Podiatry Services

Philip Hollobone Excerpts

Wednesday 4th December 2013 Westminster Hall

[Andy Sawford]

The hon. Gentleman is absolutely right, and I shall turn to that point in describing the consequences of some of the changes in my area. There is a pattern across the country. I am sure that he, too, will be concerned to ensure that services are available in his area.

On 30 July this year, the clinical commissioning groups announced that their governing bodies would approve the cessation of “low risk” podiatry. They have been unable to explain to me what the standard assessment process will be for categorising patients in that way. They qualified the announcement by stating that the decision would not apply to children or vulnerable groups, which was a response to the strong feedback that the public and I, and perhaps other hon. Members, gave. I challenged the Nene CCG on the definition of “vulnerable groups”, and it told me that the term refers to

“The frail elderly and people who are likely to neglect foot-care for financial reasons”.

That is good to hear, but it is not clear who will make that assessment, and on what basis. We must ensure that the most vulnerable can access care.

[Mr Philip Hollobone (Kettering) (Con)]

I congratulate the hon. Gentleman on securing the debate. He is serving his constituents extremely well on this issue. I had an e-mail from a constituent who says:

“I have an appointment this morning, where I am expecting to be told that I shall not be receiving any more services from”

the podiatrist.

“I have Psoriatic Arthritis in my hand and feet and other joints”,

and

“insoles made to help me walk. ‘I am unable to reach down to do my feet myself’ I told the podiatrist, to which he replied, It can’t be helped. He then said I would have to get my husband to do my feet.”

She goes on to say that her husband

“has issues himself, I cannot ask him to do yet another task for me.”

That is an example of a vulnerable person who clearly does not feel that she has been included in the exemptions that the hon. Gentleman describes.

[Andy Sawford]

I thank the hon. Gentleman for his intervention. I welcome his support for the debate. He is assiduous in working on local health matters; indeed, we have worked together on some issues. I welcome him raising his constituent’s concern. It illustrates the worry about the impact of the changes and the reality of people already being advised that services will be withdrawn—even those who the hon. Gentleman and I would hope would fall under the definition of “frail” or “vulnerable”, including those who may not be able to afford care.

Access is part of the problem. At the same time when the consultation exercise was carried out, the foundation trust reviewed its estates and facilities to make savings. It closed some podiatry clinics and relocated some services, making them more difficult to access. We are talking about people who may not have transport or who may have mobility issues, so difficulty in accessing services is a further problem.

In Northamptonshire, 107 private podiatrists are registered with the Society of Chiropodists and Podiatrists. I am grateful to the society for its helpful briefing for today’s debate. Those private podiatrists are expected to provide care to low-risk patients. Costs vary across the area, so will the Minister comment on how we can safeguard our constituents’ interests by ensuring that costs are affordable where people are told that they must meet costs themselves and that as many people as possible are not charged at all where there is a clear need, in accordance with the CCG’s stated wish to include the frail and vulnerable?

I have received letters from Northamptonshire Healthcare NHS Foundation Trust podiatry staff, who told me that their jobs were being put at risk. There have been 16 whole-time equivalent podiatry posts lost, including leadership posts and the posts of musculoskeletal and diabetes specialists. That is inconsistent with the Government’s stated aim of maintaining high-quality clinical services. The reductions will create a high level of clinical risk by putting patients at an increased risk of falls, ulceration and amputation. We all want to ensure that our local hospital services, for example, can meet growing needs. We do not want more people presenting at accident and emergency or needing hospital admissions because they were not effectively treated through podiatry services.

The staff in the local podiatry service down-banded to bands 5 and 6 will be expected to carry out the same role that they currently deliver at bands 6 and 7. The view of the Society of Chiropodists and Podiatrists is that that is a deskilling or de-professionalisation of the service. I am concerned about that. Podiatry is not the most glamorous or attractive part of medicine. Not everybody wants to deal with people’s feet, for reasons we can all understand, but such work is incredibly important. Those who do it are proud of their professional skills, and we do not want them diminished, or want people not to be paid at the right level for their qualifications, because in the end that will lead to a recruitment problem

I understand the importance of the quality, innovation, productivity and prevention challenge to the national NHS strategy. I met the chief executive of the Northamptonshire Healthcare NHS Foundation Trust on Friday to discuss the issues. She talked to me about the rationale behind the changes, but she also said that there had been “learnings”. What I am learning is that the term “learnings” in health care usually means, “We recognise that we didn’t go about this in the right way. We perhaps rushed too quickly.”

