Changes to Health Services in London

David Burrowes Excerpts

Wednesday 30th October 2013 Commons Chamber

[Mr Hunt]

There is no humiliation in doing the right thing for patients, and I will always do that. Sometimes it is difficult and we have battles with the courts, but no one is above the law. I have said that I respect the judgment made by the court yesterday, and that is what I shall do.

[Mr David Burrowes (Enfield, Southgate) (Con)]

Are there not three lessons to learn from the Secretary of State’s statement and the response from the shadow Secretary of State? First, we should listen to the opinions of local doctors. Secondly, delay puts at risk patient safety. Thirdly, we should not play politics. For Enfield, is it not the case that we should recognise that local doctors have united to say that we need to get on and implement changes, because delay would put at risk patient safety this winter, not least at our new, expanded North Middlesex hospital in Enfield? The future of Chase Farm is secure, but it could also be put at risk if we do not allow the implementation of good changes. We should not play politics, but Enfield council is doing so by trying to challenge the changes.

Oral Answers to Questions

David Burrowes Excerpts

Tuesday 22nd October 2013 Commons Chamber

[Norman Lamb]

First, I acknowledge my hon. Friend’s campaigning on behalf of his constituents—he has worked very hard. I understand that, as part of the case for change and for reconfiguring health services at Chase Farm hospital, a doctor will be available to see patients at Chase Farm 24 hours a day, seven days a week. However, given that my right hon. Friend the Secretary of State for Health has been named as a defendant by Enfield council in the judicial review, it would not be appropriate for me to comment further at this time.

[Mr David Burrowes (Enfield, Southgate) (Con)]

Does the Minister recognise that the question is not if the changes take place, but when? Does he recognise that all my local doctors say that it is in the best health interests to get on with the changes, not least given that the £200 million invested in the new North Middlesex hospital in Enfield was dependent on them?

[Norman Lamb]

I recognise my hon. Friend’s work in this regard. Decisions should be based on clinical judgment and the views of local doctors are important. He draws attention to a fantastic new facility. I pay tribute to everyone who has worked to achieve it. It will serve the local community well.

Backbench business

David Burrowes Excerpts

Thursday 14th February 2013 Westminster Hall

[Caroline Nokes]

That is a difficult question. Later, I may even suggest that we are moving backwards. Unfortunately, these are hidden conditions that the media and others have chosen, occasionally, to trivialise. They are not trivial and they need much higher priority.

[Mr David Burrowes (Enfield, Southgate) (Con)]

I congratulate my hon. Friend on securing this debate. On the subject of this being a hidden illness, in recent times mental health has risen up the agenda, and attention has been given to the topic in the House, which has shone a light on the issue of mental illness. Why, even in the field of mental illness, has this area in particular not received attention, when its mortality rates are the worst?

[Caroline Nokes]

My hon. Friend makes an important point about the mortality rates, compared with those for other mental illnesses. In this place, we have made great strides in being far more open and willing to discuss mental illness. This illness is hidden, and has not received priority or generated the attention that it so desperately deserves. It is incumbent on all of us to ensure that the Minister, who I am sure is listening, gets that message loud and clear.

--- Later in debate ---

[Mr David Burrowes (Enfield, Southgate) (Con)]

I congratulate my hon. Friend the Member for Romsey and Southampton North (Caroline Nokes) on securing this debate. I was privileged to support her application to the Backbench Business Committee and, with others from across the House, to commit firmly to this debate. I hope that, at the very least, one thing that comes out of it will be a greater number of Members of Parliament pressing for improvement.

I, too, am straddling debates and trying to be in two places at once. I apologise, Mrs Osborne, for the fact that I must leave to go to the Marriage (Same Sex Couples) Public Bill Committee, which is continuing its deliberations.

All of us must declare an interest when it comes to eating disorders. All of us have to accept that we know a friend, family member or constituent who is dealing with the issue, and if we do not know one, we are out of touch with what, sadly, is the reality. All too often, that is a hidden reality, which is why I so welcome our shining a light on this important concern.

I do not come to the subject as a great expert, but I have been involved over the years—I share this with the Minister—in the issue of addiction, which is similar. I increasingly see great similarities between the issues. There is the profound loss of freedom; the diminished and, sadly, lost lives; the effect not only on patients, but on family members and all those around them; the health concerns, and the wider social concerns for society; and the whole process of treatment and recovery, with individuals, their family and society at large having to make a long-term, continual commitment. That matters, in terms of the quality of treatment and the support from family members and peers. All those issues should be promoted.

Although there are, sadly, the negatives—I will predominantly talk about the problems—I have been particularly impressed by the power of recovery. The positive stories of those in recovery are immensely powerful, and we must given them a much louder voice.

