NHS Spending
Mike Weir Excerpts(7 years, 10 months ago)
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Mr Hunt
It is perfectly reasonable to make the assumptions that the hon. Gentleman mentions, and there are plenty of reasons why we could look at some of the early impact on the economy even in the past 12 days and be concerned about the potential impact on the tax base and public spending more broadly. My nervousness as a Minister about talking those things up is that I do not want to talk down the British economy. Even though, as I say, I campaigned against the Brexit vote, I recognise that we are now going to leave the EU, I want the economy to be successful and I want us to make the most of the opportunities that face us.
On the broader issue of NHS funding, this debate indicates that there is some consensus—the Prime Minister mentioned this earlier today at Prime Minister’s questions—on the umbilical link between the health of the economy and the amount we are able to spend on the NHS. We are proud of the fact that we were able to protect spending in the last Parliament and to increase it by £10 billion in this Parliament on the back of a growing economy. Given that Health is the second biggest spending Department, we must recognise that it is vital to the NHS that we maintain that growth, despite the choppy period we are possibly about to go through.
Mike Weir (Angus) (SNP)
I understand what the Secretary of State is saying about the health of the economy, but this debate also links to the previous debate because of the number of EU nationals who work in the health service. Has he made any estimate of the cost to the health service if all these EU nationals were forced to leave the UK in the course of this Brexit?
Mr Hunt
We are currently doing the analysis the hon. Gentleman is concerned about, but I should just say to him that I accept the Home Secretary’s assurance and confidence that we will not end up in a situation where EU nationals, upon whom we absolutely depend in the health and social care system, and who do an absolutely outstanding job, would not be allowed to remain in the UK. She has said she is very confident that we will be able to negotiate a deal whereby they are able to stay here as long as they wish and to continue to make the important contribution they do, and I accept that assurance.
Dr Whitford
I was not on the planet in 1956, so I do not quite remember. We know from the recent cheating that there is a lot more work to be done on the control of car emissions, which cause a lot of ill health, but some of the progress in that area has come from EU regulation. Problems such as poor air quality and climate change cannot be dealt with by one country alone; we need to work together. In a health sense, we have had massive gains in the past 40 years, but politicians have never talked about that.
The EU has been a great whipping boy. All that the public have heard about the EU in the last 40 years is, “It wasnae my fault; the EU made me do it,” or stories about straight bananas. That is the responsibility of everyone who has had access to a microphone or spoken in this place about the EU. We should not be surprised that when people had the £350 million figure drummed into them by it being on that bus and on the news every night, they would fall for it. The mainstream media have a lot to answer for in not challenging these figures and not asking, “Exactly what is your plan? Exactly where is that money going to come from?” We should not blame people who want extra money for the NHS for wishfully accepting those claims, even when the cracks appeared around the edges.
Part of the problem has been the quality of the debate. Several of my colleagues warned people who believed in remain not just to go for a “Project Fear” type campaign, and I think that running such a campaign was a mistake. People think that “Project Fear” worked in Scotland, but in actual fact Better Together support started, as a percentage, in the mid-60s and fell to 55%. We started at 27%, and we ended up at 45%. “Project Armageddon” clawed back a little bit in the last two weeks, when we were told that the supermarkets would go and the banks would go, and that we would have no money and no food to buy, but a negative campaign of saying that the sky will fall does not lead to success.
Dr Whitford
I thank my hon. Friend for that remark. If we had spent more time reminding people honestly of what the EU has brought us, which includes all the people who have been working in our health and social care services, we might have helped them to realise that we have been gainers, not losers.
World Autism Awareness Week
Mike Weir Excerpts(8 years ago)
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Mike Weir (Angus) (SNP)
I, too, congratulate the right hon. Member for Chesham and Amersham (Mrs Gillan) on securing this debate. Like the hon. Members for Berwick-upon-Tweed (Mrs Trevelyan), for Birmingham, Yardley (Jess Phillips) and for Stalybridge and Hyde (Jonathan Reynolds), I want to add the perspective of a parent of a child with autism.
My younger daughter, now in her 20s, is autistic, with associated learning and communication difficulties. I, too, went to the launch of the booklet, “Too Much Information”; it is excellent and I recognise much of what appears in it. There are two telling statistics on page 2: 87% of families living with autism say that people stare at their child’s autistic behaviour; and 74% say people tut and make disapproving noises. Over the years, I have experienced both of these. Like many parents, I developed a very thick skin. I know one parent who said that the worst thing for her was that people who she knew and spoke to regularly would ignore her when they met her and she was accompanied by her autistic son. How hurtful can that be?
One of my constituents, Karen, contacted me ahead of this debate and asked me to say something about her experience. This is what she said:
“I have two children with autism who find going out overwhelming. I have one that will try and hide while the other will shout, become aggressive or laugh hysterically. We are stared at by the public and comments are made regarding my ability to parent or that my children are spoiled. My eldest is becoming aware of these comments and this causes her psychological distress.”
