Mitochondrial Transfer (Three-Parent Children)

Robert Flello Excerpts

Wednesday 12th March 2014 Westminster Hall

[Jacob Rees-Mogg]

I am grateful to the hon. Gentleman for that point. That is at the heart of the issue.

[Robert Flello (Stoke-on-Trent South) (Lab)]

Another issue occurs to me with regard to knowing who the third or, indeed, fourth parent is or was. Let us suppose that, in subsequent generations, further scientific research finds that another fault is being passed down generations. Without knowing whether the third or fourth parent several generations back carried some other gene that has come to the fore only after 150 years, someone would not know whether they were affected. There is a Pandora’s box of problems.

[Jacob Rees-Mogg]

That must be right. It ends up being a multi-generational experiment with the lives of people.

To return to the PNT technique, it is effectively cloning. As I said, it is telling that the licence for the experiment was adapted from the licence given to create Dolly the sheep. Cloning is widely regarded as a dangerous technique. Essentially what is being done is eugenic.

[Jacob Rees-Mogg]

As so often, my hon. Friend is right.

The dictionary definition of “eugenic” is:

“Of or bringing about the improvement of the type of offspring produced”.

The 1922 Eugenics Congress called it

“the self direction of human evolution”.

There is grave question mark about eugenics. It frightens almost every sensible person. It is not only people who share my views who think that. In a letter to The Guardian dated 15 March 2013, that fear was made explicit by a number of medical experts. It is interesting that they chose The Guardian, which is not a bastion of right-wing reaction, to make that point. In a country nervous about genetically modified crops we are making the foolhardy move to genetically modified babies.

There are three categories of risks and dangers that have not been fully considered. The first is the category raised by the hon. Member for Stoke-on-Trent South (Robert Flello), namely practical risks relating to the long-term efficacy of the therapy. An article published in Nature in October 2012 said:

“Pioneering work in nonhuman primates is critical for the development, and safety and efficacy evaluations, of new treatments.”

That view has been discounted by the Human Fertilisation and Embryology Authority without any good reason being given. Current research using PNT in macaques has yet to be shown to be successful. Macaque zygotes do not survive the PNT process well, even though their oocytes are less prone to abnormal activation and fertilisation than human ones. If that is the case, surely we should continue with such experiments first, rather than relying on the fact that four monkeys have reached the age of three.

[Robert Flello]

On that point, the research that has been done talks about generations of mice or of monkeys, but that does not address the fact that until there have been three, four, five or 10 generations, we will not know what the long-term effects are.

--- Later in debate ---

[Jacob Rees-Mogg]

My hon. Friend makes a very good point. If the Minister would say that, her standing in North East Somerset would rise even higher, although it is hard to believe that is possible.

The Government’s own consultation—this is crucial—says:

“It is estimated that 1 in 200 children born every year in the UK have some kind of mitochondrial DNA disorder.”

The number of serious disorders is much lower, but one in 200 has some kind of mitochondrial disorder. It is worrying that that is in the consultation because the premise is that 0.5% of the population are born imperfect and that in future only perfect people should be born. Many of us have imperfections, but they make up humanity, and the mixed variety of interest, thoughtfulness and development that is humanity often comes from our faults, as well as our abilities. It is a fundamentally dangerous road to start down because, although the technique cannot at this stage affect eye colour, some clever scientist will eventually work out how to ensure that babies have blue eyes and blonde hair, or whatever people want. Every time something like this happens, we go to the next stage and the argument becomes, “Well, we’ve done this, so it is logical to continue.” When that line has been crossed, the argument against going further is merely a matter of degree; it is not absolute.

[Robert Flello]

I fear that we have already had the push to having perfect babies. Abortion on ground E of disability means that babies with even slight imperfections do not see the light of day.

[Jacob Rees-Mogg]

One aspect of political correctness that I like is calling disabled people “differently able”. People with disabilities have different abilities and skills, and contribute to the benefit of society in a different way from those of us who have the use of all our limbs, and so on.

