Health Infrastructure Plan

Luke Pollard Excerpts

Monday 30th September 2019 Commons Chamber

[Edward Argar]

The hon. Gentleman rightly highlights the importance of mental health care and services for those with mental health needs. I go back to the point that this Government have placed those needs and that care front and centre of our approach and have put investment in place to back up that commitment. In respect of his specific request for a visit and a meeting, it may take a little time, given the number of colleagues who have asked to see me, but of course I am happy to do so.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

I saw the professionalism of NHS staff on one of my recent night shifts at Derriford Hospital. They told me that they need more staff, not necessarily more buildings, but may I ask the Minister about the £600 million commitment to Derriford Hospital? This is welcome but surprising, as we have not asked for a new hospital. May I ask how that figure was arrived at and, if the actual figure is more than £600 million, what will happen—will the Minister fund the difference? Does this mean that the projects we had asked for, such as the planned care centre and the health hub network, will now be approved quickly, so that we can get on and build those shovel-ready projects?

[Edward Argar]

I am grateful to the hon. Gentleman for attempting to pile a number of requests into his question. On where bids have come from for these moneys, they have come from those trusts and been worked up by those local trusts. On the specific requests he has and that he wants to raise with me about particular shovel-ready projects, I am very happy to look at those with him.

Primary Care: Plymouth

Luke Pollard Excerpts

Wednesday 10th April 2019 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

Will those not staying for this debate please be kind enough to leave quickly and quietly, because we are moving on to the important issue of primary care provision in Plymouth?

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

I beg to move,

That this House has considered primary care provision in Plymouth.

Today is a special treat for me. Not only is it my 39th birthday, but I have a chance to raise the concerns of the people I represent about a very important issue: their difficulty accessing primary care in Plymouth. This is the second time that I have spoken in this place about primary care in Plymouth, having participated in a similar debate in March last year, and never has the issue been more pressing.

I will start, though, with a welcome and a thank you. First, I welcome the new Minister to her place. I have great respect for her, and there is sincere warmth towards her from both Government and Opposition Members—although perhaps they are not in the Chamber today. She has a very difficult job, and I genuinely wish her well. She is not the type of Minister to play party politics; she does engage with the issue, and I am really pleased that she is able to respond to this debate.

Secondly, I thank all those medical professionals who work in primary care in Plymouth: the doctors, including GPs, paramedics, nurses, community pharmacists, dentists, medical students, receptionists, wellbeing professionals, volunteers, patient participation groups and many more besides. Their dedication and good will is the glue that is holding together a very fragile system in Plymouth, and I place my thanks to them on the record right away.

Many GPs in Plymouth often work long hours—12 or 13-hour days. They do so out of dedication to their patients and to the health service, but they simply cannot be expected to do more and more with less and less. I am pleased to have secured this debate. When I was elected, I said that I would try to give Plymouth its voice back in Parliament by raising the issues that really matter, and primary care is one of those issues that comes up at nearly every constituency surgery that I hold. People who live in Plymouth know that the far south-west does not get its fair share of funding, and that is true from health to education and from transport to housing—all get below-average spend. Ours is one of the lowest funded regions in the UK, and that has consequences for our public services.

I worry that with the housing crisis, the NHS crisis, the crisis in young people’s mental health and the social care crisis, we are at risk of crisis fatigue. That is where the exceptional support required to resolve any one crisis is no longer given because a crisis is no longer exceptional.

I think that these debates are best done on a cross-party basis. Plymouth is represented by three Members of Parliament, and I am sorry that the other two are not here today, but I hope the Minister will recognise that many of the things I speak about are cross-party concerns. I will attempt to keep party politics out of my remarks today.

Plymouth’s primary care is in a state of crisis. Our GPs are working to the point of exhaustion because of the lack of funding and resources not just in primary care, but throughout the system. I think that it would be helpful to hear the voices of those on the frontline. An inner-city Plymouth GP, Dr Williams, told me:

“I don’t know of a GP at the moment who isn’t working at full capacity. We are all working way beyond our contracted hours, late into the evenings, on our ‘days off’ and at weekends. Not for money, not for glory, but to give our patients the best possible care.

I have colleagues who have burnt out, friends who are burning out, friends who are back at work too soon after serious illness because we are…putting our lives on hold to prop up the job we love and the patients we are passionate about. But the system is failing, and it’s feeling like that may be intentional. We believe we are set up to give the most cost effective and best patient care—but maybe that’s wrong. Can you give an honest answer about where NHS England see primary care going? Is there an agenda or even a plan in place for change?

It has been said that Plymouth is being watched to see what happens when Primary Care fails. If there is any truth in this please tell us now—don’t watch it fail”,

but act to stop that happening. That is a common view among most of the GPs I spoke to. They have a real sense that primary care in Plymouth is being watched by NHS England and other NHS bodies to see what happens when a system falls over. Whether or not that is true, that is the sense they have.

As a result of underfunding, nurse and GP vacancies in Plymouth’s primary care sector are hard to fill. If GP practices cannot fill vacancies, the quality of care they can offer suffers as more and more patients chase fewer and fewer available GP appointments. NHS England estimates that one in seven GP posts in Plymouth have not been filled, which is alarming. A GP in Plymouth who recently advertised for a vacancy at their surgery told me that they did not receive a single application. We know that the far south-west has trouble recruiting healthcare professionals at primary, secondary and acute levels. Our peripherality as a region compounds an already extremely difficult recruitment environment for health professionals. I know that the Government have considered support for GP recruitment in Plymouth in recent months, but it has not produced the additional GPs we are looking for. Will the Minister update us on GP recruitment and on what will happen next?

A common theme in feedback from GPs is that funding and pay have decreased while job pressures have increased. If there is not enough funding GP practices cannot recruit enough doctors, nurses, healthcare assistants and other health professionals, receptionists or managers. Everyone therefore works harder, yet many GP surgeries feel they cannot meet patient demands or expectations. An inner-city Plymouth GP, Dr James Boorer, told me yesterday:

“Working in Plymouth is hard. But we are not alone—there are many other practices in similar deprived cities around the country where it is equally difficult. The problem probably stems from systematic under-resourcing of primary care over the last 10 years where demand has increasingly outstripped resource and funding.

