Nursing Workforce Shortage: England

Jamie Stone Excerpts

Tuesday 3rd March 2020 Westminster Hall

[Mohammad Yasin (Bedford) (Lab)]

I beg to move,

That this House has considered the nursing workforce shortage in England.

It is a genuine pleasure to serve under your chairmanship, Ms McDonagh. I start by recognising the skills and expertise that nurses bring. Nursing shortages impact on patient care and staff wellbeing. Wherever there are people, there are nursing staff. They work in public services, across the NHS, social care, public health and the independent sector. They are with us at every stage in life, from birth to death. I am grateful for all that health and care staff do in my constituency and across the country.

This debate was secured in response to petitions handed in by nurses from the Royal College of Nursing, calling on the Government to fix the workforce crisis. I am pleased to be their voice—and that of everyone who works in the health profession—in Westminster today, and call on the Government to do all they can to tackle nursing shortages, which have huge knock-on effects on our NHS and wider health and care system, as well as on patient safety and staff wellbeing.

There are about 40,000 nursing vacancies in health and care services in England. In my region, the east of England, the nurse vacancy rate is 10.7%, which amounts to more than 3,600 nurses. Worryingly, the vacancy rate for mental health nurses in my region is even higher, at 15.3%. Nurses are crucial in health promotion and improving population health, yet the numbers of health visitors, school nurses, community nurses and district nurses have dropped at a rapid rate and are in long-term decline. We need to see significant growth in the NHS cancer workforce as well.

I expect that the Minister will tell me that almost 8,000 more nurses work in the NHS since this time last year. Although that figure is correct, it must, as with all stats, be viewed in the relevant context. That is a growth rate of just 0.4%, which is nowhere near the scale needed to provide enough nurses now or in the future. The pace of growth is not sufficient to reassure patients that we have a workforce ready to meet their needs, and it is nowhere near the rate needed to cope with the increasing demands that are predicted to be placed on the NHS by our ageing population.

For every NHS nurse employed in hospitals last year, there was an equivalent of 214 admissions. Patient need is rising faster than the growth in our nursing workforce. Social care and public health are also without thousands more nurses. It is difficult to calculate the number of vacancies in those settings because the data is incomplete. We have no understanding of plans to support and fund social care, which I hope the new Minister will confirm are a priority.

Nursing shortages directly impact on patient safety. Even with the small increase in staff numbers, hospitals and other services are struggling more than ever. Last week, the RCN published findings from a survey of emergency care nurses, who are increasingly forced to provide care in corridors. Some 95% of survey respondents said that patient dignity is compromised, and 92% worry that patients may be receiving unsafe care. December saw the worst performances on record for A&E departments in England, with every single department failing to meet the four-hour waiting time target. Those stats should alarm us all. Chronic underfunding has led us to this point.

Trust papers from Bedford Hospital, a district general in my area, show just how intense the pressures are on our frontline workers. Staff are doing as much as they can to keep patients safe and to provide high-quality care, but the situation is outside their control. Staffing shortages are systemic, and addressing them requires political will and action.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

The hon. Gentleman mentions staffing shortages. My vast and remote constituency, which has a large and ageing population and is the most remote mainland constituency in the UK, has problems not only with recruitment but particularly with retention. Health is devolved to the Scottish Parliament and Scottish Government, but as and when the UK Government develop an approach to keeping people in the most remote and rural areas, where they are needed most, I hope that that intelligence will be shared with the Scottish Government.

[Mohammad Yasin]

The hon. Gentleman is absolutely right. There are nursing shortages in every part of the country, and nurses are struggling to provide good care. I will come to that point in a moment.

Nursing shortages also impact on staff wellbeing. One testimony from an emergency nurse describes the realities of working in the profession:

“When I witnessed elderly patients being assisted onto bed pans while on ambulance trolleys, surrounded by paramedics, other patients on trolleys, and relatives all squashed in a freezing corridor…I realised that I can no longer preserve or protect my patient’s dignity, and that I am failing them as a nurse. Dignity is the first thing that the patients are stripped of when in a queue in a dark, cold corridor, closely followed by safety.”

Sharon, a community nurse who recently responded to a House of Commons digital debate on this Westminster Hall debate, said:

“I have worked in my locality for four and a half years. In that time, we have never been fully staffed. This puts enormous pressure on the whole team and many people have left because of it. Often, we are rushed, we forget things, and we cannot give the quality of care that we would like as we are just too thinly spread. Many of us end catching up on our notes or management at home, working way over our contracted hours. We are exhausted, frustrated and disappointed.”

This is an appalling situation for all concerned, and I know from these responses that this happens daily in hospitals up and down the country. Talk of a winter crisis is meaningless when staff and patients experience crisis every day, all year round. We must all focus on fixing this.

There is a long-term plan for the NHS, but its ambitions are dependent on having enough nurses. We have no funded workforce plan, even though it was promised by the Government when they announced the funding allocations back in the summer of 2018. Will the Minister tell us when the long-promised NHS people plan will be published, and whether it will include bold and funded policies to recruit, train and retain vital nursing staff to meet the needs of our population?

