Patient Choice

Kit Malthouse Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

As so often, the hon. Gentleman raises an extremely important point about how we tackle the serious issue of eating disorders. As he knows, we are increasing our funding for mental health. It is a key priority in the long-term plan, which is providing an extra £2.3 billion a year. On different approaches, we are looking much more actively at our use of digital apps and platforms, which is an area that the Chancellor specifically funded in the last Budget. We are also looking at how we address mental health issues earlier, particularly for children. We are rolling out mental health support teams in schools because, obviously, early intervention has significant benefits and targeting schools is a great way to do that.

[Kit Malthouse (North West Hampshire) (Con)]

I, too, congratulate the Secretary of State on a profoundly Conservative step forward in dealing with the waiting list issue. Does he agree that the provision of greater patient choice holds out the possibility of stimulating more investment in private sector capacity, particularly for volume procedures such as hips and knees? However, the private sector, to make such heavy investments in facilities, requires long-range certainty. As waiting lists fall, will he review the threshold—the time limit—at which patients can seek private sector assistance in getting their operation done more swiftly, so that the efficiencies of the private sector can be realised for the system as a whole in the longer term?

[Steve Barclay]

My right hon. Friend raises a very good point. As he knows, there is interaction between what is and is not on the balance sheet. His point particularly relates to the roll-out of diagnostic centres. I have looked at the facility in Blackpool that is using artificial intelligence in endoscopy and picking up 20% more cases than would be seen with the human eye. We are thinking about how we use the private sector to add more capacity at scale and pace, and how it can use the latest technology. Obviously, we need to do that in a way that is compliant with Treasury rules. Ensuring there is greater capacity in the system—but doing so where it is free at the point of access to NHS patients—is an area where we have already done quite a lot. However, there is always scope to look at it afresh.

New Hospitals

Kit Malthouse Excerpts

Thursday 25th May 2023 Commons Chamber

[Steve Barclay]

My hon. Friend has campaigned assiduously over the past three years to make a compelling case for Airedale. I very much look forward to having the opportunity to visit in due course, and the commitment in today’s statement is to ensure that that hospital is built to the 2030 timescale.

[Kit Malthouse (North West Hampshire) (Con)]

Given the Secretary of State’s answers to my hon. Friend the Member for Winchester (Steve Brine) and my right hon. Friend the Member for Basingstoke (Dame Maria Miller), could I press him a little further for some clarity on the replacement for Basingstoke hospital? Could he confirm that it is agreed that a replacement is needed for the hospital; that the money is in the budget to do so; and that, notwithstanding the complexities regarding the site that he outlined in his previous answers, a site will be found and a new hospital will be open in the early 2030s to serve all of our constituents?

[Steve Barclay]

On the issues that my right hon. Friend raises, it is agreed that a replacement is needed and that North and Mid Hampshire will go into the rolling programme for the new hospital programme. As a result, a site will be found, and the intention is to work to a 2032-33 timescale—that is the plan. The original timescale was already stretched because of some of the complexity involved, and I have also signalled just how long previous designs for hospitals have taken, so we are speeding up the construction side but we also need to address some of the issues, particularly around junction 7 and the site design.

Mental Health Units (Use of Force) Bill

Kit Malthouse Excerpts

2nd reading: House of Commons
Friday 3rd November 2017 Commons Chamber

[Kit Malthouse (North West Hampshire) (Con)]

I think there has been an error, Mr Speaker. I am here for the second debate, not the first.

[Mr Speaker]

I thought the hon. Gentleman wanted to speak on this Bill, but if I am mistaken and he wishes to preserve his thunder then so be it. We will hear from him at a later stage.

