The National Health Service
Ann Clwyd Excerpts(4 years, 6 months ago)
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Ann Clwyd (Cynon Valley) (Lab)
Madam Deputy Speaker, you were in the Chair when I was granted an Adjournment debate by Mr Speaker on a subject which I will discuss again today. I was a patient at the time and I came out of hospital to speak.
I have a very long involvement with the health service. I sat on a royal commission on the NHS, having been appointed by Barbara Castle 40 years ago. For me, it is incredible, 40 years on, to still hear the same arguments over and over again. I wish the Health Secretary was in his place. I enjoyed writing a report on hospital complaints in England for the Department of Health when David Cameron was Prime Minister. I was very much hoping to get assurances today that the recommendations we made then have all been acted on. I do not believe that they have been.
I was also on the Welsh hospital board many years ago with Aneurin Bevan’s sister. It is quite useful to have people in this place who are a bit older, who have long memories and who can remember what has been said and done and promised. I remember going to the United States, talking to health professionals there and realising that two thirds of all personal bankruptcies in the US were because of inadequate health insurance. I think that that was still the case when I last checked. I very much hope that that does not become the norm in this country.
As a recent patient, I would like to thank everybody in the English health service and the Welsh health service for their care, because I would not be here today were it not for them.
Gerald Jones (Merthyr Tydfil and Rhymney) (Lab)
Would my right hon. Friend like to pay tribute to the NHS in Wales? As my constituency neighbour, I am sure she appreciates all the good work done in Wales.
Ann Clwyd
I have been a critic of the health service in Wales, as my colleagues know, but I am also an admirer of much of the good work it carries out, particularly in my hon. Friend’s constituency at the Prince Charles hospital in Merthyr Tydfil and at University Hospital Llandough in Cardiff, where I apparently almost died in August. I am grateful to be alive, and I thank all the doctors and nurses involved.
Over 200,000 people in Britain suffer from venous leg ulcers, a form of chronic wound. It is highly painful, I can tell you, and socially isolating. For most, treatment involves managing the symptom—the ulcer—rather than addressing the underlying cause, yet proven surgical interventions are available to treat this underlying condition. Clinical guidance is comprehensive, but the evidence shows that local-level implementation is extremely patchy.
The UK spends between £940 million and £1.3 billion every year managing venous leg ulcers. Most of that comes from the need for community nurse visits to support patients in managing their conditions. Seventy-five per cent. of costs alone can be attributed to community nursing, placing a huge strain on community care, yet evidence shows that where clinically appropriate, a surgical intervention approach is cost-neutral in year one, and that is what I would like to hear about from the Secretary of State.
While early intervention incurs high initial costs, these are quickly offset by lower one-year community nursing costs. The issue is that most cases are simply never referred to a specialist vascular service. Seventy-five per cent. of venous leg ulcers do not receive a comprehensive vascular assessment, as enshrined in National Institute for Health and Care Excellence guidance. Sixty-four per cent. of clinical commissioning groups’ commissioning policies were found to be non-compliant with NICE guidelines for the treatment of the problems responsible for venous leg ulcers.
The opportunity to provide cost-neutral treatment, proven to heal ulcers faster and help to prevent recurrence, is missed, causing unnecessary pain and suffering for thousands. I can tell the House that it is the most painful thing that has ever happened to me. I know many, many people who are living in this pain now. How can we ensure that primary and secondary care providers, commissioners and local authorities are brought together, made aware of the benefits and able to deliver early intervention in venous leg ulcers? Quite simply, it will save NHS funds and save the suffering of so many people.
Lower Limb Wound Care
Ann Clwyd Excerpts(4 years, 9 months ago)
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Ann Clwyd (Cynon Valley) (Lab)
As you know, Madam Deputy Speaker, I do not normally sit when I speak in this place, but half an hour ago I was in a hospital bed on the 12th floor of St Thomas’s when I heard that this debate was coming early, rather than later. There was a big rush to get me here, and there are very good doctors and nurses in the Gallery who helped me to get here, because I thought it was tremendously important to speak. I had secured this debate, for which I am very grateful, and I particularly wanted to talk on this subject. I was pleased to get it before the recess, and I was not going to miss it for anything. After we finish, I shall be returning, I hope, to the 12th floor of St Thomas’s and to very good care.
