Healthcare: East Midlands

Philip Hollobone Excerpts

Tuesday 30th April 2019 Westminster Hall

[Several hon. Members rose—]

[Mr Philip Hollobone (in the Chair)]

Order. The debate can last until 11 o’clock. We have got almost an hour of Back-Bench time, so there is no pressure, but the Chair will be particularly generous to any Member who wants to dilate at length on the need for an urgent care hub at Kettering General Hospital.

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[Jim Shannon (Strangford) (DUP)]

Whether we are discussing healthcare in the east midlands or in Northern Ireland, the issue of suicide is prominent in my constituency. When I became its MP in 2010, the level of suicide among young people was at its highest. That was dealt with through the involvement of community groups and of people in the community who had lost loved ones. There was also interaction with church groups and those of faith. By coming together, we reduced the incidence of suicide, and by working alongside healthcare in Northern Ireland, which is a devolved matter, we found that together, we could address the issue. It took both the community and healthcare to make that happen.

[Mr Philip Hollobone (in the Chair)]

Before Mr Tredinnick responds, I remind the Chamber that there is half an hour of Back-Bench time left, with two other Members seeking to contribute.

[David Tredinnick]

I am sensitive enough to take the hint and will not delay the Chamber for much longer, Mr Hollobone. In response to the hon. Member for Strangford (Jim Shannon), we have a street pastor campaign in Barwell in my constituency, which really gets people in. The point about suicide that is often missed is the tragedy that it leaves behind and the damage to family and friends.

In my wind-up—I know hearing that will excite you, Mr Hollobone—I will focus on the Secretary of State’s announcement yesterday about putting cigarette-packaging style warnings on opioid painkillers, which I absolutely welcome. Of course it affects the east midlands. A report in the Evening Standard yesterday was entitled, “Experts hail our opioids investigation as addiction warnings are announced”. To give credit where it is due, the Evening Standard promoted that campaign, which I think is incredibly important.

The weakness in saying that we must stop all that is that no one has actually come up with any alternatives. People take those painkillers because they are in pain. Hinckley and Bosworth Borough Council has produced a holistic therapists directory, which may be the first of its kind in the country. When my right hon. Friend the Secretary of State visited, I took him to Burbage House Health Clinic, where he could see physiotherapists and chiropractors working together. He has declared his interest—I believe his wife is an osteopath—so I hope that under this Secretary of State, we will see some movement in this matter.

We cannot just stop people taking drugs without offering them an alternative. The three most effective ways to stop back pain are acupuncture, osteopathy and chiropractic. Acupuncturists, osteopaths and chiropractors are all properly regulated, so I implore the Minister of State to look carefully at using them. The other issue I wanted to mention is polypharmacy polymorbidity, which the Health Committee looked at. I gave the Minister as a Christmas present the report of the all-party group for integrated healthcare, which I chair. I do not know whether he put it in his stocking, but I look forward to hearing if he enjoyed it over Christmas. Perhaps he will look at the issue.

We are very myopic sometimes, thinking that our system is the only one around, but the best place to look at for solving some of the problems is India, which has a Ministry of Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy. It is responsible for all the herbal medicine and the different services that are not mainstream or opiate drugs. We should look at what Prime Minister Modi has done there.

I have probably indulged myself a bit, Mr Hollobone, but it is so unusual to have any time in the House—thank you very much. I look forward to the Minister of State’s response, and again I congratulate the hon. Member for Lincoln.

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[Mr Philip Hollobone (in the Chair)]

Order. I do not think the Minister can just say it. He must allow time for Karen Lee to sum up the debate, so perhaps he will bring his remarks to a close.

[Stephen Hammond]

Thank you Mr Hollobone. I will not just say anything other than that I wanted to address a number of issues about east midlands care, so I will put them in a letter and write to Members who have participated in this debate. It is important to address the huge number of issues raised by colleagues and ensure that the context is clearly understood. This Government wish to thank all hard-working professionals in the NHS for their work. We will do everything we can to continue that support, with a plan and the money to back it up, so that, both nationally and locally, the NHS can deliver for patients.

