Dementia Care in Hospital
Theresa Villiers Excerpts(1 month, 2 weeks ago)
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Theresa Villiers (Chipping Barnet) (Con)
My constituent Lisa Rutter is the founder of the charity Dementia Club UK, which hosts events in Barnet for people with dementia and their families, to provide support, advice and much-needed time out of the house to socialise with other people who are coping with similar life experiences. This work gives Lisa great insight into dementia care and the pressures on unpaid carers, and she asked me to meet a group of carers over Zoom to hear about their relatives’ traumatic experiences when admitted to hospital. I found the meeting deeply disturbing, which is why I applied for this debate.
In the time available, I can only include brief points about each case. I cannot hope to convey the emotional impact of the stories as told by the carers themselves, and I cannot hope to get across their real distress and anger that their loved ones had been let down, but I hope to give the House an indication of the seriousness of the problem.
I will start with Lisa’s own story. Her mother, Tasoulla Gavriel, was admitted to Barnet Hospital with covid in November 2020. Sadly, she died shortly afterwards. Tasoulla was a lovely lady, and I met her on a number of occasions. She was assessed by the hospital to be an eight on the Rockwood scale, meaning that she was viewed as severely frail and approaching the end of her life. Lisa believes that this diagnosis was entirely wrong. Her mother was sitting up and alert when admitted, and she did not have serious comorbidities, apart from advanced dementia, which meant she needed help with eating.
When Lisa was told by the hospital that her mother needed an oxygen mask, she asked for Mrs Gavriel to be put in hand mittens to prevent her from pulling off the mask and harming her treatment. The hospital refused, on the basis that this did not accord with hospital policy because it amounted to a deprivation of liberty. The hospital decided that it was neither proportionate nor in Mrs Gavriel’s best interests for her to be given mittens. That is despite mittens being used when Mrs Gavriel had been admitted the previous year for a hip operation. Lisa sincerely believes that mittens could have saved her mother’s life.
Another deeply distressing aspect of this case is that covid visitor restrictions meant that Lisa had only very limited time with her mother in hospital. I raised this in Parliament at the time, urging visitor restrictions to be eased for patients with dementia. I very much welcomed the subsequent introduction of greater flexibility for people to spend time with their loved ones in hospital. We must never again return to restrictions of the sort we saw during the pandemic.
Some of the group I spoke to did not want to be named, so I will simply refer to them as Carers 1 to 5. Unlike the others, Carer 1 is not a constituent and his experience does not relate to my local Barnet Hospital, but I do not want to leave him out. He emphasised how crucial it is that people with dementia continue to move and walk, if they are to stave off further loss of cognition, but he told me that staff at the hospital to which his wife was admitted refused to help her to walk. Even more worrying, he had to intervene twice to prevent a nurse from giving her the wrong dose of medication. Had he not spotted the mistake, a potentially lethal dose could have been administered.
Richard Foord (Tiverton and Honiton) (LD)
I congratulate the right hon. Lady on securing this significant debate, as dementia is going to affect so many people’s lives in the coming decades, as more and more people are of retirement age. In Devon, the dementia specialist Jonathan Hanbury has suggested that we should place more funding and focus on community hospitals, community treatments and community services, so that people can keep their brain agile further upstream. He suggests that the NHS’s focus on funding for acute hospital services and expensive drugs misses the value of prevention. Does the right hon. Lady agree?
Theresa Villiers
Those are very valid points. It is important to keep people out of hospital for as often as possible, but that is particularly the case with dementia patients, given the dislocation and insecurity that comes with moving them to a different environment. Measures to keep people healthier for longer and to deliver care via the primary care system rather than in acute hospitals are an important way to address some of the problems I am outlining.
Jim Shannon (Strangford) (DUP)
I commend the right hon. Lady for raising this issue. Over the past couple of years, I have dealt with a number of incidents similar to the one she refers to. Does she agree that, for those with dementia and Alzheimer’s, the emotional upheaval of being taken from a safe place where they feel comfortable can often lead to incredible distress, which can, in turn, result in aggressive behaviour? I know of one young nurse who had her arm broken in two places. It was not the patient’s fault, as he was simply beside himself and could not let go of her. Does the right hon. Lady agree that there must be enough staff in place to ensure that one young nurse should not be left screaming in pain, with no one there to help her? Does she also agree that that patient deserves compassion and understanding for their outburst?
Theresa Villiers
The hon. Gentleman makes an important point. One problem that emerges from some of the cases I will talk about tonight is that disruptive behaviour by patients with dementia, including shouting, can often be just an attempt to communicate. It is vital that staff understand that. Of course, I agree that it is essential that we have sufficient numbers of staff to ensure that they can give appropriate attention to patients with dementia in these circumstances.
