Public Health

Cheryl Gillan Excerpts

Wednesday 6th January 2021 Commons Chamber

[Dame Cheryl Gillan (Chesham and Amersham) (Con) [V]]

I am pleased there is more that finds common cause across the political divide in this time of national emergency than divides us. These regulations are retrospective and not amendable. That, sadly, reflects the impotence of Back Benchers, which should be rectified, and I would like to identify myself with the remarks made by my hon. Friend the Member for Altrincham and Sale West (Sir Graham Brady). The regulations last until the end of March, but there should be weekly reviews and a debate on the Floor of the House at least every two weeks during this period when such draconian restrictions have been placed on our citizens.

The vaccination effort in this country is remarkable, but we need to do more, particularly when so much fake news is being circulated. Many of my constituents are constantly picking up fake stories about everything from so-called cures and drugs that protect someone from covid to conspiracy theories and priority being given to privileged people. Can we boost the Government communications effort, so that firm rebuttals and accurate information are issued rapidly and widely to prevent more fear and anxiety? Can we have a frequently asked questions section on the Government website, to help combat this fake news? Can we add teaching staff to the priority list, alongside young adults with learning disabilities and autism, as the PHE data has shown their vulnerability? The Prime Minister missed the opportunity to respond to my question earlier today.

Throughout the last year, Heathrow has provided a valued air bridge for repatriation flights and vital cargo, including medicines and PPE. It is facing a proposed reduction of only 7% in its £118 million rates bill, while airports in Scotland and Northern Ireland and even supermarkets have a 100% waiver. We are lagging behind other international countries, so can we have more support for the aviation sector and review it, so that its services are not threatened?

We need more assistance for the excluded, and we need to examine how we can spread the help to that group, who have received nothing for nearly a year. These regulations stop golf and outside activities. This is patently ridiculous and we need some common sense, for goodness’ sake, as this sort of nonsense damages our credibility.

Most of all, we need an exit scenario set out and the goals identified publicly, as the most frequent question is, “When is this going to end?” The Prime Minister has set a 15 February date as a milestone and we need to know, for example, at what stage we hope to have sufficient people vaccinated to, say, open our schools safely again, or at what point the levels of incidence and spread of the virus will allow retail and hospitality to reopen.

I finish by saying, locally, how fantastic Buckinghamshire Council and Buckinghamshire Healthcare NHS Trust have been throughout this terrible period. People will never know the amazing work that they have put in to keep our county functioning and our residents safe. Let us not forget what further burdens these regulations place upon them and our tireless public sector workers, and if we have to face these restrictions on our liberty, let us at least do the frontline staff the courtesy of observing them.

Covid-19 Update

Cheryl Gillan Excerpts

Wednesday 30th December 2020 Commons Chamber

[Matt Hancock]

For areas in tier 4 where we still need to get the infection rate down, the most important thing we can all do is take responsibility to restrict the spread of infection, because this new variant spreads so easily from person to person. Everybody has to behave. If everybody behaves like they might have the virus and therefore restricts their social contact, that is the best way we can get these rates down. It does take all of us do this; it is not just about the rules that are set out from this Dispatch Box and voted on by this House.

I know that people in Wallasey and across Liverpool have done so much and got the rates right down under control, but unfortunately they have started to rise again, and with the new variant, it has been necessary to put Liverpool into tier 3. I just hope, like the rest of the country, that we can get out of this after the next few difficult weeks.

[Dame Cheryl Gillan (Chesham and Amersham) (Con) [V]]

Buckinghamshire health services are under severe pressure with escalating rates of covid and hospital admissions. On behalf of all my colleagues in Buckinghamshire, may I give an enormous public thank you to our healthcare staff, who are working round the clock in a growing emergency, as well as providing testing and vaccinations at multiple sites in the county? Despite those pressures, the trust is establishing a centre to help people with the effects of long covid, which are now causing increased concern. It will be at Stoke Mandeville. What extra resources can the Secretary of State make available to support our valiant health workers and, in particular, to help those now suffering from the effects of long covid, which are very serious in some cases?

[Matt Hancock]

My right hon. Friend is absolutely spot on. The issue of long covid is very serious, and we have put more support into the NHS and into research to try to understand long covid better. I know about it very much myself, and I understand the impacts that it can have, which can be debilitating on people’s lives. I am delighted that there is a long covid centre at Stoke Mandeville. It is such an excellent hospital, and I am not surprised that it is doing all the cutting-edge work that is needed, but the single most important thing we can do to support those who have long covid is to understand better the causes and therefore understand what we can do to help people get their lives back to normal.

Covid-19 Update

Cheryl Gillan Excerpts

Tuesday 20th October 2020 Commons Chamber

[Matt Hancock]

The Prime Minister is seeking precisely to do that and he, like me, very much hopes that the local leadership in Greater Manchester will do their bit. When it comes to Cheshire and indeed Warrington, which we talked about earlier, I am worried about the cases. I will make sure that the engagement that the hon. Gentleman and his councils seek happens as soon as possible.

