Oral Answers to Questions

Nigel Mills Excerpts

Tuesday 7th May 2019 Commons Chamber

[Caroline Dinenage]

This is all about getting more money into the system. That is why we have increased spending on adult social care by 9% over the last three years. We are focusing on attracting more people into adult social care, which is why we had the “Every Day is Different” recruitment campaign, to ensure that we get more brilliant-quality staff into adult social care roles.

[Nigel Mills (Amber Valley) (Con)]

T10. Does the Secretary of State agree that nursing associates are an excellent new role on the frontline of the NHS, delivering hands-on care for patients? If so, what more can be done to get more of them across the country?

[Stephen Hammond]

My hon. Friend is absolutely right. That role has been introduced to help build the capacity of the nursing workforce and support nurses and wider multidisciplinary teams. As he will have heard me say earlier, I am delighted that Health Education England is leading the national nursing associate training programme, with a commitment to train 7,500 nursing associates this year.

Oral Answers to Questions

Nigel Mills Excerpts

Tuesday 15th January 2019 Commons Chamber

[James Cartlidge (South Suffolk) (Con)]

11. What steps he is taking to ensure the adequacy of mental health service provision in the long term.

[Nigel Mills (Amber Valley) (Con)]

16. What steps he is taking to ensure the adequacy of mental health service provision in the long term.

--- Later in debate ---

[Jackie Doyle-Price]

My hon. Friend is quite right: I have stood at this Dispatch Box a number of times to address concerns from all the local MPs in Norfolk and Suffolk. I can advise him and the House that the trust is receiving increased oversight and enhanced support from NHS Improvement. It is in special measures for quality reasons. It is also receiving peer support from the East London NHS Foundation Trust, which is an excellent and outstanding trust. We will continue to take a close interest in developments, but I can assure him that the trust is receiving every possible attention to improve its performance.

[Nigel Mills]

Will the Minister also set out what steps will be taken to ensure that care for someone experiencing a mental health crisis is available 24 hours a day, seven days a week?

[Jackie Doyle-Price]

I am grateful to my hon. Friend for his question, because this was top of my list of asks as we were developing the forward plan. The NHS has reiterated its commitment to ensure that a 24-hours-a-day, seven-days-a-week community-based mental health crisis response for all adults is in place across England by 2020-21. All adults experiencing a mental health crisis will be able to be directed to support via NHS 111. This is based on best practice as shown by the Cambridgeshire and Peterborough NHS Foundation Trust. I am grateful to my hon. Friend for his interest in this, and I can assure him that NHS England, all the commissioners and I are very much on it.

Derbyshire CCGs’ Finances

Nigel Mills Excerpts

Tuesday 4th September 2018 Westminster Hall

[Nigel Mills (Amber Valley) (Con)]

I congratulate the hon. Lady on securing this important debate. I agree with her: the work that volunteers do in my constituency and the support they get from the centre for voluntary services is vital. Does she agree that it is short-sighted in the extreme to try to fix a medium-term funding issue by creating irreversible long-term damage to voluntary services in the area? The way it was done—with the threat of little notice—was equally crazy, as there was no way of replicating the structures in that time. We need a long-term, sustainable solution, not a short-term quick fix that does long-term damage.

[Ruth George]

The hon. Gentleman has just summarised the next 11 minutes of my speech extremely well. I absolutely agree with him.

Having asked their commissioners to make a decision about all the cuts to voluntary services two weeks ago, after just four weeks of consultation over the summer, and in the face of challenges from Healthwatch Derbyshire and the county council’s health scrutiny committee and a large public outcry, the CCGs are now being forced to look again at some of the cuts, but they are still on the table. They come on top of all the other cuts to health and social care in Derbyshire, where the county council has lost more than half of its funding since 2010.

--- Later in debate ---

[Stephen Barclay]

My hon. Friend is absolutely right. I was coming on to address the allocations for the four CCGs, which I am told by NHS England are above where NHS England independently sets the target. To be precise, according to NHS England, in the case of the Derbyshire CCGs, North Derbyshire is 6.2% above its target allocation, while Erewash is 2.31%, Hardwick 1.92% and Southern Derbyshire 0.25% above the target.