The father of Carer 2 died a month after being admitted to Barnet Hospital. This constituent reported that food and drink was often just left in a tray, with little apparent effort made by staff to feed her father. He was left all day in a chair or in bed, with no attempt made by the staff to encourage him to walk. He was not supported while in the toilet, and when that led to distressing and undignified consequences, including the soiling of his clothes and hands, he was not washed until the following day.
Carer 3 told me that her husband’s condition deteriorated significantly during a stay in Barnet Hospital. Apparently, the nurses complained and said that he screamed all night. My constituent explained to them that that meant he wanted to get up to go to the loo but was prevented from doing so by the side bars on the bed. He was simply calling out for help. She often found food left untouched, yet no one seemed to note that her father had stopped eating. The catering staff just took the uneaten meals away. His medication was also stopped without his family being told, which led to a worsening of his symptoms and his anxiety.
Carer 4 told me about her partner, who has early onset Lewy body dementia and was admitted to Barnet Hospital in April 2022 after a fall. Apparently, until that point he was walking, climbing stairs and coping fairly well at home, albeit that he was a little wobbly on his feet. But the last time he ever walked was when he arrived at the Barnet accident and emergency department.
My constituent was initially restricted in visiting hours and had to fight to be allowed to stay in the hospital outside those times. She felt that the staff, especially some of the agency workers, did not understand her partner’s care needs. She was given the number for the specialist dementia nurse covering the hospital trust, but the phone was never picked up, no matter how often she rang. During his stay in the hospital, her partner deteriorated far more quickly than he had before. He was kept in bed constantly and lost the ability to walk—he is only 55. At one point, after undergoing an MRI scan, he was left distressed and confused in a cold hospital corridor, wearing a hospital gown damp with urine after radiographers had removed incontinence Conveen equipment. After he got out of Barnet Hospital, he said he would never, ever go back, no matter the circumstances.
Carer 5 told me about her father, who was admitted to Barnet Hospital with pneumonia in November 2021. When an ambulance was sent to pick him up, he was able to walk downstairs without assistance and climb into the back. Throughout his stay, it was extremely difficult for my constituent to get to speak to any doctor or nurse about his care.
Theresa Villiers
Carer 5 became increasingly desperate to take her father home as his condition deteriorated. He had always been meticulous about his personal hygiene, an old-style gentlemen who always dressed in a shirt and tie, no matter what the occasion. After time in Barnet Hospital, he was unshaven and unkempt, and he stopped eating. It apparently took six months for him to return to something like his old self, but his appetite never returned to what it had been. He has since passed away.
Themes that emerged again and again in my discussions with this carers’ group included: repeated difficulties in carers getting to speak to nurses or doctors about the care needs and health of loved ones; failure by staff to understand the care needs of people with dementia; failure to ensure patients ate and drank; and failure to keep patients mobile and walking. From what I heard from my constituents, it is clear that allowing extensive visitor access is crucial for patients with dementia, so relatives can help communicate with staff and assist with feeding and care. As I said, we must never again tolerate the type of restrictions that were in place during covid. Communication by doctors and nurses to relatives must be improved as well.
The group asked that the NHS develops a much larger volunteer programme, training many more people to support dementia patients with eating and walking if they do not have family to help them. In addition, volunteers should be trained to advocate for dementia patients if they do not have relatives who are able to do that.
These cases show a need for a more in-depth and effective training programme for NHS staff on how to look after patients with dementia. I commend the training programme on understanding dementia that Barnet Council has commissioned my constituent, Lisa Rutter, to carry out and I urge local NHS services to consider taking part in that programme. We need to do as much as we possibly can to keep people healthier for longer, and ensure that when they get ill there is an option for treatment in the community, to keep as many people out of hospital as possible.
I want to emphasise that I appreciate the efforts being made by frontline NHS staff to care for and support people with dementia. I appreciate that, although there have been some serious failings in the cases I have referred to, thousands of people spend time in Barnet Hospital every year and receive the best quality care. I thank all the NHS workers who make that happen. I accept that there is currently great pressure on staff, as healthcare need continues to expand exponentially and the NHS undertakes the massive task of catching up after covid.
When I raised these cases with Barnet Hospital, it emphasised its commitment to ensuring that patients with dementia and their carers have the best experience possible. Staff told me they had set up a dementia service in 2016, managed by a dementia clinical nurse specialist. In 2023, the hospital apparently treated 356 patients, trained 1,598 members of staff and received some very positive feedback from patients and carers. In 2015, it was one of the first NHS trusts to sign up to John’s campaign to ensure carers can visit patients with dementia at any time outside visiting hours, by prior arrangement with the ward manager.
