parents if needed. As a result of George, Ben and Joel’s treatment at the unit, the Linthwaite Clough school council has decided to support it as its annual chosen charity. Already, it has organised a series of fundraisers, including a colourful, cheerful day. For the reasons I have given, I think that the Safe and Sustainable review should be renamed the safe, sustainable and supporting families review.
Finally, on behalf of Ben, Joel, George and many others, I shall support the motion.
Mr Steve Brine (Winchester) (Con)
I begin by congratulating my hon. Friend the Member for Pudsey (Stuart Andrew). There have been some interesting moments in the past week and I know he has enjoyed every minute of it.
I want to be clear from the outset that I have never called and am not calling for the Safe and Sustainable review to be stopped or even paused. The Children’s Heart Federation said to me this week, as it said to many Members:
“We urge MPs countrywide to support the need for change and fight for the highest quality national children’s heart service.”
I could not agree more and I could not have put it better myself. In the words of Sir Ian Kennedy, whom Members know well:
“Mediocrity must not be our benchmark for the future.”
Spot on, again.
On that point, let me take head-on the inevitable comments in some of today’s newspapers. Intellectually the case for change is compelling and, to be clear, I am not co-sponsoring today’s debate out of political or personal interest. For me, today is about getting us back to a point where the focus of the review is on quality. I recognise 100% that, since the recommendations from the Bristol inquiry were published a decade ago, professional bodies and patient groups involved in children’s heart care have been united in pressing for changes in the organisation of services to drive up the quality of treatment.
The Safe and Sustainable review states its main aim as providing
“excellent care for children with congenital heart disease”.
I have yet to meet one person who disagrees with that statement, but I have met many who take issue with how we are trying to get there. Each speaker this afternoon has in mind the children’s heart centre serving their constituents and many of us, myself included, will no doubt make points in support of the option containing their unit. That is fair enough. As my hon. Friend the Member for Loughborough (Nicky Morgan) said, we are MPs and would not be representing our constituents if we did anything less.
However, for me it is not all about my backyard. The points I have to make about Southampton have a wider purpose and illustrate the bigger picture. During the past few months, Members from across the House have listened to one another speak on the subject and heard the arguments ring one or two bells. For me, that moment came in the Adjournment debate that my hon. Friend the Member for Pudsey secured in March. That is what brought us together. As so often happens in this House, disparate parts come together to form something much bigger.
It is true that some campaigns in other parts of the country have been bigger and more muscular than others. It is also true that the campaign based around the so-called option B, which is to retain children’s heart surgery at Southampton, has been enormous by any measure. Its momentum flows directly from the fact that 17 weeks ago, when the options were published, the second-best children’s heart unit in the country was given only a one-in-four chance of survival. I want to be crystal clear that the team from Southampton supported the Safe and Sustainable review taking place and, on balance, still does, but it was shocked to the core to learn that a process that is about quality could put one of the world’s top centres on such a sticky wicket.
This week I received the final submission from the Hampshire health overview and scrutiny committee to the joint committee of primary care trusts. The opening paragraph does not pull any punches:
“Given that it has taken over a decade to reach this point, our observation is that the overarching objectives of this exercise—to improve the quality of these services for children—has been lost in an adversarial and divisive consultation exercise which has focused predominantly on defending the process and not on delivering the desired outcome.”
My fear is that Sir Ian Kennedy’s feared “mediocrity” is exactly the outcome that we are in danger of delivering unless those leading the process change their focus. The scrutiny committee also said:
“The responses to issues raised by clinicians, parents and other stakeholders seem to reflect a preoccupation by those driving ‘Safe and Sustainable’ with defending the process against legal challenge rather than securing the prize of better quality care for these patients. This is not acceptable or in the interests of the patients affected.”
That puts it very well.
The Isle of Wight factor is fast moving centre stage in the Southampton campaign. My hon. Friend the Member for Isle of Wight (Mr Turner) spoke with his usual force on the subject, so there is no need to say any more on it, other than to say that it is not too late in this regard and that the Safe and Sustainable team is listening carefully to the island’s arguments.