My hon. Friend is absolutely right that it is about how effectively the money is spent. He is also right that, within that search for efficiencies, alongside the additional £20 billion of funding that the Government have allocated, we need to address the point that the hon. Lady correctly raised about the value for money of many of the voluntary services. He correctly identified that there is a cross-party consensus and indeed concern that the value for money of those services should not be the first line of call when seeking efficiencies.

As part of that discussion, the CCG has confirmed that, having looked into this, three of the voluntary services will be protected. The south Derbyshire, Chesterfield and north Derbyshire Cruse Bereavement Care and the Stroke Association support services will be protected. The hon. Lady made a point about the value for money of night services costing £34,000, which within a £51 million target is a very small sum, and the New Mills where she cited the £2.26 per hour. That is exactly the discussion that the CCG is having. It is unhelpful to scare local people ahead of those consultations, because those decisions have not been taken. One of the benefits of the hon. Lady calling this debate is that it allows Members from across the House to put on record their support for voluntary services as part of looking at the legitimate question of where the efficiencies from economies of scale can be identified across the CCGs.

The Government are allocating more funding to the NHS, but they are looking at areas that are above their target allocation to ask, “Where are the inefficiencies and how do we spend that?” As part of asking taxpayers to contribute £20 billion more a year to the NHS, it is right that we ask how effectively that money is spent and that we ensure that we drive efficiencies.

The hon. Lady did not mention this, but it is pertinent that there is funding to Derbyshire in other forms: for example, the £12.5 million that has recently been provided for the four CCGs to spend on increasing theatre capacity at the Royal Derby Hospital. Again, that is part of enabling the CCGs to drive efficiencies. Some £40 million of sustainability and transformation partnership capital bids are yet to be approved. There are additional funding bids in the Department, NHS Improvement and NHS England as part of driving those efficiencies that the CCGs are being asked to deliver.

Alongside that is the vanguard programme—the CCGs agreed a business case in January 2018 to spend £1.1 million to continue to fund significant elements of the Wellbeing Erewash programme. My hon. Friend the Member for Erewash (Maggie Throup) has been an extremely strong champion of the benefits and importance of the programme in Erewash in her interactions with ministerial colleagues. The CCGs have introduced a range of financial measures to improve their financial position, including development of an efficiency strategy and a move to joint leadership arrangements, to which the hon. Member for High Peak referred. Closer functional working across the four CCGs in Derbyshire will help, but so will the additional capital that is being sought and innovation to work more efficiently through programmes such as vanguard.

On the voluntary sector, which was the meat of the hon. Lady’s remarks, it is important to stress that decisions have not been taken and that a consultation process is under way. The CCGs will have those discussions with local stakeholders. It is important to be clear that before taking any final funding decisions on services through the voluntary and communities sector, that further round of engagement and consultation with the local communities, local authorities, patients, GPs and other stakeholders will take place.

[Nigel Mills]

What we desperately do not want is a short-term saving made to fix a short-term problem. Bringing those services back in 18 months’ time when the much-welcome increased funding is available will not happen, because the volunteers and the organisations will have gone. Can there be any kind of downpayment on that future funding, or some slight relaxing of the annual deficit calculations, just to get us through the gap so that we do not do something now that we regret in 18 months’ time?

[Stephen Barclay]

To some extent, that is already happening in the form of the £45 million of the deficit that is being absorbed by NHS England, but part of the NHS England consultation is assessing where the CCGs are against their target allocation—it is part of the consideration of the £40 million of capital bids for Derbyshire and part of the £12.5 million that was secured for the improvements at Derby county. It is also part of other issues in the NHS such as length of stay—43% of patients in acute hospitals do not clinically need to be there and would be better served in the community, which is where those value for money assessments need to play a part.

Phenylketonuria: Treatment and Support

Nigel Mills Excerpts

Tuesday 26th June 2018 Westminster Hall

[Liz Twist]

I certainly agree with my right hon. Friend. It has become clear, as we have looked into the issue, that there is a very complex way of assessing drugs. Clearly, we want to get the process right, but there needs to be a rigorous look at that process, not just for Kuvan, but for other treatments for rare diseases. PKU perhaps falls between the cracks, because it is not quite rare enough to be in that group, but it is still very rare, and will be pushed to the back of the queue if it goes into a more general group.