I have said that I am no great expert, but from those close to me and from constituents, I have learned that we cannot find one magic solution, or seek a simplistic or generalised one. Eating disorders are complex and contradictory, and in many ways there is ambiguity as regards recovery. That makes them particularly problematic, in terms of illness, mental illness and recovery. They are highly resistant to change; unlike with a physical illness, the patient wants to hold on to these disorders as a method of coping, so they are inherently hard to treat.

I want to concentrate on treatment and recovery. We must accept that we have a problem, and I would be interested to hear the Minister’s response to that. We have a problem in terms of the prevalence of eating disorders. They are on the rise in the UK, which has one of the highest rates of hospital admissions in Europe. The most vulnerable may well be teenagers, but eating disorders cover all genders and ages. Indeed, it is right to mention boys: 25% of those affected at school age are boys, whereas I understand that 10 years ago that figure was 10%. We also have an NHS problem—I have to say that—and a family problem in relation to how families are involved.

[Mary Macleod (Brentford and Isleworth) (Con)]

Does my hon. Friend agree that there might also be a problem in schools? We need to talk more about the issues with children at a very young age. Teachers can be part of that process by aiming to explain some of the issues and making young people feel more comfortable about body image.

[Mr Burrowes]

Very much so. The guidance is all on the side of early intervention. Indeed, the Government are very much on that side, and I am sure that there is a cross-party call for early intervention. That is a key area, and we must tackle the issue through not only better treatment, but profoundly better education and prevention, as well as culturally, through the media. That is an area on which we can give our views, which we are airing here, and where we can be part of a changed culture, but it really happens at an early age.

I particularly point to the pressure on services and waiting lists—an issue that has already been mentioned. The pressures on GPs and others for referrals to out-patient and in-patient services are growing. Anorexia and Bulimia Care—I pay great tribute to that leading national charity, among other good ones, on eating disorders—has told me that adult sufferers can wait up to nine months or even a year to receive treatment. That is profoundly damaging for adults, but think of young children who are susceptible to rapid weight loss waiting, at a time when they are growing. That wait for treatment while the right service is found could quickly put their life in danger.

Training in the complexities of eating disorders has been mentioned, but the general training that should be mainstreamed for GPs does not exist. Health professionals wrongly diagnose patients, mishandle their cases and lack sensitivity and proper judgment. Short time allocations for appointments mean that GPs cannot get to the heart of the physical and emotional needs of patients, who require time and cannot simply be moved on quickly. They need a proper rapport with GPs and investigations that involve the wider health community. With the pressures on GPs, are patients properly followed up, rather than allowed to slide into both physical and mental danger?

Sadly, among the most common causes of death are heart failure and, indeed, suicide, and the issue therefore needs to be grappled with properly and carefully. We must ensure sensitivity in the handling of that long-term involvement—because shortages in treatment services mean that patients end up falling back on pressurised GPs for the monitoring of their health and safety—but, sadly, that does not happen.

We have too few specialist in-patient units for eating disorders. The NHS has St George’s hospital, Tooting, a mental health unit largely for adolescents, which offers general mental health provision. Children who are already traumatised are going there; they are even more traumatised after going to units that do not have the specialists that we want them to see. We want more eating-disorder-only establishments. I will return to that in due course.

As has been mentioned, there is a profound issue about parents and carers. Parents raise the issue of their needs, and the important role that they play in recovery; those things are sometimes ignored or excluded, particularly if the child lives at home, as 16-year-olds often do. I understand that carer support services can be hard to find in several counties, and parents complain that they are simply shut out from the practical care of their children. That is totally contrary to the way that child and adolescent mental health services were set up to deal with such cases, but sadly, it happens all too often.

We have already taken up the issue of the statute with the Under-Secretary of State for Education, my hon. Friend the Member for Crewe and Nantwich (Mr Timpson), who has responsibility for children, and I look forward to meetings with the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) in relation to mental health. The Children Act 1989 seems to lead to a statutory anomaly, in that those aged 16 and over are given the right to refuse treatment for an eating disorder; there is therefore the prospect that they will be sectioned, and that that will be on their health record for life.

In effect, the Children Act enables GPs to tell children aged 16 and above that they can refuse treatment, which might sometimes undermine the work and values of parents. The number of complaints that I have received on that issue reflects the fact that it is a systemic concern. One set of parents told me about their 16-year-old child who was living at home—I know that this illness covers all ages and not just 16-year-olds. They were responsible for feeding and looking after her, but were excluded from her care. Such treatment might well have perpetuated the illness, and the dire straits that she was in; she may have been at the stage of trying to manipulate the system. These 16-year-olds, who are often intelligent and able young people, know the system as well as anyone else, and their manipulation of it can hinder the practical medical process of recovery.