Nursing students in England can receive grants of up to £5,000 a year, and for some they can go up to £8,000. However, these do not reflect the true cost of living. Just as importantly, tuition fees are also a huge burden on nursing students, and it is important that this is addressed in the forthcoming Budget. As a father of four, I believe that financial barriers to education must be removed.

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[Jim Shannon (Strangford) (DUP)]

I congratulate the hon. Member for Bedford (Mohammad Yasin) on securing this debate. Although this debate is about nursing shortages in England and health is a devolved matter in Northern Ireland, I believe we are experiencing the same problems in Northern Ireland that exist in Wales, Scotland—as mentioned by the hon. Member for Caithness, Sutherland and Easter Ross (Jamie Stone)—and the whole of the United Kingdom. The solution must be UK-wide.

The Minister has responsibility for England, but I want to refer to things that are happening in Northern Ireland, which I believe the UK Government can change to the benefit of the devolved Administrations. We are currently facing a crisis in nursing care. Although nurses in Northern Ireland have received a pay increase, which they deserve, that does not ease the conditions in which we are asking them to work. Those conditions are the same as in England, Scotland and Wales.

During the election, nursing was perhaps the largest issue I was confronted with on the doorstep, along with the dysfunction of the Northern Ireland Assembly, which, although we are not directly responsible for it, people still wanted to talk to us about. When we got past the misinformation that had been fed to people in a deliberate attempt to skew the vote, it was clear from speaking to nurses that, although the pay issue had been an insult to them, they had genuine concerns about staffing levels—the subject of this debate. The concerns I heard on the doorstep were clear to me, as I am sure they were to all hon. Members from across the United Kingdom of Great Britain and Northern Ireland. There was a genuine concern that the everyday nurse felt guilty about taking annual leave; they felt that they were letting people down by having their hard-earned time off. That should not be so.

The health service in Northern Ireland has a registered nurse vacancy rate of 11.6%, equating to precisely 2,103 empty posts, as well as a shortage of 421 nursing assistants. The cost of employing nurses via agencies has increased from £10 million in 2012-13 to £32 million in 2017-18. I know that the last few years, with a non-functioning Assembly, were an issue regarding the employment of agency staff.

I had a meeting with the Royal College of Nursing some six weeks ago in my office, and I welcome the fact that the Northern Ireland Assembly is up and running. I also welcome the fact that the Minister who has responsibility for the Health Department in Northern Ireland, Robin Swann, has committed to recruiting more nurses. I understand that 700 nurses will be recruited, which will go a long way to addressing some of the empty posts. However, that will still be only a third of the way to filling all the vacancies that exist; the other two thirds of vacancies also have to be filled.

[Jamie Stone]

The hon. Member makes an extremely interesting point. At the last election, constituents and voters said to me on the doors that they would prefer that nurses were employed by the public purse—by the Government—rather than via an agency, which, by definition, makes a profit on the salaries for those nurses. I suggest that the general public does not like that and, if I am reading him correctly, he does not like it either.

[Jim Shannon]

I thank the hon. Gentleman for his intervention, and that is exactly what I am saying. I know that the Health Department in Westminster does not have responsibility for recruiting nurses in Northern Ireland. The Minister in Northern Ireland now has, and he has made the first step towards addressing that issue. It is hoped that over the next couple of years the number of vacancies—over 2,100 nursing posts, as well as 400-odd nursing assistant posts, making about 2,500 vacancies in total—will be addressed. We hope that the cost of agency staff and the extra financial burden created by the fact that agencies are profit-making organisations—this is how they make their money—will be addressed in a way that helps to reduce the shortcomings.

This situation means that nurses cannot simply work their 37.5-hour working week. They are called in on days off and asked, “Can you do the twilight shift? Can you give me a couple of hours?” That is not the fault of the ward sisters; they need the floors covered and are under pressure. It is simply that we do not have enough full-time working nurses in the NHS. That means that conscientious nurses, who do not want to leave the ward or the district short, are working additional hours themselves, and not in the short term to save money for a holiday or a renovation of their house. Instead, they are consistently working overtime to help on the wards, and so they are not getting their family time, their social time and—more importantly—their rest time

I have had glimpses of this situation. Some 6,500 nurses live in my constituency, so I have regular contact with them. I got a brief glimpse of the work of a nurse during my surgery and was in awe of how they stayed on their feet, and remained both sharp and compassionate —as they do. Doing all that with no rest is simply unsustainable. So, for a better system and a better caring system with better nurses, who are more able to work within that system, we need to address the shortage of nurses.

It used to be the case that bank nurses were only used in an emergency, but now they are used ever more frequently and their use is becoming the norm. They are no longer just used in the emergency. Using them is now just the fall-back position: “Let’s just do it”. That is not good either for morale or for finances—the current finances clearly indicate that it is not. It is more costly to have agency staff in than it is to have nurses on full-time pay.

