Cervical Cancer Screening

Steve Rotheram Excerpts

Thursday 1st May 2014 Commons Chamber

[Steve Rotheram (Liverpool, Walton) (Lab)]

I beg to move,

That this House notes the e-petition relating to the tragic death of Sophie Jones from cervical cancer; believes that the Government should urgently issue guidance stipulating that all women should have the choice of taking a smear test regardless of their age and in consultation with their doctor; and further notes that the best way to combat cervical cancer is by increasing awareness of its symptoms so as to ensure that early diagnosis rates are driven up, doctors and nurses understand that although it is very rare, younger women can develop cervical cancer, and high levels of coverage among young girls of the HPV vaccination programme introduced in 2008 are achieved.

I am grateful for the opportunity to bring this important debate to the Floor of the House, although I wish it was not under such tragic circumstances. The number of MPs present does not necessarily reflect the wider public interest in the issue. Perhaps that shows that many MPs have lots of competing interests and that many who would have liked to have been here today are, unfortunately, unable to attend.

I want to place on record my thanks to members of the Backbench Business Committee, skilfully chaired by my hon. Friend the Member for North East Derbyshire (Natascha Engel), for listening to the voices of the tens of thousands of people who wanted this issue debated, and to the Leader of the House for recognising the considerable national interest in it. I also thank the Liverpool Echo, the Daily Mirror and the Daily Mail for their continued coverage of Sophie’s case and the steps they have taken to raise awareness of this debate and, more importantly, the issue of screening and the early identification of symptoms, which I will go into in more detail during my contribution.

I want to place on record my gratitude to Sophie’s mum, Peri, and to each and every one of the 321,925 people who signed the online petition following the heartbreaking death of her daughter earlier this year. They made history in the process by accumulating the largest ever number of signatories to a Government e-petition.

There has been a lot of speculation and conjecture about what is actually being requested today, but my motion, seconded by my hon. Friend the Member for Wirral West—

[Alison McGovern (Wirral South) (Lab)]

South!

[Steve Rotheram]

Sorry—she will kill me for that!

The motion is clear in its intent. I am not calling for the introduction of routine cervical screening for all women and young girls under 25, but I am calling on the Government to issue guidance that stipulates that all women should be able to request a cervical smear regardless of their age. Put simply, young women and teenage girls who present to their GP with possible symptoms of cervical cancer should have the choice, if they so desire, to have a smear test, but that must of course go hand in hand with extensive consultation with their GP to ensure that they are informed of all the potential consequences of the procedure. Given the limited number of cervical cancer cases in women under the age of 25—just 47 in England in 2011, according to Department of Health figures—such an option would not open the floodgates to thousands of unnecessary, costly or possibly damaging tests for young girls.

The motion is an attempt to promote the issue, and to encourage the medical profession to take up the provision that is already available to doctors of granting screening tests to females of any age in exceptional circumstances. It must be said that some of the medical profession are clearly not exercising that power, and that has proven fatal in cases such as Sophie’s. Indeed, at the heart of the motion is one simple premise—that a woman of any age over 16 should, through written departmental guidance, have the right to make an informed choice for themselves.

I will highlight areas in which I believe the Government could take immediate action to educate and inform both patients and medical professionals better about the symptoms and diagnosis of cervical cancer in young women and teenage girls, but I want to make it clear that I am very much of the opinion that any changes to age restrictions must be evidence-based.

Sophie Jones was a much-loved and popular 19-year-old girl from the Wirral who had her whole life ahead of her. She had fashioned a successful career in modelling, and was described by her twin sister Ashleigh as

“the life and soul of everything”.

In 2013, after experiencing constant stomach cramps for more than a year, Sophie visited her GP. She advised her doctor of her symptoms and asked for a smear test. Sophie knew that something was seriously wrong, but she was continually refused a test solely on the basis of her age. Instead, Sophie’s GP incorrectly diagnosed her with Crohn’s disease. Last November, Sophie was forced to enter hospital permanently, due to the deterioration in her health and the escalation of her condition. Despite that, numerous doctors still failed to recognise her symptoms or to diagnose her illness accurately.

Eventually, Sophie and her family’s worst nightmares were confirmed when she was diagnosed with cancer of the cervix. Tragically, by the time doctors were able to make an affirmative diagnosis, it was too late. The cancer had spread to other parts of her body, and by then she was terminally ill. For four months, Sophie fought against her devastating disease and, with her family and friends alongside her at her hospital bed, fought bravely to the end. On 15 March, after four long and excruciating months, Sophie’s defences were overwhelmed by her condition and she lost her struggle for life.

There was a time in Britain when a cancer diagnosis struck the fear of God into people, but thanks to advances in medical treatments and preventive measures, early diagnosis ensures that cancer patients survive in more than half of cases. Cancer is no longer a death sentence if caught early enough. Sophie’s diagnosis came too late for treatment to be successful, but it should never have been that way. That is what makes her case so painful for her family and friends.

I know that I speak on behalf of my hon. Friends the Members for Wirral South and for Liverpool, Wavertree (Luciana Berger) when I pay tribute to Sophie’s family and friends for the dignity that they have shown, and for their determination to highlight Sophie’s story to prevent anyone else from ever having to go through what they have been through. Sophie was failed by the current system, and that should not be allowed to happen to anyone again.

Moreover, I am confident that Sophie’s case is not an isolated incident. I am aware of other cases, and other Members will speak about cases that have been brought to their attention. Those cases include that of Maryanne Makepeace, who was told that she had a water infection, before she was finally diagnosed with terminal cancer.

