Aortic Dissection: Patient Pathways and Research Funding

Debate between Dan Poulter and Pauline Latham

Tuesday 13th December 2022 Westminster Hall

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I pay tribute to my hon. Friend’s bravery in bringing this debate to the Chamber. I know that she has been through a lot personally. As she says, no parent would want to experience the death of a child as a result of aortic dissection and her subsequent and recent work to bring this debate here and her work with the charity is commendable. I am sure that it will lead to many lives being saved in future.

On the point about diagnosis, I remember from my days in the emergency department that fast scanning, which is a simple technique that uses an ultrasound scan to check for free fluid in the abdomen, was a very important tool that we could use to detect aortic dissection. It is a simple thing to train ED doctors to do, but that training is not available in the way that it should be. Will my hon. Friend join me in pressing the Minister to ensure that the focus is not always on service delivery in ED? If we are going to have good clinicians, we need to have the right training for them and this is an area that would save lives. Can the Minister put some funding aside specifically for that purpose?

[Mrs Latham]

I thank my hon. Friend for his intervention, knowing as he does what it is like to work in an emergency department. A lot of people come through the department, but the study he refers to about the abdominal aortic aneurysm was only for men of a certain age. This affects people from 17, or even younger, to 90. Although that sounds like a good idea, I am not sure that it would work in practice. We need more CT scanners used more frequently in emergency departments, and that is what is missing in part from emergency medicine settings.

The next phase in the patient pathway for those who have been correctly and speedily diagnosed is treatment. As I mentioned, 80% of those diagnosed survive. That is not enough and research is ongoing into better methods of treatment. However, one area where we can certainly improve is long-term treatments that do not require further medical interventions. There is currently a call for research proposals into that from the National Institute for Health and Care Research. That is excellent news and I encourage the Minister to make as much money as possible available for this area of research.

After treatment, it is imperative that the follow-up treatment for aortic dissection patients and their families is of the highest quality. Two thirds of survivors of aortic dissections have some kind of post-traumatic stress disorder. They need specialist treatment by somebody who understands their conditions. Furthermore, aortic dissection survivors have a long-term condition that places them at risk of future complications. They need to be monitored by specialist teams and currently, that provision is highly variable. Teams exist in some specialist hospitals, but not all patients are reliably followed up, and too often that is a failure to take a holistic approach to follow up. The employment of specialist nurses in every aortic centre, similar to those in cancer and palliative care, would greatly strengthen follow-up.

The massive improvement in the patient pathway would not be expensive. Although I understand that every penny is being counted in the current situation, to provide a specialist nurse in each of the 29 NHS centres in the country that deal with aortic dissection, for two days a week, would cost less than £400,000 in total per year. The charity has explored the replication of the Macmillan nursing model for aortic nurses and, with funding, would be well positioned to support the design and roll-out of that initiative. Given the enormity of the NHS budget, I hope that is something that the Minister will confirm that she will look into.

The final stage of the patient pathway is genetic screening. About a third of patients who suffer an aortic dissection have some sort of genetic predisposition to the condition. That is why I welcome funding. Screening relatives of sufferers can detect those at risk and proactive treatment can significantly reduce their risk. However, that requires specialised clinical genetics input, access to which is, again, very variable. The technology exists to do that, and it would certainly save lives every single year.

There are two steps the Minister could take to improve this stage of the patient pathway. First, the employment of the specialist nurses I mentioned would be of great assistance. They would lead on the patient’s follow-up plan, part of which would include screening for their relatives. The second step would be for the Minister to facilitate a series of meetings between the relevant professional societies and appropriate NHS staff, to agree and implement a set of NHS guidelines for genetic screening for those suffering aortic dissection and for their relatives.

As I have set out, there are improvements to be made all along the patient pathway, which would go a long way towards saving many of the 2,000 patients every year who would otherwise die from aortic dissections. If nothing is done, that number will only increase in the coming years, so it is crucial that we act now.

Turning to the opportunities for investment in research, which would make a huge difference to the diagnosis and treatment of aortic dissection.

Derby County Football Club

Debate between Dan Poulter and Pauline Latham

Tuesday 28th June 2022 Westminster Hall

[Mrs Pauline Latham (Mid Derbyshire) (Con)]

I beg to move,

That this House has considered the administration of Derby County Football Club.