I will give another example, of a nurse who approached me in my office and asked me to clear up rumours about nurses, their employment and so on. She is a young nurse in her early 20s who has been working at the Ulster Hospital in Dundonald—the main hospital in my constituency—but she has been left as a staff nurse in charge at night on numerous occasions. What she said to me was simple; she just said to me, “Jim, keep the pay rise and please give me an extra nurse per shift.” That was her initial reaction, because she can feel the pressures of delivering this system, and was saying, “I physically can’t do it all for much longer”.

This is a lovely young girl who is dedicated and good at her job, but who knows that when she has kids she will not be able to work 60 hours a week. She is asking me to do something about that, and today I am on the path towards doing something; I am highlighting this issue. I am very happy to do so.

NHS Funding Bill

Jamie Stone Excerpts

2nd reading & 2nd reading: House of Commons
Monday 27th January 2020 Commons Chamber

[Craig Mackinlay]

My hon. Friend makes a good point. How much do trusts spend on recruitment consultants? There is a whole panoply of expenditure on other things that the NHS, as a very big procurer, could get at competitive, keen prices.

My hon. Friend the Member for North Dorset (Simon Hoare) made a good point about the cost of medicines and repeat prescriptions. That has to be a major issue: across the country, £20 billion a year—nearly one sixth of the NHS budget—is spent on medicines, many of which are on free, repeat prescription. My wife, a pharmacist in the community, far too often sees bags full of expensive drugs come back to the pharmacy after the demise of a loved one. They have to be thrown away, and the money is completely wasted. We need to ask some difficult questions about the NHS. Let us not try to throw more money at it in the hope of a better outcome, because we need to be rather more clever. Great as it is—it has become a national institution, greatly loved—the NHS does not always do things perfectly.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I thank the hon. Gentleman for giving way, and I have been listening with great interest to the excellent contributions of new Members.

There is some evidence that NHS provision in Scotland is somewhat rackety. The hon. Gentleman has described the cost of bits of paper, and so on. Would it not be a good idea to apply the same tests to the delivery of NHS services in Scotland?

[Craig Mackinlay]

Obviously the hon. Gentleman takes a great interest in Scotland. This is a debate about England, but I think there should be a serious debate in every part of the country about whether the NHS is operating as we would operate if this were our own business, and I think that in many areas of procurement, whether the item in question is paper, telecommunications or power, the answer will be “Probably not.”

I have benefited from a couple of interventions adding to my time, but I will end by saying this. As I said earlier, the NHS does not always do things perfectly, and in that regard I reflect on the death of young Harry Richford at the Queen Elizabeth the Queen Mother Hospital maternity unit, and on what the coroner said last week. The coroner said that the death of young Harry—who died after a week, following a very difficult Caesarean—had been “wholly avoidable” and “contributed to by neglect”, and that “Harry was failed”.

We cannot just keep saying that we will learn from these things. We need to embed improvements so that our healthcare system in this country is much the best on the planet, and I am sure that the Government will deliver that.

The National Health Service

Jamie Stone Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Matt Hancock]

I am delighted to have been able to give that assurance and I thank my hon. Friend for the work he has done.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

This is further to the point made by the hon. Member for Stirling (Stephen Kerr). As this Chamber has heard me say before, pregnant women have a 200-mile round trip to make from Caithness to Inverness to give birth. Some months ago, a mother gave birth to twins 52 miles apart on the A9 from Caithness. In the past two days, a pregnant woman came all the way down from Caithness only then to have hours of agony because there was no bed ready for her. I concede that this is a devolved matter, but would Her Majesty’s Government, for my sake and that of my constituents, share the best safety practice with the Scottish Government and with NHS Highland?

[Matt Hancock]

We will absolutely do that. The hon. Gentleman rightly says that this provision is a devolved matter, and we have already had a debate about the relative funding increases, but this case clearly needs looking at seriously. I will make sure I get in contact with my colleagues in the Scottish Government who are responsible for the provision of this service to make sure that it is looked at properly.

Baby Loss Awareness Week

Jamie Stone Excerpts

Tuesday 8th October 2019 Commons Chamber

[Caroline Dinenage]

I thank the hon. Gentleman so much for that intervention. He is absolutely right. In this place, we have a unique opportunity to raise subjects that people find it difficult to talk about out there. In doing so, we shine a light on those subjects, and we are able to really begin to move the dial and to change practice.

With that in mind, I would like to pay tribute to the hon. Member for Eddisbury (Antoinette Sandbach) and my hon. Friend the Member for Colchester (Will Quince), who is desperate to speak, although, being a Minister, he is prevented from doing so, so we will have to restrain him. However, in a late-night Adjournment debate back in 2015, they began to raise awareness of the variation in care for families bereaved by baby loss. It was an incredibly moving debate—I remember listening to it at the time—and it really made such a magnificent difference. It was followed by the Baby Loss Awareness Week 2016 debate, which was about bringing the subject to light and challenging the idea that baby loss is an uncomfortable topic that we do not like to talk about. I am grateful to the Members from across this House who shared their personal experiences on that day back in 2016 and have done since.