Does the Minister accept that if people cannot access services where they are needed, the changes in Northamptonshire, and perhaps other areas, could create long-term problems and prove to be a false economy? I hope she agrees with that. Will she look at the staffing changes in Northamptonshire? I was asked on BBC Radio Northampton this morning what an Adjournment debate achieves, and I said that one thing is that the Minister will take an interest in what is happening in my area. I hope that one outcome of today’s debate will be that she will look at the changes in Northamptonshire, if she has not had a chance to do so already.

I do not want the Minister to override the proper role of local decision makers in deciding on the best pattern of services in our area, but a sense check on the Government’s intentions around the shift to prevention and the best use of resources, and how short-term decisions are made locally to find savings, may be a counter to that.

There seems to be a contradiction between the Department of Health’s vulnerable older people’s plan and policies that put older people at higher risk through the downgrading of incredibly important and much valued services. Along with the demographic time bomb that the NHS is facing, there is also a diabetes challenge; 2.9 million people, or 4% of those in the UK, have been diagnosed with diabetes.

Tobacco Packaging

Philip Hollobone Excerpts

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

I thank my hon. Friend for his support. The exact technicalities are still under review. As I said, we are strongly minded to use the affirmative procedure, but that matter is not completely resolved. Of course, we do have a little time, because we expect the review to report in March 2014.

[Mr Philip Hollobone (Kettering) (Con)]

What steps are being undertaken with other Departments to enforce against the illegal sale of tobacco products to young people?

[Jane Ellison]

My hon. Friend is right to draw attention to the issue. He may or may not know that when I responded to a recent Adjournment debate that was secured by the hon. Member for Solihull (Lorely Burt), we discussed that point, and I invited trading standards officers to submit evidence on the enforceability of just those sorts of measures. I will be interested to hear from Members and others about how they think those might work.

G8 Summit on Dementia

Philip Hollobone Excerpts

Thursday 28th November 2013 Commons Chamber

[Huw Irranca-Davies (Ogmore) (Lab)]

I am delighted to speak in this debate on behalf of many of my constituents from all areas who have asked me to attend, listen and contribute. I will focus in particular on Wales and Wales and the G8, as well as on the importance of collaboration, but I want to thank the hon. Member for Chatham and Aylesford (Tracey Crouch), my right hon. Friend the Member for Salford and Eccles (Hazel Blears), the right hon. Member for Sutton and Cheam (Paul Burstow) and others, including my hon. Friend the Member for Liverpool, Walton (Steve Rotheram), not only for securing the debate but for championing the cause continually over a number of years. I also join them in praising the Prime Minister for putting this front and centre of the G8 summit. It is a worthy ambition, but as the right hon. Member for Sutton and Cheam set out, doing so has raised aspirations over what will be delivered. I sometimes feel for the Minister because he repeatedly faces people saying that we must do more on treatment, care, prevention and research on many conditions, but putting dementia four square at the head of the Government’s ambitions for the G8 summit shows that there is a level of desire for some real outcomes, not least of which should be long-term strategy and the co-ordination of spending internationally to make the most of it and see what more can be put into the pot. It is a once-in-a-lifetime opportunity.

Right hon. and hon. Members have mentioned the ambition. My right hon. Friend the Member for Salford and Eccles spoke about turning the spotlight on to AIDS and HIV in the 1980s and 1990s, which really did make an unprecedented step change because there was an international focus on treatment and care. Massive interventions were made in previous decades on cancer treatment, and they had the same effect. There is a desire across the international community, especially given the opportunity provided by the G8, to have that same impetus. It is not simply an issue of spending; it is an issue of real focus and relentless drive on everything from prevention to treatment, care and research.

In Wales more than 45,000 people now have dementia, and that figure is forecast to increase to almost 60,000 by 2021. Hon. Members may be interested to know that in Wales only 38.5% have received formal diagnosis of their condition. That is lower than in other parts of the UK, which is interesting. There is good work going on within Wales. The Welsh Government published back in 2011 the national dementia vision for Wales, setting out their commitment to supporting research. The Welsh Government have also pledged to support research in dementia cause, cure and care. They offer funding opportunities to researchers who want to undertake research into dementia.

