Social Care

Andrew Gwynne Excerpts

Wednesday 25th October 2017 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

We have had a good and full debate. I wish to thank the 25 Back-Bench colleagues who have contributed to it, including my hon. Friends the Members for Leicester West (Liz Kendall), for Leigh (Jo Platt), for Colne Valley (Thelma Walker), for Sheffield, Brightside and Hillsborough (Gill Furniss), for Bedford (Mohammad Yasin), for Batley and Spen (Tracy Brabin), for Warrington South (Faisal Rashid), for Bury North (James Frith), for Crewe and Nantwich (Laura Smith), for Weaver Vale (Mike Amesbury) and for Birmingham, Edgbaston (Preet Kaur Gill) and the hon. Members for Totnes (Dr Wollaston), for Erewash (Maggie Throup), for Halesowen and Rowley Regis (James Morris), for St Ives (Derek Thomas), for South West Bedfordshire (Andrew Selous), for Yeovil (Mr Fysh), for Faversham and Mid Kent (Helen Whately), for Rochester and Strood (Kelly Tolhurst), for Bexhill and Battle (Huw Merriman), for Chelmsford (Vicky Ford), for Redditch (Rachel Maclean), for Thirsk and Malton (Kevin Hollinrake), for Aldridge-Brownhills (Wendy Morton) and for Edinburgh West (Christine Jardine).

Clearly, on both sides of the House, there is a shared concern over the Government’s inaction on addressing the growing crisis in social care. It has been illuminating to hear the thinking of the Social Care Minister in her opening speech. I am astounded that a Minister of the Crown thinks that austerity is the mother of invention.

[Jackie Doyle-Price]

rose—

[Andrew Gwynne]

Let me finish. I will let the hon. Lady in if she wants to apologise.

It is a play on words of the old English proverb that necessity is the mother of invention. Let me tell the Minister that she might be quoting a councillor, but she did not deny that it was her view, too. There is nothing necessary about austerity. It is a political choice, and it is a choice that is driving up inequality and unfairness.

[Jackie Doyle-Price]

I need to remind the hon. Gentleman that the only money that we can spend is that we collect from taxpayers. I pay tribute to the innovation shown by local authority leaders who deliver better outcomes with less money. That is good value for money and should be celebrated by Opposition Members, too.

[Andrew Gwynne]

I pay tribute to councillors who are making very difficult decisions under very tightly constrained financial situations. I remind the hon. Lady that, yes, we can only spend money that we have, but it is a question of priority about how we spend it. That is why we set out in the election exactly how we would use the money in a better, smarter, fairer and more equal way.

As Members of Parliament, we have a duty to our constituents to defend the services on which many rely and the services that are there to protect us all should we find ourselves in need of support—care homes for the elderly, child protection and support for parents with disabled children. It is the duty of all Members to protect the principle on which our welfare state was founded. All people deserve a life of dignity. As shadow Secretary of State for Communities and Local Government, I speak to council leaders, to councillors, to council staff and to organisations delivering public services, and they are all telling me the same thing. They are not only unable to cope financially; they have lost confidence in this Government. The country needs fresh ideas and leadership. Instead, it is suffering from the weakest and most divided Government in memory. One thing is clear: this Government are facing a looming crisis of trust in local government. Many within the local government sector, including the Tory chair of the LGA, had hoped that the Prime Minister would use her Tory conference speech to announce new measures to help to alleviate the pressures on adult social care. But I, like many, think they were left wanting for leadership.

Our ageing and growing population means that there is more demand for social care. An increasing number of people will need support with their mental health, a physical disability or learning and social needs. Skills for Care has predicted that we will need an additional 220,000 to 470,000 workers by 2025 due to population growth and ageing, but local government will be unable to meet this demand under current and projected budgets.

We do not have to wait until 2025 to witness a crisis. Across the country right now, our health and social care system is straining at the seams. Last year, councils spent over £366 million more than they had predicted on their social care budgets. That is double the overspend reported in 2015-16, and it is not sustainable. The only response that we receive from this Government is the long-awaited consultation, which a Minister first promised would be published in the new year. Now it is suggested that it might even be delayed until next summer.

When will our communities see action to help the one in eight elderly people who will not receive the care they need, such as help getting dressed, going to the toilet and washing themselves—basic dignity for those most in need? When will we see an end to the closure of children’s centres that are providing support to families in need? Right now, one children’s centre closes every week. When will people no longer have to live in fear in their own homes? Cuts to care hours mean that a fall in the home could leave somebody trapped on the floor, unable to get up for several hours. If Ministers had discussed these issues with the sector, they would know about them. They would know that the sector is warning that social care faces a perfect storm of staffing shortages, rising demand and a lack of funding made worse by this Government’s policy on transfer of care.