Government Mandate for the NHS

Philip Hollobone Excerpts

Thursday 25th April 2019 Commons Chamber

[Stephen Hammond]

The hon. Gentleman is right to point out that a consultation is being undertaken on various aspects of the long-term plan and the legal framework that needs to be put in place. It is entirely up to local CCGs to make decisions on their procurement policy.

[Mr Philip Hollobone (Kettering) (Con)]

Record investment is going into Kettering General Hospital and a record number of patients are being treated, but the best way that the Minister can deliver the NHS mandate and long-term plan for the people of Kettering is by providing the funding for a new urgent care hub, the site of which he has visited at Kettering General Hospital, and by working with the Ministry of Housing, Communities and Local Government to take advantage of local government reorganisation in Northamptonshire to create a health and social care pilot. Will he commit to both?

Hormone Pregnancy Tests

Philip Hollobone Excerpts

Tuesday 23rd April 2019 Westminster Hall

[Several hon. Members rose—]

[Mr Philip Hollobone (in the Chair)]

Order. The debate can last until 1 pm. I am obliged to call the Front-Bench spokespeople no later than 12.27 pm, and the guideline limits are 10 minutes for the Scottish National party, 10 minutes for Her Majesty’s Opposition and 10 minutes for the Minister. Yasmin Qureshi will then have three minutes at the end to wind up the debate.

We are in Back-Bench time until 12.27 pm. Six Members are seeking to contribute, so please do not speak for more than six minutes. Unhelpfully, only one of the monitors is working—the one to my right—so to assist Members, I will gesticulate at them in a friendly way when they have a minute to go.

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[Sir Mike Penning]

I cannot understand how a drug company, now owned by Bayer, could know what was going on and continue to supply the drug in an underhand way to GPs. As a father—as a human being—I simply do not understand it. What on earth was going on? The MHRA, which gave evidence to us, was in complete denial. We did not ask for a cause. I was lucky enough to be a Minister in seven Departments. If I had said, “This is the review that you are going to do, and these are your terms of reference,” and those terms of reference were changed by the review group without my permission, I would have smelled a rat. I would have thought something was going wrong.

We can go through all the science, which cannot be denied. I do not blame any Minister—I can feel the special advisers’ eyes on my back—but something went dramatically wrong, and it has been covered up by several Governments. That must stop now. If compensation has to be paid, fine. Most of the families simply want an apology. Why is there no apology? Because there would then be the threat of legal action. Mistakes happen. When we make mistakes, we should admit it, no matter what Government are in power. We should sort it. We did that over Hillsborough when I was a Minister in the Home Office. It was a really difficult decision to make, but we made it, and the right conclusion was reached. That should be the case in this instance.

[Mr Philip Hollobone (in the Chair)]

I am afraid I will have to impose a five-minute limit on speeches, or we will run out of time.

Primary Care: Plymouth

Philip Hollobone Excerpts

Wednesday 10th April 2019 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

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

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

I beg to move,

That this House has considered primary care provision in Plymouth.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

for many months—

“as they are changing their systems.”

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

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

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

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

Another told me:

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

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

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

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

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

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

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

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

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

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

Access to Medical Cannabis

Philip Hollobone Excerpts

Monday 8th April 2019 Commons Chamber

[Matt Hancock]

Yes, of course; I am very happy to do that. Perhaps I should take this opportunity to welcome the new public health Minister, the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for South Ribble (Seema Kennedy) to her post. She will, no doubt, have listened to all the questions today. She and I will be working on making this happen.

I would add to the hon. Lady’s list, because this is not just about the Home Office and the Department of Health and Social Care; it is about making sure that the independent medical establishment has confidence in the evidence that is presented. It is not enough for her and I to have confidence as lay politicians; it is important that the professionals who put their signature on the line have confidence in the evidence as well.

