Preventing Avoidable Sight Loss

Tania Mathias Excerpts

Tuesday 28th March 2017 Westminster Hall

[Dr Tania Mathias (Twickenham) (Con)]

It is a pleasure to serve under your chairmanship, Mrs Gillan. I commend my hon. Friend the Member for Wealden (Nusrat Ghani) for securing this important debate; there have already been useful contributions. I want to make a short speech. I declare an interest: before I was a Member of Parliament, I worked in the NHS as an ophthalmologist.

I hope that the Government can achieve their own 20/20 vision for eye care in England. I hope that the Minister will go away with knowledge of what that should mean for the Government. We have heard about delays in the NHS. The figure from the Royal College of Ophthalmologists is that 20 people a month in England experience sight loss because of delays with appointments. I do not know about anyone else, but I have found that the hairdresser and dentist are better at telling me about appointment times than the NHS. It is the 21st century, and I believe that that is negligence—I do not know if lawyers would call it wilful negligence. It is one thing for a doctor in a clinic to have to tell a patient, “I am sorry, there is nothing I can do for you,”—it is the worst part of the job—but it is even worse to have to say, “If you had come to me a month ago, I might have been able to help you.” That is England today. The NHS and Government need to be transparent about where they are letting patients down.

The other 20 in my 20/20 plea to the Government—I have mentioned it to the Minister—concerns the £20 million cap that NHS England is talking about for the annual cost of new NHS drugs. The Minister is aware that for dry macular degeneration—the commonest form of macular degeneration, accounting for 90% of cases—there is currently no treatment. Those are among the sad cases in clinics when people are told, “There may be nothing we can do.” However, a phase 3 trial is being undertaken of a drug that may help with dry macular degeneration. If everyone present were to have an examination, I am sure that there would be people here now with signs of dry macular degeneration—perhaps even the Minister himself. The drug will be an exciting change in medicine. It is not about just preventing sight loss; it is about maintaining independence. I do not believe that the £20 million cap takes into account the cost when someone loses their central vision, through losing independence and depending more on social care or family members who may take time off work to help.

The Government need 20/20 vision. We need to be transparent with patients. We heard about the case of Jean Rugg, who was losing her sight because of delays with appointments. A lady who came to my constituency surgery told me she was getting private treatment for her husband, because she realised that the delay in the monthly appointment for an injection for wet macular degeneration would cost him his sight. She was not angry; she just wanted me to be informed. If there is a £20 million cap, every MP will have people in their surgery saying, “I am trying to sell what I have to save my family member’s sight.” The £20 million cap must not apply to sight-saving treatments. I hope that there will be other speeches—it is a wide field—but that is my plea for the Government to have 20/20 vision.

Oral Answers to Questions

Tania Mathias Excerpts

Tuesday 21st March 2017 Commons Chamber

[David Mowat]

My hon. Friend is absolutely right that one of the things we need to achieve is either to encourage older GPs to work part time or to make it easier for them to step down into more of a mentoring role. With the Royal College of General Practitioners, we have brought forward a scheme called GP Career Plus, which enables GPs in 10 pilot areas—the pilots are being rolled out now—to work as mentors across practice areas, and not to feel as though they have to retire, as GPs too frequently do at the moment.

[Dr Tania Mathias (Twickenham) (Con)]

12. Which hospitals providing congenital heart disease services do not meet the standard for the co-location of paediatric services; and what plans his Department has to stop providing congenital heart disease surgery at those hospitals.

[The Minister of State, Department of Health (Mr Philip Dunne)]

Standards for paediatric co-location for congenital heart disease services are not currently met by the Royal Brompton, Leicester and Newcastle hospitals. NHS England is consulting on proposals to cease commissioning level 1 surgical services from the Royal Brompton and Leicester. No final decisions have been made on the proposed changes. Public consultation continues until 5 June 2017, and I encourage my hon. Friend to participate in that consultation.

[Mr Speaker]

I doubt the hon. Lady will require any encouragement.

[Dr Mathias]

Mr Speaker, you are absolutely correct in your comment.

Does the Minister agree that the standards review found that not all clinicians are in agreement about how essential the co-location of paediatric services is, bearing in mind that a child being treated right now at the Royal Brompton will have 24-hour access to all necessary medical specialties? Will he tell us what improvements co-location at the world-class Royal Brompton hospital would achieve?