Health Service Medical Supplies (Costs) Bill

Kit Malthouse Excerpts

2nd reading: House of Commons & Programme motion: House of Commons
Monday 24th October 2016 Commons Chamber

[Mr Hunt]

Absolutely. The money comes back to the Department of Health and is invested in the NHS. Indeed, it would be wonderful if it was more than £1.24 billion, because there is an awful lot of need on the NHS frontline right now; the funds are much needed. Our concern is that companies have been exploiting the differences between the voluntary and statutory schemes, particularly the loophole, which the Bill seeks to close, that if companies have drugs in both schemes, we are unable to regulate at all the prices of the drugs that would ordinarily fall under the statutory scheme. That is why the Bill is so important.

[Kit Malthouse (North West Hampshire) (Con)]

Notwithstanding the Bill’s objectives, which I can see are admirable, does the Secretary of State accept that hundreds of millions of pounds could be saved in the drugs budget if there was better analysis of NHS prescription patterns? I have called before for the appointment of analytical pharmacists to look at the balance between prescription efficacy and cost and at trying to increase the use of biosimilars. Some of that £1.24 billion could be invested in that greater analysis.

[Mr Hunt]

Yes. My hon. Friend makes an important point. The third part of the Bill will provide for much better data collection to allow that analysis to take place. We are also seeking to break down the barriers between the pharmacy sector and general practice. During this Parliament, we will be financing 2,000 additional pharmacists to work in general practice so that we can learn exactly those sorts of lessons.

Community Pharmacies

Kit Malthouse Excerpts

Monday 17th October 2016 Commons Chamber

[David Mowat]

The hon. Lady made several points. On her last point, the access scheme on which we are currently consulting will protect pharmacies in rural and deprived areas. That is precisely the point of the scheme.

The hon. Lady’s first point was that Scotland has moved ahead on minor ailments, and we agree. I am on the record as saying that the pharmacy first scheme in Scotland is a good model. We want the profession to move away from just dispensing towards more value-added activities, such as services. That is precisely why we are putting into effect the minor ailments scheme that has been piloted. It will be implemented right across the UK—right across England, I should say—from April 2018.

[Kit Malthouse (North West Hampshire) (Con)]

In the lee of Watership down in my constituency, the village of Kingsclere was so alarmed by the Government’s plans that it raised a petition, possibly for the first time in its history, in support of its precious local pharmacy. Will the Minister confirm that, notwithstanding the consultation, the idea of protecting the dwindling number of rural pharmacies will come out at the end of the consultation as part of the access scheme?

[David Mowat]

Yes, I will confirm that. I am not in a position to announce today precisely how the access scheme will work, but I agree with my hon. Friend that a central part of it will be to make sure that everybody has a baseline distance to travel to get to a pharmacy and that everybody in the country will be able to access pharmacies within a reasonable time.

Southern Health NHS Foundation Trust

Kit Malthouse Excerpts

Wednesday 8th June 2016 Westminster Hall

[Suella Fernandes]

There is a lot of pressure from the public, patients and families for people to step down, and the resignation of the chairman of the board is a reflection of the seriousness with which Southern Health takes this issue.

The report continued:

“Due to a lack of strategic focus relating to mortality and to the relatively small numbers of deaths in comparison with total reported safety incidents this has resulted in deaths having little prominence at Board level… There are a number of facets to this poor leadership…: a failure to consistently improve the quality of investigations and of the subsequent reports; a lack of Board challenge to the systems and processes around the investigation of deaths…; a lack of a consistent corporate focus on death reflected in Board reports which are inconsistent over time and which centre only on a small part of the available data; an ad hoc and inadequate approach to involving families and carers in investigations; a lack of focus on deaths amongst the health and social care services caring for people with a Learning Disability; limited information presented at Board and sub-committee level relating to deaths in these groups…; and a lack of attention to key performance indicators…indicating considerable delays in completing…investigations.”

The report also found:

“There was no effective systematic management and oversight in reporting deaths and the investigations that follow… The Trust could not demonstrate a comprehensive, systematic approach to learning from deaths”.

In what I consider one of its most damning findings, the Mazars report also found evidence of repeated warnings being ignored:

“Despite the Board being informed on a number of occasions, including in representation from Coroners, that the quality of the…reporting…and standard of investigation was inadequate no effective action was taken to improve investigations”.