Finally, I will be supporting the motion because it clearly welcomes the aim of sustaining the provision of services based around quality. Above all—this is the key part that we worked so hard to include in the motion—I support the call for the joint committee not to restrict itself to the four options outlined in the review document. A case can be made for options A, B, C or D, but it can also be made for E and F. I ask it to bear that in mind as it goes forward to the end of the process on 1 July.
Oral Answers to Questions
Steve Brine Excerpts(12 years, 11 months ago)
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Mr Lansley
Yes, I think my hon. Friend is absolutely right about that. What has been interesting in the listening exercise is the clear expression—on the part of front-line clinicians, general practitioners, doctors, nurses and other health professionals—of a desire to take greater responsibility for commissioning. They are only too aware of a decade of decline in productivity in the NHS, in which administration costs and staffing ballooned while front-line staffing did not increase to anything like the same extent. They want to deliver better clinical services for their patients, and to have the responsibility to do so. We are determined to give that to them.
Mr Steve Brine (Winchester) (Con)
14. Whether his Department has considered the merits of introducing a supplemental ultrasound breast screening examination as part of the NHS breast screening programme.
The Minister of State, Department of Health (Paul Burstow)
The answer is no. Mammography is the only screening modality that has been proven to reduce mortality from breast cancer, and is supported and promoted by the World Health Organisation’s international agency for research on cancer. Ultrasound screening may be used within the breast screening programme as part of the triple assessment process.
Mr Brine
The Minister will be aware that forms of cancer such as lobular breast cancer are far more difficult to detect with a mammogram than other types of breast cancer. Will he perhaps clarify exactly what guidance his Department issues to primary care trusts on the use of ultrasound screening as part of the triple assessment process? Sadly, in the case of my constituent Lindsay Jackson, mammography failed to detect that form of lobular breast cancer.
Paul Burstow
I am grateful to the hon. Gentleman for his question. The Department does not issue guidance, but the National Institute for Health and Clinical Excellence does. Its guidance on improving outcomes in breast cancer states that mammography and ultrasound imaging should be available in breast clinics as part of the triple assessment of women with suspected breast cancer. In addition, the guidance states that ultrasound is useful in predicting tumour size and in planning surgery, and that it can complement mammography in differentiating malignant and benign disease. That guidance is the key tool used in making such decisions.
NHS Reform
Steve Brine Excerpts(13 years, 1 month ago)
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Mr Lansley
No, I will not, because we are very clear about the strategy and the principles of the Bill. We are equally clear that now we have the opportunity to work with the developing GP pathfinder consortia, the health and well-being boards in local authorities and the wider community to ensure that the implementation of the Bill and its structure support those developing organisations.
Mr Steve Brine (Winchester) (Con)
I thank the Secretary of State for his helpful and useful update this afternoon, and welcome his assurances that the coalition wants to reform and modernise our NHS, right in line with its founding principles. He knows that I will continue to argue for greater transparency for the new GP consortia, and I hope we can still find a way to do that, but I warmly welcome his listening exercise, the measures contained in the Bill and the way he has made himself freely available to colleagues since taking up his post last year. May I urge him to continue doing that both in the House and, of course, outside it?
Mr Lansley
I am grateful to my hon. Friend. We will do that, not only formally across the country but in the informal manner that we do in the House. His point of view exactly illustrates the purpose of my statement. He served on the Committee that debated the Bill. Notwithstanding the good progress that the Bill has made and that we are making around the country, people have legitimate concerns and questions. They want to raise those and to know that we will listen and act on them.
NHS Reorganisation
Steve Brine Excerpts(13 years, 1 month ago)
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Rosie Cooper
The health service was not an issue at the general election, and why? Because people broadly supported it and were not worried about the state that it was in. Government Members must listen to the furore that will happen and prepare to defend their seats in light of the decisions that they take now.
