Medical Cannabis under Prescription
Mike Penning Excerpts(4 years, 12 months ago)
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Sir Mike Penning (Hemel Hempstead) (Con)
I beg to move,
That this House reaffirms its welcome for the change in the law that allows access to medical cannabis under prescription, but notes that only a handful of prescriptions for whole-plant-extract medical cannabis have been issued on the NHS, which has left a significant number of patients, many of whom are children with intractable epilepsy, with no access to medical cannabis and experiencing severe distress; and calls on the Government immediately to act to ensure that medical cannabis is available to appropriate patients and in particular to children suffering severe intractable epilepsy, such as Alfie Dingley whose plight and campaign did so much to secure the change in the law.
It is a real privilege to stand here and represent families from across the country, alongside colleagues from across the House who I am sure will scamper into the Chamber in all haste when they realise how fast the previous business has been dealt with. This gives us a suitable amount of time—some five hours—in which to debate this really serious matter.
On 8 April, Mr Speaker granted me, with support from other colleagues across the House, an urgent question on the medical use of cannabis. This followed the removal of a young lady’s medical cannabis from her family’s possession as they came through customs at Southend airport in Essex. The young lady’s name was Teagan, and her family are ardent campaigners on this issue. They know, because they have been abroad to get medical cannabis oil for Teagan, that it has a really helpful effect on her.
What had an even more dramatic effect on Teagan’s family was that, perhaps not unexpectedly, Border Force confiscated the oil. I do not blame Border Force or the Home Office—we will go into the history of how we got to this position in a moment—who were doing their jobs However, after long conversations on the phone that evening and conversations with the Speaker, I was really pleased to be granted the urgent question.
The urgent question meant that the House could come together to ask why an oil that had been prescribed—admittedly it was prescribed abroad; nevertheless it was prescribed—should be taken from a young lady who desperately needed it because of the seizures that she suffered as a result of her epileptic condition.
The oil was taken away, and the family were promised, quite rightly, that it would be kept in a safe place and not damaged.
On the Saturday a week after the urgent question, the prescription was eventually accepted by the Department of Health and Social Care and the Home Office. I say “eventually” because there is such confusion surrounding this prescribed medical product. It is fascinating to me and even to those within the medical profession.
The first prescription was rejected, and Teagan was not allowed to have the oil back because the prescription did not mention the word “oil”. Even though the description of the product was completely accurate, it was rejected because it did not contain the word “oil”. A new prescription was issued that included the word “oil”, and the oil was released. Believe it or not, conversations then took place about who was going to pay for the transportation of that medical oil to Teagan.
Kevin Brennan (Cardiff West) (Lab)
I congratulate the right hon. Gentleman and my hon. Friend the Member for Gower (Tonia Antoniazzi) on the work they have done on behalf of the all-party parliamentary group on medical cannabis under prescription, and on behalf of my constituent Bailey Williams and his family. His mother has written to me about today’s debate, which unfortunately she cannot attend, to say that Bailey really needs urgent access to medical cannabis because of the continuing effect that his constant seizure activity is having on him. Does the right hon. Gentleman feel as frustrated as I do that, many months after the Government first indicated that this medicine could be prescribed, he is still having to speak about it today and I am once again having to raise Bailey’s case on the Floor of the House?
Sir Mike Penning
I thank the hon. Gentleman for his intervention. That is what we are here for. Yes, we are frustrated and angry, but actually we are here to do something very important. The only reason the Home Office deregulated this drug and we are in this position today is that this House came together and, more importantly, because the families came together. Those families have young children—I am a father myself, like lots of colleagues in the House—and we all came together to say that the situation was fundamentally wrong. We asked why medical cannabis was illegal if we knew that it helped our children.
Sir Desmond Swayne (New Forest West) (Con)
Am I right in my assessment that Ministers have bent over backwards and we have acted in the Chamber to ensure that these products are now available, but that the problem is in the medical profession? What more can we do now? I know that this is interfering in the medical profession, but, frankly, that is now becoming necessary.
Sir Mike Penning
My right hon. Friend is absolutely right. The Secretary of State for Health and Social Care stood at the Dispatch Box during the urgent question and laid out in plain English that it is not illegal for a suitably qualified person to prescribe these medical products, so how are we still here?
Frank Field
I thank the right hon. Gentleman very much. When we heard the Home Secretary speak about this initiative, we all thought that those whose children’s lives were being ruined by fits would from now on find solace. That was not the case for those whose children were beyond help at that stage, but we thought that it would apply in the future. Given that we want it, given that the Home Secretary wants it, given that the parents want it, and given that individual doctors want to prescribe it, some group at a regional level in the Department of Health and Social Care is clearly preventing prescriptions from being issued in a way in which they can be delivered.
Sir Mike Penning
I will touch on many of the right hon. Gentleman’s points later in my speech. The Home Secretary was ever so helpful, as was the Health Secretary, but the Prime Minister played an absolutely diamond role, and we took Alfie Dingley and Hannah Deacon to No. 10 with the petition. I know that we are not supposed to refer to the Gallery, but they are up there watching us, and they were scuttling up the stairs very quickly.
It is vital that we have a proper debate over the next five hours, without worries about time limits. I am not fussed about whether the Government lose their business later.
Sir Mike Penning
There is Government business later on, but I do not care about that. We need to try and flush out and identify the blockages, which is what the Health Secretary tried to do.
Norman Lamb
In response to another intervention, the right hon. Gentleman indicated that there is a degree of resistance within the NHS and among clinicians, but does he agree that this is about more than that? This is also about the Government’s regulatory framework, which is restricting access to this medication. Many people in acute pain are resorting to opioids, which are highly addictive and potentially fatal, while being unable legally to access cannabis, which can often ease their pain.
Sir Mike Penning
The right hon. Gentleman and I often debate health issues. We were both shadow Health Ministers at the same time, and we agree on most things, including on the prescribed medical use of cannabis. The other area to which he was alluding is not for this debate. It is not referred to in the motion. The reason we have managed to get such huge cross-party support and support from families around the country is that we have stuck to the specific issue of prescribed medical use without going into casual use.
Sir Mike Penning
If I can, I will make a bit of progress, because there is plenty of time for colleagues. I am really chuffed that the Backbench Business Committee gave us this opportunity. When has the Backbench Business Committee ever had five hours for a debate on a Monday afternoon? I am simply thrilled, and I intend to use as much of that time as possible. I got a little note from the Clerks saying, “You should speak for 12 to 15 minutes, Mr Penning”—yeah, in your dreams. [Laughter.]
There is a blockage in the NHS if someone cannot pay for the prescription. There are consultants both within the NHS and outside, but if someone can pay for it in the private sector, private prescriptions are being honoured. The product is available in this country, perfectly legally, to those who can afford it, and that sticks strongly in my throat.
At the conclusion of the urgent question, although it is not in Hansard, I clearly heard Mr Speaker tell the Secretary of State for Health and Social Care that, whatever happens, we will not leave it—he was referring to me. We will go on and on about this until we get justice for these young people.
Looking beyond the small cohort of desperately ill children, there are others in the country who would clearly benefit from medical cannabis. I am not a doctor, but hundreds and hundreds of families have come to ask me whether this means they can get some help. The MS Society has sent an excellent briefing to colleagues today, and the Brain Tumour Charity and many others have also provided briefings.
Constituents come to my surgery, and I tell them that we need to make sure that their specialists, the experts in their area, are saying that they need medicinal cannabis, and then we can fight their corner. We have such specialists in the sector now who are saying that children and young people with epilepsy—my constituent has just turned 18, so their mum will want me to talk about post-18, too—get a tangible benefit from treating their seizures with these prescriptions, prescribed by a suitable specialist.
We know exactly what are in those pharmaceuticals, yet we still have a crazy situation in which hospitals are telling parents that if they bring these products on to a ward when their child is ill, as part of their ongoing medication, social services will be called to look into what they are doing with their family—for a product prescribed by a consultant.
My constituent has just turned 18. When I wrote on behalf of the family to her GP and the clinical commissioning group, which was blocking the prescription, they said, “We are not interested in homeopathic products.” What on earth is going on inside the medical profession in this country? If they do not know what it is, they should go and ask someone before they write stupid letters back to people and break their hearts. I had to send the letter on.
We should look carefully at what we can do to help. It is not for any politician in this House who is not suitably qualified to say to anybody that they deserve to have this product. What we must do is break down the blockages—that is what the Secretary of State alluded to in his answer to the UQ—and find out the reason for them.
Charlie Elphicke (Dover) (Con)
My right hon. Friend and I share a passion for this subject. Does he agree that the absurdity lying at the heart of it is that heroin is legally prescribed as morphine, which has been well understood for many years, but that a medical prejudice kicks in when using cannabis for medical purposes? Does that not highlight that there is an inconsistency that needs to be addressed—and addressed quickly?
Sir Mike Penning
I completely agree with my hon. Friend. I have been referring to Teagan, and he is her MP. As he knows, she got her medication seven days late, and I am convinced that she would not have got it if we had not secured the urgent question, which is why such debates are important.
I used to be a Minister, and I always panicked about UQs. I always asked, “Why don’t we just do a statement? It is a damn sight easier, and we can control the agenda going forward.” The business managers did not always agree with me on that point.
I might be wrong, but as far as I am aware from our investigations the only NHS prescription that has been issued was through the Home Office. Alfie Dingley got his medication through the panel the Home Secretary set up with the expert group in the Home Office. As far as I am aware, since we changed the law in November no NHS prescription has been honoured. We have had trusts clearly threatening consultants not to do this and we have had their professional bodies do the same—I have seen some of the correspondence. As I alluded to earlier, families have been threatened with social services for bringing the product into the hospital where their child was being treated, even though this was a prescribed drug that is perfectly legal in this country today.
The real issue is: why can only those who have the money, those who have a donor and those who have crowdfunded, or, as in the case of my constituents, those to whom one of the manufacturers has given it for free—there is no way in the world they could afford this, and I thank the manufacturer for doing that, particularly for the family—get this? In the country that is so proud of the NHS, how on earth have we got into a situation where those who are poor do not get it?
Norman Lamb
I agree with the points the right hon. Gentleman is making, but the fact that the one prescription that has been issued has been through the Home Office raises an important point: the Home Office should have nothing to do with a health issue and this should be transferred, without delay, by the Government to the Department of Health and Social Care?
Sir Mike Penning
To be fair, it has been, and that was before we changed the law in November. The Home Office set up a panel while we looked at the changes of the law. This does not really matter, but a Health Minister is at the Dispatch Box today and a Health Secretary was there for the urgent question, so this is clearly sitting in that Department, but the connotations are still there in respect of, for instance, bringing this into the country—
Sir Mike Penning
I understand that point, but this drug has been moved out of its category into the Department of Health and Social Care and it can be prescribed. The issue is not prescription. Even though there were a limited amount of private prescriptions, they are being issued. I thank the consultants who have met me and my colleagues from across the House who have been campaigning on this. They are willing to do this. As far as I can work out, the blockage is that this was moved too fast to help the families whom we wanted to help; the Department of Health and Social Care and the Home Office were not ready.
That fascinates me, because four and a half years ago— it is that long since I have been a Minister—I stood in Westminster Hall as the Minister responsible for drug policy and said then that the Government were minded to allow the medical use of cannabis under prescription. Do they not read our debates? Do they not listen to what Ministers have to say? I do not know whether they thought I was having a flier and as a Minister of State was just doing this because I felt like it on that day. But the then Home Secretary is now the Prime Minister, and of course I did it with her permission.
Norman Lamb
What did Ministers do after the right hon. Gentleman made that point in Westminster Hall? He says that that was four years ago. Why did it take until last year for the Government to do anything?
Sir Mike Penning
You should have seen the reaction of some of my civil servants when I got back to the Department after making that comment in Westminster Hall! You would understand then why this went exactly nowhere, even though I pushed and cajoled. Sadly, or fortunately, I was moved to the Ministry of Defence after the 2017 election.
So why are we here today? Why have colleagues come into the Chamber, which was completely empty 10 or 15 minutes ago, when they could probably go, as I do not think there is going to be a vote? I say that because the Government have indicated to me that they have accepted the motion, which is votable, if we needed to do that. I have indicated to the Whips that if we needed to do this, I would push it to a vote. I do not think we need to, simply because, after listening to the debate, the Minister will realise, “Hey, we’ve got to move faster.”
Are we moving fast? No. Are we moving faster than we were? Yes, but more needs to be done. Why is that? Because young people are having massive seizures that are affecting their lives and those of their loved ones. They are affecting their families and their quality of life in this country today.
We can do something about that. We are on the journey of doing more about it, but I ask more as a father than as a politician: why do they have to find the money and go to Holland or to Canada? If they cannot find the money, they are not going to get it, unless someone donates it to them or they crowdfund. In the 21st century, why are we allowing these children to be given drugs that are not working and that were never designed for the use for which they are being given, while we have products out there that the pharmaceutical companies are producing, and we know exactly what is in them? It may not help—it may not stop those seizures—but for some people it clearly does. It is morally wrong for us to sit back and allow those children to suffer, and I have no intention of doing that.
Frank Field
On the unsatisfactory position that the right hon. Gentleman has described, with desperate families going to Holland to buy these drugs, could the Home Secretary not say today that he has instructed Border Force not to prevent anybody from bringing the drugs back into this country?
Sir Mike Penning
I forgot to do so earlier, so I pay tribute to the right hon. Gentleman. We both asked some questions in the House prior to the Home Secretary’s changing his decision, and the right hon. Gentleman kind of goaded me into some of the things that I wanted to do. The right hon. Gentleman and colleagues might remember that an important debate on Europe was due to take place on the Wednesday, when Alfie Dingley and his family were going to Holland, and on the Monday I said that the right hon. Gentleman and I would go to Holland with Alfie Dingley and bring it back, and if we were arrested, so be it. I think the Government might have lost that vote on the Wednesday had we not changed the law in time. I do not think that matters; what matters is that Alfie got his medication.
On the right hon. Gentleman’s specific point, the answer is yes, if it has been brought back with a prescription. We are still in Europe and, as I understand it, European prescriptions are as good as ours—I am told they are, but who knows?—and if they have been over and brought it back with the prescription, it is seriously wrong to take that product off a young child.
Jeff Smith
I am delighted to have given way to my hon. Friend to allow him to pay that tribute to our visitors today.
I have received two letters from a constituent of mine, who has asked me to keep his name confidential. I am happy to give it to the Minister on a confidential basis. My constituent first wrote to me on this issue last September, after the Government accepted the principle that we should be able to prescribe medical cannabis, because the aim had not been fulfilled. He wrote:
“I have a grandson who suffers from a severe form of Crohn’s disease. He is in constant pain and finds that his present regime of opiate-based pain killing has difficult side effects. He tells me that his consultant doctor is willing to prescribe the cannabis-based alternative as soon as it is permitted. My grandson has never obtained cannabis illegally and does not intend to do so.”
My constituent wrote again to me in April. Things had moved on, but this probably illustrates the problem. In the second letter, he wrote:
“The position in my family is now relatively fortunate. Left in limbo for a long time by the NHS, and enduring frequent nausea and serious debility, my grandson used his own initiative. He found a private doctor specialising in pain control, a highly respectable man, formerly an NHS consultant, who gave him a prescription for a cannabis product. This has been successful. His symptoms are under control, his general health and capacity to eat are much improved, and he is being phased back into his job, which he had been likely to lose. I am meeting the financial cost to the tune of £695 per month currently. By tightening my belt I can do it, at least for a reasonable time to come. I never spent money to better effect in my life, and I am so grateful for medical science. But some of the sufferers on the TV programme have no financial resources. And for an old Socialist like me it goes against the grain to use private medicine.”
Madam Deputy Speaker, you do not need to be an old socialist to think that this is an unacceptable situation.
Jeff Smith
The right hon. Gentleman, who set out the case very well, is certainly not an old socialist. As we heard from him, there are multiple examples of patients who want to access medical cannabis, and whose doctors want them to access it, but are not able to do so. These are patients who last year were given hope that their pain, anxiety and seizures would end, only to have their hopes dashed and frustrated.
Jeff Smith
My right hon. Friend makes an excellent point. He is absolutely right. I am not aware of any evidence of the product making a condition worse. People have been using cannabis for thousands of years. If these worries about side effects were really justified, I think we would probably have seen them by now.