[Dame Cheryl Gillan (Chesham and Amersham) (Con) [V]]

Can I commend the Secretary of State for his localised approach, and for the calm way in which he is dealing with some unwarranted attacks on both him and the Prime Minister?

The Epilepsy Society is based in Chalfont St Peter in my constituency. It provides specialist care to a number of vulnerable residents and has, according to one relative, worked wonders in keeping residents safe and secure. However, visits from relatives cannot take place as the incidence of covid-19 grows, and the home is now locked down again. With 60-minute tests now available down the road at Heathrow airport, could we not arrange for this type of testing for close relatives so they could visit their loved ones? It would make all the difference in the world to my constituents and many others in long-term care.

[Matt Hancock]

The answer is yes. We absolutely want to use this sort of testing as it becomes more widely available to do exactly the sort of thing that my right hon. Friend sets out.

Covid-19 Update

Cheryl Gillan Excerpts

Programme motion
Monday 19th October 2020 Commons Chamber

[Matt Hancock]

That decision was taken in consultation and agreement with the local area. Part of the work with local areas on this has been to agree the exact details of the package in level 3.

[Dame Cheryl Gillan (Chesham and Amersham) (Con) [V]]

At the moment, the only defence against the virus is modifying people’s behaviour. Cases of covid are rising in Buckinghamshire, and we want to stay in tier 1. Our NHS trust and council have taken the initiative and filmed a strong local public health message, which is now on YouTube and social media and is recorded by Dr Tina Kenny, our medical director, asking local people to follow the rules to reduce the spread of this highly contagious virus. Will the Secretary of State commend this communication from our local health trust and council and encourage other health authorities and clinicians—who people trust and have confidence in—to engage directly with their populations to send these vital messages out?

[Matt Hancock]

Yes. I applaud the work that has been done across Bucks to deliver public health messages and try to get the whole community to support the action that we all can play our part in and that my right hon. Friend rightly raises.

Covid-19 Update and Hospitality Curfew

Cheryl Gillan Excerpts

Thursday 1st October 2020 Commons Chamber

[Matt Hancock]

We have got this record testing capacity and I am incredibly grateful for all the people who work to deliver it. I will not have this divisive language; I just won’t have it.

[Dame Cheryl Gillan (Chesham and Amersham) (Con) [V]]

Restricting hospitality hours and venue capacity, although not ideal, can present us with a good opportunity to explore and support our local businesses such as Griffiths Brothers, the excellent gin distillery in the village of Penn in my constituency, which operates a shop where people can sample its high-quality gin made from the best of the best, and in fact take it home to enjoy at leisure, without a curfew. What can the Government do to encourage people to visit these local distilleries and breweries, which are a vital part of the hospitality industry and many of which have had a lean time during the pandemic?

[Matt Hancock]

I will do everything I can, both policy-wise and personally, to support our great distilleries, including in my right hon. Friend’s part of the world. One of the wonderful things of the last few years has been the massive expansion in the number of local distilleries and breweries, and I am glad she supports her local gin distillery, no doubt both in her official capacity and perhaps with a tipple at home.

Covid-19 Update

Cheryl Gillan Excerpts

Thursday 17th September 2020 Commons Chamber

[Matt Hancock]

On the NHS funding, the Barnett consequentials will operate in the normal way for the hon. Gentleman’s constituents in Northern Ireland and right across the country. When it comes to the question of the vaccine, of course, we will allow a vaccine to be put in place across the board only when it is safe. The Medicines and Healthcare products Regulatory Agency is one of the most respected and high-quality regulators in the entire world. It is that body that will make the decision on whether it is safe to license. Of course, the question of who should be vaccinated and in what order is again a clinical decision, on which we will take advice from the Joint Committee on Vaccination and Immunisation.

[Dame Cheryl Gillan (Chesham and Amersham) (Con) [V]]

I thank the Secretary of State on behalf of myself and my colleagues in Aylesbury and Buckingham for the extra A&E funding for Stoke Mandeville. It will make a great difference to patients and our valued NHS personnel in the Buckinghamshire health trust. But, in my constituency, in common with other Members, I am having a problem with the education system. A headteacher has written to me saying that we now have teachers and teachers’ children with covid symptoms, which means that they are off in isolation, and they are being told that there no tests available for 21 days. She writes, “This is very tricky, as we have to pay a lot for supply teachers to cover classes. Would it not be sensible to prioritise testing for teachers if it is a priority to keep schools open, as once too many teachers are off waiting for tests, schools will have to close, and then people won’t be able to return to work?” What can I tell my headteacher, and how can we get those tests into schools more rapidly to mitigate the problems that are coming down the line?

[Matt Hancock]

My right hon. Friend raises several important points. First, Stoke Mandeville Hospital is a famous and excellent hospital and I am delighted that we are able to expand its emergency facilities in this way. She has done more than anyone to represent the needs of Stoke Mandeville Hospital and all those who serve in that great hospital, so I welcome her comments on that. On testing, absolutely, we have sent tests to all schools to make sure that they have tests available. But of course I also recognise the challenges in getting hold of tests. I do not accept at all that there is a delay of 21 days and nobody should accept that. That is not Government policy. I have just looked up the figures: across Buckinghamshire, just over 1,000 people a day are getting tests, so there are tests available. This is part of the challenge of having the record capacity but demand having gone up. I am working as hard as I can to ensure that all those who need a test—all those who have the symptoms—get a test. I understand that it is a very human instinct to think that if a close contact has symptoms the best thing to do is to get a test, but if people do not have symptoms please do not come forward and use a test that is needed for somebody who has symptoms, so that either they can get a negative result and get back to their normal lives such as teaching at a school, or, if they test positive, we can give them the treatment and support that they need.