[Mr Philip Hollobone (Kettering) (Con)]

Does the Secretary of State appreciate the public’s concern that, at a time when several police forces have openly admitted that they will not take action against those involved in recreational cannabis use, the full weight of the Home Office’s Border Force is deployed to intercept medication for a seriously ill young child? Surely getting medication to a seriously ill young girl should never be a crime.

[Matt Hancock]

My hon. Friend makes an important point. The Border Force should not be criticised in this case, because it was following the rules: if a clinician has not signed something off it cannot come in. It is incumbent on us on the health side to sort out this problem. He makes a broader point, however, that this is a completely separate issue to the recreational use of cannabis. I do not support a change in the rules on the recreational use of cannabis; this is about the specialist provision of drugs to some children who are the most vulnerable people in society, and the need to ensure that the medical benefits of such drugs can be brought to bear on people who really need them.

Infant First Aid Training for Parents

Philip Hollobone Excerpts

Wednesday 3rd April 2019 Westminster Hall

[Mr Philip Hollobone (in the Chair)]

Although the title of this afternoon’s debate is “Infant First Aid Training for Parents”, there is some debate about whether it should not be “parental first aid training for infants.” No doubt, all will be revealed. I call Sarah Newton.

[Sarah Newton (Truro and Falmouth) (Con)]

I beg to move,

That this House has considered infant first aid training for parents.

It is a pleasure to serve under your chairmanship, Mr Hollobone. You make a good point—I was never an excellent scholar, and I am sure my English can be improved upon. In the course of the debate, I hope to provide a good explanation of what I was seeking to achieve in securing it.

I would like to begin with Rowena’s story. Rowena had been shopping in a department store with her mother and her five-month-old daughter. They had stopped for coffee in the children’s section, where there were lots of mothers with their babies. Seated near their table was a mother feeding her nine-month-old baby girl some home-made food. Given that they both had little baby girls, they exchanged compliments on the girls and continued with their business.

Leaving her daughter with her mother, Rowena went off to buy some coffees. While in the queue, she heard screaming and a terrible commotion. Looking around, she realised it involved the mother she had just met. Rowena could see that something was wrong with the little girl, who was not moving and was very quiet. Instinctively, she left the queue and ran to the back of the café to see what she could do.

When Rowena arrived back at the table, she saw that two other customers had come to the mother’s aid. They were trying to calm the mother down while furiously patting the back of the baby girl. Rowena quickly realised that the baby was choking on the baby food that she had been fed. Fortunately, Rowena knew what to do. She told the women attempting to help to stop and that she had first aid training, and she took the baby. Because she had completed a baby first aid course, she felt confident enough to help.

Rowena sat on a chair and held the baby face down along the length of her left leg, with the head lower than the knee. She started to give her back blows, hitting her firmly between the shoulder blades. After Rowena delivered the second or third back blow, the baby girl started to cry, so Rowena realised that she could breathe and that the blockage in her throat had gone. She handed the girl to her mum and reassured both of them that everything was okay.

The mother was quite shocked and upset, and so was Rowena. She realised the significance of her intervention. She said:

“I didn’t fully realise until that point what had just happened and the gravity of it”.

She said it had a big impact on her. That day, Rowena had done something remarkable, yet so very simple. With a few simple actions, she had saved that baby’s life. I want to enable every new parent or carer to receive high-quality training.

--- Later in debate ---

[Several hon. Members rose—]

[Mr Philip Hollobone (in the Chair)]

Order. The debate can last until 4 o’clock. I am obliged to begin calling the Front Benchers no later than 3.27 pm. The guideline limits are 10 minutes for the SNP, 10 minutes for Her Majesty’s Opposition and 10 minutes for the Minister, and then Sarah Newton will have three minutes at the end to sum up the debate. Until 3.27 pm, it is Back-Bench time. Two Members have indicated that they would like to speak. I call Douglas Ross.

