Oral Answers to Questions

Tania Mathias Excerpts

Tuesday 22nd March 2016 Commons Chamber

[Mr Hunt]

I am somewhat surprised at the complacency of the hon. Gentleman’s question after Audit Scotland identified in the autumn that performance against seven of the nine key targets for the Scottish NHS had deteriorated in the past three years, that spending since 2009 had fallen in Scotland while increasing in England, and that spending on private sector providers was increasing. The hon. Gentleman should think about that before he criticises what is happening in England.

[Dr Tania Mathias (Twickenham) (Con)]

T5. Successful cardiopulmonary resuscitation often involves people knowing where the nearest public access defibrillator is located. In my constituency, however, it is difficult to find out exactly where such defibrillators are located. Will the Minister ask the Department of Health to carry out a live mapping of public access defibrillators as well as ensuring that every workplace with a first aid point has a clear sign showing where the nearest defibrillator is located?

[The Minister for Community and Social Care (Alistair Burt)]

This work is already in hand through the British Heart Foundation. I should like to add that last week the Chancellor announced another £1 million to make public access defibrillators and CPR training more widely available in communities across England. Coupled with last year’s funding of £1 million, that means that there are now over 690 more publicly accessible defibrillators in communities across England. That mapping work is important, however, and my hon. Friend is right to raise it.

NHS: Learning from Mistakes

Tania Mathias Excerpts

Wednesday 9th March 2016 Commons Chamber

[Mr Hunt]

As ever, I commend the right hon Gentleman’s interest in mental health. May I reassure him that this is very much about what happens in mental health and also the area of learning disabilities? In fact, some of the thoughts were prompted by what happened at Southern Health. It is absolutely vital that we investigate unexpected deaths in mental health as much as we do in physical health. The measures we take will go across those areas, and I am more than happy to meet him to discuss the very laudable aim of zero suicides.

[Dr Tania Mathias (Twickenham) (Con)]

May I applaud the Secretary of State for this culture of safety and learning? Will he consider increasing the use of exit interviews in the NHS? I have worked in the NHS, aid organisations and charities, and the NHS is the only one where I have not had an exit interview. May I suggest that decreasing the use of agency and locum staff, as we hope to do, provides an opportunity to learn from good staff about sharing good practice and avoiding bad practice? I absolutely applaud the world summit on patient safety, and I very much hope the Secretary of State has invited St John of Jerusalem eye hospital, from East Jerusalem. If that was somehow forgotten, please will he ensure that it is invited to the Berlin summit next year?

[Mr Hunt]

I feel prompted by my hon. Friend’s question to investigate what I am sure is excellent practice at St John of Jerusalem eye hospital. If I may, I will take away her very good point about exit interviews. We also heard a good point about agency staff. Part of the thing that inhibits a learning culture is if a large percentage of staff are in an organisation only on a provisional or temporary basis, rather than being part of regular teams and therefore not being able to transmit lessons learned. That is why we have to deal with the virus of an over-reliance on agency staff in some parts of the NHS.

Junior Doctors’ Contract Negotiations

Tania Mathias Excerpts

Monday 8th February 2016 Commons Chamber

[Ben Gummer]

The hon. Gentleman tempts me with kindness, and I repay the compliment. However, having been involved in this process for some months now, I have found it incredibly frustrating. Up to the end of November, every time we asked the BMA to come and talk to us, it refused, despite personal entreaties. And when it did talk to us, we often found that we had nailed down an agreement only to find it slipping out of our fingers the next day in front of the media. This has been a hugely frustrating and difficult process for everyone concerned—not only for us but for the junior doctors, who have been left confounded and confused by the whole thing.

[Dr Tania Mathias (Twickenham) (Con)]

Does the Minister agree that most, if not all, junior doctors exceed their contracted hours and that a 72-hour limit is therefore essential? Will he also acknowledge that, even after the negotiations are complete, many junior doctors will continue to exceed their contracted hours?

[Ben Gummer]

Some junior doctors exceed their contractual hours. The average across the service is 48 hours, but some are working as many as 91, which is the current permitted limit outside the working time directive. We wish to stop that altogether and bring it down to an absolute maximum of 72 hours a week, which would equate to a 48-hour average over the agreed period, which is currently six months. The key is to get the number of hours down, because working excessive hours is unsafe for patients and for doctors.

NHS and Social Care Commission

Tania Mathias Excerpts

Thursday 28th January 2016 Commons Chamber

[Dr Lee]

The hon. Lady is right. Tomorrow I will be working as a doctor. I am very proud to be working as a doctor. I have been very public and open about it throughout my time here and I will continue to practise medicine for the foreseeable future. I encourage her to face down her internal critics, as well as those rather ill-informed external critics in the Scottish Daily Mail. I actually stood for election calling for the closure of my local hospital. I did not want my constituents going to an ill-equipped hospital, or thinking that it provided care that it did not. I have sought to educate my local electorate about the need for a 24-hour angio suite and for a 24-hour stroke unit.

