NHS Shared Business Services

Liz McInnes Excerpts

Monday 27th February 2017 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. This is a very big part of our transformation plans for the NHS. Where the NHS does well internationally is in out-of-hospital records; our GP records are among the best of any country’s. GPs have done a fantastic job over the past 15 years in keeping all their records electronically, and they provide a lifetime snapshot of a patient’s history. Where we are less good is in our hospital records, where one can still find paper records in widespread use. That is not just very, very expensive but—he is quite right—unsafe at times.

[Liz McInnes (Heywood and Middleton) (Lab)]

I used to work in a pathology lab, and it absolutely pains me to think of those results generated by the hard work of pathology staff languishing in a warehouse somewhere, unseen by anybody. If GPs do not get lab results, they will ring the laboratory and ask for them, so has the Secretary of State made any estimate of the time wasted in phone calls from GP surgeries to pathology labs?

[Mr Hunt]

I am sure that, regrettably, because of what happened extra work was created for GPs. However, because of GPs’ commitment to their patients, it appears that in the vast majority of cases patient harm was avoided. When results do not come through that a GP is expecting, the GP chases them to make sure that the right thing is done for patients—but of course, as the hon. Lady rightly says, at the cost of extra work.

Oral Answers to Questions

Liz McInnes Excerpts

Tuesday 7th February 2017 Commons Chamber

[Marie Rimmer (St Helens South and Whiston) (Lab)]

7. What assessment he has made of the effect of changes to local authority social care budgets on demand for health services.

[Liz McInnes (Heywood and Middleton) (Lab)]

15. What assessment he has made of the effect of changes to local authority social care budgets on the provision of adequate health and social care services.

[The Parliamentary Under-Secretary of State for Health (David Mowat)]

The relationship between health and social care budgets is complex. A recent study by the University of Kent has shown that, for every pound spent on care, hospital expenditure falls by between 30p and 35p. The hon. Lady will also be aware that there has been an increase in delayed transfers of care over the past two years, which has resulted in an increase in the number of unavailable hospital beds. Our best estimate of that increase is around 0.7% of total NHS bed capacity due to the increase in social care delays.

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[David Mowat]

I agree that budgets make a difference, which is why we are increasing spending by £7.6 billion over this Parliament, but so do leadership, grip and best practice. Some 50% of all delayed transfers that are due to social care delays occur in 24 local authorities. Many other local authorities have virtually no delays. I recently visited the IASH team—Integrated Access St Helens—in the hon. Lady’s own constituency, which, working with Whiston hospital, has achieved spectacular results and some of the best outcomes in the country. I am sure that she will want to join me in congratulating those responsible.

[Liz McInnes]

My local council of Rochdale has had to make cuts of £200 million in the past six years. It has a further £40 million of cuts to implement, which will pile the pressure on our social care budgets. The 2% precept will raise only £1.4 million, which is a drop in the ocean when our total adult social care budget is £80 million. With our hospitals reporting a 70% increase in delayed discharges, I call on the Minister to bring forward the better care fund scheduled for the end of this Parliament so that our social care services can cope now.

[David Mowat]

As a direct answer to the hon. Lady’s question on the improved better care fund, let me tell her that it will be allocated in such a way that the combination of the fund and the precept will address real need. That is what we will be doing during the remainder of this Parliament, starting from April. We spend more on adult social care in this country than Germany, Canada and Italy, but it is very important that we spend it well.

Pennine Acute Hospitals NHS Trust

Liz McInnes Excerpts

Tuesday 17th January 2017 Westminster Hall

[Graham Stringer (Blackley and Broughton) (Lab)]

I beg to move,

That this House has considered the future of the Pennine Acute Hospitals NHS Trust.

It is a pleasure to serve under your chairmanship, Mr Streeter. We have a delicate path to tread in this debate. Over the past 10 years, there has undoubtedly been a scandalous failure of care within this NHS trust. It has been well documented; I will come to that in the middle of my comments. There has been a failure in the structure of the trust, a failure of management and, in individual cases, failure by clinicians, and people have suffered and died because of those failures.

That discussion and debate needs to be aired, while ensuring—this is the delicate balance—a solid and credible future for the hospitals in the trust, and particularly North Manchester general hospital in my constituency. The vast majority of clinicians, staff and employees in the trust are committed to the good care of patients, want the best for those patients and devote their careers and time to giving it to them. There is a delicate balance to be struck: I do not want any criticism of the trust to undermine morale further, but we have a responsibility to debate the issues. This is not about the present general debate on NHS cuts or the impact of the Health and Social Care Act 2012; it is specifically about the structures of the Pennine trust and some of its failures, and what we should do to secure its future.