Sir Mike Penning
The hon. Gentleman has touched on a very important point. Because we are talking about pharmaceutical prescription drugs, the risk has been relatively alleviated. There is evidence of people using cannabis in a casual way that does have an adverse neurological effect. That is why this whole debate and campaign had to be separated from that so that it is about prescribed use. There is a separate debate to do with casual use. He is absolutely right—people have used it for thousands of years. Some people think that is correct and other people do not. For me, it is about knowing exactly what is in the product that is being given to the patient.
Jeff Smith
The right hon. Gentleman is absolutely right. That points to the issue about where we get the product from. The problems, allegedly linked to increased episodes of psychosis, are from high-THC street cannabis, which is not what we mean when we talk about medical cannabis products. As I said, there are lots of different types of cannabis products. They are very often CBD-based, but when they contain THC—the psychoactive element—it is a much, much smaller amount than in street cannabis. It is like comparing apples and pears. He makes a really important point.
We need to look at how we can learn from evidence in countries such as the Netherlands, Germany and Canada, as well as countries that have successfully introduced medical cannabis regimes, such as Australia and Denmark. What work are the Government doing to learn from the experience of those jurisdictions? There are currently at least 138 medical cannabis trials worldwide. We need to take into account that global evidence.
I would like to ask the Minister a number of questions. Why can clinicians make individual decisions on certain conditions but not others? For example, clinicians can make individual decisions on a case-by-case basis on Crohn’s disease, which my constituent’s grandson suffers from, but not on some other conditions.
We need a scoping exercise to look at how we can enable patients to get this medicine now. There are estimated to be something like 3 million cannabis users in the UK, with around 1 million of those using it for medical purposes. Those figures may be high but, whichever figures we look at, there are hundreds of thousands of people using cannabis to alleviate pain or help with a medical condition. At the moment, they get their product from the street—from the illegal trade. That is not good for them or for society. That is the key point. People are already using cannabis for medical reasons and getting it from illegal suppliers.
Madam Deputy Speaker (Dame Eleanor Laing)
The hon. Gentleman made reference to the late Member for Newport West. The House will remember fondly that the late Paul Flynn raised this subject in the House persistently over many decades, and got very little support. I keep looking behind me, expecting to see him there in his usual place—
Madam Deputy Speaker
The right hon. Gentleman says Paul Flynn is watching us, and I have every confidence that he is. I say on behalf of the whole House that we remember him fondly.
John Howell
I thank the hon. Lady for her excellent intervention, and I agree with much of what she said.
One of the main barriers that I see is the simple question of who is allowed to prescribe. The General Medical Council holds a list—a specialist register—of specialist doctors who are allowed to prescribe. Why do we have a specialist list, and why can only those on that list prescribe? Is it because people are nervous about their careers or other things? Why do we limit the number of doctors who can prescribe in this way? I have read claims that something like 110 patients have been prescribed the medicine, but from what has been said in this debate, I understand that only one has received it.
Sir Mike Penning
My hon. Friend gives me a great opportunity to correct Hansard—I have received the message that there are two, both prior to the 1 November decision. In other words, the Home Office specialist team gave it to two, whereas none has had it since the Department of Health and Social Care took this over.
John Howell
My right hon. Friend makes a valid point. The question is: why have so few—as he says, only two—actually received their medicine? Why has nobody else received them?
John Howell
I will come to the point about training in a moment, if my hon. Friend will be patient, but he makes a valid point.
I appreciate that we have to go carefully, in view of the harm that the unrestricted use of cannabis might do, but the number of people who have received their drugs is a mere pinprick on the surface of those who need them. I am not surprised people go abroad to get their drugs, because it is the only source.
Sir Mike Penning
A person can only go abroad if someone is paying for it—if they have reserves or a benefactor, if Grandma or Grandad is paying. If they do not have those things and are relying on the NHS, nul points—they don’t get it.
John Howell
I accept that point. In cases of children who need cannabis oil, I am aware of it being crowdfunded, which can be a valuable way of proceeding, but it seems a complete nonsense in a country that is proud of its NHS that people should have to go into the public arena to crowdfund a drug.
I have some questions about this short list that the GMC maintains of doctors who can prescribe medical cannabis. How accessible are these doctors, and what is the waiting time to see one? These are practical barriers to people getting the drugs they need.
A young girl in my constituency—her name is not important—has intractable epilepsy and there is a great hope that medicinal cannabis would improve the quality of her life. Many women who suffer the sort of pain and discomfort she suffers during her menstrual cycle take birth control pills, which eases the pain considerably, but she cannot do that because it reduces the efficacy of her epilepsy medication and leads to a radical increase in the number of serious fits. For Hannah—that is her name—her epilepsy is life-threatening, as she is in a high-risk group of epilepsy sufferers who could experience sudden unexpected death in epilepsy syndrome, and we ought to think about how we can make it easier for her to obtain these drugs and so make her life easier. I mention that because to make these points we need to bring this debate back to examples of real constituents.
My second point is that raised by my hon. Friend the Member for Lichfield (Michael Fabricant) about the availability of guidance and training. In respect of both, there is a great lack of information, and it is not just us who lack information; so does the medical profession. We should do all we can to increase doctors’ knowledge and awareness so that, among other things, we can broaden out that list and GPs and family doctors can have the information they need to make decisions. I have no problem with this being a clinical decision rather than a political decision.
Tonia Antoniazzi
I completely agree. The families of children with intractable epilepsy are in exactly the same position, as are so many other people throughout the United Kingdom. My friend Chris is a very good example of how wrong it is that people with MS or epilepsy have no access to whole plant medical cannabis. As we know, it will never be a cure for everyone, but, as Chris told me yesterday, it provides the chance of a better quality of life. That is what people want. It is what the parents of children with intractable epilepsy want. They are at the end of the road. They have tried everything from the ketogenic diet to unlicensed drugs, which make the children unreceptive and do not improve their quality of life.
Sir Mike Penning
I pay tribute to my co-chair of the all-party parliamentary group: without her support, we would not be here today. I feel for her constituent as well as mine. They are asking us to help, and we are doing everything we possibly can, but we are not medics and we cannot prescribe. Doctors seem happy to sign off and prescribe off-label drugs for purposes that have absolutely nothing to do with what those drugs were licensed for, but they are not willing to license medical cannabis. Does the hon. Lady not agree that that is an imbalance?
Tonia Antoniazzi
I do agree. It just does not make sense, which is infuriating, because I like to apply sense and logic to most situations, and the current situation is not logical.
Not being able to access medical cannabis leads people such as Chris and the parents of children with epilepsy to consider alternative ways of accessing cannabis, which—as has already been pointed out—is fuelling a dangerous online trade in which, for all we know, they could be buying anything. That is dangerous and wrong. Clinicians to whom I have spoken often ask parents what they have given their children in addition to over-the-counter drugs. Access to CBD alone has great health benefits that are not recognised by many in the medical profession. The right hon. Member for Hemel Hempstead has referred to its being described as homeopathy. When I say that one of my interests lies in medical cannabis, there will always be someone—even a politician—who will make the pun about wacky baccy, and it is really not appropriate. ‘
There seems to be a theoretical concern about the exposure of children to THC, but that is about recreational use; it is not about medical cannabis. Discussions about the legalisation of cannabis for recreational use and about the rescheduling of cannabis for medical use under prescription must not be conflated in the House. Let me put the position into perspective. The law changed because of one boy, Alfie Dingley, and the campaign spearheaded by his mum, the fantastic Hannah Deacon, who is in the Visitors’ Gallery today.
Patrick Grady (Glasgow North) (SNP)
I congratulate the right hon. Member for Hemel Hempstead (Sir Mike Penning) and the hon. Member for Gower (Tonia Antoniazzi) on securing this debate, and I thank the Backbench Business Committee for managing to schedule it so that we have enough time for a reflective, open and consensual debate—[Interruption.] So far! I am really looking forward to hearing what the Minister has to say in response.
We are debating an issue whose time has come. The individual cases have come together into a campaign that shows where the consensus is beginning to lie. I want to reflect a bit on that, and to speak, as many others have done, about an individual constituency case. I also want to think a bit more about the consequences of the wider campaign.
At the beginning of the debate, some Members, including the right hon. Member for Hemel Hempstead and the hon. Member for Reigate (Crispin Blunt), talked about the growth of the campaign and of public awareness of this issue. Campaigns such as these can often start with what seem to be quite isolated cases. An individual comes to one of our surgeries and the Member then has the incentive to raise the issue here in the House, after which others join in, saying, “I’ve had that as well.” Then we get the urgent questions and the Back-Bench debates, and the issue becomes much more live and mainstream. Members of the public are encouraged to come forward to their MPs with their individual cases, and the broader public are encouraged to support the overall issues. We have seen this in a number of areas. I am reminded of the WASPI campaign—although that is a completely different situation—because of the way in which it snowballed as people came forward to their individual MPs with their local cases and it built into a positive campaign from there.
The policy environment on medicinal cannabis is ripe for change. We have heard today about the knowledge and experience in other countries as the different kinds of cannabis medicines have been rolled out effectively. In fact, we have heard about that happening here as well, because those people who can afford private prescriptions are feeling the benefit of these medicines. However, it is incredibly frustrating for those who, for whatever reason, cannot access the right kind of medicine privately. The whole point of the NHS is that treatment should be available free at the point of need, and that it should be blind to people’s individual financial circumstances. The progress that the Government have made has to a certain extent been welcome, but the hope that was provided when the reclassifications and the provision for prescriptions from individual doctors were announced has now been dashed.
Sir Mike Penning
In the spirit of this cross-party consensus, I say to the hon. Gentleman that this is not a dig. This matter is devolved in Scotland, Wales and Northern Ireland. These medicines have been prescribed privately in Northern Ireland. Progress was made there. Scotland could do this; we could do it; and Wales could do it. I know that discussions are going on within the Department, but we must not take this in isolation. This must happen across the United Kingdom. I passionately agree with devolution, but no child should suffer because one area is devolved and people are playing catch-up with the other parts of the United Kingdom.
James Cartlidge
My hon. Friend makes a good point. I would just be cautious about using the term “life-saving”, because this is about easing pain. These medicines are not cures; they relieve the pain of seizures. However, I understand my hon. Friend’s point, as we all did.
The meeting that I organised was instructive for me in many ways. Since then, I have obviously continued to correspond with my constituents to try to explain to them the powers that I have in this case and the next steps that they need to take. When this debate came up, they emailed to ask me to put one question to the Minister. Remember, they are not being prescribed THC-based compounds; they have been offered Epidiolex, which is a CBD-based medicine. They want me to ask whether any other children with epilepsy, or any other condition—of course, it is primarily complex epilepsy—have been prescribed THC-based medicines.
That information is in the public domain in the form of a written answer. As I understand it, 110 items—items, not people—of CBD-based medicine have been prescribed, along with 16 items of THC-based compounds, six of them on the NHS. That is an important point, as my constituents want to know whether others have been granted such medicines, and clearly they have. Where is the consistency? That is the confusion. Of course we cannot know the unique personal medical facts of each case, which must always be down to the clinicians, but we now know that THC-based solutions have been prescribed.
Sir Mike Penning
It is fantastic that we have the time to talk these things through. We do not have one NHS because, as my hon. Friend says, some people have been prescribed this. My constituent has been completely refused CBD, and the letter came back saying, “No, Mr Penning, we don’t give homeopathic therapies.”
The fear for those who use CBD is whether the European Commission will consider banning not the prescription but the public purchase of CBD. Apparently the Commission sees it as a novelty food, which we need to discuss because a lot of our constituents use non-THC products, which are perfectly legal, to ease their pain. My constituent has just texted me to say thank you because the medical company has given her some more oil, which the CCG has refused and thus her GP cannot write a prescription.
James Cartlidge
I am sure my right hon. Friend’s constituent is very pleased by that intervention. He underlines the key challenge, which is that these medicines are what is known as “artisanal”. They are unlicensed, and they are not standardised pharmaceutical medicines, which can be a problem for doctors who want to know their standard chemical make-up. Doctors feel they cannot entirely rely on these medicines. The nub of it is to what extent we in this place should be pressing those who have to make clinical decisions.
My hon. Friend the Member for Henley (John Howell) said that this has to be a clinical decision, and my hon. Friend the Member for Reigate (Crispin Blunt) made the brilliant point that, if not for us, we would not be in this position and what has been prescribed so far would not have been prescribed. Let us be honest about it: this has been the result of campaigning, which is why I congratulate all those who have campaigned.
Nevertheless, this ultimately has to be clinically based. We cannot have political prescribing. It may be that applying maximum pressure has resulted in some prescription decisions. I hope that is not the case but, in reality, it may have been. We must have a consistent, transparent system that we have faith in and that leads to clinical decisions delivering the best outcomes for our constituents.
Sir Mike Penning
That is exactly why NHS England is reviewing the blockages in the signing of prescriptions. The Minister can confirm this, but I understand that the interim report will come out by the end of this month, and I believe the full report will go to the Secretary of State by mid-June, which is very quick for the NHS.
There has to be a level playing field. It is not for us to tell the doctors but, if a suitably qualified doctor is prescribing it, what is the blockage for my hon. Friend’s constituent and for the rest of them?
James Cartlidge
That is what I have been trying to understand. If I were to hazard a guess, I think there has been institutional resistance to CBD in general, but particularly to THC. In a sense, we have helped to force an open-mindedness towards it. When people say there is no evidence, what they mean is that there is no evidence from standard clinical tests. The idea there is no evidence is not true, because the evidence is our constituents’ lives and what they are seeing every day. My constituents do not go to Holland, having crowdfunded all that money, to buy something that does not work. They are parents, and we must have faith in them—by the way, all the doctors put a lot of store in that—but nevertheless, the institutions whose guidance lays the foundations for medical decisions ultimately need clinical trial evidence for it to be sustainable, in addition to individual circumstances.
I welcome the Minister to her position, which she very much deserves. My appeal to her is that we put everything we possibly can into getting that empirical evidence and undertaking those trials so that we can say to our constituents that everything is being done to ensure that clinicians can make decisions with the greatest confidence and without the nervousness we have all encountered.
Finally, and this needs to be said, I was asked in my meeting, “You do realise we are being trolled?” We have had debates in this Chamber about the horrible abuse we receive—some of us, particularly female colleagues, have received obscene abuse—but members of the medical profession are now getting the same thing. I understand the frustration of a parent who has done everything they can to support their child and who feels that the system is not helping them. That is why we are having this debate, because we want them to be supported by the system, but there can be no justification for people in the medical profession being subjected to trolling and the sort of abuse I know they have received because they feel they have to make an objective decision. They have the best interests of the patient at heart, and I have faith in the medical profession. It is nervous because of the lack of evidence, so we need to move on with trials as quickly as possible. We need to be able to give our constituents confidence that the system is fair, transparent and consistent, and is not acting in an ad hoc fashion.
Stephen Twigg (Liverpool, West Derby) (Lab/Co-op)
It is a pleasure to follow the hon. Member for South Suffolk (James Cartlidge), who made a powerful and reflective speech. I particularly endorse what he says about the importance of having such evidence, a lot of which comes from the families themselves.
I join in congratulating the right hon. Member for Hemel Hempstead (Sir Mike Penning) and my hon. Friend the Member for Gower (Tonia Antoniazzi), the co-chairs of the all-party parliamentary group on medical cannabis under prescription, both on securing this important debate and on the leadership role they have played on a cross-party basis in putting this important question on the House’s agenda.
As many Members have said, hopes were raised last year when the Home Office did what it did, and I strongly support what my hon. Friend the Member for Manchester, Withington (Jeff Smith) said about the importance of achieving a bespoke solution for our country. In particular, I support what he said about learning from international evidence. That combination of listening to the families and the campaigners and learning from the evidence of other countries could assist us in achieving the urgency that we all want to see.
Sir Mike Penning
Every other country that has done this has done it in a bespoke way. The fear is that if we introduce a bespoke system for a product or drug, everybody else will jump on the bandwagon, but most countries in Europe have addressed this. It has to be bespoke, not least because cannabis was illegal as a schedule 1 drug in this country for so long, but the evidence is here in the mums and dads and the children.
The Parliamentary Under-Secretary of State for Health and Social Care (Seema Kennedy)
This has been a very moving and important debate. As I know from my own constituency, and as has been outlined with such passion by Members on both sides of the House, this matter leads to great distress for patients and their families. I recognise the deep frustration of families and patients, which has come across strongly this evening. All of us who are parents or who have cared for a loved one can empathise with them. I pay tribute to the hon. Member for Middlesbrough (Andy McDonald) and his wife Sally, who shared their experience with us. It is them and parents like them whom we are concentrating on this evening.
