Grammar and Faith Schools

Debate between Neil Carmichael and Sarah Wollaston

Tuesday 8th November 2016 Commons Chamber

[Neil Carmichael]

I thank my right hon. Friend for that very good point. It is clear that the disparities between authority areas, and therefore schools, is too great for us to be complacent. We must take action.

The third area of alternative priorities is the post-16 sector. Too many people in any year group post-16 are not proficient in numeracy or literacy. According to the OECD, backed up by the World Economic Forum, about 20% of any year group are not comfortable with numeracy and literacy. That is not good enough for a modern economy that aspires to be open and to conquer social mobility and productivity. We have to focus on what matters, so I repeat that the issue of grammar schools is something of a distraction.

Whatever we say about education policy, we must be mindful of two things. First, social immobility in this country is simply too great. The fact is that there are communities with too many young people who are basically trapped, and who stay trapped—that is the difficulty. That is the first issue that we must always think of when considering education. The second point, which is just as relevant, is productivity. If we can have a more productive economy, we will by definition have one with more skills and higher salaries and wages. That is a contribution to social mobility—enabling people to improve and develop. The two things are linked.

[Dr Sarah Wollaston (Totnes) (Con)]

My hon. Friend is making a powerful speech. Does he agree that the third issue should also be about social cohesion? Does he share my concern about some of the proposals on faith schools? I recognise the contribution that they make, but can he think of a single reason why the child of an atheist parent like myself should be excluded from a school because of their parents’ lack of faith? Does he also share my concern that 100% selection by faith risks driving communities into further segregation and does nothing to improve social cohesion?

[Neil Carmichael]

I thank my hon. Friend for that instructive intervention. It goes off the issue of grammar schools, which I was hoping to talk about, but she is right that the issue of faith schools should be addressed. I say two things. First, we must have an inclusive society; we cannot parcel people up in that sector and say, “That’s you—off you go!” That is not acceptable. We must make sure that our faith schools do not do that and instead are all embracing. It is the outward-looking school, of whatever faith, that will do a good job.

Meningitis B Vaccine

Debate between Neil Carmichael and Sarah Wollaston

Monday 25th April 2016 Westminster Hall

[Dr Sarah Wollaston (Totnes) (Con)]

It is a pleasure to follow my hon. Friend the Member for North Devon (Peter Heaton-Jones), and I apologise to my hon. Friend the Member for Bath (Ben Howlett) for missing his opening statement, because of a statement in the main Chamber.

I start by thanking all the families who gave evidence to the Petitions Committee and the Health Committee. Through their very brave and dignified testimony, they have done more to raise awareness and save lives than any Government-led awareness campaign could possibly hope to achieve.

It is wonderful to be in a debate in which we are airing the positive benefits of vaccination, which has undoubtedly been one of the greatest achievements of modern science. We stand on the brink of eradicating polio from the world, and it is worth pausing to thank all those who have been involved in the development of vaccination over the years.

[Neil Carmichael]

At this point, I would like to salute Dr Edward Jenner, who worked on a smallpox vaccination and was based in my constituency. That underlines the importance of vaccination, and that work then is directly linked to the work of Meningitis Now.

[Dr Wollaston]

I thank my hon. Friend. In fact, I will take us back even further by mentioning Ben Franklin, who said that

“an Ounce of Prevention is worth a Pound of Cure.”

He was referring to fire services in Philadelphia, of course, but the principle still stands.

In paying tribute to all who have brought us to where we are today, we should remind ourselves that vaccination is becoming increasingly complex to develop. Bexsero is being developed through reverse antigen mining and is extraordinarily expensive. That is why we have to consider cost-effectiveness, because in a system where finances are limited, what might be displaced if a new intervention is funded? In other words, we in this House and beyond have a responsibility to ensure that the money we spend can save as many lives as possible, and to consider that in the round.

That is why it is important to take account of the work of the Joint Committee on Vaccination and Immunisation in making its incredibly difficult decisions and judgments. It is absolutely important that we allow the JCVI to carry out its work without undue political interference. The role of this House is, of course, to raise awareness and to hold the Government to account for the way in which—and the framework under which—the JCVI operates. However, our role must never be to lean directly on members of that committee in the very difficult decisions that they make. I pay tribute to the JCVI—to Professor Andrew Pollard and his team—for their work. Their decisions are extraordinarily difficult, and they need to apply the science with a combination of judgment and sensitivity. It is absolutely right that we regularly review the criteria that they are able to take into account.

I thank the Minister for her letter today confirming that the cost-effectiveness methodology for immunisation programmes and procurements working group, or CEMIPP—it may need a catchier title—is going to publish its work in full. Perhaps she will say whether she has now received that report. It is absolutely important that the principle of transparency applies, so that we can all be clear about the decision-making process.

I support Members who have said that we should review the so-called discounting rate if it means that, as my hon. Friend the Member for Faversham and Mid Kent (Helen Whately) has pointed out, by the time someone is in their 20s, effectively no account is taken of them. It clearly seems reasonable that we apply the same principle that is applied to public health decision making in the NICE methodology, with its lower discount rate, so that we can take full account of that situation. It is also right for the House to reflect on views beyond this place by thinking, for example, about the social costs. I do not wish to repeat the many important points that have been made about that today.