Covid-19 Update

Cheryl Gillan Excerpts

Thursday 16th July 2020 Commons Chamber

[Matt Hancock]

Yes, of course. The hon. Lady rightly references an incredibly important report. We brought in a system of annual reports precisely to bring such issues to public attention. I am also glad to report that the number of people with learning disabilities and autism who are in secure settings has fallen significantly over the past few months—that is a connected area in which I know the hon. Lady takes a great interest.

[Dame Cheryl Gillan (Chesham and Amersham) (Con) [V]]

May I offer my support to the Secretary of State, who has been working tirelessly during this crisis? Epilepsy Society is a major charity based in my constituency. It states that people with epilepsy are adversely affected by covid-19, particularly because the fever associated with coronavirus can trigger an increase in the number of seizures and cause breakthrough seizures. Despite that, the Secretary of State will know that people with epilepsy are not classified as clinically vulnerable for coronavirus or the flu, and they do not qualify for the free flu vaccine or any future covid vaccine. Will the Secretary of State look into that and ensure that that is remedied as soon as possible, so that we can protect that valuable cohort of people?

[Matt Hancock]

My right hon. Friend is an incredibly strong voice for those who suffer with epilepsy, and I will ensure that the clinical decision makers who make recommendations on the order of priority for any vaccine, both flu and coronavirus, take a specific look at the latest evidence on epilepsy. I cannot give her the guaranteed assurance that she seeks, because those decisions are rightly taken on the basis of recommendation from clinicians. I would not want to break that important principle, but I can ensure that the latest information, including on the impact of coronavirus on those with epilepsy, is taken into account in the decisions.

Autism and Learning Disability Training: Healthcare Professionals

Cheryl Gillan Excerpts

Monday 22nd October 2018 Westminster Hall

[Mike Wood]

The hon. Lady is absolutely right. That enormous employment gap is a tragedy in terms of not only the lost opportunities for those people directly affected, but the wasted opportunities for the many employers who could be benefiting from the skills of people with autism and other learning disabilities, and for wider society, which is losing the contributions that they can make.

Finally, I will touch quickly on the issue of mental health. Autism is not a mental illness, but we know that people with autism are much more likely to be affected by many mental illnesses, particularly anxiety-related illnesses, than the general population. We need to ensure that the new framework is properly embedded across mental healthcare as well as physical healthcare, so that our mental health services can ensure that people with autism get the proper services they need. Far too often, people with autism find not only that their condition means their mental health problems are not properly diagnosed at an early stage, but that, if diagnosed, their condition can interfere with their receiving the appropriate treatment in a way that might be expected elsewhere.

We must ensure that autism is one of the four clinical priorities right across the healthcare system and that the training our healthcare professionals receive reflects that. Only then can we start to address the healthcare inequalities that we see in this country and, hopefully, try to ensure that there are fewer repeats of the terrible stories we have heard this afternoon.

[Dame Cheryl Gillan (in the Chair)]

Before I call the next speaker, I think that, without compromising the objectivity of the Chair, I should probably have put on record at the beginning of this sitting that I currently chair the all-party parliamentary group on autism, in case people have not gathered that by this stage. Secondly, I apologise for the temperature in this room, which is below what I would consider comfortable standards. We have made inquiries and unfortunately we cannot adjust the temperature unless the room is vacated and the engineers come in to look at the equipment. I apologise for that, but, unusually, if anybody wants to put on their coats, they are welcome to. I understand that some people are feeling very cold in this environment and I can only apologise.

[Jared O'Mara (Sheffield, Hallam) (Ind)]

It is interesting that you mention the temperature, Dame Cheryl, because I am the first autistic MP and a symptom of my autism is that I prefer the cold and get really irritated and anxious when it gets just above body temperature. This is perfect for me—I am wearing a T-shirt.

[Dame Cheryl Gillan (in the Chair)]

Every cloud.

[Jared O'Mara]

Yes. This is one of those circumstances where Parliament has worked out in my favour, because so far my autism has not been taken into account by Parliament.

I have asked for adjustments from the Speaker’s Office so that I can comfortably speak more in the Chamber, because with things such as shouting, when everyone is heckling, the aggression and the loud noises mean I cannot cope. I have only been to Prime Minister’s questions once because of all the shouting. A Conservative MP, who I believe was the hon. Member for Rochford and Southend East (James Duddridge), was not wearing a tie, and that adjustment was made in part with reference to me, because of my cerebral palsy. Much like Oliver, I have anxiety, cerebral palsy and autism—Oliver had those three—and on top of that I have depression.