This has led to a failure to recruit new GPs and retain others who have left the profession early because it has been so difficult. The challenge is so great that we feel abused by the government who know we are dedicated and will stay until the job is done no matter how hard it gets. But there is a limit—we do break.”

That sense of getting to the point where they cannot go much further came across from a lot of GPs, and we have witnessed that in the number of practice handbacks across Plymouth. About 15% of Plymouth’s population is now covered by non-general medical services primary care, where a contract has been handed back and an emergency provider has stepped in. That should worry the taxpayer as well, because those organisations consume two to three times as much resource as normal primary care. Last year, instead of about £79 per patient, the step-in provider got about £191 per patient. If that is acceptable as a step-in provision, I would like the Minister to look at whether increasing the per patient funding would avoid the need for practices to hand back their contracts. Levelling funding across a city in this respect, rather than adding extra resources to those practices that have handed back their contract, might be a more efficient tool to address the funding crisis and to deal with the emergency situation.

Deprived practices in Plymouth are not the only ones that are underfunded and under-resourced; the crisis is a national one affecting the whole of primary care, but the crisis is crystallising in hotspots, where the funding and resources are more markedly different from elsewhere in the country. It gets tough in those hotspots first, so GPs leave to work in better resourced areas, and it is harder to recruit in those practices when partners retire. This inequality in funding is driving the crisis. Will the Minister reconsider whether levels of deprivation and health need can be taken into account in the funding formula to ensure that inner-city practices are well resourced?

On average, GPs in more deprived areas have a higher workload, with 20% more consultations with patients, who are more likely to have multiple morbidities, with both physical and mental conditions, but they do not necessarily receive the additional funding to address those complex needs. The Care Quality Commission has described primary care in Plymouth as at a “tipping point”. It found 15% GP vacancy rates, with several practices having handed back their contracts or at risk of doing so, in some cases owing to recruitment difficulties. It also found that between 25% and 35% of GPs and practice nurses would be retiring in the next five years. I realise that issue is not specific to Plymouth, but it is a trend across primary care that we need to address if we are to continue providing patients with the care they deserve. I should be grateful if the Minister responded to the concerns that those GPs have raised and set out what steps her Department is taking to address GP recruitment and retention, in particular. I think that a lot of GPs will be watching the debate and looking for reassurance that there is light at the end of the tunnel, albeit the route to it may not be an easy one. They are looking for confidence that there is a plan.

In a similar debate in March 2018, I spoke about primary care in Plymouth and the Minister’s predecessor, the hon. Member for Winchester (Steve Brine), agreed to meet to discuss the issue with Plymouth GPs. I spoke to him about it in the Tea Room the other day and, while I realise that the Minister will not be controlling her diary in the same way as she did before being elevated to ministerial office, I should be grateful if she confirmed that she too would be happy to meet Plymouth GPs, so that they can raise their concerns directly with her about the direction in which primary care in Plymouth is going. I should welcome it if the meeting were with a cross-party delegation, to make sure that the concerns were not party political.

A crisis in primary care means longer waiting times. It means patients will experience longer waits for routine appointments, have trouble getting through on the phone, and face reduced availability of urgent appointments. Healthwatch Plymouth published a report in November about primary care in our city. One patient had this to say about their experience:

“I had a brilliant surgery. But since merging with another I have had problems. I had the flu bug over Christmas, I received a diagnosis of a throat virus over the phone. I waited 7 weeks to see my doctor. Then when the results of my ultrasound came in, I found out from the receptionist that my doctor had retired. I have just tried to make an appointment and have been told I can’t make an appointment”—

for many months—

“as they are changing their systems.”

I think that is an isolated example, but it is part of a trend of concerns that patients express not only to the patient participation groups in practices—groups of patients who deserve special thanks and who are often overlooked in our debates—but by way of representations in the postbags of councillors and MPs.

The Care Quality Commission found that people could not always access a GP when they needed one and GPs told the CQC that it is not uncommon for the waiting time for a routine appointment to be four weeks. There are even some areas of the city where people are having difficulty registering or cannot register with a GP, because GP surgeries have closed and there is not sufficient bandwidth in the system to accept additional patients. I know that because my GP surgery in Plymouth closed and it was a struggle for the patients to find another with places available.

People in Plymouth have reached out to me on social media, and I have been inviting comments on my Facebook page. It was nice to get comments that were not about the B-word. I will recount a few of those experiences, but should the Minister or officials want to look at them again there are plenty more on my Facebook page. I heard from a pregnant woman who told me she had to wait three weeks for an appointment. Someone else said:

“For months now, it’s been impossible to book appointments online at my doctor’s. It takes three weeks to see a GP, and two just to see the practice nurse. After becoming part of a merged practice, the surgery has declined drastically.”

Another told me:

“Telephone consultations now seem to be the norm. Better than nothing, but a poor substitute for thorough examination.”

There is, of course, a growing role for community pharmacy in Plymouth, as there is across the country, and our pharmacists do a superb job. More people need to access services provided by community pharmacists, and I encourage the Minister to continue to promote the services that pharmacies offer as part of the broader array of services to address the primary care crisis.

GPs are on the frontline of healthcare and many people in Plymouth have told me that pressure has increased as community services have been cut back in other areas. A large proportion of the patients that GPs see consists of patients with severe, complex and enduring mental health difficulties who need regular GP support, and for some their GP is their only point of contact. While GPs continue to go above and beyond for their patients, they are not being given enough help to ease the pressure, particularly with patients with complex needs. Mental health services in Plymouth have significantly longer waiting times than other areas in Devon. Patients struggling with their mental health consult their GPs more frequently, until they are accepted into a specialist service that can support them in appropriate settings. That means that GPs in Plymouth have far more appointment demands to support patients with mental health needs than GPs elsewhere in Devon. At a meeting I held with GPs last year there was general agreement that integration of general practice, mental health and community services would be beneficial and would lead to patient care being not only better but more efficient.