Many parents will recognise that.
As parents we find different strategies to deal with our children’s behaviour. It is often the unexpected that hits us. Our daughter was, and still is, fascinated by Disney cartoons. When she was younger, her favourite was “Cinderella”, especially the mice that were Cinderella’s friends, Jaq, Gus and Suzy. She has soft toys from the Disney store, and she carries them everywhere. We took her on holiday to Disneyland Paris. On the first day there, Cinderella was out and about, and we took her to meet her and her friends—but, of course, the mice she met were not the small characters she expected. They were bigger than her, and she simply could not cope with that—it was not what she expected. Like other families, we spent the rest of the holidays checking where the characters would be on each day—but they to go and meet them, us to discover ways and routes to avoid meeting them.
We face a similar problem every year with summer fairs, coffee mornings and similar events, now that so many have face painting for children. Our daughter simply cannot comprehend what is happening when children have their faces painted to look like a tiger, a cat or some other animal, and she will freak out if she sees it. We have to carefully avoid taking her to such events.
My daughter still loves her cartoons, particularly “Thomas the Tank Engine”, which she watches on video so she can pause, rewind and watch repeatedly small sections that appeal to her. Frankly, after 20 years of this, I could cheerfully strangle the Fat Controller, but I also live in fear of the day when the video machine finally gives up the ghost, because such machines are not so easy to get hold of these days.
In many ways we are lucky: we live in a small town and most people know us; our daughter is well known in the local shops and particularly in the charity shops throughout Angus where she hunts for videos. She is accepted, and no one really bats an eyelid at her sometimes seemingly odd behaviour. In common with many autistic people, my daughter needs the comfort of routine. When we go shopping, we go round the shops in a specific order. It may not be a logical order to anyone else, but that is the order in which it must be done. If it is not, there will be trouble.
If we are going to do something different from our usual routine, we need to lay the groundwork well in advance, explain what we are doing, when we are doing it and why, and let our daughter think through it and mull it over for some time, discussing the implications with her. Sometimes we can manage to do that.
I am conscious of the fact that this may all sound a little depressing, but as with any child, there are joys as well as challenges. One of the things my daughter’s school did was to take her to Riding for the Disabled—and she took to it like a duck to water. Neither I nor my wife had any background with horses, but our daughter was captivated and formed a real bond with the horse. It is quite incredible and joyful to see her on a horse, concentrating on what she is doing and on the direction of the instructor as she guides a horse around the course, making it trot and being very much in charge. I remember going up to the stable on one occasion to find her being given a frightening-looking instrument to hoick stones out of the hooves of a horse. My daughter was cheerfully doing that—something I would never have attempted.
I was a practising solicitor at the time, and my wife—rather ironically, perhaps—had been a teacher of children with special educational needs, yet we had difficulty in negotiating the system and securing education that was suitable for our daughter. We first had to obtain a record of needs, which, at that time, was a passport to the provision of the educational resources required. It sounds easy, but we faced the apparent reluctance of professionals to give a clear diagnosis of what was wrong with our daughter. That is an experience that many other Members have described. The education department involved said that a child should not be labelled; the cynic in me wonders whether that was because once a record of needs had been granted, the facilities would have to be put in place and costs incurred.
After that, we needed to find a suitable school. We looked at many before we found one that we felt understood the difficulties and offered a way forward. It was not within our local authority area, although it was close to our home, and we had to negotiate around that to ensure that funding was available. A deal was done, which required us to arrange transport to the school ourselves. That school made a great difference to our daughter. It was a small school attended by other children with special needs, and it had an excellent speech therapist. Our daughter flourished, and, as I said earlier, it was there that she got into horse-riding.
Are things better today? Yes, I think they are. Are they perfect? No, of course they are not: there is a huge amount still to be done. As some of my hon. Friends have pointed out, the Scottish Government have a strategy for autism, which is a real attempt to bring services together and ensure that autistic people are given the assistance that they need. That does not apply only in the public sector, but I should mention that in Arbroath we now have a fantastic community dentist. We had great difficulty in persuading anyone to look at our daughter’s teeth, although not because it was thought that she might bite them if they tried! The community dentist, however, had been trained in providing dental care for autistic people. Our daughter was introduced to the dentist’s surgery gradually: she was taken into the waiting room first, and was taken gradually onwards. The dentist managed to look at her teeth, and they were fine, which is just as well.
As I have said, however, the Scottish Government’s strategy does not involve just the public sector. A few years ago Aberdeen airport introduced a similar scheme, allowing autistic people to visit the airport and become used to it before their first flight. Cinemas and theatres are now putting on special shows for autistic people: the sound is lowered and the lighting increased to make the experience easier. However, difficulties remain, and many other Members have spoken of them.