There is something called comorbidity, which means that if someone has one disability, they are likely to get another. In the autism strategy of 2009 and its update for 2014, I cannot find the word comorbidity. It is a word that needs to be in the lexicon of Government and politics, the NHS and education. The same can be said for intersectionality, which is basically about the negative symbiosis between different marginalised groups and different factors. We need to look at that, and at how being disabled means that someone is more likely to be socioeconomically disadvantaged, including by being on benefits, unemployed or in prison.

Going off on tangents is also a quirk of my autism—I was talking about wearing a tie in Parliament and how the hon. Member for Rochford and Southend East was not wearing one. One adjustment that Mr Speaker kindly made was that I should not have to wear a tie, because my cerebral palsy and the co-ordination difficulties that I have with my autism mean that I cannot do a tie. Also, wearing a clipper tie will irritate the skin around my neck. The hon. Gentleman was not wearing a tie the first time I was at Prime Minister’s questions, and several Labour MPs behind me shouted at him, “Wear a tie, you scruff.” Imagine how much that hurt me. I turned around and looked at them and shook my head, but I may as well have been invisible.

This is not only about my treatment by Parliament but by the Labour party; for those who think Parliament has not made many adjustments or treated me right, Labour is another thing entirely. I am not talking about Labour as a whole. I am talking about the leadership and the people who run it, and the people who run the application process. I was not listened to or asked how they could help me. They made the sum total of one adjustment for me, which was to give me an office near the Chamber.

However, I am not here to talk about me. I am here to talk about Oliver. Some people say that people with autism do not have the capacity for empathy, including Simon Baron-Cohen—the cousin of the actor who played Borat—who came up with the empathising-systemising theory. That does not resonate with me, because I can systemise and empathise, and I want to be an autistic person who gives everybody a lesson in empathy. Think about Oliver. That is not just a name, but it is good that we give him a name, because disabled people are so often treated as statistics on a balance sheet—“Can we afford to spend this money on disabled people?” The key word in “disabled people” is “people”. We are people, with names.

Let us take a moment to think about Oliver. Imagine what it would have been like for him, being given that medication and being bullied and being scared, and his anxiety going through the roof. He did not know what was happening. He looked and saw his mum and dad, who were in a state, and the doctors would not listen to them. He says, “Mum and dad, help me. Help me.” Just think about what that would be like. [Interruption.] No. I am autistic. Do not do that.

Think about Oliver’s mum and dad. They have lost their son. That could have been my mum and dad. A year ago, I tried to hang myself in a hotel over the road, because people were bullying me over things that I did not understand when I was 20 or 22. They made false accusations of sexism and homophobia. They did not listen to the interviews I had done. They did not listen to me talk about how I am an intersectional feminist and about equality. They did not listen to me when I said that my local pub, where I have been going all the time for 12 years, is a gay bar.

I used homophobic words, but they were the words of the time; they were on the Eminem record that I listened to at the time. It was before November 2003— [Interruption.]

[Dame Cheryl Gillan (in the Chair)]

Order. Please try to keep on the subject of the petition.

[Jared O'Mara]

I know, but it is relevant—hold on.

[Dame Cheryl Gillan (in the Chair)]

You are giving a very powerful testimony, but I hope that you may try to confine your remarks to the subject of the petition in hand. That would be helpful to me in the Chair. Thank you.

[Jared O'Mara]

I mentioned that I go off on tangents; this is an example. Basically, there is a tendency in type 1 autistic people to mimic both the world around them and their peers, to try to fit in and not get bullied. That is what I was doing, and my bullying is an example of how people with autism are misunderstood and not listened to. It has huge parallels with what happened to Oliver and with the autistic people who my hon. Friend the Member for Cambridge (Daniel Zeichner) says have committed suicide.

I managed to stop myself—Lord knows how. It was probably because I thought of my mum and my sister and my niece and my nephew and my dad. That is probably what anchored me and brought me down off that chair—well, that and the fact that I could not climb it properly because of my cerebral palsy. That sounds like a joke, and sometimes we have to laugh at our disabilities, because it is all we have. I mastered humour and making my friends laugh, because that makes people like me. Sometimes people have to do that, because of all the bullying they get over their autism and all the misunderstandings, like those Oliver went through. Sometimes all you can do is laugh.

However, I hope that, at this juncture, people do not laugh but take a moment to reflect on what it is like for Oliver’s parents, and what it was like for Oliver at the time his life ended. I thank Oliver’s parents for bringing the petition to the Chamber, and I thank every Member here. I am being non-partisan—I am an independent Member—and I ask Members to please show the video of the debate and give copies of their speeches to their colleagues in their respective parties. I am just riffing, as Members can tell, but by showing their colleagues the video on parliamentlive.tv and giving them copies of their speeches, they can spread the word that people with autism are being misunderstood.

One fifth of the UK population are in the disability community, and a quarter of people will have mental health disabilities at some point during their lives. We are not being listened to and we are not being understood. Our parents are not being listened to. The respective experts in clinical psychology and psychiatry and medicine are not being listened to. It is time that we were listened to and what we want acted on.