The subject of this debate was brought to my attention by Lord Hunt, our colleague in the House of Lords, where they had a debate not long ago about what plans the Government have to develop a strategy for improving the standards of wound care in the NHS. As somebody who needs wound care right at this moment, I know what a big subject it is. I did not know before—I was totally ignorant—but I have discovered what a challenging subject it is for so many people.
As a patient myself, I can talk about the subject with some feeling. I have to say that it is the most painful thing I have ever come across, and I had no idea that people suffered this kind of pain. A week ago, when I had to be taken to a local hospital in Merthyr Tydfil, I was asked by an ambulance driver what level of pain I was in, on a scale of one to 10, and I said, “Nine.” I do not usually exaggerate; it was that painful. I am grateful to everybody who has helped me, and I want to make sure that the service develops and people get all the help they need in such circumstances.
Jim Shannon (Strangford) (DUP)
I congratulate the right hon. Member for Cynon Valley (Ann Clwyd) on securing the debate. She often features in Adjournment debates in this House. We are very pleased to see her in her place, and we thank her for all that she does. Does she agree that many people fear that the NHS neglects leg ulcers and the required treatment is not being given? The latest statistics, according to Dr Adderley’s speech at the Health Service Journal patient safety congress, show that leg ulcers account for 40% of chronic wounds but only 7% of the chronic wounds that are treated. There is quite clearly an anomaly.
Ann Clwyd
I am grateful to the hon. Gentleman for making my speech for me. I am sure we will be in total agreement as my speech develops.
Some interesting points were made during the debate in the other place, including the point that wound care is a massive challenge to the NHS, but it currently lacks priority, investment and direction. I want to push the Government, if they need pushing, on the need for urgent action and the development of a strategy across care providers to improve the standard of wound care.
A staggering 2 million patients are treated for wounds every year, at a cost of more than £5 billion and rising. While 60% of all wounds heal within a year, a huge resource has to be committed to managing untreated wounds. The NHS response is very variable. Healing takes far too long; diagnosis is not good enough; and inadequate commissioning of services by clinical commissioning groups compounds the problem, with under-trained staff and a lack of suitable dressings and bandages.
There has also been a very worrying drop in the number of district nurses, whose role in ensuring safe and effective wound care in the community is crucial. I was shocked when I talked to a friend in Cardiff about the problem of putting on surgical stockings, and her experience highlights the need for district nurses. My friend had had a serious operation, and she could not bend to pull on the stockings. I asked her what she did, because she is a widow who lives on her own. She said, “I go out in the street and ask somebody to help me.” I am sure that people are very ready to help, but no one should be in that situation. I think we would all agree that the drop in the number of district nurses is very worrying.
I am told that, ideally, 70% of venous leg ulcerations should heal within 12 to 16 weeks, and 98% in 24 weeks. In reality, however, research shows that healing rates at six months have been reported as low as 9%, with infection rates as high as 58%. Patients suffer, and the cost of not healing wounds swiftly and effectively can lead to more serious health problems, such as sepsis, which is often the result of an infected injury. We also know that foot ulcers on diabetics can unfortunately lead to amputations if they are not dealt with properly.
In the other place they talked about the Bradford study, and there is a very good summary of it in the House of Lords Library. It underlines the importance of evidence-based care, with nearly one third of patients interviewed in the study failing to receive an accurate diagnosis for their wound. As the study puts it:
“Wound care should be seen as a specialist segment of healthcare that requires clinicians with specialist training to diagnose and manage…There is no doubt that better diagnosis and treatment and effective prevention of wound complications would help minimise treatment costs”.
We learn most of all from our own experience. My experience is that when I first developed a farthing-sized spot on my leg, I did not know what it was. I asked my chiropodist, who looked at it a few times and said, “I think you had better go and see your GP.” I went to see my GP—a very good GP—who did not know what it was either. Eventually, I was referred to a skin specialist—this is some weeks ago, now—who looked at it and said, “I don’t know what it is, but why don’t you try putting Vaseline on it?” Now, I do not think the experts up there in the Gallery would think that that was a very good idea, but I did put Vaseline on it and I do not know whether that did me any harm or not. You do worry a lot when something like that happens, whether you have knocked your leg or injured yourself in some other way, and you wonder what on earth it could be.
I think that maybe diagnosis is difficult, but rapid diagnosis is absolutely essential. I am sure the Government would agree that we need to get to grips with a nationally driven strategy. Without it, patients will receive worse care for their injuries and the financial burden on other parts of the NHS will continue to increase, because patients develop chronic wounds or catch an infection that could lead to life-threatening illness.