International Baby Loss Awareness Week begins tomorrow and finishes next Tuesday. This year, the focus is on the need for specialist psychological support for bereaved parents who need it. The Baby Loss Awareness Alliance group of charities will be publishing a report highlighting that some parents need that kind of support as part of their bereavement care.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I wholeheartedly support the thrust of this debate and what the Minister is saying. I am not going to make a speech today—I did that last year—but when a child is lost, which as Members know has affected my family, counselling and gynaecological advice are hugely important. However, my constituents are over 100 miles from the nearest hospital where someone can give birth. I just want to put it on the record that a 200-mile round trip from Caithness to Inverness makes getting the counselling and gynaecological advice so difficult. My constituents are losing out on that front, and I wish that Caithness general hospital in Wick could be used for such purposes.

[Caroline Dinenage]

I am grateful to the hon. Gentleman for raising that. The situation is particularly difficult in rural communities where people live a very long way from services. As we set out in the NHS long-term plan, maternity outreach clinics are going to start to integrate maternity, reproductive health and psychological therapy for women experiencing mental health difficulties arising from or related to maternity experience, and we must keep in mind those living in very remote communities when we talk about those outreach facilities.

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[Caroline Dinenage]

My hon. Friend is right to raise that matter. When a tragedy could have been avoided by something as simple as sharing patient records, there is no option but to embrace the technology we need to make that a reality. Both the previous and the current Secretary of State for Health and Social Care are in favour of that.

Every trust is now using the perinatal mortality review tool to review stillbirths and neonatal deaths to make sure lessons are learned so that other families do not have to suffer in the same way. The first annual PMRT report is due for publication later this week, and it will provide an analysis of the first 1,500 cases. Overall, a review has been completed on 96% of stillbirths and 86% of neonatal deaths since the tool was launched.

[Jamie Stone]

The Minister talks about safety advice and safety good practice, so may I ask her and the UK Government to share that advice with NHS Highland and indeed the Scottish Government, who have never in my two years or so here given me a straight answer on the safety of pregnant women? Some of those women, who might be in labour, are being transported more than 100 miles from Caithness to Raigmore Hospital in Inverness, in the middle of winter, when the A9 can be blocked. I think lives are in danger.

[Caroline Dinenage]

The hon. Gentleman has put his thoughts clearly on the record, and if there is anything we can ever do to share best practice with colleagues across the devolved nations and around the rest of the world, we are always happy to do that.

The Healthcare Safety Investigation Branch is another remarkable innovation. It commenced investigations in April 2018 and has been operational in the 130 trusts providing maternity services since the end of March 2019. By the end of August, the HSIB had completed 88 investigations, with 169 draft reports looking into maternity and neonatal deaths currently with trusts and families.

NHS Resolution recently published a report on the first year of its early notification scheme for potential birth brain injuries. The scheme requires all births at NHS trusts in England from 1 April 2017 meeting qualifying criteria to be reported to NHS Resolution within 30 days for investigation, so families with a baby affected by a severe brain injury attributable to substandard care can receive significantly earlier answers to their questions. This approach means that they do not have to resort to full court proceedings and can receive financial support with their care and other needs at a much earlier stage. In the first year, 746 incidents were eligible for the scheme. There have been early admissions of liability for 24 families, who have been provided with detailed explanations, admissions of liability and, very importantly, an apology. Families have been provided with financial support for early access to additional care, respite and, where needed, psychological support and counselling.

I am happy to report that this summer the Office for National Statistics reported that the stillbirth rate in England had decreased from 5.1 stillbirths per 1,000 births in 2010 to four stillbirths per 1,000 births in 2018. That represents a 21% reduction in stillbirths two years ahead of our ambitious plan.

Social Care Funding

Jamie Stone Excerpts

Tuesday 1st October 2019 Westminster Hall

[Sir Vince Cable]

That is the case, and I hope that when the Green Paper appears there will be a proper, objective look at free personal care. In the past this has been an ideological issue, but there is no reason why it should be. It is a practical proposition. As I understand it, the Scottish model has pluses and minuses—it is certainly very popular with the people who benefit from it, but there are much stricter tests for eligibility in terms of physical functioning—but at least let us consider it objectively. It is costly, however—about £8 billion a year over and above the other items I have mentioned.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

This was a flagship policy of the coalition Government in which I served in the Scottish Parliament, and I am proud of that. One problem that we never got around—I think this also applies to rural English constituencies and Welsh constituencies—is the issue of sparsity and distance. How do we deliver this service when there are vast distances between the various old people involved? When there is a low population base, how do we find the number of carers that we desperately need to tend to those elderly people, who deserve dignity at that stage of their life? It grieves me to say this, but in north-west Sutherland in my constituency we have a distinct problem with finding those carers. People have come to see me in the last few weeks who have not had a carer for three, four or five days, which is terrible.