In the light of my intervention on the Minister’s speech, what is he doing to ensure that knowledge is disseminated well not only internationally but in Wales and England and other regions of the UK, that best practice is shared, and that research collaboration is streamlined properly? What is being done to co-ordinate at a government level in different parts of the UK work on dementia priorities? It would be a tragedy in times of stretched spending if there was duplication and a waste of effort all the way from social care through to research and so on. Let us make sure that it is all lined up in the right way. That is what the G8 summit can do on the international agenda as well.

[Mr Philip Hollobone (Kettering) (Con)]

I understand that around the world some $40 billion has been spent on dementia research, but all the drug trials have failed. The emphasis surely should be far more on prevention. Professor Smith, who was mentioned earlier, maintains that Alzheimer’s could be cut by a quarter. If he is right on that subject, that would mean massive savings on health care costs in Wales and across the rest of the country.

[Huw Irranca-Davies]

The hon. Gentleman makes a good point, which was also touched on by my right hon. Friend the Member for Salford and Eccles. It is a startling fact that 0.1% of funding goes into prevention. Surely there has to be greater emphasis on that, because the outcomes of prevention are so beneficial.

I am sure that the Minister is aware of what is going on in Wales. The Welsh Government’s National Institute for Social Care and Health Research funds and manages the research activity in Wales. The total spend last year was £75.7 million, of which £3.54 million was spent on biomedical research project funding. Just over 15% of the budget was awarded to researchers working on projects directly relevant to neurology research, including mental health. The same organisation awarded the Wales dementias and neurodegenerative diseases research network £743,000 over five years for its research. It is about knowing what is going on not only in Wales and different parts of the UK, but internationally so that we can co-ordinate and make the optimum use of regional, national and international spend on prevention, care, treatment and research.

My final point—it is probably one for another debate—is that we cannot divorce the strategic matters from the operational ones, and that means looking at the huge stretch in social care. There are real and intense pressures on social care, and not just on resourcing, but on staffing, staffing expertise and the necessary reform of long-term social care funding. That is probably a subject for another day, but the reality is that there are pressures on the ground affecting many people with different types of dementia and their families. There is real anxiety.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 26th November 2013 Commons Chamber

[Mr Hunt]

The hon. Gentleman has raised some important issues. We do face big challenges. We have increased the number of doctors in the NHS by 6,600 over the last three years, but it is still very difficult to attract as many people as we need to disciplines such as A and E.

I know that Calderdale and Huddersfield NHS Foundation Trust is especially concerned about A and E staffing. I had a very good meeting with representatives of the College of Emergency Medicine last week to discuss A and E consultants’ terms and conditions and, in particular, their antisocial working hours. We are giving the matter close consideration, but I agree with the hon. Gentleman that we need to do better in this regard.

[Mr Philip Hollobone (Kettering) (Con)]

While it is important to recruit and retain more A and E specialists, part of the problem is that a third of the patients who are dealt with in A and E departments could receive better treatment closer to their homes. What can the Secretary of State do to encourage that?

[Mr Hunt]

My hon. Friend is absolutely right. One of the biggest mistakes made in health care over the past decade was the introduction of the disastrous changes in the GP contract in 2004, which broke the personal link between GPs and their patients. Hard-pressed A and E departments, including the one at Kettering hospital, say that one of the things that will make the biggest difference to them is the provision of a named GP for the over-75s, so that they know that someone is responsible for those people when they are not in hospital.

Mid Staffordshire NHS Foundation Trust

Philip Hollobone Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

My hon. Friend is absolutely right. True culture change is incredibly difficult to achieve unless we get behind the people on the front line and get them to want to change the culture. That is the insight in the report that Professor Berwick delivered in August. That is why today’s response is about backing front-line staff to deliver the care that they want to deliver and to be open when they are worried, and about supporting them in what is a very challenging period for the NHS. If we do not back them to do the right thing, then no matter what happens at the top, we will not see change on the front line.