During the course of my journey, I have met many interesting people. For instance, I did not know there was an all-party group on vascular and venous disease. I just happened to see it in the all-party notices the day after I had been in St Thomas’s. I rang up the chair, the hon. Member for St Ives (Derek Thomas), and asked him if I could come along to a meeting. He said that I was welcome to. I went along and, apart from the chair, I think I was the only MP there. There was a fascinating mixture of people, who were all involved in this problem in some way.
There was somebody who runs a leg clinic, who had a lot of stories to tell. In fact, she sent me a whole pile of patient stories—there is not time to read them out today, but they are very interesting. I realised how difficult it is for patients to get the right diagnosis and the right treatment. I took a list of all the people—they are mainly consultants—and I know that some people in St Thomas’s would have come along if they had known of the existence of such a group. It introduced me to the Lindsay Leg Club Foundation, which is run by Ellie Lindsay OBE, who is the president. There are leg clubs in many towns and cities around the country. She was very encouraging—I say that as somebody who was a bit afraid when they realised what they had. She rang me up several times, and her patient stories were fascinating.
Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)
I am listening with great interest to what the right hon. Lady is saying, not least because this is an important debate on something that we do not talk about as much as we should in this place. Am I picking up correctly what she is saying on patient experience? Is she saying that we should encourage patients who have been through this transition and experience to share that experience with others in order to make other potential patients more aware of what might be out there and what they could do?
Ann Clwyd
Yes. That is a very positive idea. People need to talk to one another, particularly in this House because of the age differences. A lot of people talk about this in the other House, because on the whole they are much older than we are—except for me in this place; I am pretty old. I am just surprised that I had never heard of this before. Talking encourages people when they have discovered that they have this problem to seek the right advice.
Jamie Stone
Can I make absolutely sure that I understand this? By age difference, the right hon. Lady means people of my age—I am considerably older than some hon. Members—sharing experiences with people who are younger and might need to know these things. Is that correct?
Jamie Stone
Is this about the older generation, who might have had some experience in this regard, sharing experiences so that the younger generation—considerably younger than I am—might know the potential of what they will look at or deal with in future?
Ann Clwyd
Yes. I am very glad that there is an all-party group, for example, because it is important that such groups exist. I have seen the work that has gone on there over several months. As the hon. Gentleman knows, there are dozens and dozens of all-party groups in this place—I am sure that we do not know of the existence of most of them, but it is good to draw attention to this one.
Another person I met was Professor Julian Guest, who is a health economics consultant. People are very good at sending information. He sent me a list of things that, as a health economist, he has been working on. He says that wound care requires
“a change in its service delivery model that could include…Enhanced support for safe self-care (possibly by integration with local pharmacy support and supervision)…Improved diagnostic support underpinned by increased training and education of non-specialist nurses in the fundamentals of wound management…Consistent and integrated progressive care pathway with agreed defined trigger points for senior involvement and onward referral for investigation and differential diagnosis and a shared management plan to be implemented regardless of care setting…Establishment of dedicated wound care clinics in the community, possibly in general practices.”
So there are several papers by people working in this area who are thinking deeply about it.
I heard from consultants at St Thomas’s about an excellent development called the Camden Health Improvement Practice pilot wound clinic. Dr Geraghty, who runs it, is working on wound care for people who are sleeping rough—for the homeless. I think everybody would applaud that as a very necessary and useful thing to do, and we look forward to hearing more about it. I am looking at the clock, and there is not much time left, but I hope the Minister will respond on this issue, because when I think of the pain inflicted on people—luckily, my pain is managed, but the pain of the homeless, for example, who are sleeping rough on the streets, is not generally being managed—it is clear that this Camden project is a very welcome development.
I had a new knee about a year ago, which is not a pleasant thing to have done. However, I have known nothing as painful as this leg wound, and I am grateful that so many good people are working in this area and highlighting its importance. It is probably not as glamorous as others in the health service, but it is absolutely necessary for people’s wellbeing, comfort and health, and I hope we can do a lot more to support people in this area, to support new initiatives and to assist the doctors, nurses and other practitioners who do such an excellent job.
I am out on parole, Madam Deputy Speaker. I will, I hope, be returning to my bed in St Thomas’s before too long, and I hope to come back after the recess with very positive views and a continuing interest in the whole subject of wound care in the NHS.