It would be remiss of me not to mention my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) and the hon. Member for Gower (Tonia Antoniazzi), all their work on the all-party group and their tenacity in keeping this issue on the agenda. Many points have been raised. Great frustration has been expressed and I have heard that. I will be speaking to the Secretary of State again and taking back all the messages to the officials, but I will try in my remarks to answer the points made.
In November last year, the law was changed to ensure that doctors on the specialist register of the General Medical Council can legally prescribe cannabis-based products for medicinal use in the UK. It is right that we put these decisions in the hands of clinicians because they are the ones with the best knowledge of all the treatments available for conditions in which they specialise. The Secretary of State and I have been clear that whether to prescribe must remain a clinical decision, to be made with patients and their families, taking into account the best available international clinical evidence—I want to reassure the House that we are in close contact with colleagues in other countries to ensure that we learn from their experiences—and the circumstances of each patient.
It is not for me as a politician to second-guess or pillory clinicians’ decisions. I was alarmed to hear my hon. Friend the Member for South Suffolk (James Cartlidge) say that doctors are being trolled for the decisions they are or are not making. They have the best interests of their patients at heart and their primary focus is to do no harm. But I recognise that we do not have the optimal system in place yet. It is undesirable that patients are travelling abroad. The Secretary of State and I are determined to do everything we can to ensure that patients can obtain medicines in this country if it is medically appropriate. There are already systems in place to do that and I want to do everything I can to understand why patients are not using those systems to access medicines here in the UK.
We want to continue to refine the system so that the demands of patients who want to try medicinal cannabis are balanced against other demands on NHS funding. Given the embryonic state of the evidence base on the effectiveness and cost-effectiveness of medicinal cannabis, that is not easy. However, we are working hard to ensure we get this right, because it is crucial. I have had many discussions about this with my hon. Friend the Member for Reigate (Crispin Blunt), who spoke with great passion. He mentioned the need for more evidence and the issue of growing a market. We will explore that with the Department for International Trade.
I want to pick up on a point that my hon. Friend the Member for Henley (John Howell) made about the number of prescriptions issued since November last year. Data show that, until the end of February, there had been six items issued in the community under NHS prescription. He thought there were none at all.
Sir Mike Penning
The evidence from the families and the APPG that I co-chair is that there have only been two. If the Minister knows of six, we would love to know not the individual cases but where the other four have come from. The families are confused because at the moment we only know of two.
Seema Kennedy
My information is that there are six and I will happily write to my right hon. Friend with more information.
As the House heard last month, the Secretary of State for Health and Social Care has met many of the families and patients who Members know through their work on the APPG or their constituencies. All of us could not help but be moved by these distressing cases and the continued efforts of those who support loved ones. The Secretary of State asked NHS England to conduct a process review to identify any inappropriate barriers to clinically appropriate prescribing. I am pleased to say that the review is under way, and NHS England is working with my right hon. Friend the Member for Hemel Hempstead, the all-party parliamentary group on medical cannabis under prescription and patient representative bodies to identify cases that might best illustrate the experience of a range of patients.
Sir Mike Penning
We have lots of time, but the Minister is being generous in giving way. Can she confirm when the interim report will be issued on the blockages and when the final report will be made to the Secretary of State? It was indicated to us at a meeting with NHS England only last week that there would be an interim report by the end of May and a report to the Secretary of State in June. Would the Minister like to confirm that?
Seema Kennedy
I will come on to timelines later in my remarks. NHS England is currently obtaining patient consent and scheduling the necessary interviews with clinicians, decision makers and their patients. The first interviews were held today.
I want to touch briefly on devolved matters. Health is a devolved matter, but officials across the UK have been working closely on the development of this policy. The law is exactly the same in all four countries of the UK and only funding is devolved. Members have said that clinicians might be nervous about prescription and that we need to improve training. I will talk about this later, but the training package that has been commissioned from Health Education England will be made available across the UK.
Sir Mike Penning
Not only was I enormously proud when I went before the Backbench Business Committee to ask for this debate last Tuesday, but I was a bit shocked to get the debate this afternoon—at least we have not had to go home early. We have had an absolutely brilliant debate.
To be honest with the Minister, I am not sure how far this has taken us. Fundamentally, I have an issue with the fact that there are families who, through crowdfunding, or however they fund it—I understand that some parents have had to remortgage—are getting this drug for their children perfectly legally, and qualified consultants and specialists are issuing prescriptions on the NHS, but they are not being honoured. That is something that the Department of Health and Social Care is wholly responsible for. I fully accept that there are other issues to do with the Home Office.
Many people have been marched up to the top of the hill. I accept that for many years, when Paul Flynn was campaigning on this and a Government of a different colour were in office, it did not happen because it was in the “too difficult” pile called schedule 1. We are not in that position now; we are in a position where this House—we have now debated this issue for four and a half hours—can tell the country and the Government that what is happening now, with people who can afford it getting this medicine and those who cannot afford it not getting it, has to stop. This Government have to stop that.
I know how difficult it is. I was the Home Office Minister responsible when this was discussed. I was the Minister who stood at the Dispatch Box. I know the blockages. I have sat with my APPG co-chair, the hon. Member for Gower (Tonia Antoniazzi), and the NHS chief pharmacist. We know that we need to unblock this. We need to believe that the NHS, free at the point of delivery, will deliver for these young families, and that the cheque book is not going to win.
I will raise money and crowdfund, because I will do anything I possibly can to help, but we should not have to do that. The medical evidence is there from other countries. We are going to have to make exceptions, as has been said, because this situation is different. We cannot put one of these children on a placebo, because we know that it will make them really ill when they withdraw from what they have already been given.
The children who have been given this product, and some adults, as in my constituent’s case, need to have confidence going forward. They do not need to beg, borrow and steal to get their lives back on track—and they will not be put back on track fully, because this is not a cure, it just eliminates some symptoms for some people with some conditions. We really do not know the full position yet because, as the Minister has said, we have to do more work. However, in quite a lot of specific cases of paediatric epilepsy with seizures, it appears that cannabis oil makes a difference to the quality of people’s lives. We were sent here not to chat for the sake of it, but to make a difference to people’s lives, and I hope that is exactly what the Minister will do.
Finally, I will clearly not get another urgent question for a while, but Mr Speaker said to the Secretary of State for Health and Social Care that we will persist. He was referring to me, but I say that on behalf of the all-party group, which now has over 100 members. This is what this House is good at, and if we get it right we are very good at it. This has been an excellent debate.
Question put and agreed to.
Resolved,
That this House reaffirms its welcome for the change in the law that allows access to medical cannabis under prescription, but notes that only a handful of prescriptions for whole-plant-extract medical cannabis have been issued on the NHS, which has left a significant number of patients, many of whom are children with intractable epilepsy, with no access to medical cannabis and experiencing severe distress; and calls on the Government immediately to act to ensure that medical cannabis is available to appropriate patients and in particular to children suffering severe intractable epilepsy, such as Alfie Dingley whose plight and campaign did so much to secure the change in the law.
Hormone Pregnancy Tests
Mike Penning Excerpts(5 years ago)
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Sir Mike Penning (Hemel Hempstead) (Con)
It is a pleasure to be involved in this debate, to be part of one of the largest all-party parliamentary groups in the House, and to look after my constituents and speak for them and the others who have been so dramatically affected. They trusted the NHS and the drug company and so thought that the drug they were taking was safe. As was suggested, these ladies went to their GP surgery perhaps because they had missed their period or had some of the other symptoms of pregnancy. It was such an important time in their lives. Often the GP just opened a drawer, gave them the tablets and said, “This will tell you whether you are pregnant or not.” There were no pamphlets and no advice, even though the risks were known to nearly everyone, apart from those ladies who took those tablets.
In this excellent debate, we have touched on a lot of the science. I am not a scientist or a lawyer; I am just a dad who is trying to help out some constituents in this area and as part of the group. In the debate that followed the publication of this so-called independent review, I said that it was a whitewash, but it was not; it was a cover-up, and we have to discover what is being covered up. Is it the legal side of the NHS giving a drug to a woman on its premises when it knew there was not only a risk, but an effect? Is it the drug company having undue influence on the report, the Medicines and Healthcare products Regulatory Agency, the Department of Health and Social Care, or a bit of everything?
I say to the Minister that this is not about this Government, but Governments. The issue was being discussed when I was the shadow public health Minister, not least by thalidomide campaigners. They were supportive of this campaign, and they had to rely extensively on evidence that was there, but that the Government and the drug companies had ignored over the years.
Hannah Bardell (Livingston) (SNP)
Is it not the case that we do not need to be lawyers or medical experts to realise that a drug that is 40 times the strength of the contraceptive pill—it was being given in such countries as Germany as an abortive—would surely have profound impacts on unborn foetuses, or children who were born after their mothers had taken Primodos?
Sir Mike Penning
No one in this room or anyone listening to this debate could disagree with that, unless they were a lawyer working for the drug company, the Department of Health and Social Care, or perhaps both.
Believe it or not, Mr Hollobone, 70% of me, you and anyone else in the room is the same as a zebrafish. I swim really well, but I did not realise that until this morning. We chuckle, but the point is that the effects of an experiment on zebrafish will be similar to those on a human being. There are many studies, but the link is important. Professor Neil Vargesson’s report in 2018 supported Professor Heneghan’s report. What does that mean? We all know about the disgrace of thalidomide. Through experimentation on zebrafish, it was proven that thalidomide damaged children. We do not want to experiment on humans. It appears that that is exactly what has gone on here. It is obvious that the mechanism of the action of thalidomide is the same as that shown by the Primodos tests. Everybody can read the technical stuff. There was an effect on zebrafish, who share 70% of their genes with humans. Does that mean it could have had an effect on humans? Of course it does; it is not rocket science.
Gordon Marsden
The right hon. Gentleman is taking us through the history. Does he not agree with me that it is extraordinary? We need to remember the chronology. The thalidomide episode took place in the 1960s and was exposed by The Sunday Times and Harold Evans in a great step forward, but the drugs continued to be supplied afterwards. Even now, 40 years later, there is, in the statement of Lord O’Shaughnessy, doubt about whether such things should still be used. We should surely say that they should not be used.
Sir Mike Penning
I cannot understand how a drug company, now owned by Bayer, could know what was going on and continue to supply the drug in an underhand way to GPs. As a father—as a human being—I simply do not understand it. What on earth was going on? The MHRA, which gave evidence to us, was in complete denial. We did not ask for a cause. I was lucky enough to be a Minister in seven Departments. If I had said, “This is the review that you are going to do, and these are your terms of reference,” and those terms of reference were changed by the review group without my permission, I would have smelled a rat. I would have thought something was going wrong.
We can go through all the science, which cannot be denied. I do not blame any Minister—I can feel the special advisers’ eyes on my back—but something went dramatically wrong, and it has been covered up by several Governments. That must stop now. If compensation has to be paid, fine. Most of the families simply want an apology. Why is there no apology? Because there would then be the threat of legal action. Mistakes happen. When we make mistakes, we should admit it, no matter what Government are in power. We should sort it. We did that over Hillsborough when I was a Minister in the Home Office. It was a really difficult decision to make, but we made it, and the right conclusion was reached. That should be the case in this instance.
Mr Philip Hollobone (in the Chair)
I am afraid I will have to impose a five-minute limit on speeches, or we will run out of time.
Brendan O'Hara (Argyll and Bute) (SNP)
It is a pleasure to serve under your chairmanship, Mr Hollobone. I add my thanks to the hon. Member for Bolton South East (Yasmin Qureshi) for securing this hugely important debate. I congratulate her not only on winning this debate, but on the way in which she forensically exposed the failings of the expert working group—how it changed the terms of reference of the inquiry; its failure to report properly, if at all, on its meta-analysis findings; and the serious questions about the independence and impartiality of the group. She finished by rightly describing the issue as the biggest legal and medical cover-up of the 20th century, but that cover-up has individual victims.
I have met Wendy Brown, a constituent from the Isle of Mull, on numerous occasions. She knows that her disability was brought on by her mother’s use of Primodos when pregnant. Wendy has been a formidable campaigner for the victims of Primodos over the years, and last week she wrote to me, saying:
“My hands and both feet are deformed, which was very hard as a child due to the constant bullying. I also had damage to my neck at birth and was baptised at home as I wasn’t expected to live. The older I am getting the more...pain I am in, especially in my feet which can really wear me down, as no matter what shoes I get they are always painful. I am now getting a very painful wrist, which is due to the way I have held my hand in order to conceal it because it has unnatural motion. This is a growing concern for me because...I work in the Post Office in Tobermory and am not sure how much longer I could keep going.”
That is the day-to-day reality of people living with the effect of Primodos.
Wendy and other members of the campaign group rightly demand justice. We owe it to Wendy and all the other victims never to abandon them in their fight for justice. It is scandalous that the people whose lives have been so badly affected and who, day in and day out, have to live with the physical, social, emotional and psychological pain are being denied natural justice. They will continue to be denied natural justice as long as the United Kingdom’s medical establishment continues to deny the link between hormone pregnancy tests and serious foetal abnormalities.
If justice is to be seen to be done, surely it is time for a statutory inquiry, similar to that for the contaminated blood scandal, in which every single piece of evidence is examined forensically and transparently. If the Government are so sure of their case, they have nothing to fear from such an inquiry. At the very least, it would restore public trust in a system in which it is lacking right now.
Sir Mike Penning
The key is for evidence sessions to happen under oath. That is what we called for in the House, and what should happen now.
Brendan O'Hara
I wholeheartedly agree; they have to be under oath. Justice would also be served if the Secretary of State were to appear before the Health and Social Care Committee to answer detailed questions about the way the inquiry was conducted, and to explain and defend its findings.
I sincerely hope that the Government are not simply playing for time with this scandal, hoping that in time it will go away. Thankfully, there are people in this House, such as the hon. Member for Bolton South East, the right hon. Member for Hemel Hempstead (Sir Mike Penning), my hon. Friend the Member for Livingston (Hannah Bardell), and many others in the all-party parliamentary group on hormone pregnancy tests, who will not allow that to happen.
Finally, I put on the record my thanks to the members of the APPG for their work to continue to shine a light where some vested interests would rather one not be shone, and for their tireless work in advocating strongly for justice for the victims of Primodos and other hormone pregnancy tests.
Jackie Doyle-Price
I am not satisfied that that is actually what happened. When we receive drafts of reports that are circulated to committees, they often go through amendment.
Let me continue going through the chronology of events. As I said, the evidence did not support a causal association, nor did it disprove one. We will of course continue to review evidence as it arises.
Sir Mike Penning
I think this is a really fundamental point. I apologise if it seems like I am going to give the Minister a hard time, but I am. They were not asked to look for a causal link; they were asked to look for an association, and we have now seen evidence that they knew it was there. I know what happens when the notes are written for the Minister. They were not asked to look for a causal link, but for an association. They decided among themselves to change what they were supposed to look at, which is why they came out with the results that they did. That is a really fundamental point.
Jackie Doyle-Price
I hear what my right hon. Friend says. There has to be some element of cause, otherwise there is no scientific basis for a judgment. I will have to agree to disagree with him on that point.
Access to Medical Cannabis
Mike Penning Excerpts(5 years, 1 month ago)
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Sir Mike Penning (Hemel Hempstead) (Con)
(Urgent Question): To ask the Secretary of State for Health and Social Care if he will make a statement on the return of medical cannabis that was seized from Emma Appleby at Southend airport on Saturday 6 April and which is needed to treat her very ill daughter Teagan’s extreme epilepsy, and to take steps to make sure that medical cannabis is available for prescription around this great country.
The Secretary of State for Health and Social Care (Matt Hancock)
My sympathies go out to the patients and their families who are desperately seeking to alleviate their symptoms with medicinal cannabis. We are working hard to get the right approach. The law was changed on 1 November last year to ensure that it is now legal for doctors on the specialist register of the General Medical Council to prescribe cannabis-based products for medicinal use in the UK.
Whether to prescribe must remain a clinical decision to be made with the patients and their families, taking into account the best available international clinical evidence and the circumstances of each individual patient. Indeed, prescriptions have been written for the products that the family attempted to bring into the country and these have been supplied to patients. Without clinical authorisation, it is of course not possible to import controlled drugs, which is why the products were seized by Border Force on Saturday. However, we have made available the opportunity for a second opinion and the products have been held but not destroyed, as would normally be the case.