In my experience, the transition from education to life after education is very difficult. In many instances, there are not many facilities for autistic people. It can be very difficult, especially in rural areas, to find somewhere to move on to after school, and the future is uncertain when it comes to such matters as housing. At our age, our thoughts begin to turn to what will happen when we are gone. What housing and other help are available to people like my daughter, who will never be able to lead an independent life? All authorities must consider that growing problem.
If there is one thing that I would ask of those who are watching the debate, or who will read the report of it, I would ask them to get hold of the National Autistic Society’s excellent booklet. The next time they see a child being loud or inappropriate, or a parent having difficulty controlling a child, they should not assume that it is a case of bad parenting or bad behaviour, as my constituent Karen said. Something else may be going on, and it could well be autism.
Operational Productivity in NHS Providers
Mike Weir Excerpts(8 years, 10 months ago)
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Mike Weir (Angus) (SNP)
I am glad to speak in this important debate under your chairmanship, Mr Pritchard. I congratulate the hon. Member for Hendon (Dr Offord) on securing it.
Obviously, in Scotland the situation is slightly different, because the NHS is devolved, but many issues cross over, wherever our health services are located. I was very interested in some of the points made. NHS Scotland has produced a framework for efficiency and productivity going up to 2015. We recognise that it is essential to be more efficient and productive, to ensure careful use of the public purse.
To an extent, the situation in Scotland is slightly different, because the NHS budget has been protected from cuts as a result of the Scottish Government’s action. However, we still face inflationary pressures arising from demographic changes and increasing drugs and staff costs, which mean that NHS boards will need to make a minimum of 3% efficiency savings just to break even.
I was interested in what the hon. Gentleman said about the many issues faced by the NHS, particularly in England. I understand that much of the savings to date have been made by freezing staff salaries, squeezing prices paid to hospitals for the treatment they provide and cutting management costs. I wonder whether there is a correlation between those savings and the frauds and difficulties in some hospitals, which he mentioned. We all want to cut management costs, but sometimes there is a cost to doing that, because if management is cut back it cannot have the same hands-on experience of what is going on in all areas of the operation. That has to be weighed in the balance when we consider such savings.
The hon. Gentleman talked about the Carter review and the time spent by people on the frontline, whether with patients or doing other things. Again, that has to be built in. The hon. Member for Coventry South (Mr Cunningham) made a good point about the difference between productivity and efficiency. A staff member could be deemed much more efficient if they just dealt with patients, but down time for staff has to be worked into the system, because any doctor, nurse, or other NHS staff member will be working at a high level for very long periods. There are dangers if down time is not built in.
All of us would want savings made where they can be safely made, but the hon. Member for Bristol South (Karin Smyth) made an interesting point about the King’s Fund, which estimates that another £30 billion of savings will be required by 2020-21. The Government have made much of the fact that they will put another £8 billion into the NHS. Although I am sure that is welcome, it still leaves £22 billion in savings to be achieved through productivity improvements. With the best will in the world, I find it difficult to envisage £22 billion of savings being made through productivity improvements in the NHS. If it can be achieved, that is fair and well, but it does seem a very tall order, as the King’s Fund stated.
An organisation cannot keep freezing staff wages forever; there will have to be a change in that regard. Management costs cannot be cut indefinitely, because, again, management is needed to run the system.
Mr Jim Cunningham
Admittedly, it has been some years since I was involved in negotiations relating to productivity, and so forth, but the fact remains that there are consequences if people are not paid a decent wage. I worked in industries where wages were frozen and saw the consequences. The only way to increase productivity in the NHS and maybe save money—I use the word “maybe” advisedly—is by having incentives. That is the only way it can be done. It was not clear, in the speech made by the hon. Member for Hendon (Dr Offord), what percentage of people would have time off. There is a tolerable, acceptable percentage in that regard, but I was not clear what the percentages were.
Mike Weir
The hon. Gentleman makes a good point. He is right about incentives. A happy workforce will be a much more productive workforce. There is a danger of putting increasing pressure on the workforce, especially in the NHS, where mistakes can be disastrous and can do a lot of damage in the long term, both to the system and patients. We have to be careful about some of these things. I was interested in what the hon. Member for Hendon said about the cost of agency workers. I think we would all agree on that point. It would be preferable to have full-time staff in the NHS, but agency workers are used for a reason: shortages.
The hon. Gentleman also talked about people from outside the EU working in the NHS, but again, this shows that there needs to be a more holistic Government policy. The Government recently announced an earnings threshold of £36,000, under immigration policy, for those who have been working in this country for six years. Many nurses working in the NHS throughout the United Kingdom are not earning that sort of money and have been in the NHS for many years. The Royal College of Nursing stated that if this policy was imposed, thousands of nurses could leave the NHS and could have to leave the UK. That is not in the best interests of the health service at the moment. When considering efficiency savings and how the NHS can better work for all our constituents throughout the UK, we have to think about such things .