The Minister for Care (Caroline Dinenage)
It has sometimes been said that MPs in this House speak about things they do not know about, and sometimes MPs speak about things about which they have only a little experience, but I do not think I have ever had the honour of responding to a debate where a Member has spoken with so much current, relevant experience. I must congratulate the right hon. Member for Cynon Valley (Ann Clwyd)—
Interim NHS People Plan
Ann Clwyd Excerpts(4 years, 11 months ago)
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Stephen Hammond
I thank my hon. Friend for that question. The Department will launch the consultation at the end of this month. It will set out the proposals, which we spoke about yesterday, to introduce greater pension flexibility. They are designed to take away the disincentives not only for senior clinicians but clearly for GPs. That consultation will last for the normal length of time, and I hope we will be able to proceed quickly thereafter.
Ann Clwyd (Cynon Valley) (Lab)
When I came to Parliament 35 years ago, I had served for three years on the royal commission on the NHS. We made many recommendations. When I hear the Minister talk about things that will be done and say that notice has been taken of reports, I am reminded that that report landed on Margaret Thatcher’s desk. The recommendations that we made were never carried out. One was about the shortage of doctors. Thirty-five years ago, we knew that there would be a shortage of doctors. We made many other important points, which should have been acted on. What assurances can the Minister give so that on this occasion the recommendations in the report will be acted on? What is the point of all these words and all this work done by people on things such as royal commissions unless the Government take action?
Stephen Hammond
The Government are taking action specifically on the points that the right hon. Lady made. We committed to increase the number of undergraduate medical school places by 1,500, and 630 are already in place.
Licensing of Medical Devices
Ann Clwyd Excerpts(5 years, 2 months ago)
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Owen Smith
Yes, I absolutely agree. There are many instances of similar mis-selling of these products to women. We need to examine the relationship between the doctors who are selling or marketing these products to their patients and the companies that develop them. Some have an interest in those companies, and others are getting a money benefit through doing this in the private sector. All these things desperately need to be looked at.
The terrible truth is that the surgical mesh scandal that is unfolding is just one of the scandals relating to medical devices. We had the metal-on-metal hip joint scandal, with metallosis poisoning people’s bodies. We had the scandal of textured PIP breast implants poisoning women’s bodies. Those implants are now connected with increased incidences of cancer. We had spine-straightening devices for children that were only ever tested on corpses. We had pacemakers such as the Nanostim, which was designed to sit inside the heart and work for up to 19 years. It has now been removed from the market because the batteries started to break down and cease to work and, worse, it was giving people electric shocks. The devices are now being cut out of people. Between 2015 and 2018, UK regulators alone received reports of 64,000 adverse events involving medical devices. A third of those incidents resulted in serious medical repercussions for patients, and 1,004 resulted in death.
Ann Clwyd (Cynon Valley) (Lab)
I would like to pay tribute to the tremendous work that my hon. Friend has done on mesh. Quite a number of people in my constituency have suffered as a result of the use of mesh, and they are extremely grateful for the work that he has been doing. About 20 years ago, we had the scandal of silicone implants, and someone in my constituency had a double mastectomy because the silicone had leaked inside her body. These problems are still happening. We set up a register, but suddenly the register disappeared. I am glad that my hon. Friend has made a point about the register and asked for the Minister’s commitment on this.
Owen Smith
I am grateful to my right hon. Friend for her kind words. She is completely right to say that there are devices on the market here and across the world that are still causing grave medical problems for patients. The question we have to ask is: how did these things get on to the market in the first place? How have we got so many of these devices that are causing such significant problems? The common problem that unites mesh with all the other device scandals in our country and across the globe is the weakness of the regulatory system in the UK, in the EU and, to a lesser extent, in America, where the pathway for testing approval, marketing and surveillance of such devices just is not good enough.
How does the system work? It will shock people to hear that we do not have a central body that is responsible for checking out, authorising and licensing devices in the same way as for medicines. If a company in the UK wants to create a new prosthetic hip joint, it does so and then it shops around among a group of what are called notified bodies. These are effectively commercial organisations that are in turn licensed by the MHRA to be a body that checks safety and efficacy through the clinical data provided by the companies and then gives them their conformité Européenne—their EU kitemark. Once a company has received that mark, the device can be sold all across the EU.