[Mr Dunne]

My hon. Friend has considerable expertise, but I am advised that having all relevant children’s specialties on the same site is the optimal model of care for the most critically ill children. It promotes closer, more integrated ways of working between specialist teams, and ensures rapid access to key services, such as paediatric surgery, at the most critical times when they are needed.

Oral Answers to Questions

Tania Mathias Excerpts

Tuesday 7th February 2017 Commons Chamber

[Mr Hunt]

Because, as we have said many times, post-Brexit this country will remain open to the brightest and the best.

[Dr Tania Mathias (Twickenham) (Con)]

My constituent, Nicola Johnson, has had primary breast cancer. The secondary was discovered at 10 months. Will the Minister meet me and Nicola, because she falls within the six-month to 12-month period? She is eligible for neither pertuzumab nor trastuzumab emtansine.

[Nicola Blackwood]

I shall be very happy to meet my hon. Friend about that very difficult case.

Defibrillators in Public Areas

Tania Mathias Excerpts

Monday 16th January 2017 Commons Chamber

[Dr Tania Mathias (Twickenham) (Con)]

I commend the hon. Member for Garston and Halewood (Maria Eagle) for her excellent and thorough speech. I want to make only a few points. I absolutely agree that this is such a vital matter that it is for the Government to take some initiative. Although charities—including, as I have learned, the Oliver King Foundation—do amazing work, the matter is so important that it must be overseen by the Government.

In my constituency, thanks to the British Heart Foundation, we have some amazing kits for CPR work. I have had great fun going round businesses that have taken up my offer of hiring out those kits for nothing. They do the training in their lunchtime or before work, and in 20 minutes they are confident about doing CPR, thanks to the excellent “Mini Anne” resus kits, as we call them. That is fabulous.

Another Member mentioned defibrillators in red phone boxes, which is the work of the Community HeartBeat Trust. I do not know about others, but when I am travelling around I now notice when there is a defibrillator in a red phone box. It is a wonderful initiative, and, again, it is being done by a charity.

One of my concerns is about a situation I have encountered in my constituency. After one business had enthusiastically taken up my offer of use of the CPR kit, I said to those in charge of it, “You are in my central town of Twickenham. Would you consider having a publicly accessible defibrillator?” They looked into it, but they were put off not just by the initial up-front cost—as the hon. Member for Garston and Halewood said, it is realistically £1,000-plus—but by the maintenance costs and responsibility. If a defibrillator is used once, it has to be reset and checked, and there is some money involved in maintenance. I think it was the idea of having the responsibility for such vital equipment that put off my local business.

Public Health England or clinical commissioning groups could map the location of publicly accessible defibrillators and encourage schools, sports facilities and stadiums to have them. In London, we have the community toilet scheme, but we do not have an equivalent community defibrillator scheme whereby everybody would know where the nearest defibrillator was and somebody would be responsible for maintenance. That is all that would be required.

The great thing is that Members on both sides of the House—and I commend my hon. Friend the Member for Lewes (Maria Caulfield)—are all thinking the same way, and there is an appetite among charities and the public for this, but I believe that now is the time for the Government to lead.

NHS and Social Care Funding

Tania Mathias Excerpts

Wednesday 11th January 2017 Commons Chamber

[Mr Hunt]

That is absolutely the point, and the last point I want to make before concluding on funding is that we miss a trick—I think the shadow Health Secretary is in some ways more reasonable than his leader on these issues, which is probably terminal for his career—if we say that this is just about money. We forget the debate we went through on schools in this country 20 years ago, when there was, again, a debate about money, but we realised that the issue is actually also about standards and quality. That is what has happened in Sherwood Forest, and I congratulate the trust. It is important that we do not let debates about funding eclipse that very important progress that we need to make on standards.

[Dr Tania Mathias (Twickenham) (Con)]

rose—

[Mr Hunt]

I am going to conclude now because lots of people want to come in, I am afraid.

The shadow Health Secretary’s central claim—these are his words—was that the culpability for what is happening in the NHS “lies at the door of Downing Street”. I owe it to the country and this House to set the record straight on this Government’s record on the NHS. It is not just the fact that there are 11,000 more nurses and 11,000 more doctors; not just the fact that, on cancer, we are starting treatment for 130 more people every single day, and have record cancer survival rates; not just the fact that we have 1,400 more people getting mental health treatment every day and some of the highest dementia diagnosis rates in the world; and not just the fact that we are doing 5,000 more operations every day and that, despite those 5,000 more operations every day, MRSA rates have halved. We have an NHS with more doctors and more nurses, and despite difficult winters, with patients saying they have never been treated more safely and with more dignity and more respect.