The report also stated:

“Despite the Trust having comprehensive data relating to deaths of its service users it has failed to use it effectively to understand mortality and issues relating to deaths of its Mental Health or Learning Disability service users.”

By any measure, those criticisms were immensely serious and required a robust response.

Following the report’s publication, my right hon. Friend the Secretary of State for Health expressed his determination to learn the lessons of the report and set out a number of measures to address the issues raised, including a focused inspection by the Care Quality Commission looking in particular at the trust’s approach to the investigation of deaths. As part of that inspection, the CQC was asked to assess the trust’s progress on implementing the action plan required by NHS Improvement and on making the improvements required by its last inspection, published in February 2015. Separately, the CQC was also asked to undertake a wider review of the investigation of deaths in a sample of all types of NHS trusts in different parts of the country. That is particularly important because we need to know whether the problems and failings at Southern Health are exceptional outliers or whether there is a similar problem in other parts of the country.

The trust accepted the findings of the Mazars report and apologised unreservedly for the failings identified. NHS Improvement set out in January 2016 its plans to provide assistance to the trust to ensure that it delivers on plans to implement the agreed improvements, which include the appointment of a new improvement director and the taking of advice from independent experts. All those measures were agreed by the trust’s management, and in January we had a letter from the chief executive officer setting that out.

[Kit Malthouse (North West Hampshire) (Con)]

I congratulate my hon. Friend on securing this important debate. She is outlining that there is an improvement plan, that the board has agreed and that NHS Improvement is helping, but one thing that seems to be frustrating people, particularly in my constituency, is the lack of a hard date on which we can judge that the corner has been turned. Does she agree that it would be sensible for NHS Improvement, or the board itself, to set some kind of deadline by which a judgment can be made? Otherwise, improvement is purely on the never-never and we will never know publicly whether the trust has got to where it needs to be.

[Suella Fernandes]

My hon. Friend makes a sensible suggestion, which I echo. A deadline with key targets and dates would be hugely valuable, not only in motivating people and focusing minds but in restoring public trust in all the organisations involved.

--- Later in debate ---

[Suella Fernandes]

I totally agree with my hon. Friend’s observation. There is a challenge here. This is unfamiliar territory for the NHS, and funding will be necessary to support any new attempt to make progress following debates such as this one.

Inspectors from the Care Quality Commission visited Southern Health as part of the planned inspection during January of this year. Following that inspection, the CQC announced on 6 April that it had issued a warning notice to Southern Health, telling the trust that it must make significant improvements to protect patients at risk of harm while in the care of its mental health and learning disability services. The announcement stated that the notice required the trust to improve its governance arrangements to ensure that there was robust investigation and learning from incidents and deaths, to reduce further risks to patients.

The team of inspectors also checked on improvements that had been required in some of the trust’s mental health and learning disability services following previous inspections. They found that the trust had failed to mitigate significant risks posed by some of the physical environments from which it delivered mental health and learning disability services.

On the wider issue of reporting deaths, the inspectors found that the trust did not operate effective governance arrangements to ensure robust investigation of incidents, including deaths; did not adequately ensure that it learned from incidents, so as to reduce future risk to patients; and did not effectively respond to concerns about safety that had been raised by patients, their carers and staff, or to concerns raised by trust staff about their ability to carry out their roles effectively.

All those findings, and the serious step of issuing a warning notice, reinforce the most serious of the Mazars findings. Dr Paul Lelliott, the CQC’s deputy chief inspector of hospitals and lead for mental health, was quoted as saying that the services provided by Southern Health required “significant improvement”. He said:

“We found longstanding risks to patients, arising from the physical environment, that had not been dealt with effectively. The Trust’s internal governance arrangements to learn from serious incidents or investigations were not good enough, meaning that opportunities to minimise further risks to patients were lost.

