NHS

Kate Green Excerpts

Wednesday 5th February 2014 Commons Chamber

[Andy Burnham]

No, I do not accept that. This has been the worst year in a decade in A and E departments. Almost 1 million people have waited more than four hours to be seen. In my year as Secretary of State for Health, the figure was 350,000. There has been a big increase in the number of people who are waiting a long time. I was going to come on to the average waiting time, but since the hon. Gentleman mentions it, let me make the situation clear now. The figure that he is talking about and which appears in the Government amendment relates to the waiting time until an initial assessment, not the total waiting time in A and E. [Interruption.] The Secretary of State is nodding because, as ever with him, it is all about the spin. That figure does not mean anything to the public. They want to know how long they will spend waiting in A and E in total. We need to have a bit of truth in this debate.

[Kate Green (Stretford and Urmston) (Lab)]

My right hon. Friend was making a point about the wider economic pressures that are leading to greater pressure within A and E. Was he as shocked as I was to read in the Manchester Evening News last year that people in our area are presenting at A and E as a result of malnutrition? Is it not an appalling indictment of the Government that they have allowed that to happen in the 21st century? It is putting huge pressure on A and E departments across the north-west, including those at Wythenshawe hospital and Manchester Royal infirmary.

[Andy Burnham]

That is an indictment of the Government. They have made it harder for people to afford a good basic diet. We have seen a rise in hypothermia, rickets and scurvy. Sadly, we have also seen the rise of food banks under this Government. That is why I am beginning my speech by saying that there is a range of reasons for the sustained pressure on A and E.

--- Later in debate ---

[Kate Green (Stretford and Urmston) (Lab)]

It is a great pleasure to follow the hon. Member for Suffolk Coastal (Dr Coffey) and to speak in this debate.

I have spoken several times about the experience in my area, where in recent months we have been undergoing a major reconfiguration of hospital services, particularly accident and emergency. I have to report that, whatever the metrics or the resourcing may be demonstrating, the patient experience as reported to me, particularly regarding our A and E departments at Manchester Royal infirmary and at Wythenshawe hospital, is that there is a great deal of pressure and strain in the system. People are reporting long waits in very pressured environments, and there is a genuine sense of unhappiness about the atmosphere in which they feel emergency care is being provided because of the stretched services. A whole range of pressures are coinciding. There is rising demand due to some of the social reasons that right hon. and hon. Members have mentioned, including individuals’ behaviour; public health crises; pressures on resourcing in the NHS; and the pressures brought about by reconfiguration itself. It is hard to disentangle which of those different pressures is contributing to so much stress in the system.

I would like to highlight a few key points that I hope the Minister will take on board. There is no doubt that more change is coming in the NHS and we are learning quite a lot in my area as we go along. First, the reconfiguration of accident and emergency services and their downgrading to an urgent care centre at Trafford general hospital has immediately been followed by rising numbers at neighbouring A and E departments. My hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) mentioned the huge rise, in percentage terms, at Salford Royal hospital. That is also the case at Wythenshawe, in particular, as we are discovering on the doorsteps in Wythenshawe and Sale East. My colleague Mike Kane, who I hope will very soon be an hon. Friend in this House, has been talking to hundreds of local people, and we know that Wythenshawe hospital is experiencing very great pressure.

On 10 out of 13 days in January, Manchester Royal infirmary’s A and E department failed to meet the four-hour waiting time target, as did Wythenshawe on 11 out of 13 days, and four Manchester trusts failed to meet the target in quarter 3. It is difficult to disentangle whether that is attributable wholly or in part to the reconfiguration of services. None the less, there are real pressures in our A and E departments in Greater Manchester. Particularly in the immediate aftermath of the reconfiguration at Trafford, there have been reports of long ambulance queues, especially at Wythenshawe. That is not surprising, because the reconfiguration has inevitably created significant numbers of additional ambulance journeys as people are presenting at what is now an urgent care centre but may have to be transferred elsewhere for specialist care. I understand that there have been 100 extra ambulance journeys in the immediate aftermath of the reconfiguration. People are also going to what are, in effect, their own places. I think that is understandable, because, as the hon. Member for Stafford (Jeremy Lefroy)—who is no longer in his place—has said, the picture is confusing.

Local road signs used to say, “A&E”, but now they say, “A&E not 24 hours”, following the reconfiguration at Trafford. To be frank, that is an utterly meaningless piece of information for somebody driving to an A and E department, because it gives them no idea of when during those 24 hours the service will not be open. There is also real confusion about what is or is not available at the urgent care centre and whether it is safe to go there.

Local people tell me that the reason they do not go to Trafford is that they do not believe they are any longer allowed to go there. That was not the clinicians’ planning assumption when the urgent care centre was introduced, but that is what patients believe. As the hon. Member for Stafford said—Sir Bruce Keogh has put his finger on this, too—it is really important that patients are given clarity about what is available, where to go and when. We have to pay much more attention to educating the public about that.

Another difficulty that we discovered very quickly is that the decision tree used by North West ambulance service has resulted in its taking cases to Wythenshawe and to Salford Royal and Manchester Royal infirmary which should, under the original plan, have gone to Trafford urgent care centre. We are learning a lot from what is going on in the aftermath of the reconfiguration. It would be interesting to hear from the Minister how the lessons will be taken on board and distributed.

Pressure is also being created in a wider context. My right hon. Friend the Member for Leigh (Andy Burnham) mentioned in particular the pressure of rising poverty, which is, without question, leading to higher levels of need and people presenting at our hospitals. The number of hospital admittances as a result of malnutrition nearly doubled—it went up from 3,161 to 5,499—between 2008-09 and 2011-12. They did not all present at A and E, but they did all present at a hospital and that is of real concern.

[Andy Burnham]

Was as my hon. Friend as surprised as I was at some of the sneering from Government Members when she intervened on me to point out that the number of malnutrition cases has gone up significantly? All we got from them was sneering abuse, but the facts speak for themselves.

[Kate Green]

When the Manchester Evening News published a report about the shocking rise in malnutrition in our region, people were horrified and commented voluntarily on how disgraceful and shameful it was that, in such a rich economy, we could be in such a situation. There is no doubt that that is partly because of pressure on family incomes.