Almost exactly 10 years ago, on 24 January 2006, I sponsored another debate on the Pennine Acute Hospitals NHS Trust; it can be found in Hansard at column 372WH. Shockingly, when I read that debate, I found that it covered almost exactly the same points that I believe we will discuss in this one. On the day of that debate, the front page of The Times highlighted misdiagnoses, with serious consequences, by the radiology teams at North Manchester general hospital, as well as at Trafford general hospital, which is not part of the Pennine trust. At the time, Professor George Alberti and Dr Joan Durose had written a report on the Pennine trust, which had been going for only three years, having been set up on 1 April 2002. The report found low staff morale, poor communications and poor administration, which is almost exactly what the Care Quality Commission’s current report found. The human resources director and medical director of the trust had already left, and after the 2006 debate, the chair and chief executive left.

We hoped for a better future and improvement through Professor Alberti’s 25 recommendations, but today we find that the chief executive of the trust has gone elsewhere and the current director of operations is on gardening leave. We are almost back where we were 10 years ago. In the meantime, there have been numerous warning signs that things have been going terribly wrong. One question on which I shall focus is why, even with all those red lights flashing all over the place for 10 years, with dire consequences for patients, the national organisation of the NHS and, more recently, the clinical commissioning groups did not notice them and sort out the situation.

The first strong warning sign that things were wrong came in a report from Channel 4’s “Dispatches” on 11 April 2011. “Dispatches” sent secret cameras into North Manchester and Royal Oldham hospitals in the Pennine trust, and found very poor care, amounting almost to low-level torture of some patients, who were shown not getting what they asked for. It was a terrible situation. At the time, I took up the case, and I am told that staff were disciplined.

[Liz McInnes (Heywood and Middleton) (Lab)]

Is my hon. Friend aware that the nurse who was dismissed as a result of “Dispatches” took her case to a tribunal, which instructed the trust to give her back her job?

[Graham Stringer]

I was not aware of that. There are obviously many technical details about the disciplinary situation of which I am not aware. However, I saw the programme, and the patients in that situation were undoubtedly treated appallingly. One cannot resile from what one sees directly.

[Liz McInnes]

I caution my hon. Friend against reading too much into the “Dispatches” programme. The tribunal overruled the trust. The reporters spent six months in the trust and managed to find two incidents, which they broadcast. When the case was heard by a tribunal, it ruled that the nurse in question should not have been dismissed.

[Graham Stringer]

As I just said to my hon. Friend, I will not go into the details, but I probably know more than she does about the situation from the patients’ side, because a relative was affected. I have no doubt that those patients were treated appallingly. I cannot comment on the details of personnel issues, but I can comment on the fact that patients have been badly treated. Given the technicalities of the situation and having watched the programme, I find it worrying that although one or two cases were found after six months, the nurses were re-employed.

After “Dispatches”, the CQC report found scandalous failings within the trust. It found that the safety and wellbeing of patients were inadequate, and that the trust’s responsiveness and effectiveness needed improving, but that the care of patients was good. That report was very worrying; the trust would have been put in special measures, if a new team had not already been put in place to deal with the situation.

As I say, the CQC report found that the care of patients was good, but within a very short time—and after excellent investigative work by Jennifer Williams of the Manchester Evening News and other journalists—an internal report on maternity care was made public, showing that the care provided by some individuals was very poor indeed.

It is worth reading out for the record an extract from that internal report, because we have now had a 13-year period of failure. It is also worth remarking that both that internal report and the CQC report relied on nothing but internal statements by the trust’s staff. A paragraph from the internal report really contradicts the CQC report, as it states:

“Staff attitude has been a feature of a significant number of incidents, from the most basic reports of staff relationship breakdowns, resulting in women and their families exposed to unacceptable situations, to an embedded culture of not responding to the needs of vulnerable women”.

The report went on to say of one woman that

“in one incident it is clear that the failure of the team to identify her increasing deterioration and hypoxia attributed her behaviour to mental health issues. Failure to respond to deterioration over a period of days resulted in her death from catastrophic haemorrhage.”

That means that, according to internal sources, the situation was actually worse than had been thought.