Next year the NHS will be 70 years old. This Government’s vision is simple: we want it to offer the safest, highest quality care anywhere in the world. When we have difficult winters and an ageing population, of course that makes things more challenging, but it also makes us more determined. It means that we are backing the NHS’s plan; it means more GPs and better mental health provision; and it means an NHS turning heads in the 21st century just as it did when it was founded in the 20th century.

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[Sir Simon Burns (Chelmsford) (Con)]

Thank you very much, Madam Deputy Speaker.

I certainly welcome today’s debate and the opportunity to discuss an issue that is extremely important to all hon. Members in all parts of the House. During recent weeks, there has been a significant problem because of the increasing number of people needing services at A&E and from local health services. I would like to pay tribute to the magnificent work, often in very difficult circumstances, that doctors, nurses, consultants, ancillary staff and people in general practice carry out on a day-to-day basis—not simply during a winter crisis period, but throughout the year—looking after people to the best of their abilities.

My own hospital, Broomfield hospital in Chelmsford, is doing a fantastic job, in difficult circumstances, to provide the best possible care in good times and in more difficult times. As a constituency MP, I am certainly aware that there have been some problems for some of my constituents over the last week or so, because of the demand and the pressure.

We have to look at what we can do to move forward in a positive—not a partisan, politicised—way to make sure that our constituents get the best treatments possible. There is no point in just shouting. As the Chair of the Health Select Committee, my hon. Friend the Member for Totnes (Dr Wollaston), said, it is no good engaging in yah-boo politics. We have to be mature and come up with sensible suggestions.

Funding is, of course, a key issue. I am extremely proud of this Government’s record and commitment to funding the NHS over the last seven years and their commitments for the next three to four years. We made sure when we came into office, at a time of austerity when Departments’ budgets were cut, that the Health Department’s budget was one of the few to be protected, so that we got a real-terms increase in funding every year we were in power—albeit, I accept, a modest real-terms increase. It nevertheless showed our commitment and our intent to invest in improving the national health service.

I am also proud of the fact that I and all my right hon. and hon. Friends fought the last general election on a commitment that over the five-year period of this Parliament, we were going to increase NHS funding substantially—to what has turned out to be to the tune of £10 billion. That is more, I say in a very gentle way, than was on offer to the country from certain other parties. I am pleased, too, that my right hon. Friend the Secretary of State and the Minister of State have been planning for any potential strains of demand during this winter period with the provision of £400 million to local health economies and other measures such as the vaccination programme, a preventive health measure that has got a record number of 13 million people vaccinated to try to offset some of the potential health problems that can flow during a winter period. That is using foresight and planning to try to minimise problems, while at the same time providing funding to back up their actions. That is what a responsible Department of Health should do and has done.

Now, people can demand as much money as they like for the health service, but my argument is this. Yes, the health service does need extra money—year in, year out—but it should not just be thrown at an issue. A far bigger part of the equation is building on the performance, standards and quality of care that the health service will provide to our constituents.

[Dr Mathias]

I entirely agree with what my right hon. Friend is saying about the increased resources, but does he not agree with me that we now need more resources for integrated health and social care and that this is the time to stop using the NHS as a political football and engage in a cross-party review?

[Sir Simon Burns]

I certainly agree that, under the leadership of the Department of Health, we should work with anyone and everyone to come up with a solution.

I was the Social Care Minister in the late 1990s, before we left office. Integrating health and social care was then at a very early, formative stage, and the ambitions were immense and tremendous. I am afraid that the reality has not matched the ambitious nature of what was being said in the 1990s, which is why I was particularly interested by the comments of my hon. Friend the Member for Totnes. Yes, we must think about that, but what we must also think about—let me push the funding element to one side for the moment—is building on the work of my right hon. Friend the Secretary of State for Health, particularly his investment in patient safety, the raising of standards, dignity for patients in our hospitals and throughout the health system, and the cutting out of waste and inefficiencies.

In 2010, when I was at the Department of Health for the second time, we had the Nicholson challenge, which was to save £20 billion over three or four years by cutting out waste and sharing best practice to improve the quality of care. I know from a debate that we had just before Christmas that the NHS achieved £19.4 billion of those savings. The beauty of that was not just that it created greater effectiveness and efficiency in the delivery of healthcare and the sharing of best practice, but that the Treasury did not receive £19.4 billion with which it could do as it wished. The £19.4 billion was reinvested in patient care.

