Lower Limb Wound Care

Debate between Jim Shannon and Ann Clwyd

Tuesday 23rd July 2019 Commons Chamber

[Ann Clwyd (Cynon Valley) (Lab)]

As you know, Madam Deputy Speaker, I do not normally sit when I speak in this place, but half an hour ago I was in a hospital bed on the 12th floor of St Thomas’s when I heard that this debate was coming early, rather than later. There was a big rush to get me here, and there are very good doctors and nurses in the Gallery who helped me to get here, because I thought it was tremendously important to speak. I had secured this debate, for which I am very grateful, and I particularly wanted to talk on this subject. I was pleased to get it before the recess, and I was not going to miss it for anything. After we finish, I shall be returning, I hope, to the 12th floor of St Thomas’s and to very good care.

The subject of this debate was brought to my attention by Lord Hunt, our colleague in the House of Lords, where they had a debate not long ago about what plans the Government have to develop a strategy for improving the standards of wound care in the NHS. As somebody who needs wound care right at this moment, I know what a big subject it is. I did not know before—I was totally ignorant—but I have discovered what a challenging subject it is for so many people.

As a patient myself, I can talk about the subject with some feeling. I have to say that it is the most painful thing I have ever come across, and I had no idea that people suffered this kind of pain. A week ago, when I had to be taken to a local hospital in Merthyr Tydfil, I was asked by an ambulance driver what level of pain I was in, on a scale of one to 10, and I said, “Nine.” I do not usually exaggerate; it was that painful. I am grateful to everybody who has helped me, and I want to make sure that the service develops and people get all the help they need in such circumstances.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Member for Cynon Valley (Ann Clwyd) on securing the debate. She often features in Adjournment debates in this House. We are very pleased to see her in her place, and we thank her for all that she does. Does she agree that many people fear that the NHS neglects leg ulcers and the required treatment is not being given? The latest statistics, according to Dr Adderley’s speech at the Health Service Journal patient safety congress, show that leg ulcers account for 40% of chronic wounds but only 7% of the chronic wounds that are treated. There is quite clearly an anomaly.

[Ann Clwyd]

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

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

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

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

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

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

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

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

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

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

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

NHS Complaints System: Wales

Debate between Jim Shannon and Ann Clwyd

Wednesday 4th July 2018 Commons Chamber

[Ann Clwyd]

The normal is less than six; it was 8.7 on Owen’s admission, and eight days later it was 10.6.

Doctors will tell us that they do not just look at the results of blood tests; they also look at the patient. In Owen’s case, they failed to look at the blood tests and they failed to look at the patient. Members will no doubt be surprised to hear that although Owen’s inflammatory markers had increased during his second week in hospital, this was not recorded in his clinical notes. The tests that noted the increase in CRP and the neutrophil count were done on the Friday. That was four days before his death from hospital-acquired pneumonia. No one saw the results. No one saw Owen. No doctor saw him on Saturday. No doctor saw him on Sunday. By Monday, it was too late. I think it is reasonable to assume that if Owen had received effective antibiotics when his inflammatory markers were increasing, he would have stood a fighting chance and would have survived that infection.

I continue to be shocked by the way the hospital board has dealt with my concerns. Members might have heard of so-called independent reports. There was nothing independent about this particular report. All the members were employees of the Cardiff and Vale University Health Board. The chair was the deputy nursing director, Mandy Rayani. The board’s investigation failed to comment on the medical deficiencies that I have mentioned, but it very quickly acknowledged my “adverse perception” of what happened.

Most of my claims of poor care were denied. Of the 31 concerns that I raised, 21 were rejected. This was despite the fact that a few weeks after my husband’s death, Health Inspectorate Wales, the body that inspects Welsh hospitals, visited the ward where my husband had been a patient. While it was inspecting the ward, it noticed that senior nurses went off for their lunch leaving patients who needed assistance to eat without any help, that some patients were found without buzzers to call for assistance, and that individual care plans were not in place for the patients, yet my concerns were dismissed as my “adverse perception” by the deputy director of nursing, Mandy Rayani, in UHW’s so-called independent report.

I remain unhappy with the attitude of the health board. When Owen died, the chief executive was Adam Cairns. He has now left the country and is working in the middle east. When he left, I took my complaint up with other executives and I have found—as I did when I was writing my report for the Government on hospital complaints—that the culture of deny, delay and defend has continued.

I wrote to Maria Battle, the chair of the health board. I wanted to know why no one had spotted the abnormal blood results. I wanted to know why Owen’s low grade temperature did not appear to be of concern to anyone. The first meeting was postponed. We eventually met on 2 August last year. Despite my PA telephoning the board to ask for a copy of its response a week earlier, my medical colleague and I were not allowed to see the report until we arrived in the building for our meeting. I was astonished to hear Ruth Walker, the senior nurse, saying that she had taken it upon herself not to release the report prior to the meeting. I would have expected such a decision to be made by Maria Battle as chair of the board, by Dr Graham Shortland, the medical director, given that the matters mainly related to medical care, or by Dr Sharon Hopkins, who at that time was the acting chief executive.

I believe that the decision of the board to refuse to release this document beforehand reflects its dismissive, insulting and gratuitous attitude to members of the public and to the families of loved ones. It reflects the overall cover-up mentality that is all-pervasive in this health board.