[Mr Philip Hollobone (Kettering) (Con)]

I am sure that my constituents will welcome what the Secretary of State has said about transparency and openness, especially with respect to Kettering general hospital. When somebody goes into hospital, they want to have confidence that they will be treated efficiently and with a great deal of care. They get that confidence not just from statistics on the number of nurses or clinicians on a ward, but from the experiences that they hear about from friends and relatives who have been treated at the same hospital. They also get confidence from hearing examples of where things have gone wrong—some things will always go wrong—and that the complaints have been handled quickly and efficiently, and have not been dragged out. Does my right hon. Friend agree that hospitals should provide examples of good care that has gone right to give local people the confidence that their local hospital is doing the very best for them and that, when things do go wrong, people will put their hands up, admit it and deal with it quickly and efficiently?

[Mr Hunt]

Absolutely. It is a sign of great confidence when a hospital is open about things that have gone wrong. When I meet the top chief executives who are running the best hospitals in the country, I am always struck by how willing they are to be open about the problems that they have had. It is often in the less well-performing hospitals that the management feel less confident and willing to talk about the problems. That culture is really important. I hope that today is a step in the right direction.

Urgent and Emergency Care Review

Philip Hollobone Excerpts

Tuesday 12th November 2013 Commons Chamber

[Mr Hunt]

The number of hospital nurses has gone up since the election, and as a result of the changes in the Francis report—the hon. Gentleman’s party refused to have a public inquiry many, many times—I hope that the NHS will recruit many more nurses.

[Mr Philip Hollobone (Kettering) (Con)]

The three Members for north Northamptonshire— the hon. Member for Corby (Andy Sawford), my hon. Friend the Member for Wellingborough (Mr Bone) and I—have come together on a cross-party basis, and are working with local clinical commissioning groups and Kettering general hospital to try to attract more investment to our local A and E because of the increase in the local population. May I share with the Secretary of State the fact that all agree that up to a third of attendees at A and E could be better treated closer to home, particularly in excellent urgent care centres such as that in Corby?

[Mr Hunt]

My hon. Friend speaks extremely wisely. He invited me to visit Kettering hospital, and I saw for myself that it was a very, very busy hospital. In the end, if we just stick with the current model we will reach bursting point, which is why we need to look at new models. That is why tomorrow’s review is important, and part of that—in fact, the bulk of the work in tomorrow’s review—is about how we transform out-of-hospital care, which is the big strategic change that we need to make in our NHS, and on which I am afraid the previous Government made so little progress.

Accident and Emergency Departments

Philip Hollobone Excerpts

Tuesday 10th September 2013 Commons Chamber

[Mr Hunt]

There has been exhaustive analysis of the problems in A and E departments and whenever I have visited such departments I have not heard a single person say that the reorganisation was the cause of them. What they talk about is the underlying problems, which we are addressing today.

[Mr Philip Hollobone (Kettering) (Con)]

Despite the best efforts of its hard-working staff, the A and E department at Kettering general hospital has been under huge pressure for some time. It has failed to meet its targets and the chief executive resigned recently as a result. Would my right hon. Friend be kind enough to confirm the amount of additional funding to the A and E department at Kettering, and what is his assessment of the analysis that up to a third of those who present themselves to A and E departments could receive better, quicker and more appropriate treatment elsewhere?

[Mr Hunt]

My hon. Friend has campaigned assiduously for Kettering hospital, including by inviting me there to see it for myself. I think that its staff are working extremely hard. I am pleased to confirm that today’s announcement means that an extra £3.9 million will be given to the hospital to help it meet those pressures over this winter. I think that the people working in A and E would be the first to say that where there are alternatives in the community, they should be used. The long-term change we need to make is to reverse what has happened over the past decade, which is that it has become easier and easier to go to an A and E department and harder and harder to get an appointment with a GP. That was the profoundly wrong change made by the previous Government and that is what we have to put right.

Tobacco Products (Plain Packaging)

Philip Hollobone Excerpts

Tuesday 3rd September 2013 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

There are a lot of Members here, and I am keen that all those who have indicated that they wish to speak should be able to do so. However, because of the numbers, I am afraid that we will have to limit Back-Bench contributions to three minutes. Front-Bench speakers will have no more than 10 minutes.