For those whom Kuvan will not help, and who still need to manage their diet carefully, there is another issue that must be addressed: access to low-protein foods, which help to maintain the diet. Individuals may be advised through their dietician and their specialist centre that they need a particular level of foodstuff supplies, such as the low-protein flour I mentioned, which I am told can be used in many ways to try to make the diet more palatable. General practitioners, however, may not have a complete understanding of the condition or the dietary needs, and may feel that patients are just trying to get food on the cheap, and they may limit or deny prescriptions for those foodstuffs. They may feel that they are like gluten-free foods, which can be bought at supermarkets.

The fact is that those foods and supplements cannot be bought; they are available only on prescription, and the absence of them creates a real injury to those affected. It is not just that they are not there; it is actually damaging if they are not available. It would be good if the Minister could address how we can ensure that GPs prescribe the specialist foodstuffs that form part of the treatment that those with PKU need, and how we can close the gap between the specialist services, clinical commissioning groups and GPs.

[Nigel Mills (Amber Valley) (Con)]

I add my congratulations to the hon. Lady. Does she agree that there should be clear guidance, so that GPs or CCGs that are thinking about stopping prescribing that stuff can be told quickly and clearly that that is the wrong thing to do, and that there is no other way of getting this bread, and so that if one of them is foolish enough to go down that line, there can be a quick resolution?

[Liz Twist]

I thank the hon. Gentleman for that comment, and I agree. Last week at the APPG meeting, we heard some terrible stories; over the years, people have felt as if they were asking for a favour in asking for those goods. They are not; the goods are absolutely essential, and they cannot be bought over the counter. We must do something about that. We need to square that circle.

Finally, for the 75% who will not benefit from Kuvan, it is important that new, innovative treatments are developed and assessed quickly, so that more people can benefit from treatments that enable them to live well and safely with the condition.

To conclude, it is important that we listen to individuals and families who are living with PKU day in and day out. It is time that this condition was acknowledged, and that we addressed the need for effective treatment. I hope that the Minister can give us positive news that will move us forward in helping those with PKU.

This Thursday, on National PKU Awareness Day, I and many other hon. Members in this room and across the House will undertake the PKU “diet for a day” challenge. We will restrict our protein intake to 10 grams a day, avoid all those things we normally eat without thinking, such as that piece of toast in the morning or Rice Krispies with real milk rather than coconut milk, and drink tea or coffee without milk. We know that we will not really face those restrictions day in, day out, or the relentless grind of getting the diet right to stay well, but we hope that it will help raise public awareness of PKU, and help to bring about change.

Oral Answers to Questions

Nigel Mills Excerpts

Tuesday 19th June 2018 Commons Chamber

[Stephen Barclay]

I am grateful for my hon. Friend’s support on tier 2 visas. She will be aware that clinicians who reach the £1 million lifetime allowance limit can expect a pension of about £44,000, payable at age 60, increasing with inflation, plus a tax-free lump sum of about £132,000. Although these are ultimately issues for the Treasury, it is important that we ensure that tax allowances, two thirds of which go to higher-rate taxpayers, are fair to other taxpayers.

[Nigel Mills (Amber Valley) (Con)]

16. What steps his Department is taking to support the use of innovative drugs and devices in the NHS.

[The Parliamentary Under-Secretary of State for Health and Social Care (Steve Brine)]

The Government are committed to ensuring that innovative healthcare products reach patients faster than ever before. We have established the Accelerated Access Collaborative to identify transformative innovations and help their route to market, and today we have appointed Lord Darzi as the new chair of the AAC to lead this work.

[Nigel Mills]

I welcome the fact that the Prime Minister in her speech yesterday announced much more funding for personalised medicines and new technologies that will transform care. On that basis, will the Minister update the House on when the groundbreaking CAR-T— chimeric antigen receptor T-cell—therapy might be made available to NHS patients suffering from cancer?