Oral Answers to Questions

Tania Mathias Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Dunne]

I am aware of the right hon. Gentleman’s campaign on this matter. It would be wrong for me to pre-empt the work that is being done in reviewing both the STP process and the policy priorities of NHS England. Once those plans have been put forward to Ministers, we will be able to consider which we can prioritise.

[Dr Tania Mathias (Twickenham) (Con)]

The STP for south-west London includes mental health crisis needs, but there is a current crisis of lack of in-patient facilities for mental health patients. Will the Minister look into extra immediate funding to increase the number of in-patient mental health beds?

[Mr Dunne]

As my hon. Friend is well aware, given her experience in this area, mental health is a priority of the Government and of the STP process. I will take away what she says in relation to in-patient beds.

Oral Answers to Questions

Tania Mathias Excerpts

Tuesday 11th October 2016 Commons Chamber

[Mr Hunt]

I agree with the hon. Lady that the way this case was handled was by no means satisfactory. The truth is that it took some time to establish precisely what had gone wrong at Southern Health. As this House knows, because we made a statement at the time—I think it was an urgent question, actually—there was a failure to investigate unexplained deaths. I do not think the NHS handled the matter as well as it should, but we now have much more transparency and we do not have a situation where people go on and get other jobs in the NHS, which happened so often in the past.

[Dr Tania Mathias (Twickenham) (Con)]

T4. What will the Government do to scrutinise and assist the London ambulance service, which has had an appalling and consistently poor record on call-out times for category A emergencies?

[The Minister of State, Department of Health (Mr Philip Dunne)]

My hon. Friend is right to highlight the fact that the London ambulance service is in special measures and has been for some time. I visited it this summer and am pleased to confirm that some £63 million of additional funding has been provided to the ambulance service since April 2015. The service is starting to make significant inroads in increasing the number of paramedics who are available on call, with some 250 more being added over the last couple of years.

Oral Answers to Questions

Tania Mathias Excerpts

Tuesday 10th May 2016 Commons Chamber

[Ben Gummer]

Funding for nurses has increased over the past six years. It is because of the sixth largest increase in the NHS budget that we can guarantee that nursing numbers will remain in that strong position for the remainder of this Parliament. That will include specialist nurses. My role is to make sure that as many nurses as possible get additional training so that we have a wider and richer skills mix, specifically so that nurses can develop their careers—something that I am afraid was often made more difficult rather than easier under the previous career structure.

[Dr Tania Mathias (Twickenham) (Con)]

3. What steps he is taking to encourage the use of biosimilar medicines in NHS treatment.

[The Parliamentary Under-Secretary of State for Life Sciences (George Freeman)]

The biosimilars—the generic versions of biologic products—represent part of the extraordinary range of new drugs that are becoming available for the benefit of our patients. The Government are committed to ensuring access to drugs for UK patients at the highest level of quality and safety, and to ensuring that effective biosimilar medicines are available. That is why we are leading, not just here but in Europe, the regulatory regime through the Medicines and Healthcare Products Regulatory Agency as the lead assessor and rapporteur. In the NHS, the chief pharmaceutical officer, Keith Ridge, and the commercial medicines unit in my directorate have put together a framework agreement for biosimilars, and through the medicines optimisation programme we are looking specifically at biosimilars, and we have set up a national biosimilars medicines group.

[Dr Mathias]

I thank my hon. Friend for that answer. May I ask also that where NHS pharmacists are involved in oncology clinics, there is a higher prescribing of biosimilars? What steps are in place to encourage more oncology clinics to involve NHS pharmacists at the start of the patient’s treatment journey?

[George Freeman]

Not surprisingly, my hon. and, in this field, learned Friend makes a very important point. We have set up a number of initiatives to that very end: to make sure that our pharmacologists and pharmacists in the system are alert and have all the information they need to increase the prescription of biologics and the generic versions, biosimilars. I will happily write to her, describing a range of initiatives that are in place which we are pursuing to that end.

Digital Records in the NHS

Tania Mathias Excerpts

Thursday 28th April 2016 Westminster Hall

[Dr Tania Mathias (Twickenham) (Con)]

It is a pleasure to serve under your chairmanship, Mr Wilson.