It is time that the laws that are already in place, such as the autism strategy, the duty to make reasonable adjustments under the Equality Act 2010 and disability discrimination law, are acted on. Let us have full legal aid, and let us expand the definition of corporate manslaughter, because I believe that what happened to Oliver was corporate manslaughter, whether that fits with its definition in law or not.

--- Later in debate ---

[Wera Hobhouse]

I thank the hon. Gentleman for his intervention. I have said at another occasion today that the word “Parliament” comes from the French word “parler”, which means to talk, but we are also here to take action, so we must stop talking and take action. The issue of mandatory training is something that we can fix or determine here, and I very much hope that the Government will take that on board.

The urgent need for better training on autism and learning disability and the complications of the condition could not be shown more starkly than by the failings in Oliver’s case. In February, the charity Mencap launched the “Treat me well” campaign, which is aimed at transforming how the NHS treats people with a learning disability in hospital. In particular, women with a learning disability suffer disproportionately from health inequalities. We have heard the statistics today; they die on average 29 years before women in the general population, and men with a learning disability die on average 23 years before those in the general male population. That cannot be overlooked. We have also heard these figures today, but that does not matter—it will do no harm to repeat them: a YouGov survey conducted in 2017 found that nearly one quarter of the health professionals surveyed had never attended any training on learning disability, and two thirds wanted to have more training, so what are we waiting for?

Any illness or disorder that is either misdiagnosed or diagnosed late leads to far greater problems down the line. Early intervention depends on early diagnosis, and early diagnosis on training of those who come into contact with the sufferers. We are calling today for better training of healthcare professionals, which is an obvious start, but why not go even further? Let us look at the settings to which young people are exposed from an early age—namely, nurseries and schools. Given that ASD is so widespread, nursery nurses and teachers should receive at least some basic training to recognise the early warning signs. Far too little is being done. In my constituency of Bath, we have an autism board, but it rarely meets and has not even set up a work plan yet. Clearly, none of this is good enough.

ASD and learning disabilities can be successfully treated to give sufferers a full life. The earlier we diagnose the problem, the better the outcome. Many people with ASD also suffer from mental health problems, often as a consequence of not being diagnosed early enough. Let us end this tragedy. I fully support the recommendations that have been made, and I hope that we have the cross-party consensus to really do something quickly.

[Dame Cheryl Gillan (in the Chair)]

We now move to the Front-Bench spokesmen, and it gives me great pleasure to call Hannah Bardell.

Organ Donation (Deemed Consent) Bill

Cheryl Gillan Excerpts

Committee Debate: 1st sitting: House of Commons
Wednesday 12th September 2018 Public Bill Committees

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to serve under your chairmanship, Mr Wilson. As the Democratic Unionist party’s spokesperson on health, I add my support to the hon. Member for Coventry North West, who has endeavoured courageously to push the Bill through. Every one of us is greatly impressed by him. I put my hands on his shoulders last night and said, “You’re making history tomorrow, boy.” We are all pleased that he is able to do that.

I am also pleased that the Minister responded right away in a positive fashion and ensured that the Bill would become a law, through Government support. Today, as happens often in this House—we could probably see it happen a wee bit more, if we are honest—we can all work together collectively to change lives and make things better. It is important for me. The hon. Gentleman asked me if I would be on the Committee, and I was more than happy to do so, to add my support in a small way to the legislation coming forward.

Why is this important? Every one of us has told a story, and we do that because those stories shape who we are as individuals. I met a wee nephew, Peter, who was born with only one small kidney the size of the wee thumbnail on my hand, so from an early stage he was in need of a kidney transplant. The problem for him was that getting the right donor was difficult. At one time his mother was to be the donor, but then she fell pregnant and that was not possible. As it turned out, another kidney became available in the meantime, and from being the small boy who was not physically able to do much and whose face was—if I can use these words—“custard yella” because of his kidney malfunction, his life was changed. This wee boy loved racing motorbikes and wanted to do a newspaper round but could not do that, and the donation totally changed his life for the better. I was therefore keen to be on the Committee because right away I can see the benefits that will flow from this legislation.

The other story I want to tell is one that a gentleman from my constituency came to tell me. His son was injured in an accident in which unfortunately a lady was killed. Ultimately his son’s life-support apparatus and machinery was turned off. I tell the story because he donated all his son’s organs, which then gave life and improved lives as the organs benefited a number of people.

Before I became a Member of Parliament, I was on Newtownards council, which thought it would be good to create a memorial garden in the council’s area. We therefore have a memorial garden in the main town of Newtownards, where families who have lost someone, or whose family members’ organs have been donated—whatever the case may be—can go and have a wee bit of contemplation or quiet time for remembering. The reason I want to tell these stories is because they are all part of why we need the Bill to go through, and of how important it is for the Minister and the Government to support the Bill promoted by the hon. Member for Coventry North West.

The right hon. Member for Don Valley, who spoke before me, made a compelling point; everybody made a compelling argument. The right hon. Lady made a reference that I was going to make. I am glad that was done and I will do it again. In this House we always repeat things, but that is by the way. It is important that those who feel they cannot go with this can opt out. That is what the legislation does. It does not compel anybody to do anything, but it gives an opportunity. That is the important issue that the right hon. Lady drew attention to, which I wish to endorse.