Mental health legislation, including the Mental Capacity Act 2005, and the inherent jurisdiction of the High Court are interwoven in the treatment of this complex condition. We must also consider how we link in the organisations on the ground, such as CAMHS, to ensure that we involve all the relevant bodies in the health and care of our loved ones. Stigma and public misconception are also important issues, as the attitudes of the public and of health service professionals can hinder treatment.

I want to leave the final word to the experts—the families, who, sadly, have never wanted to be experts in this area. These are the sorts of stories that I hear all too often. One constituent became concerned about their daughter’s sudden loss of weight. They went to their GP, who made a referral to the local CAMHS team, which passed the matter on to the specialist eating disorder unit at the Royal Free hospital. The first appointment came up a couple of months later. The girl saw a consultant and dietician weekly or fortnightly. She attended various groups and family therapy sessions, but at no time did she receive any individual therapy.

Four months later, the child became abusive and violent towards her family. Despite attending regular hospital appointments, her intake of food was becoming more and more restricted. Her weight loss continued until she became skeletal. At times, the parents were in desperation. They phoned the hospital, pleading with it to admit their child, because they were reaching a point where they just could not cope. The response from the hospital was that in its opinion hospitalisation was not deemed necessary.

The parents felt completely helpless and as if they were battling the illness on their own. That went on until they found a helpline number for Anorexia and Bulimia Care, which proved to be a lifeline. A doctor eventually saw their daughter, who was so poorly that they were unable to get a blood pressure reading. There was no hospital involvement or admission at that stage, but the parents realised how important it was, and that their daughter needed to be admitted. Indeed she was admitted, not to an NHS clinic, but to Rhodes Farm clinic, which provides exceptional care. ABC underwrote the cost of treatment. We have been battling ever since to try to get the health service to take some responsibility for that cost of treatment.

Since then, there has been progress. No one would say that the girl is out of the woods, because it is a continuing process, but for her to be able to take food, gain weight steadily, feed the mind and the brain, and engage with processes has helped. The parents have said that without the support of ABC, they dread to think where they would be today; it saved their lives.

I have another example, which involves not lay people but a local doctor, who says:

“doctors know all about Anorexia and the best way to treat it, and the latest development in treatment—WRONG!”

She goes on to say:

“The help was not there. The doctors at best were sympathetic, at worst were downright dangerous.”

This is the mother of an intelligent and gifted daughter. She said that she could have been anyone’s 15-year-old, and yes, it could have happened to a boy as well as a girl. She was a normal loving child. The mother told me what happened:

“We went to doctors, paediatricians, bowel specialists. They found nothing wrong with her stomach. I told them of my worries. ‘Oh no. She is not thin enough to be anorexic!’”

The daughter was asked whether she was eating. “Yes”, she said. “Well, you need to eat more, sweetie”, her mother said. The daughter promised that she would try,

“But she didn’t. Always there was an excuse.”

The problem got worse. It is a familiar story:

“Every time we mentioned food or insisted on eating, she threw plates, broke things, kicked, screamed, destroyed her room. Her brain was now completely malnourished, starved of even basic nutrients. She had the look of a wild, caged animal. She told us…she was a bad person and wanted to die. ‘Please let me die mummy’ she would scream.”

Eventually, the parents got her to casualty and were told that she most likely had anorexia. The doctors said that a referral would be made to the CAMHS team. The parents were desperate. Their child had become psychotic and was in danger of starvation. The mother said,

“Even though I knew, hearing the doctor actually say ‘Anorexia’ made it real. ‘Anorexic? No way! She’s normal. She’s clever. She wouldn’t do this. She is not one of those silly girls!’ The guilt. The feelings of desperation, the sheer magnitude of what was happening was overwhelming. What a terrible parent I was! How could I have let this happen? How could I have not realised?”

There were no terrible parents involved in that story. This is an issue that must be tackled at an earlier stage, so parents do not go through that desperate nightmare. In conclusion, there is a good end to that story—well, not so much an end as a positive outcome.

Another parent who had the help of ABC and who used Rhodes Farm clinic said that they considered their daughter to be one of the lucky ones who has, through that excellent treatment facility, been given the chance of having a full life again one day. They said, “For every such one, there are 100 others who are not receiving the care they need or deserve for this dreadful illness, but hopefully they will.” As hon. Members on both sides of the House have said today, we can, hopefully, help to change that.