Companies do not need clinical trial data in order to substantiate their claims that devices are efficacious and safe. Quite often—this is true of a remarkable proportion of the devices on the market—they do not even have to undertake first-hand clinical evaluations themselves and can rely on being follow-on products that go through a regulatory pathway that is termed as being “substantially equivalent” to the products that have gone before. For instance, there are examples of mesh on the market now that are the 61st iteration of an original licensed mesh that is no longer on the market because it was proven to be dangerous. There is no real mandatory post-marketing surveillance of these devices.
Given that the difficulty of randomised control trials versus placebo for a device—someone cannot put a wooden heart into one patient and a pacemaker into another in order to see which one works—means that there will be a degree of risk in testing such things in the real world, one would think that we would have a system that would test how devices are doing in the real world and get companies or the Government to monitor them, but we do not, which is in stark contrast to the regime for medicines. Changes are coming into effect, however. A new medical devices regulation was launched across the EU in 2017 and will come into effect in May 2020. It was introduced with the acknowledgement of many of the problems that I have highlighted.
Oral Answers to Questions
Ann Clwyd Excerpts(5 years, 9 months ago)
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Matt Hancock
How could I say no? The integration of health and social care is vital and long awaited, and there is so much to do.
Ann Clwyd (Cynon Valley) (Lab)
As someone who is about to have a knee operation, may I tell the Secretary of State that it is a painful thing to wait for and that people should not have to stay on waiting lists for long periods of time? My question is about hospital medical staff. Western Mail carried out a survey to look at the effect of EU nationals leaving the national health service because of Brexit. It found one health board saying that there were 1,200 more nurses than there were four years ago, and another saying that there were 1,400 fewer. No one seems to be able to tell us with absolute certainty the numbers of these staff in the health service.
Matt Hancock
I listened carefully to the right hon. Lady because she has long been a campaigner on health issues, and I very much take her point about knee operations. Of course, the number of EU nationals working in the NHS in England has risen by over 4,000 since the referendum. I know that there are concerns in specific areas, but I hope that we can all take reassurance from the fact that that number has continued to rise. We are determined to ensure that the NHS has the workforce that it needs.
Breast Cancer Screening
Ann Clwyd Excerpts(5 years, 12 months ago)
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Mr Hunt
According to the advice that I have received so far, there is no read-across to other screening programmes, but obviously the independent review panel will look into that as it seeks to examine all aspects of the issue. We have made the commitment today that we will invite for scans all those who either should be scanned or should consider whether they wish to have a scan, and will offer them a date before the end of October, although we hope that in the vast majority of cases it will be much sooner than that.
Ann Clwyd (Cynon Valley) (Lab)
What conversations has the Secretary of State had with the Welsh Secretary? Having long since passed the ages he mentioned, I certainly was never invited for a screening; I had to ask for one, and I eventually got the screening in England.
Mr Hunt
We have not had conversations at ministerial level, but we have had conversations at official level. The Welsh Administration do not believe this problem has affected them, even though Wales was using the same IT system we were using in England. Our concern is about people living in England who are registered with a Welsh GP or people living in Wales registered with an English GP. That is why we are having constructive discussions to share IT information and make sure everyone in England or Wales registered with a GP will get that letter.
To respond to the earlier question about what people should do now, anyone is free to call the helpline number, which will be made public today, but we are hoping to get the letters out as quickly as possible over the next four weeks, during the month of May, so that everyone can be pretty confident that they are okay if they have not received one of those letters.
Southern Health NHS Foundation Trust
Ann Clwyd Excerpts(7 years, 12 months ago)
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Mr Speaker
I just note in passing that four Members on the Opposition Benches are standing and none of them hails from the area covered by the trust. That does not preclude a question, but I should just make the point that the question must be about this trust and this set of circumstances, rather than, as is commonly deployed in this House, “and elsewhere”. It is just about this matter, in this situation, covered by this trust—a matter that will be approached with great dexterity, I am sure, by Ann Clwyd.
Ann Clwyd (Cynon Valley) (Lab)
I will attempt that, Mr Speaker. I just want to ask the following: how long does it take to effect change? Some 45 years ago, the Ely hospital inquiry took place, under the chairmanship of Geoffrey Howe, and recommendations were made. I took part, writing a report on the condition of mental health facilities throughout Wales. We are talking about some 45 years here, and it seems to me that things are going at such a slow pace that we will be asking the same question again in 45 years’ time.