In relation to childhood epilepsy, the British Paediatric Neurology Association has issued interim clinical guidance. NHS England and the chief medical officer have made it clear that cannabis-based products can be prescribed for medicinal use in appropriate cases, but it must be for doctors to make clinical decisions in the best interest of patients, to balance the risks and benefits of any proposed treatment—including cannabis-based products—and to make a decision with patients and their families on whether or not to prescribe.
To date, research has centred on two major cannabinoids, tetrahydrocannabinol and cannabidiol. There is evidence that CBD may be beneficial in the treatment of intractable epilepsy, and over 80 children have already been supplied with CBD products in the UK on the basis of a specialist doctor’s prescription. I entirely understand how important this issue is to patients and I have met and listened to families. I know just how frustrated they are. Therefore, after meeting parents, I have taken the following actions.
First, I have asked NHS England rapidly to initiate a process evaluation to address barriers to clinically appropriate prescribing. Secondly, to improve the evidence base and to get medicinal cannabis to patients in need, I have asked the National Institute for Health Research and the industry to take action to produce that evidence in a form that will support decisions about public funding. The NIHR has issued two calls for research proposals on medicinal cannabis and I look forward to the responses to those consultations. That is in addition to the training package being developed by Health Education England to provide support to clinicians to enable them to make the best decisions with their patients.
This is a very difficult area, with some heart-rending cases. I look forward to working with all Members of this House to ensure that patients get the best possible care.
Sir Mike Penning
I thank you for granting this urgent question, Mr Speaker, on behalf of constituents around the country who need help from medical- prescribed cannabis, and I thank the Secretary of State for coming to meet the families and their loved ones who feel that medical cannabis on prescription may help.
Some of these young children—though we are not talking only about children—have 300 seizures a day. They are given drugs that do not seem to work at all. There is not a cure, but these medical oils can and often do reduce the number of seizures. Many colleagues in the House will know of the case of Alfie Dingley—the only young boy that has an NHS prescription for the medical use of cannabis oil. He is now a relatively naughty boy. He has learned to ride a bike. His sister has a brother she has never really experienced before.
This is not a cure, but these parents are absolutely desperate. When the Government did the right thing and changed the law, they thought the situation was going to get better. In my capacity as joint chair of the all-party parliamentary group on medical cannabis under prescription, I warned them that this was just the start of the journey, and that it would be a long one.
Anyone who saw the footage from Southend airport at the weekend—any father, any parent, anyone who has a loved one in their family who suffers—would understand what that family were trying to do. Cannabis had been prescribed by a consultant abroad because it could not be obtained in this country. Many families are relying on charity to raise the money—in some cases, £1,500 a month—to obtain it on prescription. As the Secretary of State knows, prescriptions are being issued by the relevant experts, but the clinical commissioning groups and the trusts are refusing to honour those prescriptions. It is a disgrace that that should happen in this country, and we should all be ashamed.
I welcome the trials and I welcome the review, but, sadly, people need these medicines now. Can we unlock the door? The Border Force staff at Southend airport were very polite and very helpful. They thought they were doing their duty. We should do our duty, and get that medical cannabis back to Teagan.
Matt Hancock
I pay tribute to my right hon. Friend and the all-party parliamentary group for their work in bringing this issue to the attention of the House and the country, and in supporting the parents involved. My right hon. Friend has been characteristically emphatic and reasonable in providing that support, and I entirely understand his concern. Meeting some of the parents as part of the APPG delegation was a very emotional experience.
Of course the Border Force staff were doing the right thing—and I am glad that they were doing it in a reasonable way—according to the existing rules, under which if a controlled drug is to be imported it needs a licence, and the import of an unlicensed controlled drug therefore requires a prescription from a specialist doctor. There are just over 95,000 registered specialist doctors in the UK. Any one of them who has the relevant experience can prescribe the drug, and it will be then allowed in. That can happen now. The guidance is not a barrier, and it is not a barrier to prescription. However, it is clear to me that this process is not working. I have therefore initiated a process evaluation, which is NHS language for looking at exactly why it is not working and what we need to do about it.
Acute NHS Care: South-west Hertfordshire
Mike Penning Excerpts(5 years, 2 months ago)
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Sir Mike Penning (Hemel Hempstead) (Con)
I beg to move,
That this House has considered acute NHS care in South West Herts.
It is a pleasure to serve under your chairmanship once again, Sir David. I start by saying that none of my comments about the health provision that allegedly looks after my constituents or about the West Hertfordshire Hospitals NHS Trust are, in any shape or form, about the frontline staff. The doctors, the nurses, the porters and the cleaners are fantastic. However, as I said the other day in a letter to Mr Stevens, the chief executive of NHS England, frankly we have absolutely no confidence in the management of the clinical commissioning group for West Hertfordshire Hospitals NHS Trust.
That lack of confidence that we are being represented and looked after in the best possible way has united the community over many years. It is not new. We have been let down time and again. Unlike a certain other subject that is occupying a lot of our time at the moment, there is no political or community division in west Hertfordshire about what we need from hospital acute provision in our part of the world. I will not go on about the other problems we have with health provision, but I have called the debate today—indeed, I was asked to do so by the community—to discuss how we can trust what is going on in our area.
A package is being put together that is convenient for West Hertfordshire Hospitals NHS Trust and it appears that the CCG and, I am sad to say, NHS Improvement and NHS England are going along with it. To put it in context for the Minister, we used to have acute hospitals in St Albans, in Hemel Hempstead and in Watford. Years ago, there was an evaluation and the decision was taken to close the acute facilities at St Albans. We were told not to worry, as Hemel was very close and would continue to have its acute provision, and there was a minor injuries-type facility in St Albans for elective surgery. After another consultation called “Investing In Your Health”, all the promises that had been made went out of the window and the acute services in Hemel were closed. As a sop, we were given a 24-hour urgent treatment centre.
Guess what? The urgent treatment centre is now not open for 24 hours a day and has a completely different name. Is it open at night? No, it is not. Where does everybody have to go? Even though Hemel is the largest town in Hertfordshire, we go to Watford. Watford General Hospital is a Victorian building next to the football stadium, in the heart of Watford, which is very densely populated. Promises were made about how quickly the ambulances could get there and how good it would be. They have completely gone out of the window, particularly when Watford football club is playing at home. Even though I am not a Watford supporter, I do not want to criticise the football club in any way. Watford football club is there, and has been for a long time.
Now we are looking to the future, not so much for my generation but for the younger generation in this massively growing area of the country. What is the future of the acute provision and hospital provision in my constituency? Historically, West Hertfordshire Hospitals NHS Trust is a small trust that has not been well managed. I have lost count of the number of chief executives it has had during the time I have been MP for Hemel Hempstead. They come and go repeatedly. What always happens—every time—is that the trust gets into deficit, and it is then bailed out in some way. That happened when there were primary care trusts, and now it is being done with the clinical commissioning groups. The trust is in deficit and failing. I do not know how it managed to get something positive into the newspaper the other day, when yet again it is failing in four out of five categories.
That means my constituents are at risk. We rely on the CCG and the trust. I will come on to our involvement in that process in a second, but it appears that as an elected Member of Parliament I have absolutely no influence at all on the CCG’s decisions, West Hertfordshire Hospitals NHS Trust decisions or decisions about any other NHS provision in my area. Joe Public does not understand that there are a myriad pillars and silos inside the NHS. The public just sees the NHS, which people are rightly massively proud of; we all are, including me, and it is fantastic that we are putting more money into it. However, we have got more managers, finance directors and heads of nursing. Why on earth have we got all these people divided up inside the NHS? That is an important point I will come on to.
Part of the appraisals and discussions for the strategic outline case—the Minister will know what I mean by a SOC—was about making decisions on what acute hospital provision should be provided in my constituency. I went with constituents to see Mr Mackey, the head of NHS Improvement. I said to him, “What are the criteria here? Tell me, face to face, what are the criteria for the decision that the West Herts hospital trust is going to make about the future?” He said, quite categorically, that fundamentally different options must be put to us. I asked, “Including a greenfield site?” We have greenfield sites available. He said yes. I received a letter of confirmation that that was a requirement of any SOC that was put forward.
Moving forward to where we are now, we apparently cannot have a new greenfield hospital. Why? That is the question that every one of my constituents asks. It would not necessarily be in the middle of Hemel, St Albans or Watford, but somewhere where there is decent access and transport links for the whole community. We cannot have that. Why not? We are not allowed to borrow more than our income. Because we are a very small trust, the income happens to be £350 million. We cannot borrow more than that. Why? Why do my constituents suffer because we have a small, inefficient, badly managed acute trust?
If we amalgamated with another trust, the income stream would probably be about £500 million, or we could amalgamate with another acute trust and double the income to £700 million. All of a sudden, we get somewhere near the fictitious figure of £750 million, which keeps coming up for how much it would cost to build a new acute hospital. The figure of £750 million is why the trust is ruling out new build at the moment. I am not aware of any new hospitals in this country—leaving aside private finance initiative problems that we had in the past under the previous Administration—that cost £750 million. Interestingly, one of my constituents recently emailed me about the new hospital in Birmingham, which was being built by Carillion—we all know about that problem—that is costing £300 to £350 million. The new hospital in Liverpool is costing about £350 million. These are brand new hospitals, which is exactly what I am asking for and certainly what my constituents are united in wanting.
Where has the figure of £750 million come from? It is being used as part of a narrative to block any new acute hospital in my constituency, which would also look after people in St Albans and Watford. In my area, we seem to be fixated on the idea that the only way to use that £350 million is, believe it or not, to plough it into the Victorian hospital in middle of Watford. There are supposed to be evaluation panels, with the community engaged.
The community evaluation panel sat, and some of the members said, “Could we not have on the list a new hospital on a greenfield site?” There was no request for a show of hands, or vote. It just went forward; but it appears it has been completely ignored. The boards of both the West Hertfordshire hospitals trust and the CCG have disregarded it. It is all too expensive. We know, however, that it is not too expensive. Other parts of the country have an open mind, not a closed mind. They are not the same people who closed our hospitals in the past, making the same decisions on the future of Watford hospital.
I have concerns for the people of Watford—the patients of Watford hospital—and the staff. I am concerned about stripping out and fundamentally refurbishing what is a predominantly Victorian hospital, which was massively refurbished in the 1960s and 1970s. How can a full acute hospital continue to operate while that is going on—with all the risks? I have recently written—my old ministerial role was in the relevant Department—to the head of the Health and Safety Executive, because we know there is asbestos in the building. It is fundamentally dangerous, and it is not just because of asbestos, although that is the most prominent issue, and something that can have a massive effect. A tiny fibre in the lung is a death sentence. We know it is there, but we do not understand why the figure of £750 million has been used, and why the figure of £350 million is trapping my constituents in a certain quality of care, simply because we happen to be small and badly managed—not just by the present management but over many years.
Why are we being penalised? That is how we feel, as a community, across political divides—across everything. Labour were massively involved with the problem long before we took over in Government. Why does not NHS England say: “This trust is failing again. It is not big enough. It cannot cope. Let us sort it, management-wise, and bring trusts together.” Then we would go over the £350 million income stream figure, up into the £500 millions. Strangely, £500 million was the figure for what has just been built in Leeds. It seems strange that for Hertfordshire’s largest town, and one of its most historic towns, St Albans, which have massively growing populations, Watford is the option. I do not want to take anything away from Watford until there is a new build. I do not want to take anything from it that will undermine what it has—unlike what happened to us. However, perhaps the Minister would like to come to Watford when Watford football club is playing at home—or even just during the rush hour. He will have a very different experience coming from Hemel or St Albans from the one he would have coming from any other part of Hertfordshire. It is chock-a-block.
I want to touch on a final thing before I hand over to the Minister, because I want him to have time to respond. I have already asked him not just to read out what has come from the trust. I know, having been a Minister, exactly what happens. An MP asks for a debate, the Department writes to the CCG, the CCG speaks to West Herts, and the speech is halfway written before the Minister has even got to Westminster. I ask him please to listen. We are passionate people and are not going to give up. Some people in the campaign group for the new hospital have been working on it year after year. I want to pay tribute to Zena Bullimore, who sadly passed away, and who was chairman of the hospital campaign, and to Edie and Ron Glatter—Professor Glatter. Even though they have been retired for some time, they are a driving force behind the campaign that I was part of long before I was elected. That is how far we go back.
I have some anecdotal evidence to show how wrong it is even to contemplate going further with Watford, instead of getting a hospital out of Watford in a suitable place. One of my constituents had a heart attack and the ambulance arrived in good time. The paramedics did a wonderful job and she was taken to Watford. The ambulance was turned away by the police from the fastest route to accident and emergency. The police had a cordon up so that the fans could use the streets, so it had to go another way, at which stage the non-local ambulance driver got lost. I went to see the officer in charge of the football match and said, “Did you turn the blue light ambulance away?” He said, “I can’t quite—”. I said, “Let’s do another one. Would you have turned away the blue light ambulance that was trying to get to the A&E because you had a cordon up?” He said, “Yes, I would.” I said to him, “If one of your officers had been assaulted and stabbed, would you have let the blue light ambulance in to pick him up?” “Yes, of course I would.” What is the difference between my constituents and the police? I want the police protected, and he would have been absolutely right to let the blue light in. However, the Department and NHS England seem to have tunnel vision about the situation.
I had a response in the last couple of days to a letter I sent to NHS Improvement—to Mr Stevens, actually—saying, “Would you please analyse this very in-depth document that goes into five pages, and give us your opinions?” I got, apart from the signature, one piece of A4 back, which in my opinion was written by the West Hertfordshire hospital trust. If it did not write it, it contains all the same language—probably the same language that is in the Minister’s notes. We have to open up to the fact that there must be accountability in the NHS. It is right that Ministers do not these days make decisions in the way they used to, but things have gone too far. There are people running CCGs who are not qualified to do so. I do not think that a GP is highly qualified to chair and run such a trust.
My acute trust has to make a fundamentally important decision, based on fact, but it is ignoring fact—not just public opinion or “This is the best place for it”, but fact. They keep going on about “You can’t afford it. It will be over £350 million. It will cost £750 million.” Frankly that is a pack of lies and we need to wake up. As I said the other day among colleagues, “Wake up and smell the coffee.” The public will not put up with a second-rate management system in the NHS. It is affecting my constituents—and I class myself as a member of the public. I live in the middle of the town. I am not going to put up with a second-rate system of management, and incompetence in running a trust.
I shall probably ask to intervene on the Minister during his speech.
The Minister for Health (Stephen Hammond)
It is a pleasure to serve under your chairmanship, Sir David, and to respond to my right hon. Friend. I want to say at the outset that one thing we absolutely agree on is what he said in his opening remarks. He expressed, in bringing forward this important matter for debate on behalf of his constituents, recognition of and admiration for the frontline staff. Even though I do not know the frontline staff in his area, I know from my visits in my short time as Minister and from my constituency experience that the professional care they deliver is admirable and extraordinary. We should never forget the effort they put in, and my right hon. Friend is right to acknowledge that.
Before I address specifics, and before what I suspect will be an iterative debate, I want to deal with two fundamental points, which I know my right hon. Friend knows, but are worth putting on the record. First, any service change in the NHS must clearly be based on clear evidence. Secondly, before any substantive change is made, patients and the public should be consulted. My right hon. Friend raised two interesting subjects on which we could have a debate of an hour and a half, or probably even three hours. One was local accountability in the NHS, in its wider sense and form, and how he is accountable as the Member of Parliament. The other was funding criteria.
My right hon. Friend has, I think, addressed two other Ministers on his passion for the longstanding need to improve the quality of hospital infrastructure in west Hertfordshire. That has been a stated aim of the Hertfordshire and West Essex sustainability and transformation plan since its inception. I know it is engaging in the process of looking at how a redevelopment and redesign of the hospital provision in west Hertfordshire can be achieved, working alongside NHS England and NHS Improvement.
I recognise that my right hon. Friend has real concerns and real scepticism about the work of the CCG. I hope he will recognise the work that the sustainability and transformation partnership is involved in in the hospital development process, and the fact that the director of strategy took part in a process and evaluation meeting in February 2019, at which a shortlist of our options was discussed. The STP is also due to take part in the next evaluation event.