Accident and Emergency Departments

David Burrowes Excerpts

Thursday 7th February 2013 Commons Chamber

[Nick de Bois (Enfield North) (Con)]

I am not sure I can keep up with the pace of the hon. Member for Lewisham West and Penge (Jim Dowd), but I am delighted to follow him and I have some sympathy with one of his points. I felt compelled to write to the NHS medical director, Sir Bruce Keogh, having seen his comments about the role of politicians.

[Mr David Burrowes (Enfield, Southgate) (Con)]

It is 2-1.

[Nick de Bois]

It is true. As my hon. Friend says from a sedentary position, the Evening Standard claimed, “Nick de Bois 2, Sir Bruce Keogh 1”, so I hope I wrote on behalf of all Members. The medical profession is at the root of this issue. If it wants to win arguments based on evidence, so be it, it can win those arguments against politicians, but it also has to win the hearts and minds of the people it serves. That is why we should not be taking lectures on the role of MPs and democrats.

I would like, unapologetically, to talk about my hospital, which has been introduced briefly by my neighbour, the hon. Member for Edmonton (Mr Love). As a hospital facing threats of change—not all good by any means—Chase Farm hospital must predate almost every Member present in the Chamber, perhaps with the exception of the hon. Member for Islington North (Jeremy Corbyn). Going back to the early 1990s, it was promised the proceeds from the disposal of the Highlands hospital. As my hon. Friend the Member for Newark (Patrick Mercer) said, the story I am telling crosses more than one Government, so I will try to tell it in a non-partisan way because my interest is in getting the best for my constituents.

After my constituents were let down by the promise of investment from the sale of Highlands hospital—now a pleasant residential area—no money was forthcoming, and in 1999 an administrative merger between Barnet and Chase Farm hospitals was proposed, which we were assured would lead to no clinical changes and have advantages. The effect of the merger was that the healthy balance sheet of Chase Farm was sucked dry to support a hospital that was bleeding payments—the hon. Member for Lewisham West and Penge may identify with that. Again, my constituents were let down.

Just before May 2005 we were told that we would have £80 million investment in our district general hospital. Sadly, that investment did not materialise, and shortly afterwards, in 2006, a programme of downgrade—reconfiguration, as it is known—was started, particularly in our maternity and A and E units. That was confirmed in 2008, but judicial review by the local council held it up. Hopes were just beginning to rise, and with the change of Government those hopes were raised again from the moratorium. I have said this before on the Floor of the House but I will repeat it for the avoidance of doubt: my constituents were utterly let down by the Secretary of State when we were again downgraded.

Hon. Members will therefore understand why my constituents—I am sure this resonates with hon. Members on both sides of the House and their constituents—and the public the acute hospitals serve are so sceptical when they are on the receiving end of advice and recommendations. It is a question of trust and transparency.

Like every hon. Member, I understand the full implications of the strategic drive for, and some of the benefits of, centralisation. However, I oppose the reconfiguration because of the inconsistency in what we have been told. There has been a clinical case for change, and a clinical and safety case for change, and yet in 2011, the Care Quality Commission said that Chase Farm hospital was running up to standards.

At that point, the PFI situation emerged. The PFI deal sealed for North Middlesex hospital—a neighbouring hospital in the south of the constituency—meant an investment of £129 million over 31 years, meaning a total repayment of £640 million. That £2 million a month comes off the operational budget. On 22 November, the then Secretary of State was quoted in the very reliable Daily Mail as saying that the recent downgrade was partly because of unsustainable PFI debt.

One reason often cited for the proposed downgrade of my hospital is that GPs support it. Three hospitals—Barnet, North Middlesex and Chase Farm—were part of the downgrade plan, and GPs from Haringey, Barnet and Enfield were asked about the proposals. The vote was organised like a communist meeting. If we ask people in Haringey or Barnet whether they have a problem with the downgrade in Chase Farm, I suspect they will say no if it benefits their hospital. The figures show that only 44% of Enfield GPs approved, but of 129 GPs asked, only 48 responded, so only a positive 16% recorded their support. I hope the Minister asks her officials to reflect on that point.

I oppose the reconfiguration but recognise that I need to fight for the best possible deal for Enfield. It is therefore important to examine the so-called pre-conditions of implementation of the strategy that we were promised —we were guaranteed that they would be put in place.

[Mr Burrowes]

I commend my hon. Friend for his continuous efforts, although perhaps he should take his seat since he has given way.

[Mr Deputy Speaker (Mr Nigel Evans)]

That is my job, not the hon. Gentleman’s.

[Mr Burrowes]

My hon. Friend has continuously stood up, not just in the House but in his constituency, against the closure of the A and E in Chase Farm and for securing health improvement in Enfield. He has secured a cross-party delegation meeting with the Secretary of State, at which we want an assurance that the £10.6 million being invested in primary care in Enfield ensures we get effective primary care improvements before the reconfiguration.