It is a pleasure to serve under your chairmanship again, Mr Hollobone. At the outset, I would like to thank the Minister for his support and for his willingness to discuss this issue with local MPs. That has really been appreciated.

Last week marked nine months since Derby County entered administration on 22 September 2021—nine months of pain and uncertainty for Rams fans, who have shown so much devotion and dedication to the club during this, the toughest of all seasons. Since September we have seen a string of deadlines set, and missed, by Derby administrators Quantuma and the English Football League. We had an urgent question on the Floor of the House in January because the EFL had set a deadline of 1 February for the club to exit administration. That, like every other deadline throughout the process, was missed and the administrators were allowed to delay again.

In April we finally got the news we were waiting for: a preferred bidder, Chris Kirchner, was announced. We were told on 3 May that it was “almost done”, on 14 May that it was “almost complete”, and on 27 May that they would be closing by the end of the month. On 2 June, we were told that the delays were nothing to worry about and that UK and US bank holidays were preventing the bank transfer, which no one on either side of this multimillion pound deal had apparently foreseen or planned for. All along, the administrators had assured Team Derby—made up of Members of Parliament, councillors and local stakeholders—that nothing was wrong and that Kirchner’s deal would be completed.

Two weeks ago, it was announced via the media, rather than a direct communication from the administrators, that Kirchner had pulled out. Quantuma had made a terrible miscalculation in giving Chris Kirchner 65 days of exclusivity, which could have been spent seeking other, more credible buyers. Those 65 days have come at an absolutely crucial time for the club. We really are at one minute to midnight. Derby has only seven players contracted for next season, and the EFL has not yet lifted the transfer ban. Derby needs to be able to sell season tickets and agree sponsorship and commercial deals, and there are just weeks to go until next season.

In a spark of good news, local businessman David Clowes has been announced as the new preferred bidder and, crucially, has already acquired Pride Park, the stadium, so he is in a good place to finalise his deal. We very much hope he is able to conclude the sale of the club by tomorrow, Wednesday the 29th, but Derby fans have been here before and will not believe it is over until the ink has dried on the contract.

However, it was also announced this week that our inspirational manager, Wayne Rooney, who has given his all to the club over the past year, has left. He fought against all the odds to rescue us from relegation. Despite a transfer ban and a 21-point deduction, he very nearly achieved that feat. Without our points deduction, Derby would have finished comfortably out of the relegation zone, in 17th place. I thank Wayne for all he has done for Derby County. We understand the difficulties and challenges he faced. Rams fans will be giving all our support to interim manager, Liam Rosenior, who has supported Wayne throughout the past year and now has the chance to lead the team forward and hopefully eventually back to the championship and beyond.

With all that context in mind, I have three main points I would like the Minister to respond to. My first relates to the conduct of the administrators, Quantuma. For some time, I have been very concerned about its competence in handling a business of Derby’s size. It took more than a month to work out that Kirchner was not able to provide the funds he promised. There are reports that it failed to communicate effectively with other interested buyers, and it has therefore run the club dangerously close to the edge of liquidation over the past nine months.

Furthermore, Quantuma’s manner of communication with local stakeholders through Team Derby has been incredibly poor. It has constantly told us that it is on the edge of breakthroughs, which never materialised. Our weekly updates barely had any new information. Quantuma refused to discuss key matters, on the grounds of commercial sensitivity, only for those matters to appear in the newspapers the next day. It is reported that Quantuma racked up more than £2 million in costs in the first six months of the administration. Its latest response to supporters’ groups assures us that no fees have been drawn so far, but not that it will not be taking them out of the sale proceeds.

It appears to me that the conduct of the administrators has fallen far short of what Derby County has a right to expect. However, there are no fans’ voices in this process. Fans have had no say in who the new owners of Derby County will be, and the administrators have failed time and again to communicate clearly with the fans.

[Dr Dan Poulter (Central Suffolk and North Ipswich) (Con)]

I congratulate my hon. Friend on securing this debate and on her and other local MPs’ tremendous efforts and leadership in championing the needs and future of Derby Town. This fate could befall any football club or any large sports club. She reflected on the conduct of the administrator. Does she have some suggestions for the Minister about how the process could be improved? We all look at our local football clubs and do not want to see a similar situation occurring. If it does, we want to make sure that the situation can be remedied as quickly as possible.