Pancreatic Cancer

Philip Hollobone Excerpts

Tuesday 2nd April 2019 Westminster Hall

[Nic Dakin]

I thank my hon. Friend: in sharing that personal story, she makes a powerful argument about the need for better early diagnosis. Sadly, the story that she tells is the familiar one of undiagnosed general symptoms eventually, in an emergency, being diagnosed as pancreatic cancer. Very often, it is then too late to take action to address the illness. However, I want to focus on the fact that when we do diagnose early, we need to act early to cure people, because that is an area where we can certainly up our game.

At the moment, only one in 10 pancreatic cancer patients receives potentially curative surgery and only two in 10 receive chemotherapy, meaning that a massive seven in 10 people receive no treatment at all. That has to change. Last month, I delivered to the House a petition signed by an incredible 100,600 people supporting Pancreatic Cancer UK’s campaign to “Demand Faster Treatment”. They are asking for pancreatic cancer to be recognised as a cancer emergency and for people to be able to access treatment within 20 days of diagnosis in order to have the best chance of survival.

That ask is based on the latest evidence and best practice from existing fast-track models for operable and inoperable patients. Those models show that treating people with pancreatic cancer within 20 days increases the number accessing surgery by 20% and the number accessing chemotherapy by 25%. Those are significant improvements. Fast-track surgery will allow more people to access life-saving treatment, and we know that the survival rate is 10 times higher for those receiving surgery. The 100,600 people who signed the petition believe that those models should be the basis of a national optimal pathway for the diagnosis and treatment of pancreatic cancer to ensure that people with the disease can be treated within 20 days.

I want to be clear that I am not talking here about early diagnosis, important though that is—hon. Members’ interventions have underlined that—and I welcome the focus of the Government and NHS England on early diagnosis of all cancers. That can only be a good thing and it will help. However, there are currently many people with pancreatic cancer who have been diagnosed early enough to receive treatment but, unacceptably, do not receive it. That is the issue that I am focusing on today.

For example, more than half of people with stage 1 and stage 2 pancreatic cancer die within a year, and almost half of them, 42%, do not receive any active treatment at all—neither surgery nor chemotherapy. The data suggests that those patients are not prioritised and have not been treated as an emergency. Unfortunately, all the evidence shows that the Government’s current and proposed waiting times are not fast enough for people with pancreatic cancer. A one-size-fits-all approach is not improving, and will not improve, survival rates for pancreatic cancer.

It was disappointing that the recently published interim report of the clinically-led review of NHS access standards did not take the opportunity to propose a differentiated target for pancreatic cancer. If we really want to transform outcomes, it is high time that we had differentiated targets, including a 20-day treatment target for pancreatic cancer.

Behind the statistics are real people. We have heard about some of them today, and their stories help us truly understand the missed opportunities and devastating consequences of the current system. No one did more to mobilise people to sign the petition and help make the case for faster treatment than Erika Vincent. In February 2018, Erika was diagnosed with stage 4 pancreatic cancer, yet despite its advanced nature, she was made to wait two months for treatment—something that she described as psychological torture for her and her family. While she waited, her cancer spread, bringing her more pain and complicating the care that she would eventually receive. Erika believed that the delays to her treatment reduced the time she had left with her family. She chose to spend much of that time championing the need to treat pancreatic cancer as an emergency, believing, as I do, that pancreatic cancer patients cannot afford to wait. Sadly, Erika passed away just weeks before the petition calling for faster treatment—a petition that she had done so much to assemble and put together as part of a campaign—was presented to the House.

Erika’s story stands in stark contrast to that of Liz Oakley. When Liz was diagnosed with pancreatic cancer in January last year, it took just 12 days for her to be scheduled for surgery—the only cure for pancreatic cancer. Liz had already survived breast cancer twice. She is both a testimony to the remarkable progress that has been made in the treatment of other cancers and living proof of what is possible for patients with pancreatic cancer.