Just last week, the BBC in Wales reported the case of 20-year-old Jessica Bradford, who was also told by her GP that she was too young for cancer. Initially, she was diagnosed with thrush, with the doctor believing that she had a sexually transmitted disease, but Jessica was eventually diagnosed with cancer of the cervix. She has been told that she is now infertile, having undergone radiotherapy and chemotherapy. That is one example of how a woman exercising her right to a test resulted in her being given treatment, which I hope will lead to a full and complete recovery.

Cervical cancer is the second most common cancer worldwide. It is the 11th most common cause of cancer-related deaths in the UK, amounting to about three in every 100,000 women, according to the crude mortality rate of Cancer Research UK. There are, on average, just short of 1,000 deaths from cervical cancer each year in the UK. Three women are diagnosed with the disease every day.

As Jo’s Cervical Cancer Trust points out, almost all cases of cervical cancer are caused by the persistent high-risk human papilloma virus. The NHS guidance on the HPV vaccine indicates that 99% of cervical cancers are caused by an HPV infection, and that four out of five sexually active adults will come into contact with it during their lives. The condition is not one that solely women can get; men also carry the HPV virus. The thing is that many people do not necessarily present with any particular symptoms.

It is worth highlighting the other risk factors that can affect a woman’s propensity to develop cervical cancer. They include smoking, as carcinogens weaken the immune system and leave the individual more likely to attract an infection of the cervix, as well as unprotected sexual activity at an early age, teenage pregnancy, multiple births, decreased immunity in women receiving immunosuppressant drugs and, in some cases, mothers given the DES—diethylstilbestrol—infertility drug when pregnant. Some medical opinion suggests that long-term use of the contraceptive pill, for instance for more than 10 years, can slightly increase the risk of developing cervical cancer, although I am sure there is consensus that the benefits of the pill far outweigh the risks for most women.

The previous Labour Government’s decision to introduce the HPV vaccination programme was extremely apposite. It has saved and will continue to save many thousands of lives across the country. However, we must be relentless in rolling out the vaccination programme in our schools and colleges. Typically, year 8 girls—those aged 12 and 13—are offered the vaccination, and the take-up rate is about 80%. The vaccination offers protection against their developing the condition in later life. A catch-up programme was also introduced by the previous Government in 2009-10, in which almost 1 million girls aged between 12 and 18 were vaccinated. The continued roll-out of vaccination in girls before they become sexually active will greatly decrease the chances of their contracting the infection, and it will increase the chances of cervical cancer survival.

As many as 2,800 women a year are diagnosed with cervical cancer, and more than a third of sufferers die each year because of the failure to catch the cancer through early diagnosis. It is impossible for women on their own to detect abnormalities in cervical cells, but symptoms that seem inconsequential when taken in isolation can amount to a clear indication of cancer of the cervix when assessed cumulatively. Those include abnormal bleeding during or after sexual intercourse or between periods, post-menopausal bleeding if a woman is not on hormone replacement therapy or has stopped it for six weeks, unusual and/or unpleasant vaginal discharge, discomfort or pain during sex, and lower back pain. As the cancer develops, it can cause additional symptoms such as frequent urination, blood in the urine, rectal bleeding, diarrhoea, incontinence and lower-limb lymphoedema.

[Alison McGovern]

My hon. Friend is giving an excellent description of the symptoms that everyone should be aware of. It is refreshing to hear a man talking about the symptoms of women’s cancers. Does he agree that one thing that we can definitely do today is raise the awareness of those symptoms and encourage men and women to understand more about women’s cancers?

[Steve Rotheram]

My hon. Friend makes a powerful point. In all honesty, I did not know an awful lot of this information before I was asked to head up the campaign in the Backbench Business Committee to get this matter debated in the House. I suspect that the same is true of many male colleagues on both sides of the House and many men in the wider public. We must destigmatise the use of words like “period” or “vaginal discharge” by men, because it is important that such things can be spoken about openly. As the father of two daughters, I certainly want them to be aware of the symptoms of this condition, so that they can bring them to my attention and I can help and guide them should they need a consultation with the GP. This is an important matter for us to debate in the Chamber. I am sure that other colleagues will go into the symptoms of this horrible disease.

The danger of highlighting the symptoms is that some women might misdiagnose themselves, causing them unnecessary worry. Conversely, if doing so means that one person with the symptoms is diagnosed with cervical cancer and has her life saved, it is well worth it.

According to the NHS figures, the vast majority of women’s test results come back normal. For about one in 20 women, the test will show some abnormalities in the cells of the cervix. Most of those changes will not lead to cervical cancer and the cells often return to normal on their own. Indeed, that is particularly true of young patients. In some cases, the abnormal cells need to be removed so that they cannot become cancerous.

About 3,000 cases of cervical cancer are diagnosed each year in the UK, which amounts to 2% of all cancers diagnosed in women. As I have stated, cases of cervical cancer in women under 25 years of age are extremely rare. They amount to about 1% of all cervical cancer sufferers in England. However, the relatively small number of occurrences should not be dismissed as statistically negligible. The mission of the NHS cervical screening programme is

“to reduce the number of women who develop cervical cancer and the number of women who die from it.”

The screening programme is credited with saving the lives of about 5,000 cancer patients a year across the board.