Rosie Cooper
No, I have very little time now.
I believe that what Michael Portillo said on the BBC’s “This Week” programme was an accurate reflection of how the Government have sought to mislead the people of this country. When asked by Andrew Neil why the Government had not told us about the plans for the NHS prior to the general election, he responded:
“Because they didn’t believe they could win the election if they told you what they were going to do. People are so wedded to the NHS. It’s the nearest we have to a national religion—a sacred cow.”
He could not have been more clear: the Government intended to misrepresent their position and to mislead voters.
As I have said previously, this Conservative Government have been prepared to play to the gallery while playing Russian roulette with the future of people’s health services. That is still the case, but the gallery is now empty. They are on their own and have no mandate—
Mr Dorrell
I thought that the hon. Gentleman was going to make the point that he has made in the Select Committee—a point with which I agree—that the purpose of GP-led commissioning is to engage the entire clinical community, not just GPs, in the commissioning process. That is a principle that my right hon. Friend the Secretary of State agrees with. It is also a principle that Sir David Nicholson has made clear will be part of the principles that will be expected to be applied in GP-led commissioning consortia.
Before the hon. Member for Middlesbrough South and East Cleveland (Tom Blenkinsop) led me down the road of competition policy, I was going through the principles that are consistent across the health policies implemented by all Health Secretaries since 1990, with the single exception of the right hon. Member for Holborn and St Pancras.
Hospice Care
Steve Brine Excerpts(13 years, 3 months ago)
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The Minister of State, Department of Health (Paul Burstow)
I congratulate my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) on securing this debate and on laying out the issues so clearly. We must draw attention regularly and repeatedly to the contribution that hospices make to our society. As he rightly said, they are in the vanguard of the big society. He was right to paint the picture of the factors that drive us to focus on the role of hospices, such as the demographic pressures that he described.
My hon. Friend talked with eloquence about the difference that St Elizabeth hospice makes to his constituency and his constituents. I join him in paying a warm tribute to that hospice and to the others that have been mentioned. Recently, I have had the privilege of visiting my local hospice, St Raphael’s, and St Ann’s hospice in Cheadle Hulme. I share his and other hon. Members’ admiration for the tremendous care and compassion that is provided by staff in those places.
We want to ensure that these institutions grow and flourish as part of a more personalised approach to end-of-life care. How can we do that? First, we need to get the funding right to ensure that hospices can plan for the future with confidence. Secondly, we need to be much clearer about the role that hospices can potentially play in end-of-life care, and have that role recognised in the commissioning and shaping of local services. Thirdly, we need to establish end-of-life care as a clear priority for improvement across the NHS, using levers such as the outcomes framework, the operating framework and the forthcoming quality standard.
I know that my hon. Friend the Member for Central Suffolk and North Ipswich and others have concerns about funding. He will know from his recent visit that St Elizabeth hospice has recently undertaken a refurbishment programme. It had to raise a lot of money to pay for that work, but I am pleased to be able to say that part of the cost was funded from a £40 million capital grant scheme that we are making available this financial year. One of the coalition Government’s first actions was to confirm that funding, as an early indication of our commitment to hospice care. Well over a hundred hospices, such as St Elizabeth, are receiving funding from that grant to help them improve their facilities.
My hon. Friend will know that that is part of a much larger sum that we have made available to support the end-of-life care strategy for adults. In the current financial year, £198 million was made available to help improve the quality and range of services for people in the final stages of life. That was an indicative amount set by the previous Government, and there have been doubts, expressed not least by the Public Accounts Committee, about whether the new money for the implementation of the strategy was being used for its intended purpose. The big question is how to ensure that the funding gets through.
Some argue, although the argument has not been advanced tonight, that ring-fencing is the answer. I actually believe that it would be likely to be a retrograde step. It would give the NHS less flexibility, less discretion and less scope to meet local people’s needs at precisely the time when we need the NHS to have a more personalised approach. Ring-fencing can act as a cap rather than a guarantee, putting an artificial ceiling on the amount that an area can spend on end-of-life care rather than encouraging that amount to be commensurate with need.