The report continued:

“A further example of staff attitude and culture has been experienced recently when a woman gave birth to her baby just before the legal age of viability (22 weeks and 6 days)…whilst no resuscitation would be offered to an infant of this gestation, compassionate care is essential. However, when the baby was born alive and went on to live for almost two hours, the staff members involved in the care did not find a quiet place to sit with her to nurse her as she died but instead placed her in a Moses basket and left her in the sluice room to die alone.”

That is inhuman treatment.

These failings are the failings of individuals, of management, who failed to sort things out, and of the structure of the Pennine trust itself. I could list a whole series of other cases. In fact, late last night I was contacted by constituents I know about another case. I do not know the details of that case, but my constituents wanted me to take it up, as they strongly believed that a misdiagnosis meant that proper therapeutic care had not been provided. So problems in the Pennine trust continue.

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[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Streeter. I am an ex-employee of Pennine acute. I worked for Pennine acute and its predecessor trust from 1987 for 27 years before I was elected to this place. I come to this debate very much from the Pennine acute staff point of view and our experiences of working there.

We have always worked against a background of change. Ever since I started work in the NHS, I cannot remember a time when there was not a new scheme coming up. It was always couched in the same language and everything was going to be different under the latest proposals. That has been my experience of working for the NHS in a 33-year career. There was always a new scheme on the horizon that promised the earth. We would try to give it a go and work with the new system, but systems were never given time to bed in. Just as we were getting used to a different way of working, a new system would come along promising the earth and everything was going to be wonderful under the new system. We all wondered what was so wrong with the old system that we had been told would be so good and solve all our problems. That, in a nutshell, is my experience as a member of staff working in the NHS.

Listening to the views of my hon. Friend the Member for Blackley and Broughton (Graham Stringer) and the hon. Member for Bury North (Mr Nuttall) was very interesting. They have been MPs in the area for a long time. My hon. Friend the Member for Blackley and Broughton said that Pennine acute was formed from four trusts that were jealous of each other, but I feel that is a misinterpretation. He was partially right in quoting Bill Egerton: the trust was formed because North Manchester general was worried about being swallowed up by Central Manchester. That was a fear shared by the staff as well, because none of the four hospitals that form the Pennine Acute Hospitals NHS Trust are teaching hospitals. There was a real concern among the staff that North Manchester general, a local hospital, might be swallowed up by teaching hospitals in central Manchester and disappear. Patients were also concerned that their local hospital would disappear. The trust treats a disadvantaged area, as has already been highlighted. The fact that life expectancy is low in that region is more to do with the quality of life rather than the standard of hospital care there.

Pennine acute was formed in 2002 from a merger of four existing trusts that I think merged to support each other. It was very much a banding together of four non-teaching hospitals that wanted to work together and make a success of Pennine acute. Obviously, any change is difficult, and the merger was a major change, but when Pennine was formed there was a real spirit to make it work. It was one of the biggest trusts in the country with 10,000 staff.

[Graham Stringer]

I am glad my hon. Friend agrees with me about the reason for the formation. Does she recall that within three years of the formation of the trust the consultants and the unions had an unprecedented vote of no confidence in the management? All the different hospital sites believed they were going to be closed at the expense of another site. Within three years the formation was not working.

[Liz McInnes]

I was coming to that point because my hon. Friend referred to the chief executive leaving. I inferred from his speech that that was as a result of a debate my hon. Friend had held in Parliament, but the chief executive left because the doctors had a vote of no confidence. The trade unions similarly expressed concern about the way in which the trust was being managed, but, as I recall, the trade unions did not have a vote of no confidence. Unless my memory is not serving me well, I do not recall the trade unions voting on that. I was heavily involved in the trade unions and I have no recollection of our having a vote of no confidence. That came purely from the doctors, who were concerned about the direction the trust was going in. It was as a result of that vote that Chris Appleby resigned from the trust. I was heavily involved in trade union activities as I was a workplace rep for Unite the union while I worked at the trust.

I want to highlight the issues involved in constant reorganisation and relocation. With the single hospital service proposal and with Healthier Together, we have two proposals running concurrently now, both of which seem to have different aims with different groups of hospitals working together. Healthier Together relies on the four Pennine acute hospitals working together and the single hospital service review, commissioned last year, proposes that North Manchester general should now work with Central Manchester and South Manchester. To add to the background of the constant confusion of reorganisations, we now have two different schemes that do not seek the same outcomes. I am sure everybody can understand how confusing and worrying such uncertainty is for the staff.