We have made some progress on reconfiguration, particularly on stroke care. In London and in Greater Manchester, stroke services have been consolidated. That is why people are now surviving and survival rates for strokes are improving. Patients are taken to appropriate units and appropriately cared for. The appropriate intervention can be applied within the appropriate time. Sadly, that is not possible across the country. It is available only in areas where difficult decisions about reconfiguration have been taken. On oncology, there is a widespread belief that cancer outcomes are all to do with late diagnosis in primary care. Forgive me, but that is not necessarily the whole story. It is the quality of cancer care when patients reach the hospital—any delay in receiving radiotherapy and so on—that is having a profound impact on cancer outcomes. If we consolidated oncology services into fewer sites, we would get better clinical outcomes.

On out-of-hours care, when I turned up here I said that I would scrap out-of-hours care as it is currently constituted. Most people looked at me and thought, “Are you slightly nuts?” The answer is no. Having done many, many, many sessions in the primary care out-of-hours arena, I realised that there was the potential to delay the care of the acutely unwell in a way that could have an adverse impact and, in extremis, lead to someone’s death. I suspect, without knowing the details, that the case we heard about in the urgent question on Tuesday was such an example. I do not believe it is clinically possible to properly assess a sick child via a telephone. We can go some way towards doing it with an adult, because—guess what?—an adult can express themselves more accurately. With a child, we have to see them and touch them, and, in particular, we have to see the mother’s response towards the child, to assess how acutely unwell they are.

The problem, with all best intentions, is that with a telephone service these types of incidents are always going to happen. It was no different with NHS Direct; the medical profession used to get very frustrated with that, and 111 is the same. The symptoms of sepsis can be the symptoms of many things, so if we tighten the protocols we end up flooding the service with more and more people worried that their child has sepsis when, actually, it is not that common.

I would revisit the whole out-of-hours settlement. We could get away with having fewer doctors during antisocial hours primarily looking after the housebound and those who are terminally ill. The list of patients who could be visited by said doctor would be compiled by GP practices in that region. Patients would not get a visit unless the GP practice has said they are entitled to a visit because of a diagnosis of being either terminally ill or housebound. In future, I would put the resources into urgent care centres. For now, I would put one in each casualty to sift through. I would make sure it was a doctor. Forgive me, but doctors are taught to triage and to diagnose. No other healthcare professionals are taught in the same way. The best thing to do is to put one’s most experienced and qualified person at the front end, because then proper triage can take place.

[Dr Tania Mathias (Twickenham) (Con)]

In my constituency, the borough has a brilliant GP-led out-of-hours system that I would invite the Secretary of State to considering rolling out. I appreciate the idea of a commission, but we already have the vanguards and out-of-hours services, such as the one being led from Teddington memorial hospital, which I believe set the right standards. What can a commission do that we cannot do without one?

[Dr Lee]

I thank my hon. Friend for her intervention because it allows me to elaborate. A couple of years ago, I had a meeting with the right hon. Member for Leigh (Andy Burnham)—all the polls were saying that the Opposition would win the election, so I thought I would have a meeting with him in advance. I said, “Look, Andy, you’re going to have a problem. We’ve got all these hospitals. We know some of them are not fit for purpose. We know we’ve probably got too many because of how healthcare has changed. Some 80% of care delivered in the NHS is for chronic conditions. Why don’t you have a cross-party commission so that all the parties can share the political pain of deciding which hospitals should be retained as acute hospitals, delivering the 24-hour stroke and angiography suites, the surgical interventions and the like, and then have more community hospitals, with urgent care centres attached”—the hub-and-spoke model. At the time, he looked at me and said, “Well, maybe”, and made no commitment.

My point was that it was extremely difficult for colleagues in marginal seats to come out and say what I said in my constituency, which was that the current local hospital settlement was not in the best interests of my constituents. It is very hard to do that in a marginal seat, be it Labour, Conservative or whatever, so, with a cross-party commission, we could all share the pain.

All the royal colleges, particularly the paediatricians and obstetricians, know that staffing in some district general hospitals is not ideal. It is extremely difficult to provide the level of care we know we can deliver. How do we get to that point? A couple of years ago, I thought that having all the parties and independent experts in a room would be one way of going from approximately 200 to 100 such hospitals in England and Wales. That is the sort of scale change I am talking about. I hope that that answers the question from my hon. Friend the Member for Twickenham (Dr Mathias).

Childhood Obesity Strategy

Tania Mathias Excerpts

Thursday 21st January 2016 Commons Chamber

[Geraint Davies (Swansea West) (Lab/Co-op)]

It is a pleasure to follow the hon. Member for Mid Worcestershire (Nigel Huddleston). I agreed with everything he said, including his disagreement with the hon. Member for Colchester (Will Quince). I also agree with the points made by the hon. Member for St Austell and Newquay (Steve Double). We are both members of the SAS—Surfers Against Sewage, that is, before people get the wrong idea.

I congratulate the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), on introducing this debate. As she will know, I have been active in this area, not least in the Sugar in Food and Drinks (Targets, Labelling and Advertising) Bill, which has its Second Reading tomorrow. The Bill basically asks for sugar labelling because people do not realise how much sugar they are eating. As I said earlier, this morning I bought three products from Portcullis House: a can of Coke, which has nine spoonfuls of sugar, the daily limit for a man; a container of yogurt, which has seven spoonfuls, more than a woman is allowed; and a Snickers bar, which has five spoonfuls.