I recently asked the Minister whether his Department had conducted an assessment to ensure that local authorities had the financial and staffing capacity to comply with their statutory social care duties. I was told that these were decisions for local authorities, not for the Government. Well, I have done the work for the Minister. The number of social care workers has fallen each quarter for five years to its lowest level since 1999. It has decreased almost 8% in the last year alone. Councils face a £2.3 billion annual social care funding gap by 2020. With this black hole in the Budget, I am unable to understand the justification for fining cash-strapped councils for failing to meet transfer targets. The Minister denied that it is a fine. But if it looks like a duck, waddles like a duck and quacks like a duck, it is a duck; and this is a fine.

The Government are at odds with the whole sector. As the LGA has also argued, I am unable to see how this will not make the financial pressures affecting social care even worse. Ministers have failed to understand the depth of the problem with delayed transfer. Too many patients are stuck in hospital who could be better cared for elsewhere, but ensuring that patients can be cared for in the right settings requires investment in not only social care, but intermediate care, reablement services, and sheltered and supported housing. Added to that, we know that there are issues about pay too.

I urge the House to recognise that this problem does not fall on party lines: these cuts hurt all our communities, whichever side of the House we sit on. The Evening Standard reported this week on a new poll. Three quarters of Conservative councillors said that long-term funding for children’s social care was a major concern. Over half said the Government’s cuts had made it difficult to deliver legally required services. So this is a crisis in not just adult social care but children’s services.

History will not look kindly on a Government who promised so little and delivered even less. That is why I urge Members on both sides of the House to vote to support Labour’s motion. Abstention is a cop-out—join us in the Lobby.

NHS Sustainability and Transformation Plans

Andrew Gwynne Excerpts

Wednesday 14th September 2016 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

My hon. Friend is making a very important point. She has already touched on the financial problems in the NHS, but allied to those are the financial problems in adult social care. We shall not have the truly integrated health and social care that we all desire when these STPs are being swept under the doors without people knowing precisely what they will mean for public services in their areas.

[Ms Abbott]

My hon. Friend has made an important point.

The danger is that, in a blizzard of apps and Skype, patients—particularly the elderly—will find it harder to access one-to-one care, and that those who can afford it will find themselves forced into the private sector.

Let me now say a word about the increasing private sector involvement in the NHS.

--- Later in debate ---

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

I am sorry that this is such an acrimonious debate. I welcome the principle of the sustainability and transformation plans, as they are a key opportunity to reverse fragmentation and to reintegrate the NHS, but we have to get it right. To turn this whole matter into just a game of moving the deckchairs on the Titanic is something that we would all regret in a few years’ time. We are talking about a place-based approach, which is very similar to what we have in Scotland. I absolutely welcome it, but the places must be right—they need to cover the whole population and the geography must make sense. That is in the relationships of the organisations that are there, but we have to think of things such as public transport. There is no point plonking a community in an STP if there are no connections to it. How these places are designed is really important, as are the partners that are in them. All of this should be about integration and re-integration from acute care through to primary care and local authority care. We need single pathways and wrap-around patient-centred care.

[Andrew Gwynne]

I have some sympathy with what the hon. Lady is saying. Does she agree that that integration will not happen if any one part of those partnerships is severely underfunded? For example, she mentions local authorities. Many of the pressures in the NHS today are solely as a result of the severe underfunding of adult social care. Do we not need to ensure that the finances are in place for these STPs to work?

[Dr Whitford]

I totally agree with the hon. Gentleman. I was about to come on to that. However, it is not just the funding, but the entire model. The tariff model that we have at the moment rewards hospitals for doing more minor things, and punishes them for doing more acute things. Taking on more A&E cases and more complex cases, working harder and doing more make their deficits grow. Our problem is that we have all sorts of perverse incentives in the system that mean that organisations will still be looking out for their budgets and their survival instead of working together.

In Scotland, we got rid of hospital trusts and primary care trusts, and, since 2014, we have had integrated joint boards. Those boards were handed joint funding that came from health and the local authority, which meant that the whole business of “your purse or my purse” disappeared. They were then able to start to look at the patient’s journey and the best way to make the pathway smooth. That is what we want to see.

Having a shared vision of where we are trying to go to is crucial. That means that stakeholders—both the people who work in the NHS and the people who use it—need to believe in where we are trying to get to. Public conversations and public involvement are the way forward. We should not be consulting on something that has already been signed off, but involving people in what they would like the plans to be, as that would make those plans much stronger.

We need to make deep-seated changes to the system, as opposed to only talking about the money for the deficits. This is something that the Health Committee has been talking about for ages. The phrase “sustainability” has become shorthand for paying off the deficit. Of the £2.1 billion earmarked for sustainability and transformation, £1.8 billion is for deficits, which leaves only £300 million to change an entire system. I know that we talk about money a lot in here, and of course it is important, but we have far bigger sustainability issues than the £2.5 billion deficit in the NHS. We have an ageing population, and those people are carrying more and more chronic illnesses, which means that we have more demand, more complexity and more complications. That is one of the things that is pushing the NHS to fall over. On the other side of that, we have a shortage in our workforce; we do not have enough nurses or doctors, and that includes specialists, consultants, A&E and particularly general practitioners. Although the advice has been very much that finances were third, and prevention and quality of care were meant to come first and second in delivering the five year forward view, finances seem to be trumping everything else.