[Steve Brine]

Yes, indeed. As the cancer Minister, I consider CAR-T to be one of the most innovative and exciting treatments ever offered on the NHS. NICE is considering the first of the therapies this year and preparations are well under way. We are working closely with NHS England to make these transformative medicines available to cancer patients.

Infection Prevention and Control

Nigel Mills Excerpts

Tuesday 15th May 2018 Westminster Hall

[Nigel Mills (Amber Valley) (Con)]

I congratulate the hon. Member for Strangford (Jim Shannon) on securing this debate. It reminds me of a debate on much the same topic that we had a few months ago. Its aim was to find out from the then Minister when the Government might enforce the strategy they had announced. It is a pity that we are repeating that debate a few months later and we still do not have the answers. The case has been set out very clearly by the previous speakers. There is not much advantage in repeating it, but, just to reinforce the point, we are talking about 5,000 deaths annually. The World Health Organisation estimates that half of those are preventable through effective hand hygiene. I do not know of other situations in UK life where we could have 2,500 people die each year unnecessarily and that would not be a national scandal. We would do anything we possibly could to fix it. There are things we can do to save a large proportion of those lives that are not very difficult or expensive. Our strong message today is: let us get on and do them.

I accept it will not be easy. We are not talking about finding the number of people who do not practise any hand hygiene and making them practise it; we are talking about making sure that as many health staff as possible get up to the very high levels of compliance with hand hygiene rules, rather than being in the middle. I suspect that no health service staff are deliberately not cleaning their hands as often as they ought to. We know they work in high-pressure situations. They do their very best for patients, and occasionally some behaviours creep in that perhaps should not. The important thing is to have processes in place that can identify when performance is perhaps slipping and then remind people, gently and constructively, how important hand hygiene is. That is why we need accurate and sensible monitoring.

We all know what happens when a colleague in a team says, “We have got to do one of these audits today. I’ll go round and watch to make sure you are all practising the right hand hygiene.” We all know what will happen. We have all been in those situations. We are all very careful to make sure we wash our hands as best as we possibly can. We all think we know the same rules, so we all comply with the same things. The person observing probably does not know the rules any better than those being observed. It is no surprise, therefore, that we end up with near 100% compliance. In fact, it is a surprise that we do not end up with 100% compliance in that situation. It is like the driving test. I have never looked in my mirror as much in my life as on my driving test, because I knew I was being checked on that.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

Is there not a simpler approach? Should not the audit be unannounced and carried out by people like secret shoppers, which is a technique that we use in Scotland?

[Nigel Mills]

Yes, that would be clear progress. However, I sense that we would notice an unknown person walking round the ward with a clipboard, which might make someone behave more carefully. I am not sure how easy it is to stop the word going round the hospital that such work is being done, but I accept that that is better than one member of the existing team doing it. The question is: can we find a better way of monitoring compliance and getting the data we need, so that we can work out what is happening, see what the trends are, and see whether they are reflected in infection rates? As hon. Members have pointed out, there are various techniques on the market to do that electronically.

Simply counting how many times the ward dispensers are squeezed will not work because we need to know the type of ward, how many patients there are and how sensitive the work is to know how many times people need to squeeze the dispensers. We need a system that says, “On a ward carrying out this sort of activity with this number of patients, we would have expected this level of hand hygiene-compliant moments, and we actually got this many squeezes on the dispenser. That is only a quarter of what it ought to have been. That tells us there is a big problem on this ward.” Or it might tell us that we got 80%, which is probably a sensible level to get.

In my constituency is the Deb Group, a large employer that produces hand hygiene gel and monitoring techniques. I accept there are many rivals on the market and many different ways of monitoring. Some people prefer to have each member of staff wear a badge with a sensor that can tell how often that member of staff approaches a hand hygiene gel dispenser, so that we can monitor at an individual level rather than a ward level.

All those ideas are out there. We need the Government, and presumably the Care Quality Commission or NHS Improvement, to say to hospitals, “We want you to collect real data. We don’t want you to do stupid observations that give you 99% compliance, which we know is meaningless, just so that you can tick a box to say that you’re compliant. We want you to collect real data. We don’t mind how you do it, and we’re not going to punish you, take money off you, or put you in special measures if that data shows that you’re at 25% or 35% compliance, and all your rivals are at 97% because they’re doing it wrongly. We want you to do it properly, get the data, use the data, and improve your performance where you can see that it is linked to infections being too high.”