In 2004, the last Labour Government increased the age at which young females could have a test from 20 to 25, in accordance with international recommendations from the World Health Organisation. America has adopted the position that a test should happen at 20 years of age or within three years of first sexual activity, whichever comes earlier. To me, that seems an appropriately flexible policy to have. It is estimated that early detection and treatment prevents up to 75% of cervical cancers. The contention centres on the appropriate age at which screening should become routine and on the health consequences for somebody who chooses to have a test before the recommended age of 25.



So that I am not accused of presenting an imbalanced view of the medical thinking on this issue, I should say that there is an opinion among some professionals that smear tests on young women and teenage girls can lead to false positives, unnecessary treatment, anxiety for the patient, infertility or pre-term delivery later in life. There can also be discomfort, embarrassment or, less commonly, pain during the screening test. There is a very small chance of getting incorrect results, which could lead to abnormalities being missed or to unnecessary distress and treatment. There is also a chance of unnecessary treatment occurring if the abnormalities would have corrected themselves naturally. Some of the treatments that are used to remove abnormal cells may increase the risk of premature delivery in pregnancy.

Undoubtedly, there is still extensive debate in the medical profession about whether tests on young women would have the desired impact. In 2009, the British Medical Journal released a paper on the effectiveness of cervical screening with age, which concluded:

“Cervical screening in women aged 20-24 has little or no impact on rates of invasive cervical cancer up to age 30. Some uncertainly still exists regarding its impact on advanced stage tumours in women under age 30. By contrast, screening older women leads to a substantial reduction in incidence of and mortality from cervical cancer.”

For that reason, it is important to reiterate that the motion does not call for routine screening for under-25s.

I believe that it is the duty of any Health Minister to adhere to the medical advice that is presented to the Department. To my knowledge, no new evidence has emerged that is substantial enough to change the Government’s position on screening ages. I believe that, at this juncture, it would be prudent to follow the decision of the Advisory Committee on Cervical Screening in 2009 to reaffirm the policy that the age for routine screening should remain at 25. However, although it is right that politicians should not ride roughshod over medical experts, it is the job of Health Ministers to examine the orthodoxy of the day, to keep matters such as age restrictions under constant review if new evidence emerges and to scrutinise international patterns and comparisons.

I must mention that I am not a medical expert. My opinions are predicated on what I have read and learned about the subject. The debates on either side of the screening argument need to be qualified by further research. I believe that there are steps that the Minister can take right now to address those concerns and the concerns that have been highlighted by Sophie’s death. For me, the Minister should get to work on five things immediately.

First, the Government should address the online advice and guidance that is available to young women and girls who suspect that they have the symptoms of cervical cancer. At present, it is far from adequate. In the course of my research for this debate, I was amazed at the total non-existence of good online advice for young women who suspect that they are displaying the symptoms of cervical cancer. Despite young people having a higher propensity to use the internet to access information than most adults over the age of 30, there is an absence of advice on what steps should be taken by young people who are concerned that they are exhibiting the symptoms and on the support that is available. On the NHS “Your health, your choices” website, there is no mention of what young girls or teenagers should do. Instead, there is a vague information section on smear tests for over-25s. Users of the Public Health England website are forced to wade through pages and pages of material and to follow hyperlink after hyperlink before they finally find the information that they need in the frequently asked questions section. It appears that some of the information online—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. I was very reluctant to interrupt the hon. Gentleman, but he has been going on for over 23 minutes. Other Members wish to speak and there are other debates today. The guidance is that Members should speak for 10 to 15 minutes, so I have given him a lot of latitude. I would be grateful if he thought about speeding through his points so that we can move on to another speaker.

[Steve Rotheram]

That is not as I was informed, Madam Deputy Speaker, so apologies if I have overrun my time limit. I was told absolutely the opposite. I will try to conclude, and I will contact the Minister in writing with any points that I miss out.

Whatever is said and decided today, this debate needs to be the beginning of the process, not the end. I said when I made my application to the Backbench Business Committee on 8 April that I was there as a spokesperson for the 320,000 signatories to the “Sophie’s choice” petition. Today, I have presented their case, which is a case for women’s right to choose, for clearer medical guidance for patients and professionals, for improvements to the sex and relationships education system—I will inform the Minister about that in writing—and for immediate action to tackle the blind spot that exists in the vaccination programme for 19 to 24-year-olds.

We must not forget that it was the people who put this debate on the Floor of the House today, and now it is time for the Government to listen to the British public and act. In their name, let us ensure that Sophie’s legacy is a life-saving one, so that her family and friends can take comfort from the fact that despite failings of the highest order in her case, Sophie did not die in vain.

--- Later in debate ---

[Steve Rotheram]

I thank all Members who have taken part in today’s debate, especially the Minister and the shadow Minister. As I said to the Backbench Business Committee, Parliament is often accused of debating only issues that stimulate interest in the Westminster bubble and that do not resonate with the wider public. That accusation cannot be levelled at us today. My hon. Friends the Members for Wirral South (Alison McGovern) and for Liverpool, Wavertree (Luciana Berger) have met Sophie’s family, and their contributions today were examples of how moved they have been by this case and reaffirmed my belief that we should do everything we can as parliamentarians to use Parliament as a mechanism to put this issue on the national media agenda.

I thank the hon. Member for Basildon and Billericay (Mr Baron) for his insightful speech, much of which I agreed with, in particular his excellently made point about the need to focus on outcomes rather than targets. The right hon. Member for Sutton and Cheam (Paul Burstow) and the hon. Member for Cheltenham (Martin Horwood) rightly highlighted the conflicting advice by some in the medical profession about the dangers of smear tests for young women, and the recent Sasieni research, which calls into question the guidance from 2009.