This is a good moment to talk about something that Plymouth is really good at, as well as having challenges: the introduction and roll-out of health and wellbeing hubs. Plymouth City Council, our local clinical commissioning group, and Livewell Southwest—our social enterprise that provides NHS services in Plymouth—have come together to roll out health and wellbeing hubs across our city. Many of them are in the north of Plymouth, which is represented by the hon. Member for Plymouth, Moor View (Johnny Mercer), but three weeks ago I attended the opening of an all new wellbeing hub at the Cumberland centre in Devonport in my constituency. Those are genuine attempts to provide wraparound care, in addition to primary care, and to provide more thorough and effective services. I believe that Ministers should roll that model out across the country as it has real benefits. We should listen to our doctors, not just when it comes to our health but about what is best for our health services. They claim that the health and wellbeing hub model is an important addition to GP services, although not a substitute for them.

Plymouth City Council has submitted a bid to Ministers for £13 million funding to create more hubs across the city, including a superhub in our city centre. I have spoken to the Minister of State for Health about that a number of times, and I will be grateful if the Minister looks favourably on that funding application if it crosses her desk, as it is a genuinely pioneering project. The superhub would bring together in one location NHS dentistry and Plymouth’s award-winning dental school, sexual health testing, mental health support, social care, and new forms of directly employed general practice doctors, as well as wellbeing services. A site has been identified for those services in the Colin Campbell Court development, and my Labour colleague on the city council, Councillor Mark Lowry, and our health lead, Councillor Ian Tuffin, would jump at the chance to brief the Minister and her officials about that project.

As GP services in the localities continue to close in Plymouth, that project would create a new south pole in Plymouth for health services, as well as the north pole at Derriford Hospital in the northern tip of our city. We all want to discourage people from attending hospital if they can access their care in local communities, and health and wellbeing hubs, as well as the new superhub, could make a transformative difference in Plymouth.

The doctors and patients I have spoken to in Plymouth all agree that our primary care is in crisis, but recognising that there is a crisis is the first step to solving it. The crisis is not because our doctors, nurses and health professionals are not working hard enough; it is because they need more support and a better system to support them in their work. Dr Boorer said:

“We regularly continue working late into the night, often still doing administrative tasks and checking bloods at 10 to 11 pm, or catching up at weekends so we can meet the needs of our patients. But this level of work is unsustainable as evidenced by practice closures. With the current crisis, related as a result of sustained under resourcing, we see sub-optimal care for patients, burnt out GPs handing back contracts and leaving the profession”.

I praise those GPs who have chosen to work in inner-city practices such as those in my constituency, because they genuinely care about their patients and the quality of care they receive. I am concerned, however, that the current GP partnership model, and the high costs of buying into it, is not sufficient or appropriate for 21st century Britain, especially when we are suffering from a recruitment and retention crisis. We need to attract more younger talent as we seek to replace those GPs who are nearing retirement, and I believe there are ways to flex the model of providing primary care.

Research shows that cities such as Plymouth have been hit hardest by some of the cuts to public services. Levels of deprivation are high, and the wraparound care provided by other providers—in particular council services—is not as present as it used to be. We know that when the primary care system breaks, costs for the taxpayer rise and people suffer. The scale of the challenge we face is great. I genuinely welcome the Minister to her new role. I hope we will be able to work together to address the specific challenges faced by Plymouth, and come up with some solutions.

[The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)]

It is a pleasure to serve under your chairmanship, Mr Hollobone. I thank the hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) for securing this important debate and for his kind words. I wish him a very happy birthday.

The hon. Gentleman spoke passionately about his constituency, as he always does, and he raised a number of pressing issues related to GP provision in Plymouth. I join him in thanking GPs and all the 1.3 million dedicated NHS staff for how they coped with increased demand on services over a challenging winter. The Government will continue to give the NHS all the additional support it needs over winter to ensure that patients continue to receive high-quality care.

The Government recognise the vital role primary care plays at the heart of our NHS, but a growing and ageing population, and increasing numbers of patients with long-term conditions, are putting strain on the system and adding to the challenges we face in recruiting and retaining GPs. Those real pressures can affect the quality of care that patients receive. We fully recognise those huge challenges, which is why we have made primary care a clear priority.

I will set out the significant measures that we are taking to support and reinvigorate general practice, which will improve GP services for patients across England, including the hon. Gentleman’s constituents. In 2015, we set an ambitious target to recruit 5,000 more GPs. That is challenging, but it is vital to ensure that we have more GPs in the NHS, so we remain committed to delivering that commitment as soon as possible. The NHS long-term plan, which was published in January, made a clear commitment to the future of general practice, with primary and community care set to receive at least £4.5 billion more a year in real terms by 2023-24.

In January, we launched the new five-year GP contract, which was agreed with and widely welcomed by the profession. It will see billions of pounds of extra investment for improved access, expanded services at local practices, and longer appointments for patients who need them. We have listened to GPs about the biggest pressures they face and where we must focus to deliver reform of general practice. GPs have told us that one of the biggest pressures they face is an often unsustainable workload, which is a key reason why many dedicated GPs leave the national health service. Our new GP contract seeks to address the workload pressures that have resulted from a workforce shortfall. NHS England has committed to further expanding community-based multi-disciplinary teams and will provide funding for up to 20,000 other staff, such as physician associates and social prescribers, in primary care networks by 2023-24. Those bigger teams of staff will provide a wider range of care options for patients and free up more time for GPs to focus on their true passion—treating patients.

Another huge cause of concern for GPs has been professional indemnity. In recent years, the spiralling cost of purchasing professional indemnity cover has been a major source of stress and financial burden for GPs. That is why we addressed it in the GP contract and why just last week, on 1 April, we launched the new state-backed clinical negligence scheme for general practice. That brings a permanent solution for indemnity costs and coverage and includes all staff delivering primary medical services, including out of hours. It will remove a huge cause of worry for GPs, which will help with the recruitment and retention of GPs.

