NHS Commissioning Board

Lilian Greenwood Excerpts

Tuesday 5th March 2013 Commons Chamber

[Norman Lamb]

I absolutely agree with my right hon. Friend. There has been a lot of cant and hypocrisy in this debate. The guidance given by the previous Government to primary care trusts in 2010 makes absolutely clear their commitment to competition. That shows how crazy this debate has become. We will ensure that the debate is balanced and that the interest of the patient trumps everything else, as it should.

[Lilian Greenwood (Nottingham South) (Lab)]

My constituents’ view is absolutely clear: they do not want back-door privatisation of our national health service. I am pleased that the Minister is making a U-turn on these regulations, but given the chaos of recent days, how could anyone trust this Government with our NHS?

Backbench business

Lilian Greenwood Excerpts

Thursday 14th February 2013 Westminster Hall

[Caroline Nokes]

I commend my hon. Friend on the work that she is doing in that area. I sincerely hope that we see some progress on that, so that these websites, which are proliferating—there is evidence of a 470% increase in just one year, between 2006 and 2007—can be prevented from being accessed from family homes. US studies have shown a clear correlation between increased body dissatisfaction and viewing such sites.

We live in a complex, changing world where higher numbers of people than ever suffer from mental illness, and so it is with eating disorders. It is not just the number of sufferers, but the severity, that is increasing. What would have been considered an eating disorder 20 years ago might now be regarded merely as a bit of disordered eating. I do not say that in any way to dismiss the seriousness of disordered eating, but to demonstrate that the conditions now have to be a great deal worse to be recognised as such, and to make a sufferer a priority for treatment. That is one of the serious issues that I would like to mention.

In my home city of Southampton—not in my constituency, but in that of the right hon. Member for Southampton, Itchen (Mr Denham)—is April House, a unit specialising in eating disorders, which I have had the privilege of visiting, and where I met service users and health care professionals. I attest to the outstanding work done there. Some of the service users and staff are here today. I admire their courage and determination.

I agree with the firm message that I received from staff at April House. With all eating disorders, there is a critical window of opportunity when a sufferer has been diagnosed, wants help, has acknowledged that they have a problem, and are reaching out for the assistance they desperately need. That opportunity can easily be lost if help is not available at that time.

[Lilian Greenwood (Nottingham South) (Lab)]

The hon. Lady is making a powerful speech. I was concerned when I received an e-mail from one of my constituents, a student nurse, who wrote:

“I am currently on a mental health placement and two of my clients have eating disorders of varying degrees, however cannot seek support for their eating disorder due to cuts in services.”

Does the hon. Lady share my belief that, having raised awareness of eating disorders and encouraged sufferers to seek help, we must not then fail to provide the support and assistance that they need?

[Caroline Nokes]

The hon. Lady makes exactly the point that I am coming on to: it is critical that when sufferers feel that they can reach out for help and acknowledge that they have a problem, the help is there for them. A delay of six to nine months can be dangerous—or, indeed, fatal.

Cancer Care (England and Wales)

Lilian Greenwood Excerpts

Tuesday 12th February 2013 Westminster Hall

[Alun Cairns (Vale of Glamorgan) (Con)]

Thank you, Mrs Riordan, for calling me to speak and for chairing this debate. It is a privilege to serve under your chairmanship.

The subject under discussion is cancer care in England and Wales. Naturally, I understand that the Minister who is here is only responsible for treatment and care in England, and that health is a devolved matter, with responsibility for it in Wales falling to the Welsh Government. However, the different approaches will allow each nation to share best practice and compare outcomes, with the objective of raising the standard of cancer care wherever we live.

I do not want this debate to be party political; this issue is far too important for that. I want to compare the facts and to recognise success, wherever that may be found. The starting point for the debate must be mortality rates or, to put it another way, the success of any medical intervention. Overall, life expectancy among men in Wales is 77.6 years, and in England it is 78.6 years. Among women, life expectancy is 81.8 years in Wales and 82.6 years in England. I am sorry to say that the figures for Scotland and Northern Ireland are worse than the figures for either England or Wales.

However, focusing purely on life expectancy is too broad an approach, and we need to consider the influences on life expectancy. There may be historical and social reasons for the differences in life expectancy, but it is fair to say that cancer survival rates are a significant factor, which brings me to my key points. The most commonly diagnosed cancers are breast cancer among women and prostate cancer among men.