[Sir Vince Cable]

My hon. Friend is right to point out the practicalities of this issue. That links to one of the current difficulties with domiciliary care, which is that providers are often not compensated for travel. I imagine that in a remote constituency that would be accentuated many times.

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[The Minister for Care (Caroline Dinenage)]

It is a great pleasure to serve under your stewardship in this important debate, Sir Charles, and I share the sentiment of many Members across the House in congratulating the right hon. Member for Twickenham (Sir Vince Cable) on securing it. I also wish to highlight the incredibly constructive and collaborative nature of the way that he opened this debate. He was right to highlight from the outset that the only way to find a solution to this thorny issue, which is not unique to our country but a challenge faced by countries around the world, is by working in a co-operative, collaborative, and constructive way.

The right hon. Gentleman rightly pointed out that successive Governments have tried and failed to deal with this thorny issue, and despite everybody recognising the need for consensus, for too long it has been weaponised. We have heard expressions such as “dementia tax” or “death tax” used by all parties over the years. That has not been helpful, and it is one reason why different parties and Governments have placed this issue in the “too difficult” pile. He was also right to highlight the sense of urgency, because we no longer have the luxury of time to place the issue in that pile.

Over the past couple of years the Government have responded to huge short-term pressures, and funding for local government has gone up, as opposed to being cut, as outlined by Labour Members. However, we must set out our long-term plans, and consider how to solve the thorny issues of long-term funding for adult social care. At the moment, one in 10 people face what we might call catastrophic care costs in excess of £100,000, and potentially lose their home to pay for their long-term care.

I thank hon. Members across the House who have spoken with great passion and, in most cases, an enormous amount of collaboration and desire to work together to find solutions to these problems. I join them in recognising and paying tribute to the carers, nurses, social workers, and unpaid friends and families of those who require care. Every day, carers work tirelessly to ensure that people live dignified and fulfilling lives, regardless of how tough that challenge is. In doing this job and fulfilling this role, it has been my greatest privilege to meet those people on an almost daily basis and hear their stories. The hon. Member for Kingston upon Hull West and Hessle (Emma Hardy) said that carers must be accorded the status that they deserve, and given resources to drive the right amount of quality, and she was absolutely right. She was wrong, however, to say that we have lost caring from the caring system. People may be driven to that point in some respects, but they care and they do so in the most beautiful way.

[Jamie Stone]

May I associate myself with what the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) said about young carers who go home and look after parents who may have an alcohol or drug dependency problem? In my constituency an organisation called The Young Karers East Sutherland helps to support them. My mother died four years ago, but she was cared for at home very well. The younger carers—those who had left school and gone into the profession for the first time—were the most amazing. They embraced this profession, and one could see they had a vocation. I suggest that one way to sort out this problem is to encourage the recruitment of young people by giving them taster sessions and letting them come from school and see what it is like. Often, we might get converts who will stay in the profession for life.

[Caroline Dinenage]

That is an excellent intervention, and the hon. Gentleman is right to say that we must do more to recognise and support young carers. The hon. Member for Plymouth, Sutton and Devonport said that we must do more to help schools to identify young carers, and that was a key part of the carers action plan that was announced last summer. A young carers’ takeover day of Parliament is planned in the months ahead: every MP across the country will be encouraged to invite a young carer from their constituency, which will give us a real in-depth understanding of what an amazing job young carers do.

We all recognise the challenges that the social care system faces. As a population, we are getting older: by 2040, one in four people in the UK will be 65 or over, as the right hon. Member for Twickenham pointed out. It is also important to understand that social care is not just a service for older people; the number of people under 65 who have carers is growing and accounts for more than half of social care spending. That can have quite a disastrous impact on local authority budgets, as the hon. Member for Plymouth, Sutton and Devonport pointed out. I will certainly take forward the points that he made.

These long-standing trends put increasing financial pressure on local authorities. In response, we have taken steps to ensure that the social care system has the funding to meet urgent challenges in the short term. In 2017, we announced an additional £2 billion in grant funding for social care, which we supplemented with a further £650 million in the 2018 Budget. Councils have responded by increasing their spending on social care, which has risen in real terms in each of the past three years.

Lower Limb Wound Care

Jamie Stone Excerpts

Tuesday 23rd July 2019 Commons Chamber

[Ann Clwyd]

I am grateful to the hon. Gentleman for making my speech for me. I am sure we will be in total agreement as my speech develops.

Some interesting points were made during the debate in the other place, including the point that wound care is a massive challenge to the NHS, but it currently lacks priority, investment and direction. I want to push the Government, if they need pushing, on the need for urgent action and the development of a strategy across care providers to improve the standard of wound care.

A staggering 2 million patients are treated for wounds every year, at a cost of more than £5 billion and rising. While 60% of all wounds heal within a year, a huge resource has to be committed to managing untreated wounds. The NHS response is very variable. Healing takes far too long; diagnosis is not good enough; and inadequate commissioning of services by clinical commissioning groups compounds the problem, with under-trained staff and a lack of suitable dressings and bandages.