It is only now, following our latest inspection and in response to the warning notice, that the Trust has taken action and has identified further action that it will take to improve safety at Kingsley ward, Melbury Lodge in Hampshire and Evenlode in Oxfordshire. The Trust must also continue to make improvements to its governance arrangements for reporting, monitoring, investigating and learning from incidents and deaths. CQC will be monitoring this Trust very closely and will return to check on improvements and progress in the near future.”

The CQC published the full report of its January 2016 inspection at the end of April 2016. It confirmed the concerns that had been raised in the warning notice and gave further details of specific issues. The chairman of Southern Health’s board, Mike Petter, resigned the day before the report was published.

On the same day that the CQC published its warning notice, NHS Improvement issued a statement announcing that it was seeking further powers to intervene in the trust’s governance, to ensure that the trust complies with the improvements required of it. NHS Improvement said that it intended to insert an additional condition into the trust’s licence to supply NHS services, which would allow NHS Improvement to make management changes at the trust if progress was not made on addressing the concerns that had been raised.

The additional condition was imposed on 14 April, and the statutory notice contained severe criticism of the trust and its leadership. It stated that undertakings that the trust gave in April 2014 that it would comply with enforcement notices relating to breaches of its governance conditions were yet to be delivered in full. It notes that additional undertakings were made by the trust in January 2016 in response to the Mazars report and summarises the CQC’s findings from its inspection in January, saying that the warning notice had identified “longstanding risks to patients” that had not been addressed. It then said:

“In the light of these matters, and the other available evidence, Monitor”—

that is, NHS Improvement—

“is satisfied that the Board is failing to secure compliance with the Licensee’s licence conditions and failing properly to take steps to reduce the risk of non-compliance. In those circumstances, Monitor is satisfied that the governance of the Licensee is such that the Licensee is failing and will fail to comply with the conditions of its licence.”

On that basis, NHS Improvement, or Monitor, has imposed a new condition to Southern Health’s licence, requiring that it

“has in place sufficient and effective board, management and clinical leadership capacity and capability, as well as appropriate governance systems and processes, to enable it to”

address the failures in governance

“and comply with any enforcement undertakings, or discretionary requirements, imposed by Monitor in relation to these issues.”

[Kit Malthouse]

I am grateful to my hon. Friend for giving way to me for a second time.

One of the frustrations that I think we have all had throughout this sorry saga has been about the lack of any sense of personal responsibility or line management for particular risks. A thought occurs to me. Can my hon. Friend say who at NHS Improvement will take the decision about whether the trust should be given its licence? I ask that because I have a sense that unless we know who that person is, we will not be able properly to take a view about whether their judgment is right. If the decision disappears into a bureaucratic organisation, it may well never emerge in a timely fashion. Does she have an idea of who is responsible? If she does not, perhaps the Minister could let us know what the processes are regarding the taking of the decision and who finally gets to sign on the dotted line that everything is all right, or not.

[Suella Fernandes]

I agree that there is a real risk, as my hon. Friend says so eloquently, of this issue falling into a bureaucratic abyss. It is absolutely vital that we have clear processes and that the identities of the responsible people and professionals are clear, so that there is a clear line of accountability for users and indeed for MPs.

Following the resignation of Mike Petter as chairman of Southern Health, NHS Improvement exercised its power to intervene to appoint his replacement, Tim Smart, who is now acting as interim chairman. The notice directing the trust to appoint him stated:

“These matters demonstrate that the Licensee”—

that is, Southern Health—

“does not have in place sufficient or effective board management and clinical leadership capacity and capability, as well as appropriate governance systems and processes as required by additional licence conditions. Monitor is therefore satisfied that the Licensee is breaching the additional licence condition.”

Time and again, in report after report, Southern Health has been criticised for its failures of management and leadership, and the effects that those failures have had on the care that it provides. That is why I called for this debate that focuses on the governance of the trust. We all accept that, sadly, tragic failures in care will inevitably occur from time to time, and those at the top of an organisation cannot be held responsible for every incident on the frontline.