There is a compelling case for treating pancreatic cancer as a cancer emergency and for creating optimal fast-track pathways. Far too many people have been lost to this disease too early. For far too long, pancreatic cancer has been forgotten, neglected, written off. The Government can commit today to changing that. Will the Government look at developing optimal pancreatic cancer pathways? Will they evaluate rolling out fast-track surgery models across England? Will they commit to the ambition of allowing people with pancreatic cancer to access treatment within 20 days of diagnosis by 2024?

Thankfully, we have seen huge changes for other cancers. Lung cancer is a good example. Back in 2005, the national lung cancer audit showed that patients with operable lung cancer were not referred for surgery, and it was shown that the surgery rate could be tripled in a cancer network within one year. Between 1985 and 2005, there were just 3,000 operations a year; that increased to 7,250 in 2016. That is inspirational. It shows what we can do. It shows what we can achieve when a cancer is treated as a cancer emergency, as pancreatic cancer must be now. Hope is contagious. Let us make it happen.

[Mr Philip Hollobone (in the Chair)]

The debate can last until 4.34 pm.

Oral Answers to Questions

Philip Hollobone Excerpts

Tuesday 26th March 2019 Commons Chamber

[Stephen Hammond]

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

[Mr Philip Hollobone (Kettering) (Con)]

The best way that Kettering General Hospital could deliver the NHS’s 10-year plan would be to have the funding for an urgent care hub. I thank the Hospitals Minister for visiting recently. What can he do to ensure that that project is delivered?

[Stephen Hammond]

I was delighted to visit Kettering and to meet the chief executive and the chairman of the trust again. They made very strong representations. The representations by my hon. Friend and the trust have been heard, and he knows that they are at the forefront of my mind.

Health Inequalities

Philip Hollobone Excerpts

Wednesday 20th March 2019 Westminster Hall

[Lucy Allan]

I thank the hon. Lady for her comment. There was an interesting debate on that issue on Monday night in the Chamber. This is an important issue, and I have a lot of sympathy with what she says.

On the injustice of unequal health outcomes, I said at the outset that that is of course not about spending more, and that poor health is not only about healthcare but is a much wider issue. However, if the NHS overlooks its statutory, constitutional and moral duty to properly consider health inequalities when making major spending decisions, the Secretary of State has a legal duty to act; he cannot just sit on his hands and say it is down to local clinicians. That response is all the more frustrating in my case because all six voting members of the Telford CCG voted against the transfer of resource from an area of deprivation and to an area of relative affluence, whereas all six voting members of the CCG in the more affluent Shrewsbury naturally voted for the funding resource to be transferred to their area.

In our case, Telford CCG was made to vote again until it came up with the right answer and allowed that transfer of funding. [Interruption.] That is very topical, yes. This whole issue reminds me exactly of Brexit. I wish I had not come on to that point; this should be a Brexit-free zone, for a change, so that we can all maintain our sanity. However, it is similar in the way that those in power have not been listening to the people. It is extremely important to note that, if we give that sort of funding to relatively affluent areas and take resource away from the most disadvantaged, we are doing something wrong. No Government could think that that was a good idea. I am grateful to the new Health Secretary, who came to Telford to visit our Princess Royal Hospital earlier this month and took the time to see for himself the fantastic work being done in the very areas that the management is seeking to close and to transfer 19 miles away to Shrewsbury hospital.

I would like to get something else off my chest, to further illustrate the problem of unequal health spending. Six months ago the Government gave the Shrewsbury and Telford Hospital Trust £3 million for winter pressures. The trust decided to spend all of it in Shrewsbury—all of it—despite there being no evidence that the decision reduced health inequalities between the areas that it serves and not even an indication that it had considered health inequalities when making that decision.