I want to highlight the position of disabled people in particular, who face extra costs for special diets, aids and adaptations, prescription charges and continence pads. All of those costs have to be met by disability benefits that are of dwindling value. There is also further pressure on the services on which they rely, including day services, respite care, access to mobility aids and care at home, which is under great pressure because of social care budget cuts.

In conclusion, against a backdrop of great pressure—some of it to do with changes to the NHS, some with rising remand and some with wider environmental factors—change and further reconfiguration may be necessary, but it is very difficult to do it. I want to finish by making three points to the Minister about what we are learning from the situation in Trafford, where we are integrating health and social care. First, it is not a quick fix. Secondly, it is not possible to remove services from our hospitals before the care and provision is available in the community—that is of real concern at a time when budgets are pressed. Thirdly, there is a huge piece of work to be done—the Government have not embarked on it—on educating the public and driving up public understanding. The public in my local area are extremely confused about what the NHS is able to provide to them and where they should go to get it. I am sure we are not unique. The situation is undoubtedly creating additional pressure for hospitals and other NHS providers, and I hope the Minister and his colleagues will address it.

Accident and Emergency

Kate Green Excerpts

Wednesday 18th December 2013 Commons Chamber

[Mr Hunt]

I am going to make some progress and then I will give way.

There are 216 more consultants and 111 more registrars than during Labour’s time. On ambulance performance, frankly the right hon. Gentleman should be ashamed, because his whipping up of the problem so appalled the ambulance service that he received a letter from the chief executive of the south-western ambulance service, who said about his comments in the House of Commons:

“It is both disappointing and concerning that the information provided to your office has been misinterpreted and misreported in order to present a grossly inaccurate picture for the purposes of apparent political gain...I am astonished that anyone would present such misleading information to the House of Commons.”

Something else that the right hon. Gentleman did not want to tell the House regarding delays is that there has been a 28% fall in the number of 30-minute handover delays compared with the same period last year—that magically did not make it into his speech. Yes, ambulance services are under pressure; yes, there are issues with the performance of some trusts; and yes, this is a busy winter, but the one thing they and the patients they serve can do without is Opposition politicians demotivating crews by misrepresenting the reality on the ground.

[Kate Green (Stretford and Urmston) (Lab)]

Patients in Trafford will not recognise the Secretary of State’s characterisation of this as a crisis that is in the past. They are reporting long delays at Wythenshawe hospital’s and Manchester Royal infirmary’s A and E departments, particularly, as he will know, because Trafford general hospital’s A and E was downgraded to an urgent care centre and now closes overnight, as of three weeks ago. Does he agree that during transition periods for such reconfigurations it would make sense to ensure that there were adequate resources for neighbouring A and Es to take on the new patients? Those resources have not been provided to these hospitals; will he guarantee to provide them now?

[Mr Hunt]

I recognise the hon. Lady’s concern for her constituents. I have looked into the issues in the Manchester and Trafford areas very carefully, and I am assured by people on the ground that the problems and challenges they face do not relate to the changes that have been announced in Trafford.

--- Later in debate ---

[Dr Lee]

There has actually been a 37% increase in emergency admissions over the past decade, while 65% of hospital admissions are of people over 65. Dementia is doubling as we speak, and 25% of the NHS budget will be spent on diabetes by 2025. I am sorry, but to try to suggest that the genesis of the challenge we face has been during the three years of this Government is simplistic. The most polite way to put it is that the hon. Gentleman is making a simplistic argument.

[Kate Green]

I do not disagree with the hon. Gentleman about our wanting a configuration of services that ensures that patients get the best possible care and saves lives, but does he not agree that, if changes have to be made, transition planning and resources to support the transition are absolutely vital components of success? I have to tell him that, in relation to the reconfiguration we have just gone through in Trafford, I simply have not seen such resources put in place.

[Dr Lee]

I agree with the hon. Lady that the plans for many of the configurations have been somewhat made up on the hoof. They have usually been created and pushed by a series of local issues—such as 19th or 20th-century buildings that can no longer deliver 21st-century health care—but I recognise the need for a plan, and I will come back to that at the end of my speech.

I fear that a perfect storm is looming at the moment. [Interruption.] If the hon. Member for Eltham (Clive Efford) will allow me, I will come on to what I think we need to do. The perfect storm is that we have infrastructure that is not fit for purpose, too many hospitals that we cannot staff properly—one of the contributory factors in Mid Staffordshire was poor staffing levels, because it was trying to work over two hospital sites for a population that is not big enough to support one—and an ageing and increasingly obese society, as well as changes in people’s attitudes to pain and suffering and to seeking health care.

I have not yet heard a speech about the type of presentations occurring in casualty departments. Such presentations are rarely accidents and are extremely rarely emergencies. We must ask ourselves how we can address that. I am standing here with a dreadful cold and feeling pretty lousy. I have seen hundreds of patients who have presented to me as a GP or in A and E feeling like I do, but I will not go either to my GP or to A and E, because I understand that I have a viral infection that will get better by itself. The problem at the moment is that people just rock up at A and E because they think that it is the only place they will get seen, and no one questions whether they should just not bother turning up.

--- Later in debate ---

[Kate Green (Stretford and Urmston) (Lab)]

I want to speak about the current situation in Trafford and some of the lessons that Ministers might want to learn from the transition we went through when the A and E department at Trafford general hospital was downgraded to an urgent care centre and closed overnight. Despite assurances that neighbouring accident and emergency services at Manchester royal infirmary and Wythenshawe hospital would be able to cope following that change, problems are already piling up. Those problems may not have been caused wholly—or perhaps at all—by the changes at Trafford, but the impact on Trafford patients is pretty dire and we must take account of that.

Those A and E departments were already exceptionally busy, with the one at Wythenshawe working well beyond capacity. It was built to accommodate 70,000 patients a year but was already dealing with more than 100,000, as my right hon. Friend the Member for Wythenshawe and Sale East (Paul Goggins) pointed out from the outset. We welcome the fact that the Department now appears to have unlocked a route to additional funding for capacity at Wythenshawe, but that funding, let alone the additional capacity, is not yet in place.