Equally, we must pay tribute to the dedicated staff of Southern Health for the excellent care that they give day in, day out for the majority of the time. We cannot and should not tar all of them with the same brush because of the failures of others. However, when clear and systematic problems have been identified, we are entitled to ask that lessons be learned. For me, the most shocking part of the sequence of events that I have just recounted is that right up until this year—indeed, even in the last couple of months—inspectors have stated that necessary changes that have been flagged up as needing action have not been implemented.

When NHS Improvement said in its enforcement notices that the trust was failing in its obligations under its licence and did not have effective border capacity and capability, it used the present tense. That was in April. Since then, Tim Smart has been installed as chairman, and I repeat my thanks to him for meeting my parliamentary colleagues and me yesterday in Westminster. He has been conducting an initial review of governance, and I was pleased to hear that he expects to make some announcements on his findings and proposals within the next month. I am sure I speak for many when I say that we will be looking for some far-reaching changes to recognise the gravity of the situation.

That brings me on to the issue of personnel. I have been asked repeatedly whether I am calling for the resignation of Southern’s executives, and in particular that of Katrina Percy, the chief executive. I have resisted doing so because, as the Minister has said in the House, politicians and Ministers demanding that heads must roll can often cause more problems than they solve. I repeat my thanks to Ms Percy and her team for coming to meet my colleagues and me on a number of occasions to answer our questions. However, I will now say publicly what I told her at our last meeting: I find it difficult to have confidence that she has properly acknowledged the scale of the problems under her leadership or how difficult it will be for patients and families to have their faith in the organisation restored without a visible sign of a fresh start.

Resignations are a matter for individuals, and Katrina Percy has said that she believes her responsibility is to provide stability by remaining in post. I understand that position, but the sheer weight of criticism of the trust’s leadership over a prolonged period while she has been chief executive would lead many to a different conclusion. The fact that NHS Improvement has now taken the power to direct changes at board level if it considers them necessary sends its own message.

Oral Answers to Questions

Kit Malthouse Excerpts

Tuesday 10th May 2016 Commons Chamber

[George Freeman]

Not surprisingly, my hon. and, in this field, learned Friend makes a very important point. We have set up a number of initiatives to that very end: to make sure that our pharmacologists and pharmacists in the system are alert and have all the information they need to increase the prescription of biologics and the generic versions, biosimilars. I will happily write to her, describing a range of initiatives that are in place which we are pursuing to that end.

[Kit Malthouse (North West Hampshire) (Con)]

One of the issues around the adoption of biosimilars and, indeed, driving down the NHS drugs budget generally is the lack of local analysis of patterns of prescribing against efficacy and cost. I wonder whether the Minister would consider encouraging clinical commissioning groups to appoint analytical pharmacists, who could look at this equation and recommend different prescribing decisions on a local basis.

[George Freeman]

My hon. Friend makes a really interesting point. It goes to the heart of the work that we are doing at the moment with CCGs, in terms of use of data to map and track prescribing practice across the system. I will happily pick up the point about ensuring that biosimilars are incorporated in that.

Southern Health NHS Foundation Trust

Kit Malthouse Excerpts

Tuesday 3rd May 2016 Commons Chamber

[Alistair Burt]

I can do nothing more than repeat what I said earlier. I am aware that there might be circumstances in which an inquiry would bring out more and would demonstrate the degree of concern that colleagues in the House might find appropriate and that the families and others would understand. My first duty is to make sure that everyone is safe in the trust and to ensure the completion of the work that needs to be done to deliver what the CQC has found. Even after this very thorough work by CQC, which is transparent—that is why we are talking about it today—if anything further is needed, I will give it genuine and serious consideration.

[Kit Malthouse (North West Hampshire) (Con)]

The Minister is right to call the report disturbing. It has caused alarm and uncertainty across my constituency, and it is with the uncertainty that I hope he can help. In common with other Members, I am keen to know whether he has a hard date by which the trust is to be reviewed again. If it were to fail that hurdle, what would the next action be—revocation of the licence or further improvements? He will understand that most of my constituents want to see a deadline for compliance, and after that significant change that might mean a new era at Southern Health.