I applaud my hon. Friend the Member for The Cotswolds (Geoffrey Clifton-Brown) for securing this debate on an incredibly important topic. He has covered all the points that should be covered, and I just want to make a few comments from a personal point of a view, as a doctor and as an MP with a constituent who has dealt with this matter.

I was very struck by the story of Les Halpin, and I have always firmly believed that the NHS’s greatest resource is the patients. I believe in the patient expert, and that the patient expert should be top of the medical team. I agree that we need state-of-the-art IT in the NHS, although I will come to some practical concerns later. Synchronicity of appointments would be a dream—I believe that dreams can come true, so I am not saying that it is not possible. Co-ordination among services would be another, and I believe that, too, is possible to achieve in the NHS soon. Primarily, I support the idea of the patient controlling the data. I wish that more of that was in place right now, even before we have the required level of IT.

There are practical concerns for a clinician. Even as a medical student, when I was dealing with paper records, far too often I had to say to a patient—I think I have said it in every clinic I have ever worked in—“I’m sorry, I haven’t got your notes.” That is a waste of the clinician’s time and a family’s time. Whenever I gave patients a physical record of an appointment, they always produced that copy at the next appointment, even if it was a few months later or an annual check. That is why we have to take the lead from the patients.

We now have some digital records. In my field, ophthalmology, computerised records are great, but the IT can be a problem. The software is fine, but many units and hospitals do not have the hardware they need for the size of the graphic information on digital records. That is why state-of-the-art IT is a little bit of a dream at the moment.

My hon. Friend mentioned Les Halpin. I have a constituent who is the father of a little girl called Eleanor. She is part of a great charity, Eleanor’s Voice—google it, and see the tweets—and is a wonderful little girl. She is undergoing treatment for cancer, which requires many appointments at many different places. Her father is good with IT and realised that people often did not have the notes they needed and were not co-ordinated. As a patient expert—or rather, as a patient’s family member expert—he produced a Dropbox folder. If he goes to an appointment at a clinic with Eleanor now, taking her out of her little primary school, he can say, “Don’t worry, I’ve got everything on my Dropbox. I can give you my password.” Eleanor has therefore never had a clinical meeting in the NHS that has not been useful.

We must not underestimate the practical problems with this great goal. The NHS can lead, because having one health system that so many people can access is an amazing resource—nowhere else in the world has that. Let us put the patient first and learn from the patients.

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[Stephen Metcalfe]

My hon. Friend is completely correct; that is the key. It is about making sure that the Government put in place the correct mechanism not only to protect data but to give people confidence, and that is one of the biggest challenges that we face. I will make sure that is heard loud and clear.

The other big challenge is having the correct personnel to analyse the data. A major challenge for big data as a whole—not just in the clinical setting—is to have people who understand how the data work. Big data will be worth many billions of pounds to the UK economy over the next few years, and not just in the health sector, so we need to make sure that we have the right stream of well-trained, informed people coming through.

[Dr Mathias]

On the point about the problems with big data, I concur with my hon. Friend the Member for The Cotswolds (Geoffrey Clifton-Brown). Our problem is that if we are not first in this, we will be the losers.

[Stephen Metcalfe]

My hon. Friend is absolutely right: we have to be at the front of that race. One way to do that is by making sure that those who are currently in schools and colleges understand what big data are, what the benefits will be in the future and how they can have a productive, valuable and rewarding career, not just for themselves financially, but that makes a significant difference to us as a nation. The phrase “big data” slips off the tongue very easily but does not actually encompass everything that it means.

I have laid out some of the challenges and benefits. In summary—again, I am grateful for you allowing me to speak in this debate, Mr Wilson—it is obvious that the full digitisation of records will potentially solve some of the biggest problems and challenges we face in spotting patterns and helping to develop new treatments and therapies. It will help to improve patient safety and, as my hon. Friend the Member for The Cotswolds (Geoffrey Clifton-Brown) said, patient-focused care by putting the patient right at the centre again.

Of course, cost savings are available, and they are always required in these difficult times. Good IT can lead to good cost savings. The right way forward has to be accuracy and the accurate keeping of records, stopping doubling-up and making sure that records are in the right place at the right time for the right patient. My hon. Friend the Member for Twickenham (Dr Mathias) gave an excellent example of a patient who had taken control of their records via—I think—Dropbox, which meant that for every appointment the patient had access to everything that was needed to make it a productive and valuable experience. That is very positive and I am sure that, as Members, we have all had reports from constituents who say that they had a wasted experience at their local doctor’s because the right records were not there. If that one small aspect is dealt with, that has to be welcome.