The trust provides dementia training above the expectations set by NHS England, including mandatory tier 1 dementia awareness training on induction. Specialist dementia training is also provided for all volunteers. To support patients during meal times, a red tray system is in place: patients who need additional time, encouragement or assistance are identified and provided with a red tray.
In 2017, it launched a “Keep me moving” campaign, which focuses on keeping patients as active as possible while they are in hospital. There is a telephone line for carers and loved ones to contact dementia clinical nurse specialists.
Although I recognise the value of these measures, and I welcome all of them, I am afraid that the cases I have outlined indicate that they are simply not always delivering the intended results; they are not enough. I believe that the failures in these cases demonstrate that more must be done to ensure that dementia patients receive the best care possible and that they receive dignified treatment at all times. I therefore hope that the management at Barnet Hospital will reflect carefully on the matters raised by my constituents, which I have set out this evening.
Care and support for people with dementia is one of the most important challenges of our generation. This is a task that is likely only to grow in scale when, in years to come, around one in three people born today are expected to develop dementia. We must ensure that every one of those people has access to high-quality health and social care. That means continuing to increase resources for the national health service, so that staff can give each patient the time and attention that they need.
In this financial year, the NHS resource budget is due to be £157.4 billion. It is due to reach £162.6 billion in 2024-25. I welcome the announcement this afternoon by the Chancellor of a further £5.85 billion. The total is far higher than ever before, meaning that the NHS has more hospital doctors and nurses than ever before and is delivering more appointments, tests, treatments and operations than ever before. But if we are to relieve pressure on the NHS and tackle waiting lists, and ensure that every patient gets the best care, we need to tackle delays in discharging people back into care settings in the community. To do that, it is essential that we fund local government to play its part. I welcome substantial increases in funding for social care over recent years, but the cost of social care continues to place real strain on council budgets.
If we are to have the care home places that we desperately need, care providers also need to be paid a rate by councils sufficient to provide the level of care needed by people with dementia. We also need a long-term strategy for the social care workforce to ensure that we train and recruit the people that we need to carry out these vital roles, and that we pay them appropriately given the importance of the job that they do.
Now that the Government’s science and research budget is one of the biggest in the world, we must give high priority to dementia research to tackle this massive epidemic. Lecanemab and donanemab represent an incredible breakthrough; finally, there is a glimmer of hope. These are the first ever drugs shown to address the disease itself rather than just its symptoms. We must ensure that the NHS is ready to start delivering these treatments once final approvals are given. That will require a step change in testing capacity so that we identify people who can benefit from the drugs in time for them to have an effect.
As a society, we must do everything we can to support unpaid carers, including with respite care. According to the Alzheimer’s Society, around 1.8 million people in England provide some form of care and support for friends or relatives with dementia. The overall value of those services provided amount probably to £12.2 billion.
I conclude this evening by paying tribute to every carer who looks after a loved one with dementia, including the six brave individuals who spoke to me about their experiences and prompted this debate today. They are all heroes to whom this country owes a huge debt of gratitude; they deserve our deepest thanks and our support.
Oral Answers to Questions
Theresa Villiers Excerpts(2 months, 3 weeks ago)
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Victoria Atkins
I was genuinely delighted to welcome the hon. Lady to the Government’s women’s health summit last week to announce the consolidation, and indeed the improvement, of the women’s health strategy that this Government have launched. We saw significant success last year with hormone replacement therapy improvements and she knows, because she attended the summit, that I have just announced a £50 million research fund looking at maternity disparities and also research into female-specific conditions. Any concern she has about operation times she should take up with the local trust and it will perhaps tell her what impact industrial action has had, sadly, on elective surgery.
Theresa Villiers (Chipping Barnet) (Con)
The Minister for Health and Secondary Care (Andrew Stephenson)
I know this is an issue close to my right hon. Friend’s heart and pay tribute to her for her work as vice-chairman of the all-party group on radiotherapy. The pandemic has of course presented a real challenge to delivering the Government target to diagnose 75% of stageable cancers at stage 1 or stage 2 by 2028, but I am pleased to be able to tell the House that we are coming through that and last year diagnosed more cancers at stage 1 and stage 2 than ever before.
Theresa Villiers
Cancer Research UK has published an ambitious plan, “Longer, better lives”, which reminds us that for some cancer patients just a few weeks of delay can make the difference between whether they can be offered curative treatment or just palliative care. Will the new diagnostic centres being opened by the Government, including at Finchley Memorial Hospital, bring waiting times down and secure that early diagnosis that is so important to surviving cancer?