During the formation of Pennine acute, as a union rep I dealt with many staff who struggled with suddenly being told that their job was moving to another site and that they would be expected to relocate. Very little attention seemed to be paid to staff’s caring responsibilities. I dealt with several staff with disabilities, who had real issues about suddenly being told their job at North Manchester general no longer existed and that they were now expected to get themselves to Oldham at the same time in the morning, even though they had an extra six or seven miles to travel. There were real issues in dealing with staff and relocation in a sensitive manner. Such issues lead to uncertainty for staff and also make Pennine acute look an unattractive place to work.

In the meeting that we had with staff, they were very concerned about the maternity report that had been reported in the Manchester Evening News and the detrimental effect that it would have on staff who wanted to work there. At the meeting we heard from a representative from the Royal College of Midwives that a scheme had been put in place for improvements. The scheme is ongoing and midwives are now being recruited. There was an anomaly with the grade on which midwives were employed. They were being employed one band lower than they should have been, but that has been remedied. So there is an improvement plan in place and we need to be careful about extrapolating from dreadful incidents and saying that the whole of the trust is failing. I caution against that.

I have spoken about Healthier Together and the single hospital service running simultaneously, but seemingly both requiring different outcomes. The staff at Pennine are concerned about the single hospital service and the proposal that Central Manchester, South Manchester and Pennine acute should begin working together. Unfortunately, a lot of staff have been through it all before. They have been through the assurances that their jobs will be safe and that they will not have to move, but they have seen those promises eroded over time. Many are concerned about the prospect of having to journey right across central Manchester to go to work at Wythenshawe. That will be a lot of commuting for staff and they are very concerned about the proposal. The single hospital service review makes a virtue of staff being transferable—that is quoted in the document—and yet, at the moment, staff are being assured that they will not have to move.

On maternity care, the hon. Member for Bury North said that it is not a funding issue, but the appalling report on maternity services highlighted the lack of funding. In the past, there was a proposal to improve maternity services, called “Making It Better.” That was based on an annual birth rate of 3,500. The trust is now dealing with 10,000 births per year on the amount of funding that was settled on 3,500 births, so the funding issue obviously needs to be addressed.

The building stock at North Manchester is a real issue, as my hon. Friend the Member for Blackley and Broughton already mentioned. In my understanding, it was never a workhouse and has always been a hospital, but it was built to serve the workhouse that was built next door. The state of the building stock was always the reason that Pennine acute could not get foundation trust status.

NHS and Social Care Funding

Liz McInnes Excerpts

Wednesday 11th January 2017 Commons Chamber

[Dr Allin-Khan]

Will the hon. Lady give way?

[Liz McInnes (Heywood and Middleton) (Lab)]

Will the hon. Lady give way?

[Maria Caulfield]

I will not.

--- Later in debate ---

[Liz McInnes (Heywood and Middleton) (Lab)]

Two days ago, the Health Secretary read out a statement in this Chamber on the crisis in our NHS. His answer to his Government’s failure to meet A&E waiting time targets is to downgrade those targets, rather than seeking to take any action to treat the malaise at the heart of our NHS.

The Health Secretary heaped praise on our hard-working and dedicated NHS staff—praise they richly deserve—but it will ring hollow with many of them. I speak from years of experience working in the NHS as a clinical scientist with staff of all grades, skills and experience. The simple truth is that NHS staff are demoralised, and, as I said two days ago, they continue to work with care and compassion in spite of, not because of, his action.

Since that statement, I have been inundated by NHS staff wanting to tell me their stories: of how the service they were once proud to work in is now in perpetual crisis; of the strain of wanting to do their best for their patients but being prevented from doing so because of short staffing, overcrowding, delayed discharges and underfunding; of the emails they get from Ministers demanding to know what they will do about the failure to meet targets; and of their listening to the same Ministers telling the public that the NHS does not have a problem.

Health managers are saying that we have a perfect storm of ageing patients who need more care just at the time when social care has been cut to the bone, leaving hospitals to pick up the pieces. An A&E doctor at Manchester royal infirmary told me:

“Crisis is the new normal”.

The doctor said that it has become usual to have 10 patients waiting in a corridor.

In my constituency of Heywood and Middleton, the Pennine Acute Hospitals NHS Trust has just been the subject of a damning report revealing appalling neglect in maternity care that led to the avoidable deaths of mothers and babies. The trust had the most 12-hour A&E waits in October and the second most cancelled urgent operations in November. In December, it was forced to divert ambulances 14 times in total, one of the highest figures in the country.