The reason for a focus on fizzy drinks, other than the reasons set by the Chair of the Health Committee, is that they represent a very large proportion of the overall sugar intake of children, and so they represent an easy big hit, early on. There was a trading of statistics about the efficacy of sugar taxes, but we need only look at the elasticity of demand for fizzy drinks. Part of my background is in marketing products in multinational companies—not these products. I was the marketing manager for Colgate, for example. People have talked about the impact on teeth. When I was at Colgate, we thought that with the advent of fluoride we were going to see the end of tooth decay. However, there has been such a big increase in the consumption of fizzy drinks through focused marketing, that we have turned the corner and gone into reverse, and people’s teeth are dropping out. The point about marketing aimed at children highlights some of the demographic differences in the impact of sugar, because high consumers of television tend to be less well-off people who pick up brand awareness from watching it and then follow those brands.

I am in favour of labels noting the number of spoonfuls of sugar. I know that the Minister will say that there are issues with packaging in Europe, but my understanding is that, while there is a European competence, we have a national opportunity to do our own thing, and that is what we should do. Jamie Oliver and the Health Committee are following up on that. Retailers could put pressure on manufacturers to take voluntary action, but, sadly, even though retailers claim they are doing so, they are not taking proper responsibility, certainly not on cola drinks, which is a massive problem.

At one point in my distant past, I promoted the School Meals and Nutrition Bill. Its suggestions that Ofsted should be required to audit nutrition in schools and to get rid of unhealthy vending were agreed. I also still stand by its suggestion to gate children in schools so that they could not run to McDonald’s or elsewhere at lunchtime.

Obesity is costing the economy about £47 billion a year. This is not just about diabetes and the cost to the NHS, which is terribly important; the overall economy is suffering. Members have mentioned bullying in school, but obesity also has an effect on people’s quality of life. It is uncomfortable and those who are obese live shorter lives. If people know that one jar of pasta sauce has six teaspoonfuls of sugar and another has three, they will be able to make a rational choice; otherwise they will pick the one that is sweeter. The mechanisms available are simple. Members have also mentioned the need to encourage exercise, which is clearly very important.

On the main thrust of the debate, I agree with a fizzy drinks tax, but I want us to move towards an ingredient tax, which would mesh into the reformulation. Professor Graham MacGregor, who is now working with Action on Sugar, has been instrumental in getting the salt content down through reformulation. As I have said, if a 10% tax is put on a Hobnob, for example, the producer could reduce the amount of sugar and the price would not go up.

There are concerns about regressive taxation. The sad fact is that poorer people find it more difficult to afford fresh foods. People pooh-pooh that argument, but if various products are mashed up with sugar, salt and fat and then frozen, they will stay on the shelf for months on end. However, if produce has to be sold within a week because it is going to decay, it will be more expensive, which causes problems. There is a case to be made for taking the revenues from the tax and hypothecating it to provide easier access to fresh foods for people with less money. As well as putting up the prices of sugar-rich products, we need to provide information. We have a battery of opportunity to confront this difficult task.

It has been suggested that multinationals have been helping. Such companies are rational, focused and see the lie of the land. They know that people have cottoned on to the fact that sugar consumption is costing the country an arm and a leg, sometimes literally. Productivity is down and costs are up, and they know that the Government will ultimately take action, so they are following a rational trajectory. We need to encourage them to do so.

We have heard stories about elasticity of demand before. As every economist knows, when the price is put up, demand goes down. That is not a point of argument. Certain manufacturers used to say that there was nothing wrong with smoking. We know there is a problem with sugar. The emerging science suggests that if, for example, I and the hon. Member for Colchester both consumed 2,000 calories a day but I took in more sugar than him, over time I would develop a predisposition that meant that more of the calories I consumed would settle as fat. I would then feel hungry and listless and become obese. There are, therefore, other issues associated with sugar consumption.

The World Health Organisation has said that the sugar calorie intake should be 5%. Those of us here know that that means six spoonfuls for women and nine spoonfuls for men, but people out there do not realise how much sugar they are supposed to have, and even if they did they are not able to calculate it. Public Health England has produced an app that enables people to scan products with their phone to find out how many cubes of sugar they are consuming. It is difficult to calculate how much sugar is in one chunk of chocolate and in the bar as a whole. It would be better if it was all clearly labelled, without having to go through that process. The app is helpful and I welcome it, but it is not a serious solution.

[Dr Tania Mathias (Twickenham) (Con)]

I concur with the hon. Gentleman on labelling. Does he agree that, whether we label a chocolate bar or fruit, we need information on sucrose, glucose and fructose? We need to know how many of those chemicals are in everything we consume, including fruit.

[Geraint Davies]

I agree that people should be aware of that. My big beef, as it were, is that people do not know how much added sugar they are consuming. For instance, they do not know if there is twice as much sugar in one jar of pasta sauce than another. People need to know how much sugar they are taking in. To a certain extent, people prefer naturally occurring sugar in bananas and similar products, but I agree with the hon. Lady that people should know what they are eating.

The manufacturers argue that they have done everything they can. The back of a packet of Frosties has all the information, so long as people have a PhD and a lens through which to read the data. Products are packaged in such a way as to give the impression that they are healthy. The Bill that I am promoting tomorrow argues that products should not be allowed to be promoted as low fat when they are in fact high in sugar, because people infer from that that they are healthy. It also proposes an overall, aggregate sugar target—similar to a carbon target—so that the Government can see how much sugar we are consuming overall and gradually manage strategies to get it down.