I understand what my right hon. Friend says about the capital. I hear his criticism and scepticism of the West Hertfordshire hospitals trust, but it has been taking the lead in developing the strategic outline case for change. I understand that it and NHS Improvement had dialogue, and feedback was provided on the strategic outline case for the acute hospital redesign submitted by the trust. I also understand, as he will, that the feedback made two key points: it was clear, first, about the need for funding, and secondly, that the overall public money for hospital redevelopment is relatively limited.
My right hon. Friend has raised the issue of the £350 million; he knows that the turnover figure is a key criterion and a key threshold for capital investment, and that any options that significantly exceed the £350 million capital cost have been excluded from the current shortlist. He is obviously aware of a £750 million figure being used locally, but I must confess I am not aware of that figure. I would be delighted to offer him a chance to sit down and try to work out with me where that figure came in—recognising, as he rightly points out, that it will not be a Minister who makes any decision. If it is helpful to him, I am happy to have that discussion.
Sir Mike Penning
I had that discussion with the Secretary of State, a couple of days after he was appointed. It is not just Ministers that I pick on—Secretaries of State get it in the ear as well. There are two points I would like to touch on. First, how can it be fair to a community that, if it is just based on the turnover of a trust and that trust happens to be a very small one, the provision we get locally is second class? We cannot even go to that territory. Secondly, on the £750 million, I will ask the Minister to step in, because that is the figure being used locally to rule out the greenfield site. There was an evaluation panel, and members of the panel asked for the greenfield site to be put in, and fundamentally, it appears to me, they have been completely ignored.
Stephen Hammond
I made the point a moment ago that, because the cost of that greenfield site exceeds the £350 million threshold, it has currently been dropped from the shortlist of options. My right hon. Friend repeats a point that he made during his speech, questioning the criteria; he will know that I have heard what he has said. As he has just informed me, he has made a representation to the Secretary of State about that figure, and I have offered to have a meeting with him so that we can both explore it.
I do not think that, in the relatively short time available, I should get into the debate about the loan criteria, as I said at the beginning. We can have that debate at some other stage if my right hon. Friend wishes to put it forward, but he knows that at the moment the key threshold for capital investment would be the turnover, and therefore options that significantly exceed a £350 million capital cost have been excluded. As part of the option appraisal process, senior leaders and clinicians, as well as expert analysts, were involved in information gathering to put together the option evaluation. He will know that that included demand and capacity analysis based on population, hospital activity and operational planning.
With regard to reviewing that process, my right hon. Friend, as he said, wrote to both NHS England and NHS Improvement concerning the approval process. As he referenced in his speech, he forwarded to them an email from Professor Ron Glatter of the New Hospital Campaign. I understand that in that email, the professor requested a full statement of the outcomes of NHS Improvement’s review of the trust’s acute transformation strategic outline case.
In its answer, NHS Improvement has so far said that it has not started its formal review because the Treasury and the Department have not yet decided whether the proposal represents a scheme that can in principle be supported by central Government. I recognise the strength and effort of the campaigning for the new hospital option and I acknowledge the expert views that have been sought. While it is obviously not right for me to prejudge the answer from NHS Improvement, I know my right hon. Friend will recognise that I and the Department must take a wider view and that decisions made on capital funding must be the same for everyone across the country.
There has clearly been a huge amount of public engagement throughout the process, and I understand that further public engagement is planned for this month. Notwithstanding my right hon. Friend’s scepticism, I understand that the results of those consultations, in terms of the preferred way forward, will be taken to the trust board and the CCG in June 2019.
I recognise my right hon. Friend’s commitment to improving services; I assure him that the information provided by the New Hospital Campaign is being considered and will be considered as part of the review. As I said, it is not appropriate for Ministers to comment on specific decisions but, as he knows, the Government are determined to encourage innovation and to ensure that all patients have access to high-quality services. The updated proposal will clearly help to inform both the Department and the Treasury about capital allocations in the next spending review. I will not rehearse the arguments about the extra £33.9 billion of cash to support the NHS, or the additional capital and the bid we are putting forward in the comprehensive spending review.
Sir Mike Penning
If we accept that the rules at the moment are that any bid cannot be over the revenue income, which is the £350 million, can the Minister explain to me why, in Birmingham, the new build for 750,000 people cost between £300 million and £350 million, which we know because of the Carillion contract that collapsed, and the Royal Liverpool cost £335 million, yet we have been ruled out of having any new build on land that is actually owned by us—one of the sites is on Crown Estate land, public land—because it would exceed £350 million? I know he probably will not have the ability to answer that this second, but a letter in the next few weeks would be very helpful.
Stephen Hammond
As my right hon. Friend knows, all Ministers can make an attempt at an answer, but I am sure he would prefer a detailed answer. Therefore, I will make that detailed response to him, as he has asked, in a letter. I also know that he would like me to commit to the spending now, but he will know that I am unable to do so at this stage. I have listened carefully to his points about what might be the cost of the redevelopment that he believes should happen, and he will know that I have heard that. He will also know that I have heard the differences that he has pointed out between the supposed or quoted cost and the cost of build in other areas. He knows that I will have taken that on board.
At this stage, with just 30 seconds to go, I thank my right hon. Friend for bringing this matter to the Chamber and for making the case yet again for his constituents. He should know that the Minister and the Department have listened, and I will respond to him and have that meeting with him.
Sir David Crausby (in the Chair)
Order; I do not think we have time, Sir Mike. There is no right to sum up in a half-hour debate.
Question put and agreed to.
Diabetes: Artificial Pancreas
Mike Penning Excerpts(5 years, 5 months ago)
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Mr Howarth
The common-sense approach is to look at what is going on elsewhere—in Scotland and in other parts of the world—to get the best of what is available and use it in the most effective way. My hon. Friend is quite right about that.
It is pointless giving type 1 diabetics the latest technologies, such as an artificial pancreas system, if they are not given structured education to support them to use the technology that is available. The limited uptake of educational programmes is a matter of great concern, and I hope the Minister shares that concern. Despite guidance from the National Institute for Health and Care Excellence, in 2014-15 only 2% of people newly diagnosed with type 1 diabetes were recorded as having attended structured education courses. For some, that lack of knowledge of the key principles of self-management is a major barrier to the use of technology, because without sufficient education, type 1 diabetics are not equipped to get the best results from the technology available.
Sir Mike Penning (Hemel Hempstead) (Con)
This is a very important debate and I am pleased we have time to listen to it. I will have to go and listen to my leader at 5 o’clock, so I apologise if I leave in the middle of the debate. With type 1 and type 2 diabetes, it is crucial to diagnose as early as possible. With type 1, which is very different from type 2, it is possible to diagnose very early on in the life of that person. Perhaps the right hon. Gentleman will allude to the differences between lifestyle issues and something that a person normally has when they are born. Surely the answer is testing early, so people can find out and have their educational needs met, and hopefully the product can be available across this great nation of ours.
Mr Howarth
I am glad that the right hon. Gentleman, who has a background in these matters, has drawn attention to the distinction between type 1 and type 2 diabetes. That is not to say that one is superior to the other, but they are two entirely different conditions brought about by entirely different circumstances. As I said in opening my speech, type 1 diabetes is an auto-immune condition. Nobody is entirely sure what triggers it in some people, but those in whom it is triggered have some predisposition towards the condition.
Mr Howarth
Yes. I pay tribute to my right hon. Friend, who does a massive amount of work as chair of the all-party group on diabetes. He is very knowledgeable on the subject and the issues involved, and he is of course right. I think I had already said more or less the same thing as he just said, but obviously I agree with myself and with my right hon. Friend.
Let me move on to the digital solutions, such as apps, which could offer platforms to deliver education in a convenient and personalised format. I should add the rider that mobile apps need to be safe, reliable and accredited to be clinically safe. It worries me that some apps out there are produced commercially but do not contain wholly accurate information. It is unsafe to rely on apps that are not properly accredited and that have not been assessed and evaluated by experts who know what they are talking about.
In addition to the low uptake of structured education, the number of specialists working in diabetes care is falling. Between 2010 and 2012, there was a 3% fall in the number of NHS sites that employ any diabetes specialist nurses. Anyone who has any experience of dealing with young people with diabetes will know that nurse specialists are often the very best possible source of advice.
In the light of this shortage, a national network of centres—possibly between eight and 10 expert diabetes technology centres, supported by virtual clinics—could well be a potential platform for the development of more effective structured education for patients, and for professionals as well. I shall say more about that in a moment. Such a network would be helpful for training future generations of diabetes clinicians effectively to provide artificial pancreases, and in the development and evaluation of new technologies.
One of the problems that type 1 diabetes sufferers tell me that they experience is the merry-go-round of different services that they have to access. They may have a problem with neuropathy, or a foot or eye problem, but they cannot access all those services in one place. Many diabetologists, although brilliant at dealing with the diabetes side of the problem, are not equipped to deal with young people who have, for example, psychological problems. All the services need to be better integrated.
Sir Mike Penning
I do apologise, Madam Deputy Speaker, but I will have to slip away straight after this intervention.
One group of people the right hon. Gentleman missed out, although it was not intentional, was parents. When a child is diagnosed with type 1 diabetes, there is a journey for the parents as well as the child, so there needs to be support for them. I completely agree with the right hon. Gentleman that diabetes does not pick on certain people from certain areas; it just picks on an individual. Sometimes it is hereditary—a lot of work is being done around the hereditary route—but it is not a choice; it is something that comes on to the family, rather than just the individual.
Mr Howarth
The right hon. Gentleman is right, and it was an omission on my part not to have acknowledged that. Any parent of a diabetic child has to experience the disease—at second hand, but in very important ways. The younger the child, the more responsibility parents have to take, so that is important. By the way, training and other support for parents needs to be built into the system.
Access to Orkambi
Mike Penning Excerpts(5 years, 10 months ago)
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Mr Lewis
I think that, in this context, we can all unite behind the concept that we want a resolution that is UK-wide if at all possible. Clearly, that would require different organisations to be involved, but if we can set a precedent here, we could make rapid progress, and that can only help all parts of the United Kingdom. May I make some progress, and then I will give way to other hon. Members?
All of us who have the privilege of serving in this House are mothers or fathers, brothers or sisters, grandparents, uncles or aunts, godparents, friends or neighbours. It could very easily be one of our family members or friends who is diagnosed with cystic fibrosis at birth and who struggles with a life of perpetual illness, frequent hospitalisation and a daily multitude of drugs. Worse still, they could be living with the fear of premature death at an age when many young people are getting married, starting a family or taking their career to a new level.
I ask hon. Members to imagine that their family member or friend was denied access to a drug that could improve their quality of life and prolong their life for many years—a drug that was readily available in 12 other countries. No one in this Chamber today would accept no for an answer, or remain silent as the NHS and a major drugs company traded increasingly public blows as to who is to blame for unnecessary suffering and potential loss of life. If the situation is not good enough for our loved ones, it should not be good enough for anybody else’s.
I first became aware of Orkambi when a young constituent from Prestwich attended my constituency surgery with her mother. Many Members will have met constituents in a similar situation. Alex Darkin is 10 years old and suffers from cystic fibrosis. She is a remarkable girl, whose courage and positivity are truly inspirational. Alex started this year with 80% lung function—a number that scared her mother, Emma, because Alex’s lung function was over 100% a few months previously. These days, Emma would give anything to see the number 80 again. Alex’s lung function continues to drop and is now around the 54% to 56% mark.
Alex has physio and takes a large amount of medication just to manage her condition. She brought all that medication to my surgery and I found myself looking at a young person who has to go through the routine of taking that medication every day; that, in itself, is a massive challenge. Alex has intravenous antibiotics every three months, and her daily life is inevitably dominated by her drug and physiotherapy regime. Very sadly, she now has irreparable lung damage. A consultant recently advised that doctors are running out of options with regard to medication, and explained that if Alex were a year older her parents would be able to apply for Orkambi on compassionate grounds, as her lung function had deteriorated more than 25% in less than three months. Emma and Alex contacted me because they could not afford to wait another year to get this drug on compassionate grounds. Surely a truly compassionate society would ensure that this drug was available to all who needed it.
Sir Mike Penning (Hemel Hempstead) (Con)
I congratulate the hon. Gentleman on securing this debate. I think that we all tried to get this debate, which is why we are all here. One of the reasons I said to Mr Speaker earlier that I was not happy was that I wanted us to get on to this debate. We have all heard stories in our constituencies, as I am sure you have, Madam Deputy Speaker. As a country of this wealth, we should be ashamed. People in countries with nowhere near the wealth of this country have been given these drugs to improve their quality of life. We are here to right that shame.
Mr Lewis
The right hon. Gentleman speaks for everybody present this evening and probably many who are not.
There is inevitably sadness, but there should be real anger because this situation is causing human misery to many people who have enough challenges in their lives without not being able to resolve this situation. It would not be right for any of us to pretend that these decisions are easy. NICE does a good job in very challenging circumstances, on the whole. In no way should we or do we seek to undermine its work.
Ian Austin
I am very grateful. This is a really frustrating process, and the Government have to find a way of bringing it to a conclusion. I agree that NHS England and Vertex have to get back into negotiations, which should not stop until this is resolved. Does my hon. Friend agree that it might be an idea for the Secretary of State to get Sir Simon Stevens and Jeff Leiden, the chief executive of Vertex, in a room—
Ian Austin
The right hon. Gentleman could lock the door, but first he has to get them in there so that negotiations resume and are not concluded until they resolve this issue, because it really does have to be sorted out.
On that point, does my hon. Friend agree that it was worrying to read the word “final” in NHS England’s response to Vertex yesterday? It cannot be final. I really hope the Minister is listening to this. [Interruption.] The word “final” was in there. [Interruption.] Well, he is the Minister. The word “final” cannot be used until it is finally resolved. That is when it will be final.
NHS Trusts: Accountability
Mike Penning Excerpts(5 years, 10 months ago)
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Sir Mike Penning (Hemel Hempstead) (Con)
It is a privilege to have so long for this Adjournment debate on such an important subject. I know that when other colleagues realise that the debate has started, they will scamper to the Chamber. When I put down the title for this debate, I did not intend it to be a general debate, but when I have raised this issue in the House, many colleagues and those on the Front Bench have acknowledged it, particularly when I have raised it with the Leader of the House at business questions.
The NHS is not owned by politicians. It is not owned by doctors and nurses, and it certainly is not run by the bureaucrats in charge of the NHS. It is owned by the people. The people’s NHS was founded 70 years ago, which we are celebrating today. I would never advocate that we go back to the time when politicians and Ministers ran the NHS, but we are in a situation now where the bureaucrats who run the NHS have very little accountability. Time and again, my constituents say to me, “Why are they not listening to us? Why are they not listening to you, my MP? At the end of the day, you represent us in the House of Commons—you are there to represent our money.” That is the principle of our democracy today and has been the founding principle ever since we first elected people to this House over 900 years ago.
I find it amazing when we question the clinical commissioning group or one of the numerous trusts in my constituency. I never understand why, in a small county like mine, we have so many NHS trusts, acute trusts, mental health trusts and community trusts. The people do not understand it. They just see an NHS. They do not realise or want to know how many chief executives, finance directors or directors of nursing there are. They just want to be looked after by the NHS, which was the promise when the NHS was founded.
There are a couple of examples from my constituency that might resonate with colleagues around the House, as it may have happened in their constituencies as well. A few years ago in my constituency, we lost the NHS trust’s chief executive. The chief executive had been involved in the downgrading and closure of the acute hospital in my part of the world, and once he had done that, he decided to go to pastures new at very short notice. The then regional health authority seconded a new chief executive on what we thought was a temporary basis, but we noticed some time down the line that the role of chief executive of the West Hertfordshire Hospitals NHS Trust had not been advertised, and there did not appear to be anybody saying that we should have people applying for such a senior position in the trust.
The gentleman’s name was Jan Filochowski. I know Hansard will ask me to spell that name later, and I will attempt to help them as much as I can, but anybody in my part of the world will know who that gentleman is. I did not have any particular gripe with Jan. I completely disagreed with the running down that he continued to do, but I did have one specific gripe, as did the hospital action group in my part of the world. In particular, Mr Ron Glatter picked up the argument, and I fired off several really important questions to the NHS regional health authority: “Hold up a second, has this person got this job now? Has he been appointed, and if he has, when was it advertised, and when was he interviewed?”