Social care across Greater Manchester faces collapse. That is borne out by the delayed discharge figures for Greater Manchester, which doubled in the year to October. Greater Manchester asked for £200 million for social care in the autumn statement, but the issue was not even mentioned. Some see Greater Manchester’s devolved healthcare system as a solution, but even its chief officer, Jon Rouse, says that although devolution can help closer working it is not “magic dust”.

I remind the Health Secretary of the NHS constitution for England, which was updated in October 2015 and establishes the principles and values of the NHS in England. It sets out rights to which patients, the public and staff are entitled, and it sets out pledges that the NHS has committed to achieve. Enshrined in the constitution is the patient’s right to be cared for in a clean, safe, secure and suitable environment and their right to be protected from abuse and neglect—in other words, not to have to wait in an A&E corridor.

Patients and the public have the right to be involved in the planning of healthcare services, in changes to the way that healthcare services are provided and in decisions affecting the operation of those services. For NHS staff, one of the pledges is to engage staff in decisions that affect them and the services they provide, yet I see precious little evidence of staff, patients or the public having any input into the 44 STPs covering the regions of England, which appear to have been drawn up behind closed doors and are shrouded in secrecy. Their impact on healthcare in our regions could be huge, but where is the public involvement?

Patients are being failed on this Government’s watch and their rights to safe care are being neglected. All the Health Secretary has for NHS staff is the occasional flurry of warm words, yet the war he waged over the junior doctors’ contract showed his real attitude towards NHS staff. Nye Bevan said:

“no government that attempts to destroy the Health Service can hope to command the support of the British people.”

That is from Bevan’s book of essays “In place of Fear”. Sadly, the current Health Secretary has managed to achieve “replacing the fear”.

Mental Health and NHS Performance

Liz McInnes Excerpts

Monday 9th January 2017 Commons Chamber

[Mr Hunt]

I thank the hon. Lady for her work on the all-party group. I am more than happy to meet Dr Colgate. The purpose of the refreshed suicide prevention strategy is to try to ensure that we adopt best practice throughout the country. Some areas of the country are doing a very good job in suicide prevention, particularly in co-opting the public so that they understand that they can make a difference, too, but I am happy to explore with the hon. Lady what more can be done.

[Liz McInnes (Heywood and Middleton) (Lab)]

The Secretary of State rightly pays tribute to NHS staff, but the reality is that many of our NHS workers are now at breaking point. They continue to perform their work with care and compassion in spite of, rather than because of, any action taken by the Health Secretary. It is now time for him to act. What commitment will he give to investing properly in NHS staff, and to reversing the process of the deskilling, demoralisation and downgrading of NHS staff that he and his Government have presided over since 2010?

[Mr Hunt]

With respect to the hon. Lady, who I know cares passionately about the NHS and often asks me questions about it, we now have 11,400 more doctors and 11,200 more nurses in the NHS than in 2010. We protected the NHS budget in 2010, when her party wanted to cut it, and we promised £5.5 billion more for the NHS than her party was prepared to promise at the most recent election. Her characterisation of this Government as not being prepared to back NHS staff is utterly absurd.

Oral Answers to Questions

Liz McInnes Excerpts

Tuesday 20th December 2016 Commons Chamber

[Mr Dunne]

I congratulate my hon. Friend on his role in championing Medway Maritime Hospital, which I visited earlier this autumn. The CQC is in the process of re-inspecting Medway and will publish its findings in the new year. I congratulate the trust on its improvements thus far that were highlighted by my hon. Friend, which include reducing its average length of stay on admission wards from 11 days to only 3 days.

[Liz McInnes (Heywood and Middleton) (Lab)]

A recent damning report on maternity care from the Pennine Acute Hospitals NHS Trust care referred to appalling neglect that lead to the avoidable deaths of mothers and babies. The trust has implemented an improvement plan, but plans for maternity services under the Making It Better scheme were based on a predicted birth rate of 3,500 a year, and the reality is that the trust deals with 10,000 deliveries a year. What action will the Minister take to address that situation?

[Mr Dunne]

I am grateful to the hon. Lady for raising some of the issues at the Pennine trust. We are well aware that it needs improvement, which is why we have buddied it up with the outstanding Salford Royal NHS Foundation Trust next door. The Salford trust is led by Sir David Dalton and the Secretary of State referred to it earlier. I will take up the matter raised by the hon. Lady directly with Sir David.