It is absolutely correct that health is no longer buildings; there are lots of methods of health that are bringing care closer to patients, and also some things that are taking patients further away from their homes. We have hyper-acute stroke units, and we have urgent cardiac units, where they will get an angiogram and an angioplasty that will prevent heart failure in the future. However, we cannot start this process there; we cannot shut hospitals and units to free up money to do better things. We have to actually go for the transformation and do the better things first. We have to design the service around the pathways we need—that wrap-around care for patients—and then work backwards. If more health and treatment is coming closer to the patient, at some point they will say, “Actually, I don’t go to the hospital very often. I want the hospital to have everything it needs when I need it.” Then we can look at the estate to see whether we have the right size of units and the right type of units in the right place. What concerns me is that the process we have seems to be the other way around—we are starting with hospitals, which is often a very expensive thing to do, and hoping it will deliver everything else.

NHS Spending

Andrew Gwynne Excerpts

Wednesday 6th July 2016 Commons Chamber

[Dr Whitford]

I thank my hon. Friend for that remark. If we had spent more time reminding people honestly of what the EU has brought us, which includes all the people who have been working in our health and social care services, we might have helped them to realise that we have been gainers, not losers.

[Andrew Gwynne (Denton and Reddish) (Lab)]

The hon. Lady is absolutely right in the case that she is setting out. Is not part of the reason why people voted the way they did because they actually wanted to give additional money and resources to an NHS and social care system that has been badly starved of cash? That is particularly true of social care. People have seen their elderly relatives being unable to get the help, the aids and the adaptations that they need in the home, which piles pressure on to the NHS. They wanted the NHS to have that cash.

[Dr Whitford]

I totally agree. Of course, we all want the NHS to have more money. It is the United Kingdom’s single most prized possession and creation. The problem is that we did not counter the argument that it was struggling because people from the EU were taking up the appointments and the beds. EU nationals are much more likely to be looking after us than to be standing in front of us in the queue. There is an absolute responsibility on us all, particularly on the missing members of the leave campaign. This is very much a case of a big boy doing it and running away—very, very quickly.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 5th July 2016 Commons Chamber

[Jane Ellison]

My hon. Friend is right to champion these new technologies. In fact, the Department has already invested in research into CRP. We look forward to seeing what that brings and, in due course, to seeing how it might move forward. It is very much already on our radar.

[Andrew Gwynne (Denton and Reddish) (Lab)]

There is an impending public health issue in this regard, not least with strains of gonorrhoea, for example, that are starting to show resistance to antibiotics. A number of doctors are incredibly concerned about this. What more can be done to incentivise research and development to ensure that this public health concern does not become a public health crisis?

[Jane Ellison]

The hon. Gentleman, who knows a great deal about these matters, is right. Incentivising discovery is absolutely at the heart of the O’Neill review. O’Neill has made a series of recommendations about unblocking the drugs pipeline, and we will respond to that in full. It is a critical issue. In the meantime, conservation of the antibiotics we have and sensible prescribing is critical to making sure that, as the hon. Gentleman says, drug-resistant strains of gonorrhoea, for example, do not take hold.

NHS Commissioning (Pre-Exposure Prophylaxis)

Andrew Gwynne Excerpts

Tuesday 7th June 2016 Commons Chamber

[Andrew Gwynne (Denton and Reddish) (Lab)]

(Urgent Question): To ask the Under-Secretary of State for Health if she will make a statement on NHS commissioning in relation to HIV pre-exposure prophylaxis.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I am grateful for the opportunity to respond to this urgent question. As the House knows, HIV can be a devastating illness, and we know that pre-exposure prophylaxis—PrEP—can make a difference to those at risk of contracting HIV and to those who are already HIV positive. However, it is crucial that we have a full understanding of all the issues surrounding PrEP.

As with any new intervention, PrEP must be properly assessed in relation to clinical effectiveness and cost-effectiveness. That is why we have today asked NICE to conduct an evidence review of Truvada for PrEP of HIV in high-risk groups. This evidence review signifies the next step forward and will inform any subsequent decisions about commissioning. It will look at the evidence for effectiveness, safety, patient factors and resource implications. The NICE evidence summary will run alongside a pilot scheme in which we are investing up to £2 million. Public Health England is currently identifying the most effective places for the pilot to take place.

It is also important to remember that Truvada, the drug used for PrEP, is not yet licensed for this use in the UK. That is why, as well as the pilot scheme, the Government want to see the evidence review, which will help to inform future commissioning decisions about PrEP.