Andrew Gwynne (Denton and Reddish) (Lab)
The hon. Gentleman is making an important point. Would it not be counterproductive if NHS nurses left to work abroad? That would leave a massive gap in the NHS workforce, probably requiring an increase in agency workers, which would cost the NHS more.
Mike Weir
The hon. Gentleman read my mind: that was my next point. Agency nurses are causing a drain on resources, because we have to employ so many already. That will not get any better if nurses cannot work in the NHS because of immigration policy. These people did not come to this country a few months ago; some have been here for many years. Many of these nurses are working in hospitals in all parts of the UK, whether Scotland, Northern Ireland or England. They are also working in the care system.
The Government are making a bad situation worse, perhaps because of other pressures on them to do with immigration, and are not dealing with the realities of the health service. Training new nurses to take the place of those who may leave will not happen overnight. It takes years to train a nurse properly. If these people have to leave suddenly, they will leave a huge hole in the NHS. That raises a question about the sustainability of the system. In summing up, the Minister might like to consider that; and perhaps he will take the matter up with Home Office colleagues and discuss the impact this policy may have on the NHS.
Efficiency savings are fine where they can be made. We are all looking for efficiency savings, and we understand that there can be some. For example, there are some interesting responses in the Carter review on medicines and prescriptions. Savings could be made there. A lot of medicines can be wasted if prescriptions are too large. Such system changes can save money, but it is wrong to look for the silver bullet that is going to change things and produce the £22 billion in efficiency and improvement savings.
Mr Jim Cunningham
If the hon. Gentleman thinks back 12 months or so, he may remember that it took a long time for the Secretary of State to reach an agreement with the pharmaceutical companies because some issues were held up. We should consider that. It seems to me that a gun was held to the Secretary of State’s head on costs.
Mike Weir
Again, the hon. Gentleman makes an excellent point. One difficulty with the NHS is the cost of medicines. All our constituents are pushing us to get costly new medicines on the NHS for diseases, including rare diseases. They might be extremely costly in the first instance for good reasons, but demand always increases costs in the system, and it is difficult to deal with that. The pharmaceutical companies have a role to play in that, because much of their business comes through the national health service. If cost savings can be made by negotiating with those companies, that should be done. I am sure that the Secretary of State will at all times try to persuade them on that point, but I am not so sure how well he will do, given the competing pressures from constituents and Members for new drugs to be made available on the NHS. None of these issues are easy, and I have some sympathy for Ministers who are struggling with them, especially given the pressures on all areas of Government spending, but I urge caution in looking for simple solutions.
Mark Pritchard (in the Chair)
While it will be unorthodox, it is not irregular for me to call Jim Shannon, who briefly left the Chamber during a very good speech from Karin Smyth that was slightly shorter than I expected.
Ben Gummer
Absolutely. There are examples of that all over the country, but there are also examples of people working together in what might be considered competitive situations, so it is about ensuring that we copy the best and delete the worst.
Before I turn to the shadow Minister’s comments, I want to reflect on the contribution of the hon. Member for Angus (Mike Weir). The SNP spokesperson on health, the hon. Member for Central Ayrshire (Dr Whitford), has used a constructive tone in the Chamber so far, bringing some of her expert experiences as a clinician and also the experiences from Scotland. It is nice to be able to sit here and hear the experiences of people in Northern Ireland and in Scotland, and it would have been nice to have heard from Wales in this debate. Indeed, we do not yet properly learn from the best in Scotland, which would be all to our good, let alone the best in America or India.
The £22 billion in savings is an estimate not from the King’s Fund but from NHS England. It formed part of its plan, devised at the end of last year and some years in the making, which identified £30 billion of additional money that needs to be put into the service over the next five years. It stated that £22 billion could be generated internally—that was Simon Stevens’ estimate—which leaves an £8 billion shortfall. That is what we are pledged to provide. None the less, he, like everyone in the Chamber, has correctly seen that £22 billion is a large number and one that will take a great deal of intellectual and moral work to deliver. I welcome the tone with which everyone has approached this challenge in the debate.
Ben Gummer
It is not a tall order, but it is a challenging one. Whoever was sitting in my place, from whatever party, would be facing a similar challenge, no matter how the needs over the next five years were framed. The challenge must be addressed, and it is better addressed if we all come together to do so.
The hon. Gentleman touched on pharmaceutical savings, which I have not yet addressed, and Lord Carter’s comments on them. Lord Carter will make more detailed recommendations later in the year, but the hon. Gentleman is absolutely right that there is much to be done to ensure that we save money on the provision and purchasing of drugs and by not wasting them. Lord Carter is looking at that, and the service is already implementing his initial recommendations.