As the Minister will know, in the past couple of weeks Wythenshawe A and E has reached “black” status for waiting times, and privately there are indications that the quarter 3 target for waiting times at the hospital will not be met. There are also reports that waiting queues for ambulances are doubling outside Wythenshawe hospital, and pressures are mounting at Manchester royal infirmary. The other day a constituent told me that she had visited on the evening of Sunday 8 December with her diabetic daughter and there were not even enough seats for waiting patients. Some people were forced to wait outside.

Those pressures were predicted. Last year, Manchester royal infirmary and Wythenshawe hospital struggled to meet waiting time targets, and indeed failed to meet them on at least one occasion in 30 out of 35 weeks. The Secretary of State was clearly concerned about the pressures on those hospitals because one criterion he set down for the reconfiguration of services at Trafford was that neighbouring hospitals should consistently meet waiting times before the changes were made.

On the basis of performance in the two summer quarters, the NHS asserted that the criterion on waiting times at those hospitals had been met, despite warnings from many people—including me—that not measuring performance during the winter months would give a distorted picture of the capacity of those hospitals to cope. The Minister must recognise that that caused a great collapse of public confidence—they were not very confident about the proposals for the reconfiguration anyway—because it seemed that fudging was going on to present an impression that hospital services could cope, when it then turned out they could not. To use data that are clearly applied in a way that suits the outcome NHS managers want, rather than being in the best interests of patients, is a matter of great concern. Will the Minister say how we can have genuine and robust criteria for reconfigurations in which the public can have confidence? The total absence of clarity and the fudging over the decision at Trafford over the past few weeks has had an unfortunate effect.

When the Secretary of State announced the funding in September, neither Manchester royal infirmary nor Wythenshawe received extra money to deal with winter pressures. I was surprised because we knew by then that reconfiguration would create extra demand on those two A and E departments. I am anxious to hear from the Minister about the Department’s approach to ensuring adequate additional resource to support transition for such reconfigurations.

[Grahame M. Morris]

My hon. Friend makes an important point about demand in deprived areas. The Government’s health and social care information centre has identified that in each of the past five years at least twice the number of attendances have been from those living in the 10% most deprived areas, compared with those from the 10% least deprived areas. That should be reflected in the allocation of funding, but unfortunately such areas receive no additional money at all.

[Kate Green]

Two pressures could be highlighted. The first is the way that funding fails to take adequate account of deprivation. Secondly, there will inevitably be a hump at the time of transition, as new arrangements settle down and people adapt to the changing service configuration. When providing resources to Manchester royal infirmary or Wythenshawe, no account seems to have been taken of the effect of that transition and the likely need for additional resource to take those hospitals through that period. Indeed, in a private meeting with the Secretary of State, after the reconfiguration was announced, he confirmed that there would be no additional transitional funding. I could, however, look forward to additional funding to enable greater integration of services, although not until 2015-16. Furthermore, it would not be new funding, but funding that had been moved from the NHS to social care.

I am as strongly in support as anyone of seeing funding directed as much as possible to preventive care and care that can be provided at home in the community, but we cannot take services from hospitals before we put that care in place in the community. Such care is simply not adequate in Trafford today.

The other matter I want to raise was alluded to by the right hon. Member for Sutton and Cheam (Paul Burstow). There is utter confusion among patients about what services they should access and when. As soon as Trafford was downgraded to an urgent care centre, Trafford patients believed they could not go there. That was not the intention of NHS managers, but the impact was undoubtedly to drive more traffic to neighbouring A and E departments.

[Mr Slaughter]

My hon. Friend makes an important point. A and Es and anything we would recognise as such are being closed. They are turned into urgent care centres, which deal with minor injuries with GP cover at best. They are called second-tier A and E units, which is incredibly damaging, dangerous and confusing for people. It is done simply as a political fix, so that Tory councils and others can distribute leaflets saying, “There’s still an A and E on this site.”

[Kate Green]

Whatever the motivation—NHS managers in my area have tried to communicate the changes and how patients should respond to them—there is huge patient confusion about where they should go, what time they should go and what treatment they will receive. The right hon. Member for Sutton and Cheam referred to Sir Bruce Keogh’s report, which highlighted patient confusion. During periods of transition, confusion is heightened as people become used to new configurations. What lessons are being learned on how to communicate effectively with patients so they have proper understanding of what services are available and where they ought to go?

Massive problems are piling up over this winter period, when we might expect additional pressures—we see them every winter. There is a failure of local planning and ministerial engagement in ensuring that those transition processes work smoothly for patients in Trafford. I hope the Minister comments on how transitions will be handled in future. I venture to suggest that Trafford is, I fear, an early example of how not to do it. I look forward to his response.

[Several hon. Members]

rose—

Care Bill [Lords]

Kate Green Excerpts

Monday 16th December 2013 Commons Chamber

[Mr Hunt]

I am going to make some progress.

Some 100,000 older people will benefit financially and everyone will be protected from the catastrophic cost of care.

[Kate Green (Stretford and Urmston) (Lab)]

rose—

[Andrew George (St Ives) (LD)]

rose—

--- Later in debate ---

[Mr Hunt]

The right hon. Gentleman will have a chance to speak later.

We want to be one of the first countries in the world where it is as normal to save for one’s social care costs as it is for one’s pension, and this Bill’s provisions make that possible. The deferred payments scheme, with a threshold of £23,250, on which we openly consulted, excludes only the wealthiest 15% of people entering residential care. How extraordinary it is that Labour should play politics by feigning concern for the richest in society, when they failed to do anything for the poorest over 13 years when they had the chance to do so.

[Kate Green]

Will the Secretary of State give way?

[Mr Hunt]

The Government’s response to the tragedy of Mid Staffs has been widely welcomed, which is why the Opposition’s stance today is so disappointing. Robert Francis welcomed our measures as a

“carefully considered and thorough response”

to his recommendations that will

“contribute greatly towards a new culture of caring and making our hospitals safer places for their patients.”

The BMA said that it supports

“the Government’s commitment to put patient care first and foremost”.

The Patients Association said that it believes that this

“is a move towards restoring the faith patients have in the NHS.”

This Government would prefer to proceed on vital matters such as this with cross-party support, but I must warn the Opposition that we will do what is right for patients, whether or not we have their support. If they are today refusing to learn those lessons by not supporting this Bill, the country will draw its own conclusions about their fitness to run the NHS. They will know that for Labour it is all about politics, and it is politics before patients every time. We, on the other hand, profoundly believe that if we focus on patients, our NHS can be the safest, highest quality, most compassionate and fairest health care system in the world, and we will stop at nothing to make that happen. I commend this Bill to the House.