CQC: NHS Deaths Review

Liz McInnes Excerpts

Tuesday 13th December 2016 Commons Chamber

[Mr Hunt]

My hon. Friend makes a really important point. I will have discussions with the Minister responsible for social care, the Under-Secretary of State for Health, my hon. Friend the Member for Warrington South (David Mowat), about what we can do in the social care field. I am optimistic that we can do something, because if we make this part of the framework of the new CQC inspection regime—obviously, that has to happen with the consent of the CQC—we can create a very strong incentive for adult social care providers to do what we want and to follow what is happening in the NHS.

[Liz McInnes (Heywood and Middleton) (Lab)]

I, too, want to raise the issue of the appalling neglect in medical care at Pennine Acute. The report—the extremely damning report—only came to light following the persistence of Jennifer Williams, a journalist on the Manchester Evening News, and the bravery of a whistleblower at the trust. I know that the Secretary of State will do what he can to protect whistleblowers, but how will he enforce a no-blame culture and a culture of openness in a trust such as Pennine Acute that appears to have tried actively to suppress this extremely damning report?

[Mr Hunt]

There should be no hiding place for managers who neglect their legal responsibility, which is the duty of candour that we in this place passed into law in 2014. That is my first point. It is also important to be realistic about the ability to impose a culture on organisations by ministerial diktat, but we can achieve that because this is something that NHS staff want. In some ways, what is most worrying about Pennine is that Salford Royal, one of the best hospitals in the NHS, is virtually next door to it, but the transmission of learning at Salford Royal did not seem to penetrate even into a neighbouring hospital. That is why we must get much better at sharing learning between hospitals.

Social Care Funding

Liz McInnes Excerpts

Monday 12th December 2016 Commons Chamber

[David Mowat]

The number of beds available in the system right now is about the same as it was six years ago. There is an issue with managing the financial performance of significant care providers. One thing we brought in two years ago was a robust process, led by the CQC, to look at the financial performance of the biggest providers and to warn us of any issues that may arise. We are very keen on pursuing that and making sure that it happens.

[Liz McInnes (Heywood and Middleton) (Lab)]

This is a national crisis that this Government have wilfully ignored for years. The Minister said in his opening statement that there is no issue that cannot be solved by throwing money at it. Is it not about time that he put his money where his mouth is?

[David Mowat]

The hon. Lady paraphrases what I said rather inaccurately. I said that money would help with any system, but the issues are about quality, leadership and best practice as well. All those things are within the ambit of my job, and that is what I am pursuing.

Reducing Health Inequality

Liz McInnes Excerpts

Thursday 24th November 2016 Commons Chamber

[Liz McInnes (Heywood and Middleton) (Lab)]

It is a pleasure to follow the hon. Member for Congleton (Fiona Bruce), who made a number of interesting points. She made a convincing argument for introducing compulsory personal, social, health and economic education in schools. That is something that the Government could well do to foster good, healthy relationships, and it would go a long way to reducing health inequalities.

I congratulate the hon. Member for Totnes (Dr Wollaston) on securing the debate and thank the Backbench Business Committee for recognising the importance of the subject. I was pleased to hear the hon. Lady refer to drug and alcohol treatment services, as did the hon. Member for Congleton. The future of substance misuse services is in jeopardy when some local authorities face huge cuts to public health budgets and have no statutory obligation to provide such services. We need to address that when we talk about health inequalities.

I would like to add to the list something that I do not believe anyone has mentioned: the responsibility of local authorities in England to commission sexual health services. Sexually transmitted infections are increasing because cost-efficiency, rather than clinical need, seems to be the overriding factor when commissioning such services. We need to ring-fence funding for sexual health services as a matter of urgency; otherwise we face the development of a serious risk to public health.

I want to concentrate on diabetes and diabetic care, and throughout my speech I will refer to the report by the all-party group for diabetes entitled “Levelling Up: Tackling Variation in Diabetes Care”, which was launched yesterday. I declare an interest as secretary to that group. I urge everyone with an interest in diabetes care, and in health in general, to read a copy of that excellent report. We took evidence from people with diabetes, healthcare professionals and clinical commissioning groups. One theme that came out from people with diabetes was the inconsistent quality of care. I am pleased that the Government and NHS England have recognised the need for improvement in diabetes services. During the investigation, NHS England announced £40 million of funding for diabetes improvements—diabetes is one of the six clinical priorities in the improvement and assessment framework for clinical commissioning groups—and it is vital that this opportunity to transform diabetes services is taken.