New drugs are a problem faced by health services across the world. Indeed, it is a profound challenge, because the new drugs coming online are of an expense that has never been experienced in health systems before. They are also for increasingly small numbers of patients, precisely because they are personalised, which drives up the cost even further. That is why the Under-Secretary of State for Life Sciences, my hon. Friend the Member for Mid Norfolk (George Freeman), is bringing forward his accelerated access review and doing some exciting work, trying to use the muscle of the NHS—our ability to be an research lab, effectively—for those developing new drugs, so that we can use the NHS to drive costs down and provide patients with treatments earlier and more cheaply. There is a win-win there, but it requires a fundamental change in the system, which at the moment is not working.
Finally, I turn to the comments of the shadow Minister, mindful of the need to give my hon. Friend the Member for Hendon time to wrap up. I thank the hon. Member for Denton and Reddish for his kind welcome; it was good of him to say that. I hope that over the next couple of years we will be able to thrash out some of these difficult issues in the manner in which he has begun the process. If we do so, we will come to a better understanding of what is needed in our national health service.
The hon. Gentleman asked a number of questions, such as where the £8 billion is coming from. I believe it is coming from general taxation—my right hon. Friend the Chancellor will be providing greater details of that in the Budget next week. The hon. Gentleman also asked where the £22 billion was coming from. NHS England has devised the plan. It is NHS England’s plan to implement, and it will provide further detail about the £22 billion shortly. It will be an evolving plan that will necessarily change over the five years. NHS England is confident that it is achievable, but it will take some incredible heavy lifting by all of us and, dare I say it, the dropping of political shibboleths throughout the House—if one can drop a shibboleth; I am not sure.
The hon. Gentleman raised the issue of provider deficits, which is a problem across the system. He will know that there was a similar issue towards the end of the Labour Administration—in CCGs, rather than in hospitals. It does not necessarily require more money; it requires getting a grip on where the problem is. We have started that with announcements on agency spending. Many trusts in the country are doing well financially. Not surprisingly, they are often the trusts that are also delivering good care, because—to return to the comments of the hon. Member for Bristol South—if the care is right, the money flows from it. That is why Lord Carter’s review and a concentration on care quality will, we hope, produce the savings that we need, not just at this immediate moment to address provider deficits, but to achieve the £22 billion.
The hon. Member for Denton and Reddish also mentioned sales reps and procurement. I absolutely agree that the subject is covered in the report from Lord Carter. The numbers of product lines certainly should come down. I am not sure that the NHS, before having greater responsibility for purchasing, was any better at buying, but we need to be better at it. Procurement is a science. It is not one that I pretend to know a great deal about, but I know that in the end we will always end up in not quite the right place, because we might centralise too much, which takes away decision-making from the trust responsible. That is why we have to get the balance right.
On the cost of competition, the hon. Gentleman quoted a figure of £100 million. However, I understand that the costs of the reorganisation have been outweighed by the benefits, to the tune of about £1.5 billion annually. I think we all agree across the House on the producer-provider split. There will always be a degree of competition in the NHS; it is about getting the balance right between competition and collaboration.
In the last 30 seconds, let me touch on sub-acute services. The hon. Gentleman made his most pointed—and fair—remarks about the need to integrate social care with the NHS. The Government’s contention is that creating a new national structure for health and social care does not produce the end that we all want to see. That is why we want to see local solutions—we believe a good one is already emerging in Manchester—across the country, which will suit different areas according to their needs. In the end, we come back to money. We all know that money will be tight in local government. Our aim over the next few years is to ensure that as much of the resources that we can put into local government are going towards social care. That is the essence of the better care fund, which lies at the heart of what we are doing on integration over the next five years. I know the hon. Gentleman will want to comment on that as we proceed on those lines.
I thank all Members who have spoken in what has been an invigorating debate from which I have learnt a great deal. I again thank my hon. Friend the Member for Hendon for raising these important issues.
National Health Service (Amended Duties and Powers) Bill
Mike Weir Excerpts(9 years, 5 months ago)
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Mr Mike Weir (Angus) (SNP)
There is an interesting argument taking place between the two Front Benchers about who is responsible for bringing competition into the health service, but the fact is that, no matter who is responsible, the health service could now come under the transatlantic trade and investment partnership. Why will the Government not specifically exclude health services from TTIP before it is negotiated?
Dr Poulter
I will come on to TTIP later, and I hope I will be able to reassure the hon. Gentleman.
The previous Labour Government attempted to make commissioners compliant with the law by publishing the “Principles and rules for cooperation and competition” in 2007 and establishing the competition and co-operation panel in 2009, to oversee Labour’s NHS marketplace. Let us be clear: it was the previous Labour Government who chose to introduce private providers into our NHS and it was the previous Labour Government who set up the legal framework to support private providers in the health service.
It has been said that
“the private sector puts its capacity into the NHS for the benefit of NHS patients, which I think most people in this country would celebrate.”—[Official Report, 15 May 2007; Vol. 460, c. 251WH.]