[Dr Tania Mathias (Twickenham) (Con)]

May I join other Members in applauding my hon. Friend the Member for Totnes (Dr Wollaston) for securing this important debate? I did not come across paediatric type 2 diabetes when I was a medical student. Perhaps her experience was similar to mine. Like many people, I was shocked to find at the turn of the century that there were instances in this country of childhood type 2 diabetes. There are now more than 100 cases a year in this country of that incredibly serious condition. Just a few months ago, a three-year-old in America was diagnosed with type 2 diabetes. The treatment involved decreasing the weight of the child, who was obese.

I believe that the Minister’s strategy should be cultural. The papers show that more evidence is emerging and it is prescient. It involves not just genetics, but nurture. Studies of children who have been adopted by obese parents show that there is a risk that they will have childhood obesity.

On culture, I, like others, have seen many households with a TV room but no dining room. Families do not eat at a dining table in the same way as previous generations did. Members have talked in depth about the cultural change relating to exercise. I applaud the head of St Ninians in Stirling, who introduced a 1-mile-a-day idea for the primary schoolchildren. Interestingly, obesity levels on entry to the school are not as high as those in other schools; the figure a few years ago was one in 10. There is now an association—we are not talking about causation—between the 1 mile a day and pupils leaving St Ninians without being obese. That lady has rightly been given Pride of Britain awards. I want that culture change to continue and for the House to applaud it.

At the moment, I am not in favour of new taxation. In our culture, we can access such information. I absolutely agree with what everybody has said about better labelling, and we need more of it. However, as I said to the hon. Member for Swansea West (Geraint Davies), we need information about all the foods we eat—about fruit and vegetables, as well as about fast food. There is a debate about using sucrose as opposed to fructose, but we need to be aware of all such chemicals. In our culture today, we can give people that information. I would like to have such information myself.

As we get more evidence, the treatment and management of, as well as education about, childhood obesity will rise to the levels available for adult obesity. For many people, the concern is not about the obesity itself, but about its medical consequences. An obese adult who goes to their GP can look at the algorithm or the chart, and discuss the five or 10-year risk of their developing cardiovascular problems. If we give parents such information about their child, they will, in time, change their family habits. They do not want their child to have an increased five or 10-year risk of cardiovascular complications.

[Geraint Davies]

On that basis, does the hon. Lady advocate removing the tax on cigarettes?

--- Later in debate ---

[Dr Mathias]

The hon. Gentleman is testing me. I would say yes if I followed the argument all the way through, but I would not now go back on the tax on cigarettes. In my experience, education and information are the most powerful factors. Sadly, all GPs have treated people who later died from lung cancer. In my limited experience, it is information, not the effect on their pocket, that will change such people’s behaviour. I want an obesity strategy that will provide such information, because I trust the patient to make an informed choice. For me, the facts and the evidence are key.

We need to hold up a mirror to our culture at the moment. We have a culture of fast food and little exercise. I want that to flip to become a culture of slow food and more exercise. I encourage the Minister to look at such a culture, rather than at taxation.

Anti-TNF Drugs

Tania Mathias Excerpts

Wednesday 9th December 2015 Westminster Hall

[Fabian Hamilton]

I agree with my right hon. Friend. In fact, the Olivia’s Vision charity has been in touch with me and offered its full support for this debate and any future effects of it, which will hopefully include a decision from the Government that both infliximab and adalimumab will be available on the NHS. Those anti-TNF drugs are clearly completely effective in the treatment of refractory uveitis alone. I will talk a bit about the effects of anti-TNF drugs on other conditions.

[Dr Tania Mathias (Twickenham) (Con)]

I greatly appreciate the hon. Gentleman giving me time to speak. For information, I am an eye doctor. Does he agree that what is important with severe conditions such as refractory uveitis is the principle that it must be up to the senior clinician—no one else; not NHS England and not a Minister—to decide if and when these treatments should be prescribed, and that the clinician must not be prevented from doing so?

[Fabian Hamilton]

I am grateful to the hon. Lady for her contribution, especially given her expert knowledge in the field. I agree 100% with her; it should be for clinicians to make such judgments and decisions, provided the drug is deemed safe. Enough testing and evaluation has so far been done to show that these drugs are not only safe but highly effective.

The point I was going to make, before those helpful interventions, was that it would cost no more than £1.2 million per year for all the patients in England to be treated with adalimumab or infliximab. To put that in context, I ask this question of the Minister: what would be the cost of paying benefits to all the young adults—most of the sufferers are young, working adults—who will suffer from sight-threatening uveitis for the rest of their lives if they lost their remaining sight for lack of a sight-saving drug that has already proven highly effective, as the hon. Member for Twickenham (Dr Mathias) said? Surely the taxes that they pay now and will pay in the future would more than outweigh the cost of allowing the use of this medication, never mind the additional cost of paying benefits to blind people who can no longer be as economically productive.