PrEP is only one of a range of activities designed to tackle HIV, which is of course a Government priority. It is also important to stress that the challenge remains of tackling high rates of some sexually transmitted infections, particularly in high-risk MSM—men who have sex with men—communities. Our £2.4 million national HIV prevention and sexual health promotion programme gives those at highest risk the best advice to make safer choices about sex.

The UK has world-class treatment services and is already ahead in reaching two of the three UNAIDS goals of ensuring that we have 90% diagnosed infection, 90% of those diagnosed on treatment and 90% viral suppression by 2020. In 2014, 17% of those living with HIV had undiagnosed infection, but 91% of those diagnosed were on treatment, of whom 95% were virally suppressed. We are determined to continue to make real progress to meet these goals, and we are considering carefully the role that PrEP can play in helping us to get there.

[Andrew Gwynne]

I thank the Minister for that reply. This is a subject we do not debate enough in the House, and I am grateful to Mr Speaker for giving us the opportunity to debate it today.

Seventeen people are diagnosed with HIV every day. Each year, there are thousands of new infections. In the UK, there are more people living with HIV than ever before. We know that PrEP has the potential to be a game-changer—it has proved effective in stopping HIV transmission in almost every case—yet as a result of this latest decision, this life-changing drug will remain inaccessible to people at risk of HIV. Does the Minister therefore share my concern about the precedent this decision sets in terms of NHS England shunting other preventive costs on to local government? Will she explain why pre-exposure prophylaxis is being dealt with differently, compared with the correct commissioning model for PEP, or post-exposure prophylaxis?

I want to ask the Minister three specific questions. First, does she accept that, under section 7A of the National Health Service Act 2006—a mechanism by which the Secretary of State can delegate power—the Health Secretary can give NHS England the power to commission PrEP? If so, why has he not done so? Secondly, if the Government expect local authorities to commission PrEP, how much additional funding will the Minister make available to them? Can we assume that there will be no further cuts to public health grants, or is this just a case of passing the responsibility and the financial buck? Thirdly, on the next steps, I understand that key stakeholders, including the National AIDS Trust, have written a joint letter to the Public Health Minister requesting an urgent meeting. Will she today agree to meet them to see whether a way forward can be found without the need for costly, protracted legal action?

PrEP has been described as the beginning of the end for the HIV epidemic. It is time for the Minister to show some leadership, to use the section 7A powers she has and to think again.

[Jane Ellison]

Some of the shadow Minister’s questions are simply ahead of the moment, as it were. As I said clearly in my statement, NHS England has made clear how it feels about being the commissioner, based on a legal argument that it has published. No decision has been made about who the commissioner is. Clearly, we need to reach a decision, and we discussed that earlier today in the Health Committee. However, there are a number of stages we have to go through—as I say, the drug is not even licensed for use as PrEP in the UK.

We have set out a series of stages we will go through, which will help to inform a final decision. On the questions the hon. Gentleman posed, we are not in a position to make a judgment. There is more we need to know about clinical effectiveness and cost-effectiveness and about the pilot—

[Andrew Gwynne]

We know.

[Jane Ellison]

No, that is not the case. There has been an important study—the PROUD study—but that looked at clinical effectiveness. There is a wider piece of work to be done—of which the pilot programme that we have announced is part—to enable us to understand where PrEP fits in in terms of clinical and cost-effectiveness, and how it fits into the HIV prevention landscape more broadly, alongside other HIV interventions that are commissioned. There is work yet to do, but we are not standing still. We have announced this important pilot and committed money to it, and we have asked NICE for an evidence review. All this will go into our consideration.

HPV Vaccinations for MSM

Andrew Gwynne Excerpts

Tuesday 7th June 2016 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I add my congratulations to the hon. Member for Finchley and Golders Green (Mike Freer) on securing this debate, and on the important cross-party work he does in the House on championing the cause of men’s sexual health. I also thank other hon. Members for their contributions.

I understand the importance of the quasi-independent nature of the JCVI, and I do not want to change that, but I believe the Minister has an important duty to the country to ensure that the JCVI operates efficiently and with the right priorities in mind. In that spirit, I have a series of questions to ask her on this important matter, some of which have been covered in the debate. First, I will raise the long delay in the decision on whether all boys should be vaccinated. The JCVI began its assessment on whether boys should be included in the national vaccination programme in 2013. A decision was originally expected last year, but was subsequently rescheduled for 2017. Experts in the field are already convinced that boys should be vaccinated, and I urge the Minister to ask the JCVI to make its recommendation this year, so that implementation can begin as soon as possible.