Although the current aim is small, 10 children every year, who might have been born, will be replaced by 10 different babies. That is not a major problem crying out for an urgent solution, but the solution that is being proposed is a fundamental change in our understanding of our own humanity.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

It is a pleasure to serve under your chairmanship, Mr Pritchard. With the limited time available to me, I will set out some of the process by which we got to this point, but it goes without saying that these are extremely serious issues. I listened respectfully to colleagues’ concerns. There were some technical interventions and I will get back to colleagues about any concerns that I cannot answer now.

This is exactly why we are having consultation, and why I can confirm that the matter will be debated on the Floor of the House. The regulations will be subject to the affirmative procedure and there will be every chance to return to the issue and to debate it in full. I give that assurance. I know that I will not have time to respond to some points that are technical and scientific and I do not want to get them wrong, so I will write to hon. Members after the debate.

[Robert Flello]

On that point, will the Minister allow me to intervene?

[Jane Ellison]

I have not said anything yet, but go on.

[Robert Flello]

When the debate does come before the House, right hon. and hon. Members will look at things such as Library briefing notes and Parliamentary Office of Science and Technology notes, which normally I commend in the highest terms. My concern about the POSTnote entitled “Preventing Mitochondrial Disease”, which is Number 431 from March 2013, is that it talks about people who oppose this as simply being in a pro-life camp. That sort of language is very unhelpful, because the opposition is far wider than that.

[Jane Ellison]

I did not write that brief. I have never used that language and I would not. I accept—indeed, it is right—that this will be a subject of parliamentary debate, because it involves important issues. Just as Parliament has previously debated advances in science, such as IVF, and considered and weighed in the balance the concerns and the potential benefits, so that will happen again. I am certain that people will come to their own conclusion. These matters are normally decided by votes of conscience. I would be very surprised if this matter was not decided in the same way; in fact, I am sure that it will be.

Let me try to respond to some of the points and at least go through the process by which we have got to this point. I should say, though, in response to the intervention that was picked up by colleagues that we will arrange parliamentary briefings with, for example, some of the scientists involved and with the chief medical officer. I hope to be able to give hon. Members the opportunity to put questions directly to some of the people involved. There will be opportunities at all stages along the way, I hope, for colleagues to ask questions and get answers. What they think of the answers will obviously be down to them, but we will try to make it possible for people to come to a very informed view.

I am grateful for this opportunity. I am grateful that hon. Members have had a chance to put some of their concerns on the record, because that helps us in preparing for debates ahead. It gives us a heads-up on some of the areas of particular concern. Obviously, I have also been receiving correspondence about the matter.

The chief medical officer for England announced last year that the Government would go ahead with the development of draft regulations to allow mitochondrial donation in treatment. The consultation began on 27 February and will run until 21 May. I have already recognised the deep sensitivity of these issues. Since we were first approached in 2010 to make the regulations, we have been comprehensively collecting expert opinion and public views, and I will explain how that has been done. However, I understand that for many hon. Members and for many members of the public, this will ultimately be an ethical question. There will be strong views on both sides of the House, as we have seen today.

My hon. Friend the Member for North East Somerset (Jacob Rees-Mogg) touched on what mitochondrial disease is. It is a genetic condition of mitochondria—the part of the body’s cells that produces the energy that they need to function. It tends to be described, for the benefit of the general public, as the “battery pack” that powers a cell.

A person’s mitochondria come from their mother’s egg. Therefore, if a woman has mitochondrial disease, it is likely that she will pass it on to any children she may have. Mitochondrial DNA is separate from an individual’s genomic DNA, which is in the nucleus of the body’s cells. Mitochondrial DNA disease can be devastating, but the disease affects everyone differently. The range of different effects can include heart disease, liver disease, poor growth, loss of muscle co-ordination, visual and hearing problems and mental disorders. Rare conditions caused by faulty mitochondria include forms of Leigh’s syndrome, which can cause multiple symptoms in infancy, such as muscle weakness, heart and kidney failure and nervous system dysfunctions.