The JCVI’s independence is absolutely vital. We in this House are not in a position to make judgments about the effectiveness and safety of vaccination. We have to rely on experts, and we are very grateful to them for their work. However, one thing that we have to do is hold the Secretary of State to account for implementing the decisions of the JCVI in a timely manner and for the time that it takes to carry out the negotiations on the cost of vaccines.

I would like to make a further point, which I do not think Members have brought up today. The level of variation in the roll-out of existing vaccinations needs to be looked at. During the Health Committee’s current inquiry into public health, we have been hearing evidence about the difficulty that public health professionals and directors of public health have in being able to access the data and information that they need to tell them where the gaps are in the roll-out of vaccination. Perhaps the Minister will update the House on where we are in that regard, because it clearly cannot make sense that artificial barriers have sprung up between those who are responsible for implementing the programme and those who are delivering it on the ground. It would be helpful to have an update on that issue.

It is also absolutely right that the House holds the Minister to account on what is being done to follow up the work that is happening on sepsis. As she will know, early diagnosis is critical. Although we want to focus on the number of cases that we can prevent, we cannot prevent them all, so we must also focus on early diagnosis and intervention and on ensuring that we have the right pathways in hospitals, so that the time it takes from the moment someone enters a hospital until they receive life-saving antibiotic therapy is kept to a minimum. Perhaps the Minister will update us on that.

Community Hospitals

Debate between Neil Carmichael and Sarah Wollaston

Thursday 6th September 2012 Commons Chamber

[Dr Wollaston]

Indeed I do, and there are many community hospitals that support first responders in the way my hon. Friend describes. That is an important role, and there is perhaps even an extended role in housing, where step-down housing can enable people to make the transition back to full independence. Indeed, there are many such roles.

What are the current barriers to providing the right care at the right time and in the right place? I would like the Minister to deal with five points. First, the biggest challenge we need to address is the tariff and tariff reform. She will know that most acute hospitals are paid through a system known as payment by results, which creates some perverse incentives, whereby acute hospitals want to hoover up as much activity as possible. Often, people are treated in an acute setting when they could be more appropriately cared for in a community hospital setting or at home. Can the Minister update the House on the progress we are making on reforming the tariff, by, say, working towards a “whole year of care” model or looking at other ways to remove the incentive in the system that means that people cannot be transferred into community hospitals or provided with the right care in the right place?

[Neil Carmichael (Stroud) (Con)]

I congratulate my hon. Friend on securing this debate and I entirely agree with her important point about the tariff and acute hospitals. I hope she agrees that it is also important to signpost patients to the right place, which, because we are talking about a caring issue, is in many cases a community hospital.

[Dr Wollaston]

I thank my hon. Friend for making that important point. Quite often patients are not aware of the full range of services available in their community hospitals. We can do far better in signposting them. It is also important that GPs understand and support those services and make referrals to the right place.

The second issue I would like the Minister to address is the community hospital estate. She will be aware that many community hospitals around the country are being pushed into ownership by NHS Property Services. However, there are examples around the country of community hospitals that are owned by their communities, for example, or by a social enterprise. If those hospitals are unable to have ownership of their premises, that can hold them back if they have ambitions to expand their roles in future. Obviously we want to reassure the public that these valuable community assets remain in public ownership, as it were, but we also want to ensure more flexibility in their ownership model. I would therefore be grateful if the Minister addressed that point.

Thirdly, there is an accountability issue. There are occasions where having multiple providers operating out of a community hospital can cause confusion. Situations can arise where, because everybody is responsible, nobody is responsible, and accountability can end up being shunted around the system. Does the Minister agree that it would make more sense to have a single body, or even individual, with overall responsibility for what happens to patients and the way in which care is organised in a community hospital?

Fourthly, I want to raise an important point that goes beyond community hospitals to the whole way in which we look at a primary care based system, namely the looming crisis in general practice numbers. For the first time we now have a vacancy rate for GPs of 12% in the south-west. On top of that, in about four or five years we will have a retirement bulge—I am afraid that I have not helped the situation—and we are also moving, quite rightly, from a three-year period for general practitioner training to a four-year period. All that coming together means that across the country, the south-west included, we will face a shortage of skilled practitioners both to deliver commissioning and to staff our community hospitals. We need their support. It would be a great shame if GPs who were enthusiastic about getting involved in commissioning and helping out in their community hospitals were unable to do so because of their clinical commitments. Can the Minister therefore update the House on how we are going to stop the problem, which has been going on for years, of too many medical students going into training in acute hospital specialties? We need more of them to go into general practice.

Finally, will the Minister support the Community Hospitals Association? It does a tremendous job. In 2008 it received a £20,000 grant to help set up a detailed database that documented not only where community hospitals are but what they do. At this time of change I hope she agrees that it is particularly important that we keep track of what they are doing. The CHA has also highlighted innovation and helped to spread best practice, so I hope that she will give it further support.

No debate about community hospitals would be complete without thanking the leagues of friends, which around the country have provided millions of pounds. They do not provide luxuries; we are talking about major building projects, equipment, funds for care, volunteers who come into the hospital—an extraordinary level of support. We could not manage without them in our community hospitals. I know that the whole House will want to join me in paying tribute to our leagues of friends.

This is a call to arms to people listening to the debate. If you value your community hospital, let your GPs know, let your commissioners know, let HealthWatch know, let your local health and wellbeing boards know. If we want community hospitals to be treasured, as we all do in the House, we need to make that very clear.