Secondly, I want briefly to discuss the JCVI’s approach to making the decision. As we have said in other debates in this Chamber, the JCVI is far too constrained in its approach. Its analysis of cost-effectiveness focuses solely on the cost to the NHS and takes no account of social costs, the costs of care or welfare benefits, or the costs to employers and to individuals and families affected, in this case, by HPV-related diseases. For example, 50% of people with mouth cancer never return to work, so there really needs to be a wider assessment.

Thirdly, I would like to raise the issue of the implementation of the vaccination programme for men who have sex with men. The JCVI was right to recommend that men who have sex with men should be offered the vaccine via sexual health clinics, but since the recommendation was made in November last year, no announcement has been made about the implementation.

I asked the Public Health Minister about this matter in a written question last month. She replied that a pilot project was beginning this month, which I was pleased to hear. I would be grateful if she could explain what is being planned and the timetable to which that will happen. We already know that the vaccine works, and I have some fears that this could be an attempt to kick it into the long grass. I hope not and that she can offer some reassurances to Members today. Given the level of risk currently being faced by men who have sex with men because of HPV infection, including not least the very high rate of anal cancer in that group, there is surely a strong case for a national roll-out now so that as many men as possible can be vaccinated without delay.

Fourthly, I am concerned that the UK is in danger of being left behind other countries in its approach to HPV vaccination. As we have heard, Australia, Austria, Canada, Israel, Switzerland and the United States are among those now recommending gender-neutral vaccination. That is now under active consideration in the Republic of Ireland and Norway as well.

If I may, I will make a slightly tangential point. Is the Minister aware of the complaint made to the European Medicines Agency by the Nordic Cochrane Centre about the alleged maladministration of the safety review of the HPV vaccination? If side effects have been ignored or people more susceptible to side effects have been given the vaccine unnecessarily, that is a breach of trust and I expect that she will want to look into the matter.

Finally, I have been asked by HPV Action to announce that a letter from 13 eminent scientists and clinicians in the field of public health has been sent to the Secretary of State for Health, calling on him to ask the JCVI to accelerate its assessment of the vaccination of boys. The signatories include the director of the World Health Organisation collaborating centre for oral cancer, the president of the British Association for Sexual Health and HIV and the vice-president of the Royal College of Surgeons. Their views should carry weight in the corridors of Richmond House and I trust that the Secretary of State will listen very carefully to their points.

I also hope that the Minister has listened to the very valid points that hon. Members have made this afternoon. It has been a short but well informed debate, and I am pleased that we have had the chance, thanks to the application made by the hon. Member for Finchley and Golders Green, to be able to debate this issue in such a timely manner.

Dietary Advice and Childhood Obesity Strategy

Andrew Gwynne Excerpts

Monday 23rd May 2016 Commons Chamber

[Alistair Burt]

I am delighted to welcome the question from my hon. Friend the Member for Bury North—may God bless all who live there. I had a small bet with the Secretary of State on how long it would be before the words “nanny state” were uttered, and I was not disappointed.

My hon. Friend is right to ask the question, and we still want to encourage children to move more and eat less—there is nothing contradictory about that. However, a Government who take children’s health seriously, whether in relation to dentistry, deprivation and the environment, or indeed their physical health, weight and wellbeing, are as entitled to comment on this issue as anyone else. The childhood obesity strategy will not contradict efforts to encourage physical activity, but it will, I hope, have elements that my hon. Friend and everyone in his constituency welcomes.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Obesity, and in particular childhood obesity, is one of the biggest public health challenges facing our country. Today’s report not only questions official Government advice, but says that it may have had disastrous consequences. Whether that is right or wrong is a matter for debate.

Let me start by asking the Minister about today’s report. It makes a number of recommendations, but perhaps the most controversial has been the call to stop recommending the avoidance of foods with a high saturated fat content. I am pleased that the Minister has reaffirmed that he has no plans to review the Government’s official advice in the light of that call, and has also reaffirmed that the evidence on the current dietary advice remains valid, but does he share the views of experts, including the British Heart Foundation, who have today stressed the importance of official guidance being informed by robust evidence, free from interference by industry?

On the childhood obesity strategy, as my right hon. Friend the Member for Leicester East (Keith Vaz) said, in September we were told that it would be published before Christmas. Then at Christmas we were told that it would be published in the new year. In the new year we were told that it would be published in the spring, and now we are told that it will not be published until the summer, so can the Minister explain this delay? May we now have a cast-iron guarantee that the strategy will be published before the House rises for the summer recess, so that Members will have the chance to question Ministers on the contents of that strategy?

We welcome the recent announcement of a sugar levy, but does the Minister agree that alongside action on cost, we need action on advertising and labelling? Perhaps the real cause of rising childhood obesity has been not the Government’s dietary guidance, but their failure to take tough action on the marketing and packaging of unhealthy products. Will the Minister confirm that the strategy will contain comprehensive and co-ordinated action to tackle this growing public health challenge? Some of the best advances in public health have come about because past Ministers have shown leadership and vision, so may I say politely to this Minister: “Enough of the delay. It is now time to act”?