Andrew Stephenson
My right hon. Friend makes an important point. Diagnostic checks are a key part of the cancer pathway and the 150 community diagnostic centres opened by this Government, including the one at the Finchley Memorial Hospital, will provide earlier diagnostic tests, support earlier diagnosis and bring down waiting times, benefiting millions of patients. These centres have delivered more than 6 million additional tests for all elective activity since July 2021 and we expect the Finchley Memorial Hospital CDC to provide over 126,000 tests for elective care in the next financial year.
Draft Health Education England (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023
Theresa Villiers Excerpts(1 year, 1 month ago)
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The Minister for Health and Secondary Care (Will Quince)
I beg to move,
That the Committee has considered the draft Health Education England (Transfer of Functions, Abolition and Transitional Provisions) Regulations 2023.
It is a pleasure to serve under your chairmanship, Sir Edward. I am grateful to be in the Committee today to debate these important regulations, which are intended to transfer all the functions of Health Education England to NHS England and to abolish Health Education England. They use powers under section 103 of the Health and Care Act 2022 that allow regulations to transfer functions between relevant bodies listed in the Act and to abolish a body if that transfer of functions has made it redundant.
The merger is in line with a recommendation from the Public Accounts Committee back in 2020 to review the effectiveness of having a separate body overseeing the planning and supply of the NHS’s future workforce, which the Department of Health and Social Care accepted.
Theresa Villiers (Chipping Barnet) (Con)
Regardless of the transition and of who is in charge of education to train the doctors and nurses of the future, we need a lot more of them. Will the Minister assure us that the workforce plan that the Government are going to publish will deliver the doctors and nurses we need to meet rising healthcare need?
Will Quince
My right hon. Friend is absolutely right. We need medics across the NHS in various functions: consultants, doctors, surgeons, allied health professionals, nurses, nursing associates, apprentices and so much more. That is exactly why we commissioned NHS England to undertake a long-term workforce plan. She will know that the Chancellor set out in the autumn statement, and reiterated in the recent Budget, that we will publish that plan very shortly—certainly this spring. It will also be independently verified. It will set out our plan and the workforce requirements for the next five, 10 and 15 years. It needs a bit of patience, but it is a hugely important piece of work because, as she rightly says, the NHS needs that workforce to plan for the future.
Urgent and Emergency Care Recovery Plan
Theresa Villiers Excerpts(1 year, 2 months ago)
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Steve Barclay
I think the hon. Lady was welcoming the transparency on 12 hours—I certainly hope so. The ICBs became operational in July, and we are working with them as to how, by taking a system-wide view, they can baseline the gaps in data, and one key area of that is on the community side. When she talks about matching capacity, part of that is about understanding virtual ward capacity, what conditions that applies to, what the physio wraparound services are, what is available within residential care versus community care and other domiciliary care packages, as the right hon. Member for Islington North (Jeremy Corbyn) touched on in terms of local authorities. We need to look at the data package across the piece on a system-wide basis. That is why we are setting up control centres. I am keen to make that much more transparent, because to be blunt, as a Secretary of State, I get the transparency anyway when things go wrong. Like the hon. Lady, I would rather have much more transparent data so that ICBs themselves can be better held to account, and indeed that is what the Hewitt review is looking at in terms of that wider transparency piece.
Theresa Villiers (Chipping Barnet) (Con)
I welcome the fact that Barnet Hospital’s emergency department will be expanding and improving its facilities and taking on new staff, and of course I welcome today’s announcement, but I urge the Secretary of State to ensure that it is effective on the ground soon, because there is a real crisis out there. This is a good announcement, but it must be delivered so that patients and staff feel it on the frontline as soon as possible.
Steve Barclay
I could not agree more, which is why this morning the Prime Minister and I were at University Hospital of North Tees, where it is effective on the ground. It is about looking at hospitals where such measures have been effective and are having an effect on the ground, such as in North Tees and at Maidstone Hospital, and how we take best practice from them. We then have to do what has sometimes been more difficult in the NHS, which is to scale those innovations and get them adopted across the piece.
Oral Answers to Questions
Theresa Villiers Excerpts(1 year, 5 months ago)
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Neil O’Brien
I actually agree with the first part of the hon. Gentleman’s point. That is why, as well as the huge direct support to households, we are investing £12 billion in Help to Heat schemes to help make people’s homes warmer and cheaper to heat, another £1.1 billion in the home upgrade grant, and £500 million in the sustainable warmth competition. We take this issue very seriously, and colleagues at the Department for Levelling Up, Housing and Communities are taking further actions to clamp down on squalid housing.