Sometime down the line—hidden with lots of mirrors in lots of different parts of the NHS—it was revealed that the gentleman had got the job without it being advertised and without being interviewed for it. However, because he had been given a contract, it would have been too expensive to remove him and to start again from scratch. We eventually found out that his remuneration package was in excess of £300,000, which is well over twice what the Prime Minister of this country earns. I accept that someone does not become the Prime Minister to earn a lot of money—clearly, there are other reasons why someone becomes Prime Minister—but surely, within the NHS of all places, that sort of remuneration package is not only excessive, but actually sick. The money that person was earning! I am sure there are others who are earning close to that, perhaps more or perhaps slightly less.
John Spellar (Warley) (Lab)
Does it not get even worse, in that individuals who fail in such jobs are given pay-offs to get them out of the hospital, but in a fairly short space of time the magic circle again fits them up with an appointment in another hospital, where they again fail and again cost huge sums of money?
Sir Mike Penning
The right hon. Gentleman is absolutely right. The gentleman did not stay very long, but he caused carnage in our NHS trust and morale went through the floor. I am sure some of the books might have looked a bit better, but certainly acute care was really struggling. The gentleman left after two years, or something like that, and he went to Great Ormond Street Hospital as the chief executive. I am sure he went on a huge pay cut—no, I am being cynical: I doubt it. He has now retired.
On the right hon. Gentleman’s point, before that gentleman there was another chief executive involved in investing in our health, who went off under a cloud. I managed to get him summoned to the Health Committee, when I was a member of it, to find out the truth about what was happening with the closure programmes. The right hon. Gentleman is absolutely right because, a few years later, he appeared back in my constituency as the chief executive of the community trust. He then had the audacity to ask, “Can we put all that behind us, as this is a new job and a different project for me?” Yes, it goes full circle: just as the right hon. Gentleman said in the previous debate, it is jobs for the boys, and they come back round again.
Jim Shannon (Strangford) (DUP)
I congratulate the right hon. Gentleman on securing this debate, in which he is highlighting a very specific issue. Does he not agree that there is a duty of care on Government-funded bodies, which quite clearly pay people from Government funds, to ensure that employees at every level are accountable to trusts? More must be done to inspire confidence in the NHS—this is quite clearly a confidence issue—as well as to provide transparency and clear accountability.
Sir Mike Penning
I could not agree more with the hon. Gentleman. We have discussed and debated this before, and this must be like “Groundhog Day” for the Minister. I should have thanked him earlier for bearing with me in what may be a much longer debate than he probably assumed when he saw it on the Order Paper.
It is important that there is proper due process when we employ people who work in the NHS, and in relation to salaries. I am sure that the Minister will now go away and check with the Treasury how this happened. My understanding was that such remuneration—and we are going back a couple of years—would not have been allowed even then. Trust in the NHS is vital. There are other examples, which I will produce, that will show that although the NHS is absolutely world renowned, there are errors in it that infuriate the people who it is supposed to be representing and looking after.
Mr Jim Cunningham (Coventry South) (Lab)
This is a timely debate. I agree with my right hon. Friend the Member for Warley (John Spellar): it seems to me that a game of musical chairs is going on. We see chief executives who leave under questionable circumstances get a job outside the NHS and then turn up at another trust somewhere else. There does not seem to be any accountability.
As politicians, we are often accused of being remote, but nobody is more remote than people at some of the trusts I have looked at. Someone trying to get information from them about their budgets and where the expenditure goes has a job on their hands. It is about time that how the Department is run is looked at; it gives directions to the rest of the chief executives in the country, even on appointments.
Sir Mike Penning
I agree almost completely; I would just say that sometimes these people do not even leave the NHS—they stay within the structure of the NHS, but just go to a different trust in a different part of the country. Then they just reappear again and again.
I have often wondered about something. A director of nursing should clearly have come up through the nursing ranks; I understand that. Clearly, also, clinicians have to be involved in the clinical side. But why does NHS management have to be completely incestuous in how it works? If someone started as a nurse or doctor, how on earth do they have the necessary qualifications to run a massive multi-million pound organisation? Yet that is how it seems to happen. It took a long time for Mr Ron Glatter to get the figures when he was challenged. When we eventually got them, it was like pulling teeth: was it a package or a salary? “This is personal information.” This is taxpayers’ money. One of the most difficult things is to find out exactly where the money is going.
Dr Caroline Johnson (Sleaford and North Hykeham) (Con)
My right hon. Friend mentioned nurses, doctors and other clinicians taking on managerial roles. To what extent is that driven by a desire to reduce the number of managers in hospitals—to call them “nurse managers” and claim they are nurses when they are actually fulfilling a management role?
Sir Mike Penning
My hon. Friend brings great expertise to the debate, and I thank her for joining us. She is absolutely right. I declare an interest: my mother was a nurse in the days of “sister” and “matron”. Then there were nurse managers and other managers—all of a sudden, we went that way, but we seem to be coming back again. We can change the name on the Titanic, but it is still the Titanic: a manager is a manager, no matter what title we put on them.
It seems to me that we are not reducing the number of managers. I vividly remember that there were 11 primary care trusts in the Dacorum area of my constituency. Then the number reduced to two—one, actually, because there was only one director of finance. When we looked at the head count, the cost analysis, which should have massively reduced, it had actually gone up.
I want clinicians to be involved in the day-to-day care of my constituents, but I am not convinced that a GP should chair a clinical commissioning group, especially given that in most cases they do not seem to be full time in the role. What qualifications do they bring? I know that GP practices are much more business-orientated now than ever before, but they employ practice managers—the partners do not run things.
More recently, there has been an understandable concern in my constituency about the proposed closure of one of the facilities called Nascot Lawn; it is not in my constituency, but was playing a vital role in looking after the most vulnerable children in my community. Brilliantly, the families and loved ones came together to challenge the closure. They got the MPs on board and we were involved. I then scratched my head and said, “Hold on a second, I remember being told that Nascot Lawn was going to provide the respite care for my constituents when they closed a place called Woolmer Drive.” Woolmer Drive was a desperately needed respite centre where young people could go, and where their carers and loved ones could spend a bit of time. So not only did Woolmer Drive close, which meant that patients had to go to Nascot Lawn, but Nascot Lawn was closing. That was challenged, but there was very, very little consultation.
I will talk about consultations in quite a lot of depth. Frankly, most consultations are a sham. The decisions are made before they consult. They make the decision to close, put it in their budgetary regime and then consult. They then come out and say, “We’ve listened to the consultation and we are going to ignore you.” So what is the point of the consultation?
Rachel Maclean (Redditch) (Con)
My right hon. Friend echoes our experience in Worcestershire. The Minister will know the deep concern my constituents have about Worcestershire Acute Hospitals NHS Trust. Exactly the same thing happened before I came to this place. Services were taken away from the hospital and people were told, “You’re being consulted.” All that happened was that services were removed. It was part of a plan, I understand that, but the idea that it was a consultation is really for the birds.
Sir Mike Penning
It is a tick-box exercise. Most of the time trusts cannot even get that right. In this particular case—I will come on to another case in a moment—we challenged it. We judicially reviewed it not once, but twice. But why should members of the public have to come together to raise money to judicially review such decisions? There is currently no other process with proper discussion and involvement of patients, which challenges the decisions we hear day in, day out.
Mr Cunningham
The right hon. Gentleman is being very gracious in giving way. We had a case involving two consultants. With one in particular, the case actually ended up in the courts. We have never been able to find out the cost of the litigation, but it was anywhere between £2 million and £4 million. On the one hand, the public has got to raise the money if they want to challenge something, but within the NHS itself, where resources are very scarce, a lot of money is wasted on litigation. This consultant was taken to task because he was a whistleblower. On the one hand they encourage whistleblowers, but if they do not like what the whistleblowers have to say they suspend them and eventually try to get rid of them through litigation.
Sir Mike Penning
I was coming on to that point, but let me meet it head on now. I speak to nurses and other frontline staff who look after my local patients, including some doctors, and they are petrified of telling their own MP what is going on in case of retribution. Perhaps the Minister will help me to get to the bottom of the number of gagging orders out there at the moment in my trust, whereby things have been settled and people have been gagged. The types of threats in the gagging orders that are put on them are very severe.
There was a consultation panel in my constituency about the future of health, and the people allowed on the panel had been gagged. These are members of the general public who have been told categorically not to talk to me. They are not to tell me what is going on in the NHS in my own local community. They will be thrown off the panel if they do, and it is worse for the staff who have gagging orders against them. This is very serious.
We see the amount of money the NHS uses in litigation, whereas our patients have to raise money themselves. The NHS seems to settle very easily when there are threats against it relating to malpractice or when something has gone wrong at the trivial end of things, but when things are really serious and deaths have taken place, down come the shutters. Nationally, we have seen what happens—it has happened recently in Gosport and in Staffordshire when I was a shadow Minister—unless the staff have 100% confidence that they can go to their MP or their line management and tell them what has been going on. Sometimes it can be quite trivial, but often it is very serious, and there is clearly retribution against them should they do so. That is something we need to sort out.
Dr Caroline Johnson
It is extremely important that all health professionals in hospitals are able to report any concerns that they have. I understand that there is to be a whistleblowing champion for each trust. What does my right hon. Friend know of those, and does he think they will help?
Sir Mike Penning
It is all well and good saying that there should be, perhaps in legislation, but unless people have the confidence that their career is not going to be curtailed, or unless they are close to retirement and are not going to put their pension at risk, they are not going to blow the whistle. What really upsets me is that although I was sent to this House to represent people and for them to be able to tell me, in confidence, anything that they needed to, so that between the two of us we could discuss how to take it forward—often without using their name, but if necessary we can—that is not happening. That really worries me an awful lot.
To go back to Nascot Lawn, we went to a judicial review. We have done that before in our part of the world. The judge sided with the patients, but all that happened—it was about process, of course—was that it went back to the CCG, which turned around and said, “We will consult slightly differently. We will address what the court said, and by the way, we are going to go ahead and do it.” It is a sham, and we should be honest about that in the House.
When we tried to prevent our acute hospital from being closed—I pay tribute to my community for that—we did everything in the world. We got a coffin on a trolley, and thousands of us pushed it from my A&E that was going to close to the nearest one at Watford hospital, which it was proposed people should go to, in order to show just how much passion there was. We managed to get the money together to go to judicial review—a lot of money; in excess of £60,000—and the judge said, “You have a moral case. You have an ethical case. I agree with you, but you don’t have a case in law because all the powers are with the trust and the PCT”, as it was then. I ask the Minister: how can it be right that people must be so concerned, not just in my constituency but elsewhere?
Lastly on this part of my speech, let me talk again about what happened when we lost our A&E. I have raised this in the House before, so the Minister knows what I am talking about. To go back a bit further, St Albans, Hemel Hempstead and Watford are covered by West Herts, and at one time all three had A&Es. We are a massively growing population. The largest town in Hertfordshire is Hemel, which will have a projected 20,000 new homes in the next 20 years. St Albans is expanding, and so is Watford. There was a consultation, but the public were ignored. The A&E was closed and made into an elective surgery facility in St Albans. The public promises to the people of St Albans were that Hemel’s A&E would look after them. It is not a particularly long ride—it is clearly not in St Albans town centre, but that was going to be that. However, a few years on, those responsible said, “Let’s shut Hemel’s A&E and move it to Watford, because that can look after West Herts,” so the promises went out the window. The public went mad in St Albans and in our area. They were all on the streets, and what did we get? An urgent care centre, some out-patient services and a fracture clinic. Really and truly, that is all that is left in Hemel.
Rachel Maclean
My right hon. Friend is generous in giving way a second time. Again, the parallels with Redditch are interesting. Does he agree that the problem for the public comes when they see that their town is growing and they feel that trusts have not planned for the future? That is exactly what we have in Redditch as well, because it is a new town and it is growing, and people do not understand how the future demand will be catered for in the trust’s plans.
Sir Mike Penning
That is absolutely what I hear every day in my constituency. I also hear, “What are you going to do about it, Mr MP? Get off your backside and do something about it!” I am doing everything I possibly can—I am meeting Secretaries of State and trusts—but what happens? I get ignored, because I have no powers at all; it is all in the hands of bureaucrats.
Dr Caroline Johnson
We have a similar situation in Grantham A&E, which serves my constituency. My hon. Friend the Member for Grantham and Stamford (Nick Boles) and I have been working to try to get Grantham A&E reopened around the clock since it was closed without consultation in August 2016.
Sir Mike Penning
If the A&E was closed without consultation, that is illegal. I think the Minister will confirm that it is illegal to make major changes to a community’s health provision without consultation.
Hemel Hempstead A&E closed after a bogus consultation, and everything moved to Watford. We were promised that it would all be okay, and that we would have a 24-hour urgent care centre manned by GPs. Let us go back to just before Christmas 2016. There had been chaos—and I mean chaos—at the acute admissions unit in Watford hospital, which has just recently come out of special measures. All the ambulances were getting held up in big bottlenecks at the A&E at Watford. The big, new, bright idea was that we would close the urgent care centre that had replaced the A&E in Hemel Hempstead, and that that would be okay.
I had a meeting with the chief executive of the trust, who told me, “Mike, we are only doing this on safety grounds, because we cannot get the GPs to cover the hours.” That was really surprising to me, because there is a GP drop-in centre in the next room—not across the other side of town or even in a different part of the complex, but in the next room. I was told, “That is a different contract. We can’t touch that, mate; it’s nothing to do with us.” The chief executive said to me, “Don’t worry, Mr Penning, we can’t close the 24-hour service, because we have not consulted. This is just a temporary, emergency measure.” She went on the local radio station—I did not ask her to do that—and reiterated exactly what she had told me. In fact, she went further and said that the centre would be closed for only a couple of months and that it would reopen, because it would be categorically illegal to change the hours without consultation.
Reducing the hours of an urgent care centre—which used to be an A&E—from 24 to 10 is a major thing. Eighteen months later, the trust consulted on a proposal to turn the 24-hour urgent care centre into an urgent treatment centre, which would shut at 10 pm. Perhaps the Minister can explain to the general public the real difference between an urgent care centre and an urgent treatment centre, because I struggled to do so. I know that there is a methodology within the Department, but all that Joe Bloggs, my constituents, saw was a downgrading.
By the time of the consultation, the centre had already been closed for 18 months, so what choice did we have? We could not rewind the clock 18 months. The trust misled us by saying that the measure was temporary. The chief executive promised me that to my face, and she repeated that promise on the local radio station. That commitment was not worth the paper it was written on—or rather the voice that spoke it. My constituents have suffered a massive loss of trust in brand NHS. Their trust has been decimated, because promise after promise has been broken.
Naturally, the vast majority of consultation responses —do not quote me on this, but I think it was about 80%—said that the centre had to be open 24 hours. Guess what, Madam Deputy Speaker? It is not. It has been renamed an urgent treatment centre, and it closes, allegedly, at 10 o’clock at night. Within the last few days, however, a very senior person in my constituency whom I trust implicitly saw someone collapse outside the centre at approximately 9.30 pm—half an hour before it was supposed to close—but the doors were locked. It was only because a member of the public opened them from the inside that the patient was seen. The doors were not opened by the NHS staff who were inside, even though they must have known that the patient was there. I hope and pray that she is okay.
I am now told that the doors are regularly locked at any time after 9 pm. That is disastrous for my constituents when they turn up there, but many of them simply do not trust the centre to be open at night. What is going on? Naturally enough, although sometimes inappropriately, they go to the A&E at Watford, which is causing it even more of a problem—but can we get anyone to listen? No, we cannot.
Watford General Hospital is in the middle of Watford, next to a football club about which a great many of my constituents are passionate, Watford FC. It used to be the home of Saracens, and I am passionate about them as well. The hospital was built in Victorian days, and the best way to describe it is “not fit for purpose”. The people of Watford will probably say, “Please do not run down the hospital, because it might be closed”, and I fully understand that, but the truth is that we all need a new hospital.
Although, as we heard earlier from my hon. Friend the Member for Redditch (Rachel Maclean) about her area, the population is growing massively, we are now supposed to listen to the management telling us what they are likely to provide. I have attended meetings with the Secretary of State and NHS Improvement about the applications from my local acute trust and clinical commissioning group, and it petrifies me that yet again they are not going to listen—I do not mean to me, or to the Minister, who knows that he has no powers and will be treated with the disrespect that I often receive; they just ignore us—but to the people whom they are supposed to be serving, and who pay their wages out of their taxes.
I am not a clinician, although I was a paramedic in the armed forces and I know a little bit, but surgeons, GPs and frontline senior nursing staff have been speaking to me privately. It is fundamentally wrong and dangerous to keep saying that Watford can cope with the ever-growing population of west Hertfordshire.