--- Later in debate ---

[Andy Burnham]

The Secretary of State began by quoting the principles of the NHS. I was always led to believe that one of the principles is that the NHS should respect need—that funds should follow those in greatest need. [Interruption.] The Secretary of State says, “Absolutely.” In constituencies in parts of London, the midlands, the north-west, Yorkshire and the north-east, male life expectancy is 10 years lower than in other parts of the county. There is real need in those communities, but they will be the biggest losers if the change goes ahead. I believe that it is immoral to take money out of those communities to hand it to areas where life expectancy is already longer.

I hope that NHS England is listening to this debate. Quite apart from the morality of whether the change should be made, how is it that a quango can distribute about £80 billion of public money to our constituencies while we seemingly have no locus whatever in such a decision? Should not the Secretary of State be at the Dispatch Box either to defend changes that he makes or to say that such changes will not go ahead, so being accountable to this House? Instead, a quango—the biggest in the world—seems to be about to take money out of some of the most deprived parts of the country.

[Kate Green]

I was very disappointed that the Secretary of State would not give way to me, because he did not once mention the position of disabled people in his opening remarks. Does my right hon. Friend not agree that councils being forced to raise the threshold to “substantial” or “critical” will pile up costs for disabled people and their isolation? They cannot get access to moderate levels of care, go out to work or volunteer in their communities, but are shut at home unable to participate. That is bad for them, and it is a false economy.

[Andy Burnham]

I could not agree more. I would guess that disabled people listening to the debate today will be very worried about what they are hearing. The change will restrict support for them, and it is a false economy. If they cannot go out to work, how on earth does that help them or, indeed, anybody? The change will have an impact on disabled people, with some losing their support.

I was going on to make the point that disabled people and older people are already paying much more for care as a result of changes in recent years. As research by my hon. Friend the Member for Leicester West (Liz Kendall) has shown, they are paying almost £740 more a year for vital home case services compared with 2010, up on average by almost £50 a month. That is a hidden cost of living crisis, because who sees that older people have to pay more out of their bank accounts? It goes unnoticed by the media and large parts of society, but the most vulnerable people in society are bearing the brunt.

Oral Answers to Questions

Kate Green Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Mr Hunt]

I absolutely can reassure my hon. Friend about that. The point about the new, improved system for recovering charges is that we want the money to go back to the people providing the services so that they will be able to resource them better. This is not the diversionary tactic that some have accused us this morning of introducing; £500 million could have a huge impact on the NHS front line and allow his GPs to do a much better job.

[Kate Green (Stretford and Urmston) (Lab)]

This evening, the joint health overview and scrutiny committee for Trafford and Manchester will meet to consider whether the preconditions for the reconfiguration of services in Trafford, including those set down by the Secretary of State, have been met. I understand that the NHS area team has already confirmed that it believes the conditions have been fulfilled, but will the Secretary of State tell me what would happen if, as seems possible, the scrutiny committee were to take a different view tonight and decide that not all the conditions had been met?

[Mr Hunt]

We will obviously respect the legal processes, but if the scrutiny committee were to take such a view tonight, we would certainly look very closely at its concerns and ensure that we had satisfied ourselves on them before proceeding.

Accident and Emergency Departments

Kate Green Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

I am delighted to hear about the excellent Vale community hospital in Dursley. On my hon. Friend’s general point, we have not been good at persuading the public that there is anything between GP surgeries and A and E departments. The NHS has tried repeatedly to come up with walk-in centres and urgent care centres. Some have been successful, and some have not. At the heart of the challenge is the fact that the public want a 24/7 service for accidents and emergencies and urgent care. We have to ensure that they have it and that they understand where it is.

[Kate Green (Stretford and Urmston) (Lab)]

Last year, Central Manchester University Hospitals NHS Foundation Trust and University Hospital of South Manchester NHS Foundation Trust both missed their A and E waiting targets on 30 out of 35 weeks. This year, of course, they will be coping with the additional challenge of absorbing the fallout of the downgrading of the A and E at Trafford general hospital. I note that neither trust has been awarded additional funding today. Can the Secretary of State assure me that the risk model that NHS England applied has properly taken account of the consequences of having to absorb major organisational change and, if it turns out that there are more pressures on those A and E departments this winter, that provisional funding will be looked at again?

[Mr Hunt]

I can absolutely reassure the hon. Lady on that point. We are extremely careful—I have had good discussions with her about this—before making any structural changes, to ensure that the impact on neighbouring A and E departments is properly thought through. Since the statement to the House about Trafford hospital, we have approved a capital funding programme for one of the neighbouring hospitals that will be affected. That is extremely important and we will continue to monitor it closely.

Organ Transplants

Kate Green Excerpts

Wednesday 17th July 2013 Commons Chamber

[Kate Green (Stretford and Urmston) (Lab)]

Last week was national transplant week, and the NHS highlighted an important campaign to increase organ donation. Donor rates have, pleasingly, increased by 50% since 2008, but although almost every one of us would accept a donated organ if we needed a transplant, only 57% of relatives agree to organs being retrieved. However, that proportion rockets to 95% if the deceased has discussed his or her wishes in advance with family members. Some 19.7 million of us are on the organ donor register, but three people still die each day while waiting for a transplant, so I wholeheartedly support the efforts of NHS Blood and Transplant to increase the number of organs donated. I add my voice to those who advocate an opt-out scheme.

Having met and talked to transplant survivors, I can testify to the immense gratitude that they feel to donors who have literally given them a new lease of life, but donation is only half the story. Although the selection and allocation of organs for transplant is much less widely discussed, it is also a complex and controversial issue.

A few weeks ago, I met my constituent, 18-year-old Natalie McCusker, who had been on the waiting list for a lung transplant for 19 months. She described to me what it is like to live in a state of limbo waiting for a suitable transplant. She has been too unwell to go to school, although her school arranged for her to participate in classes via Skype. She wanted to study sciences, but could not because oxygen cylinders and science experiments do not mix. As a young girl, she had enjoyed and been very good at sport, but that has become impossible since she became too ill. The effects on her family have also been profound; for example, her mum has taken a five-year career break.