Theresa Villiers (Chipping Barnet) (Con)
Access to GP appointments is particularly important to help to deal with winter pressures, so can the Minister update the House on progress in implementing the improvements promised in October last year to help GPs to expand to meet demand over the winter?
Neil O’Brien
My right hon. Friend is so right, and she has been a powerful champion on this issue. We have invested £1.5 billion to get an extra 50 million GP appointments per year. The number of appointments in September was up 7% compared with the same month in 2019. We now have an extra 2,300 doctors working in primary care compared with 2019, and an extra 19,300 primary care professionals, on the way to the goal of 26,000 extra primary care professionals. This is hugely important, we are investing in it, and my right hon. Friend is right to campaign on it.
Women’s Health Strategy for England
Theresa Villiers Excerpts(1 year, 9 months ago)
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Steve Barclay
Again, it is partly by having an ambassador that will be tasked with advocating in that space, by having the data to give visibility to that, and also by working in partnership with commissioning groups, with the NHS, and with the royal colleges on training, that much greater focus will be brought to these issues.
Theresa Villiers (Chipping Barnet) (Con)
I thank the Government for bringing forward this strategy. It really is astonishing that this is the first Government ever to have produced such a strategy. Will my right hon. Friend use this to drive forward improvements in care for endometriosis, including, in particular, updating the National Institute for Health and Care Excellence guidelines NG73 to make sure that people have earlier diagnoses and better access to pain relief for this debilitating condition, of which too many doctors do not have a high enough awareness?
Steve Barclay
That was one of the key issues that came out of the consultation responses. Indeed, in my conversation with Dr Watson at Homerton, we looked at different pathways for treatment that avoid the need for theatre. Key to that is some of the innovation on pain management that physicians are looking at, and how, through NICE, we socialise that innovation across the NHS.
Ambulance Services and National Heatwave Emergency
Theresa Villiers Excerpts(1 year, 9 months ago)
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Maria Caulfield
The North East Ambulance Service is one of three areas of concern in terms of performance. I reassure the hon. Member that I have met the families, and offered other families a meeting, to discuss the matter. In relation to his constituent, there is a tribunal ongoing. It is difficult for me to meet him while that is ongoing. Once that is over, however, I would be happy to meet his constituent to discuss the issues that he raised as a whistleblower.
Theresa Villiers (Chipping Barnet) (Con)
The Minister will be aware that the chances of recovery for those who suffer a stroke are greatly improved if they get specialist care within the first half hour, 45 minutes or so. So will she do everything she can to address administrative blockages and other delays, to ensure that people get the chance of life-saving treatment at the earliest possible stage?
Oral Answers to Questions
Theresa Villiers Excerpts(1 year, 10 months ago)
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Sajid Javid
It is an important question, and the hon. Lady will know that specific guidance is already set out for those who are immunocompromised. As she will also know, Evusheld has conditional marketing authorisation from the independent Medicines and Healthcare products Regulatory Agency. With the MHRA and others, further tests are going on via the UK Health Sciences Authority, because it is essential to ensure that Evusheld works well and satisfies clinicians when it comes to omicron.
Theresa Villiers (Chipping Barnet) (Con)
To tackle the covid backlog, it is essential that we expand the capacity of the NHS, and that means more people, so what is the Secretary of State doing to ensure that we recruit the skilled professionals we need for the NHS?
Sajid Javid
My right hon. Friend is absolutely correct, and that is why that is one of our biggest priorities. As well as asking the NHS to come up for the first time with a 15-year, long-term workforce strategy, we are also recruiting at a record rate, with more doctors and nurses working for the NHS than ever before.
Access to GP Appointments
Theresa Villiers Excerpts(2 years, 3 months ago)
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Theresa Villiers (Chipping Barnet) (Con)
I beg to move,
That this House has considered access to GP appointments.
It is a pleasure to serve under your chairmanship, Mr Robertson.
GPs are at the heart of our health service and our communities, and I thank them all for their dedicated work. They have been at the frontline of one of the most successful vaccination programmes in the world, thanks to which we have some of the lightest covid restrictions and one of the most open economies. Family doctors have also delivered an incredibly rapid adoption of new digital means to interact with patients when lockdown meant that it was vital to be able to give health advice without vulnerable patients having to visit a surgery. This is quite a switch for a health service that just a few years ago was still using about 9,000 fax machines.
Phone or digital consultations are here to stay, and for many they are a great way to get help from their GP, but not for everyone. In particular, many elderly people, people with learning disabilities or other cognitive impairments and those with language barriers may not be able to cope easily with digital communication. They may find anything other than a face-to-face meeting difficult. It is vital that these vulnerable people can still see their doctor, and there has been some real progress in recent months. There are now more appointments in general practice than there were before the pandemic, and, judging by the latest figures, about 65% of those were face to face.