Alistair Burt
The frustration in the NHS is that although what the right hon. Lady says is not true in some places, it is in others; the special measures process in effect at the moment has effected change and has done so more quickly. There are other places where that does not happen. I am concerned that in mental health the sense of defensiveness which we know has characterised parts of the NHS for too long has probably had too great a grip, and we have not always got things done more quickly or demanded that things are done with the degree of urgency that we would expect, on behalf of constituents. I am very determined that any difficulties in getting things done locally in trusts when they need to be done will not be aided or abetted by any lack of urgency in the Department or the upper reaches of the NHS with which we have contact. The concern to make sure that urgency is there is rightfully expressed by the House, and we have to see that that is delivered.
Health and Social Care
Ann Clwyd Excerpts(8 years, 11 months ago)
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Ann Clwyd (Cynon Valley) (Lab)
As I, too, come from the Vale of Clwyd, I welcome the hon. Member for Vale of Clwyd (James Davies). I am only sorry that he had to depose Chris Ruane, who was a colleague of mine, and I am sorry for the reasons that he was deposed, but I welcome the hon. Gentleman nevertheless. I fought that constituency myself in 1970, when there was a 25,000 Conservative majority, which is now much decreased but, of course, the boundaries have changed.
I shall speak today specifically about one aspect of health—the regulation of cosmetic surgery. Some 20 years ago I got a letter from a constituent of mine who had had a double mastectomy. That was because of silicone implants which had erupted inside her body. As a result of that we set up an organisation called SOS—Survivors of Silicone. If more attention had been paid to some of our findings at that time, we might not have had the PIP scandal which followed all too quickly.
I introduced a ten-minute rule Bill on the regulation of cosmetic surgery in 1994 and again in 2012, which shows that one must be persistent in this place. The Bill generated huge publicity and loads of letters. Unfortunately, despite calls from a wide range of organisations, not enough has changed since the mid-1990s. As a result, thousands of women, and men now, have continued to face the horrific consequences of unregulated cosmetic surgery.
I had a letter the other day from somebody who wrote:
“I think the operating table was a dental chair”,
describing her experience of liposculpture in a London clinic. She continued:
“They asked me to turn over onto my stomach, but the chair was the wrong shape and it was very difficult. At some stage during the operation I woke up. I was in tremendous pain and began screaming. They were still taking fat from my legs. The doctor told me afterwards that he had to continue with me awake or my legs would have been uneven.”
It turned out subsequently that the so-called cosmetic surgeon was a general practitioner. He had performed a surgical operation without any surgical training and had administered a general anaesthetic without an anaesthetist.
I read recently about a writer who has been left with blurred vision from botched laser eye surgery at a private clinic. After a five-year battle she has finally received £250,000 compensation, but has permanent scarring of her eyes. Such incidents are, sadly, only too common. The pressure on women and now also on men is considerable. Most of us want to change something about ourselves. Huge pressure is put on women in particular to change their looks. Private sector clinics offer a multitude of cosmetic procedures to achieve the perfect shape and a wrinkle-free face. “Too old, too thin, too fat, never just right”—that is the message. Cosmetic surgery, including breast implants, continues to be a growing industry.
In 2014 members of the British Association of Aesthetic Plastic Surgeons conducted over 45,000 surgical procedures. Between 2002 and 2011 the number of boob jobs rose by 324%. Facelifts, tummy tucks and nose jobs are still popular. Plastic surgeons also operated on over 4,000 men, with nose jobs and man-boob jobs the most popular procedures. Many people face exploitation by private sector clinics and even cowboy surgeons if they are unable to receive treatment through the NHS. Most of the botched surgery or mistakes are then rectified by the NHS, as we have seen with the removal of PIP implants.
“In no other area of medicine is there such an unregulated mess. Imagine a ‘2-for-l’ advert for general surgery”,
as appeared in the paper recently.
“That way lies madness,”
said a former president of the British Association of Aesthetic Plastic Surgeons. In one newspaper recently there was a piece headed “Plastic surgeons offer ‘buy one get one free’ deals on breast enlargements” and other jobs.
The Royal College of Surgeons has issued a statement criticising the Government for not including greater regulation in the Queen’s speech. The RCS said:
“We were disappointed that the Government chose not to introduce legislation to reform the regulation of health professionals.”