[Alistair Burt]

I am sure the Under-Secretary, my hon. Friend the Member for Battersea, will be able to pick up a number of issues that the hon. Gentleman has raised, but let me respond to some.

First, in relation to the report, as I emphasised by quoting the remarks from Public Health England, any advice that goes into the public domain which is to have credibility and upon which people should want to rely must be fully evidence based and as thoroughly researched as possible. If there is any doubt about that—if the evidence appears to be scant—it is right that such advice should be dismissed as irresponsible. We should continue to urge people to look at far more in-depth studies and internationally accepted views on health, diet and wellbeing. I made that point and I am pleased that the hon. Gentleman agrees.

In relation to the Government’s activity, the childhood obesity strategy will come forward in due course, but it cannot be said that nothing has been done in the meantime. The sugary drinks tax has been taken forward, and I can assure the hon. Gentleman that advertising, labelling and promotion definitely come into the strategy and will be looked at. Having spoken to my right hon. Friend the Secretary of State for Health, I am sure that the intention is to get the report out at a time when the House will be able to consider it. There is little likelihood of the House not having an opportunity to discuss and debate such an important matter, but it is important to get the report right. It is important that it meet exactly the challenges that the hon. Gentleman made from across the Dispatch Box. If it is not seen to be thorough, well researched and well evidenced, it will fall foul of the concerns raised by the irresponsible report today. I am grateful for his support. The outcome is something we all want to see, and I can assure him that my hon. Friend the Minister will be studying his remarks carefully.

Oral Answers to Questions

Andrew Gwynne Excerpts

Tuesday 10th May 2016 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right to draw attention to what is, in a way, the most fundamental point of the five year forward view, which is getting care to people earlier to help them live healthily and happily at home. Perhaps the most significant announcement we have had in the past few weeks has been the extra £2.6 billion a year that will be invested by the end of the Parliament in general practice. That is a 14% increase that will allow us to recruit many more GPs and, I hope, dramatically improve care for her constituents and others.

[Andrew Gwynne (Denton and Reddish) (Lab)]

Yesterday the Health Secretary admitted to the Health Committee that “we didn’t protect the entire health budget” in the last comprehensive spending review. I am pleased that he appears to have adopted a bit of straight-talking, honest politics, so in that spirit will he now admit that the very real cuts to public health budgets over the next few years will make it harder to deliver the “radical upgrade” in public health that his five year forward view called for?

[Mr Hunt]

In the spirit of straight talking and honesty, which I think is an excellent thing, perhaps the hon. Gentleman might concede that those cuts and efficiencies that he is talking about would have been a great deal more if we had followed Labour’s spending plans—that is, £5.5 billion less for the NHS than this Government promised, on the back of a strong economy.

North East Ambulance Service

Andrew Gwynne Excerpts

Wednesday 4th May 2016 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Bailey. I congratulate my hon. Friend the Member for Washington and Sunderland West (Mrs Hodgson) on securing this very important debate and on the eloquent way she made the case for her constituents, as have other right hon. and hon. Members for their constituents. People deserve a better service from the North East Ambulance Service.

I join other Members in praising the dedication and commitment shown by the thousands of paramedics who work in the NHS today. They are the best the NHS has to offer and they work under incredibly difficult circumstances delivering life-saving treatment. I add my thanks for the service they provide to us and to all our constituents every day of the week. Although ambulance services continue to deliver a good service for most, as we have heard today, they do not do so for everyone and the service is patchy across the country.

Members have spoken in detail this afternoon about the difficulties facing the North East Ambulance Service and the poor care that many patients have received from it. Over the past few years, the North East Ambulance Service has seen a dramatic deterioration in its performance against national response time standards. Between June 2012 and March 2013, the trust responded to 77% of the most serious emergency calls within eight minutes but, three years later, only 70% of ambulances were arriving within eight minutes. That is compared with the national target of 75%. The decline in standards is even worse for other emergency calls: that figure has fallen from 77% to 62%.

Behind each of these statistics are seriously ill patients and tragic stories of failed care. I hope that my hon. Friend will allow me to say that, when researching this matter, I was deeply shocked to read about an elderly man in her constituency who was told in December that he faced a five-hour wait for an ambulance after collapsing from a suspected stroke—a five-hour wait for an ambulance on the street in the middle of December. That is not what we should expect for our loved ones from our NHS.

When the Minister responds, I hope she will set out what actions the Department of Health is taking to prevent such incidents from ever happening again. The sad truth is that that decline in performance is not restricted to the north-east. The House of Commons Library has forecast that this year only three trusts in the whole of England will meet the national performance target for responding to emergency calls. The service in England has met the target only twice during the past 12 months, and more than 45,000 seriously ill patients have had to wait longer than eight minutes for an ambulance to arrive.