There has also been a very worrying drop in the number of district nurses, whose role in ensuring safe and effective wound care in the community is crucial. I was shocked when I talked to a friend in Cardiff about the problem of putting on surgical stockings, and her experience highlights the need for district nurses. My friend had had a serious operation, and she could not bend to pull on the stockings. I asked her what she did, because she is a widow who lives on her own. She said, “I go out in the street and ask somebody to help me.” I am sure that people are very ready to help, but no one should be in that situation. I think we would all agree that the drop in the number of district nurses is very worrying.

I am told that, ideally, 70% of venous leg ulcerations should heal within 12 to 16 weeks, and 98% in 24 weeks. In reality, however, research shows that healing rates at six months have been reported as low as 9%, with infection rates as high as 58%. Patients suffer, and the cost of not healing wounds swiftly and effectively can lead to more serious health problems, such as sepsis, which is often the result of an infected injury. We also know that foot ulcers on diabetics can unfortunately lead to amputations if they are not dealt with properly.

In the other place they talked about the Bradford study, and there is a very good summary of it in the House of Lords Library. It underlines the importance of evidence-based care, with nearly one third of patients interviewed in the study failing to receive an accurate diagnosis for their wound. As the study puts it:

“Wound care should be seen as a specialist segment of healthcare that requires clinicians with specialist training to diagnose and manage…There is no doubt that better diagnosis and treatment and effective prevention of wound complications would help minimise treatment costs”.

We learn most of all from our own experience. My experience is that when I first developed a farthing-sized spot on my leg, I did not know what it was. I asked my chiropodist, who looked at it a few times and said, “I think you had better go and see your GP.” I went to see my GP—a very good GP—who did not know what it was either. Eventually, I was referred to a skin specialist—this is some weeks ago, now—who looked at it and said, “I don’t know what it is, but why don’t you try putting Vaseline on it?” Now, I do not think the experts up there in the Gallery would think that that was a very good idea, but I did put Vaseline on it and I do not know whether that did me any harm or not. You do worry a lot when something like that happens, whether you have knocked your leg or injured yourself in some other way, and you wonder what on earth it could be.

I think that maybe diagnosis is difficult, but rapid diagnosis is absolutely essential. I am sure the Government would agree that we need to get to grips with a nationally driven strategy. Without it, patients will receive worse care for their injuries and the financial burden on other parts of the NHS will continue to increase, because patients develop chronic wounds or catch an infection that could lead to life-threatening illness.

During the course of my journey, I have met many interesting people. For instance, I did not know there was an all-party group on vascular and venous disease. I just happened to see it in the all-party notices the day after I had been in St Thomas’s. I rang up the chair, the hon. Member for St Ives (Derek Thomas), and asked him if I could come along to a meeting. He said that I was welcome to. I went along and, apart from the chair, I think I was the only MP there. There was a fascinating mixture of people, who were all involved in this problem in some way.

There was somebody who runs a leg clinic, who had a lot of stories to tell. In fact, she sent me a whole pile of patient stories—there is not time to read them out today, but they are very interesting. I realised how difficult it is for patients to get the right diagnosis and the right treatment. I took a list of all the people—they are mainly consultants—and I know that some people in St Thomas’s would have come along if they had known of the existence of such a group. It introduced me to the Lindsay Leg Club Foundation, which is run by Ellie Lindsay OBE, who is the president. There are leg clubs in many towns and cities around the country. She was very encouraging—I say that as somebody who was a bit afraid when they realised what they had. She rang me up several times, and her patient stories were fascinating.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I am listening with great interest to what the right hon. Lady is saying, not least because this is an important debate on something that we do not talk about as much as we should in this place. Am I picking up correctly what she is saying on patient experience? Is she saying that we should encourage patients who have been through this transition and experience to share that experience with others in order to make other potential patients more aware of what might be out there and what they could do?

[Ann Clwyd]

Yes. That is a very positive idea. People need to talk to one another, particularly in this House because of the age differences. A lot of people talk about this in the other House, because on the whole they are much older than we are—except for me in this place; I am pretty old. I am just surprised that I had never heard of this before. Talking encourages people when they have discovered that they have this problem to seek the right advice.

[Jamie Stone]

Can I make absolutely sure that I understand this? By age difference, the right hon. Lady means people of my age—I am considerably older than some hon. Members—sharing experiences with people who are younger and might need to know these things. Is that correct?

[Ann Clwyd]

Sorry; I did not hear the last part.

[Jamie Stone]

Is this about the older generation, who might have had some experience in this regard, sharing experiences so that the younger generation—considerably younger than I am—might know the potential of what they will look at or deal with in future?

[Ann Clwyd]

Yes. I am very glad that there is an all-party group, for example, because it is important that such groups exist. I have seen the work that has gone on there over several months. As the hon. Gentleman knows, there are dozens and dozens of all-party groups in this place—I am sure that we do not know of the existence of most of them, but it is good to draw attention to this one.