[Mrs Latham]

I thank my hon. Friend for that contribution. I must correct him: it is Derby County, not Derby Town. Yes, this is a problem that could happen to any club at any time and in later remarks I will address what could be done.

The fans and the club deserve so much better. Can the Sports Minister update us as to how best we can hold Quantuma to account? In particular, how would he expect administrators to consult and communicate effectively with fans during a sale process? Furthermore what, specifically, will the Sports Minister do to ensure that Quantuma is acting in the best interests of Derby’s fans? The club is not out of the woods yet and I have lost all confidence in Quantuma. Therefore, I call on the Sports Minister and the Secretary of State to take a close interest and ensure that the interests of Derby fans are represented in what are hopefully the very final stages of the sale to Clowes Developments Ltd.

My second point relates to the English Football League, which has an important role in saving Derby County. It is responsible for the particular set of insolvency rules that govern football clubs and for resolving disputes between clubs. Unfortunately, its apparent desire to take a back seat has been very damaging to Derby County. The well-publicised claims by other clubs made Derby a much less appealing prospect for potential buyers, particularly given the EFL’s refusal to confirm that those claims did not amount to football debts, which need to be paid in full. It was only after Chris Kirchner pulled out of the process two weeks ago that the EFL finally announced it would amend its position and become fully involved in the process of finding a buyer alongside Quantuma. That is far too late and should have taken place much earlier in the process.

In addition to assisting with the negotiations with interested parties, there are other key actions that the EFL can take that would help Derby County fans. First, it must lift the ban on Derby signing and re-signing players. With just weeks until the start of the season, Liam Rosenior has only seven players to choose from. The EFL must immediately allow Derby to sign players or at least to re-sign existing squad members to contract extensions. Secondly, fans have been squarely behind Derby County throughout the whole process. They have turned up to matches, and the grounds have been at capacity. However, fans have not yet been able to buy season tickets for next season, which not only hurts them but reduces the income for the club at a time when it is so desperately needed.

Derby County is a founder member of the English Football League, which has treated our club and our fans poorly, when it should be doing everything possible to ensure that the club is not liquidated and has enough players to compete in League One next season. What discussions has the Sports Minister had with the EFL to ensure that Derby fans are not punished, that they will be able to get season tickets for the upcoming season and that the club will be able to field a full side for its opening games? The EFL has been incredibly slow to step in and oversee Quantuma’s work. What assurances has the Minister received that it will be much more active in securing the future of one of its member clubs going forward?

My final point relates to the actions that we can take in this place. So much of the situation could have been avoided if the recommendations from the fan-led review into football governance, which my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) has championed, had been implemented already. The hon. Lady sends her apologies; she desperately wanted to be here and support Derby and its fans, but she has been held up.

Creating a new independent regulator for football governance requires primary legislation. An independent regulator is needed so that fans’ voices are heard throughout the process to ensure that the right people are in charge of football clubs. Football clubs are not just commercial assets or businesses; they are community assets of huge sporting, cultural, economic and historical value to the local area—no club more so than Derby County, an historic founder member of English football. It has fans not only across the region, but across the world, and its game days provide an economic boost to Derby and the east midlands.

All too often in recent years, we have seen the effect on the local area of a football club going into administration. My hon. Friend the Member for Bury North (James Daly) made the point eloquently during my urgent question in January about Bury football club. An independent regulator is desperately needed to ensure that the right people are in charge of football clubs and are meaningfully taking the views of fans into account. Please, for the sake of Derby fans, Bury fans and so many more, will the Minister confirm that that crucial legislation will be brought forward?

In conclusion, I have concerns—to which I would like the Minister to respond—about the administrators, the EFL and the fan-led review of football governance. I thank right hon. and hon. Members for their participation in the debate. I know that the Minister will be able to see the strength of support for Derby County here in the Chamber. I also want him to be aware that other colleagues would have liked to contribute to the debate, but cannot because they are Whips or Ministers. None the less, they are still local Members of Parliament who have also been involved. Many Members support our cause, because if these things can happen to a club such as Derby County—a founder member of the Football League—they can happen to anyone.

I look forward to the Minister’s response and hope for assurances that he and the Secretary of State will be taking a keen interest in the resolution of the administration over the next day or two—a resolution firmly in the interests of Rams fans.