Jim Shannon (Strangford) (DUP)
I was interested when I saw this issue on the agenda for Westminster Hall. I am interested in lots of things that are debated in Westminster Hall, but this is one in which I have a particular interest. Does the right hon. Lady agree that for many people who are not comfortable about describing their symptoms over the phone, or eloquent enough to do so, it is essential that they can request to see their GP without having to prove to the receptionist the reason why they need to?
Theresa Villiers
That is of course correct. Phone calls are important in triaging and assessing the extent to which a face-to-face meeting with a doctor is appropriate, but it is essential that those who need face-to-face appointments are given them.
We are seeing some progress, and this has been delivered at the same time as millions of booster jabs. I give credit to GPs, NHS England and Ministers for that recovery in general practice, but it remains the case that many of us will have heard from constituents about problems in getting in to see their GP. I thank the 19,302 people who signed the online petition on Parliament’s website expressing concern about this.
Taiwo Owatemi (Coventry North West) (Lab)
The right hon. Lady makes a really important point about constituents trying to get in contact with GP surgeries. I have the same issue with one of my constituents who tried to get in contact with her surgery and had to call every day for three weeks in order to get an appointment. By the time she did get an appointment, she experienced delays in accessing the treatment she needed. Does the right hon. Lady agree that further action is desperately needed to ensure that we have a plan in place to address staff shortages and resource shortages across our NHS and across our GP surgeries so that our GPs can continue to provide the healthcare that is needed?
Theresa Villiers
I agree that we need more general practice capacity and I will come on to explain how we could do that.
There can be no doubt that GP surgeries are under immense pressure. The Royal College of General Practitioners says that the workload has never been greater. A GP in my constituency told me that as well as colleagues leaving the profession, it has become increasingly difficult to recruit new doctors. He said:
“Those of us left behind feel that we are holding up a broken system.”
In GP surgeries, as is the case across the NHS, demand has spiralled partly because, as we grow older as a population, we have greater healthcare need, partly because of pent-up demand from people who felt reluctant to seek help during the pandemic, but also partly because the decision by NHS leaders to push a range of treatments out from secondary to primary care has left GPs dealing with more serious and complex cases than in the past. As a result, one High Barnet GP told me that primary care was in a precarious position even before the pandemic. Of course, delays in accessing GP appointments have been an issue for some years in many areas, including my Chipping Barnet constituency. My concern has been intensified by the predatory demands of developers seeking to build blocks of flats in multiple locations in my constituency. The Mayor of London wants to see over 23,500 new homes built in Barnet over 10 years. That is a massive increase in population, yet GPs are struggling to serve the population we already have.
We have seen the number of doctors in hospitals increase to record levels—and that is a great achievement—but the same cannot yet be said of GPs. I have been campaigning to expand GP capacity in Barnet as part of the Government’s wider commitment to boost primary care. I very much welcome the £250 million announced in October to tackle immediate pressures on the system. This promised new cloud-based phone systems, a reduction in routine paperwork such as sick notes and Driver and Vehicle Licensing Agency checks, and additional staff to support GPs. Well, I think we probably all know that better phone systems are urgently needed in many practices, but the need to reduce unnecessary bureaucracy is also pretty obvious.
Damien Moore (Southport) (Con)
My right hon. Friend is making an excellent speech. On patients phoning up trying to get an appointment, does she agree that there needs to be more capacity in phone systems so that people are not waiting on the phone for hours on end to get an appointment with a GP?
Theresa Villiers
I think that is right, which is why it was a good decision in the Government’s October announcement to focus on an upgrade to phone systems. I really hope that the Minister will update us on how that is going and when it will be delivered, so that our constituents can experience it directly.
Returning to the issue of GP paperwork, a Barnet GP told me that
“the amount of bureaucracy and red tape has increased exponentially despite various assurances that this would be cut. Increased regulation and monitoring, whilst important from a governance point of view, seems to have generated endless form filling, policy updating, mandatory training, appraisals and paper chasing.”
When this issue was debated in this Chamber last October, the Minister repeated promises that paperwork and form filling would be reduced. Has that happened? If not, why not? It is far better for a GP to spend time with patients, rather than writing sick notes or ticking boxes.
The third element of the Government’s plan seeks to strengthen the multi-disciplinary teams in general practice, so that, where appropriate, patients can seek other professionals such as nurses, pharmacists or physiotherapists. This is intended to free up GP time for them to see sicker patients. I welcome the fact that 10,000 new staff have been recruited of the 26,000 promised in the Conservative manifesto, and I commend the work of North Central London clinical commissioning group, which is due to recruit 177 more primary care staff under the programme. However, more could be done, for example, to enable pharmacists to take a bigger role, including in prescribing. We must also ensure that GPs have a strong voice in the new integrated care boards, so that primary care is at the heart of NHS decision making. It is vital that part of the massive capital investment that the Government have promised for the NHS goes into improving GP surgery premises, which in some instances are just not fit for purpose or not physically large enough to cope with increased healthcare demand.