Teifi James is one of about 50 eye surgeons in England who specialise in the management and treatment of uveitis, out of a total of around 1,200 eye consultants in the country. He and his colleagues know from their work and the clinical evidence that adalimumab and infliximab work well, yet they are being denied the opportunity to prescribe that sight-saving treatment. Members may be forgiven for assuming that the use of biologic drugs such as adalimumab is a novel step, but that is not so. Teifi James first used Campath, one of the original monoclonal antibody therapies, to treat ocular disease as long ago as 1997. Uveitis specialists had been effectively using infliximab and adalimumab in appropriate cases for over a decade since 2000, until the NHS reorganisations changed the commissioning regulations. English uveitis specialists are frustrated that the treatments they had been using have become inaccessible as a consequence of recent changes to NHS commissioning.

If Samara or any of the other 120 young adult sufferers of uveitis were suffering from another condition as well, such as Crohn’s disease or arthritis, they could be prescribed these drugs, which would prevent the further development of uveitis. Sadly, however, without multiple conditions, uveitis alone cannot be treated with Humira or similar anti-TNF medication. I hope the Minister and anyone else listening to this debate will agree that that is highly unfair and just plain wrong.

As I have said, Samara’s remaining vision in her right eye is now failing. Mr James can operate on her eye to remove the cataract and correct the problems she is currently experiencing, but he is reluctant to do so unless she is established on treatment with Humira. He feels that the risks are too great on her present medication.

I hope the Minister will answer the following questions when he responds. First, does he acknowledge that time is of the essence and that young adults in danger of losing their eye sight cannot wait for sight-saving treatment much longer? Secondly, will he use the points I have made today to persuade NICE to speed up its review? Thirdly, will he offer my constituent, Samara Ullmann, and the 120 other patients like her the hope that a treatment senior clinicians say is highly effective can be used for their benefit without further delay? Finally, does he agree that Samara should have the chance to have a family and to see her children grow up, just like every other parent in the country?

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

May I start by thanking and congratulating the hon. Member for Leeds North East (Fabian Hamilton) on securing the debate? I am grateful to him for giving me advance notice of the issues he has raised. We serve our constituents best in debates such as this when there is a spirit of non-partisan co-operation, and he is the very embodiment of that.

The hon. Gentleman spoke incredibly fluently on behalf of his constituent, Samara Ullmann. He and I have discussed this issue, and he has raised it with the Department in recent months. I pay tribute to his work on his constituent’s behalf and, most of all, to Samara and all of those who suffer with this condition. One of my privileges in this ministerial role is to see the extraordinary patience, fortitude, courage and force of life spirit with which so many people with ill-met or unmet conditions survive. It drives me on in my work to try to accelerate the landscape and get innovate medicines and treatments to those people more quickly.

I will say something about the condition and then try to address the points raised by the hon. Gentleman. As most Members here will perhaps know, uveitis, or inflammation of the uveal tract, is the term used to describe inflammation of any structure within the eye that, when very severe, may cause visual loss. It can lead to blindness through either direct damage to the light-sensitive retina or secondary complications such as glaucoma. Uveitis is uncommon. It is estimated that two to five in every 10,000 people will be affected by it in the UK every year. It usually affects people aged 20 to 59, but can also occur in children. Despite being uncommon, it is a leading cause of visual impairment in the UK.

[Dr Mathias]

Just for information, the other problem with uveitis, apart from blindness, is intense pain.

[George Freeman]

My hon. Friend makes an excellent point. Patients experience a whole range of associated conditions.

In severe cases, treatment to try to prevent sight loss requires drugs that suppress immune cells. The drugs in standard use across the world include prednisolone and immunosuppressant drugs, which work in over 60% of patients. For the remainder, the drugs do not work or the patients suffer serious side effects that prevent the drugs from being used to their full potential. The next step in treatment is the use of a group of drugs known as biologics. As the hon. Member for Leeds North East said, those drugs are very specialised and designed to focus on specific molecules released during inflammation from cells, suppressing the inflammation in doing so.

TNF inhibitors are biologic drugs that suppress the physiologic response to tumour necrosis factor, which is part of the inflammatory response. Humira and Remicade are two anti-TNF alpha treatments that are licensed and NICE-approved for the treatment of adults with a range of conditions, including rheumatoid and psoriatic arthritis, ankylosing spondylitis and inflammatory bowel diseases, including Crohn’s disease and ulcerative colitis. In terms of the latter, I understand that the hon. Gentleman has been supporting his constituents by raising awareness for those living with a debilitating bowel disease by supporting Crohn’s and colitis awareness week, which has just ended. NICE has not yet appraised any anti-TNF drugs for the treatment of uveitis. I shall say more about that in a moment.

Decisions about funding for new treatments and drugs that are for rarer conditions, such as uveitis, and which have not been considered by NICE are made by NHS England as part of its specialised commissioning function. NHS England operates a horizon-scanning process to identify new treatments, and its clinical reference groups advise on the development of services for patients and keep published evidence under review. When NICE is not considering a therapy, NHS England can examine the evidence base and may propose commissioning treatments through its commissioning policy development process.

Turning to clinical experts, my hon. Friend the Member for Twickenham (Dr Mathias) made a really important point. Much as I would like to be able to pull a lever and accelerate treatments in response to very eloquent advocacy in this House, it is completely appropriate—I can see the hon. Member for Leeds North East nodding—that such decisions are made by the patients, clinicians and clinical experts, advised by NICE on the basis of the very best evidence available. Sometimes the collection of that evidence and the processing of those appraisals can be frustratingly slow, not least for the patients, but it is important that the process is done well.

