NHS Specialised Services

Valerie Vaz Excerpts

Thursday 15th January 2015 Westminster Hall

[Valerie Vaz (Walsall South) (Lab)]

May I be the next person to congratulate you on your elevation, Sir David? You have always been very kind to me since I entered Parliament in 2010, so I think it is well deserved.

I thank the hon. Member for St Austell and Newquay (Stephen Gilbert) for bringing a very timely debate to the Chamber. He has given us all a shove to make us realise how important this issue is. We have all had to concentrate on, and speak to our constituents about, what is going on. I also want to say something about the two Front-Bench spokespersons, who are probably two of the nicest Ministers and shadow Ministers. It is, of course, always a pleasure to follow my hon. Friend the Member for Bristol East (Kerry McCarthy).

Every hon. Member making a speech here today speaks on behalf of people who suffer from rare conditions because those people cannot do so themselves. They have complex conditions; by their very nature, they are not run of the mill. They require highly specialised and very skilled clinical responses. Many other hon. Members have concentrated on specific areas. As a member of the all-party group on epilepsy, which also considers related conditions, I shall focus on that. Epilepsy encompasses so many variations, and there are a lot of unknowns about these conditions. Sometimes epilepsy is a forgotten condition because there are no shops on the high street to remind us of how many people—children and adults—suffer from it.

The document from Epilepsy Action’s trawl around all the CCGs was put on my desk and it explains why the debate is so important. I am not sure whether the Minister has seen it. It is entitled “Epilepsy in England: The local picture”. It is quite alarming. I shall highlight just three of the major issues. Epilepsy Action says that only 10% of CCGs have a written needs assessment for people with epilepsy; just three out of 140 health and wellbeing boards are making plans for people with epilepsy; and 78% of CCGs have not developed, or do not intend to develop, a needs assessment for people with epilepsy.

According to epilepsy charities, there are also problems with the current national service specification for adult specialised neuroscience services. The problem is that it is an interim document. It was produced in 2013 and requires updating. More importantly, it does not specify which parts of epilepsy services are specialised and which are not. There seems to be a lack of accountability between CCGs and NHS England as to which are neurological services. The CCGs are interpreting, wrongly, that they have no responsibility for some neurological services but they have for others. That is why this debate is so important. How does the Minister intend to deal with that discrepancy? Will the specification be updated, and can he review that before he rolls out the programme?

The situation makes a mockery of my final point, which is about the tariff. NHS England and Monitor will bring in marginal rates of 50% for specialised services above the stated baseline. That, in effect, means that access may be rationed. Worse still, CCGs, if they underspend on their budget, can keep that money. That means that there is a perverse incentive not to commission the more expensive rather than the less costly procedures. Let us think about the kind of procedures required for epilepsy. Brain surgery is complex and highly skilled, and sometimes it is the only option for people with the condition.

I am not sure why specialised commissioning needs to change. I do not know whether the Minister is aware of the survey that the Specialised Healthcare Alliance carried out among patient organisations, expert clinicians and the industry in late 2014. It says that 90% of respondents want their service as part of specialised commissioning, not co-commissioning, and 82% do not want any change. I urge the Minister to listen to those patients and to those affected.

--- Later in debate ---

[Norman Lamb]

My hon. Friend makes a legitimate challenge. These anomalies have not been addressed so far, but they need to be at some point. I do not seek to deny his point.

The hon. Member for Mitcham and Morden (Siobhain McDonagh) highlighted the work of Headway, which provides incredible support for people with brain injuries and their families. She mentioned the helpline and the emergency fund, which will be of enormous help to families in the incredibly difficult circumstances they face.

The hon. Member for Bristol East mentioned the Cystic Fibrosis Trust—another amazing patient organisation that does extraordinarily important work. She talked about the importance of equity of access, and it is incredibly important that that principle is maintained in any changes that take place. We do not want to return to the postcode lottery that existed in the past. Again, I am happy to try to provide responses to the questions she asked at the end of her speech.

The hon. Member for Walsall South (Valerie Vaz) was incredibly generous in her remarks about the shadow Minister, and I feel the same about him—let us be blunt about that. I appreciate her kind remarks about me—indeed, the feeling is entirely mutual. She made some really important points about epilepsy and Epilepsy Action. She highlighted concerns about many CCGs and health and wellbeing boards not yet engaging fully in work on epilepsy. That critical issue goes beyond this debate, but I completely take the point that there needs to be a lot more understanding and recognition of the importance of good epilepsy care that follows good practice and addresses the awful problem of so many people losing their lives unnecessarily to this condition.

[Valerie Vaz]

The issue is actually within the scope of the debate. We are talking about co-commissioning, but CCGs are not ready.

[Norman Lamb]

I totally accept the point. Again, I hope to reassure the hon. Lady.

The hon. Member for Luton North (Kelvin Hopkins) referred to robotic assistive surgery. I do not want to give him any particular hope, but it is always possible for new procedures to be added to the list of those that come within specialised commissioning. The prescribed specialist services advisory group keeps the list under review. Just as there are proposals to remove procedures, there is always the possibility, if the case is made and the four conditions that need to be taken into account are met, that additional areas can be included.