As the hon. Gentleman mentioned, we are looking at how to make the general practice partnership model fit for GPs working in the NHS in the 21st century. We recognise the huge contribution that the partnership model has made over the last 70 years of the NHS, but we know that it faces huge challenges, because many GPs, like other NHS doctors, want more flexible and varied portfolio careers; perhaps they do not want the long-term financial and geographical commitments of joining a GP partnership. That is why we commissioned Dr Nigel Watson to lead an independent review of the partnership model to understand those challenges.

As part of that review, Dr Watson visited more than 25 practices around the country, some of them small and some super-partnerships. As the hon. Gentleman alluded to, Dr Watson visited areas that are experiencing the greatest difficulty in recruiting GPs, including meeting some in Plymouth. Those visits played a key role in informing the work of the review, which reported in January and made seven key recommendations about workforce, business models and risk. We are grateful to Dr Watson for his important work, and we will respond to his recommendations in due course, with a view to reinvigorating the partnership model and making it fit for the 21st century.

I have set out that general practice is a priority for the Government, but what does that mean for Plymouth, and the hon. Gentleman’s constituents? GPs know the needs of their patients best, which is why the long-term plan seeks to change the balance of how the NHS works by shifting more activity into primary and community care. That will be enabled by expanding multidisciplinary teams working within general practice.

In Plymouth, the funding linked to the new GP contract will create extra capacity, with a 25% increase in staff numbers expected over the next five years across Devon as primary care networks employ pharmacists, physician assistants, physiotherapists, paramedics and social prescribers. I commend the valuable work being undertaken in Plymouth to open a network of local wellbeing hubs, aimed at giving residents easier and earlier access to health advice and support.

I understand that in a meeting with the former Health Minister, my right hon. Friend the Member for North East Cambridgeshire (Stephen Barclay), there was a specific proposal for funding to develop a hub in Plymouth city centre. I understand that following that discussion the clinical commissioning group has undertaken further work on the case for investment with the local sustainability and transformation partnership, in anticipation of the next capital funding bidding process.

I am encouraged by the number of promising local recruitment schemes that Devon CCG has put in place both to recruit more GPs and to retain those already in the workforce. I am very happy to meet the hon. Gentleman, hopefully along with my hon. Friends the Members for South West Devon (Sir Gary Streeter) and for Plymouth, Moor View (Johnny Mercer), and some GPs. Other schemes include investment in portfolio careers for GPs, supported by funding from NHS England; investment in GP coaching to support retention, and a scheme to entice those who have left the primary care workforce to return to the profession, which will launch this year. It will also offer flexible working and alternative employment arrangements.

[Luke Pollard]

Flexible working is a huge opportunity. May I ask the Minister to look also at whether flexible working schemes with acute hospital trusts, such as part-time GPs and part-time acute hospital doctors, could be included in that scheme? I think there is real merit in that.

[Seema Kennedy]

I will take that salient point away and write to the hon. Gentleman.

The CCG is also working closely with the Devon Community Education Provider Network and Health Education England to develop primary care training hubs to support GP training, as well as the broader primary care workforce. Furthermore, the targeted enhanced recruitment scheme in England—an initiative that offers a one-off payment of £20,000 to GP trainees for committing to work in a specific area—has offered 24 places in Plymouth from August 2019. I am delighted to tell the House that 22 of the 24 places have been filled ahead of schedule, which is excellent news for Plymouth. It is the second highest number of places for any one area in England.

It is important to note that, despite the difficulties that the hon. Gentleman has raised, primary care in Plymouth is improving. Provision has been reviewed by the local authority’s health scrutiny committee regularly over the last five years. Most recently, the committee concluded that it was assured that the system in Plymouth—in particular, general practice—had made substantial improvements since its last review, and that although the system was fragile, significant work was under way to address recruitment issues.

I hope that I have made it clear what an absolute priority supporting and reinvigorating primary care is for the Government. We know that there are challenges with GP recruitment and retention, and other important issues facing general practice as the hon. Gentleman has outlined. However, the commitments made in the NHS long-term plan and the significant extra funding to back them up mean that we are well placed to address them. We can anticipate real improvement and reform of general practice, ensuring better access and improved services for patients in Plymouth and across England. It is such an exciting time for me as the new Minister responsible for primary care to come in and see those new commitments begin to be put into effect, and to ensure that they are delivered. I thank the hon. Gentleman for bringing such an important matter for debate, and I wish him a very happy birthday.

Question put and agreed to.

Oral Answers to Questions

Luke Pollard Excerpts

Tuesday 26th March 2019 Commons Chamber

[Stephen Hammond]

The apprenticeship levy was obviously introduced to cover the training and assessment costs of apprenticeships at a rate that would meet employee demand. I recognise some of the challenges that there are, and I would be delighted to meet my hon. Friend to discuss the issues that he has raised.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

19.   The NHS 10-year plan in Plymouth will be delivered not only by NHS staff but by social enterprise staff. Those staff who work for social enterprise Livewell in Plymouth have had difficulty accessing the NHS pay rise and the NHS pension uplift. Will the Minister agree to meet me and Livewell’s staff so that we can resolve this issue, to ensure that all staff who work for a social enterprise receive the pensions they deserve?

[Stephen Hammond]

The hon. Gentleman knows that I wrote to him on 20 March on this issue, and I outlined that officials from DHSC had contacted the scheme administrator about the issues with Livewell. I can confirm that the members there would still be dealt with in the way set out prior to the implementation date, and I am happy to meet him.