Another person I met was Professor Julian Guest, who is a health economics consultant. People are very good at sending information. He sent me a list of things that, as a health economist, he has been working on. He says that wound care requires

“a change in its service delivery model that could include…Enhanced support for safe self-care (possibly by integration with local pharmacy support and supervision)…Improved diagnostic support underpinned by increased training and education of non-specialist nurses in the fundamentals of wound management…Consistent and integrated progressive care pathway with agreed defined trigger points for senior involvement and onward referral for investigation and differential diagnosis and a shared management plan to be implemented regardless of care setting…Establishment of dedicated wound care clinics in the community, possibly in general practices.”

So there are several papers by people working in this area who are thinking deeply about it.

I heard from consultants at St Thomas’s about an excellent development called the Camden Health Improvement Practice pilot wound clinic. Dr Geraghty, who runs it, is working on wound care for people who are sleeping rough—for the homeless. I think everybody would applaud that as a very necessary and useful thing to do, and we look forward to hearing more about it. I am looking at the clock, and there is not much time left, but I hope the Minister will respond on this issue, because when I think of the pain inflicted on people—luckily, my pain is managed, but the pain of the homeless, for example, who are sleeping rough on the streets, is not generally being managed—it is clear that this Camden project is a very welcome development.

I had a new knee about a year ago, which is not a pleasant thing to have done. However, I have known nothing as painful as this leg wound, and I am grateful that so many good people are working in this area and highlighting its importance. It is probably not as glamorous as others in the health service, but it is absolutely necessary for people’s wellbeing, comfort and health, and I hope we can do a lot more to support people in this area, to support new initiatives and to assist the doctors, nurses and other practitioners who do such an excellent job.

I am out on parole, Madam Deputy Speaker. I will, I hope, be returning to my bed in St Thomas’s before too long, and I hope to come back after the recess with very positive views and a continuing interest in the whole subject of wound care in the NHS.

--- Later in debate ---

[Caroline Dinenage]

The hon. Gentleman is always full of brilliant ideas and we will only move forward as a nation if we share best practice and the expertise gained from different parts of our country. So I would be very keen to speak to his colleagues at the Northern Ireland Assembly and see if we can gain any learning from that.

[Jamie Stone]

I could not possibly let the occasion pass without commenting. Can I take it that that promise will be extended to the Scottish Parliament and the Scottish Government? The issue we have heard about today is no less a problem in Scotland.

[Caroline Dinenage]

Yes. We do not discriminate. We are keen to talk to everyone to get the best possible learning so that patients up and down the country can benefit from all the expertise that is available.

In thanking the right hon. Member for Cynon Valley for making the supreme effort to be here today, I reassure her that both the Government and the NHS recognise the importance of ensuring that patients have access to high-quality lower limb wound care and will continue to support the work of the national wound care strategy programme for England on improving the quality of wound care, including lower limb wound care, in the country. I thank her once again for being here to make her case so incredibly powerfully. I wish her a speedy recovery and send her all our love from this House.

Acquired Brain Injury

Jamie Stone Excerpts

Tuesday 2nd July 2019 Westminster Hall

[Chris Bryant]

Yes. The all-party parliamentary group on acquired brain injury—I see that two of the vice-chairs are in the Chamber—has been campaigning to ensure that everyone who does any kind of assessment for the Department for Work and Pensions, whether for personal independence payments, the employment and support allowance, or any other benefit, has a full training in acquired brain injury, so that they understand the variable nature of the condition.

One element of the personality change that may come about is that somebody with a brain injury might be desperate to please the person in front of them, so they might want to give what they think is the “correct answer” to the question being asked by the official. That can give a misleading idea of what that individual’s abilities are.

I have not asked Tom whether it is all right to say all this today—I see that he is nodding, so it is fine. When the Duracell battery inside someone’s head is running low, they talk to themselves to try to re-energise it, but that uses even more energy. That can lead to a vicious cycle: further depression and anxiety makes it more difficult to recharge the battery, in turn making it more difficult to get better.

There are others who have had much more dramatic and traumatic injuries, perhaps where something has penetrated the skull. However, in the vast majority of cases, the injury will be inside the brain. A fundamental part of what we have to address is how the mind and the personality sit inside the brain. Right hon. and hon. Members might have seen the television series “MotherFatherSon”, which deals with someone who has had a massive aneurysm and then a stroke. Lots of things in the programme are not entirely accurate, but many families and individuals have to cope with the very real element of personality change. I met a wonderful woman three months ago told me that she wished that her old self would come back. She could remember what her old self was like, but it is not the person she now is. She just does not know how to recreate that personality inside herself. Again, it is this thing of talking to yourself all the time.