My hon. Friend the Member for West Ham (Lyn Brown) spoke about the work of Sir Robin Wales and Newham council, and I pay tribute to both. I thank my hon. Friend the Member for North Ayrshire and Arran (Katy Clark) for raising the case of her constituent Suzanne Fernando, and for the work that she is doing to support Suzanne’s work. It is a first-class example of how MPs can play their part in raising awareness. I also thank the hon. Member for Strangford (Jim Shannon), who spoke of his support for the HPV vaccination programme.

The purpose of this debate was to put cervical cancer, its symptoms and the anomalies that exist in its detection on the agenda, and I believe that with the support of more than 320,000 signatories, we have achieved that. I am positive that through the dedication of her family and friends that she left behind, this debate will go some way to ensuring that Sophie’s legacy is a life-saving one for many young women in the future, and I hope her family can at least draw some comfort from that.

Question put and agreed to.

Resolved,

That this House notes the e-petition relating to the tragic death of Sophie Jones from cervical cancer; believes that the Government should urgently issue guidance stipulating that all women should have the choice of taking a smear test regardless of their age and in consultation with their doctor; and further notes that the best way to combat cervical cancer is by increasing awareness of its symptoms so as to ensure that early diagnosis rates are driven up, doctors and nurses understand that although it is very rare, younger women can develop cervical cancer, and high levels of coverage among young girls of the HPV vaccination programme introduced in 2008 are achieved.

[Sadiq Khan (Tooting) (Lab)]

On a point of order, Mr Deputy Speaker. You will be aware that we on the Labour Benches have on a number of occasions expressed concern about the Government’s policy on legal aid and its consequences. This morning His Honour Judge Leonard QC sitting at Southwark Crown Court stayed proceedings in the Crown v. Crawley and others, a £4.5 million fraud trial, after he heard representations from one of the country’s leading and most respected QCs that the case should not proceed, as a fair trial was not possible because of the consequences of the legal aid changes introduced by the Lord Chancellor.

This case alone has cost the taxpayer tens of thousand of pounds and justice has not been done, but it is extremely serious for the criminal justice system in this country, which has not just been brought into disrepute, but is now rendered ineffective by a Lord Chancellor who is out of his depth. [Interruption.] I understand that there are at least eight other complex criminal cases, including—

Type 1 Diabetes (Young People)

Steve Rotheram Excerpts

Wednesday 30th April 2014 Westminster Hall

[Mr Howarth]

I am grateful to my hon. Friend for that intervention. She is quite right to say that social media has an important role to play. I will say more about that shortly, but one example was drawn to my attention where Facebook removed an image of someone injecting on the grounds that that was offensive. That is offensive, but not in the way that it thought. I will say something more positive about how social media can be used in a few moments, but it is important that more people understand exactly what we are saying.

I was talking about psychiatric services. On a national scale, psychological support is not necessarily integrated into the diabetic service, and the practitioners are therefore unlikely to have sufficient understanding of diabetes. Psychiatric services are even more difficult to access, and I am told that patients can wait up to two years for an appointment. In some cases, that is a matter of life and death. The diabetes attitudes, wishes and needs survey, known as DAWN, published in Diabetic Medicine, interviewed 15,000 people in 17 countries and found that people with diabetes are more likely to suffer from depression. Those services are therefore very important.

I want to say a little about young people with type 1 diabetes who also have an eating disorder. According to the charity Diabetics with Eating Disorders, as many as 40% of young women between the ages of 15 and 30 admit taking insulin as a means of achieving weight reduction. The phenomenon sometimes referred to—although it is not a medical term—as diabulimia is increasing. Rapid weight loss is achieved when diabetes is left untreated, but the consequences can be catastrophic. DKA, a potentially fatal condition where the body turns on itself for energy, rapidly develops. Even if it does not prove fatal, it can result in serious health complications.

Diabulimia is difficult to diagnose and there are no current NHS guidelines on how to deal with the issue. Young people can be treated for their diabetes and for an eating disorder, but there is no integrated thinking to cover the two elements of care. Yet the treatment for a diabetic with an eating disorder is quite different from that for a person without diabetes. DWED has provided an example of a young woman who was admitted to a unit dealing with eating disorders, where no insulin needles were available and where the patient was fed via a tube without any insulin being administered. That exacerbated the problem that the unit was supposed to be treating.

There is a clear need for a more integrated service, with mental health professionals who have a knowledge of diabetes. A further and tragic example from DWED illustrates the point well. Jane, the mother of Rhys, a young man who was suffering from diabulimia, repeatedly requested that he be assessed psychiatrically. She did so every time her son was admitted to A and E suffering acute DKA, which happened on several occasions. She repeatedly raised it with the diabetes clinic and with the community mental health team. Unfortunately, her pleas were ignored, despite her saying that she was terrified that she would find her son “dead in bed”, and her son lost his battle with diabulimia on 25 July 2009. The ombudsman concluded that

“had a more coordinated and holistic care plan been put place it might have resulted in a different outcome.”

Jane has been fighting for recognition since 2009, and says that there was never an investigation into why her son died, which she attributed to his mental health problems. That was another complaint upheld by the ombudsman.

There is a serious need for a much more integrated service, so that all aspects of the treatment of type 1 diabetes can be dealt with together. There must be greater investment to ensure that emotional and psychological support becomes an accepted and routine part of management for all children with diabetes and that appropriate services are in place. Incorporating psychological services with routine clinic visits would avoid much of the stigma associated with treatment for mental health problems. In addition to regular clinic attendances, young diabetics require separate appointments for special eye checks and chiropody. Those should be available under one roof in an effort to improve the care achieved.