Our report identified three key things that people with diabetes need and deserve: first, high-quality consultations with the right healthcare professionals; secondly, support to manage their condition; and thirdly, access to key technologies. On the first point, a big part of how people with diabetes perceive their care is determined by how healthcare professionals communicate with them. People told us that they sometimes felt that they were criticised in appointments for not meeting treatment targets and that they were being dictated to about how to manage a condition that they had to live with. Our report found that people who have an input into their own care have better treatment outcomes. Consideration of their own lifestyles alongside their diabetes management, as well as an interpretation of National Institute for Health and Care Excellence guidelines, allowed for tailored treatment plans. In this case, it seems that collaboration brings far better results than confrontation.

People also talked to us about the difficulty of getting access to specialists, with some reporting that services were simply overwhelmed. Others said that they had to seek local services proactively to get a referral. The services that patients really valued were diabetes specialist nurses, dietetics and podiatry. Additionally, people affected by diabetes also valued their pharmacists and saw how their role might be significantly expanded to provide more information and support. That might well be worth reflecting on, given the Government’s recent cuts to community pharmacy services.

On the second point, about the support given to those with diabetes to help them to manage their condition, there is a huge variation in the information and education that is provided. Those who attended structured education courses generally reported that they found them valuable and that those courses helped them to manage their condition better. However, there is huge variation in the offer and uptake of these courses. In my constituency of Heywood and Middleton, only about 20% of people with diabetes are offered these courses, and the uptake is even lower. Clearly, that health inequality needs addressing. People in work often reported the problem of getting time off work to attend a five-day intensive course, while those with children also reported that accessing childcare was a problem. There is a job of work to be done to persuade employers that they will also reap the benefits of having a happier, healthier and more productive employee if they are reasonable about allowing time off.

The third point, on access to key technologies, serves to emphasise that technology now plays a key role in diabetes care, particularly for type 1 diabetes. Again, however, patients face a postcode lottery in getting the technology they need. That was cited as a major concern by the parents of children with diabetes. Worryingly, many type 2 diabetics reported that they had to self-fund their own blood glucose meters and test strips, which are essential for the self-management of their condition. Some type 1 diabetics reported the same thing, which sounds harsh, as it is a legal requirement for diabetics on insulin to test themselves before driving, and the Driver and Vehicle Licensing Agency now advises people who take medication that causes hypoglycaemia to test themselves before driving. Similar postcode lotteries were reported regarding access to insulin pumps, and continuous and flash glucose monitoring, all of which can help diabetics to control their condition better and improve health outcomes. Sadly, inequalities in health outcomes persist because only the better-off are able to access devices that make living with diabetes easier.

The motion calls for support for policies to reduce health inequalities, and our report identified four areas the Government should look at: care and support planning; support for self-management; access to key technologies; and a strong, local diabetes system. Variation and inequality in diabetes care show us that good care can be achieved, but our task and the task of the Government is to make that happen everywhere so that best practice is shared, we end the postcode lottery in diabetes care and we tackle the diabetes crisis.

Clinical Commissioning: North Durham

Liz McInnes Excerpts

Wednesday 23rd November 2016 Westminster Hall

[Dr Roberta Blackman-Woods (City of Durham) (Lab)]

I beg to move,

That this House has considered changes in clinical commissioning group commissioning practices for GP referrals in North Durham.

I asked for this debate as a result of a development that affects many in my constituency and other constituencies covered by the North Durham clinical commissioning group. I was made aware of it not by the clinical commissioning group but by “BBC Look North”, which received a tip-off from a GP about an upcoming change to the way GPs refer patients to a specialist. The change made by North Durham CCG fundamentally alters the way in which a GP refers a patient to a specialist.

It was always the case that if a GP saw a patient and considered that their health condition needed further investigation, they would be able to refer that patient directly to a specialist. The scheme introduced by North Durham CCG adds an additional layer of referral: if a GP wants to refer a patient, they must send a letter and medical records explaining why to a private health company called About Health, which will decide whether a patient should be referred to a specialist. That means that, in effect, a private company that has never seen the patient can overrule the decision of the patient’s GP to refer them to a specialist in a hospital. Conditions that would be referred under the new system include cardiology, gynaecology, dermatology and gastroenterology. Suspected cancer cases would be excluded from the system, although many cancers are detected when patients present with other health issues.

The decision to implement the scheme was taken following a year-long trial carried out by North Tyneside CCG. We do not yet know the clinical outcomes of the patients involved in that trial, but North Durham decided to roll out the scheme even without that information. North Durham CCG’s decision to adopt the new practice for referrals was also made without proper consultation of local residents or patients. Many patients were not even informed that confidential information about their health status was being shared with a private company. My hon. Friend the Member for North Durham (Mr Jones) and I had a meeting with the clinical commissioning group in September, only weeks before it introduced the new scheme, and yet it made no mention of the scheme whatever.