Once again, those are not my words, but those of the right hon. Member for Leigh when he was a Minister in the previous Government. That is a fitting memory of the previous Labour Government’s expansion of private providers in the NHS. Let us remind ourselves of the right hon. Gentleman’s words again: he said that most people in this country would celebrate the private sector in the NHS.
Physical Inactivity (Public Health)
Mike Weir Excerpts(9 years, 6 months ago)
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Mr Mike Weir (in the Chair)
Order, About eight hon. Members want to speak, and I want the winding-up speeches to start at 10.30 or 10.35, so although I will not impose a time limit on speeches at the moment, I suggest that if Members stick to about six minutes each, we can get everybody in.
Mr Mike Weir (in the Chair)
Order. I am afraid that we are now running up against the clock, so from this point I will set a formal five-minute time limit on speeches.
Grahame M. Morris (Easington) (Lab)
I also congratulate my hon. Friend the Member for Blaenau Gwent (Nick Smith) on securing this debate, and I congratulate the Backbench Business Committee on allocating time for a subject whose importance is increasingly being recognised. The Select Committee on Health, of which my good and hon. Friend the Member for Worsley and Eccles South (Barbara Keeley) and I are members, will be holding an inquiry on the impact of physical activity and diet on health, so this is a timely debate. I am sure that the evidence compiled by the Select Committee will be brought to the Minister’s attention, and that appropriate action will be taken.
Many hon. Members who have contributed to the debate have covered the general subject areas, so in the interests of brevity I do not intend to repeat the statistics, but I will mention some specific issues that affect my constituency of Easington, County Durham in the north-east of England. The figures on physical inactivity quoted by hon. Members earlier in the debate are even higher in my region. Some 32% of people in County Durham are classed as physically inactive, and all the projections indicate that the problem will get worse. Higher degrees of inactivity are predicted by 2030.
International comparisons show that our levels of inactivity are twice those in Germany and France. I thought we would be rather more active than the United States, but our levels of inactivity are 20% higher. It is generally recognised that physical inactivity is a considerable public health problem. The numbers of people who are likely to suffer as a consequence of physical inactivity were identified earlier in the debate. It has been suggested that physical activity can help to combat, or at least delay the onset of, conditions such as heart disease, type 2 diabetes, obesity and even dementia.
The costs are not just for the individual; there are also costs for communities and our economy. There are various estimates of the cost to the UK economy, and I have seen a figure of £20 billion a year, so there are direct costs associated with the health issues. My hon. Friend said that £9 billion a year is spent on costs associated with treating type 2 diabetes, but many other health issues are also caused by inactivity. There are also indirect costs such as, for example, lost days of work and low productivity. Employers need to take note. Some 16 million working days are lost every year due to obesity-related illnesses, so improving workplace health could have an immense impact on individual businesses and the economy. It is in everyone’s interests to address physical inactivity.
There have been some welcome improvements, and hon. Members have mentioned local authorities that are trying to prioritise physical activity, but local authorities are facing considerable pressures as a consequence of cuts in central Government funding, which have inevitably had an impact on their ability to deliver activities and opportunities to engage in physical activity. My local authority, Durham county council, is one of the hardest hit, and such authorities face some of the greatest challenges in relation to physical inactivity. Such authorities have seen the deepest cuts to their overall budgets. Indeed, 13 of the 15 local authorities with the most inactive populations are located in areas that are considered most deprived or more deprived. Despite facing huge challenges, particularly public health challenges, Durham county council has had to implement £135 million of cuts in three years, with another £44 million of cuts in the pipeline.
Patient Medical Records
Mike Weir Excerpts(10 years, 2 months ago)
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Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Sir Peter Bottomley
On a point of order, Mr Weir. I do not want to intervene again, but the hon. Gentleman asked a question, the answer to which is no, it does not. Inertia is the big problem.
Mr Mike Weir (in the Chair)
As you well know, Sir Peter, that is not a point of order. It is up to the hon. Gentleman to decide whether to take interventions.
Mr Godsiff
Thank you very much, Mr Weir.
The Pulse survey found that as many as one in 12 GPs are considering opting out all of their patients from the scheme, and 33% said that they were undecided. Unless public awareness and GP confidence improves massively in the next six months, we will see huge opt-outs. What would the consequences of that be for the health service? I asked the Minister what would happen if a GP refused to upload patient data. His rather disconcerting reply was that
“NHS England would need to consider whether to take remedial action for breach of contract.”—[Official Report, 25 February 2014; Vol. 576, c. 275W.]
Will the Minister tell us whether such remedial action would make it impossible for GPs to continue to practise? Can he guarantee that doctors will not lose their jobs for doing what they believe to be best for their patients by protecting the confidentiality of personal data?