Some affected children live short and painful lives. They are constantly in and out of hospital. The quality of life for them and their families is seriously diminished. I have been contacted by a family in that position in my constituency and I suspect that other hon. Members will be as we continue to engage in this debate in the coming weeks and months.

The condition affects approximately one in 5,000 adults, although one in 6,500 babies are born with a severe form of the disease that can lead to death in early infancy. It is estimated that about 12,000 people live with a mitochondrial disease in the UK, and there is no cure. However, research has been ongoing at the Newcastle centre for life, among other places, for many years. In anticipation of significant advances in this field, the Human Fertilisation and Embryology Act was amended in 2008 to introduce a regulation-making power to allow mitochondrial donation to treat serious mitochondrial DNA disease. At the time that amendment was made, Parliament was made aware that there was the potential for these techniques to be developed. The Act was thus amended and that was included.

The mitochondrial donation techniques involve removing the nuclear genetic material from an egg or embryo with unhealthy mitochondria and transferring it to a donor egg or embryo with healthy mitochondria, as my hon. Friend the Member for North East Somerset said.

Francis Report

Robert Flello Excerpts

Wednesday 5th March 2014 Commons Chamber

[Andy Burnham]

That is the problem. The Government’s focus is on hospitals. All the while, alternatives to A and E are being degraded and taken away. It is an undeniable fact that it has become much harder to get a GP appointment under this Government. The Patients Association warns that it may soon be the norm to have to wait for up to a week. [Interruption.] The Secretary of State says, “Nonsense.” He should get out and speak to people. The people I speak to tell me they are getting up in the morning and ringing the surgery at 8 am or 9 am, only to be told there is nothing available for weeks. As my hon. Friend the Member for Stockton North (Alex Cunningham) said, they ring 111 and the advice given is to go to A and E.

The Government have created the situation that the Secretary of State will not address. He wants to put it all in his own terms, but this is the reality in the NHS right now and this is what has happened since the publication of the Francis report. He has put more pressure on hospitals, because he has made it harder for people to get a GP appointment, and hospitals today face greater difficulty in meeting their targets. Indeed, as I just said, in the 12 months since the Francis report, hospital A and Es have missed the target 32 times running. These issues go to the heart of what we are debating today.

[Robert Flello (Stoke-on-Trent South) (Lab)]

Constituents across the country will be really concerned that the Secretary of State was shaking his head when my right hon. Friend noted the fact that hospitals are under pressure and that that will have an adverse impact. Macmillan Cancer Support notes that four in 10 people are leaving hospital without enough support from health and social services. That shows there is a crisis across the entirety of the NHS, not just in A and E.

[Andy Burnham]

That is what I am saying: A and E is the barometer of the whole system. If there is pressure anywhere, in the end it shows up in A and E. Hospitals become jammed: they cannot admit people from A and E to the ward because people in the ward cannot be discharged home. This is what we are seeing. The Secretary of State is in denial, basically. He is shaking his head and saying that this is nothing to do with the issues raised by the Francis report. I am afraid that this is the real experience of people—staff and patients—up and down the country, and the sooner he wakes up to it the better for us all. If he thinks the situation with regard to getting a GP appointment is acceptable at the moment that is up to him, but those of us on the Opposition Benches find it completely unacceptable. It is simply not good enough and the sooner he pulls his finger out and does something about it the better.

The Secretary of State’s failure even to acknowledge these issues today is a matter of some amazement, given that he could find time to talk on an area that is not his responsibility—the NHS in Wales. There are, of course, important issues that the Welsh Assembly needs to address, but voters in England might appreciate it if he spent a bit more time sorting out problems here rather than pointing the finger over there.