Natalie was first told that she would need a transplant when she was 15. She initially hoped it would be carried out at Great Ormond Street children’s hospital, but people transfer to the adult register at the age of 16, so she was advised to delay transplant surgery until she moved to the adult list.

When Natalie first moved on to the adult system, she was able to access treatments that are deemed unsuitable for children. At first her condition improved, but seven weeks after taking her GCSEs, she became much more unwell. She was eventually listed for a transplant in November 2011. I completely accept that there are different clinical demands when treating children and adults, and that there is a need for separate systems. However, from the patient’s point of view, it seems that the transition may lengthen waiting times, and it also means that a new relationship of trust and confidence must be built up between the patient and new teams of clinicians.

[Jim Shannon (Strangford) (DUP)]

I am grateful to the hon. Lady for bringing the matter to the House. I have a particular interest in organ transplants and donation because I have carried a card since I have been able to do so. In Northern Ireland, we carried out about eight transplant operations in 2008, but now in 2013 we carry out more than 50 a year—almost one a week. That has happened not only because those who carry the card pass on their organs when they die, but because we have the largest number of live donors in the whole of the United Kingdom—far above the average for England and Wales. If more effort was made on live donors, it could help to address the problem faced by the hon. Lady’s constituent. The evidence from Northern Ireland indicates that the longer one is on a donor list, the less one’s health deteriorates, so perhaps the Minister will address that point when she responds to the debate.

[Kate Green]

I note with interest what the hon. Gentleman says and I am sure that the Minister will want to respond to that point. Obviously, we would want to explore all methods of increasing the number of donor organs available. We should bear it in mind that one person may donate up to nine organs following their death.

I was talking about the crucial importance of a sense of trust and confidence between patients and clinicians. For a course of treatment as massive and life-changing as transplant surgery, that is certainly no trivial matter. I cannot suggest any easy answer to that, but my first point to the Minister is to ask her to consider ways in which the disruption of the transition process between childhood treatment and the adult list could be minimised, with a particular interest in ensuring that waiting times are not extended unnecessarily.

There are other concerns relating to the allocation of organs for those on the waiting list. The current process for allocating hearts and lungs for transplant is based on dividing the country into a number of zones. That means that if someone lives in one zone and a suitable organ becomes available in another, they might not receive it simply because they are on the wrong waiting list. In following a rigid zonal approach, important considerations of equity across the country could be neglected. A patient can be registered on only one list, and the result can be a postcode lottery for treatment.

Patients in my region, the north-west—it is your region, too, Mr Deputy Speaker—wait the longest in the country for lung transplants: over 400 days in Manchester, compared with under 200 in Cambridge. According to a written answer I received from the Minister on 15 May, between April 2008 and March 2011 62.2% of patients in the north-west waited more than six months for a lung transplant, compared with an England average of 47.3%, and 23.2% of patients in the north-west waited more than 18 months for such a transplant, compared with an England average of 15.8%. The north-west also has among the highest death rates for those on the waiting list for a lung transplant—between 20% and 30%.

I believe that we need to look again at the operation of the zonal system so as to get the balance right between the underlying issues of urgency, geographical proximity between donors and recipients, and waiting times. The most urgent cases should clearly take priority. One approach could be to treat urgent cases on a national basis and, if no urgent case exists, to allocate on a zonal basis. If that approach were adopted, zones would need to be more dynamic. In other words, if the waiting list grew the zone would also expand to give access to more organs.

More radically, we could move to a fully national allocation system, whereby patients could be matched with suitable organs across the country. I recognise that geographical considerations are of course important, not least if the ischemia time, the time between organ retrieval and transplant, is integral to the success of the operation. For heart transplants, in particular, it very often is, and the system for heart transplants in fact appears to work effectively. That seems to be much less true for lung transplants. Equity is also a consideration. It is of course important to have regard to the interests of those who have been on the waiting list the longest, and that really should not be dependent on where someone lives and which list they are on.

I understand that the NHS is now considering whether to move to a national registration system, which would be fairer to patients in regions such as ours. In the US and much of Europe this approach has already been adopted or is being considered. The evidence suggests that it could achieve greater equity without any increase in mortality rates, or indeed cost.

So what is the block? Inertia and convenience undoubtedly play a part. I acknowledge that there is already better sharing of organs between zones when a suitable match cannot be achieved within a zone, but it seems that some transplant centres might be more interested in building up the scale of their own activities rather than progressing the idea of a national scheme that could deliver greater equity for all patients. Progress towards delivering a national list scheme in this country is proving painfully slow.

What steps are being taken to make progress towards a more equitable national scheme of allocation, and what is the Minister’s attitude to the development of such a scheme? What work, if any, is being done to develop a national approach, and over what time scale might progress be expected? How best can we make use of technology and the sharing of data to facilitate the allocation of organs between zones? What learning and best practice can be adopted from other countries? What incentives would encourage a more equitable system of allocation between transplant centres and protect or improve outcomes for patients?

I am very pleased to report that Natalie had a successful lung transplant two weeks ago. She is growing stronger every day and it is hoped that she will be well enough to return home next week. She and her family are of course absolutely delighted and hugely appreciative of the treatment she received from the transplant team at Wythenshawe hospital. However, for 19 months, while waiting for her transplant, her life was put on hold. Perhaps that wait could have been shorter if she had not been restricted to a single zonal waiting list. Yesterday she wrote to me to say how pleased she is that this debate is taking place in Parliament, which she says she hopes will help “to achieve something that will in future benefit the thousands of people that will need life saving transplants.”

I hope that the Minister will be prepared to commit tonight to working towards a national system of organ allocation that offers equity of access to organs for transplantation and rapid progress towards achieving this. I am very grateful for the opportunity to raise this matter and look forward to her response.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Let me begin by congratulating the hon. Member for Stretford and Urmston (Kate Green) on securing this debate, raising this important issue, and enabling us to discuss it for this very short period. It is not really a debate but a number of questions quite properly asked, no doubt many of which I will not answer, through no unwillingness on my part but because, as I always say, the usual rules apply. However, all questions will be answered, if not by me tonight then certainly by way of a letter. I thank the hon. Member for Strangford (Jim Shannon) for his helpful and interesting contribution. He has been good enough to provide me with a clipping. I believe that it is about kidney transplants and kidney donations, and I will make further inquiries.