Eurotunnel: Payment

Luke Pollard Excerpts

Monday 4th March 2019 Commons Chamber

[Matt Hancock]

I mentioned in my statement that the pharmaceutical industry has stepped up to the plate and acted extremely responsibly in order to put in place the stockpiling that is necessary for a contingency in the event of a no-deal Brexit. All of us in this House can do something about the potential of a no-deal Brexit: we can vote for the deal.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

I know that the Health Secretary dreams of being Prime Minister, but to his great surprise, and to ours, he woke up as the Transport Secretary’s fall guy this morning. Trying to explain to constituents what is happening in this place is really hard. Trying to explain why a Transport Secretary has not been fired or has not resigned for effectively taking a decision that has lost the taxpayer £33 million is really difficult. Why is it that the Health Secretary cannot get up and simply apologise for the Transport Secretary’s error here? It would go such a long way to restoring confidence in politics. At the moment, this shows Parliament and the Government at their very, very worst.

[Matt Hancock]

I think I have mentioned that the point of this settlement was to ensure the unhindered supply of medicines, which is very much a matter for me as Health Secretary. People watching these proceedings will also be astonished that the Labour party can argue against a settlement such as this when it is refusing to vote for the deal that could ensure that we have a smooth and orderly exit and that the plans and the contingency plans for a no-deal Brexit are not necessary. Mr Speaker, the hon. Gentleman should vote for the deal, too.

Oral Answers to Questions

Luke Pollard Excerpts

Tuesday 15th January 2019 Commons Chamber

[Matt Hancock]

We will respond to the consultation very soon. We wanted to get the NHS long-term plan published first, because clearly the two are strongly linked. I pay tribute to the hon. Gentleman’s work chairing the all-party group on radiotherapy and I look forward to working with him.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

Plymouth is pioneering health and wellbeing hubs—a new type of NHS facility. I am most excited about the new one in Plymouth city centre, which will include directly employed GPs and mental health, sexual health and dentistry services. We have submitted a funding application to the Minister. When will he be able to fund and support that pioneering project, a new type of NHS facility delivering in some of our poorest communities?

[Matt Hancock]

The hon. Gentleman’s neighbour in Plymouth has already brought this to my attention and made the case very strongly for it. I am still waiting for the “Thank you” for the new facilities at Derriford Hospital, but I am a massive supporter of the work that is going on in the local area and the NHS in Plymouth will go from strength to strength under this Government.

NHS Long-term Plan

Luke Pollard Excerpts

Monday 7th January 2019 Commons Chamber

[Matt Hancock]

My hon. Friend is dead right. It was a real pleasure to visit Pilgrim Hospital in Boston, where my grandmother worked as a nurse for 30 years, and to meet the staff. He is absolutely right about the recruitment challenges that they face, which is why a whole chapter of the report, and ongoing work, is dedicated to improving recruitment. When we put £20 billion into a public service, of course we will need more people to deliver it.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

At this very moment, Derriford Hospital in Plymouth is on OPEL 4 alert—the new name for black alert. The real shame is that that is now so commonplace that it no longer always makes the news. Will the Secretary of State, who I know visited the hospital recently, explain whether the new NHS plan will address the structural inequalities in funding for the regions, especially the far south-west? Those inequalities often contribute to the underfunding of services, which is why our hospital is on OPEL 4.

Oral Answers to Questions

Luke Pollard Excerpts

Tuesday 27th November 2018 Commons Chamber

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

Will the Minister support Plymouth’s Peninsula Dental School in training more dentists and encourage use of the underspend in the south-west dental spending pool?

[Steve Brine]

Yes. I would be interested to hear more about anything that can increase access to dentistry in the hon. Gentleman’s part of the world.

Oral Answers to Questions

Luke Pollard Excerpts

Tuesday 23rd October 2018 Commons Chamber

[Mr Speaker]

No, no; Yorkshire is the most marvellous place, but it is a considerable distance from the narrow ambit of the question, from which the Minister did not stray. The ingenuity of those Members will be served later in our proceedings.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

9. What steps he is taking to support health and social care hubs.

[The Minister for Care (Caroline Dinenage)]

Health and social care hubs are a great example of health and care systems coming together through sustainability and transformation partnerships and integrated care systems to transform services in local areas. The NHS long-term plan will set out how we will enable and encourage better integration.

[Luke Pollard]

The Minister will know that Plymouth is leading the way in developing health and social care wellbeing hubs. She will also know that we have bid for £15 million of funding to create more hubs across the city, especially in our city centre, to bring together NHS dentistry and dental schools, sexual and mental health support, social care and new forms of general practice. Will she do all that she can to look positively on that bid, so that we can help to improve our health outcomes?

[Caroline Dinenage]

I am really pleased that the hon. Gentleman has raised this issue. Plymouth is indeed leading the way in creating hubs and showing how incredibly valuable they are in bringing together all the relevant services in one place, not only to tackle people’s current healthcare needs but to play a vital role in prevention.

Oral Answers to Questions

Luke Pollard Excerpts

Tuesday 24th July 2018 Commons Chamber

[Mr Speaker]

The Secretary of State is working extremely hard. I hope that he will take it in the right spirit if I say that I do not think he has yet quite secured the Shipley vote.

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

Sarah, who runs the Devonport Live café in Devonport, one of the poorest parts of the country, used to provide cookery classes for local young mums, but she cannot do that anymore because of a lack of funding to provide the support, facilities and food to help young mums—especially those on low incomes—to get the skills that they need to cook healthy meals for their children. What support can the Secretary of State give to young mums and to people such as Sarah who want to provide cookery lessons to support tackling childhood obesity?

[Matt Hancock]

The hon. Gentleman makes an important point. Funding is available from lots of sources, not just taxpayers. Nevertheless, he will have noted that I have already started talking about the importance of getting funding out into the community, whether that is through social prescribing or wider public health efforts, to make sure that we try to tackle health problems at source and keep people out of hospital as much as possible, rather than spending all the money on sorting things out later in hospital.

ME: Treatment and Research

Luke Pollard Excerpts

Thursday 21st June 2018 Westminster Hall

[Luke Pollard (Plymouth, Sutton and Devonport) (Lab/Co-op)]

I thank the hon. Member for Glasgow North West (Carol Monaghan) for securing this debate and for speaking so passionately. I stand with her and all the people affected by ME in not allowing the voices of ME sufferers to be silenced by anyone for any reason.