[Nick de Bois]

That goes back to my point—it is a question of trust. It is vital that that promise is delivered, but it is already some four years since the change was envisaged, and very little has been put in. It is therefore right that we press the case for implementation and delivery on the ground if the strategic review goes ahead.

I welcome the opportunity to meet the Secretary of State—I hasten to add that a cross-party delegation will meet him—but I have some questions to put to the Minister on the Floor of the House. Is she aware of the growing health inequalities in the borough, which have increased since the original 2008 assessment? According to the latest census, the population is far removed from the original assessment—there are 40,000 more people.

Liverpool Care Pathway

David Burrowes Excerpts

Tuesday 8th January 2013 Westminster Hall

[John Pugh (Southport) (LD)]

I also congratulate the hon. Member for Montgomeryshire (Glyn Davies) on introducing this important debate in such a measured and sympathetic way. It was effective indeed.

I do not like the term “Liverpool care pathway”; I prefer talking about guidelines for palliative care. That is probably a less contentious way of discussing it. The Liverpool care pathway was developed in Broadgreen, and I was born in Broadgreen. More importantly, my grandmother died there, having been readmitted several times. The last time she was admitted she had declined somewhat at home and I can remember the expression of horror on her face indicating that that was not the right way to treat her. She knew that she was going to die and she wanted to die at home, and she was being admitted unnecessarily to hospital. I regret that we arranged for that to happen. It is very important to get the last years, months and weeks of people’s lives correct and we certainly did not; hence there is a need for things such as the Liverpool care pathway and a more understanding, measured and sensible approach to affairs.

There is a need for the hospice movement, but the reality is that most people do not die in hospices; they die in the NHS and there is a need for the NHS to have some clinical guidelines to follow. That is particularly the case for those in their last hours, day, weeks and months, whose death is imminent and who cannot have that death prevented or, realistically, postponed. That is quite a high threshold to be met, and finance should in no way come into meeting that threshold. When finance does come into it, it can only corrupt the process. The Liverpool care pathway guidelines imply constant review and no one wants that coloured by financial incentives. After all, there is always the remote possibility of people getting the diagnosis wrong.

That is not a case against having guidelines at all or against thinking that we sometimes need to opt for a palliative choice rather than a remedial one, if there is no realistic remedial choice available. If that choice has to be made, there is no in-principle case for involving relatives and the patient in it, with the important caveat that what is done should be in the patient’s interest. I am not always sure there is an obligation to clarify the situation for the patient or their relatives, if they prefer to die in hope or expectation of recovery and find the thought of their inevitable demise insupportable, particularly if it will not change clinical behaviour and the only option is palliative care for that person. That is a difficult issue, which every clinician needs to face and be guided on in facing it.

There is certainly a need to inform the patient and/or relatives if expectations about care are starting to differ, or if the nature of the palliative care offered is unclear. That might be the case if a patient is wrongly categorised, or if there is a debate about the palliative care itself, and it is seen as substandard. Some of the episodes of dehydration that have been described in the national newspapers have seemed to me to be substandard palliative care. The bottom line is that palliative care should not worsen the condition or augment the suffering of somebody who inevitably will die, unless the patient chooses it. In certain circumstances, I can imagine somebody trading pain for more life.

Care can be worsened in two quite different ways: it can be worsened by disruptive, painful, pointless, futile interventions, and it can equally be worsened by neglect, and indifference to people’s symptoms and the manner of their decline. My aunt recently died in the Royal Liverpool, which has taken over Broadgreen. I remember going to her bedside and seeing the signs that said, “Nil by mouth”, and wondering whether we should offer her a drink while we sat there and talked. We never managed to get round to having a sensible conversation about that with the medical staff. I was never sure what I was confronted with. It might have been wise care; there may have been a genuine risk of choking, which I believe is one of the reasons why people are not given liquids at that stage. It might just have been neglect or absence of thought. What did not happen—and should have—was a discussion about treatment: a sort of negotiation.

If palliative care is the path chosen—it should only be chosen when it is, in a sense, the only path—there needs to be a negotiation. It is the trick of getting that negotiation right that is the difficult thing. We need to respect the rights of all people concerned, and the patient’s rights sometimes differ slightly from the family’s rights. The family fearing bereavement can only wish the patient to live at all costs. That may not always be the patient’s aspiration in that circumstance. The hon. Member for Montgomeryshire has started us along the path of having a measured discussion and review of these matters and I hope it continues.