Finally, my hon. Friend the Member for The Cotswolds made the point that with this move we will—and should—be able to achieve more for less, and that is always welcome. I congratulate him on securing this debate and thank my hon. Friends the Members for Twickenham and for Bury St Edmunds (Jo Churchill) for their contributions. I very much look forward to hearing what the Opposition spokesman has to say and, in due course, the Minister.

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[George Freeman]

My hon. Friend makes an interesting point. I will come to our plans, and to the process and timetable for setting out the national data guardian’s recommendations on how we should proceed. I would expect that one of her recommendations will be about the importance of communicating to the public and patients why data are so important. As part of the annual National Institute for Health Research Parliament day that I launched, we might have a themed event focused on the power of data and why they are so key to a 21st century NHS.

[Dr Mathias]

We have been talking about the speed with which the Government should be digitalising records, hence the idea of a chief of information for the NHS. I believe that the public are already ahead of the Government. That is the problem—I fear that the Government may already be too late. There are too many apps out there, too many different clinicians are doing different things and too many patients are devising their own systems. We are behind everybody else.

[George Freeman]

My hon. Friend makes an excellent point. She knows my frustrations with the situation, and the truth is that healthcare is digitalising very fast. That is not just driven by commercial app manufacturers. As she says, many doctors are developing apps for their own benefit and that of their patients. Many patients are also developing apps. The revolution is coming. Part of our strategy is to ensure the digitalisation of the NHS, which is no mean undertaking. In fact, I would liken it to Crossrail and HS2 as a global project. It is the digitalisation of the world’s fifth biggest employer—a vast undertaking. There are a number of lessons to be learned from previous Government initiatives.

In many ways, we are catching up. The challenge is to catch up in a way that understands the pace at which healthcare is digitalising and seeks not to monopolise, but to provide an aircraft carrier—a mother ship—on which the exploding range of various digital healthcare products can land. I have mixed my metaphors in an ugly way there, but the challenge is to turn the NHS into a catalyst for leading and unlocking NHS leadership in digitalisation.

I totally accept the point made by my hon. Friend the Member for Twickenham that, in many ways, we are catching up and trying to provide a platform for leadership in a rapidly emerging space. In response to the point that she and my hon. Friend the Member for The Cotswolds made about the need for leadership in the NHS, I can confirm that NHS England is about to appoint a chief information technology officer. A major part of that function will be to be lead champion, to explain and to be a point of patient information in the NHS.

Through the creation of my role, we have for the first time created a single ministerial portfolio with responsibility for this area. Until the post was created, every Minister in the Department had a little bit of information and digitalisation in their portfolio, which in many ways was appropriate but also meant that there was no single point of leadership. Part of my mission is to ensure that the Department brings that together.

The three great pillars that require the quiet revolution of digitalisation include research and individual care. However, I want to touch on the third pillar, which is system safety and performance. The NHS is the fifth biggest employer in the world. It is an incredible public service and an incredibly complex set of organisations. We talk of it as if it were one, but under the national health service’s magnificent initials are a whole range of GPs, hospitals and care providers, which all operate independently within a healthcare system. We are building the railway tracks for patients’ records to move along, so that we integrate them. A fundamental part of that, in addition to research and individual care, is ensuring that the NHS can deliver an essential contract with patients in a 21st century health system. We have a duty to know where best practice is and where worst practice is. We should not have to rely on whistleblowers to put themselves at huge personal risk by sighting and highlighting worst practice. The computer will do it for us.

The other day, I looked at a piece of software that was developed—for a very small amount of money, by the way—by an Oxford academic. It shows prescribing data for one important class of drugs across the whole of NHS England. There is one outlier, and it happens to be in Norfolk, which is why I took a particular interest. It is clear that there is a very small group of GPs that somebody has not got the guidance to or rung up. I am sure that as soon as those GPs have the information, their prescribing practice will fall into line with the rest of the country.

That is computing power being used to promote patient safety and efficiency. The third pillar—system safety and performance—is important, and one of the lessons from the Francis report is that we need to use data much better to identify best and worst practice. When people ask why we are doing this, I suggest that it is for those three noble purposes, which support each other. The digitisation of the system should drive patient care, system safety and research, and the same datasets run between them.