[Jim Shannon (Strangford) (DUP)]

I congratulate the right hon. Lady on securing this debate and on the very personal and poignant way in which she has told the story of her husband’s last few days in hospital. Has she at any stage considered referred this matter to the medical ombudsperson and asking them to investigate her complaint? Hopefully, they would come up with an answer that would satisfy her and perhaps give the Minister a way of taking this forward.

[Ann Clwyd]

I am grateful for that kind intervention, and I can assure the hon. Gentleman that I have been down all the official routes.

At the meeting, I soon discovered that it was impossible to get straight answers to my straightforward questions. Ruth Walker, for example, said that the problems of Owen’s care have been addressed by the introduction of the EWS—early warning signs—system. When my medical colleague pointed out to her that all the nursing notes were entered in the EWS format, she could not come up with an explanation. I was also astonished that Dr Shortland was unable to give a straight answer when asked about the arrangements for weekend medical cover. The board members were prepared to hide behind another independent report, but the report was incomplete, failing to comment on Owen’s continuing low grade fever, the rise in his white blood cells, the rise in his C-reactive protein count, the failure of an effective handover process between medical staff and why no doctor saw Owen during his two weekends in hospital.

I have always been a strong supporter of our national health service. I can be proud of representing Cynon Valley, a constituency that is both geographically and philosophically close to the community that bred Aneurin Bevan. It was the community that formed Bevans’ views on the need for an effective health service that is free at the point of need and where the quality of care is not influenced by one’s ability to pay.

Long before becoming a politician, I was on the Welsh Hospital Board from 1970 to 1974 with people such as Arianwen Bevan-Norris, who was Aneurin Bevan’s sister, and Archie Lush, his agent, and I know what they would be saying to me today: “Carry on. Keep on going.” They would not have accepted these kinds of answers. I was also the only Welsh member of the royal commission on the national health service, which met for three years from 1976 to 1979. We made many recommendations at the time, but they were unfortunately not acted upon. If they had been, I am sure that some of today’s problems would have been avoided.

The House will understand my sorrow at the loss of Owen. It is heartbreaking to find that the people whom we appoint to safeguard our services, and who benefit from a significant income and a highly respected position in our society, are unable to address the failings of their organisation, engaging instead in obfuscation and half-truths. The cover-up mentality has to stop. We all make mistakes, but we should be ready to admit them.

My case is not unusual. I have previously told the House of the thousands of letters I received from people from all over the country when I was producing a report for the Government on complaints in England. I knew that the NHS did not treat its complainants well, but I did not expect to be here still looking for answers nearly six years later. In the past, Mr Speaker has allowed me to read out letters that I have received, and more than 4,500 people have written to me about NHS complaints, 500 of which related to the University Hospital of Wales. I am sorry to say that two of my close friends have since died at the same hospital, and complaints have been made about their treatment as well.

In the introduction to the shocking report on Gosport War Memorial Hospital, which was published a few weeks ago, Bishop James Jones of Liverpool said that

“what has to be recognised by those who head up our public institutions is how difficult it is for ordinary people to challenge the closing of ranks of those who hold power. It is a lonely place, seeking answers to questions that others wish you were not asking.”

I will continue to ask those questions on behalf of my family and of the many others who are grieving and who have not had answers.

International Human Rights Day

Debate between Jim Shannon and Ann Clwyd

Wednesday 20th December 2017 Westminster Hall

[Ann Clwyd (Cynon Valley) (Lab)]

I beg to move,

That this House has considered International Human Rights Day and the UK’s role in promoting human rights.

It is a pleasure to serve under your chairmanship, Ms Dorries. I am very pleased to have been given a Westminster Hall debate this year to mark International Human Rights Day, which was on Sunday 10 December, and to discuss the UK’s role in promoting human rights, including on the international stage.

Highlighting the fundamental importance of international and universal human rights to each and every one of us in the UK and abroad, and of the UK remaining a human rights champion on the international stage, is still vital. The international human rights framework, much of which emerged out of the destruction and the depravity of the second world war, with millions killed, destruction and despair widespread and those deemed undesirable led to the gas chambers, is under considerable threat. Authoritarian regimes the world over are trampling over hard-won rights such as freedom of expression, assembly and association, the rule of law and judicial independence, the right not to be arbitrarily detained or tortured, and even the right to life itself.

[Jim Shannon (Strangford) (DUP)]

I thank the right hon. Lady for bringing this debate to Westminster Hall. Unfortunately, half an hour is not enough, but that is by the way. Does she share my share my concerns that, according to the Pew Research Centre, approximately four out of every five people on this planet live in countries where their right to freedom of religion or belief is significantly and violently restricted?

[Ann Clwyd]

Yes indeed, and I thank the hon. Gentleman, who is always about on these issues, and is very often heard in the Chamber.

Principles, processes and people are unfortunately viewed as expendable if that is justified by the needs of the ruling elite: national security, state unity, the fight against terrorism and/or the quest for greater development or prosperity. That is increasingly apparent in a growing number of countries, such as Russia, Egypt, Turkey, Bahrain, Ethiopia, Cambodia, Burma, North Korea and Venezuela. Of course, that list is not exhaustive; I could go on and on, unfortunately, as I have not even mentioned those countries being ravaged by violent conflict.