As you will know and understand, Mr Deputy Speaker, this matter has come up by way of the fact that hon. Lady, as she explained, has a constituent, Natalie McCusker, who has had a lung transplant. We are all delighted that she was able to have that lung transplant.

As we know, the donation of organs is sometimes from a living source, to put it in crude terms. There are many examples of people who have made the most amazing sacrifices, often within families, to supply a kidney to a loved one so that they can live. There is, of course, the whole additional subject of what happens on death and the wishes of somebody in relation to their organs, and the absolutely amazing difference that that generosity after life can make to people. No doubt Natalie is a very fine example of that, and no doubt she and her family are profoundly grateful to the person who had the good sense to indicate that they were willing that on their death their organs would be donated. Then there is the great and often very emotional matter of the family deciding that they are all content for this to happen. There is nothing worse than when someone is taken from us when they die. It is very difficult for anyone in the medical profession—we have nurses who are specially trained in this—to approach the family in those profoundly difficult times and discuss the possibility of organ donation. The work of those nurses and other medical professionals is one of the reasons we have seen an increase in organ donation.

We all know the benefits of transplants and know that we need to do more to increase the number of organs donated. That would give many more people the opportunity to benefit from a transplant that could save their life or significantly improve the quality of their life. About 8,000 people are listed on the national transplant list waiting for a transplant. Many more could be listed if more donated organs were available for transplant. Many people wait months and years for a phone call telling them that a suitable organ has been donated and calling them in for a transplant. I am aware through my work as a Minister of some of those families and their anguish as they literally sit around waiting for that phone call, especially when it is a child who so desperately needs the transplant to, in effect, save or improve the quality of their life. For some, that phone call never comes and about three people—adults and children—die every day waiting for a transplant that could have saved their lives.

Given that the number of people needing organ transplants in the United Kingdom is greater than the number of donor organs available, there has to be a system to ensure that patients are treated equitably and that donated organs are allocated in a fair and unbiased way. Allocation is based on the patient’s need and the importance of achieving the closest possible match between donor and recipient, which is often very difficult.

All patients waiting for transplants are registered on the national transplant database. Rules for allocating organs are determined by the medical profession in consultation with other health professionals in health departments and specialist solid organ advisory groups. The blood group, age and size of both the donor and the recipient are all taken into account to ensure the best possible match for each patient, and the cardiothoracic advisory group is currently looking at improving the allocation of donated lungs to help to ensure equity and better outcomes for patients.

At present, lungs are allocated to the transplant centre based on the location of the donor, as the hon. Member for Stretford and Urmston said. The transplant centre will decide whether or not to accept the lungs and will select the most appropriate recipient. NHS Blood and Transplant is working with transplant centres to consider whether the current allocation system can be improved. It is considering whether it would be worth while implementing a national allocation scheme offering lungs and other organs nationally, rather than by centre. Other models are also being considered. NHS Blood and Transplant monitors the current allocation system closely to ensure that there is equity of access across the UK, and a recent analysis showed no statistical differences in outcomes across the UK in relation to lung transplant centres.

[Kate Green]

I appreciate that the Minister may not immediately know the answer to this, but does the equity of outcome apply not just to survival rates, but to waiting times?

[Anna Soubry]

As the hon. Lady has anticipated, I do not have the answer to that question in my brief, but I will make sure that she receives a proper answer.

Over the past five years, we have been strengthening the donation infrastructure by implementing the 14 recommendations of the organ donation taskforce, which were published in 2008. Is it not nice that in this sort of debate we can pay tribute to another Government of a different political persuasion? We are all united on this issue; it is not a party political issue and it is always a pleasure to take part in these sorts of debates.

The number of donor co-ordinators across the United Kingdom has nearly doubled. They are working closely with intensive care clinicians and families to identify potential donors and obtain consent. As I have said, it is difficult work but, goodness me, what a difference it can make when it is successful.

We have appointed clinical leads and established donation committees and chairmen in all trusts. This has driven improvement in hospitals, optimising the potential for organ donation. I am delighted that we have achieved an increase of 50% in organ donor rates and of 30% in transplant rates over the past five years, helping many more people to have the transplant that they so desperately need. We need to do more, however, to enable many more people like Natalie to receive the organ transplant that in many circumstances will save or enhance their life.

On 11 July, NHS Blood and Transplant published the new UK strategy for organ donation and transplantation. “Taking Organ Transplantation to 2020” sets the agenda for increasing organ donation and transplant rates to world-class standards over the next seven years by aiming to improve consent rates to organ donation to more than 80%—they are currently 57%—and transplant more organs and increase the number of people receiving an organ. The strategy calls for a revolution in public attitudes and behaviours, and emphasises the importance of individuals and families agreeing to donation. That important work needs to take place irrespective of someone’s background, ethnicity, religion, faith or whatever else. We need to ensure that more people in all parts of society sign up to donate their organs and that we are able to persuade people’s families to allow their organs to be donated upon death.

Oral Answers to Questions

Kate Green Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Hunt]

The truth is that we do not know the cost, which is why we are carrying out an independent audit this summer. The £12 million figure is the amount written off by the NHS each year because of unpaid overseas invoices, but many people think that the costs are much greater. We want an answer for the hon. Gentleman and everyone in the House, so we are carrying out that independent audit and we will publish the results later in the autumn.

[Kate Green (Stretford and Urmston) (Lab)]

T1. If he will make a statement on his departmental responsibilities.

[The Secretary of State for Health (Mr Jeremy Hunt)]

I know that the whole House will want to recognise the fact that this month marks the 65th anniversary of the NHS. This country blazed a trail by introducing universal health care coverage in 1948, and the NHS remains the single biggest reason why most people are proud to be British. The whole House will want to note that whatever failings are being exposed by a new era of transparency in NHS care, the overwhelming majority of doctors, nurses, health care assistants and managers do a remarkable job, working incredibly long hours for the benefit of us and our families, and we salute them for all they do.