I am grateful that the urgent need to improve access to and integration of services is now being recognised with the introduction of the best practice tariff for paediatric diabetes. From April this year, the standards included in the best practice tariff are mandatory for all paediatric diabetes units, and the tariff has been extended to cover in-patient care, which will hopefully incentivise lower admission rates. However, I would argue that the best practice tariff should be extended to include all young patients up to the age of 25. Each young person is different, and transition from child to adult services must happen at a stage and time appropriate to them. The current cut-off for the tariff is 19, but the available data suggest that that is too soon, because 25% of all hospital admissions for diabetic ketoacidosis involve young people aged 16 to 25; the annual cost is £5.3 million. Extending the best practice tariff to 25 would provide an opportunity for better alignment of the service with the needs of young people.

[Steve Rotheram (Liverpool, Walton) (Lab)]

My right hon. Friend is making a powerful speech on an issue close to his heart. I hope that hon. Members will know his family circumstances. He is raising an important matter; there is a need to inform a much wider audience, not only so that everyone will be more aware of problems and issues to do with type 1 diabetes, but to inform people with the condition who believe they can manipulate their insulin intake for one reason or another. Does he believe that more should be done to highlight the problems that can arise when people do not stick rigidly to their insulin intake regime?

[Mr Howarth]

My hon. Friend makes his point well, in support of my argument, and I am grateful.

One in four children are diagnosed with type 1 diabetes when they are already in DKA, and the rate is even higher for children under the age of five. A number of clinicians I have met recently have advocated the removal of barriers between primary care and specialist teams, arguing that primary and secondary care teams should be sharing their expertise with one another in an attempt to close the skills and knowledge gap. In Merseyside, for example, specialist nurses have been working as mentors in practices to support primary care development and tackle deficits of knowledge, skills and confidence. Education is a major component of the improvement of care and outcomes. In many European countries, diabetes-specific training is mandatory for health care professionals who provide paediatric diabetes care. That is not the case in the UK. Although there has been a huge amount of work in the past five years to improve education for health care professionals, investment is needed to ensure that all paediatric units can access nationally standardised and accredited training.

Francis Report

Steve Rotheram Excerpts

Wednesday 5th March 2014 Commons Chamber

[Andy Burnham]

I am pleased that the hon. Gentleman has acknowledged that it was I who appointed Robert Francis to begin the process of an independent inquiry into what went wrong. I shall say more in a moment about what I did, why I did it, and why I stand by what I did, because in my view what I did was help to get to the truth while also helping Stafford hospital to recover.

[Steve Rotheram (Liverpool, Walton) (Lab)]

As my right hon. Friend knows, my wife is a community psychiatric nurse who sees mental health services at the sharp end. Does he agree that the coalition seems to view mental health as a Cinderella service rather than an integral part of the NHS?

[Andy Burnham]

My hon. Friend is right: it is the poor relation that has always been on the fringes of the system, and is always the first service to be targeted for cuts. That has happened again in these difficult times. The Government are cutting mental health services more deeply than the rest of the NHS, and that has led to all the problems that I have been describing.

I went to Stafford recently to meet campaigners who are working to support the hospital. One of them told me that because of the lack of available mental health beds, beds had had to be found in the hospital for people who were experiencing serious mental health crises. That is what begins to happen when we do not have adequate capacity on the ground. Government Members say that this is not relevant, but it is directly relevant to all the matters that we are discussing today.

NHS

Steve Rotheram Excerpts

Wednesday 5th February 2014 Commons Chamber

[Andy Burnham]

I acknowledged that there is always pressure in A and E, but the fact is that it performed better in every month when I was Health Secretary than it has under the current Health Secretary. The hon. Gentleman mentions Norfolk again. We have been looking at the Minister’s website, which makes us wonder whether he considers himself a Minister or an observer of events in the NHS. Under the headline “Norman Lamb’s North Norfolk Ambulance Survey” he states:

“I have been campaigning over the last year to improve unacceptable ambulance response times in rural Norfolk.”

My God, this is the Minister! He is campaigning against his own Government.

[Steve Rotheram (Liverpool, Walton) (Lab)]

I wonder whether the Minister will write to the Minister about that problem. The spin from those on the Government Front Bench may kid some of their Back Benchers, and it has certainly kidded some Liberal Democrats who I have been speaking to across the Chamber, but it will not kid patients who go to A and E and see people on trolleys, camp beds or blocked in ambulances.

[Andy Burnham]

My hon. Friend is absolutely right, and I would love the Government to explain that everything is fine and that there is no problem at all to more than 100,000 people who have waited more than four hours on a trolley this year, or almost 1 million people who have waited more than four hours in A and E. The complacency is not justified, and if those people were to read the Government’s motion, I am afraid, quite frankly, they would be astonished.

--- Later in debate ---

[Andy Burnham]

The beard is certainly helping. I suggest that the hon. Member for Taunton Deane (Mr Browne) visit Liverpool Walton, because he will see more food banks there than anywhere else in the country. He will meet families who cannot afford to put enough food on the table to give their kids a decent diet. He will see the direct effects of some of his Government’s policies on some of the most deprived communities in the country.

[Steve Rotheram]

If people who turn up to A and E have malnutrition, it plays havoc with their medication. If they are not eating properly, they can be violently ill from their medication. Does my right hon. Friend agree that that is a growing problem?