NHS England has said that it is delaying the scheme for six months because it wants to ensure that the public better understands the proposals. That is a hugely arrogant argument. NHS England is basically saying, “Look, we know best. We tried to get this through by stealth but we got found out. We will therefore delay it by six months while we try to explain it better to you, the public. We know best—we understand and you do not.” As I just said in response to the hon. Member for Worthing West (Sir Peter Bottomley), 87% of the population have considerable concerns about the scheme and do not want their data to be taken outside of the confidentiality agreement that exists between a patient and their doctor.
Mr Godsiff
No, I have given way on many occasions.
NHS England must start listening. GPs in Birmingham, where my constituency is, have said that they simply do not have time to have a proper conversation with patients about data sharing. GP surgeries are already stretched, and patients struggle to get an appointment within a reasonable time frame. Are we really suggesting that GPs should be talking to patients about the minutiae of a data-sharing scheme when ill people already cannot get an appointment? Would that really be the best use of doctors’ time?
My hon. Friend the Member for Easington (Grahame M. Morris) raised the issue of who is going to extract the information, and pointed out that Atos appears to have won the contract. At first, I thought that that was a joke, and I looked at the calendar to check that it was not 1 April. If it is seriously being suggested that Atos, probably the most loathed and inept company operating in the UK, is to be left to extract the data, all I can say is God help the patients of this country. The Department for Work and Pensions has found that 60% of Atos disability assessments have been overturned on appeal. The company is absolutely hopeless. How on earth can the Government award it a contract to extract patient data? I ask the Minister: will it be done in this country, or on the other side of the world? I have no confidence whatever that Atos will be able to retain the confidentiality that patients want.
In conclusion, some people say that the choice is between protecting patient confidentiality and saving lives, but that is a false choice. As I said right at the start of my speech, people such as me who are concerned about the scheme are not against medical research or the provision of information to allow research to go ahead. I am opposed, along with the vast majority of people in this country, to private information about patients being sold off to private companies for private gain. That cannot be right. I urge the Government to look at the issue again and listen to what doctors and patients are saying.
Mr Mike Weir (in the Chair)
Order. Sir Peter is seeking to make a speech, but given the time, I can let him do so only if both the Minister and the hon. Member for Birmingham, Hall Green (Mr Godsiff) agree to it. I do not know whether the hon. Gentleman has received any notice that Sir Peter wishes to speak.
Mr Godsiff
A number of Members had asked me whether I would mind their interventions, Mr Weir, and I took many of them, including two from the hon. Member for Worthing West (Sir Peter Bottomley).
The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)
indicated assent.
Mr Mike Weir (in the Chair)
I shall call Sir Peter, but it must be a very short speech.
Early Childhood Development
Mike Weir Excerpts(10 years, 3 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Liverpool Care Pathway
Mike Weir Excerpts(11 years, 4 months ago)
Westminster HallRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Mr Mike Weir (in the Chair)
Order. Several Members wish to speak. I want to call the first of the Front Benchers no later than 3.40 pm. A quick calculation suggests that, if Members keep their speeches to about seven minutes—and interventions are brief—I will be able to call everyone.
John Pugh
That in part is the dilemma. I know that the saying is “No treatment about me, without me”, but there are certain circumstances that we will all be aware of where the patient is dying and the clinician is in an acute moral dilemma over whether to inform them that that is the case—that there is no hope and that they will be given purely palliative treatment. I am fairly confident that a good number of people will die in our hospitals for years to come, despite the Liverpool care pathway or any other guidelines that we put in place, who will, until the moment of their decease, expect recovery.
Mr Mike Weir (in the Chair)
We have just under 12 minutes left and two speakers to go. I ask that they bear that in mind.
Health Funding
Mike Weir Excerpts(13 years, 11 months ago)
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Westminster Hall is an alternative Chamber for MPs to hold debates, named after the adjoining Westminster Hall.
Each debate is chaired by an MP from the Panel of Chairs, rather than the Speaker or Deputy Speaker. A Government Minister will give the final speech, and no votes may be called on the debate topic.
This information is provided by Parallel Parliament and does not comprise part of the offical record
Sarah Newton (Truro and Falmouth) (Con)
It is marvellous that Andrew has secured this debate so early in the new Parliament, because this is an important issue for everyone living in Cornwall. I applauded the previous Government’s efforts to focus on closing inequalities in health. However, their measure of success, which focused on average life expectancy, did a great disservice to people in Cornwall, as it masks a lot of the problems there. On the face of it, the average life expectancy is way above the national average—
Mr Mike Weir (in the Chair)
Order. I remind the hon. Lady that interventions have to be brief.
Sarah Newton
I shall wind up, then. The crude measure of average life expectancy covers up many problems of poor health and the cost of providing services in remote, sparsely populated areas to an ageing population.
Sarah Newton (Truro and Falmouth) (Con)
I add my support for all the things that Andrew has said. I should like to touch on two ways in which my constituency is affected by the underfunding of the NHS in Cornwall. First, there is the considerable debt that has been acquired by the Royal Cornwall Hospitals Trust. Andrew and I have three hospitals in our constituencies.