[Lilian Greenwood (Nottingham South) (Lab)]

Is the hon. Gentleman aware of the “Hear me now” report by Rose Thompson, the chief executive of BME Cancer Communities, which was launched here in Parliament yesterday? It revealed that the death rate from prostate cancer is 30% higher among black men than among their white counterparts. Does he agree that such inequalities in cancer outcomes must be addressed?

[Alun Cairns]

I am grateful to the hon. Lady for making an extremely valid point. The collection of data is exceptionally important, to identify which groups are potentially more vulnerable or which groups are not seeking the right sorts of treatment. Comparison between the home nations is important, but so is comparison between groups within the home nations, in order to bring the data together. It is exceptionally important if we are to reach the right conclusions.

I will focus on breast cancer to begin with. As I have already said, the mortality rate from breast cancer in England is 24.3 per 100,000 people, and in Wales it is 25.8 per 100,000 people. Clearly, those are worrying data, and it is worth considering the different approaches to treatment in the two nations.

In England, a patient concerned about the possibility of breast cancer can expect to see a consultant within 10 working days of the GP referral. In Wales, there is a different approach, which means that a GP differentiates between urgent and non-urgent cases. In cases that are deemed urgent, 95% of patients should expect treatment to start within 62 days, and in cases deemed non-urgent, the patient should expect treatment to start within 26 weeks. I want to underline this situation: a woman in England who is concerned about the risk of breast cancer will be reassured, or have her case elevated to the next level, within 10 days. In Wales, however, a patient has no such guarantee of consultant expertise until much, much later in the process.

We need to recognise that these are different measures and approaches. Breakthrough Breast Cancer has a helpful quote. It says that waiting for a referral is like being “left in the dark”.

Liverpool Care Pathway

Lilian Greenwood Excerpts

Tuesday 8th January 2013 Westminster Hall

[Glyn Davies]

My hon. Friend makes a very good point. Patients on the pathway should be monitored regularly, and if the patient shows signs of rallying, as does happen in a minority of cases, the treatment should be modified to support recovery. If that is not happening, the pathway is not being implemented properly. The Liverpool care pathway is not a pathway to death —a phrase I have seen used often, but which I think is unbelievably awful. It is a travesty of the truth to describe it as a form of euthanasia.

Why have we reached the point of huge public controversy, which has caused so much angst and fear? It has arisen from allegations—serious allegations, some of them from doctors and nurses—that the pattern of end-of-life care I have described has not been followed in some cases. There have been stories of dying patients being deprived of the food and water they needed and others being kept continuously sedated until they died; and of patients being placed on the pathway without consultation with them or their families, or to meet targets. The fear of that is especially shocking, and I hope the Minister will comment specifically on the issue of targets.

Let me look at some of the allegations in more detail. According to the Daily Mail in June last year,

“NHS doctors are prematurely ending the lives of thousands of elderly hospital patients because they are difficult to manage or to free up beds”.

The report is based on a presentation to the Royal Society of Medicine by Professor Patrick Pullicino, a consultant neurologist. He stated:

“The lack of evidence for initiating the Liverpool Care Pathway makes it an assisted death pathway rather than a care pathway.”

That is the debate being led by the Daily Mail. Professor Pullicino continued:

“Very likely many elderly patients who could live substantially longer are being killed by the LCP.”

Imagine how a frail elderly person entering hospital a few weeks after reading that would feel. Professor Pullicino added:

“Patients are frequently put on the pathway without a proper analysis of their condition.”

According to the Daily Telegraph, in September, a group of experts stated in a letter that

“dying patients…can…have fluid and drugs withdrawn and many are put on continuous sedation until they pass away.”

The letter—again according to the Daily Telegraph—spoke of a “national crisis” in patient care, and

“a national wave of discontent…building up, as family and friends witness the denial of fluids and food to patients.”

According to the newspaper, some patients were wrongly being put on the pathway, which created a “self-fulfilling prophecy” that they would die. The report continued:

“Patients who are allowed to become dehydrated and then become confused can be wrongly put on this pathway”,

and,

“many doctors were not checking the progress of patients enough to notice improvement in their condition.”