[Mr David Burrowes (Enfield, Southgate) (Con)]

I respect what my hon. Friend says on communication with the patient, but I would like to clarify something. A survey by the Marie Curie Palliative Care Institute Liverpool and the Royal College of Physicians said that half of those on the LCP are never told that they are on such a pathway. Also, the LCP is not just a framework of good practice but a pathway, taking the patient towards the presumed outcome of death. Surely, therefore, it is important to make it clear that there should be communication with the patient; it should not be only the best half who know.

[John Pugh]

That in part is the dilemma. I know that the saying is “No treatment about me, without me”, but there are certain circumstances that we will all be aware of where the patient is dying and the clinician is in an acute moral dilemma over whether to inform them that that is the case—that there is no hope and that they will be given purely palliative treatment. I am fairly confident that a good number of people will die in our hospitals for years to come, despite the Liverpool care pathway or any other guidelines that we put in place, who will, until the moment of their decease, expect recovery.

NHS Commissioning Board (Mandate)

David Burrowes Excerpts

Tuesday 13th November 2012 Commons Chamber

[Mr Hunt]

As the hon. Lady knows, we manage our finances extremely carefully but we do have underspends. We try to minimise them and there has been a real-terms growth in spending—actual money spent in the NHS, compared with Labour’s plans. In the first year of the review there was a real-terms increase and we will continue to manage NHS finances with a commitment to protecting the budget, which did not ever happen when the right hon. Member for Leigh was in post.

[Mr David Burrowes (Enfield, Southgate) (Con)]

I welcome the Secretary of State’s priority to reduce the disparity in health outcomes, not just across the country but across local areas. Will he reassure me that the mandate, delivered in partnership with local health and wellbeing boards and local GPs, will end the scandal—Labour’s legacy—that from the west of the borough of Enfield to the east, the age mortality rates decrease by more than 10 years?

[Mr Hunt]

My hon. Friend is right. That is why, at the heart of the mandate, is an information revolution so that the public can understand exactly how well different parts of the system work, and so that we create the right pressures on the system to improve where performance is poor. I agree that the central, top-down structures that we had before did not allow that to happen. If we had cut the budget, as the Opposition wanted, it would have been even more difficult now.

Oral Answers to Questions

David Burrowes Excerpts

Tuesday 17th July 2012 Commons Chamber

[Paul Burstow]

Notwithstanding some of the perhaps intemperate exchanges we have in this place, my colleagues and I are still determined, if those on the Opposition Front Bench are, to engage in talks on how we reform the funding system. Indeed, the debate we had in the Chamber last night confirmed that both sides of the House wish to support the principles of the Dilnot reforms, so I hope that we can have such talks and that they can be reflected in the Bill.

[Mr David Burrowes (Enfield, Southgate) (Con)]

I welcome the Government’s commitment to support the provision of free and fully integrated end-of-life care. While the palliative care funding pilots are progressing, can lessons be learnt quickly in my borough of Enfield where, sadly, most people are dying in hospital rather than, as is their choice, at home or with the support of local hospices?

[Paul Burstow]

My hon. Friend is absolutely right. Just last week we published the world’s first ever survey of bereaved people’s experiences of the end-of-life care received by loved ones. It revealed quite stark variations from one part of the country to another, and will prove a valuable tool in driving up performance of areas that are not doing well by families in end-of-life care. As for the White Paper, we have said clearly that we are committed to doubling funding for the pilots to ensure that we have the data to take decisions about the introduction of free personal care when it comes to end of life.

Oral Answers to Questions

David Burrowes Excerpts

Tuesday 12th June 2012 Commons Chamber

[Anne Milton]

I can assure the hon. Lady that I am not at all worried about the politics of the issue. To ensure a brief answer, I refer her to the Government’s alcohol strategy, which mentions all those factors and draws attention to the substantial progress we expect to see on those figures.

[Mr David Burrowes (Enfield, Southgate) (Con)]

I welcome the Government’s commitment to supporting GP screening for alcohol misuse, but given that less than a third of GPs use an alcohol screening questionnaire, and of those a third use them for an average of only 33 patients a year, how can the reformed national health service incentivise those GPs to ensure that they support early intervention and minimise alcohol harm?

[Anne Milton]

We will introduce an alcohol check within the NHS checks for adults from April 2013. My hon. Friend is right to highlight the substantial impact that identification and brief interventions in the GP’s surgery and elsewhere can have.

Health and Social Care Bill

David Burrowes Excerpts

Tuesday 13th March 2012 Commons Chamber

[Valerie Vaz]

My hon. Friend makes an important point. He should read the front page of the left-leaning newspapers, and he will see how much money is being spent on locums.