When the CQC reviews hospitals and other health environments, it should check that hospitals are collecting that data sensibly and using it to improve performance. The CQC should be very serious about that when it assesses a hospital. Can we see that hospitals know what their performance is, have a plan in place to improve it, and are improving it, and that infection rates are falling? It would be a serious matter if hospitals were not doing that work properly—if they were just having a quick half-hour assessment now and again, and producing data that they must know is complete rubbish.

We have the right plan; we know what we want hospitals to start doing. Let us get it in force, and task the CQC to ensure that hospitals are doing it. Let us set out clearly what we want hospitals to do and ensure that they are not too scared to go down that line, thinking that their data will suddenly get worse and they will be punished for it. Let us do what we know we need to do, and hope that we do not have to come back in another couple of years to talk about the fact that 2,500 people have died because we have not managed to put something in place that is easy and relatively cheap, and that we know works.

Oral Answers to Questions

Nigel Mills Excerpts

Tuesday 20th March 2018 Commons Chamber

[Mr Hunt]

My hon. Friend is right to draw attention to antimicrobial resistance because China is one of the big countries that can make a difference on that, and yes, we have had lots of discussion with Chinese Health Ministers about how we can work together on that.

[Nigel Mills (Amber Valley) (Con)]

9. What progress Public Health England has made on implementing his Department’s policy of publishing data on hand gel usage in NHS trusts as an indicator of hand hygiene compliance.

[The Minister for Care (Caroline Dinenage)]

Patient safety, and particularly infection prevention, are among the Government’s key priorities. Public Health England has carried out some initial analysis of available data. However, currently the data is incomplete and would not give a true reflection of the usage of hand gel. We are working with Public Health England to explore how we can improve that data.

[Nigel Mills]

I am sure the Minister will agree that it is a matter of real importance that all NHS staff wash their hands at all the required five moments of patient contact. Does she agree that it is disappointing that we have not quite got that data published yet, and will she set a date when we will be able to see that data for each trust?

[Caroline Dinenage]

As I have said, we will continue to look at that, but, as my hon. Friend knows, the Department has a really strong track record of tackling infection. Incidents of MRSA are down 54% on 2010. We have published a revised code of practice on hand hygiene and we are working with partners across health and social care to ensure that this remains a focus.

East Midlands Ambulance Service

Nigel Mills Excerpts

Wednesday 21st February 2018 Westminster Hall

[Stephen Barclay]

My right hon. Friend makes a pertinent point. As he mentioned, he is my constituency neighbour and I am very aware of the specific challenges posed by the geography and the road network in Lincolnshire. I am happy to take that specific point forward. It will not surprise him that I have already zeroed in on some of the challenges in Lincolnshire, particularly around United Lincolnshire and Northern Lincolnshire and Goole, how that interplays across the spectrum of primary care, how the patient pathway goes through, the various blockages in the system and how we look at that in a more systemic way.

That issue interplays with a much wider debate, outside the scope of this one, but to give my right hon. Friend one statistic, 43% of beds are occupied by 5% of patients. If we take the average length of stay from 40 to 35, that is the equivalent of 5,000 hospital beds, each at £100,000 per year. We can see how there is an interplay between what we are debating with the ambulance services and the wider Lincolnshire health economy, which is a specific point. I am happy to have further discussions with him on that.

The hon. Member for Bassetlaw (John Mann) raised three points about the report on the disproportionate calls, which were pertinent to a conversation I had just this morning about spikes in care homes and what action might be taken. For example, to what extent can we improve GP access into specific care homes in Lincolnshire through Skype, as one of the mitigations of ambulance demand? We are looking at how we assess the return on investment between the cost of ambulances and emergency admissions and what that investment might do if it were put into a more preventative role—care homes, for example.