Those are shockingly serious allegations. If they are true, urgent corrective action is needed.

There is another side to the equation, however. More than 20 respected organisations, including the Department of Health, Age UK, the Alzheimer’s Society, Macmillan Cancer Support, and the Royal Colleges of Physicians, General Practitioners and Nursing, have signed a declaration that

“Since the late 1990s, the Liverpool Care Pathway has been helping to spread elements of the hospice model of care into other healthcare settings”.

It mentions:

“Published misconceptions and often inaccurate information”—

referring, I think, to the stories in national newspapers I have quoted. Our task and the Minister’s is to reconcile the support of all those organisations for the Liverpool care pathway with the allegations made—in good faith, I am sure—by people who believe that the pathway is what they call a pathway to death.

Any tool is only as good as the workman who uses it. The declaration states clearly that the Liverpool care pathway

“Relies on staff being trained to have a thorough understanding of how to care for people who are in their last days or hours of life.”

We have to face the fact that, in most professions, there are instances of excellence and malpractice, and health care is no exception. It would be surprising if, when 130,000 people a year are dying on the Liverpool care pathway, there were no cases in which the pathway had been misapplied. That applies to every branch of medicine and, indeed, every occupation. There are good and less good doctors and nurses; there are well run and less well run hospitals; but to lay the blame at the door of the Liverpool care pathway is like tearing up “The Highway Code” because there are some bad drivers. Where there is bad practice and poor care, it should be rooted out and replaced with good care.

It seems to me that the review the Government recently launched provides an excellent opportunity to consider thoroughly all those issues. It is urgently needed. The review should call for any evidence of poor end-of-life care. We need the Minister to assure us this afternoon that the stories I have quoted will not simply be taken at face value, but will be investigated in detail, so that we can establish the scale of poor end-of-life care, and understand the causes and correct them.

[Lilian Greenwood (Nottingham South) (Lab)]

I am listening carefully to the important points the hon. Gentleman is making. My constituents John and Mary Roche lost their mother five years ago. They came to see me because, having seen the media reports, they were concerned about her care toward the end of her life—she had been admitted to hospital and subsequently had her food and nutrition withdrawn. Does he think my constituents and others like them should be encouraged to share their stories, so that they can be taken into account in the Government’s review of the Liverpool care pathway and its appropriate use?

[Glyn Davies]

I thank the hon. Lady for making that point, because I most certainly do agree. I hope that, as a result of today’s debate, more people will come forward to put their experiences, especially of bad practice, in front of the Minister and the review.

We must not forget that it is necessary not to allow the shortcomings of some end-of-life care providers to undermine the outstanding work that the majority of doctors and nurses perform. It is easy to forget that, for those caring for people in the last days and hours of their life, alarmist stories cause real problems, misleading vulnerable people and their relatives into thinking that the unhappy experiences reported so prominently are typical of end-of-life care as a whole, making them reluctant to accept care that is genuinely beneficial, and generating fear of going into any sort of care setting. My sense is that the high profile given to these serious allegations, unaccompanied by supporting evidence, is analogous to shouting “Fire!” in a crowded theatre. We need to know that the Minister will consider all the allegations that are made, including those that have been reported, look at the evidence, and institute whatever changes are needed to ensure safety and thereby confidence in the integrity of the Liverpool care pathway.

I end with a general observation. I was appalled, as I am sure everyone in the Chamber was, by the recent revelations of poor care in a Worcestershire hospital, in Winterbourne View and in Stafford hospital. I was moved, as many of us will have been, by the observations made in the main Chamber before the Christmas recess by the right hon. Member for Cynon Valley (Ann Clwyd) regarding the inadequate and cruel care given to her late husband. We are reading about too many such cases. Considerable advances have been made in medical science, but we must ensure that, at the same time, we do not lose commitment in the NHS to basic care. I cannot help wondering whether the examples of poor end-of-life care that some relatives believe was given to their loved ones stem from the wider malaise of forgetting how to care for the sick, rather than from any specific clinical protocols such as the Liverpool care pathway.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 27th November 2012 Commons Chamber

[Dr Poulter]

I thank my hon. Friend for that question. This point has been raised before and although it sounds like a good idea in principle, the problem is that different aspects of care in different wards—for example, an older people’s ward compared with a ward that looks after younger people—will have differences in the intensity of nursing. Therefore, a mandated ratio would be difficult to implement. A ratio may be counter-productive to making sure that we can give more intensive nursing cover where it is needed, and could even encourage a race to the bottom.