[Andy Burnham]

I agree, and the last time we had a debate on this issue I quoted a well-known GP who said that she has taken to asking her patients whether they are eating properly, because many are presenting with unexplained symptoms that she cannot identify. People on several prescription medicines who are not eating properly are putting themselves at risk—

Dementia Care and Services

Steve Rotheram Excerpts

Tuesday 7th January 2014 Commons Chamber

[Alec Shelbrooke (Elmet and Rothwell) (Con)]

Dementia services need to be addressed now. According to the Office for National Statistics, by 2030 the number of people entitled to draw a pension will be 15.6 million, of whom more than 3 million will be over 85. Society has done much to prolong lives through a focus on helping ageing bodies and faulty organs, but for too long help for the brain has not kept pace with that for the rest of the body.

With an ageing population, it is no surprise to hear the worrying prediction that 1 million people will be living with dementia by 2021, up from 800,000 today. There is obviously a massive financial worry resulting from the figures, especially when dementia is already predicted to cost the UK economy £23 billion a year, which is more than cancer, heart disease or stroke. It is therefore crucial to have plans in place that are proven to deal effectively and compassionately with dementia and that can be improved and expanded as necessary over the next 10 years.

Aside from the economic argument, the more pressing issue for me is that of compassion, care and support. When my grandmother was diagnosed with dementia 25 years ago, little support or information was available for carers. Being painfully aware that the last two years of her life were spent with little memory or recognition of family members, I now wish that she could have received an earlier diagnosis, so that we could have found professional help much earlier.

To put the problem that we face in context, I will give some statistics from the Alzheimer’s Society, which has been hugely supportive during my preparation for this debate and has worked to raise awareness of these issues in Parliament and throughout the country. One in three people over 65 will die with dementia. Two thirds of care home residents have some form of dementia. There are 600,000 family carers of people with dementia. It is estimated that a quarter of hospital beds are occupied by people with dementia. The most poignant statistic for me when I was preparing for this debate was that dementia is now the most feared health condition among people aged over 55.

[Steve Rotheram (Liverpool, Walton) (Lab)]

I congratulate the hon. Gentleman on securing this debate on such an important issue. As we know from previous debates, this issue is close to the hearts of many people in this Chamber who have first-hand experience of dementia. Given what he has said about people living longer, which is to be welcomed by everyone, does he agree that one of the most important things that we can do is to ensure that there is better co-ordination in the research into the prevention of dementia? The issue of treatment is secondary. Preventing people from getting dementia is surely the most important thing that we can do.

[Alec Shelbrooke]

I am grateful for the comments that the hon. Gentleman has made. He is right that we must not only treat the illness, but consider what preventive work can be done. I will speak later about the need for the national strategy to focus not only on the treatment of people with dementia, but on what other research can be done.

It is obvious that dementia is on the radar of an ageing society. However, given the emotional toll of dementia and its prevalence at the end of life, I was horrified to hear that only 48% of people who live with dementia receive a formal diagnosis, meaning that many people are denied the care and support that they and their loved ones need. Before the national dementia strategy for England was introduced in 2009, the rate was 33%. If further proof were needed that dementia care and services need to be improved as soon as possible, those awful diagnosis rates should be enough to show that something needs to change.

I am proud to be part of a coalition Government who have shone a long-overdue light on dementia, not least through the Prime Minister’s decision to host the G8 summit on dementia last month. However, there is still much to do before we can be confident that everyone who is living with dementia—individuals and families—is able to have a fulfilled life.

--- Later in debate ---

[Norman Lamb]

I broadly agree with my hon. Friend. The most important thing is that the care and support should always be right for the individual. Whatever they need they should be provided with. I recently visited the most amazing GP surgery in Gnosall, Staffordshire, which has managed—this demonstrates a point that my hon. Friend the Member for Elmet and Rothwell made about the variability of dementia diagnosis rates—to achieve diagnosis rates of close to 100%. That demonstrates what is possible. Most of the diagnosing is done in the community within primary care without referral to a memory clinic. What they have found is that by getting early diagnosis and then having very good community follow-up and support—the general practice is central to that—people are staying in their own homes and maintaining a good life for far longer and admissions to care homes and nursing homes are significantly reduced. That demonstrates what is possible and confirms the point that my hon. Friend the Member for Montgomeryshire (Glyn Davies) made.

[Steve Rotheram]

Will the Minister give way?

[Norman Lamb]

I will. I am still on page one of my speech.

[Steve Rotheram]

I thank the Minister for giving way. He is absolutely right about the individual care package that somebody who, unfortunately, has dementia or Alzheimer’s gets. Thankfully, long gone are the days when somebody was given a couple of tablets in the hope that that might somehow affect their condition. Is he aware of the House of Memories project in Liverpool? Is he also aware that there is an event that I am hosting here on 17 June that Members of this House are welcome to attend?

[Norman Lamb]

I thought for a moment that the hon. Gentleman was not going to mention the House of Memories. He always does. Of course I am aware of it because he keeps talking to me about it and knows what I think. I am incredibly impressed by it and there is a plan for me to visit and see it for myself. He is right constantly to make the case for it and for spreading what has been demonstrated is possible in Liverpool to other parts of the country.

It is less than two months since the last debate on dementia and it is a measure of the importance that Members put on the subject and the extent of the challenge that we face as a nation that, thankfully, the House has recognised the importance of debating it regularly. It is also less than two months since we published our dementia state of the nation report, which sets out the progress that we have made on dementia and the challenges we are facing.