I have opted to carry an organ donor card since I started driving, and that was not yesterday, Mr Wilson. In Northern Ireland, legislation requires someone to tick a box on their driving licence application to declare themselves a donor. I have been doing that all those years. I still have the wee donor card and the wallet, which is long-time faded, as it has been there for 40-plus years. It is important that we move this forward.

In conclusion, we have a consensus and a collective opinion. We see legislation that can change lives for the better. That is the great pleasure of coming here as a Member of Parliament. It gives pleasure to be an elected representative at any time, be it on a council, Assembly or in the House. To come forward and be part of a legislative change that brings good gives a good feeling. Today is a good day for Parliament. I thank everyone for their contribution, especially the hon. Member for Coventry North West, and the Minister for supporting the measure so enthusiastically. That means something to us all.

[Dame Cheryl Gillan (Chesham and Amersham) (Con)]

Mr Wilson, it is a pleasure to serve under your chairmanship. I rise to support the amendments in the names of the hon. Member for Coventry North West and the Minister.

I rise only briefly to say that I am a convert. Originally, when I was Secretary of State for Wales, I was not convinced that an opt-out system would be beneficial. I have changed my mind; when the facts change, one should, as a politician, change one’s mind. One of the things that has changed my mind is personal contact with a family where an organ will be needed to save a young man’s life. There is nothing more powerful than having that presented to one as a politician. That means that all of us must have an open mind about so many things.

The way the trend has been going, particularly in Europe, is interesting. I think now more than 24 countries in Europe have some form of opt-out system. Although we have not yet really seen the benefits in Wales of the legislation that came in in December 2015, I frankly think that we need to improve the mathematical odds. We will do so only by creating a culture in which organ donation is spoken about, not in hushed tones or with accompanying difficulty, so that it becomes part of the common parlance.

The testimonies given by other Members in Committee show that the fact that a loved one may go, but parts of that loved one can contribute to saving or enhancing the lives of others, has to be a good thing. I support the amendments and hope the Bill gets a very fair wind so that it becomes law.

[The Parliamentary Under-Secretary of State for Health and Social Care (Jackie Doyle-Price)]

It is a pleasure to serve under your chairmanship, Mr Wilson, and with colleagues across the Committee. Without exception, everyone in the room has been a passionate advocate for organ donation. I am grateful for all the efforts made to promote this important procedure and movement.

With your indulgence, Mr Wilson, I would like to reflect on some of the comments made by members of the Committee before I address the amendments in detail. The Government fully support the Bill and are grateful to the hon. Member for Coventry North West for promoting it. The amendments are a tidying-up exercise and I put my name to them.

Integrated Care

Cheryl Gillan Excerpts

Thursday 6th September 2018 Westminster Hall

[Luciana Berger]

I am listening closely to my hon. Friend’s remarkably informed remarks. Taking him back to his second priority, prevention, does he agree that the Minister should be thinking about what he should be doing beyond his own Department? The Minister and his colleagues in the Department of Health will not on their own be able to do what is needed on prevention as well as tackle this country’s mental health crisis and increasing lifestyle-related disease. If we are to address those challenges seriously, it will also be about what happens in our communities, our schools and our workplaces. That comes from local government and is what will ultimately make the difference.

[Dame Cheryl Gillan (in the Chair)]

I remind colleagues that interventions are meant to be short. I hope Members will be able to keep them a little briefer.

[Dr Williams]

I thank my hon. Friend for her informed comments. I agree with her. We need a cross-governmental approach, particularly for children. There is a glaring absence of a cross-governmental strategy that would enable us to focus on all the things that have an impact on children.

The third area I want to mention is legislation. Under current rules, clinical commissioning groups will remain the statutory accountable bodies, even as the relationship between commissioners and providers starts to evaporate. At the moment, STPs, where the providers and commissioners are getting together, are making decisions—often behind closed doors—which are then rubber-stamped by the accountable bodies, which are the CCGs. That does not feel to me like particularly good governance. Legislation needs to follow the new provision arrangements.

We might also need to consider legislation to improve information sharing. The duty to share information—the eighth Caldicott principle—is often forgotten. In my experience the biggest barrier to integration is the fear that NHS providers have about sharing information with other parts of the system, and their resistance to do so. We are not necessarily doing enough in legislation to protect that duty to share information in the interests of providing good-quality clinical care.

The current situation on procurement is very difficult for CCGs. The law says that many services have to be procured if they are over a certain value. CCGs, as small organisations with accountability for their local pot of NHS funds, genuinely fear legal challenge. When they ask lawyers they are, unsurprisingly, advised that they have to follow the law, but the political and NHS England leadership strategy is to integrate care, which often cannot be achieved when care is fragmented by putting services out to tender, and provided by numerous different organisations. Many CCG governing bodies want and need to be cautious. They are just not going to take the risk given the current legislative framework.