The RCS had called for the General Medical Council to be given a new power to tell the public and employers which surgeons are qualified to undertake cosmetic surgery. At present the law allows any doctor, including non-surgeons, to perform cosmetic surgery without undertaking additional training or qualifications.
The BAAPS has said something similar:
“It was very disappointing to see that yet again the government have shied away from regulation in the cosmetic surgery industry.”
One former president of the Royal College of Surgeons says that animals are better protected in Britain than people are. That is an absolute disgrace. I will not be here in 20 years’ time—[Hon. Members: “Yes, you will!”]—but I will continue to push for the Government to introduce legislation to protect this potentially vulnerable group of patients. It is high time we had action.
Maternity Services (Morecambe Bay)
Ann Clwyd Excerpts(9 years, 1 month ago)
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Mr Hunt
I am afraid I can only commit now to us introducing independent medical examiners as soon as possible. We are wholeheartedly committed to this. It is incredibly important for relatives, because where they have a concern about a death and possibly a mistake being made in someone’s care in their final hours, the availability of an independent examiner has been shown in the trials we have run to be very effective, so we are committed to doing that.
I should have answered the shadow Health Secretary on the point about a review of maternity services, because he raised it as well. NHS England is doing that review; we have already announced that to this House. Today it is publishing the terms of reference of that review. That is important, because there has been a big debate inside the health service—a debate with which many people will be familiar—about what the minimum appropriate size for maternity and birthing units is, and we need to get to the bottom of the latest international evidence.
Ann Clwyd (Cynon Valley) (Lab)
During the period when I was writing the report on complaints in hospitals, I met Mr Titcombe. I was impressed by his persistence, because persistence is what anyone who is trying to tackle a complaint needs. I understand what he means when he says he is haunted by personal grief: I think of all those parents and relatives who have waited all this time to try to get some answers to their questions. The length of time it takes to answer people’s complaints is still not satisfactory. I myself have waited over two years and three months and I still do not have answers—I know that is not in his bag, but it is generally true of the whole of the United Kingdom. I support what my right hon. Friend the shadow Secretary of State said in calling for the medical scrutiny of all deaths that are not referred to a coroner. That is an important point. I want to ask the Secretary of State again: will he ensure that achieving the highest standard of complaints handling is included in the next NHS mandate?
Mr Hunt
No one has done more than the right hon. Lady to try to improve the standard for complaints, with the excellent work she did with Professor Tricia Hart. We are in the process of implementing her recommendations, but as the right hon. Lady knows, with the fifth largest organisation in the world, it is one thing to make a commitment in this place, but another to make it happen on the ground. There is definitely much work to do.
I also agree with the right hon. Lady’s comments about James Titcombe. This is a man who gave up his job working in the nuclear industry to come down to London and work in the CQC so that he could actively be part of the culture change that he wanted to see in the NHS. I do not think anyone could have done more than that. It is truly remarkable.
As the right hon. Lady has mentioned Wales, let me say that we have put 20 trusts into special measures in England and it is inconceivable that there will not be trusts with similar problems in Wales. I urge her to encourage the Labour party in Wales to look at introducing a special measures regime and a chief inspector of hospitals in Wales, because that has had such a powerful effect on improving standards of care in England.
Health
Ann Clwyd Excerpts(9 years, 10 months ago)
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Ann Clwyd (Cynon Valley) (Lab)
This is the seventh occasion I have quoted from patients’ letters on the NHS. They are patients from all over the country. In some cases I will name where they come from, because they have given me their permission to do so.
A few weeks ago, when I gave evidence to the Select Committee on Health, I was asked whether things had changed as a result of the report I produced jointly with Professor Tricia Hart last year. The only way I could answer was to say that I will know that things have changed when the letters stop. I am afraid the letters have not stopped: they keep coming, and while they keep coming I shall continue to quote from them.
I received a letter from a woman who went to see a friend in hospital. The friend was given an enema while she was there. The letter states:
“Myself and other visitors therefore waited outside while this took place. The nurse then disappeared for forty minutes. When I questioned the nurse about being away for so long she explained that there are two other staff members on the ward but they are not qualified to carry out this procedure…I then waited outside again while she was changed. Once this was finished I noticed that her nightgown had not been changed, so therefore assumed it was clean. The next morning when I arrived with a clean nightgown, she was still in the previous day’s clothing and was not changed until she had been washed. Later, when I was going home, I found the previous nightgown shoved into a cupboard in a plastic carrier bag. The nightgown was completely soiled, so it was evident that she had been left wearing this from roughly 2pm and throughout the night. I reported this to a nurse who said she could not explain why this had happened.”