No Government could possibly condone transferring resources from an area of need to an area of greater affluence and better health outcomes. The Government have a legal responsibility to ensure that that does not happen. Everyone in this room will agree that NHS funding decisions must focus on the areas of greatest need, and where that is not happening, we cannot ignore it. The trust has been able to forge ahead with a plan that has never made sense to local people, that was roundly opposed by a consultation that took place, bizarrely, two years after the original decision was made, and despite MPs and councillors vocally pointing out the plan’s shortcomings and its failure to address health inequalities. The hospital trust and CCGs carried on regardless. It cannot be down to local people to enforce the Act. I can only conclude that decision-makers perhaps do not understand their duty to narrow health inequalities or—of more concern—that they do not understand the extent of the need, disadvantage and health inequality in the area they serve.

The flat-out refusal to even discuss the reconfiguration’s impact on health benefits and outcomes for the most disadvantaged has been extraordinary. I have written letter after letter for a considerably longer period than the consultation lasted and I have not received any answers. My trust treats the issue as if it was entirely irrelevant to its reconfiguration plan. If it is not able to show how its plans narrow health inequalities, it must think again.

I know that once the Secretary of State receives the relevant documentation from my local council, he will carefully consider whether to call in the Telford proposal for review by an independent reconfiguration panel. For that, I am most grateful. I hope the panel will look closely at the failure to address need and disadvantage and, on those grounds alone—there are many others—throw out the scheme. If the Government are committed to reducing health inequalities and not only focusing on better health for all, they need more than just warm words. I ask the Minister to remind hospital trusts and commissioners generally, and the Shrewsbury and Telford Hospital Trust and its commissioners specifically, to give due regard to their duty to demonstrate how their spending decisions narrow health inequalities.

In conclusion, I ask the Minister to keep focusing on this issue. It is so easy to lose sight of the reason we all came to this place, and it is too easy for the Department or the Minister to believe that health spending is allocated and targeted towards need, and that we do not have to look beyond the spreadsheet. We have to ensure that it is happening in practice on the ground. We cannot simply say that we have done our bit and that there is no need to look any further. Health inequalities are a shameful injustice of unequal lives and unequal life chances. I know that the Secretary State wants to ensure that no NHS decision-maker allocates funding in a way that exacerbates this injustice, whether in Telford or any other area.

[Mr Philip Hollobone (in the Chair)]

The debate can last until 5.30 pm. I am obliged to call the Front-Bench spokespeople no later than 5.07 pm. The guideline time limits are five minutes for the Scottish National party spokesperson, five minutes for Her Majesty’s Opposition’s spokesperson and 10 minutes for the Minister, with the mover of the motion having two minutes at the end to sum up the debate. The next 18 minutes will be for Back- Bench Members. You can all contribute if you speak for no more than four and a half minutes each.

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

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

This has been an excellent debate, and I start by thanking the hon. Member for Telford (Lucy Allan) for securing it and for her excellent contribution. Sadly, many areas across the UK face similar issues to those affecting Telford, as we have heard. As we know, our NHS was built for everyone. The original leaflet explaining the NHS to households across the country read:

“Everyone—rich or poor, man, woman or child—can use it or any part of it.”

Seventy years on, we cannot forget that ethos, which is why this debate is so important. I also thank all other hon. Members for their contributions to the debate. Due to time, I will not name them all.

Health inequalities are avoidable, but they still persist so clearly, both nationally and locally, within our communities, as we have heard. It cannot be right that in England men and women from the most disadvantaged 10% of areas on average now die 9.3 and 7.3 years respectively sooner than those in the 10% least disadvantaged areas. And those living in the most deprived areas not only die much earlier than those living in the most affluent areas but they also live much longer in bad health. For example, between 2014 and 2016 women in the most deprived areas could expect to live for 51.8 healthy life years, meaning that their remaining 27 years would be spent in bad health. That is compared, for instance, to women in the least deprived areas, who could expect to live for 70.7 healthy life years, with only 15.5 years in bad health.

It has to be said that there is also a persistent north-south divide in both life expectancy and healthy life expectancy, with people in the southern regions of England on average living longer and with fewer years in poor health than those living further north. For example, 2015-17 figures show that men and women in the north-east—my region—have the lowest life expectancy at birth in England, at 77.9 years and 81.6 years respectively. That is compared to the south-east, where men can expect to live for 80.6 years and women for 84 years.