The report is an incredibly important document because it also includes online a set of interactive maps that, for the first time, allows someone to enter their postcode to see how their local dementia services are performing and how that performance compares with the rest of the country. Having this level of transparency, as well as the extent to which people will be able to hold their own local areas to account, will have a big impact on driving up diagnosis rates. I have already made the point that some parts of the country have demonstrated that high diagnosis rates are possible. There is no rocket science here and no reason why other parts of the country cannot follow suit, understand and learn that best practice and, critically, apply it to ensure that people get the support they need.

My hon. Friend the Member for Elmet and Rothwell is absolutely right when he makes the point that unless someone has had that diagnosis, they do not get access to the advice, guidance, support and services that are potentially available in a local area to make the life of that individual better and, critically, to provide more support for the carer as well. The maps highlight the variation in dementia care across the country and allow people, but also commissioners and providers, to use the data to see how they compare against other areas and then work to deliver improvements.

Around the world, someone is diagnosed with dementia every four seconds. Over 35 million people have it and as people live longer than ever before that figure is set to double every 20 years. Among them, 58% live in low to middle income countries and this proportion is projected to rise to 71% by 2050. We cannot ignore the pressure on our health and care systems and dementia costs society as a whole as much as £23 billion in the UK alone. The cost of dementia worldwide has been estimated at about £400 billion, or 1% of the world’s GDP. This is why dementia is a major priority for the UK Government and why the Prime Minister launched a dementia challenge in 2012. But we must fight back on an international scale, breaking down barriers and joining forces to address this issue, which has such an enormous human and economic cost.

Five years ago, the national dementia strategy was developed. It has achieved a lot, laying the foundations for real change. We are currently evaluating progress on dementia and on how we have achieved improvements in dementia care, and we are looking at both the national dementia strategy and the Prime Minister’s challenge. I shall come back later to the point about what comes after, and it seems to me sensible first to understand—

Accident and Emergency

Steve Rotheram Excerpts

Wednesday 18th December 2013 Commons Chamber

[Andy Burnham]

I agree. The Government have made grave mistakes. I warned them—they misquote me every week—that it would be irresponsible to give increases to the NHS, which is what they were promising, if they had to ransack local government, particularly social care budgets, to pay for them. That is a false economy. It means that older people have support withdrawn from the home, and they drift towards A and E in ever greater numbers. That is what is happening today on this Secretary of State’s watch.

[Steve Rotheram (Liverpool, Walton) (Lab)]

Given that we have just heard that Liverpool will face 62% reductions in local government settlements, does my right hon. Friend agree that the obvious consequence will be to put additional pressures on A and E in Liverpool hospitals?

[Andy Burnham]

The Government are tearing up the social fabric of England’s most deprived city. This is a city in which people struggle to feed their kids and to make ends meet. Council services are utterly crucial in helping people to cope. The Government do not understand, or they do not care, and they just rip up the fabric of an entire city. It is disgraceful.

Tobacco Packaging

Steve Rotheram Excerpts

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

The hon. Lady will know that that is the subject of negotiations, so I hope that she will forgive me if I do not comment on it further at this point.

[Steve Rotheram (Liverpool, Walton) (Lab)]

Far from doing nothing in 13 years, the Labour Government legislated to ban smoking in public places. We said that we would need convincing evidence on plain packaging, and this Government’s own consultation has now provided that convincing evidence. What further evidence does the Minister think the review will uncover?

[Jane Ellison]

As I have said, I am not going to pre-empt the findings of the independent review, and I am sure that Members understand why it is important not to do so. It will be good to have a review of the evidence, and I am sure that the hon. Gentleman will share my confidence that the review will be extremely worth while and useful.

G8 Summit on Dementia

Steve Rotheram Excerpts

Thursday 28th November 2013 Commons Chamber

[Steve Rotheram (Liverpool, Walton) (Lab)]

In my first speech in this House this year—I believe it was on 10 January when we debated dementia and mental health—I discussed my mother’s case. The debate was filled with passionate contributions from Members across the House, although I was particularly moved by the personal accounts from my hon. Friends the Members for Bridgend (Mrs Moon) and for Oldham East and Saddleworth (Debbie Abrahams).

I also spoke of my pride that a decade after my mother’s passing the city of Liverpool earmarked 2013 as the year in which it would focus efforts on dementia awareness and promote innovative approaches initiated by organisations in our city. Our work complements the findings of the report from the G8 summit on dementia. Right across the Liverpool city region, our health care providers, arts organisations and academic institutions have embraced a collaborative approach to increase awareness of dementia, early diagnosis and patient-friendly treatment, with the mission being to make dementia everybody’s business. I stand in this House proud and confident that Liverpool is well on its way towards creating dementia-friendly environments in workplaces, public areas and communities.

One of the most high-profile projects—the Prime Minister might like to bring it to the attention of G8 colleagues—is the National Museums Liverpool House of Memories project, which now has a staggering 1,000 participants. Since I spoke on the issue earlier in the year, the team, led by David Fleming, has developed its innovative approach even further, branching out into the housing sector, in partnership with local registered social landlords. In total, four north-west housing providers have joined together to fund a re-modelled initiative which has taken the House of Memories project—using art, dance, music and creativity—to 600 homes. That is set to be further expanded next year. I am pleased to report that the ambition of the House of Memories team knows no bounds. Despite our year of dementia finishing in just a few short weeks, the team already has an even more ambitious plan for 2014 to help dementia patients.