Quite simply, if we, as elected politicians, want the NHS to collaborate, we should legislate for collaboration. In my view, the Health and Social Care Committee should be an enabler of that process. We would like to provide pre-legislative scrutiny, but we would like first to ask the health and care community what changes in the law would enable them to achieve their goal of providing integrated care to patients. I would like to know whether the Minister agrees with that proposition.

My fourth point is that integrated care providers should be NHS organisations—a recommendation the Committee made in its report. There is a well-founded concern in the health and care community that, under current legislation, private companies might bid to win contracts to provide significant chunks of our health services. That concern could be alleviated if it were made clear that integrated care partnerships need to be NHS bodies. In their response to our report, the Government did not accept that recommendation, arguing that ICP contracts could be held by GP-led organisations. It would be a very good thing to have GP-led organisations running primary and community care and other parts of the health service, but I see no reason why those GP-led organisations cannot be NHS organisations.

It is a barrier to progress in the NHS that there are not community-based NHS organisations that GPs can lead and work for. I urge the Government to look seriously at the recommendations in the Institute for Public Policy Research report “Better health and care for all”, published in June, which suggests the creation of integrated care trusts in communities and a right to NHS employment within such organisations, which would provide all non-hospital care in an area.

My final point is about leadership. My hon. Friend the Member for West Lancashire (Rosie Cooper), who is a member of the Health and Social Care Committee but cannot be here today, has done significant work shining a light on leadership failures within the NHS. Integrated care is possible only if we have the best and most talented managers in the NHS. As was evident in the failure of management in Liverpool Community Health NHS Trust highlighted by Dr Bill Kirkup, we are far from achieving excellence and need to be certain we have the right mechanisms in place to ensure that we have only the best and the brightest. Will the Minister assure us that the Kark review will be expansive in its remit and that those NHS leaders charged with fixing the mess in Liverpool have been consulted for their expert views?

To conclude, the purchaser-provider split has not always achieved the best NHS care for patients. I welcome the step towards integrated care, but I do not think it will succeed when the legislation promotes, and sometimes mandates, competition. There is political will—certainly from the cross-party Committee—to work with the NHS and care system, including the NHS assembly, on proposals to change legislation, keep integrated care providers within the NHS, improve governance and remove mandatory competition. I hope the Minister will respond positively to those concerns. Integrated care has the potential to transform the lives of millions of patients in our health service. I commend the Committee’s report, and I thank the Government for the changes they are making.

--- Later in debate ---

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Dame Cheryl.

I congratulate the hon. Member for Totnes (Dr Wollaston) on her knowledgeable and measured introduction to this extremely important debate. I also thank the Health and Social Care Committee for an extremely useful and detailed piece of work on a rapidly changing area. In her speech, the Chair of the Committee set out from a patient’s perspective why it is so important for us to have a more co-ordinated approach than we do. “Having to tell the same story over and over again” was a phrase mentioned by not only the Chair but a number of other Members, and we all recognise the frustrations that we and our constituents have when that occurs. She was right to say that it is important that we look at the subject primarily from the point of view of patients. Their experience has to be at the very front and centre of all our plans for the future.

The hon. Lady articulated clearly how the financial pressures in the existing legislative framework, which we have all talked about many times, can inhibit transformation. She was right to say that an earmarked fund for transformation has to be protected, and it should not just be a capital pot. She set out clearly the need for a degree of flexibility.

As always, it was a pleasure to hear my hon. Friend the Member for Stockton South (Dr Williams). He made a pertinent point about the challenge for integrated care partnerships: to be considered successful, they should make a difference for those with the greatest health needs. He is right that we need to do much better as a nation on health inequalities, but how we approach prevention and health generally in this country does not necessarily lend itself to that. It would be most welcome if we can tackle that as part of integrated care.

My hon. Friend also expressed the genuine concern about the risk that changes could affect performance quality and safety, which are the pillars of an excellent health system. He made a strong point about governance and how existing decision-making processes are probably the wrong way round. The report acknowledges that they are certainly cumbersome and do not lend themselves to streamlined decision making. He highlighted well the dilemma faced by CCGs when tackling that agenda. This place needs to take a lead on that. He concluded by saying that integrated care has the potential to transform the lives of millions of patients—that really underscores why it is so important for us to get the integration right.

The hon. Member for Strangford (Jim Shannon) made a typically thoughtful contribution. I agree with him about the need to bring people along with us when we set out our vision for the health service. The report touches on how that has not been as successful as we might like in recent years. His comments on the use of acronyms were particularly perceptive—they may initially save time, but they actually increase complexity. Although I agree with the sentiment that we should keep things simple, anyone who looks at the Health and Social Care Act will realise that at the moment we probably cannot achieve that readily.

The hon. Member for South West Bedfordshire (Andrew Selous) made an important contribution. No one will disagree with what he said about putting patients at the centre of all this and the quote he gave about the kind of care they want. I was very interested to hear about his visit to the Larwood centre in Worksop; that sounds like the kind of model that we need to showcase what a good new procedure looks like.