Crucially, the Secretary of State and I understand that the whole digitisation programme has to be rooted and covenanted in deep and profound respect for public and patient trust and confidence. I am not revealing a state secret by saying that I am not sure that that has necessarily been the case until now, for a whole range of reasons, but partly because Government have seen digitisation as inevitable and, as my hon. Friend the Member for Twickenham suggests, slightly overdue, and therefore not something that needs to be announced. Of course, the Government are always coy about admitting problems, but I am not coy about saying to people that we are still running the NHS, in large part, on paper and cardboard, which is a problem that needs to be solved.

Unless we describe the problem clearly, we will not carry the public with us in solving it. My magnificent local hospital, the Norfolk and Norwich, has a data repository with 10 miles of shelving on which patient records are kept, held together by treasury tags and paperclips. I do not know about other Members, but I am not prepared to say to my constituents that that is an appropriate way to store their information, and indeed, my information, my mother’s information and my children’s information. Each hospital separately stores records of which patients came to it and when, which does not speak to a properly joined-up system. It is a national health service—the clue is in the name—and when someone clutches their chest in an unfamiliar bit of the country, they expect the national health service to know who they are. That is one of the benefits of a national health service. From the point of view of properly integrating, we need to explain to people where the current system is not able to deliver.

It is for that reason, and because we want to carry public trust and confidence, that the Secretary of State and I are shifting from what I crudely characterise as an agenda that, to the extent that it has been discussed publicly, has been called long overdue, essential for the running of the system, and something that patients do not need to worry too much about. Well, we only have to say the words “big data” and “big government” to most people in this country for them to be alert to the risks of what might be happening behind their back. I am trying to do it differently by saying to people “This is an urgent, overdue, phenomenally exciting and complex project that we are doing in the interests of patients,” for the reasons I have just set out. Public trust and confidence are essential to the project, and I am not revealing any state secrets by saying that NHS England’s care.data consultation last year did not demonstrate global best practice in consulting patients. It was a well-intentioned leaflet that was sent to every house, which of course does not mean that every person in the country read it, and for many people the wording was as confusing as it was enlightening. That is one of the reasons why the Secretary of State and I have gone to such lengths.

We have appointed the first ever national data guardian in Dame Fiona Caldicott, a widely respected expert in the field, to advise us on the right protocols and safeguards for ensuring that public and patients can have trust and confidence in the system. Dame Fiona has carried out an extraordinarily detailed piece of work, and her recommendations will be landing on our desks imminently. She has considered the whole range of issues, including consent; how many data should naturally flow in the system for it to function; which data transactions should be subject to additional patient consent; what the standards should be; and what the relationship between the various bodies should be in terms of accountability. That work is very important.

We have gone further and asked the Care Quality Commission to carry out a major piece of work on best practice in the system today and to set a benchmark so that we can hold the system to account. We have set up the digital maturity index, and this spring each clinical commissioning group has had to report, for the first time, on the level of digitisation in its local health economy, and we are building that into the CCG annual assessment framework so that people will be able to click on My NHS and see heat maps of the extent of digitisation across the country, which will help us to identify best and worst practice and to accelerate the roll-out.

We have also appointed Professor Bob Wachter, the American digital health expert, to come over and help us consider the cultural issues of ensuring that the NHS is properly training and supporting practitioners. It is about the human element, because we can have as many systems and technologies as we want, but it ultimately comes down to culture, practice and patients’ records being respected and treated appropriately by the system. I hope Members can see that we are taking seriously the need to put in place a series of measures that carry public trust and confidence.

[Dr Mathias]

Will the Minister ensure that there is a two-way exchange of information and transparency so that, if the NHS has my medical data, I am always offered, in a secure form such as a personal Dropbox, or whatever form I wish, everything that the NHS has on me? Every patient must be offered all the data that the NHS has on him or her.

[George Freeman]

Unsurprisingly, my hon. Friend makes an excellent point. She will know that my first parliamentary foray into this space was by championing a ten-minute rule Bill on patients’ rights to patient data. Like her, I believe that, in addition to the three noble pillars I set out, there is a fourth pillar. Not only does the digitisation of health have benefits for the system in delivering healthcare in a safer, higher quality and better way but, almost more importantly, it helps the transition of healthcare from something that, in the 20th century, was essentially done to patients by a largely benign health state—an essentially passive model of “Come to us when you are sick, and we will treat you as best we can. You can then return to normality”—to a model of healthcare for the 21st century that is all about empowering active healthcare citizenship by modern citizens. We give them the information, and we allow them to understand and take control of their health and life choices, not in a punitive way or in a way that says, “If you don’t, or if you are irresponsible, you will be ineligible,” but in a way that tries to inspire and promote a culture of active healthcare citizenship.