The clinical experts at NHS England have considered the use of Humira and Remicade as treatment options for adult patients with severe refractory uveitis. NHS England concluded that there was insufficient evidence to support the routine commissioning of those treatments. NHS England is, however, awaiting publication of the Visual clinical trial report in order to consider revising its commissioning policy in the light of the study’s outcomes. The trial report is expected to be published in a peer review journal in early 2016, at which stage NHS England will consider submitting a revised policy as an in-year service development.

The use of Remicade for children with severe refractory uveitis has also been considered by NHS England. Again, NHS England concluded that there was, as yet, insufficient evidence to support its routine commissioning at this time. That decision will be reviewed in April 2017.

On 11 November, NHS England published an interim clinical commissioning policy on the use of Humira for children with severe refractory uveitis with onset in childhood. Its use is recommended in children aged two to 18 who meet the clinical criteria set out in the policy. The policy, which has been developed by NHS England’s clinical reference group for specialised ophthalmology services with support from clinicians and patient representatives, will benefit children whose sight is threatened by the condition, and for whom other treatments have proven ineffective. That is on an interim basis pending further evidence from the Sycamore clinical trial. The interim policy will be reviewed in 2016, once the full Sycamore trial data have been published. Humira for severe refractory uveitis in children is being commissioned and funded by NHS England through specialist regional centres.

I want to mention individual funding requests, which are important in this context. All treatments for uveitis up to and including the use of immunosuppressants remain funded by clinical commissioning groups. As hon. Members know, the NHS is legally required to fund treatments recommended in NICE technology appraisal guidance. In the absence of such guidance, any funding decisions should be made by NHS commissioners, including NHS England in respect of specialised services, based on an assessment of all the available evidence and an individual patient’s clinical circumstances.

Junior Doctors Contract

Tania Mathias Excerpts

Friday 20th November 2015 Commons Chamber

[Alistair Burt]

I agree with the hon. Lady that we do not need to be in this situation. Absolutely. That is the whole point. The Secretary of State has kept his door open all the time. In seeking to conclude this, after starting negotiations three and a half years ago, the door remains open. It is for the BMA to come through it and say that it wants to continue the negotiations that it abruptly left more than a year ago.

Can and should everything be done to avert the strikes? Yes, it should. It would help if Labour Front Benchers made an unequivocal statement that they do not support strike action by doctors. I await to see whether that will be forthcoming. In the meantime, the Secretary of State has said that he is perfectly prepared to go to conciliation, but conciliation usually comes after a process of negotiations has broken down. The whole point is that the negotiations have not even kicked off again. The point is that the Secretary of State has offered such an opportunity, based on recommendations made by the independent Doctors and Dentists Review Body. That committee has made independent recommendations, including on the basis of information provided by the BMA.

For the hon. Lady to talk about a challenge to safety ill becomes the party that presided over Mid Staffs. The point is that, since he took office, the Secretary of State has, quite plainly and to everybody’s knowledge, made safety in the NHS his prime consideration. He wants a seven-day NHS to recognise the issues that have arisen at weekends. He has never said that junior doctors do not work at weekends. Of course they do—they carry the biggest burden of hospital work at weekends—but to make sure that the NHS is completely safe at weekends, as he intends, it is essential to spread out the burden and the junior doctors contract is part of that process. The hon. Lady said that it should be up to the Secretary of State to make the next move on the negotiations. I say to her that the door to negotiations is always open, as the Secretary of State has made clear.

The hon. Lady raised the issue of patient safety and the comments of Professor Sir Bruce Keogh, who is responsible for doctors in relation to emergencies. It is his role, as the national medical director, to ensure that everyone is safe. He wrote to the BMA yesterday and said:

“I would reiterate to both sides that I believe the best way to ensure patient safety is for the planned action not to take place. I would strongly urge you, even at this late stage, to come back to the negotiating table.”

He stated that

“patient safety is of paramount importance.”

Sir Bruce Keogh’s point in relation to an emergency situation was that although no one doubts for a second that, should there be an emergency in this capital like the one in Paris, every available doctor and member of medical staff would report for work, if it took place on the day of a strike when they were not already in the hospitals in the numbers required, it would take them time to get in. That was his concern about patient safety and it is a reasonable one.

I say again that we await a suggestion from the hon. Lady that it is not right for junior doctors to take strike action and that she will support the Secretary of State in saying that it is time to return to negotiations. The Secretary of State has been patient and fair, and he is clear that this is about safety. Negotiations should be returned to as soon as possible, and it would help if everyone said so.

[Dr Tania Mathias (Twickenham) (Con)]

For the record, I did not vote in the ballot. I urge the Minister and the BMA to return to the negotiating table, but without any preconditions. I applaud the new calculator on the Department of Health website, which is very helpful. I would be surprised if my colleagues and the people I know went on strike. I cannot imagine it. Therefore, there is an opportunity to negotiate and, if that does not succeed, to go to ACAS.