[Lilian Greenwood (Nottingham South) (Lab)]

T8. A recent Schizophrenia Commission report highlighted catastrophic failings in the care of people with severe mental illness. We know that suicide rates rise during times of economic hardship and that record numbers of people are being detained under the Mental Health Act. The Government have said that mental health should have parity with physical health, so why has funding for mental health services been cut for the first time in a decade?

[Norman Lamb]

Whenever the NHS is under financial pressure, there is the risk that mental health services will get squeezed. As the Health Select Committee identified, that is exactly what happened under the last Labour Government in 2006. I share the hon. Lady’s concern, however, about the report on schizophrenia highlighting how money is used: too many people in in-patient facilities and not enough prevention work. I am committed to working with others to ensure that we use the money more wisely to get better care for those patients.

Kettering General Hospital

Lilian Greenwood Excerpts

Friday 9th November 2012 Commons Chamber

[Lilian Greenwood (Nottingham South) (Lab)]

Will the Minister give way?

[Dr Poulter]

It is interesting to find a Member from Nottingham, who I hoped would be in her constituency on a Friday looking after her constituents, taking such an active interest in this debate. However, I am happy to give way once on this issue.

[Lilian Greenwood]

I am attending this debate because I was here earlier to deal with a private Member’s Bill on behalf of the shadow transport team. Whatever the Minister says, is it not a fact that in the official documents, the “best” option is downgrading Kettering general hospital’s accident and emergency, maternity, children’s and acute services, and cutting a significant number of beds? How can he say that those services are safe?

[Dr Poulter]

The hon. Lady is turning this into a political debate, which is exactly what the Labour candidate in the Corby by-election has done. That is completely wrong and what she says is not true—it is scaremongering. There are no official documents at the moment because there is no consultation of that nature at the moment. There is no NHS consultation. Perhaps she should focus more on Nottingham, which is where her constituency is. I am sure her constituents would rather she were on the train back to hold a constituency surgery, which is what I will be doing after this debate, rather than making silly, ill-founded and mistaken political points about matters that bear no resemblance to her constituents’ concerns. I hope she will draw a lesson from this. I know she has been put up to making that point, but this is not the time.

The hon. Lady’s point was ill-founded. There is no consultation active in Kettering at the moment. There were some leaked documents about a range of options, which incorrectly set a number of hares running. The Labour candidate in the Corby by-election has already retracted his position. My hon. Friend has held the debate today because of that scaremongering, and because he is such a strong advocate for the needs of his patients in Kettering and his hospital. He wants to reassure them that Kettering hospital has a viable future.

[Lilian Greenwood]

Will the Minister give way?

[Dr Poulter]

I will not give way again. This is an Adjournment debate, not a general debate on the Floor of the House. The hon. Lady did not contact me before the debate to say that she would make a point—no Labour Member did. This is not a time to raise those points. The debate is about reassuring my hon. Friend that Kettering hospital has a viable future, which it does. That is confirmed clearly by Healthier Together, which has also confirmed that no active consultation is taking place; that, at the moment, we have only potential options appraisals; that A and E and maternity are safe; and that Kettering hospital has a viable future. I hope that the hon. Lady will put as much dedication into standing up for her hospital services in Nottingham as she has to making cheap party political points in a debate about a different part of the country.

I should now like to address some of the points, questions and legitimate concerns that have been raised, mostly as a result of the outrageous scaremongering by the Labour party. The Healthier Together programme has been put together, but, as I have said, there is no formal consultation at the moment. I am sure the concerns my hon. Friend so eloquently raised will be fed into it, and that the debate, and the comments of the Prime Minister and Health Ministers, will be part of it.

We recognise, as my hon. Friend has outlined, the importance of proper public engagement throughout any consultation process—as and when it comes. He will be aware that there has already been significant public and stakeholder engagement on how services in the midlands might need to look in future. As he rightly said, there are new demographic challenges—more people are moving into that part of the country—and the process of engagement must continue. If a formal consultation is opened in future, it is important that it meets the clear clinical tests for service reconfiguration. However, I should repeat that no formal consultation has been opened and it would be incorrect to allow any further Labour party scaremongering on that point.