Putting information in the power of patients and their loved ones, in the same way as in banking and in all other important aspects of our lives, will pay huge public health benefits, with people using information and data to drive lifestyle choices. Indeed, Members are already seeing that. One of the ironies of this space is that some of the most rapid digitisation driven by patients is by the so-called “worried well”—those who take their healthcare seriously and are using Fitbits and other devices to monitor calorie intake, exercise and sleeping patterns to keep themselves out of hospital. The system should use those technologies to try to deliver better care, and we want to integrate the two so that more and more patients are able to harness such technologies to empower themselves. Ultimately, the Secretary of State and I want to get to a point where that transparency and empowerment drives the relationship with healthcare recipients, as healthcare citizens, choosing where to have their surgery and holding the system to account. Intelligent digital transparency is the greatest driver of a modern healthcare system so that every day, every hour and every week the massive diagnostic and treatment footprint of the NHS is mapped digitally, allowing patients to know that they are actually controlling the system, which is there for them.

Some clinicians, particularly GPs, take a different view—that the sovereignty of their relationship with their patient means that their patient’s data belong to the clinician, which is an interesting point. Most patients feel that their data belong to them and that they should have access to their data. There are ethical issues, as well as the question of the appropriate relationship between clinician and patient, and in no way do I want technology to get in the way of, or to undermine, that sovereignty. Indeed, the clinicians to whom I speak say that the digitisation revolution allows them to focus their professionalism and judgment on what really brought them into clinical practice, which is dealing with their patients, while the computer does what they no longer have to do—recording and accessing in a split-second all the information the clinician needs to make their judgments. Technology can support that relationship, rather than undermining it.

[Dr Mathias]

In defence of the clinicians out there, I am sure the majority believe that the patients they serve are sovereign.

[Phil Wilson (in the Chair)]

Minister, before you respond, may I say that you have been on your feet now for 30 minutes and the Minister’s response is usually about 10 minutes? I just want you to bear that in mind.

Upper Gastrointestinal Haemorrhage

Tania Mathias Excerpts

Monday 11th April 2016 Commons Chamber

[Ben Gummer]

There is variation in mortality, and I hope we will make progress in that area over the next period. We must understand comparisons of mortality across the country, and as the hon. Gentleman knows, the Secretary of State is interested in discovering and understanding that issue. We must also understand variations across the European Union, and in the United Kingdom where there are apparent variations between practice in England and that in Scotland, Wales and Northern Ireland. Some of that comes down to data collection, but we must understand where it comes down to practice and consider how we can improve in accordance with our most neighbourly health systems.

[Dr Tania Mathias (Twickenham) (Con)]

I appreciate the Government’s intention, but I do not know whether my local hospital is accredited. I am highly concerned about the current postcode lottery. What is the Minister’s plan right now, tonight, for people who are going to a hospital that does not have an adequate rota system and is not accredited?

[Ben Gummer]

The principles that inform the policy of creating a sustainable seven-day NHS are being announced in stages. The clinical standards to which I referred have been explained in this place and outside several times, and I expect that in the next few weeks and months, further details will be given on the pace at which units around the country will comply. My hon. Friend will know that in the autumn the Prime Minister made it clear that 25% of the population will be covered by 24/7 urgent emergency care services by March 2017, 50% by March 2018, and the entire service by 2020. Precisely how that happens will be made clear in short order, and I hope that my hon. Friend will be satisfied that her hospital will form part of the programme to provide the coverage she expects.

The fact that we are having this discussion is testament to the fact that we are willing to be open about variation and failure, and to do something about it. I thank my hon. Friend the Member for South West Wiltshire for bringing this issue before the House because, just as Lord Grantham popularised it for the nation at large, my hon. Friend has explained in a particular clinical area how the introduction of robust, sustainable 24/7 services will provide the improvements in clinical care that the Government seek. That is why the challenges and difficulties that face us in introducing 24/7 services require attention across the board—not just in hospital estates, but in the configuration of services, the way that services are commissioned and procured, and the contracts that ensure that rotas can be properly manned across the service. We must attack this problem on all fronts and ensure that we provide consistency of care to our constituents. They do not choose when they fall ill, but they should expect the same quality of care whether they go to one unit or another, or on a day not of their choosing.

Question put and agreed to.