[Alistair Burt]

My hon. Friend believes, rightly, that there should be negotiations. The Secretary of State has said that. He has also said that conciliation is possible if the negotiations break down. There are no preconditions, beyond what the Secretary of State has said about his right to ensure that a manifesto commitment is delivered. My hon. Friend is right about the calculator. The initial calculator was misleading, which may have swayed some people over a period of time. She is also right to recognise, as the chief medical officer said yesterday—[Interruption.] Perhaps the hon. Member for Worsley and Eccles South (Barbara Keeley) will listen to the chief medical officer, if not to me. She said:

“I recognise the strong feeling of junior doctors and will always support them as the future of the NHS, but the severity of the action the BMA proposes is a step too far. I urge junior doctors to think about the patients that will suffer and I ask the union to reconsider its approach.”

That is a very sensible position that I think we would all endorse.

Cardiac Screening: Young People

Tania Mathias Excerpts

Tuesday 27th October 2015 Commons Chamber

[Mims Davies]

I thank the hon. Gentleman. I think that is something we can absolutely pick up on. There are other ways we can reduce mortality at any age, young or old. We need to have more ready access to defibrillators and further CPR training.

[Dr Tania Mathias (Twickenham) (Con)]

Does my hon. Friend agree that a teenager should not get a driving licence unless they have CPR training?

[Mims Davies]

I absolutely agree. That is a wonderful idea to make people aware, early on, about health intervention and what can be done through training.

NHS Reform

Tania Mathias Excerpts

Thursday 16th July 2015 Commons Chamber

[Mr Hunt]

Let me tell the right hon. Gentleman why so many places are going into deficit. They have looked at the lessons of Mid Staffs and said, “We don’t want that to happen here.” That is why, in the past two and a half years, hospitals have employed 8,000 more nurses on hospital wards to deal with the scandal of short staffing that they faced and wanted to do something about. In the end, if it is not sustainable, it is not quality care, so we have to find smart ways to control deficits—not by reducing the staff and making care unsafe, but by making changes to process and through efficiencies, such as making sure that nurses do not spend too long filling out forms and can spend more time with patients. In terms of funding, I would just say that the only way to fund a strong NHS is to have a strong economy, and that is why the country voted in a Conservative Government in May.

[Dr Tania Mathias (Twickenham) (Con)]

I declare an interest as a member of the BMA.

I absolutely agree with all the points made by my hon. Friend the Member for Totnes (Dr Wollaston). I like the reforms of leadership, but will the Secretary of State recognise the existing great leadership in the NHS? A safe NHS is one in which staff morale is at its best. If every leader in the NHS was at the level of Professor Sir Peter Morris, we would already have the best and safest health service in the world.

[Mr Hunt]

My hon. Friend obviously speaks with huge knowledge—I am wondering whether she is the first Conservative MP who is also a member of the BMA —and is extremely welcome for the insights she brings to the House.

Leadership and morale are absolutely crucial. One of the ways in which we can improve morale is by giving patients and doctors alike the sense that we are honest about the problems and have good plans in place to tackle them. Nothing eats away more at morale than people going in day in, day out and not giving patients the care that they want to give and feeling that nothing is being done about it. That is why the move towards transparency, which I know my hon. Friend supports, is so important.

A&E Services

Tania Mathias Excerpts

Wednesday 24th June 2015 Commons Chamber

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow the hon. Member for Central Ayrshire (Dr Whitford). The House should listen to what she says about the point of targets.

I thank NHS staff across the UK and, given the subject of this debate, particularly those who work in the 181 emergency departments across England. Those people face immense challenges. Last year, they cared for 14.5 million patients—an increase of 500,000 on the previous year. As the hon. Lady said, this debate is about not just numbers, but complexity. We have to face that. It is a disappointment to those NHS staff when they see the debate descend into political diatribes. They want to hear constructive diagnoses and solutions from this House; they do not want to see this issue being used as a football. Let us move forward in that vein in this debate and look at the challenges.

This issue is immensely complex. Anyone who says that there is a single answer is not looking at the scale of the problem. In the few minutes I have, it would be impossible to address all the issues, so I will focus on the workforce challenge, which is key. That challenge does not relate just to emergency departments; there is a complex interaction that includes primary care, ambulance services and the voluntary sector.

We know that about 15% to 20% of people who are seen in emergency departments would be better seen in another context. How do we get the skill mix right? We need to consider the fact that not every place needs the same solutions. The solutions that are right in a rural constituency are very different from the solutions that are right in an urban area.

We need to look at the challenges of recruitment, retention and retirement. We have heard that 50% of training places are not being filled, but there is also the leaky bucket of those leaving the profession. We must consider the fact that it costs about £600,000 to train someone to senior registrar level in emergency care. The scale of the brain drain is enormous, particularly to Australia and New Zealand. How do we address that? Of course, there will always be junior doctors who want to spend a year working abroad and then return with the skills that they acquire. We should not discourage that, but we could do more to make it a two-way process. The main problem is the loss of those higher professionals who have not only the skills that are needed to look after the most unwell patients in our emergency departments, but the confidence and decision-making skills that are required to know when it is safe for patients to go home.

[Dr Tania Mathias (Twickenham) (Con)]

I absolutely appreciate what my hon. Friend says about the leaky bucket. Does she agree that every school and every careers adviser should be advising people to go into the NHS, given the 300 careers that it offers?