Mr Mike Weir (in the Chair)
Order. Let me remind the hon. Lady that she should refer to a Member by their constituency, not their name.
Sarah Newton
I am very sorry. You will have to forgive a new girl, Mr Weir. I will try much harder next time I speak. It is the first time that I have had the opportunity to speak in a debate, so I apologise for my mistake. As I was saying, the hon. Member for St Ives (Andrew George) and I share, in our constituencies, the three hospitals that are part of the Royal Cornwall Hospitals Trust. It is interesting to note that there has not always been below-target expenditure in Cornwall.
Mr Mike Weir (in the Chair)
Order. I am sorry to intervene on the hon. Lady again. She did say that this was the first time that she had spoken in a debate. She cannot speak here unless she has made her maiden speech in the main Chamber. Has she made her maiden speech in the Chamber?
Sarah Newton
It was my understanding that the rule had been waived because of the huge number of new Members waiting to make their maiden speeches. I have not yet made my maiden speech.
Mr Mike Weir (in the Chair)
I thank the hon. Lady. That has not been communicated to me, but if that is the situation, I will let her continue.
Sarah Newton
Thank you, Mr Weir. I appreciate your generosity, because the issue is of vital importance to my constituency.
It is interesting to note that there has not always been below-target funding in Cornwall. If we go back to 1997-98, we find that the funding allocation was just below the average and the hospital trusts in Cornwall were not in debt. A great gulf has arisen over the past 10 years, as has the debt that has accumulated at the Royal Cornwall Hospitals Trust. There are issues and problems at the trust, but the severe financial pressures that it has had to bear because of the unfair funding allocation over the past 10 years have definitely contributed to them, and those pressures are standing in the way of it acquiring foundation status, which would enormously improve its ability to provide excellent care to the people in Cornwall.
The other factor that I should like to mention arises from our geography. It is difficult for people in Cornwall to get to a dentist or a hospital. We have good access to GPs; most people can access a GP within a couple of miles from their home, but not a dentist or hospital. As part of a recent survey undertaken by Citizens Advice Cornwall and Age Concern, 411 people filled in questionnaires on how easy or otherwise it was for them to get to hospitals. The survey showed that a significant number of people are prevented from attending hospital by the costs involved. Of the 411 people who responded, 35 reported that the cost of getting to a hospital stopped them from attending a clinic; 28 said that it prevented them from accompanying someone to hospital; and 115 said that it stopped them from visiting friends or families.
Although I welcome the Secretary of State’s revision of the NHS operating framework yesterday, I hope that future revisions will include an examination of the whole issue of hospital transport. I say that because there is significant evidence to show that the current scheme is not always widely understood by constituents, and that some aspects of it do not work very well for people in remote rural areas who struggle to gain access to a car or public transport to get to hospital. Also, the costs involved are quite considerable for the large numbers of people living on low and fixed incomes in our part of the world.
Mr Burns
I reassure my honourable colleague that there is not a state of flux. There is a state of potential change, yes, because there is a new Government with an important vision for the future of the health service. That is a difference, but there is not a state of flux because there is stability there. I am not criticising him, but I wanted to reassure him, so that he did not get the impression that there was a state of flux, with the connotations that that has. There is no state of flux. We have a vision, which will be unveiled shortly, but we have things in place to make sure that the system is running properly.
The other thing I would like to repeat—it is so important that it does not matter if it is repeated again, because the issue has featured frequently during today’s debate—is that the Department of Health budget is, of course, protected, which means that in every year of this Parliament, it will increase in real terms. There will be pressures on the Department of Health budget but, under the coalition agreement and the commitment that my party gave prior to the general election, which has been upheld by the coalition agreement, there will be a real-terms increase in that budget. That gives a degree of stability to the health service because it knows that, in every year of this Parliament, it will receive that money.
I thank my honourable colleague for his earnest and informed contribution to today’s debate. As a constituency MP myself, I respect and appreciate the tremendous battle that he has fought over a number of years for Cornwall. I am thrilled to see that my hon. Friend the Member for Truro and Falmouth is also joining in fighting for her constituents to ensure that they, too, get the best health care possible. That is something that all hon. Members want and fight for on behalf of their constituents.
At its most basic level, allocation is a question of measuring need and distributing resources accordingly. To the outsider—and some insiders—funding allocation is a dense and sometimes opaque subject. As the former health editor of The Times wrote,
“only the brave or foolhardy venture into some areas of NHS management. Resource allocation is certainly one”.
I can safely say that my honourable colleague falls into the former category. I trust that he is reassured that although it is too early to comment on specific funding allocations, the coalition’s programme for government shows that we share the same basic belief in the importance of both independence and local decision making when it comes to setting funding levels for the NHS.
Mr Mike Weir (in the Chair)
As the Minister is not present for the next debate, I suspend the sitting until 4 pm.