In Plymouth, ME affects between 500 and 1,500 people. I agree with the sentiments expressed by hon. Members in the Chamber today that it does not get the amount of attention it deserves, in many cases because of the stigma that has been attached to it for far too long. I have heard people shrug off the condition as laziness or as something in people’s heads. Attacking the stigma and the people who peddle it needs to be an important part of how we build the case for proper action on ME.

A few days ago I mentioned on my Facebook page that I wanted to speak in the debate and I asked for stories from people in Plymouth. I have done that before for various debates and have always been struck by the level of honesty and directness that comes from people simply telling their story, not as a politician but as a person. I will share some of those stories today mainly because the speeches before mine have expertly and succinctly explained the problems with the PACE trial and current treatments. I want to make sure that those voices are heard. One word came through in nearly all of the posts on my Facebook page and on my Twitter, and that word was “invisible”. People with ME feel that they are not believed, that their condition does not matter and that nothing is being done about it. I want to address what it means to be invisible and what we can do.

Jules wrote:

“Just getting up the stairs lays me out for hours. Having a shower leaves me laid out in a darkened room. I can’t work anymore (believe me not for want of trying!) I can’t do drama, Rock Choir or Zumba in fact just making a cup of tea leaves me as exhausted as Zumba used to! I lay alone at home. I live vicariously through FB. I still get out when I can but it will usually cost me days or weeks in bed. I am one of the ‘lucky’ ones. I am not totally bed bound. But I pay for this with my invisibility. I ‘look’ so well! No one can see my pain. I smile and say I am fine then go home to bed.”

The word “invisibility” is key here. People talk about it time and again in terms of how the condition affects their lives and relationships—my hon. Friend the Member for Bristol East (Kerry McCarthy) talked about that—and how it often makes them doubt their validity and whether they are telling the truth.

Several people told me about how having ME also affects their mental health, which the hon. Member for Cheltenham (Alex Chalk) talked about earlier. Catherine wrote:

“I first became ill just before my 21st birthday. I spent weeks needing to be cared for full time by my parent—including being carried by my dad because I was unable to walk. I am always in pain, have difficulty doing things that most people take for granted and lost much of my long-term memory. Long term it affects my memory and focus, my ability to function on a daily basis. I am constantly tired no matter how much I sleep. I have lost friends and needed to give up a career in teaching that I loved. I walk with a stick much of the time, especially in the winter...because my balance is bad and I fall easily. I suffer depression, bouts of anxiety”,

and

“problems that can be very embarrassing and never know whether the next flare might put me back where I started.”

ME is not simply one thing on its own. We need to recognise that mental health problems can stem from the experience of living with ME. It adds to the condition and is not just a part of the condition itself.

[Liz Twist (Blaydon) (Lab)]

Like my hon. Friend, I have heard from many constituents affected by ME who asked me to come today to make their voices heard. He made the point about invisibility earlier, but some of the people who are not able to get out do things from their beds. For example, one of my constituents organised the lighting up of the Tyne Bridge in blue last year, so there are things that people do to make sure we get the message across.

[Luke Pollard]

Absolutely. I thank my hon. Friend for making that point. I am a big believer in digital. As colleagues in the House know, I often talk about it. The ability of digital communities to connect the ME community to help them share experiences and realise they are not on their own is especially important, and I pay tribute to all the people like my hon. Friend’s constituent who do so much.

I want to talk about the effect of ME on young people. The condition affects people of all ages, but sometimes the most acute effects are felt by those whose lives have effectively been taken away at such a young age. Dawn reached out to tell me about her son who is 16 years old and suffers from ME. It was initially brushed off as a migraine and a growing pain and she was told children sometimes get stomach aches. She wrote:

“My intelligent, sporty, active son has now spent over two years virtually housebound. This horrible illness has robbed my son of his teenage years. He only has one friend, has huge gaps in his education, won’t be at the School Leavers’ Assembly, nor the prom. He had to give up football and badminton, his real loves. And all we can do is wait until he gets better.”

The stories of young people with ME are especially powerful, because we all recognise the potential in young people and what amazing things, given the right opportunities and support, they can and will do. For many young people with ME that potential is taken away, and it is especially acute because losing time during their school years affects not only their education but their societal development and the friendship networks they build around them.

[Kate Green]

My hon. Friend will be interested to hear of the 17-year-old son of my constituent, who first contracted the illness as a young child. It took seven years to get a diagnosis. That is an incredibly large proportion of a young person’s life in which to suffer appalling ill health with no proper medical intervention.

[Luke Pollard]

Absolutely.

I want finally to mention Maya, who got in touch about her sister, who is affected by ME. She says:

“Chronic illnesses need far more support and recognition than they get.”

Her sister—like Maya herself, who has fibromyalgia—

“faced repeated uphill battles to get the help she needs, and that’s even been with health professionals.

It’s so little talked about that even doctors and nurses have been stumped as to how to help her. This disease cripples and takes lives and we need to be doing more.”

There is something that we can take from the debate today, which was mentioned by the hon. Member for Cheltenham in relation to brain tumour research—the fact that the power of talking about a condition can bring about change. We saw that with Baroness Jowell, and it is happening today with motor neurone disease, as it is global MND Awareness Day. People are talking about their condition. We also see it in the work on fibromyalgia being done by my hon. Friend the Member for Chesterfield (Toby Perkins). It is a matter of talking about things that are not often talked about. The importance of debates such is this is in raising awareness. People with ME are not invisible. They are as human as we are, and need to be seen and heard. That means investing in proper medical research and in medical education for practitioners, and in a relentless fight against stigma for all people with ME.

[Sir Desmond Swayne (New Forest West) (Con)]

The hon. Gentleman began by talking about stigma—the stigma of laziness or of something “in the head”. We all know that the sort of people afflicted by ME are certainly not lazy. As to its being in the head, there may be some psychological causes of ME but it is none the less an illness, and to treat it as if it were not is to reinforce the stigma that has been so damaging with respect to mental health.