I have met representatives of NHS Improvement with a delegation from my hospital action group, led by the brilliant Betty Harris, with Edie Glatter and her team, Jan Maddern and others, and we have joined forces with a separate campaign from St Albans. We were promised that the NHS management, as they looked at the applications for healthcare regeneration in my part of the world, would ensure that the CCG and the acute trust had more than one option on the table, rather than just ploughing more money into the Victorian hospital. I know that there have been conversations about a greenfield site, which is owned by us because it is Crown Estate land. It is by the M1, close to the M25, between St Albans and Hemel Hempstead. It is perfect for an acute facility—the infrastructure could not be bettered—but I think we are being ignored again. I cannot prove that, but it is my gut feeling, and it is certainly the feeling of the thousands of people in my constituency.
I am a loyal member of the Conservative party. I was a Minister for seven years in seven Departments, and I was on the Front Bench in opposition for four and a half years. I have to ask myself why I am supporting a Government who are allowing my constituents to be ignored. The Minister must not take this personally, but the present situation is crazy. The Department of Health and Social Care—I was not in that Department, but I have been in many others—actually has very little control over what is going on out there in our wonderful NHS. We have inspections, my local hospital goes into special measures and then comes out of them, it gets into debt and then comes out of it. However, the truth in my part of the world is that if NHS management are not accountable to Ministers or to me as their MP—and, much more importantly, are not accountable to the people whom they are supposed to be looking after—we have a serious problem. If my constituents cannot come to me and express their concern about what is going on in the NHS, there is a serious problem with our democracy, and that is something that I cannot live with.
Sir Mike Penning
I must apologise to my colleague, the now Foreign Secretary, who was so generous with his time in seeing me. I hope that the new Health Secretary will not get so upset when I am banging on his door—perhaps as much as I was on the previous Health Secretary’s door.
Stephen Barclay
I am grateful to my right hon. Friend for recognising that in the House. I think that is widely shared across the NHS.
It is right that the Government are bringing forward the draft Bill to place the Healthcare Safety Investigation Branch on a legal footing. Indeed, trusts should disclose any pay settlements to NHS Improvement. Therefore, on the concern to which my right hon. Friend brought the House’s attention—whether whistleblowers have been gagged and, if so, whether that has been induced through financial payment—both those breach the Government’s guidelines and they would need to be reported to NHS Improvement. If he is able to share any specific allegations after this debate, I will be keen to explore them.
My right hon. Friend expressed concern that service changes are “all in the hands of bureaucrats” and I must take slight issue with that.
Stephen Barclay
Well, I must take issue with that point. First, my right hon. Friend is well aware that the Government have four tests that apply to service change that ensure the voice of patients is heard and in particular that service reconfigurations are clinically led and done at a local level. I draw attention to the work that Professor Tim Briggs and Professor Tim Evans are doing through the “Get it right first time” initiative, which is all about driving through change to service provision through the leadership of national clinicians working with local clinicians in order to get that service buy-in.
Sir Mike Penning
I do not want to take up too much more of the Minister’s time, but I am afraid that, in parts of the country, certainly in mine, the requirement to consult is simply being ignored. I have given the House a classic example in which an urgent care centre was closed at night with no consultation at all. It took 18 months for a bogus consultation to take place on whether it should close at night. The changes are there to be seen by everyone. I know that the Minister is telling me all this in good faith but, as he has heard from colleagues on both sides of the House, on the frontline, in the real world, people are ignoring the guidelines, which is surely illegal.
Stephen Barclay
I shall just unbundle two separate points from my right hon. Friend’s remarks. First, his point that these changes are all in the hands of the bureaucrats collides with the Government’s own position, which is that there are four tests. What he is drawing out is not whether the guidance is there as a protection but whether it is being implemented operationally, and that obviously needs to be looked at on a case-by-case basis. Secondly, he and I debated this issue in some detail in an Adjournment debate in March, when this specific point was explored more fully. The urgent care centre in question saw an average of seven patients between midnight and 8 am, and an average of four between 10 pm and midnight. So in the period between 10 pm and the centre reopening at 8 am, an average of 11 patients were being seen. I suspect that that is why, at local level, the change was made. I appreciate that it was initially done on patient safety grounds, with the consultation following, as we explored previously.
Sir Mike Penning
This is a hugely emotive issue. Yes, the excuse was that the centre was closing at night on grounds of patient safety because it could not get a GP there, but it does not take 18 months to turn round and say, “Oh, by the way, the numbers weren’t there in the first place and that’s why we had to close the centre.” That was the excuse 18 months after it had been closed at night times. Whether the numbers are right or not—they are hugely contested by my constituents—it cannot be acceptable that no consultation took place for 18 months.
Stephen Barclay
As I have said, we did explore these issues in some detail in March, and I absolutely respect the conviction with which my right hon. Friend is championing the interests of his constituents.
In the spirit of balance, I draw my right hon. Friend’s attention to the fact that a number of enhancements have also been made, including the introduction of a number of bookable appointments through NHS 111, which includes a clinical assessment service to ensure that patients’ needs are medically assessed; the addition of near patient testing for some conditions, reducing waiting times and reducing the need for patients to attend Watford Hospital; and an improved IT system meaning that medical staff will be able to access patient records if they give their consent. The clinical commissioning group also expects the service to expand to include a greater skill mix of other professionals such as pharmacists, emergency care practitioners and community nursing staff, and to provide access to mental health services. This is not a static situation. Some improvements have been made, but I absolutely take on board the concerns that my right hon. Friend has raised.
My right hon. Friend has raised concerns about the hiring of leadership positions, particularly two chief executive roles. He will be aware that this point was also raised by the hon. Member for Blackpool South (Gordon Marsden) in respect of the chair of Blackpool Victoria Hospital in an Adjournment debate only last week. I also note that the right hon. Member for Warley (John Spellar) and the hon. Member for Coventry South (Mr Cunningham) have raised similar issues. It is right that the views of constituency Members should be taken on board as part of any consultation, because Members of Parliament interact with a wide spectrum of their electorate and they are obviously well placed to feed into such consultations. As a Minister, that is something I take very seriously, and working on the cross-party basis, I am always keen to hear from colleagues when concerns arise.
That goes back to my right hon. Friend’s point about trust. Issues in terms of pay need to be balanced. On the one hand, we need to recognise the complexity of senior leadership roles. We are dealing with hospital trusts that often have budgets running into the hundreds of millions of pounds. These are senior, complex, challenging roles that need to attract talented individuals. At the same time, those salaries and that remuneration need to be balanced with the wider values of the NHS. There is a live discussion about what the right level of remuneration is to attract talent while not being out of step with the NHS values that both sides of the House recognise.
I turn now to my right hon. Friend’s point about the new hospital site and capital investment in the STP area. He will be aware that the same STP currently has a significant new build proposal at Harlow. My right hon. Friend the Member for Harlow (Robert Halfon) is assiduous in championing that proposal, and I met with the chief executive of that trust—
Sir Mike Penning
My constituents will not know what STPs are. At the end of the day, the new site is in Essex, on the east Hertfordshire border, which is nowhere near my constituency. There is no tangible benefit when the debate is about a new hospital in west Hertfordshire.
Stephen Barclay
I beg to differ from my right hon. Friend on that, because this gets to the crux of the issue. The NHS must evolve. It has to move with technology and with the skills mix. Alongside the significant funding injection that the Prime Minister announced at the Royal Free Hospital, the NHS must also deliver productivity. At the specialist level, such as oncology or neuroscience, we often have populations of 3 million that need to be treated. Look at the footprint of the Christie NHS Foundation Trust, for example.
If we look at the other end, we need to deliver more care in the home and not have acute trusts soaking up so much investment. We need dynamic reconfigurations without acute trusts being the sole focus of our attention. We need service changes but—this goes to the core of my right hon. Friend’s remarks—they must be taken forward with clinical leadership and in a way that delivers trust.
I am happy to continue to engage with my right hon. Friend’s specific allegations on a case-by-case basis.
Orkambi and Cystic Fibrosis
Mike Penning Excerpts(6 years, 1 month ago)
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Sir Mike Penning (Hemel Hempstead) (Con)
It is a pleasure to take part in this debate. Like everybody in this room, I have constituents who suffer from this terrible genetic disease. We live in a society where sometimes those who shout loudest get heard more, but interestingly, it is not possible for those who suffer from this terrible disease and their families and loved-ones to have orchestrated the petition. Members of the general public who have no contact with someone who has CF have signed it and decided that the process is fundamentally unfair. Like the hon. Member for Dudley South—
Sir Mike Penning
My apologies—don’t forget I am a southerner.
The hon. Member for Dudley North (Ian Austin) and I had a good meeting at the roundtable. All of us learned things. For colleagues who were not there, there are some good notes to come around.
We thought we would not have a decision by tonight from NHS England on the Vertex proposals—it usually takes much longer—so I was very disappointed when I saw not only what NHS England put out, but the press release from Vertex. As the hon. Gentleman said, it is not so much because the Department, NICE or the companies are bad—our constituents could not have any of their drugs without the R&D done by those companies. NICE is not capable, under its guidelines, of properly analysing the benefits of the drug, or the other drugs coming down the line. The Republic of Ireland must have sat in exactly the same position that we are now in. It had difficult negotiations with Vertex about a plan for not just one or two drugs, but the drugs coming down the line.
Let us not beat about the bush: this drug is not a cure. It helps some people. At the end of the day, they will either have a transplant or their lungs will give way. It is wonderful that we will have an opt-out transplant system. People are dying in this country today because the organs are being wasted. Lung transplants are vitally important. We should all campaign in our constituencies to give people the confidence to tell their loved-ones what they want done with their organs, rather than just relying on the legislation. At the end of the day, to help people today and future sufferers of this terrible disease—we know they are coming, because it is genetically in the system—we need not only drugs that slow it down and stop the lungs filling with fluid, but to get a cure. I hope we get to that position in my lifetime. Those of us who have been in the House for some time will remember taking the Human Fertilisation and Embryology Act 2008 through. It was very controversial when we started using that sort of technology, research and work, but I am pleased that we passed that Act because many people are around today who have better lives and who, without us using that technology, would have been very worried.
As my hon. Friend the Member for Sutton and Cheam (Paul Scully) said, this is not about individuals. When an individual gets CF, the whole family and all their loved ones get it. If the family is not there, what happens? The NHS and social services. Several colleagues have asked about the overall cost. If we do not give people these drugs—not just this one, but the others coming down the pipeline—the cost to the NHS is greater. If we take away the moral and ethical position that we have something that will improve and extend someone’s life and look just at what NICE looks at—the cost implications—it is plainly obvious that we need to have a better system for NICE to assess the costs.
My hon. Friend called it “physiotherapy”, but someone who suffers with CF has to have a pummelling. People have to do an amazing thing to their loved ones to get the fluid out their lungs and to stop them drowning internally. Instead of saying that drug companies are bad and NICE is good, we need to bang some heads. Frankly, the only people within Government who will do that are the Ministers. That was said to me time and again when I was a Minister. Time and again I tried, and time and again I got pushed back, but I kept going.
It is obvious—to echo what I said at the start of my comments—that those who shout the loudest should not always win. In this case, we need to shout for them. That is what we were sent here for, and that is what we should do today.
Hemel Hempstead Urgent Care Centre
Mike Penning Excerpts(6 years, 2 months ago)
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Sir Mike Penning (Hemel Hempstead) (Con)
First, may I say what a privilege it is to have secured this Adjournment debate this evening, and how proud I am of my constituents who for so many years have been fighting the changes and particularly the cuts to healthcare in the Dacorum area where my constituency sits? In particular, I thank Edie and Ron Glatter and the Dacorum Hospital Action Group and its fantastic chair Betty Harris, who is very poorly; they have been fighting this campaign for many years. I also pay tribute to the fantastic work our local BBC radio station, BBC Three Counties, has done over the years, in particular that of the excellent journalist and reporter Justin Dealey; without his work, this debate would probably not have taken place.
For the national health service to carry on being the world-class service it is today, the public, our constituents, need to have faith not only in the fantastic doctors, nurses and porters and those who run the frontline services, but in the management of our hospitals and health provision. I am sorry to say, however, that the trust and feeling of commitment we need from our health service management in our part of the world are not just broken, but have completely failed.
I will not go into the history because tonight I want to talk about the urgent care centre, but the history of what has been happening to out-of-hours and urgent care, including A&E, in my constituency has been going on for many years. The previous Labour Administration decided to close the A&E and all acute services at the Hemel hospital after they had already been closed at the St Albans hospital, with all services moved into a Victorian hospital next to a football ground in Watford. We will not dwell on that tonight, however, but will come back to it on another evening.
As part of the sop to my community, we were given an urgent care centre—24/7, seven days a week, throughout the day and night—and next to it a walk-in GP centre. I was therefore surprised when Ms Fisher, chief executive of the West Hertfordshire Hospitals Trust, phoned me just before Christmas to say that, sadly, the urgent care centre would have to temporarily close on safety grounds at night. I was shocked by that, not least because the A&E in Watford struggles greatly, so the more people we can encourage to use other NHS facilities instead, the better. I said, “This is happening over Christmas which is one of the busy times,” and was told, “Don’t worry, Mr Penning, it’s only a temporary thing and we’ll have it open again just after Christmas.” They then put out a press release headed “Temporary overnight closure of Hemel Hempstead Urgent Care Centre”. Interestingly, that press release is still on their website today. I actually printed it off before I came into the Chamber this evening. As I go through my comments, Members will realise just how false that statement was.
One of my constituents then contacted Three Counties Radio, and Justin Dealey, its excellent reporter—
Sir Mike Penning
Thank you, Mr Speaker. I have even longer to pontificate, which is great news.
Justin Dealey acquired an interview with the said Ms Fisher, the chief executive of West Hertfordshire Hospitals NHS Trust. It was quite a long interview, in which Ms Fisher indicated:
“This is a short-term measure which is us acting in the interest of patient safety because, for the next few weeks over the festive period, we are unable to secure GP cover.”
I think most people would understand that, but not if they knew that the GPs were working in the room next door. But that is a separate issue. Justin went on to suggest that surely Ms Fisher understood that local constituents would have real concerns, and asked her whether she would be concerned if she lived in the area. She said:
“I completely understand their concerns, but what I want to reassure the residents of Hemel is that if there were to be any permanent change it would be our absolute intention to include people fully”
in that decision. She went on to say that
“legally we would be obliged to consult for a permanent change of that nature.”
That press release was issued not before Christmas this year but in December 2016. We have had no night provision at all in Hemel since then. Everybody has to go for urgent treatment to Watford A&E. Alternatively, they have to dial 111, which is an excellent service, but after they have been triaged they apparently get sent to Watford A&E. Watford has just come out of special measures, and I praise the work that has been done at the hospital but there is still a lot more to be done.
Jim Shannon (Strangford) (DUP)
I thank the right hon. Gentleman for giving way. I sought his permission to intervene on him beforehand. He is outlining very well the issue with the Hemel Hempstead urgent care centre. Does he agree that, although there is immense staffing pressure, closing or scaling back on urgent care units and minor injury units only adds to the pressure on A&Es? There must be more investment in these mid-level centres if we are to prevent the A&Es from crumbling under the weight of the work they have to do.
Sir Mike Penning
I clearly agree with my hon. Friend. It was kind of him to come and tell me that he wanted to intervene on me on behalf of other parts of the country that are facing similar pressures.
This was not about money. Normally, when our constituents come to talk to us, especially about the health service, it is about money. They tell us that they are really concerned that there is not enough money to provide the services, but on this occasion we were told that this was nothing to do with money. It was to do with the contractual problem with the GPs. We kept on asking what was going to happen, and then—completely out of the blue and still without consultation—we were told that the Government had said that there should be no more urgent care centres and that they should become urgent treatment centres instead. I was repeatedly told that it was the Government saying that this should be done. I asked whether the Government had said that the centre should not be open 24/7. I was told no, but that we had to move to being an urgent treatment centre. In the past couple of weeks, the unit has changed from being an urgent care centre to being an urgent treatment centre. Interestingly enough, that means that paramedics and nurse practitioners are running the facility, and in many cases—without being rude to our GPs—they have more skills than a basic GP. I have to declare an interest, in that I was a military paramedic, so I am slightly biased about these things.