However, health inequalities also exist within local authorities. For example, the longest life expectancy in the country is in the richest borough, Kensington and Chelsea; I am not surprised. Nevertheless, the most disadvantaged people in that London borough can expect to live for 14 years less than their most advantaged counterparts. Such a stark difference is completely unacceptable.

Also, children living in poverty are more likely to die before the age of one, become overweight, have tooth decay or even die in an accident. Parents living in poverty are also more likely to smoke, experience mental health difficulties, be a young parent, be a lone parent, experience domestic violence and other negative outcomes, all of which also increase adverse childhood experience risk factors that impact children’s health, too.

So, after a century of decline the number of deaths in childhood in the UK has risen for two consecutive years, with the highest mortality rates evident in the poorest communities. Life expectancy in the UK had always increased slightly, year on year, for over a century, largely due to improvements in nutrition, hygiene, housing and control of infectious diseases. However, it seems that that is not happening any more.

What are we going to do? Labour is committed to a new health inequalities target, to improve life expectancy, mortality rates and children’s health. The target would be independently assessed, and as the hon. Member for Telford called for, the Health and Social Care Secretary would be held accountable to Parliament and would produce an annual health inequalities report.

The four biggest risk factors that affect health—smoking, excessive alcohol consumption, poor diet and lack of exercise—also affect the poorest in our communities. Public health services support those people. However, there have been public health cuts to the tune of £800 million between 2015 and 2021, and local authorities have been put in untenable positions, where they have to make difficult decisions.

I believe that the Government already have a moral duty to ensure that health inequalities are reduced, but unfortunately they have not taken that duty seriously enough, so I would like the Minister not only to set out her commitment to reducing health inequalities but to lay out details of how the Government will reduce them, and I urge her once again to reverse the cuts to public health budgets.

[Mr Philip Hollobone (in the Chair)]

If the Minister concluded by 5.28 pm, that would allow Lucy Allan time at the end of the debate to sum up.

Former British Child Migrants: Payment Scheme

Philip Hollobone Excerpts

Tuesday 26th February 2019 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

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

First of all, I thank my hon. Friend the Member for Wigan (Lisa Nandy) for securing this debate, for her excellent contribution to it and, of course, for her campaigning on this issue over many years. We have seen today her continuing tenacity, and the importance of continuing to raise these vital matters on behalf of the victims. She described the inquiry report as damning, and said that it exposed harrowing abuse and that this issue was exacerbated by the lies that were told about it. She is right that this was a shameful episode for our country.

My hon. Friend was also right that the issue went beyond the abuse that people suffered; they were also wrongly separated from their families for generations. Think about what it would mean for someone to be separated from their parents, grandparents, aunts, uncles and cousins. It is very difficult to appreciate just what kind of hole that would leave in their life, and it is also very difficult to appreciate just how harmful that is. I add my voice to hers, and would like to show my appreciation of the courage of those who have been affected by the child migration programme: the 130,000-plus British children who were deported without their consent—sometimes, as we know, even without their parents’ consent—and the estimated 4,000 unaccompanied child migrants who, as we have heard, experienced sexual, physical and emotional abuse as a result of this devastating policy, which was practised by successive post-war Governments until 1974.

As was highlighted by the independent inquiry into child sexual abuse report on the child migration programme, and in the accounts that we have heard today and in previous debates, these children suffered abuse before, during and after their migration, often over a period of many years and sometimes at the hands of more than one perpetrator. As we know, for many of them, that has had a lasting—indeed, lifelong—impact on their physical and mental wellbeing, their educational attainment and their employment prospects—in effect, their whole life. No one can fail to be moved by the personal accounts that we have all heard from those who suffered abuse, and I am sure that we are all united in our desire to do everything we can to put right those wrongs, as far as it is possible to do so.