I made it clear in January that I did not see any reason why the project running in Liverpool could not be extended across every region of the UK, so it is particularly pleasing to be informed that the Minister’s Department has confirmed that £135,000 will be awarded to take the House of Memories project to the midlands region in March next year, and I thank him for that. As if that were not enough, the team are even developing an app for iPhones and iPads on behalf of, and working with, dementia sufferers, which will also be launched next spring.

The House of Memories is by no means the only successful project operational in Liverpool, so I make no apologies for bringing a number of other local initiatives to the attention of the House. The unique Sedgemoor specialist dementia support centre was opened in Norris Green, on the border of my constituency, in May, at a cost of £1.2 million. The centre features a high-tech, interactive 4D theatre, where people can immerse themselves in the sights, sounds and even the smells of the past, through old videos, cinema footage, photographs, music and even relevant scents, which trigger reaction and stimulate conversation.

There have been more highlights of Liverpool’s year of dementia. Everton in the Community, the community arm of Everton football club, is performing reminiscence work with Mersey Care. My right hon. Friend the Member for Salford and Eccles (Hazel Blears) mentioned universities, and Liverpool Hope university is providing a dementia centre of excellence, which is a physical location where members of the public, clinical services, charities, businesses and third sector organisations get the chance to meet and share expertise.

I pay particular tribute to the React service in Liverpool, the personal care services, community support service and external day services. I also praise Age UK Liverpool, Telecare, Livability and CEDAS for the work they do. Discussions are at an advanced stage to refresh the city’s joint strategy for dementia and ensure that the dementia alliance is developed and fully operational for 2014.

I urge the Minister to spend time with me, if he is going to Salford, to see first hand the differences that we are making on Merseyside. The G8 summit on dementia gives us the opportunity to push for more research into a whole host of dementias, and highlights the innovative approaches to tackle the condition—and in that Liverpool leads the way.

--- Later in debate ---

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

I, too, congratulate the hon. Members who secured the debate on their relentless tenacity, because they always provide us with opportunities to talk about this incredibly important issue. I do not think that it is an exaggeration to say that it is one of the largest public health challenges facing the world in the 21st century.

Although I would love to take a few minutes to celebrate the work I have seen in my constituency, with constituents responding so positively to the Prime Minister’s challenge to come together as a community of health professionals, voluntary sector organisations and businesses to make it a very friendly place to live in, and to celebrate many of the improvements in the local NHS and care sector, I want to draw us back, because I will probably be the last Back-Bench Member to speak, to the particular challenges and opportunities that the G8 summit presents. I will recap on the aims of the summit, because it is very much about the research. They are to identify and agree new international approaches to dementia research; to help break down barriers within and between companies, researchers and clinicians; and to secure the type of collaboration and co-operation that he been mentioned so far.

I will focus on what more we can do on the science. The Government have committed to spending a lot more money, and we have heard about other countries committing considerable sums of money to research, but, as in so many other areas, it is about more than just the money. It will be vital at the summit to listen to the expert evidence that will be considered from clinicians, the pharmaceutical industry and researchers and to look at what the barriers are to better and more effective use of the funds available for the prevention, diagnosis and treatment of dementia.

[Steve Rotheram]

The hon. Lady is of course absolutely right that the science is the most important part of this, but, as I mentioned, there are also non-pharmaceutical interventions that are equally important to people who are suffering until, I hope, we can find the cure that we would all like to see.

Urgent and Emergency Care Review

Steve Rotheram Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

If I may say so, it was the Government whom the hon. Lady supported who removed the responsibility for out-of-hours care from GPs. I welcome and want to help any GPs who want to take it back.

[Steve Rotheram (Liverpool, Walton) (Lab)]

This Secretary of State has been forced to answer more urgent questions in the House than even the Prime Minister about Mrs Bone. When will he stop blaming others about the mess he has made of our NHS, take some responsibility for the top-down reorganisation and get on with the job that he has been over-promoted to do?

[Mr Hunt]

Let me tell the hon. Gentleman how well the NHS is doing. If one listens to the rhetoric from the Opposition Benches, one could completely underestimate the hard work of people on the front line. There are 800,000 more operations being carried out every year in the NHS than ever happened under Labour. At the same time, long waits for operations have gone down. I think that is something to be proud of.

Changes to Health Services in London

Steve Rotheram Excerpts

Wednesday 30th October 2013 Commons Chamber

[Mr Hunt]

The decision on where to allocate the extra help was based on where the need was greatest, and it was taken not by Ministers, but on the basis of recommendations from people working in the NHS and dealing with these problems. They chose the 53 local health economies where they thought the pressures were greatest. The fact that nowhere in the north-east was selected indicates that A and E performance is better in the north-east of England than in other parts of the country.

[Steve Rotheram (Liverpool, Walton) (Lab)]

When the Secretary of State is not leading the smear campaign against my right hon. Friend the Member for Leigh (Andy Burnham), he is continually being dragged into the Chamber to react to events that he should be in control of. When will he finally get a grip on the problems in our A and Es across the country?

[Mr Hunt]

I completely reject what the hon. Gentleman says. There are 1.2 million more people using A and E every year than there were under the last Government, yet people are waiting for a shorter time, with more people being seen within the four-hour target. But we are doing something else. We are addressing the long-term problems of A and E, including the patent failures of the last Government over the GP contract, social care integration and the working time directive. All those things have made the pressures worse, but we are sorting them out.