[Kate Green]

When changes were made at Lewisham hospital, the Secretary of State refused to meet local campaigners. Following his announcement last week about changes to services at Trafford general hospital, local campaigners from Trafford would like to know if he is prepared to meet them.

[Mr Hunt]

That is not quite a fair representation of what happened in the case of Lewisham, or indeed for Trafford, because I agreed to meet all local MPs regarding Lewisham. These things are carefully constrained by what is legally possible so as to be fair to all sides, but I met all Lewisham MPs. As the hon. Lady knows, I have agreed to meet her—I think that we are meeting later this afternoon—and I am sure that she will express the concerns of campaigners in Trafford.

Tobacco Packaging

Kate Green Excerpts

Friday 12th July 2013 Commons Chamber

[Anna Soubry]

I am very grateful for those comments. My hon. Friend is quite right that prevalence is now at about 20%, which is better than in many other countries. There is a very good debate to be had about whether we should take legislative action or change social attitudes. That is why I am so proud of our “Stoptober” campaign and the fact that we have had up to half a million hits on our website. Half a million quitting packs have been given out. It is a subtle combination of many factors. If only there were one silver bullet—but unfortunately there is not.

[Kate Green (Stretford and Urmston) (Lab)]

When the Minister publishes the analysis of the Australian experience, will she also publish an evidenced analysis of the number of avoidable deaths and illnesses that have resulted from the delay?

[Anna Soubry]

Well, I could say that the hon. Lady’s party, when it was in government, had 13 years to introduce such legislation. Indeed, I am more than happy to say that. If it was so simple to introduce standardised packaging, why did Labour not do it? It is not as simple as they now try to make out. Most importantly, I believe, Mr Speaker—and I do speak as a lawyer—you always want good legislation that is evidence-based. That is why I am more than content to support a delay, while we wait to see the evidence as it emerges from Australia.

Health Services (North-West)

Kate Green Excerpts

Thursday 11th July 2013 Commons Chamber

[Mr Hunt]

I know that my hon. Friend has campaigned, rightly, to represent the concerns of his constituents about the extra travel that they will have to undertake. I would like to reassure him that we considered that issue very carefully. The Independent Reconfiguration Panel recognises that travel is a consideration, but also believes that for his constituents, even for the people who have to travel further, there will be better clinical outcomes for specialist vascular surgery. We are not talking about routine surgery, diagnosis or rehabilitation work but about conditions such as aneurysms and carotid artery disease which require specialist care. Patients can get much better help if that is concentrated in specialist centres.

As to why those particular centres were chosen, it was a genuinely difficult decision. There is a bigger concentration of population in the south of the region and there is also more social deprivation and more unmet need. I know it was a difficult decision, but it was decided that that would be best for the 2.8 million people in the area and also better for my hon. Friend’s constituents.

[Kate Green (Stretford and Urmston) (Lab)]

I am very grateful to you, Mr Speaker, for allowing me to ask a question, and I apologise for missing the opening statements. As you know, I think, it was only when we saw this morning’s Order Paper that we knew that a statement would be made this morning, and I was on the way to Manchester at the time to meet constituents. I am very grateful indeed for the opportunity to ask the Secretary of State a question. My constituents would be horrified were I not in the Chamber this morning to do so.

This has been one of the most contentious and difficult issues facing the health economy in Trafford since my election. Although I welcome the Secretary of State’s offer to meet me and I was grateful for his time on the phone this morning, he will understand that people are concerned that doubts and fears about the future of Trafford general hospital are already leading to a downward spiral in people going to that hospital and the level of staffing and service that they receive there. What absolute guarantees can he give my constituents that there will be no diminution whatsoever of the service they receive during what may have to be a very protracted transition process, and that in particular there will be no repeat of our experiences over the most recent winter months, when neither Manchester Royal infirmary nor Wythenshawe A and Es were able to meet the accident and emergency waiting time targets on more than 15% of occasions?

[Mr Hunt]

I recognise that the hon. Lady would have liked to have been here for the statement, and indeed that she made a huge effort to get here. As I told her on the phone this morning, I am more than happy to meet her separately to discuss her concerns. With regard to her concern about a downward spiral, I hope today to reassure her constituents that a clear decision has been taken that will secure the hospital’s future as a successful and important hospital, a centre of excellence for elective orthopaedic work, and a hospital that has a very important role to play in the local health economy. We are making huge efforts to ensure that there will be no diminution of services but that services will improve. Of the three major teaching hospitals that will now provide A and E services for her constituency, one—Central Manchester university hospital—is not meeting its A and E targets. The measures announced today will help it meet those targets and make it more likely that her constituents will get a better service in A and E. However, as I made absolutely clear in my statement, I will not allow the changes to be made until all three hospitals are consistently meeting their A and E targets.

Carers

Kate Green Excerpts

Thursday 20th June 2013 Commons Chamber

[Paul Burstow]

That is a key point, and one that I want to put to the Government very strongly. Carers can only be helped to remain in the work force and balance their working lives with their caring responsibilities if the right substitute care and flexibility are available, and if employers have the right attitudes in the first place.

[Kate Green (Stretford and Urmston) (Lab)]

Will the right hon. Gentleman give way?

[Paul Burstow]

I will take one more intervention, but I must not take too many more, because I have only 15 minutes in which to speak.

[Kate Green]

Could not public sector employers be exemplars in this respect? Can the right hon. Gentleman suggest any ways in which such good practice could be spread throughout the public sector?

[Paul Burstow]

The hon. Lady is absolutely right to say public sector employers should be—and could be, and must be—exemplars in this. Indeed, it would be great if the NHS itself was an exemplar in this area, yet as I will come on to say, I think in too many ways institutionally the NHS is rather biased against carers, and certainly blind to their needs in too many cases.

There is an economic reason why we need to do more in this area. It is estimated that as many as 50% of those involved in personal and household services operate in the grey economy. This represents a further missed opportunity in terms of job creation and lost revenue to the Exchequer. Looking across the channel to France where work began almost a decade ago to address a number of these issues, market development for homecare services has led to the creation of an additional 2 million jobs, with the industry becoming one of the biggest growth sectors in that economy.

There are clearly lessons to be learnt in how to support and strengthen carers’ ability to care in a way that supports the wider UK economy. I hope the Minister will be able to tell us when the “task and finish group” recommendations will be published.