--- Later in debate ---

[Jeremy Lefroy]

I thank the hon. Lady for her intervention, but that task is probably beyond my competence. I agree that we should use HSMRs and respond to their signals, but we should not say that they are the final judgment on specific numbers. Any HSMR that looks difficult and looks as though it needs to be investigated must be investigated—it is much better to do so than not to do so.

I will now discuss my own constituency, which, along with those of my hon. Friends the Members for Cannock Chase (Mr Burley), for Stone (Mr Cash) and for South Staffordshire (Gavin Williamson), has probably been the most affected. The spotlight has been on Stafford hospital for several years now, and it has been an extremely difficult time for those who raised their concerns, such as Julie Bailey and Cure the NHS, which were dismissed in a very offhand way by the NHS system and for which they endured abuse; it has also been extraordinarily testing for the many people working at that hospital and the one in Cannock, who have tried to carry out exemplary care at a time when the spotlight has been on them. They have, by and large, brought excellent care to patients, despite what has been going on around them. Understandably and rightly, the Care Quality Commission carried out an unannounced visit on the very day last week when it was announced that the Mid Staffs trust would be dissolved, so hon. Members can understand the sort of pressures that staff have faced. The great improvement that has been made has been recognised by the CQC and, most importantly, by patients and their loved ones. There is no complacency; there are still instances that should not happen, and the hospital and the trust are determined to ensure that they learn from all those. For Stafford and Cannock, however, it has also been a time of coming together and putting aside differences, as tens of thousands of people have worked together to save our hospitals and their services.

I will not dwell at length now on the process, the administration and the dissolution of the trust announced last week, but I will seek a debate on it, because some of the points made by the Opposition spokesman, the right hon. Member for Leigh (Andy Burnham), are fair in respect of the way the process works—or does not work. I have been critical of it and will continue to be so. I will, however, dwell on the unity. I have marched twice, not only with people who have had wonderful care at Stafford, but with some who have told me that they, too, experienced very poor care at Stafford but wish, for the sake of everyone, to see both patient safety and care improved, and services protected. Last week, the trust’s dissolution was announced, and although most services will continue, I continue to oppose decisions that mean the potential loss of consultant-led maternity services, consultant-led paediatrics and in-patient paediatrics. I will continue to fight for those services, because I believe they are essential in a hospital and a place that is at least 30 km away from the nearest other possibilities for patients. I urge NHS England, in particular, to take the consultant-led maternity review very seriously indeed.

[Robert Flello]

I pay tribute to the hon. Gentleman and the hon. Member for Stone (Mr Cash) for the work they have done. On those maternity and other services at Mid Staffs, may I say that the hon. Gentleman has support in Stoke-on-Trent South?

[Jeremy Lefroy]

I am most grateful to the hon. Gentleman, to all the Stoke-on-Trent MPs and to the hon. Member for Newcastle-under-Lyme (Paul Farrelly) for the way in which they have approached this matter together with us. We will be working with them under the new trust arrangement, with the University Hospital of North Staffordshire NHS Trust, and it is very important that we work together.

I refer to unity because the only way in which we will develop a health service fit for the 21st century is by showing that same unity of purpose nationally. I pay tribute to my hon. Friend the Member for Bracknell (Dr Lee), who is no longer in his place, for his remark about working together, and I absolutely agree with it. When the Prime Minister and the Leader of the Opposition, and later the Secretary of State and his shadow, have made their responses to the Francis report in the past year, they have been of the highest quality; they have shown a true appreciation of the gravity of the subject and the importance of a mature response.

--- Later in debate ---

[Joan Walley]

I think that there has been an extraordinary degree of cross-party support from all Staffordshire MPs for efforts to get the matter on the agenda. When we look at the initial inquiry called by the Labour Government, its extension and then its translation into a full public inquiry by the current Government, and when we consider how quickly we as parliamentarians need to ensure that we hold the Government to account, we must recognise, as the hon. Gentleman says, that it has taken an extraordinary amount of time to get this debate.