That is a worrying decline in performance. Too many people are being failed by the system and services are starting to fray at the edges. What does the Minister intend to do to improve the quality of care provided by ambulance trusts in England? What conversations has she or her colleagues in the Department had with NHS England about the performance of this ambulance service? What assessment is the Department making of the impact the decline in standards is having on the rest of the NHS in this region?

As we have heard, the truth is that that decline in performance is a symptom of a system that is at breaking point. All aspects of emergency care, from ambulance services to A&E departments, are struggling. In February, A&E departments in England reported their worse performance on record, with just 88% of patients being treated within four hours, compared with a target of 95%. During that period, every hospital in the north-east missed its A&E target and one in 10 patients had to wait more than four hours in A&E before receiving treatment.

Dr Cliff Mann, president of the Royal College of Emergency Medicine, told a national newspaper the month before last:

“The pressures have become unrelenting. In recent days I’ve been contacted by a number of senior doctors, medical directors, high-level people, who are saying the situation now is like nothing they’ve seen before…My own hospital had the busiest day I had ever experienced two weeks ago—these are situations where every time you turn round, there are another four ambulances queueing.”

Those are worrying reports. I ask the Minister to address some of the concerns raised by Dr Mann and to say whether she believes that they are isolated incidents or whether those pressures have become the norm in our NHS.

The North East Ambulance Service’s board has acknowledged that the decline in A&E services has had an impact on its performance. The trust’s most recent board paper said that there were 59% more handover delays of more than one hour in the first quarter of 2015-16 compared with the previous year and 60% more delays of more than two hours. The reality is that too often ambulance crews with vulnerable patients have to wait outside A&E departments because hospitals just do not have the space to admit them. I hope that, when the Minister responds, she will offer an explanation for that decline in A&E performance and explain how she will help trusts to turn the situation around, because A&E is struggling and in need of help.

Staff shortages are also a key factor contributing to the challenges facing the North East Ambulance Service. The region currently reports 15% vacancy rates for paramedics, which puts added pressure on existing staff. Local unions have warned that nine in 10 north-east ambulance staff are suffering from work-related stress due to excessive hours and staff shortages. Across England, the recent NHS staff survey found that almost half of ambulance staff felt unwell as a result of work-related stress and one quarter say that their employer does not take positive action on health and wellbeing.

It is clear that not enough is being done to support ambulance staff, and that is bad for patient care. Unhealthy staff mean unhealthy patients, and we cannot allow that situation to continue in the north-east or elsewhere in England. I therefore ask the Minister what steps her Department is taking to address staff shortages in the ambulance services in the north-east and across the country. Does she agree that more needs to be done to support the health and wellbeing of front-line paramedics?

It is clear from the speeches that we have heard today that this trust is struggling against a number of key performance indicators that are widely available. I hope that, when the Minister responds, she will agree that patients in the north-east deserve better than that. I hope that she will also agree that we cannot allow that dramatic decline in performance to continue and that something has to be done to stem the tide.

Meningitis B Vaccine

Andrew Gwynne Excerpts

Monday 25th April 2016 Westminster Hall

[Andrew Gwynne (Denton and Reddish) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies, as it was to serve under that of Mr Pritchard earlier. I pay tribute to the hon. Member for Bath (Ben Howlett) for opening the debate in such an eloquent and detailed fashion. The way he set out the terms of the debate is a credit to the petitioners, and we have heard a set of powerful contributions from right across the Chamber.

A week ago, I said that the Petitions Committee debate on brain tumour research was a credit to the way in which the House of Commons operates. That has followed through to this week’s debate. I thank my hon. Friend the Member for Walsall North (Mr Winnick) and the hon. Members for Foyle (Mark Durkan), for Faversham and Mid Kent (Helen Whately), for Erewash (Maggie Throup), for Bury North (Mr Nuttall), for The Cotswolds (Geoffrey Clifton-Brown), for North Devon (Peter Heaton-Jones), and for Arfon (Hywel Williams), as well as the Chair of the Health Committee, the hon. Member for Totnes (Dr Wollaston), and the hon. Member for Central Ayrshire (Dr Whitford), who leads on health for the Scottish National party. It is always a pleasure to follow her expertise on such matters. Mainly, I congratulate all 823,000 petitioners for the enormousness of their campaign, which led to the petition becoming, I think, the most popular e-petition so far. This is a huge issue for so many families affected by the disease.

The impact of meningitis B is felt long after initial contraction, and about one in 10 suffering from it will die. According to research published in The Lancet, one in three survivors will be left with lifelong disability. There is, necessarily, a huge cost to society and the individual when people are left without the ability to lead a normal life. Considering that there is a possibility of tackling the disease with just one vaccine, the issue deserves our undivided attention. Some hon. Members who are regulars in debates on health will know that I am always banging the drum for prevention, and I am not the only one. Simon Stevens, in his “Five Year Forward View”, identifies £5 billion of savings later in the review period that could be made as a direct consequence of prevention early on in that five-year forward view. Meningitis B is one instance where the case for prevention is very strong indeed. The ongoing cost to the NHS of a patient who survives meningitis can run into millions of pounds in the worst cases.