Tahir Ali (Birmingham, Hall Green) (Lab)
Many of my constituents, and constituents across the country, are concerned about how quickly they can get face-to-face appointments, especially those mentioned earlier: the vulnerable, the elderly, and those who cannot do online or telephone appointments. The investment in surgeries is most welcome, but we need immediate action to address the shortfall in patients being seen by doctors where they need to attend a face-to-face surgery.
During covid-19, elected Members received an uplift to our budgets to help us to deal with our constituents. The same needs to be done for GPs, who are under huge pressure to deliver services, and that needs to happen now rather than later, because such investment can take time to come through and we do not have time.
Theresa Villiers
I agree that we need action now to make it easier to get GP appointments, and we also need action for the longer term. Even if everything that I have spoken about is delivered, and the October package is delivered in its entirety, we still need more GPs—it is as simple as that.
It is really welcome that this year more people have entered training to become GPs than ever before, because the Health Committee identified workforce shortages as the “key limiting factor” in tackling the covid backlog successfully. In its annual report on the state of health and social care in England, the Care Quality Commission concluded that by mid-2021 there were likely to be fewer full-time equivalent GPs in total per 100,000 patients than there were in 2017.
In July 2021, the then Care Minister commissioned Health Education England to review long-term strategic trends for the health and social care workforce. That review is very welcome, but we need to see it deliver results. As the Health Committee has called for, we need an objective, transparent and independently audited annual report on workforce projections that cover the next five, 10 and 20 years, including an assessment of whether sufficient numbers of staff are being trained.
Damien Moore
My right hon. Friend is being very kind in sharing her time. Does she agree that universities that have medical placements and more capacity should be allowed to extend that capacity, so that we can train more people and have more people entering the profession?
Theresa Villiers
It is essential that we expand the capacity of training places for GPs, and I welcome the new medical schools and the progress that has been made. However, because it takes years to train up a professional, the effect of those developments is not yet being felt in local surgeries.
We need to ensure that the NHS visa scheme is used effectively to recruit skilled GPs from around the world in order to meet immediate pressures, and we have to get better at retaining the GPs that we have. A vital first step in doing that is to implement measures to relieve the stresses on GPs that I have spoken about and to address spiralling workloads.
An effective workforce strategy also needs a better plan to encourage women to stay in the profession. We need to give more thought to how we persuade women who might have chosen to work part-time while caring for children to consider coming back to work full-time.
Also, what about all those retired or non-practising GPs out there? At the start of the pandemic, the Government rushed through legislation to enable retired professionals to return to the workforce to help battle that first covid wave. Clearing the covid backlog and expanding GP services is another great national challenge and we really should try to do more to enlist the talent of doctors who have retired or moved on to other careers.
Theresa Villiers
I will just make a little progress now, because I want to give the Minister time to respond.
That means fixing the problem with doctors’ pensions. I know that efforts have been made in that regard. However, it is still worrying that it seems that once a doctor has been in practice for many years, they can face a big tax bill for their pensions. Of course, the last thing we should do is push GPs into early retirement because of punitive pension taxes. We want them to stay in practice and not retire.
In conclusion, pressure on GP surgeries is leading to appointment delays, which will only generate yet higher numbers of people showing up at accident and emergency departments that are already busier than at any time in the history of our national health service, as graphically shown on Sky News in relation to Barnet Hospital just a week or so ago.
GP services are a crucial gateway to treatment by other parts of the health service. If this gateway gets blocked up, the consequence will be that lives are lost, for example to cancer, because symptoms were not picked up early enough. So this matter is not just one of convenience; it is a matter of ensuring that we are doing everything we can to deliver the best healthcare.
The Government rightly promised 50 million more appointments in GP surgeries every year. It is essential that we deliver on that promise, so that my constituents can get the care they need within a reasonable timeframe. We must see the NHS long-term plan and the Government’s record £33 billion investment in the NHS deliver more GPs in local surgeries in places such as Barnet. It is as simple as that. We cannot carry on as we are. When he recently gave evidence to the Health and Social Care Committee, the Health Secretary said that plans to recruit 6,000 additional GPs by 2024 are not on track. I appeal to the Government to get them on track and to do all they can to expand capacity in GP practices in my constituency and across the country.