[Liz McInnes (Heywood and Middleton) (Lab)]

I am listening to the debate with astonishment. General practitioners, by their very name, are generalists, are highly trained and should be aware of the signs and symptoms of diseases and know who to refer patients to, but the intervention of a private company has been inserted as a barrier to patients getting specialist treatment. I cannot believe what I am hearing. I am sure my hon. Friend shares my surprise.

[Dr Blackman-Woods]

My hon. Friend makes an excellent point. Indeed, I was shocked and surprised. In fact, when “BBC Look North” presented me with the information, my immediate reaction was of huge concern for my constituents. I did an interview for “BBC Look North” and was then contacted by other news outlets. As a result of those interviews, I was contacted by many of my constituents, some of whom had already been adversely affected by the new referral system, and by GPs who said they were being forced to jump through hoops or to refer their patients unnecessarily to physiotherapy services when they knew that treatment would not help before they could refer to a specialist in a hospital.

I was also contacted by a GP in the area covered by North Tyneside CCG who said that he had referred a patient to a specialist for a skin condition but the referral was overruled by the new scheme, which is called the referral management system. The skin condition turned out to be cancer, but that was not discovered until months further down the line, which meant that far more radical surgery was required than would have been the case if the patient had been seen by a specialist when the GP first referred them.

I therefore have a number of serious concerns about the referral system and the way in which the decision to implement it was made. My first concern is the possible negative impact on the health of my constituents and other people who live in areas affected by the new patient referral management schemes. I am concerned because whether a referral to a specialist goes ahead or not could have a long-term impact on the health of the patient or even result in something more serious, especially if decisions are overturned by About Health. A patient might not receive the treatment they need early enough.

I am also concerned about the financial impact of the decision. I understand that the NHS is under considerable financial pressure, but I doubt whether the scheme will end up saving money in the long run. That is because, as I just set out, in many cases where referrals are rejected the problem does not go away and patients return to their GP or even go to A&E with far more serious problems, which take up more of the NHS’ time and resources. About Health, the private company deciding on referrals, will be paid a basic fee and an additional £10 for each referral letter, which in itself will incur a significant cost. I am therefore not at all sure that the scheme is cost-effective.

My final concern is about the lack of public consultation and information on the decision to implement the scheme. Last October, the Secretary of State for Health announced plans to rate CCGs to make

“the most patient-focused NHS culture ever”,

which would be

“much more accountable to their local population than previously.”

The decision made by North Durham CCG to change completely the way in which GPs can refer a patient to a specialist without any consultation flies in the face of CCGs being accountable to the local population. How are people supposed to hold a CCG to account if they are not aware of changes that are being made?

The North Durham patient reference group meets monthly in Durham city to discuss patients’ points of view and give feedback to the CCG about proposals and issues. The group, which is drawn from members of each GP practice forum across Durham, was informed of the new referral scheme only as it was about to be introduced, and it was not given any opportunity to give feedback on proposals. Despite meeting monthly, members of the group had not even heard about the plans before they were presented with them and told that they were to be introduced imminently.

Similarly, members of patient forums at local GP practices were informed of the decision, rather than consulted on it. I am told that patient forums and the North Durham patient reference group were concerned and opposed the immediate implementation of the proposals, but North Durham CCG decided to go ahead and implement the new scheme immediately in any case.

This is a really important point for the Minister. If a patient goes on to the CCG’s website, what they see does not tell them that their details will be given to a private company; they are simply told that a referral system is in place and that referrals are to “consultants” or “specialist GPs”. I think many patients would conclude from that wording that their medical information is to be sent to a specialist at a local hospital rather than to a private company.

I have written to the CCGs in the north-east to invite them to meet me and other members of the northern group of MPs to discuss this issue. It has been extremely difficult to get them to come to a meeting with us or indeed to get any information from them at all. I have some questions, which I will put quickly, to give my hon. Friend the Member for North Durham time to speak. Does the Minister know of any other clinical commissioning groups in the UK that have implemented a patient referral management service? Does he think that it is acceptable that no consultation was carried out? Will the practice be repeated by other CCGs across the UK—particularly ones ranked as in special measures? How can About Health, or other private companies, be held accountable if decisions result in negative outcomes for the health of patients? Does the Minister agree that the referral system is acceptable at all?