This illustrates again the importance of patients in hospital being shown dignity.
Another letter concerns a wife visiting her husband in hospital:
“The oxygen mask he had on had slipped down off his nose so many times it had blistered it, his wife had to put plasters from the pharmacy on herself. On his bed table at the foot of his bed was a pack of sandwiches, bottle of fizzy drink, a urine tray with urine in it and standing in that was a urine bottle half filled with urine…The man 2 beds up soiled his bed, stripped naked and walked round the ward with excrement all up his legs. Out of the ladies toilets came a lady crawling on her hands and knees with her underwear round her ankles, 2…nurses picked her up, said she was a naughty girl and dragged her up the ward. Then 5 minutes later out of the other door first appeared a walking stick, then a little man wearing a nightgown and a hat with a bobble on the top, stick in one hand and dragging his soiled nappy full of excrement behind him past”
her husband’s bed.
Another letter said:
“I have been waiting for over three months for a colonoscopy at Singleton hospital, Swansea. I have pains in my stomach. I attach an e-mail received from the Health Board stating that the waiting list for urgent endoscopies in Swansea is 35-40 weeks. No estimate is given for non-urgent endoscopies. I find the situation scandalous. If you wish to publicise this appalling state of affairs and use my name, you can do so.”
The health board wrote to the man saying:
“Unfortunately, the Endoscopy department is experiencing a backlog of patients waiting for appointments, due to the ongoing demands on the service. The current waiting time in Swansea for an urgent endoscopy can be up to 35 to 40 weeks. Plans are in place to address the backlog over the coming months. In the meantime if you are experiencing symptoms which you are concerned about, they would suggest you make an appointment to see your General Practitioner”.
Another letter states:
“My mother aged 85 was admitted to hospital…and treated as an in-patient for 3 weeks for a badly sprained wrist. My concerns about the longevity of the injury and lack of improvement, continued pain and swelling were ignored and only after an official complaint was made…by me did medical staff agree to re x-ray the wrist, where upon it was found to be badly broken. Whilst still an in-patient…when her wrist was due to be set, my mother’s call for assistance to help her to the bathroom went unanswered and she fell in the ward. I was not contacted by the hospital and advised of her fall. When I made it known to staff that I knew she had fallen I was told ‘it was nothing, a little fall and there was no injury’. My mother was discharged…I had to call out her GP”
a couple of days later
“since she was experiencing severe groin pain. Over the weekend the intensity of pain increased and my mother could no longer walk. She was taken by ambulance to Morriston Hospital, an x ray revealed a fracture of the pubis and my mother was again admitted as an inpatient that evening.”
She then talks about the standards of medical attention, stating that the
“care received was negligent, her treatment was inappropriate and exacerbated her injury. The consequence for my mother is long term and permanent impairment of mobility and quality of life.”
Another letter concerns someone admitted to a hospital in north Wales:
“Doctors were rarely seen especially not at weekends, equipment had to begged and borrowed from other wards. I feel that when he was admitted he was seen as a very old man who was probably not going to survive…He’d always been a positive, uncomplaining sort of person. It was subsequently discovered that he had an ulcerated digestive tract so forcing him to eat, as was initially happening, was bordering on the cruel.”
Finally, a letter states:
“I went to the GP last February and was diagnosed with a prolapsed womb. I was put on the proverbial waiting list. After two months I rang the Princess of Wales hospital to ask how long to my appointment. I was told the earliest I would be seen would be end of August possibly early September! A few weeks ago against all my labour principles and out of sheer anxiety of the unknown I paid £150 to see a gynae consultant (this was in one week of phoning for an appointment!) The consultant confirmed I had a prolapse, I would need a hysterectomy and a bladder repair…I was then told if I paid privately I could have the operation in two weeks!”
at a cost of £6,646. The letter continued:
“However this is the punch line. If I wanted to be put on the NHS list it would be 9/10 months! That means from seeing my GP to surgery will be 18 months. I can not believe it! I refuse to go privately; I want NHS treatment. My condition is now impacting on my everyday life…without going in to the finer details it is undignified. I went back to my GP last week asking her to expedite my referral.”
That is one of many shocking cases, and I could fill the next five hours reading out the others I have received.