Ongoing and increasing funding for end-of-life care will be part of the baseline for primary care trusts, and for the GP consortia that replace them. However, the local NHS will get freedom and responsibility in choosing how it spends the taxpayers’ resources committed to health care. That is the key refreshing change that the Government’s reforms will bring about. In return, we expect much greater transparency and accountability for the decisions that are made.
By monitoring how the new end-of-life care funding has been spent, we are doing what we can to shed light on PCTs’ decisions and on the variations in spending that occur. Last year, for instance, just 20% of the money going to PCTs was allocated to hospices. We are repeating the monitoring process for this year and conducting a survey of total PCT expenditure on specialist palliative care, including that provided by hospices. Together, that will give a clearer picture than ever of how different parts of the NHS make use of local hospices in delivering care. That is an essential component of the picture that we need to build to ensure that good commissioning takes place.
End-of-life care will also be given greater visibility in performance structures in the NHS. We have already published the NHS operating framework for the coming year, 2011-12, which emphasises the need for greater choice in end-of-life care. That care also figures prominently in the outcomes framework for the NHS, which will ensure that commissioners and providers give the matter priority. In fact, last month we published a set of performance indicators to work alongside the outcomes framework. For end-of-life care, PCTs are currently planning against the indicator measuring the percentage of deaths that take place in someone’s usual place of residence—their own home or their care home. That will provide a real incentive, real traction and a real opportunity for hospices and other providers to work with commissioners to improve outcomes.
Finally, as I have mentioned, the quality standard that the National Institute for Health and Clinical Excellence is working on will give clinicians, hospices and health managers a clear and shared idea of what best practice looks like. NICE tells me that it expects the standard to be published by November this year.
Mr Steve Brine (Winchester) (Con)
Naomi House children’s hospice in my constituency is a fantastically run hospice that raises an enormous amount of money to continue its hospice-at-home service, which recently restarted. It receives about 12% of its direct care costs from the Department of Health, but was told a couple of years ago that that would come to an end this year, and it is not having much luck in securing ongoing funding from the primary care trust, NHS Hampshire. What advice would the Minister give to that hospice for the interim period before GP consortia in west Hampshire are up and running?
Paul Burstow
Hospices need to continue to work to demonstrate the huge benefits of their provision to commissioners. If the hon. Gentleman writes to me, I will pay close attention to what is happening in that regard.
My hon. Friend the Member for Central Suffolk and North Ipswich rightly mentioned the difference that GP consortia will make. GPs are the best people to bring together the provision that I have talked about, along with the new local health and wellbeing boards. The advent of GP consortia will change the relationship—quite fundamentally, and in the right way—between hospices and GPs. It will make it natural for doctors to talk to each other and solve problems together, and to draw on different sources of support to help patients get what they need. It is encouraging to note that three of the GP pathfinders—Westminster, Bristol and Somerset—are specifically looking at how they can improve end-of-life care under the new arrangements. That is a sign of GPs’ interest in such care, and the potential for GP-led commissioning to bring about change and to address that challenge.
There is a new opportunity for collaboration and innovation, but hospices must not sit back—they must actively engage. We need them to be proactive in understanding and engaging with the new systems and structures as they settle into place over the next two years. They need to be proactive in talking with their local GPs and building up the relationships and mutual connections that will be essential to how the system works, and proactive in working with local authorities, which will play an increasingly important role in shaping and integrating care through the health and wellbeing boards. Ensuring that health and social care are commissioned and planned together is critical in the delivery of good end-of-life care.
Hospices also need to be proactive in broadening their horizons and innovating to support a wider range of people. As my hon. Friend rightly said, hospices are not just about cancer. We want people to be able to die in their own homes, where they would choose to be, and we need a more flexible and dynamic approach from both the NHS and hospices in that regard.