The GP in Walsall said that the pace of change is too fast. GPs are being forced into larger organisations. They have no experience of managing a business model. The Secretary of State says he wants to cut the numbers of managers. If the number of managers has been cut, why are the management consultants crawling all over the NHS? A group of consultants including McKinsey, KPMG and PricewaterhouseCoopers sealed a £7.1 million contract with 31 groups of GPs. Pulse found that four in 10 clinical commissioning groups across England have begun to enlist commissioning support from the private sector. That was the work that the PCTs did.

The Secretary of State says that change is happening anyway. So why have the Bill? The Secretary of State says that Monitor did not have a duty to promote competition. So why did the Government not approve the amendment tabled by Lord Clement-Jones that sought to designate the health service as

“a service of general economic interest”,

taking it out of EU competition law? That was not accepted.

The Government said that the role of Monitor is like that of Ofgem, Ofwat and Ofcom. David Bennett said:

“We did it in gas, we did it in power”.

Who are the shareholders? Look at Centrica. Its shareholders include Bank of New York Mellon, the Government of Singapore, the Government of Norway, the state of California, the Government of Saudi Arabia, and Goldman Sachs. The shareholders of the NHS are the people of Britain—but for how long?

The Secretary of State says he wants integration, but the Bill will effectively repeal the integration that started with the Health and Social Care Act 2001. Torbay is a classic example of that. What about the cost, which is £1.2 billion and counting?

[Mr David Burrowes (Enfield, Southgate) (Con)]

Will the hon. Lady give way?

[Valerie Vaz]

I am sorry, but I have nearly finished my speech and must press on.

There was a chorus of disapproval from professionals when the White Paper was published, as they wanted more information. As Rogers and Walters say in the sixth edition of “How Parliament Works”, if there is pre-legislative scrutiny, Ministers have less political capital at stake and changes are not seen as defeats; the scrutiny of a Bill in draft gives higher quality legislation. That is not a description of the Health and Social Care Bill. The pre-legislative scrutiny was in the Secretary of State’s head, not in a draft Bill.

What about my constituent Stephen Wood, who went to his local GP’s surgery only to be told that doctors would only refer him to a consultant privately, not on the NHS, as he had apparently used up his budget?

--- Later in debate ---

[Joan Walley (Stoke-on-Trent North) (Lab)]

I am grateful for the opportunity to follow the hon. Member for St Ives (Andrew George), and the House would do well to listen to what he says. The Secretary of State may feel that he can bluster his way through the debate, but people out there—our constituents—are listening. When I became a Member almost 25 years ago to the day, I made the point that the health of the people is the highest law, so even if we cannot deal with the Bill in this debate, we have three hours in which we can send a message. Although I came into the Chamber to support the motion in the name of my right hon. Friend the Member for Leigh (Andy Burnham), I have listened to what he has said and to what the hon. Member for St Ives has said, and I am quite content to back the amendment and to ask for an urgent summit—and for the trade unions to be involved as well.

[Mr Burrowes]

Will the hon. Lady give way?

[Joan Walley]

No, I will not.

I agree with the right hon. Member for Charnwood (Mr Dorrell), who chairs the Health Committee, that some aspects of the Bill are very worthy, particularly those on public health, and we do not want to lose them, but four issues need urgent clarification, and I hope the Minister will address them when he replies.

First, why are my constituents not entitled to know what is on the risk register? What is there to hide? Why can we not have it laid before us when we are making important decisions about the future of the NHS? I am quite content for there to be service changes, but not structural, top-down reform, which the Prime Minister himself, in one of his commitments before the general election, said he was not going to introduce.

The key issue for the House is whether the NHS will be subject to the full force of domestic and EU competition law, and that has not yet been clarified. The Government maintain that it will not, but the changes brought about by the Bill make certain that it will. In any event, it is not in the Government’s gift to decide, because the issue will be decided in the courts, so I genuinely believe that we are entitled to clarification on that issue—[Interruption.] I will not give way on that point. It is absolutely essential that the Government, not the law courts of this country, determine NHS policy.

Secondly, what safeguards are there against private companies using loss leaders to replace NHS services and then, once the NHS service has been eliminated, maximising profits by reducing quality? We have heard from the Secretary of State on that, but once the service is eliminated, the private companies that come in will surely have a free hand. The Government say that there will be no competition on price, but private companies will still be able to use loss-leader tactics by overloading a bid with quality for the specified price, so we must have regard to the real concerns about that.

Thirdly, how will the Government stop cherry-picking in practice? If they attempt to exclude private companies from bidding for a particular contract, will they not face court action, and in those circumstances will not services be put on hold while the courts deal with how NHS care is to be provided?

Finally, again when the Minister replies—

--- Later in debate ---

[Chris Skidmore]

I am talking about the right hon. Member for South Shields, not the hon. Member for St Ives (Andrew George).