Antimicrobial Resistance
Theresa Villiers Excerpts(2 years, 4 months ago)
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Theresa Villiers (Chipping Barnet) (Con)
It is a pleasure to serve under your chairmanship, Sir Gary, and to follow my hon. Friend the Member for Thirsk and Malton (Kevin Hollinrake), whose track record on this important issue is second to none. I warmly congratulate him on securing more time in this Chamber on this important issue.
“Before Alexander Fleming discovered penicillin in 1928, an infection from a simple cut could mean the end of life. Nearly 100 years later, the antibiotic safety blanket we live our lives with is being pulled from us.”
That is a quote from the former chief medical officer, Dame Sally Davies, on the threat posed by antimicrobial resistance. She and many others have spoken out in apocalyptic terms about the catastrophe ahead of us if we do not stem the tide of infections resistant to treatment with antibiotics, as my hon. Friend has so articulately put it.
Sir Gary Streeter (in the Chair)
We will get under way. I know Karin Smyth is not here, but I am sure she will pick up the pace of the debate when she returns. The debate may now continue until 5.55 pm.
Theresa Villiers
I started my speech by referring to the remarks of the former chief medical officer, and I was about to say that she is entirely right to have spoken out on this issue. It is not just some millennium-bug anxiety about something that might or might not happen in the future, because people are already dying. Every year, an estimated 50,000 people die from drug-resistant infections, and that number will grow massively unless we deal with the problem.
During lockdown, many of us will have viewed the video of Bill Gates’s warning about a global virus pandemic, which was made years before it actually happened. If action is not taken now on a global scale to deal with AMR, people will look back on Dame Sally’s predictions in the same way. They will say that leading scientists highlighted the potential return to the days when routine surgery, childbirth, a cut in the arm or even an insect bite could give rise to a serious risk of death, and they will ask why we did not act. The good news is that a great deal of action is under way. The O’Neill report, commissioned by David Cameron, was groundbreaking. It was highly influential around the world, and 135 countries have finalised action plans on tackling AMR.
This year, it is very welcome that the UK Government have been using their G7 presidency to try to deliver more tangible progress, as they did last time they held the presidency, in 2013. However, the fact is that developing new antibiotics is massively expensive. The attempt to do so has already forced a number of smaller firms into insolvency and caused some bigger companies to exit their research and development programmes in this area. The fact is that many hundreds of millions of pounds can be pumped into R&D, with no return on that investment whatever if a project turns out to be unsuccessful.
The high failure rates of antibiotic development apparently leave just 40 antibiotics in clinical trials globally. The problem is compounded by the fact that if a new antibiotic is successfully discovered, we want to use it as sparingly as possible, keeping it for serious conditions and to head off potentially worsening AMR problems in the future. That creates even more problems with the risk-return ratio. There is therefore an urgent need for policy reforms to create market conditions that enable sustainable investment in antibiotic innovation, including properly valuing and paying for new antibiotics.
It is very encouraging that the industry has set up a £1 billion investment fund to try to bridge the funding gaps, particularly for smaller biotech companies, that will have a strong focus on drugs that could have the maximum impact in securing and safeguarding public health. Also welcome is the AMR project, which we have already heard about from my hon. Friend the Member for Thirsk and Malton. The project, launched by the UK Government, NICE and NHS, is trialling a new subscription-style model for antibiotics. Under the model, payment is based on the product’s overall value to the NHS, rather than on just counting the pills dished out to patients. Two medicines have been selected, and contracts are expected to commence in April 2022.
It is very welcome that the project has continued despite the pandemic, but we now need to press ahead with wider implementation in order to cover more research and bring in the devolved nations, so that we have a whole-country approach. We need the project to get beyond the pilot stage, and we need to learn from it to ensure that a sustainable solution is put in place for new antibiotics that reflects their long term value to society as a whole.
In conclusion, I very much welcome the leading role that the UK Government have taken on this issue on the world stage. However, if we are to succeed in addressing this great challenge of our time, there is still a lot of work to be done. For example, we need to increase public understanding of the dangers of over-prescribing or misusing antibiotics. We must also tackle the overuse of antibiotics in farming. I do not see that as a domestic problem with our sector—we have strict rules to prevent that from happening in UK farming—but we need to use our trade and foreign policy to raise standards on antibiotics use in agriculture all around the world.
Above all, the Government need to be bold and ambitious in putting in place a long-term market solution that changes how we pay for antibiotics, so that we can reward and incentivise the scientific research that can save us from the nightmare we face: a return to Victorian medical outcomes, where 40% of our population have their lives cruelly cut short by infections we cannot treat. I look forward to hearing from the Minister what action the Government are going to take to drive this crucial issue forward.