[Luke Pollard]

Absolutely. I think those were the most words I have heard the right hon. Gentleman say since I was elected. He is famous for short questions. I agree entirely, and the challenge of addressing stigma is understanding, because stigma builds where there is not a clear evidence base, and there is no understanding of what is happening to an individual—we do not know whether it is one or many things. That is why medical research is essential. It is also why understanding how the condition changes day to day is important—as is the way the Government prepare and support individuals. The DWP assessments are a great example. The assessment system at the moment is built around a system that does not adequately recognise the day-to-day lived experiences of those with ME.

We can carry on the relentless fight that is needed against stigma, to encourage more research, if we keep talking about ME and remember that people who have it are not invisible. They have a voice and must be heard.

--- Later in debate ---

[Steve Brine]

That is so unlike the hon. Gentleman. Good clarification.

The stigma quite rightly has been mentioned by pretty much everyone who have spoken today. We recognise that people with ME have encountered significant stigma, in part due to the unfavourable media representations of the condition that not only go back to the 1980s but have continued in recent times. I have seen a clip of Ricky Gervais in one of his otherwise amusing stage shows, when he says of ME, “Yes, that’s the one where they say I don’t want to go to work today.” Ricky Gervais is a very talented comic, but given that he is quite active on Twitter, perhaps he could retract that and apologise to the ME community today. Perhaps he could put #ME so we can look out for it.

My right hon. Friend the Member for New Forest West (Sir Desmond Swayne) made a very good point about mental health; it is totally wrong and insulting to say it is all in the head, but it also goes against the grain of what we are talking about in modern-day healthcare: the parity between mental and physical health. There must be a parity, and to suggest that that somehow lessens it is wrong. His intervention was timely and good.

The physical impacts of the condition have an impact on mental health, as other hon. Members have said. I am also the Minister with responsibility for cancer, so I speak in lots of debates in Westminster Hall and we talk about the mental health impact of cancer—the hon. Member for Washington and Sunderland West (Mrs Hodgson) knows all about them. A recent example was when we talked about the mental impact of blood cancer. People with ME often report that the legitimacy of their symptoms has been questioned by family, friends, employers, healthcare professionals—yes—and society as a whole. Lest hon. Members did not understand it from my opening remarks, let me clear that Ministers—especially this one—are not among that group of people.

That stigma can and does play a part in the development of the co-morbid symptoms of depression and anxiety, particularly for young people—I will come on to them in a minute—who keenly feel the consequences of the resultant social isolation at that moment of their development. As we have heard, suicide is not unheard of. We know that those who experience stigma often also experience discrimination, which has a profound negative effect on their lives. That is unacceptable, so I welcome the debate as a forum to raise awareness of ME and talking about it. The hon. Member for Plymouth, Sutton and Devonport (Luke Pollard) mentioned that MND is being talked about, and he is absolutely right. He is a very good communicator, and I think this will probably be one of his next Facebook Live sessions.

[Luke Pollard]

indicated assent.

[Steve Brine]

He is nodding. It is important that we raise awareness and educate people, including me, about the condition and its impact on people’s lives.

I will now turn to the two issues that have primarily been debated today, research and treatment. On research, the Government invest more than £1.7 billion a year in health research via the National Institute for Health Research and the Medical Research Council through UK Research and Innovation. The NIHR and MRC welcome high-quality applications for research into all aspects of CFS and ME, which would certainly include the biomedical research that the hon. Member for Glasgow North West spoke about in her opening remarks.

Since 2011, the MRC has funded seven projects on CFS/ME totalling £2.62 million, and it is ready to support further applications of the highest scientific quality, which is required to make those scientific breakthroughs. My hon. Friend the Member for North West Norfolk (Sir Henry Bellingham) is no longer in his place, but he spoke about the Norwich Research Park—didn’t he push that a few times?—which sounds very promising. I look forward to hearing more about it, and I feel certain that he will tell me.

The MRC has had an open cross-board highlight notice on ME since 2003. It was updated in 2011 alongside a bespoke funding call in that year. ME research remains an area of high strategic importance for the MRC. Applications that focus on the underpinning mechanisms of ME are encouraged, with priority areas including immune dysregulation—[Interruption.] Sorry, I am distracted by someone shouting about stopping something outside—I think he is saying, “Stop ME!”. The priority areas include pain, improved sub-phenotyping and stratification of ME, and mechanisms of ME in children and young people.

A number of people mentioned the late Baroness Jowell. I was very privileged to meet her. I did so just the once, but I was left in no doubt about her resolve on the issue of brain tumours. Let me say in reference to her and to the research environment that, as my Parliamentary Private Secretary, my hon. Friend the Member for South Suffolk (James Cartlidge), reminded me, that journey started around the time of a Westminster Hall debate. Perhaps that is a good sign.

Our challenge with brain tumour research is the lack of high-quality research proposals that have come forward. The late Baroness Jowell was passionate about stimulating the research community to get that situation changed, and we have latched on to that. That is one of her great legacies. I would hazard a guess that her greatest legacy is yet to be reached, but that is one reason it is important to mention her today.

The NIHR has, since 2011, provided £3.37 million of funding for projects and training on ME. That might not be termed biomedical research, but as with other disorders, given that the cause and mechanisms of the condition are still poorly understood, it is important that we carry out both biomedical research, to further our understanding, and applied health research, to improve the treatment offered to people with ME now and to help to improve their symptoms and quality of life.

The NIHR and the MRC recognise that ME is a debilitating condition and are working with the UK CFS/ME Research Collaborative, which was mentioned towards the end of the debate, and with patient representatives on how best they can support a joined-up approach to encourage high-quality research into this complex disorder. I mentioned that Baroness Jowell is a good example of how to start such research. They hope to be able to update colleagues on those discussions by the end of the year, and I for one will look keenly for that update.