Professor Julian Le Grand stated on 28 February:

“With respect to the NHS bill, it is important that even those who generally prefer to rely upon their intuitions should avoid muddying the waters by accusing the bill of doing things that it does not, like privatising the NHS; and that all those involved should acknowledge the peer-reviewed evidence demonstrating that its provisions with respect to public competition…are likely to improve patient care.”

More hours have been given to debating this Bill than any other during this Session. Despite Labour’s message, which seems to be opposition for opposition’s sake, we are gradually learning what its policy will be for the next general election. It is interesting that at a rally in Manchester last week, the right hon. Member for Leigh stated, in front of his union faithful,

“And I will make you a promise today—if I am the health secretary after the next general election I will repeal this bill.”

According to the Opposition, this is the greatest reorganisation in history. Yet the Bill will save £4.5 billion straight away and then £1.5 billion recurrently, year on year, thereafter.

[Mr Burrowes]

All our constituents will be listening intently to the debate and will hear that following the health inequalities that have grown under the previous Government, the Opposition will oppose and repeal legislation that imposes a duty to tackle those inequalities. What will they think of that?

[Chris Skidmore]

We have already heard one Labour Member say that she welcomes the new measures on health inequalities, so it is a shame that the legislation could be repealed in its entirety.

Last week, Labour Members committed themselves to re-establishing primary care trusts and strategic health authorities—to reconstituting the NHS as if time had stood still, with middle-level management holding the reins. It is remarkable that Labour is not the party of the NHS patient but has become the party of the PCT, the SHA and, above all, the NHS manager.

Alcohol Strategy

David Burrowes Excerpts

Tuesday 7th February 2012 Westminster Hall

[Mr David Burrowes (Enfield, Southgate) (Con)]

I congratulate my hon. Friend the Member for Totnes (Dr Wollaston) on securing this timely debate. It is similar to the debate that I secured in May 2007, just before the publication of the then Government’s alcohol harm reduction strategy. In 2007 I was pessimistic about the direction in which the situation with alcohol was headed, but in 2012 I am optimistic. In 2007 the strategy was too limited and failed to tackle the need to reduce overall consumption and the harm caused by alcohol, as well as to be more ambitious about recovery from addiction.

Without going into too much detail, I would like to raise the issue of pricing, which, quite properly, has already been mentioned. In 2007, I was part of the Centre for Social Justice which recognised—perhaps going against its more traditional instincts of not wanting to bang the drum for taxation—that price has a particular impact on dependent drinkers and young people, which are the groups we wish to tackle when we see such enormous carnage in our communities. I am pleased that the Government are considering seriously the case for minimum pricing, and we await the outcome of those deliberations.

My experience comes not from being a politician, but from being a criminal defence solicitor. Sadly, my filing cabinet is full of notes about lives that have been damaged, or indeed lost, because of alcohol. Many of those cases involve not just one person, but a grandparent, a father and a son—the intergenerational cycle of alcohol misuse, which includes the impact of crime.

Last year in Hertford magistrates court I came across one individual—let us call him Lee—who was an alcoholic. He was aged 16, had just come out of a young offenders institution, and told me that he had been an alcoholic for three years. I asked him about his family and school background, and he said that everyone had given up on him. Indeed, when he left the young offenders institution, he stopped seeking any effective treatment because the only statutorily provided adolescent rehabilitation centre closed down last year. I asked him about school, and he said that he was known there as “Wasted.” That was how he was known, and that was how he felt. Sadly, such wasted lives litter our community, and the impact on children and young people is severe.

Some 9 million children are affected by a family member who has a problem with the misuse of alcohol. That is a massive figure, and children of parents who are problematic drug or alcohol users are themselves seven times more likely to develop a substance misuse problem.

We need to move away from the way in which we have historically dealt with alcohol treatment, focusing on the individual, to a whole-family-centred approach in order to tackle this intergenerational drug misuse. We need to ensure, as the Government are committed to ensuring, that it is not a Cinderella service—that people do not just come to the ball now and again when they show that they have a problem—but that the approach is systemic and integrated. That is what the drug strategy and the alcohol strategy show—that we are seeking to tackle drug and alcohol misuse and be much more ambitious about recovery.

We need to ensure that we recognise the evidential basis of alcohol treatment. We know from the UK alcohol treatment trials that every pound invested in treatment saves £5 in reduced health care costs, social care costs and criminal justice costs. Taking such action will ensure that the current Government are known not just for economic recovery, but for social recovery. Tackling alcohol misuse is one way to achieve that. I know that the Government are up for it. I am sure that we shall hear shortly that my hon. Friend the Minister is up for it as well.