It is worth bearing in mind that part of the reason for the concerns about services in my hon. Friend’s part of the world is the massive private finance initiative debt signed off by the previous Government to Milton Keynes hospital, which has struggled ever since the PFI was signed. That has led to significant pressures on Milton Keynes and other hospitals in the region. As we know, some services are specialist centres. It might be worth reflecting, before any further cheap political points are made, that one reason why there was a discussion about a consultation on services was the big PFI legacy of debt, which is stopping the delivery of high-quality front-line care. That is a direct legacy of the previous Government signing off bad PFI deals in health care. It is worth reflecting on that before any more scaremongering takes place.

When reconfiguration of health care takes place, the previous Government—and this Government—have laid down some key tests of what makes a good reconfiguration. It has to be led locally by local commissioners and decision makers, and my hon. Friend made that point very clearly. Any significant proposed changes to services would be subject to four reconfiguration tests set out by the previous Secretary of State for Health. They are local support for the changes from GP commissioners and clinical leaderships; robust arrangements for public and patient engagement, including local authorities; greater clarity about the clinical evidence basis underpinning proposals; and the need to take into account the development and support of patient choice.

In my hon. Friend’s region there are considerable distances between the hospitals involved and, if at some point in the future a consultation opened up, those greater travelling distances between hospitals would be taken into account as it may impinge on patient choice. I hope that restating those configuration tests is helpful. If there is concern that those tests have not been met, an independent review can be carried out by the independent reconfiguration panel, at the discretion of the Secretary of State. I hope that my hon. Friend finds that reassuring. I reiterate that at the moment there is no consultation formally on the table in Kettering, and its accident and emergency and maternity services are safe.

There are other significant challenges facing Kettering hospital and the local NHS, as my hon. Friend outlined. They are the same as those faced by the NHS everywhere— ensuring that we have services that are fit for purpose for the future to better look after the many older people—people are living longer—and the need to provide more dignity in elderly care. Part of that is having local bread-and-butter services. My hon. Friend rightly made the point that some health care services have to be regionalised, such as specialist trauma centres. The clinical evidence is that such centres save lives and, in my part of the world, we have one in Addenbrooke’s. Dedicated centres for stroke care also improve care for patients and the quality of outcomes for people with stroke, so that they can resume their daily activities much more quickly. Those day-to-day, bread-and-butter health care services that are so important, such as maternity and accident and emergency—and the cardiac services that Kettering is rightly proud of—are needed at a local level, and I am sure that any test of reconfiguration would confirm that they should remain accessible locally. We are very aware that many parts of the country are not urban. Many people face the challenges of rural life and the distances to travel between centres. Whenever services are redesigned in the future, it is important that those bread-and-butter services are available for local patients.

I reiterate the fact that there is no formal consultation proposal, and there is no place for scaremongering in these debates. I am sure that the future of Kettering hospital is a vibrant and successful one. I know that my hon. Friend has strongly advocated the dedication of local staff and I hope that he will take my reassurance back to them—so that they do not listen to the scaremongering—that Kettering hospital will still have a viable A and E and viable maternity services, and a very strong future.

Question put and agreed to.

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 23rd October 2012 Commons Chamber

[Dr Poulter]

My hon. Friend makes an excellent point. It was the previous Government who, through the “Agenda for Change”, gave flexibility to NHS trusts to allow some employers to pay a 30% premium in areas with workplace shortages.

[Lilian Greenwood (Nottingham South) (Lab)]

17. At a time when NHS budgets are under exceptional pressure, my constituents simply do not understand why the Government are so intent on pushing trusts to divert money away from patient care and into wasteful local pay bargaining. Is there not a risk that Nottingham’s excellent NHS hospitals and community services will be unable to recruit and retain the best staff if regional pay results in cuts to their salary scales? The Government are supportive of the idea, endorsed by the previous Government, that local pay flexibility allows additional rewards to be paid to staff in areas with workplace shortages, as my hon. Friend the Member for Banbury (Sir Tony Baldry) just made clear. The Government are supporting the unions, employers and employees, as the NHS Staff Council, in coming together to try to agree how we need to modify the “Agenda for Change” and other agreements to ensure that they remain fit for their purpose of protecting employees.