Moving on, one of the most practical ways to support carers is to provide them with breaks from caring. That can help reduce the stress and the often constant demands that caring involves, and allow them to have the time to improve their own physical and mental health.

In recognition of the value of carers breaks, the Government committed in the 2010 spending review to spend £400 million over four years on breaks for carers living in England. As the Minister at the time, I was convinced of the importance of giving carers a break and knew that it would make a huge difference to their lives. I therefore regret that the evidence suggests that that has not happened. Monitoring by the Carers Trust for the year 2011-12 found that action on the ground had often been slow or non-existent. Despite clear reporting requirements, in many areas it was impossible to track how money had been spent, and in a small minority of cases nothing at all had been spent on services for carers. Some fantastic work has been done, but progress has remained appallingly slow. To be fair, this problem has dogged not just the coalition Government, but successive Governments.

I ask this question: what is the common factor? The common factor is the institution we are using to direct the money, which is the NHS. It does not see carers as significantly important contributors to it, and therefore it does not see this money as worth spending on them. That has to change.

--- Later in debate ---

[Sir Tony Baldry (Banbury) (Con)]

It is good that the House has an opportunity today to debate the needs of carers. As co-chair of the all-party carers group, I welcome this debate. It provides us with an opportunity to be the collective voice for the 6.5 million carers in the UK.

In the run-up to carers week, Carers UK published a report entitled “Prepared to Care?” which had six important recommendations from carers about what they need to help them manage their caring role. They need better public understanding and recognition of carers. Carers should have access to information and the right support from the beginning. It is important to remember that every day 6,000 people take on new caring responsibilities in the UK, and from day one they need access to the right support, advice and information. Every day across the country there are people whose loved ones have a stroke or discover that they have been diagnosed with Parkinson’s or with age-related dementia, and they need support from day one.

Professionals need to understand the role of carers and share information, decision making and planning with them. The hon. Member for Worsley and Eccles South (Barbara Keeley) made the point about the GP who treated a patient for years but never asked about the carer. Carers can no longer be treated as invisible. They need access to high-quality practical and emotional support and information, as well as breaks from caring. The point made by the hon. Member for Birmingham, Selly Oak (Steve McCabe) about respite care is crucial. When Carers Oxfordshire surveyed carers in Oxfordshire last week about the issue that caused them greatest concern, not surprisingly access to respite care came very near the top of the list. Carers need flexible working practices, understanding from employers, financial support, and a fair and easy-to-navigate welfare system.

A growing recognition of the number of carers in the country is evidenced by the fact that each year carers week gathers further and greater momentum. Carers week took place between 10 and 16 June. Alongside Carers UK seven other national charity partners—Age UK, Carers Trust, Independent Age, Macmillan Cancer Support, Marie Curie Cancer Care, the MS Society and Parkinson’s UK—came together to celebrate the contribution that carers make and to signpost them to the advice, information and support that they need.

This year’s carers week was the largest ever, with more than 2,600 groups registering to take part and more than 10,000 events up and down the country—that is a lot of events. Those organising events included carers’ groups, service providers, local authorities, hospitals, domiciliary care services, hospices and GP services. Events in Oxfordshire included Carers Oxfordshire—the umbrella group for carers in the county—running outreach events and advice stalls at local Sainsbury’s, Asda and Waitrose stores. Last Friday, I visited an Oxfordshire branch of Sainsbury’s and lots of people came up and asked questions, which was fantastic, because people do not always recognise that they are carers. Outreach events to identify carers also took place in GP surgeries and town and church halls across the county.

In Parliament, there was a “Question Time” event in Portcullis House with the Minister of State, Department of Health, the hon. Member for North Norfolk (Norman Lamb), who is responsible for care and support. The event brought together the Association of Directors of Adult Social Care, Skills for Care, the Royal College of General Practitioners and Public Health England, alongside the campaign’s charity partners and carers, to debate how the NHS and social care can better support carers. Key issues discussed included the challenge of identifying and supporting carers when many people do not recognise themselves as carers, and how to ensure that carers are represented in the new NHS structures nationally and locally. Like all those taking part in today’s debate, I am sure, I was pleased when more than 100 parliamentary colleagues attended a parliamentary photocall in support of carers week. As the previous speaker mentioned, there was a useful speed networking event that enabled MPs to meet carers and hear their stories directly.

Interestingly and usefully, this year’s carers week saw increased engagement and involvement of employers in the campaign, which is important because, as Carers UK polling earlier this year showed, 2.3 million people have given up work at some point to care for loved ones, and census data published in May show that more than 3 million people are juggling work and care. That is a huge number of people, so getting employers involved in understanding the needs of carers is very important. I am glad to say that Sainsbury’s has continued its sponsorship of the employers for carers campaign, with nearly all its 1,200 stores running events, linking up with local groups and organisations to raise awareness of the support on offer to carers. Crucially, Sainsbury’s delivered information and advice not only to its customers but to staff with caring responsibilities.

I am also glad to say that Government Departments, such as the Foreign and Commonwealth Office and the Department for Environment, Food and Rural Affairs, held carers week sessions for their staff, as did a number of private organisations, as the hon. Member for Stretford and Urmston (Kate Green) mentioned. Those included the Michelin Tyre Company, KPMG, HSBC, British Gas, Northamptonshire police, the UK Border Agency, BT plc, Credit Suisse, Transport for London, the Financial Ombudsman Service and the London fire brigade. There is growing recognition from employers in the private and public sectors that they have a duty of care to those of their employees who are carers. In Oxfordshire, Employers for Carers, in partnership with Oxfordshire county council and Carers UK, launched a new membership hub for local employers large and small, which will give local employers the opportunity to share good practice in supporting carers to juggle work and caring and to raise awareness of the business benefits of keeping carers in the work force.

[Kate Green]

It is encouraging to hear that list of the many employers who want to support the carers in their work force, and I am interested in what the hon. Gentleman says about spreading good practice among employers. Does he agree that the large employers have a particular role to play in working with their supply chains to spread good practice?

[Sir Tony Baldry]

That is an extremely good point. These things are organic. A few years ago big employers such as Sainsbury’s would not necessarily have been involved in that way. Having been involved in carers policy over the years, what I find encouraging is that each year a further step is achieved.