[Dr Wollaston]

Indeed. I was going to comment further on the issue of the skill mix. This is about not only those higher skill professionals, but the mix within the NHS. I do not think that we should talk that down. We simply will not be able to manage unless we broaden the skill mix. Healthcare assistants, for example, make an extraordinary contribution to the NHS and social care. One of the reasons we lose so many of them is the lack of access to higher professional development; it is not just about a low-wage economy. This is about how we can create more pathways to becoming, for example, assistant practitioners and physician assistants, how we can use them and how we can bring in more pharmacists, who train for five years in their specialty, into what we do across the NHS?

--- Later in debate ---

[Gordon Henderson (Sittingbourne and Sheppey) (Con)]

It is a delight to follow the hon. Member for Birmingham, Edgbaston (Ms Stuart), who made some very interesting points. When I read the motion, what struck me most was that if I had read it having just stepped off the Mars to Earth express, I would have believed that Britain’s national health service was a total disaster and that nothing was being done to improve the services that were being delivered. Yes, there are still problems in the NHS, particularly in lots of our larger general hospitals, such as Medway Maritime hospital, which provides services for my constituency, including A&E cover. Medway Maritime has faced big challenges for a number of years, including under the previous Labour Government, and among those challenges was a failing A&E department. There were a number of reasons for the challenges, including the limitations of the site on which it is located and the demography of Medway towns in general.

Last year, those challenges came to a head and Medway Maritime was put into special measures. Following the appointment of a new chief executive and new trust chairwoman and with the buddying arrangements that have seen Guy’s and St Thomas’ NHS Foundation Trust provide Medway with advice and expertise, the hospital is beginning to see some improvement. Of course, much more needs to be done before Medway Maritime can provide my constituents with the health service they deserve and to which they are entitled.

There is general agreement that one way to relieve the pressure on the hospital is to transfer more of the services it provides into the community. In my constituency, I have two excellent community hospitals, Sittingbourne memorial hospital and Sheppey community hospital. They both provide local people with a very good service, albeit for a limited range of healthcare needs. I would like the services they provide to be expanded. Okay, we will never see a fully fledged accident and emergency department in Sittingbourne and Sheppey, but there is no reason why my two community hospitals cannot provide other services. Today’s Opposition motion contains the statement that

“the pressures on hospitals are a consequence of declining access to out-of-hospital services”.

There are a number of things going on in my neck of the woods that belie that statement, with a number of initiatives and pilots taking place that in the long term will benefit not only my constituency but the wider NHS. Let me tell Members about a couple of them.

Last week, I met managers from the South East Coast Ambulance Service, SECAMB, who told me about the vanguard initiative in which they are involved in Whitstable, just outside my constituency. It is one of several initiatives nationwide that will provide specialist out-of-hospital care in the local community and involves a SECAMB paramedic team, led by a specialist paramedic, working with local GPs to provide people with home treatment rather than their being taken to hospital. SECAMB is keen to replicate the model in other areas, including the Isle of Sheppey in my constituency.

[Dr Mathias]

Does my hon. Friend agree that with home treatments, the patient becomes the patient expert, which is another way of moving forward local solutions and the community helping itself?

[Gordon Henderson]

I very much agree, and I shall come onto that point in a moment. I am interested in getting that model on the Isle of Sheppey and I hope that NHS England will see the merit in the initiative and provide SECAMB with the necessary funding.

I mentioned earlier the excellent Sittingbourne memorial hospital in my constituency. It, too, is running a pilot that I believe should be extended into other areas. Last December, a wound medicine centre was opened in the memorial. It is a specialist service for patients across Swale who have chronic, complex or surgical wounds and it is operated under the care of the Kent Community Health NHS Foundation Trust. The centre uses telemedicine, with community nurses visiting patients in their home. By using mobile computer tablets to photograph wounds, nurses can send pictures back to specialists based at Sittingbourne memorial to provide an instant professional opinion. The system can also track the progress of healing wounds and use the data to work out the best treatment options, including the correct type of dressing. That has the potential to save the NHS thousands of pounds in the wasted procurement of unnecessary dressings.

Last month, I was honoured to open the HEM ultrasound clinic in my constituency. It is a new unit that provides a wide range of ultrasound scans and is the first static clinical ultrasound service in Medway and west Kent. Although it is a private clinic, it is just been contracted to Medway Maritime to help bring down its waiting lists. HEM is undertaking an average of 35 scans on behalf of the hospital every day, seven days a week. The cost to the NHS of the clinic’s service is the same as if the hospital undertook the scans itself. Let me tell those who accuse the Government of wanting to privatise the NHS that using facilities such as HEM is not about privatising the NHS but about the sensible use of private facilities to supplement NHS treatment and reduce waiting times for worried men and women.

I want to mention one particular concern. My local Swale clinical commissioning group is led by an excellent team whose members are fully committed to providing local people with more local services to reduce pressure on Medway Maritime, but Swale CCG is one of the smallest in the country and its size presented big challenges, as does the historic health deprivation in some of the wards in my constituency. Last year, Swale CCG received an above-average increase in its budget and I want to take this opportunity to urge the Government to ensure that it receives an above-average increase again this year.