[Dr Julian Huppert (Cambridge) (LD)]

13. What assessment his Department has made of the extent to which the cancer radiotherapy innovation fund will increase access to intensity-modulated radiotherapy.

Health and Social Care Bill

Lilian Greenwood Excerpts

Tuesday 20th March 2012 Commons Chamber

[Stephen Pound]

As ever, my hon. Friend makes an important point. In responding to it, I would like to ask the House to cast its mind back to the contribution of my right hon. Friend the Member for Wentworth and Dearne (John Healey). He rightly said that this is not an issue of party politics. The fact that we see party politics in its worst form—its most loathsome shape—forming before our very eyes, clouded in some foul, mephitic, stygian Hades, is to be deplored. We should all listen to my right hon. Friend and actually try to admit to ourselves that we do not know everything—that the people’s voice does deserve to be heard and that the national health service is just that: a national health service, for all people. Everybody has that right to have their voice heard.

[Lilian Greenwood (Nottingham South) (Lab)]

Does my hon. Friend agree that one of the deepest problems with this Bill is that the people’s voice has not been heard? These proposals were never put before the people in party manifestos. That is exactly why they feel so very angry.

[Stephen Pound]

I am grateful to my hon. Friend for her question. It is a great sadness and reflects ill on my personal life that I spend many a night browsing through Liberal Democrat and Conservative manifestos. I have searched; I have examined; I have deconstructed; I have applied the principles of Jacques Derrida to those manifestos. Have I found in there any smidgen, any suggestion, any hint or any implication that the NHS was to be fragmented, privatised and ultimately destroyed, and the connection between the people and the NHS to be ripped up, torn into shreds like the integrity of the Liberal Democrats, hurled from the window to flutter in the breeze of history, never, ever to be seen again? Had I found that, I would almost certainly have voted Labour—but as I did so anyway, that is neither here nor there. But the point that my hon. Friend makes is absolutely right. How can the people, who fund the NHS, who are born in the NHS, who live in the NHS and who will ultimately quit this mortal bourn in the NHS—when they depart this vale of tears, it will be with the comforting arm of the NHS about their shoulders—feel that they are best served by this organisation if their voice is not heard?

Health and Social Care Bill

Lilian Greenwood Excerpts

Tuesday 20th March 2012 Commons Chamber

[Frank Dobson]

No.

The Government have not made such a case for change. They have not convinced the 1 million-odd people in the national health service that these changes are needed, and if they cannot convince the people on whom the service is going to depend, they are taking a real chance with its future.

The Prime Minister attributes his commitment to competition, including outside competition, to some of the most worthless and shallow research that has ever been conducted at the London School of Economics—and that puts it in a pretty extreme category. The researchers said that they identified that hospitals they claimed competed with one another had achieved a 7% improvement in the period for which patients awaiting an operation had to wait once they got into hospital. A 7% improvement is a period of less than an hour. Then, without any justification whatever, they generalised from the particular and said that the hospitals they claimed competed with one other were 7% more efficient right across the board. It is on that basis that the Prime Minister says that he wants to introduce competition into our national health service.

[Lilian Greenwood (Nottingham South) (Lab)]

rose—

[Andrew George (St Ives) (LD)]

Will the right hon. Gentleman give way?

Oral Answers to Questions

Lilian Greenwood Excerpts

Tuesday 22nd November 2011 Commons Chamber

[Mr Speaker]

We are immensely grateful to the Secretary of State. He is testing the knee muscles of colleagues very considerably, and we are grateful to him for that, I am sure.

[Lilian Greenwood (Nottingham South) (Lab)]

Today’s report by Macmillan Cancer Support showed that over the past 40 years there has been virtually no improvement in life expectancy for those diagnosed with a brain tumour. Brain Tumour UK and experts such as my city’s own Professor David Walker are calling for action to improve diagnosis and treatment. What action is the Department taking to address their concerns?

[Paul Burstow]

I am grateful to the hon. Lady for her question. Macmillan has done a very good job by highlighting the need to focus on survival rates with regard not only to brain cancers but to lung cancers. Through our outcomes strategy, we are focusing on earlier diagnosis and ensuring that the care pathway is faster and delivers the appropriate treatments at the right time.