It is clear from reading the report that I am not alone in being critical of the way some of the proposals in the past few years have been communicated. I do not underestimate the damage that has done to public confidence in the aims of the policy.. Releasing the new draft ICP contract in the middle of the summer with no publicity has not increased transparency about the Government’s agenda. It was interesting that the report described how public understanding of the proposed changes has been seriously compromised by the “acronym spaghetti,” which a number of Members mentioned. At another point in the report there was a reference to the acronym soup of

“changing titles and terminology, poorly understood even by those working within the system.”

That highlights well the difficulty we all get into sometimes when acronyms can take over—that will resonate with anyone who is a member of a political party. The use of food terminology in the report shows that perhaps the author was a little hungry when they wrote it.

To reinforce the point, since the report was published we have ICPs on the horizon—yet another acronym. Although I appreciate that the change was made to avoid conflation with the American model of ACOs, it is clear that we do not need new acronyms, but a clear explanation from the Government along with a timeframe for what they are seeking to achieve and, importantly, the criteria they will use to determine whether those objectives have been achieved. The chief executive of the Nuffield Trust, Nigel Edwards, described this as

“perhaps the biggest weakness, not just with the STP process but arguably with the ‘Five Year Forward View’.”

It is clear from both the evidence sessions and the report itself that confidence in the Health and Social Care Act 2012 is at an all-time low and that the current direction of travel is really an admission that the Act has not worked. As we know, the last top-down reorganisation put in place a siloed, market-based approach that created statutory barriers to integration. Now, there is a lot of tiptoeing around the current legislation but we need an admission that that legislation has had its day. We need new proposals that are properly scrutinised.

The initial STP process was imposed from the top and was based around 44 geographical areas that were determined very quickly without recourse to the public. The Government acknowledged in their response to the report that perhaps that was done rather too quickly. Although some of the areas that emerged after that initial consideration had well-established networks of co-operation, in others there was a vast and unwieldy network of commissioners and providers with completely different approaches put together at very short notice. They were told to produce plans in private, again very quickly, which were focused not on integration but on organisations balancing their budgets. The only beneficiaries of this process seem to be the private consultants who were drafted in to complete those hastily arranged plans. As Professor Chris Ham pointed out,

“most STPs got to the finishing line of October 2016, submitted their plans and breathed a huge sigh of relief. No further work has been done on those STPs.”

Will the Minister set out what his plans are for those areas, as the local bodies appear to be working in a vacuum? They want to work together, but at the moment they have a legal duty to compete.

The report makes it clear that being asked to solve workforce and funding pressures caused by national decisions exacerbates tensions and undermines the prospect of each area achieving its aims for its patients. The report also makes it clear, as my hon. Friend the Member for Stockton South said, that where support has been provided towards integration, it has been directed at those who are furthest ahead. Those at the bottom of the curve, sometimes through no fault of their own, have lost potential funding that they need to work together to improve services. The chief executive of the NHS Confederation, Niall Dickson, told the inquiry,

“There is a sense in which some organisations find themselves in a really difficult position. Just taking their STF money away…is like somebody digging a hole. Instead of…helping them to get out of the hole, they jump in with a larger spade and dig even faster.”

That is a colourful and alarming analogy.

Where local areas are able to proceed to the next stages of integration, there is understandable concern among patients and staff about precisely what that will mean. The integrated care provider contract has the potential to radically alter the entire health and social care landscape, but is continuing without any parliamentary scrutiny. Despite assurances that it is unlikely that a private company will win the contract to be an ICP, it remains the case that it will be possible, as a number of Members have said. As we heard, not long ago the NHS was forced to pay out millions of pounds to Virgin because it lost out on a contract. I am concerned that we will face similar challenges if this process continues without legislation.

It is not scaremongering to say that the Government are introducing a contract whereby a private company could be responsible for the provision of health and social care services for up to 10 years—it is a fact and a possibility under the legislation. The Chair of the Select Committee was right to say it would be extremely helpful to have a clear statement from Government to rule that out. It is within the gift of Ministers to say there will be no private involvement in those bodies in future. Will the Minister make such a commitment today?

It is clear in the report that staff are concerned about the lack of engagement in a process that in some areas has excluded them completely. They are also concerned about their jobs being transferred to non-NHS organisations; hopefully the Minister will deal with that today. Almost half all NHS providers were in deficit last year and we are entering uncharted territory in budget setting, so what steps will be taken in the event that an ICP reaches a significant deficit position that it is unlikely to be able to resolve alone? Given the recent news that loan repayments to the Department of Health are now a bigger financial burden to providers than private finance initiatives, will the Minster confirm that deficits caused by structural funding issues will not be resolved through further loans being issued?

It is also clear from the draft contract that the ICP rather than the CCG will be responsible for managing demand. That raises questions about accountability and transparency. What safeguards are in place to prevent further rationing of services and who will be accountable in the event that patients want to challenge such a decision? These are important questions that I hope the Minister will respond to. Will he also commit to set out in full the direction of travel, the Government’s objectives, the criteria that will be used to determine when those objectives have been achieved, and a timeline for primary legislation, which just about everyone across the sector believes is needed?

[Dame Cheryl Gillan (in the Chair)]

Before I call the Minister I remind him, although I am sure he knows, that we like to leave two minutes for the Member leading the debate to make her closing remarks. I call the Minister.