Brain Tumours

Kit Malthouse Excerpts

Monday 18th April 2016 Westminster Hall

[Helen Jones]

I am grateful for the right hon. Gentleman’s intervention and I agree with his constituent. Brain tumours are perceived to be rare, although my argument is that they are not as rare as we think and the number of life years lost and the burden of the disease mean they have to be tackled. We know there is a correlation between the amount of money spent and survival rates in cancer. Survival rates for those with brain tumours went up by only 7.5% between 1970 and 2015. For cancer overall, they have doubled.

[Kit Malthouse (North West Hampshire) (Con)]

The hon. Lady is making some valuable points. Does she agree that a key issue is that a young researcher will look at the overall commitment and likely level of spending in this area during their career before deciding whether to specialise in it? The paucity of research spending in this area may mean that we do not get the amount and quality of research that is required.

[Helen Jones]

I agree with the hon. Gentleman and I will come to that.

Between 2000 and 2012, we spent about £35 million on brain tumour research. The Government have rightly said that such spending has increased tenfold. It has, but it has increased from a very low base. That £35 million is from a total of about £4.5 billion of spending on cancer research.

Dementia and Alzheimer’s Disease

Kit Malthouse Excerpts

Tuesday 12th April 2016 Westminster Hall

[Kit Malthouse (North West Hampshire) (Con)]

I realise that Members often curl their lip when Conservative Members stand up to tell the Prime Minister how brilliant he is; but since he put dementia on the global agenda in 2012 the horizon has changed remarkably. Between 2012 and 2015 something like £60 million was pumped into research, and there are incredibly ambitious targets for the doubling by 2020 of dementia and Alzheimer’s research. That includes all sources—Government, private and charity.

The issue is all about capacity building; £300 million is now being pumped in, of which £150 million is earmarked for a dementia research institute and an international discovery fund of 130 million quid. However, we must face the fact that the field of dementia research is still very small in comparison with others, particularly bearing in mind the fact that the £26 billion annual cost is more than the combined cost to the country of cancer and heart disease. Despite that, only three new drugs have been discovered in the past 15 years.

Something has to change, and that is why the Government’s announcement of a dementia research institute is so important. It is important for three reasons, the first of which is security for researchers. I do not know how many hon. Members know any scientific researchers, but they are as interested as anyone else in having a career. When they pick a specialism to devote their lives to, they need to know that there is a future in it, and the likelihood of funding to sustain them throughout their career. At the moment, dementia does not provide that. A dementia research institute will do it. At the moment about 70% of PhD graduates in dementia research leave academic research within four years of starting. That is not good enough if we are to find a cure.

Secondly, in the search for a cure, a single molecular target is highly unlikely. There is not a silver bullet to cure dementia. There are many different types of dementia and different underlying influences. If we are to find therapies and cures, and things that will assuage dementia and allow people to live with it, we will need a huge amount of collaboration. In the past 20 or 30 years, the private sector has spent about £30 billion researching dementia across the piece, but that has been happening in different silos, often with researchers working on the same dead ends, and wasting the money three or four times. It is critical that we should collaborate, particularly internationally, in the search for a cure.

Finally, given that there will be no single molecular target, it is unlikely that there will be significant advances on a cure in the next 10 or 15 years. One of the Cinderella research areas, which does not get much funding or concentration, is care, therapy and management. One of my key wishes with respect to the new dementia research institute is that it should become a soup-to-nuts research institute, looking at diagnosis, care, therapy, psychology and support for families, as well as a cure. The Government announced about 18 months ago that the institute would be up and running within five years. That means there are only three and a half years left, and I would be pleased if the Minister updated us on progress, with respect to announcing a location, funding, and who will host the institute. Only once we have that centre of global excellence will we be in a proper position to tackle what is likely to be one of the top five public health challenges of the next century.