The UK is leading the world in the fight against meningitis. Our immunisation and surveillance programmes are world-class, and everybody involved in them should be proud of the lives that have been saved and the lifelong disabilities that have been prevented over the years. However, as I will explain, we still have a long way to go. The joint work of the Petitions Committee and the Health Committee has been instrumental in really getting to the bottom of an issue that has been trundling along for far too long.

The notion of Committees taking evidence on matters raised in e-petitions is quite new, and it is right that scrutiny work is guided by the public. That was recognised by my hon. Friend the Member for Warrington North (Helen Jones), who chairs the Petitions Committee. That the Petitions Committee is proactive with other Committees of the House will be of great importance for the future work of not just the Petitions Committee, but the other Select Committees of the House of Commons. I hope that in this instance, this work will be of some comfort to the many hundreds of thousands of people across the country who are signing petitions on a variety of issues. Indeed, I checked just before the debate and 1,240 people in my constituency signed the petition before it closed. Almost exactly the same number signed it in the constituency of the Chair of the Petitions Committee, and a similar number—1,311—signed it in the constituency of the hon. Member for Bath. I am sure that the Minister appreciates the depth of feeling on the matter right across the country.

I will get into the detail, because the debate is not as clearcut as many of us would like. Indeed, very few issues in health are simple. There is always more than one side to consider, and I appreciate the merits of the Government’s case. The Minister will argue that the Government are rightly following the recommendations of the JCVI, which the Opposition agree is correct in principle, but not, having looked at this in a bit more detail, necessarily in this instance. As we have already heard, the JCVI recommended an adolescent carriage study—this was more than two years ago—to determine what bacteria young people are carrying, and my understanding is that that study has not yet started. It takes a considerable amount of time for such a study to collect usable data, so will the Minister confirm that the funding needed to carry out the study will be made available? I have seen a reasonable timetable for the work set out by Meningitis Now and the Meningitis Research Foundation. If the Department of Health will not be following that timetable, will the Minister confirm when an adolescent carriage study will begin? Has she ensured that there are sufficient supplies of the vaccine to carry out the study?

Health economics, which other Members have mentioned, frustrates me a little because there is a bit of guess-ology, or a wet finger in the air, to it. Unless the lifetime cost and benefits of, and all the associated issues with, a particular drug can be assessed, it is difficult to assess the true costs and benefits of a particular treatment. I do not think that lifetime costs are adequately considered when looking at the cost-effectiveness of drugs and treatments. Indeed, that point was raised in the Procedure Committee’s final evidence session. Professor Andrew Pollard, chair of the JCVI, suggested that the JCVI was concerned that it “might be underestimating” the lifetime costs—that point was eloquently put today by the hon. Member for The Cotswolds. Dr Mary Ramsay, head of immunisation, hepatitis and blood safety at Public Health England, pointed out that social costs, such as out-of-pocket expenses, are excluded from the JCVI formula. Likewise, as we have heard from the hon. Member for Central Ayrshire, the peace-of-mind benefits are difficult to measure, but they are also left out of the formula.

Will the Minister assure Members here today that the working group has considered how to reform the JCVI framework so that some of the health gains for children are adequately represented, and so that prevention is prioritised in the formula? I understand that the JCVI agreed to review the impact of the vaccination programme within two years of its decision. I hope that, in light of the exceptionally strong public interest in this issue, the JCVI will, as part of that review, reassess the case for extending the vaccination to all children. The current cost-effectiveness framework used to assess vaccines tends to be a little unfair when it comes to relatively rare but severe diseases in children, and I accept that changes to those procedures do not come quickly, but that is no excuse for the unnecessary and bureaucratic delays that we saw in the introduction of the vaccine for the under-ones. I hope to see promising results this autumn, showing that the vaccine works in a mainstream programme.

Finally, if the JCVI were to make a recommendation to extend the reach of the meningitis B vaccine, I would not hesitate strongly to encourage Ministers to extend the vaccination’s coverage at the earliest opportunity. The principle of quasi-independence for the JCVI is important, and it should be defended, as we have heard from other hon. Members today, but that is not to say that its procedures and remit should not be continually re-evaluated to ensure that it takes the right factors into account. I hope the Minister will listen extremely carefully to all the arguments that have been raised on both sides of the Chamber in this debate and will see the strength of public opinion on this issue as genuine and real. Given that she has a considerable amount of time in which to respond, I am sure that we will get a thorough and full reply to all the questions put by hon. Members today. I am sure that the petitioners watching the debate, both here and through online forums, will be interested in what she has to say.