At the heart of this debate is the need not only to discuss something that affects the whole country and Wales, as we heard from my right hon. Friend the Member for Cynon Valley (Ann Clwyd), but to see what lessons the three inquiries have to teach us. One of the Francis report’s main recommendations is that it is also for Members of Parliament to question ourselves on how we hold our own trust boards to account. In a way, we need the ammunition to be able to do that. I know that the previous Member for Stafford genuinely tried to get answers on what was happening at the time from the then trust board, but those answers were not forthcoming.

[Robert Flello]

If I understand the situation correctly, the previous Member for Stafford was lied to when he tried to inquire about those issues. How on earth are Members of Parliament, with the scant resources available to us, supposed to get to the bottom of things when we are being lied to?

[Joan Walley]

That encapsulates the problem of Members of Parliament trying to get to the bottom of what is happening but being denied the information. I think that the main thrust of the report is a call for transparency and openness, for freedom of information, so that we can get informed decisions being made at local trust board level on the future direction of policy. The issue is how that is constrained by the available finances. One regret is that the finances do not come into the Francis report to the extent they might. We know that at the local level those in charge of health services are trying to ensure that they deliver a service within the financial constraints.

[Joan Walley]

It may surprise the hon. Gentleman to know that I agree with him, and that the target culture has a lot to answer for. We have moved on from that now, and we are looking at how to achieve the best possible health care within the available resources. As my right hon. Friend the Member for Leigh (Andy Burnham) said, it is important to have integration, cross-cutting services and collaboration. We must move on from the target culture to look at the best possible way to achieve high standards of service throughout the country and stand-alone services in localities.

I want to put on the record my concern that lives were destroyed and that many people and their families were severely affected by what happened as a result of the systemic failures in the Mid Staffordshire NHS Foundation Trust, and specifically at Stafford hospital. There are many lessons to be learned, and we owe it to them to ensure that we move on and get the right hospital services.

For the record, may I say that at the time I supported the call for a public inquiry? I say that from these Benches.

Whatever the mechanism, the heart of the matter is that we must learn the lessons and move forward. It is right to debate the broader issues, values and culture of the NHS. We must recognise that an integral part of that is the procedures to deal with a failing hospital. As we assess progress on the implementation of the Francis report, it is vital to hold the Government to account for their handling of the parallel process—the trust special administrator’s report. It is essential for those of us in Staffordshire to have clarity from the Secretary of State—I am sorry he is not in his place—on future arrangements for health care in Stafford. That is what most concerns me and I shall concentrate my comments on that.

Reference has been made to how fit for purpose the trust special administration process is. Is it just about finances, or is it about the broader health care that should be provided? Changes are being introduced in the Care Bill, which will come to the House on Monday. The Government must address how stuck we are with the TSA and the TSA reports, and whether they are broad enough to deal with breakdown and failure in individual hospitals. Obtaining a resolution on how current hospital services in Staffordshire are being taken forward is urgent. That is part and parcel of how we take forward the lessons that the Francis report identified.

For me, the most important paragraph in the Francis report’s terms of reference is identifying

“the lessons to be drawn from that examination as to how in the future the NHS and the bodies which regulate it can ensure that failing and potentially failing hospitals or their services are identified as soon as is practicable”.

On the trust special administrators, we should aim to identify what needs to be done in advance of a hospital failing. In Staffordshire, we are stuck with a procedure. A report was carried out and sent to Monitor, and there was public consultation, which took place only in the Mid Staffordshire area. It is a great concern that when a hospital—in our case, the University Hospital of North Staffordshire—makes a proposal to rescue some of Mid Staffordshire’s services, there has been no corresponding consultation in that area about the impact of the changed configuration of health services in north Staffordshire. That is a real failing and the Government should take it on board.