On the specific matter of Sports Direct, which I was not aware of, the hon. Gentleman makes a valid point, which I will be keen to look at with officials—where there are peaks of demand, what is driving those peaks and how to mitigate them. He also mentioned the issue of privatisation from 2009. We are looking at how we take a more holistic view across a landscape and how mutual support from different parts of the system can provide assistance to that. It will not surprise the hon. Gentleman, knowing my views on Brexit, that for all the talk of some of the challenges of Brexit, the opportunities of Brexit should not be missed. I share his desire on that.

There is also the geography point—whether it is the way services elsewhere have been reconfigured or the extent to which there are, for example, centres of excellence to which his constituents are being taken. Is the issue the formal geography or how the operating protocols within that geography have evolved? That, again, is a perfectly valid point and one we can look at on a case-by-case basis.

I know my hon. Friend the Member for Boston and Skegness has championed a number of these issues over a period of time. He raised how we can get the ambulance service working together with the other emergency services. I know that is an issue that many police and crime commissioners have also identified, and many within the fire service are keen to ensure that we have a better join-up between the blue-light services.

The hon. Member for Lincoln (Karen Lee) raised the issue of hospital handovers. I assure her that daily reviews are currently being undertaken by NHS England and NHS Improvement. Greater transparency and targeted assistance are being provided, and there are also specific initiatives linked to individual hospitals, particularly including the hospital-ambulance liaison officers.

The hon. Lady also mentioned pay. It is worth reminding the House that the pay band that applies to paramedic staff has been increased from band 5 to band 6, so there has been a recognition in the system of the importance of paramedics, alongside an increase—around 30% since 2010—in the number of paramedics. However, we recognise that there is also an increasing demand, and that this service has been under considerable pressure.

[Nigel Mills (Amber Valley) (Con)]

The Minister has skirted around the issue of breaking up EMAS, which I think some areas might quite like. Does he agree that our priority should be having more paramedics and ambulances, not more chief executives and office buildings?

[Stephen Barclay]

I think most people who observed my questioning during my four years on the Public Accounts Committee will know that organograms and looking at where investment is and how streamlined structures are is extremely important to me.

At the same time, it is important that one does not make a false saving in driving down some of the management costs, so that procurement, IT investment and consultancy spend, for example—some of the big ticket expenditure—is not effectively managed and escalates. There is a balance to be struck between having good leadership of trusts and, as my hon. Friend alludes to, not drifting into areas where additional hires are created in the back office as opposed to services on the frontline, where I think Members from across the House want to see them.

In terms of the service nationally, a number of actions have been taken. Under Sir Bruce Keogh’s review of the NHS urgent and emergency care system, ambulance services are being transformed into mobile treatment centres, making much greater use of “hear and treat”, which is treating patients over the phone, and “see and treat”, which is treating and discharging patients on the scene. While we have heard of some of the challenges faced by the trust, it is also worth placing on the record that it is one of the best-performing trusts for “hear and treat”, and treats and discharges more than three in 10 patients either on the phone or on scene. There are areas of good practice that, for balance, it is only fair to recognise.

I will conclude, to allow the hon. Member for High Peak time to speak. We recognise that the trust has challenges, and I am very happy to work with the hon. Lady and other colleagues as we move forward to address those. In addition to the increase in pay bands and the increase in numbers, an active plan is under way to tackle some of the challenges we have heard about today, which I hope gives some comfort to the hon. Lady.

Adult Social Care Funding

Nigel Mills Excerpts

Thursday 6th July 2017 Commons Chamber

[Steve Brine]

I understand that the hon. Lady wants to play politics with this issue, but as I said in my response to the urgent question, I honestly think that we can do better than that.

[Nigel Mills (Amber Valley) (Con)]

I have found the CQC’s inspections of struggling care homes in Amber Valley to be a very useful way of making sure that they improve care for local people. Is the Minister confident that the CQC is sufficiently resourced and skilled to carry out those inspections in a timely fashion and to a sufficient quality?

[Steve Brine]

Yes, I think that the CQC does a fantastic job. Andrea Sutcliffe, its chief inspector of adult social care, whom Members will have heard on the media this morning, was absolutely right when she talked about services needing to meet the mum test or the dad test. Ultimately, we are all affected—I have ageing parents, like many Members of this House. The mum test or the dad test is what we want, because when people go into adult social care settings we want to feel that they are as well looked after as we could manage ourselves.