I encourage Mr Blackman not to take interventions from those who have sought permission to speak. It is my intention that Members should be able to speak, but it will greatly help their chances if they do not intervene on another speaker. Likewise, it will help everyone’s chances of speaking if Members do not take interventions during their three-minute contributions. I cannot force Members to do so, but I greatly encourage them to. If anybody has not let the Speaker know that they would like to catch my eye, they should let the Clerk know so we can add them to the list.

--- Later in debate ---

[Bob Blackman]

I do not agree with banning tobacco completely. If people want to put a cigarette in their mouth, light it and kill themselves, they make that choice as conscious adults. My concern is for young children who begin smoking before they realise the dangers; they then cannot quit, because they are addicted. The tobacco industry’s aim in its packaging is to encourage more people to start.

Tobacco packaging should be made as unattractive as possible. It should never again be used to try to recruit new addicts and new victims, particularly among the young. Standardised packaging is an inevitable and welcome step forward in tobacco control. I predict that it will come sooner or later, and on this side of the argument, the sooner the better. If not now, when? I look forward to hearing my hon. Friend the Minister making the Government’s position clear so that we know what it is. If they then refuse to introduce a debate in the House, we will.

[Mr Philip Hollobone (in the Chair)]

Order. The speeches from the Front Benches will start no later than 10.40, so we have 50 minutes remaining. Hon. Members have the right to take interventions, but the fewer there are, the better the chances of all hon. Members being able to speak, which is my sole objective this morning. I call Nick Smith.

[Alex Cunningham (Stockton North) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Hollobone—

[Mr Philip Hollobone (in the Chair)]

Order. I call Mr Nick Smith.

--- Later in debate ---

[Mr Nuttall]

It is all very well saying that, but the Minister said in a previous debate that the new packs were not going to be plain packaged at all, but were going to have lots of glamorous, glitzy holograms on them in different colours. [Interruption.] The Minister did not say “glamorous”, but she did mention different colours and holograms. The point is that I never met anyone who said that it was the packet that made them want to take up smoking.

[Mr Philip Hollobone (in the Chair)]

Order. I call Jim Shannon.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Philip Hollobone (Kettering) (Con)]

8. What assessment he has made of recent improvements in services to patients at Kettering general hospital.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

Monitor, as the regulator of foundation trusts, is working with NHS England, the Care Quality Commission and local commissioners to ensure that the trust has robust plans to make the necessary improvements. The emergency care intensive support team has given the trust advice and support to help it to develop plans to improve its A and E performance.

[Mr Hollobone]

Will the Minister congratulate all those at Kettering general hospital who have been involved in various recent developments? For instance, urology patients are being given the anti-cancer drug mitomycin C, which halves the risk of a recurrence; a CT scanner that is 10 times more powerful than its predecessor is facilitating CT angiography; and 44% of colorectal operations—twice the national average—are being performed on a keyhole basis.

[Dr Poulter]

I am happy to commend Kettering general hospital for some of the improvements in care that have been made recently. My hon. Friend will, of course, want to ensure that that progress is sustained during the weeks and months ahead. As he will know, Monitor is still overseeing the trust to ensure that patient care and performance remain up to standard.

Hospital Mortality Rates

Philip Hollobone Excerpts

Tuesday 16th July 2013 Commons Chamber

[Mr Philip Hollobone (Kettering) (Con)]

Although proud of our local hospital, residents in Kettering will be pleased that Sir Bruce has managed to expose some dangerously run parts of the NHS, but they will be concerned to know what can be done to make the future far better than what has happened in the past.

[Mr Hunt]

Absolutely, and the big point about the changes that we are bringing in—I congratulate my hon. Friend, who is a huge supporter of Kettering hospital, which he and I have visited together—is that the NHS in many ways is no different from other parts of our public services: there are excellent bits and there are bits where there is poor leadership. What we have to do if we are to sort out the poor leadership is to expose it and to make sure that the public know about it and the politicians cannot duck sorting it out. My hon. Friend’s constituents will be thinking, as a result of tomorrow’s headlines, “What about Kettering hospital?” That is why we will have an independent chief inspector who will go round and tell them how good Kettering hospital is. However much they love it, he may well find things that need to be improved, and my hon. Friend and his constituents will welcome that.