[Robert Flello]

My hon. Friend is being generous with her time. There is an issue, which the hon. Member for Cannock Chase (Mr Burley) talked about, of work going across to that hospital. The bizarre situation is that different treatments are at cost, more than cost or less than cost. It may be the case that work that ends up at the University Hospital of North Staffordshire is below-cost work, and that work that ends up at Cannock is above-cost work, so they will be a disparity in funding.

[Joan Walley]

My hon. Friend makes a good point, and I see nods on both sides of the House. We have a tariff system and there are extra needs in more vulnerable and deprived areas. The nonsense in accident and emergency services is that hospitals are criticised and penalised for treating too many patients when we have seen how GP appointment systems are breaking down. That goes back to the recommendation in the Francis report that NHS provision should be looked at in the round and in its entirety. The trust special administrator just looks at the detailed finances and the assumptions that underpin the finances. That is wrong, and that is what we should concentrate on.

Oral Answers to Questions

Robert Flello Excerpts

Tuesday 14th January 2014 Commons Chamber

[Grahame M. Morris (Easington) (Lab)]

11. What assessment he has made of the effect of social care budget changes on the number of accident and emergency attendances.

[Robert Flello (Stoke-on-Trent South) (Lab)]

13. What assessment he has made of the effect of social care budget changes on the number of accident and emergency attendances.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

16. What recent assessment he has made of the effect of social care budget changes on accident and emergency attendances.

--- Later in debate ---

[Dr Poulter]

Taking the hon. Gentleman’s question in the spirit he intends, I think there is a misunderstanding of the statistics. We need to reduce the pressure on A and E, and evidence from NHS England already shows that improvements in how social care works with the NHS over this Parliament are delivering improvements to care. In 2011-12 there were about 523,000 bed days lost because of delays attributable to social care, but in 2012-13 the number had fallen to 476,000, a drop of nearly 50,000. That shows that social care is working well to reduce pressure on A and E.

[Robert Flello]

I am absolutely amazed at the answer the Minister has just given. Stoke-on-Trent, which, despite the local authority having to cut a third of its budget, has managed to make cuts—or efficiency savings as the Government would call them, of course—and move money into social care. Despite that, however, it still has less to spend this year than it had just three years ago, and that is resulting in people not getting social care because of cuts to the budget and to eligibility. When is the Minister going to wake up and do something about it?

[Dr Poulter]

There is always a lot of political smoke around this, but spending has roughly been flat in cash terms according to the Association of Directors of Adult Social Services survey and councils are budgeting to spend more this year than they were last year on social care. In addition, we are setting up the integrated care fund of £3.8 billion to better join up health and social care, and that will help to improve the care available to patients as well as reduce pressure on budgets.

Mid Staffordshire NHS Foundation Trust

Robert Flello Excerpts

Tuesday 7th January 2014 Westminster Hall

[Jeremy Lefroy]

I am most grateful to my hon. Friend, and I return his compliments. He has likewise tremendously supported the trust and the work that has been done.

My final point is that the children and families who will be most affected by the paediatrics proposal are those on the lowest incomes. Such families are the least likely to have access to private transport to take their children nearly 20 miles to the nearest hospital at night. For them public transport in the daytime is often poor, and a taxi fare is beyond their means—certainly if they have to visit a sick child several times. I believe that those on low incomes should have fair access to health care, which both Monitor and the Secretary of State have a responsibility to ensure.

The paediatrics department at Stafford made an alternative proposal in its response to the consultation. That alternative was measured and understood the need to cut costs. The alternative proposal included a reduction in the number of in-patient paediatric beds, and consultants would have worked in a network across both of the new trust’s sites.

A pattern can be seen: critical care, maternity and paediatrics. There are sensible alternative proposals.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I echo the sentiments of other hon. Members in thanking the hon. Gentleman for securing this debate. I also echo the sentiments of my colleague and near neighbour, the hon. Member for Stone (Mr Cash).