For Members who do not know about that important collaboration, it was set up in 2013 to promote high-quality basic and applied research into ME. The CMRC brings together researchers, major funders and charities, and provides them with a mechanism for working together in a co-ordinated and collaborative way, increasing awareness of ME in the research community—that is so important if we are going to stimulate applications—highlighting priorities for research funding and increasing such funding. Both the NIHR and the MRC sit as observers on the CMRC board.

Everyone who contributed to the debate spoke passionately, but the hon. Member for Ealing North spoke particularly passionately, and I liked his point about humanity. This is a matter of good Christian humanity in many ways.

The Royal College of General Practitioners oversees GP training in England. It provides an online course for GPs and other primary care practitioners that includes an overview of the presentation, diagnosis, assessment and ongoing management of ME. The course highlights common misconceptions about ME and considers the challenges that surround that complex condition for patients, carers and primary care professionals. It is produced as part of the METRIC study, which is funded by the NIHR.

Of course GPs can always know more and learn more, but let me speak up for them for a moment. They are called “general practitioners”. Be a GP for a day—it is incredibly difficult to know everything about everything and to be a master of all. General practice is, though, where most patients with ME are likely to be managed, certainly in the first instance. The condition is identified as a key area of clinical knowledge in the RCGP applied knowledge test content guide. The AKT is a summative assessment of the knowledge base that underpins general practice in England and a key part of GPs’ qualifying exams.

Although I understand hon. Members’ points about raising awareness among medical professionals, and as a result of the debate I will redouble my efforts to do that as part of my role as Minister for primary care, all GPs certainly should be aware of ME, and should maintain their clinical knowledge of it and other conditions, as part of their commitment to continuing professional development. Indeed, I have resolved—I have already sent a note to myself—to send a copy of the report of the debate to Professor Helen Stokes-Lampard, who currently leads the RCGP, and to ask for the college’s latest thinking about this subject.

Before any medical condition can begin to be treated, it must be diagnosed. That goes to the heart of our challenge. As the symptoms of ME often resemble those of many other debilitating illnesses—we heard about Lyme disease—there is no test with which to make an accurate diagnosis. ME, therefore, is not always easy to diagnose, to put it mildly. Diagnosis relies on clinical observation of symptoms by healthcare professionals. We understand that that can be frustrating, to put it mildly, for patients—and, it must be said, for their clinicians.

People with ME should be referred to a specialist service, where care should be based on their needs, on the type, complexity and severity of their symptoms, and on the presence of co-morbidities. That decision should be made jointly by the patient and their healthcare professionals. As the shadow Minister said, referral to specialist ME care should be offered within six months of presentation to people with milder symptoms, within three to four months of presentation to people with moderate symptoms, and immediately to people with severe symptoms. Clinicians are responsible for advising patients about available treatment options.

Of course I am aware that access to services for those with severe ME is a big and ongoing issue. Under the Health and Social Care Act 2012, the configuration of services is a matter for local NHS commissioners, who have to be best placed to deliver services for their area. A number of Members referred to the report of the chief medical officer’s independent working group on ME, which was published in 2002. Following that, a central investment programme of £8.5 million was established to address the service gaps across England—I am responsible for the NHS in England. That included the establishment of 13 centres of expertise across the country, 36 multidisciplinary community teams for adults and 11 specialist teams for children and young people, and facilitation of access to advice on clinical management for patients, families and health professionals.

Linked to that—the Department is, of course, now called the Department of Health and Social Care—the vast majority of people with severe ME and their families will come into contact with social care services at some point. The Care Act 2014 requires a local authority to carry out a needs assessment where an adult or carer appears to have care and support needs. The local authority must then decide whether the person has eligible needs by considering the outcomes they want to achieve, their needs, and how those impact on their overall wellbeing. Where a person is assessed as having eligible care and support needs, those must be met by their local authority.

Let me say some more about children and young people, who were mentioned by a number of Members. There is a powerful moment in “Unrest” where a young lady is celebrating her birthday. She says, “I remember my 16th birthday in this bed, and my 17th birthday, and my 18th birthday”—and she goes on through; I think she was celebrating her 22nd birthday in the film. Although access to services was raised, I know that access to education is also a huge issue for children and young people with ME.

All schools have a legal duty to make arrangements to support pupils with a medical condition in school. Guidance to schools states that they should put in place arrangements that show an understanding of how medical conditions affect a pupil’s ability to learn and give parents and young people confidence in the school’s ability to provide effective support for their condition. Children and young people with ME should have an individual healthcare plan, which should normally be drawn up in partnership with the school, healthcare professionals, parents and the young person, and should be tailored to their needs.

Schools and other services should work together to ensure that children and young people with ME receive an education that is flexible and appropriate. That could mean programmes of study that rely on part-time attendance, in combination with alternative provision or home schooling, which was mentioned. Consideration should also be given to how children and young people are integrated back into school after a period of absence, when they are feeling better and, hopefully, more able physically to cope.

A lot was said about NICE guidelines, which are clearly a sensitive topic and a source of much unhappiness among Members and the wider ME community. According to NICE guidelines, recommended treatments for ME include cognitive behavioural therapy and graded exercise therapy. I know that many patients disagree with those treatments, and we heard powerful testimony about that. The NICE guideline is clear that there is no one form of treatment to suit every patient; that the personal needs and preferences of the patient should be taken into account; that doctors should explain that no single strategy will be successful for all patients; and that, in common with all people receiving NHS care, ME patients have the right to refuse or withdraw from any part of their treatment that they do not agree with or they think is doing them harm.

As we heard, the NICE guideline is being updated—a jolly good job, too. NICE will look at the current evidence base, including the PACE trial, which has been debated at length in the House before. Of course, we welcome NICE’s decision to undertake a full review of ME guidelines. Many of the ME charities we have heard about today are registered to take part in the guideline development process, but NICE is the independent expert body responsible for developing robust, evidence-based guidance for the NHS to design services that are in line with the best available evidence, and no one should hide from the evidence. It would be inappropriate and wrong for Ministers to interfere with the process, but I feel sure that NICE will be listening to the debate and taking a keen interest in it.