If there has been impairment of the executive functions due to a brain injury to the frontal lobes, particularly in teenagers or as the young brain is still developing, it can lead to all sorts of other problems in terms of employability, and being able to engage with the wider world and their family. Sometimes people share far too much information; sometimes they are far too timid about being able to share information.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

On that point about sharing, as I told the Chamber in the debate on 9 May, my wife suffered from a meningioma. As I think the hon. Gentleman mentioned, a certain fretfulness can come into the character. On sharing, perhaps it is because I live in such a remote area, but I am surprised those who have come through the treatment are not encouraged more to share their pre-operative and post-operative experience with people who are suffering or are about to have a medical intervention, because it would give them great courage and help.

[Chris Bryant]

Yes, that is true. Because of the pattern of brain injuries across the country, it may be difficult for people to gather with people of a similar age and background. Lots of people with brain injuries arising from road traffic accidents are quite young—in their teens or early 20s. Sometimes they get put into support groups with people in their 60s or 70s. That is not an impossible combination, but sometimes it is not the most natural grouping for those with a much longer life expectancy.

The most difficult element for a lot of people is the significant impairment in their ability to speak and communicate. Speech therapists are an essential part of the mix in bringing people back to a degree of independent living after a significant event. One worry across the whole of the UK is the shortage of people working in this field, who sometimes do not feel as valued in the team as they might. We need to ensure that speech and language therapy is still available for some time after someone has had their immediate intervention.

One of the most common things that people tell me is that they are accused of being drunk, when in fact they have difficulty speaking properly because they have had a brain injury, not because they are a bad person. They feel the sense of stigma that attaches to not being able to speak as clearly as they might have been able to before their brain injury.

Oral Answers to Questions

Jamie Stone Excerpts

Tuesday 18th June 2019 Commons Chamber

[Matt Hancock]

My hon. Friend is dead right to say that this provides a better service and saves money. I do not have the figure at my fingertips, but I will write to him with the answer and ensure that it is published for the whole House to see.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

Patients in my constituency have to travel vast distances—often in excess of a 200-mile round trip—to be seen at Raigmore Hospital. As and when properly working visual teleconsultations are brought into being, when that technology is developed, may I appeal to the Government to share the technology with the Scottish Government and with NHS Highland?

[Matt Hancock]

Absolutely. Places like Caithness are a great example of where GP consultations that can be done over the phone or over a video conference can save people hours and hours. Of course they sometimes need to see their GP in person, but not always. We are driving this agenda hard in England, and I would be happy to work with the NHS in Scotland to ensure that that technology is taken up there, too.

Interim NHS People Plan

Jamie Stone Excerpts

Wednesday 5th June 2019 Commons Chamber

[Stephen Hammond]

The hon. Lady is right: that culture is not acceptable and must be driven out. She will have read the interim people plan, which talks explicitly about ensuring that we create leadership that stops that culture. There is a chapter on making the NHS the best place to work. She will know that we have been working across the country to ensure that all staff know that they are valued, that they have the right to speak up and that the culture of bullying must be driven out. I shall speak with Baroness Harding, as I do regularly, to ensure that that message is spread throughout the NHS and that staff know that they are valued.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

I realise that health is devolved to the Scottish Government. Nevertheless it has to be said that the Scottish Government are having enormous trouble with their workforce planning, which means that doctors and nurses have to pick up the slack and that we are wasting good money on employing agency staff, which need not happen. May I make a plea to Her Majesty’s Government to share workforce planning and best practice with the Scottish Government so that they can get that right?

[Stephen Hammond]

As the hon. Gentleman rightly pointed out, health matters in Scotland are devolved, but I am delighted to share any of the excellent initiatives that are set out in the draft people plan with the Scottish Government.

Tessa Jowell Brain Cancer Mission

Jamie Stone Excerpts

Monday 13th May 2019 Commons Chamber

[Matt Hancock]

The hon. Gentleman is right to say that, and I send my condolences to his constituents. The truth is that brain cancer is one of the most, if not the most, predominant cancers among children. Although it is relatively rare among all cancers, that is not true among children. Thousands of people still die from brain cancer, which is why it was right that Parliament and Tessa Jowell came together to highlight the lack of research in the area—something that we are determined to put right.

[Jamie Stone (Caithness, Sutherland and Easter Ross) (LD)]

May I too thank the Government for today’s statement? I was heartened by the answer given to the hon. Member for Worthing West (Sir Peter Bottomley), because early diagnosis is incredibly important. There are certain things that people can recognise, such as the effect on vision. Ironing a pinstripe shirt, for example, can lead to an odd effect, which is an early sign. Early screening in built-up areas and cities is quite easy, but it is harder in rural areas, so I make a plea for the Government to consider sparsely populated regions such as mine.

[Matt Hancock]

The hon. Gentleman is right that screening is vital. One of the reasons why we are looking at the whole screening programme is that the use of technology has not been nearly good enough. For many people, but not all, that can be valuable, especially in rural areas. Technology is not only used for the screening itself, but for notification and for ensuring that we get to everybody who needs to be reached. Professor Sir Mike Richards is undertaking the review of all screening, and I would be happy to put Sir Mike in contact with the hon. Gentleman to ensure that the review properly considers the impact of rurality on the need to get screening to everybody who needs it.