There is no doubt that the victims of the child migration programme suffered for too long at the hands of successive Governments, and that successive Governments chose to turn a blind eye. Of course, these people also had to wait far too long for an apology. It saddens me that that took until 2010, when Gordon Brown, the then Prime Minister, formally acknowledged that successive Governments had failed in their duty of care.

Gordon Brown also established the £6 billion family restoration fund to help former child migrants to reunite with their families, so that they could build relationships, be involved in significant family events, or even urgently visit relatives at times of crisis. However, as we have heard from last year’s inquiry, despite this scheme, the UK Government have failed to provide adequate redress to the more than 2,000 surviving child migrants.

I am sure we all agree that victims have been let down all their lives by successive Governments missing opportunities to take action over the years. It is with regret that we note that it took more than nine months for the Government to respond to the inquiry report, especially given that the inquiry stressed the importance of urgent action because of the age and ill health of some of the surviving child migrants.

I welcome the Government’s acknowledgement that the delay in establishing the scheme was unacceptable, and that they will accept claims on behalf of former child migrants who were alive when the report was published last March but subsequently passed away. The report recommended that financial redress be established without delay, and that payments be made within 12 months. As we know, that would be by this Friday, 1 March. I share the frustration felt by my hon. Friend the Member for Wigan about the details of the ex gratia payment scheme having been published only on 31 January, and only on the Child Migrants Trust website. As she acknowledged, although the trust has excellent contacts throughout the former child migrant community, we need to learn from the Government whether there are any further things that they can do to publicise the scheme, to ensure that nobody is overlooked.

I share my hon. Friend’s concern that former British child migrants have raised legitimate points about their lack of involvement in the development of the payment scheme. In any case of abuse, it is absolutely vital that the victims’ voices be heard. In this case, they were not heard at the time of the abuse and they have not been heard since; it is important that they are heard throughout the whole inquiry process, which includes the determination of the payment to be made.

I hope that the Minister will say whether she is confident that the £20,000 figure will provide adequate redress. As my hon. Friend said, so far there has been little clarity about how that figure was arrived at. People absolutely need transparency at all times, not least when they have suffered in the way that we have heard about today.

My hon. Friend also asked reasonable questions about the taxable status of these payments, and so on. I hope that the Minister can respond to those questions, so that former child migrants do not suffer any more uncertainty about whether they will qualify for the scheme. I hope that he will also provide clarity about the eligibility criteria, as my hon. Friend requested, because there were child migrants who were sent to the receiving institutions with permission from parents or guardians, but as my hon. Friend clearly set out, no matter the vehicle by which children arrived at those institutions, the abuse that they suffered within them was the same. We hope that there will be no further delay to victims of the child migration programme receiving the redress they are entitled to. Will the Minister say whether she is confident that the Child Migrants Trust has the resources to administer the scheme? If it does not, what further measures will be put in place?

I share my hon. Friend’s concerns that the Government’s pledge to continue the family restoration fund until the end of the redress scheme does not meet the inquiry report’s expectation that the continuation of the scheme will not lead to reduced funding for the Child Migrants Trust or the family restoration fund. I hope that the Minister will take this opportunity to provide reassurance that the Government will continue to provide funding until the family restoration fund is no longer needed.

In conclusion, as a politician, it angers me to hear the inquiry’s conclusion that the main reason for the failure of Her Majesty’s Government to take action to end the child migration programme after the second world war—despite the evidence of ill treatment and abuse, including sexual abuse—was politics. I hope that in today’s politics we are a very long way away from that place—a place where the importance of continuing relations with other Governments and with charitable organisations, and the need to avoid reputational risk, was prioritised over the wellbeing of our children. The politicians of today may have our differences, but we must never again allow the suffering of children and their search for justice to be subservient to the politics of the day.

[Mr Philip Hollobone (in the Chair)]

Unusually, due to important parliamentary business elsewhere, we will have the Opposition spokespeople in a different order. We have heard from Her Majesty’s official Opposition; now we will hear from Stuart C. McDonald for the Scottish National party.