As my hon. Friend rightly pointed out—this is a key point—contrary to popular perception, only a small number of people actually die in a hospice. A great many more people benefit from their work in other ways. People could, for instance, receive day therapy in a hospice, or, as is the case with the local hospice in my constituency, they can get help from hospice staff working in the community, which was referred to by a number of hon. Members. Children’s hospices, meanwhile, could get more involved in the long-term treatment of children rather than just end-of-life care.
We need to innovate in those partnerships. We need commissioners to make imaginative use of hospices as part of their end-of-life, palliative care plans. Hospices must also have the ambition to explore new ways of offering their skills and services to NHS commissioners. My hon. Friend is right that we need to reach out beyond cancer services—it is essential that services diversify. St Christopher’s in London, which he mentioned, is doing excellent work with people with dementia who need end-of-life care. We need to focus much more on that to deliver the national dementia strategy.
I want more hospices to play a role in supporting people with other degenerative conditions—not just dementia, but conditions of the sort my hon. Friend rightly highlighted. We make that point explicitly in the national dementia strategy, as I said, and we want to reinforce it through the end-of-life care strategy.
The levers and the incentives are in place to enable hospices to secure NHS funding in the years ahead. But in the longer term we know that a new funding model is needed. We made it clear in the coalition agreement that we want to introduce a per-patient funding system that is built around a much clearer understanding of what level of care should be available through the NHS and that is fairer and more sustainable for all providers, including hospices, because it moves us away from the vagaries of grants—we have just heard about the problems those cause to the children’s hospice in the constituency of my hon. Friend the Member for Winchester (Mr Brine)—and gives them certainty of a set level of funding per person.
The debate about this subject has been going on for some time and is well developed. I encourage hon. Members who have spoken to contribute to that work. In July, the Secretary of State for Health appointed Tom Hughes-Hallett, the chief executive of Marie Curie Cancer Care, to chair an independent review covering both adult and children’s services. That review will look at the issues raised in this debate to ensure that we have services that reach out beyond the confines of the hospice and address the wider cost issues in rural communities. An interim report was published at the end of last year, which sets out a definition of dedicated palliative care and provides initial thoughts on how a new national funding system could be built.
Health and Social Care Bill
Steve Brine Excerpts(13 years, 3 months ago)
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Mr Steve Brine (Winchester) (Con)
I should like to say that it is a pleasure to follow the hon. Member for Eltham (Clive Efford), but I think that those watching the debate can make up their own mind about what they have just heard. I speak as a Conservative who loves the NHS; I am sorry to disappoint the hon. Gentleman in that regard. His comments were a great example of the knockabout that we hear in the House, which the public hate so much. I remind him that every day people die, work in and love the NHS, and they deserve better than what we have just heard.
As ever, time is short, so I will not detain the House. I want to focus on the fight against cancer and to share with right hon. and hon. Members the way I view these reforms. The Bill promises to take day-to-day power and responsibility out of the hands of Ministers and managers and to put it firmly into the hands of GPs. This means that decisions about NHS care will move closer to the patient and away from the remote organisations of which few people whom I and others represent have heard. Even fewer of those people would have the first idea what those organisations do, let alone how to contact them.
In an extremely tough financial climate, even for the NHS, we are talking about removing the bureaucracy of the primary care trusts and strategic health authorities and investing that money in patient care. As I have said in my constituency more times than I care to remember, I am concerned only about protecting the services that my constituents rely on. If they are threatened, I will dust down the placards, but I am not going to rummage around in the shed for one that reads, “Save the PCT”; I do not think that “Save NHS Hampshire” trips off the tongue.
The concept of reforming our NHS so that services and decisions come closer to patients is not one that I find disturbing, and I wish that we could at least start the process of debating this Bill by agreeing on that. However, nothing I have said thus far means that I and many others do not have questions about the next few years as we move to full GP consortia commissioning. Some Members will know that I co-chair the all-party group on breast cancer. We have worked hard since the publication of last year’s White Paper to produce a response. In October we held a health inquiry session at Breakthrough Breast Cancer’s “Westminster Fly-In”. Breakthrough’s CAN members and parliamentarians highlighted the breast cancer patient perspective and focused, as ever, on our vision of a future free from the fear of breast cancer.