Was there a consultation before that decision was made, not just to close the UCC but to change to a UTC? No, there was not, even though it is a legal requirement to have one. We are now in a consultation, however. I could not believe it when I first heard this, but I have now heard from several constituents that in the actual meetings that took place—not when people were writing in—when different plans and options were being put to my constituents, a member of the clinical commissioning group staff was at the table trying to convince the public what sort of option they should go for. If we are going to consult the public, surely we should trust them and then have the confidence to listen to them.
What I find really fascinating about what is happening in my part of the world is that people from nowhere near my constituency—from the other side of Watford—are being consulted. They would never come to my facility in a million years—unless they just happen to be in the area—but they apparently have the same rights in this consultation as my constituents, who are again losing facilities hand over fist. Those other views are being taken into consideration because they happen to be part of the trust area. My constituents just scratch their heads and say, “This is illogical.” This facility, even though it is part of the NHS and anybody could come to it, is obviously being used by the largest town in Hertfordshire and the other towns and villages within Dacorum. However, I have no problem with the people of St Albans being consulted over this, because they are clearly part of the process.
Trust has been severely damaged. A highly paid chief executive of an NHS trust went on the radio—telling an MP is one thing, but going public is another—and tells listeners, “This is temporary. Please do not worry; it will all be okay. By the way, if I did actually change the service, that would be illegal because I have not consulted.” Frankly, when they then did not consult—the UCC is quite clearly never going to open again—that breaks the trust.
I have raised the accountability issue in the House before. It is absolutely right that my good friend the Minister on the Front Bench does not make decisions about what A&Es and UCCs are open and how many beds there should be. Those are quite clearly clinical decisions that should be based on knowledge and demand in the area—that is not what happened when our A&E was closed—but we seem to have moved from one extreme to another. I am told that if we want to challenge the consultation, the only way is to put the decision to judicial review based on the consultation. We tried that when the A&E was closed and we got a judicial review. The judge was generous and said, “You have a moral case, but you probably don’t have a clinical case. You don’t have a case in law, because the consultation was done.” However, if the consultation was a complete sham or did not take place at all, where do we go?
I have asked Ministers, I have tabled questions and I have been to see the Secretary of State. At the end of the day, who are these people accountable to? I know that we can go to the health committees at the local council, but they do not have the powers to say that an individual or a trust has brought the NHS into disrepute, and yet that is what has happened here. Nobody was twisting the chief executive’s arm to go on the radio and say what she said. We all listened to it—I got a transcript the following morning—and I sat with Justin and said, “Well, that’s it, Justin. We’re okay.” I was not at all happy about the facility being closed over the 2016 Christmas period, but at least we knew that GPs were going to be recruited and that we were going to get there.
However, the exact opposite has happened. We are not getting the GPs back, and now the facility being open 24 hours a day is only one of the options. I know that the Minister’s notes will say how many people used to go to it at night and so on, but half the problem was that it was never properly promoted. There are access issues at the A&E because so many people are turning up and being triaged when a huge percentage of them do not need to be at an A&E but somewhere else within the NHS. I would argue that they should be at a UCC or UTC or that a GP should come out to them, but that is a separate issue because hardly any GPs make home visits in my constituency.
I know exactly how things work, because I was a Minister for a while and know about the advice that comes down from the trust and the clinical commissioning group, which will say things that are different from what I have said. However, I can honestly say that if there is one issue in my constituency that absolutely unites every political persuasion on my patch, it is the acute health provision in my constituency. We pushed a coffin on a hospital trolley all the way from Hemel Hempstead Hospital to Watford, to indicate that lives would be lost. We had debate after debate with the ambulance service, which said, “Don’t worry, we can get the ambulances there on time.” It probably could, if it rushed them through on a blue light in the middle of the night—if an ambulance was available. Because of the previous Administration’s botching of the regionalisation of the ambulance service, there are often not that many ambulances available, even though the ambulance depot is on my patch.
People do not want to clog up A&E; they want to have the confidence that there is somewhere safe that they and their kids can go for treatment. We have no idea what the conclusion of this retrospective consultation will be. We have no faith that even if the conclusions are in agreement with what we want, we will actually get it. Not all my constituents agree with me, but in a treatment centre I would rather have a highly qualified paramedic nurse practitioner than—I have to choose my words carefully here—an ordinary GP, simply because the paramedic nurse practitioner has so much experience in that area. That is where the modernisation of the health service has been so brilliant. But after telling me that the decision was not about money, it is, frankly, disgusting to sit people down at consultation meetings and try to convince them that it would be better if the centre was not open 24 hours a day.
I hope that the Minister understands how passionate we are about the matter. My constituency is 17 minutes from London and it shares a boundary with yours, Mr Speaker. People in the top part of my constituency all go to Luton and Dunstable—quite rightly so; it is an excellent facility—and those in the bottom part of my constituency, or anyone who comes off the M1 and the M25, end up going to Watford for their acute care.
I want Watford General Hospital to succeed. I think the location of the site is completely ludicrous, and we need a new general hospital for the growing population in our part of the world. I know that you have pressures on housing, Mr Speaker, as we have. But I want the houses, because I want people to have somewhere to live—so many families are struggling at the moment—and if we are to build those houses, we need facilities, such as schools and everything else. When my constituents go to bed at night, they need to know that the urgent care centre is open in case something happens; and that if they cannot cope, we can blue-light them to Watford or to Luton and Dunstable.
I have tried for weeks and weeks to get this Adjournment debate. My hon. Friend the Minister is lucky, because I had been asking for a 60-minute debate in Westminster Hall. We may yet end up there, but that will depend a lot on what he says from the Dispatch Box.
The Minister for Health (Stephen Barclay)
I will do my best to address the issues raised by my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) in order to pre-empt the further debate to which he alludes. I congratulate him on securing this debate. I commend him for his continuing and passionate campaign on behalf of his constituents, and for his expertise on health issues, which he has brought once again to the House.
I reiterate the fundamental principle for all service change in the NHS: it should be based on clear evidence that it will deliver better outcomes for patients. That is the framework that is applied. I understand that my right hon. Friend is concerned about the changes proposed in his constituency. He will appreciate, not least as a former Minister, that I cannot say anything that would prejudice the outcome of the ongoing consultation, but he has spoken powerfully about his concerns in the House tonight.
I am sure that my right hon. Friend agrees that any decision should be driven by what is best for the constituency clinically, by what is best for the health service in the area, and by what is of most benefit to the greatest number of people in the area. I shall briefly set out some of the background, as I understand it, to the issues that inform the consultation. As he mentioned, in December 2016, the urgent care centre was temporarily closed overnight because of concerns about patient safety as a result of problems with staffing the GP overnight shifts. The CCG’s advice was that the urgent need to address patient safety issues did not allow time for consultation about that temporary change. I appreciate the concern that he raised about the manner in which that decision was taken.
The local NHS has worked hard to manage the consequences of the decision. I understand from the CCG that the volume of overnight patients at the centre was relatively low, and that the impact that has been felt at Watford General Hospital, notwithstanding the other challenges it faces, has been of the order of one or two patients per night, usually those with relatively minor injuries. As my right hon. Friend will be aware, emergency cases have been sent to Watford since the closure of Hemel Hempstead’s A&E in 2009—he referred to the protest involving a coffin about that decision, which was taken under the previous Labour Government. On provision in the early hours of the morning, he will also be aware that journey times then will be shorter than they would be at the times when the urgent care centres are open.
Sir Mike Penning
Let me go back a fraction. If the decision has to be based on clinical advice—I understand the principle—what is the point of consulting the public, who are not clinically trained? We have to consult them, because that is what the law says, so is the law wrong for saying we should consult people who are not clinically trained? If the decision has already been made, what is the point?
Stephen Barclay
The public consultation is to inform the discussion with clinicians. If such a decision were taken by Ministers—my right hon. Friend alluded to this in his remarks—it would likewise be informed by public consultation. That is part of running a transparent and open process.
The CCG is now consulting the public on future opening hours, following a broader urgent care strategy review. The consultation seeks views on three options: retaining the current temporary hours; increasing the temporary hours by two hours at the end of the day; or re-opening on a 24-hour basis. As it runs until 28 March, I know that my right hon Friend and his constituents will wish to share their views as part of the process.
I do understand the criticism made by my right hon. Friend’s constituents that the overnight closure has been dragging on for too long and that a final decision needs to be made as soon as possible. The views gathered during the current consultation will inform the CCG’s decisions about the future opening hours for Hemel Hempstead UTC, as well as about the contract for West Herts medical centre. I further understand that the CCG has commissioned an independent research company to review and analyse all the comments received, and the feedback will be compiled into a summary report. That will be presented to the Herts Valleys CCG board meeting, in public, on 26 April, when a decision on both issues will be made.
Turning to the issue of the treatment centre’s status, on 1 December 2017, Hemel Hempstead UCC changed to a UTC, as part of national measures introduced by NHS England. I understand from the CCG that this was a change of name, not of service. The CCG therefore did not carry out a further consultation on the establishment of the UTC as it did not feel that that represented a significant change in service. I understand that no services have been withdrawn from the UTC, but there have been a number of enhancements, including: the introduction of a number of bookable appointments through NHS 111; the addition of near patient testing for some conditions, reducing waiting times and reducing the need for patients to attend Watford General Hospital for some tests; and an improved IT system, meaning that medical staff will be able to access patients’ records if they give consent. The CCG also expects services to expand to include other professionals, such as pharmacists, emergency care practitioners, those providing access to mental health services and community nursing staff.
That also dovetails with some important changes in planned care locally. I understand from the CCG that improvements in the treatment of musculoskeletal disease mean that the single point of access triage at Hemel can direct people on to community physio, where that meets their needs. That is good for the individual patient and also ensures that capacity in the acute settings is able to concentrate on those with more complex needs.
Sir Mike Penning
The Minister has just told the House that there has been a complete change in how physiotherapy is provided—it was provided at the hospital and is now provided elsewhere. There was no consultation on that, although I understand that there was a requirement to do so, because this involved a complete change of service in respect of where people go and so on. The point I am trying to make is: when there is no consultation, what do we do? Do we just sit back and say, “Okay”? Some kind of measure has to be taken when consultation continually gets ignored or does not happen at all.
Stephen Barclay
The distinction that was being drawn was in respect of services that have been removed, on which my right hon. Friend is right that there is a legal requirement for a consultation. He has expressed to the House his concerns about the process by which that temporary decision on patient safety was taken. The point I was making was that the services that have been brought to the area are bringing a benefit to the local community. I would have thought that they would be welcomed. Indeed, from April, many patients with diabetes in the area will no longer need to travel to Watford to be seen by a consultant, because the consultants will be coming to them by working in the community. Again, that is good for patients and for the system as a whole. It is part of the way in which these systems evolve: some services come closer to the community, while others, as under the decision taken by the Labour Government in 2009, are rationalised into Watford A&E.
I understand my right hon. Friend’s frustration that in his view the local CCG seems out of touch with popular opinion. Given the way in which he champions the community that he represents, I know that he is not out of touch with popular opinion—he always speaks in a well-informed way about his constituents’ needs, and I would expect that to be represented in the consultation responses that the CCG receives. The CCG is accountable to NHS England for fulfilling its functions. It is also a member of the health and wellbeing board, at which local authorities and other partners can challenge how it has been fulfilling its functions. The CCG’s activities are subject to scrutiny by local authorities and to supervision by NHS England. If NHS England believes that the CCG is failing to discharge its functions, it has the power to intervene and issue directions, or to replace the accountable officer.
It is worth reiterating that all proposed service changes should meet the four tests for service change. They should have support from GP commissioners; be based on clinical evidence; demonstrate public and patient engagement; and consider patient choice. It is right that such matters are addressed locally, where local healthcare needs are best understood, rather than in Whitehall. I think my right hon. Friend recognised the point about Ministers not making clinical-led decisions. For those reasons, I am sure that he will appreciate that I am not able to offer the House an opinion on the merits of the proposals, but of course we recognise that changes to health services inspire passionate debate, as they should, from all quarters, as we have seen this evening.
There is no standard approach on what an urgent care centre should offer. The offer varies between different urgent care centres, depending on the services required locally. Urgent care centres can treat a range of injuries, including sprains, strains and broken bones.
Sir Mike Penning
I want to help the Minister. The urgent care centre is gone. We do not have an urgent care centre; it is now an urgent treatment centre. This is something that confuses my constituents as well. I was trying to make two points. First, it is not just about the clinical commissioning group on its own. The decision to close over Christmas in 2016 was made by West Hertfordshire Hospitals NHS Trust, and it cannot escape blame, because it was the trust’s chief executive who made that decision and went on and acted. Secondly, it is also about the lack of knowledge and understanding of the community. We have had a churn of people coming through and running the services. They seem to come and go and come and go, never understanding or empathising with the constituency.
Stephen Barclay
Before my right hon. Friend’s intervention, I was just coming to the urgent treatment centre, because there is obviously a distinction. Urgent treatment centres are about standardising the range of options and simplifying the system so that patients know where to go and have clarity about which services are on offer. My right hon. Friend made the point about how we direct footfall and constituents into services at the right point to reduce the demand on the A&E at Watford by simplifying what the UTC does, what it offers and how that is understood by constituents.
Patients and the public will be able to access urgent treatment centres that are open for 12 hours a day, and that are GP-led and staffed by a range of clinicians with access to simple diagnostics. They will have a consistent route to access urgent appointments offered within four hours and booked through NHS 111, ambulance services and general practice. A walk-in access option will also be retained. They will increasingly be able to access routine and same-day appointments, and out-of-hours general practice for both urgent and routine appointments at the same facility where geographically appropriate. UTCs are also part of a locally integrated urgent and emergency care service working in conjunction with the ambulance service, NHS 111, local GPs, hospital A&E services and other local providers.
In conclusion, these are important issues, and decisions should not be taken lightly. The location of services is a difficult and often controversial issue, and my right hon. Friend is to be commended for his campaign and the points that he has made on behalf of his constituents.
Sir Mike Penning
It is not often that we get more time to speak in this place, so while I have the Minister at the Dispatch Box, can he answer this very simple question: what recourse is there for me, as the MP, and for my constituents when we are misled—I know that I have privilege, but I am using the word “misled”—by a senior NHS management team about what is going to happen to the urgent care service? I am talking about when what the team says turns out to be completely untrue. What recourse is there so that we can start to rebuild some trust in my constituency?
Stephen Barclay
As my right hon. Friend knows, it would be inappropriate for a Minister to comment on a specific allegation such as that from the Dispatch Box. I cannot comment on this specific consultation, which is under way as we speak. The point that has come out of this debate is that the decision of December 2016 was taken on patient safety grounds, owing to a difficulty in recruiting GPs at that time. A consultation is now under way, and it is for my right hon. Friend’s constituents to make their case as part of that consultation.
The people affected by these changes need to be involved in the decision; that is what the consultation will seek to achieve. Our starting point for discussing service change is that there will be no changes to the services that people currently receive without proper public consultation. I therefore urge my right hon. Friend and his constituents to make their voices heard as part of that consultation in the usual way.
Question put and agreed to.
Medicines and Medical Devices Safety Review
Mike Penning Excerpts(6 years, 2 months ago)
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Mr Hunt
I do not accept that there is a contradiction. We have to be open to the science and we have to be led by the science at every stage, and if there is new scientific evidence, we must absolutely take that on board. We must also always be led by patients in what we do, and that is exactly what I am announcing.
Sir Mike Penning (Hemel Hempstead) (Con)
It was a pleasure to lead the debate in the House when we secured time from the Backbench Business Committee to discuss this. I really appreciate the tone adopted by the Secretary of State, and by the Prime Minister when I asked her earlier if there was good news. May I also pay tribute to the Minister, my hon. Friend the Member for Winchester (Steve Brine), who is sitting next to my right hon. Friend the Secretary of State, for the work that he did, because I gave him really quite a hard time during the debate?
However, there will be huge disappointment among the Primodos campaign team. The idea of being led by the science from the expert working group is fascinating, because it refused to allow some science to come forward as it had not been peer-reviewed, but then accepted a load of other evidence from the drug companies. On this review going back to the Department of Health and Social Care, it is implicated in this, in that these drugs were given out by GPs in surgeries without prescription, so that will give no confidence at all. I therefore think that the Baroness will have both hands tied behind her back when doing her work.
Mr Hunt
I commend my right hon. Friend’s campaigning, but I am afraid I have to disagree with him. This is an important step forward; we are absolutely going to be led by the science—we have to be led by the science—and we are giving Baroness Cumberlege full rein to look at what the expert working group did, and to challenge it if she thinks fit.