The public health approach outlined in part 2 of the Bill will encourage people to be much more proactive about their health. I feel strongly that encouraging greater breast awareness is and must be an important part of that. Most breast cancers are found by women who notice a change, take the initiative and subsequently visit their GP. There is strong evidence that being breast aware—knowing the signs and symptoms of breast cancer and the importance of early treatment—and attending NHS breast screening appointments are two of the most important factors in breast cancer survival in the UK. The third is, of course, treatment. When it comes to screening, we have to do much better in this country. This change in public health must give a strong impetus to local authorities, many of which are big employers of women, as well as to GPs and local employers to come together and make sure that we do better. Women should be given time off work to attend breast screening appointments and providers must recognise that access to screening that works does not always mean nine-to-five, Monday to Friday. That is something we have discussed in our group many times.
Locally, GPs should be encouraging women to be much more breast aware and should make sure that no-shows for screening appointments, which are sometimes as high as 50% in my area, are followed up and that those women are given the support they need to get there. As I have said before, the move to pure GP-based commissioning will sharpen efforts in that regard through much more sophisticated data management and use of the lists that are currently poorly used.
Much has been said in the House and outside about the UK’s low placing in the cancer league tables, and it is often the Eurocare series, which the Secretary of State mentioned, that shows that survival for the four most common cancers in our country are lower than in the rest of Europe. As Cancer Research UK said to me and all hon. Members in its briefing ahead of today’s debate,
“commissioning of cancer services is not as good as it could or should be”,
and I know that Cancer Research UK welcomes, as do I, the recently published cancer strategy.
That superb organisation, Macmillan, tells us that more than 2 million people are living with or after cancer in this country, and by 2030 there will be 4 million. As we all know, cancer is a set of 200-plus different diseases, most of which have highly complex care pathways. I have concerns, as others have said, about the low level of GPs currently with a specialism or particular interest in cancer compared, for instance, with diabetes or mental health.
I urge Ministers, as did my hon. Friend the Member for Basildon and Billericay (Mr Baron) so eloquently a moment ago, to look again at the transition period from 2012 to 2014 to protect the cancer networks until GP consortia are in a position to make better decisions about the support and expertise they require. Solid action from the Government in this regard would reassure many cancer charities, patients and Members.
Finally, we are in danger of presenting the argument as “all that exists in the current NHS is bad or failing,” versus “all is sacrosanct and we cannot touch it.” Neither is true, in my opinion. Let us keep what works, protect it and strengthen it. That is what we are about, but let us remove what does not work and be brave enough to replace it. Do we want to give the Bill a Second Reading, find out more and examine it further, or do we want to turn against change and take the easy road? That would be the real risk. I will support the Bill in the Lobby tonight.
Oral Answers to Questions
Steve Brine Excerpts(13 years, 3 months ago)
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Mr Steve Brine (Winchester) (Con)
T10. What does the Minister think is the likelihood of the pathfinder consortia examining commissioning arrangements for neurological conditions? This is particularly important, because conditions such as Parkinson’s are not familiar to many general practitioners, and commissioning arrangements for these complex conditions are tricky, so they need specialist knowledge. They need to be getting expert support and advice, including from patients and third sector groups.
Paul Burstow
The hon. Gentleman makes some important points about how the new system provides the opportunity to access a range of new resources to develop the way in which commissioning is provided for people with neurological conditions. Not the least of these are the way in which the Neurological Alliance is working to provide a new structure for its way of operating at the local level to offer commissioning support and, from the Department, how the neurological commissioning support group will be able to work with early implementers of the health and well-being boards and pathfinder GP consortia to provide them with the necessary support to develop their capability in this area.