Before the hon. Member for Stafford (Jeremy Lefroy) concludes, I have two points. First, he is absolutely right that there are sound alternatives that need to be considered very quickly, and a proper process must be put in place. Secondly, the situation’s impact across the whole of north Staffordshire, and indeed the whole of Staffordshire, should not be underestimated. I hope he agrees that there is probably no right solution, but we must get as near as possible to a right solution.

[Jeremy Lefroy]

I entirely agree with the hon. Gentleman, and I appreciate his support and the support of colleagues from Stoke-on-Trent, Newcastle and across Staffordshire. We have worked together, which is a great achievement on a subject that can be political.

In conclusion, surely it makes sense to work through the proposed clinical networks while Stafford is joining the expanded UHNS—with things roughly as they are now—for a period of two or three years. I believe that those network solutions can work. If they prove as effective as the clinicians and I think they can be, we will have achieved the objective of securing services that are financially, clinically and operationally sustainable in Stafford, and indeed elsewhere, under the expanded UHNS. Such services would be welcomed by my constituents and would reduce the potential pressure on other hospitals, such as UHNS, the Royal Wolverhampton, Manor hospital in Walsall and hospitals in Burton.

Hospices (Children and Young People)

Robert Flello Excerpts

Wednesday 18th December 2013 Westminster Hall

[Jim Shannon (Strangford) (DUP)]

It is a pleasure to say a few words in relation to this topic. I thank the hon. Member for Pudsey (Stuart Andrew)—his constituency is wonderfully named—for his contribution. It summed up and set the scene for how we all feel about the matter. We thank him for his compassion and knowledge on the issue; it was a real pleasure.

Whenever I think of this issue, I think of Northern Ireland Hospice and its good work, and of all the other hospices throughout the United Kingdom, which other Members have spoken about, and of the scourge of cancer and specifically how it affects young people. Yesterday we had a debate on rare diseases. Perhaps the two debates could have been merged together—one on rare diseases and palliative care—because they very much go hand in hand.

As well as praising the hospices, I would also like to mention the Macmillan nurses, who, in many cases, make life just that wee bit easier for the families and those concerned. I pay special credit and thanks to those caring men and women who manage to make life that little bit less stressful for those suffering from cancer and for their families.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I, too, thank the hon. Member for Pudsey (Stuart Andrew) for securing the debate, and there is also a hospice—the Donna Louise children’s hospice—in my constituency, which does marvellous work. Will the hon. Gentleman join me in commending the caring professionals, whether volunteers or paid staff, who will be working in hospices over Christmas and new year, caring for people in often difficult, if not tragic, circumstances?

[Jim Shannon]

I thank the hon. Gentleman for his intervention. I do join him in commending them, as does everyone inside and outside the House. We recognise the tremendous work they do—they are on call at all times. I sometimes wonder how they handle the sadness and emotion they have to confront each and every day as part of their vocation.

Northern Ireland Hospice is committed to fostering, encouraging and supporting a quality research culture internally, regionally, nationally and internationally, and it is known for the high level and quality of care it gives. My right hon. Friend the Member for Belfast North (Mr Dodds), who has just left, referred to the Northern Ireland Assembly Health Minister’s commitment to contribute £2.3 million to hospices, and that commitment by elected representatives shows the appreciation of what hospices do.

It is essential that those receiving end-of-life care have the best care available and are made as comfortable as they can be in their last days. It is also essential, as the hon. Member for Pudsey said, that the family have all the information they need, whether that is in a hospice setting, the patient’s home or through a palliative care package—those are the three areas that have to be looked at.

Some 49,000 young children in the United Kingdom of Great Britain and Northern Ireland live with a life-limiting or life-threatening condition and need palliative care. There are inspirational professionals working alongside them in their family homes, hospitals, community settings and hospices across the United Kingdom.

It is horrifying to think that if we had more children’s hospices, they would be filled, because the need continues to grow. Every time we find a drug that works against a strain of cancer, for example, a resistant strain appears. For that reason, it is essential we put money into not simply hospices and nurses, but research, and I am convinced the Minister will take the issue of research on board in her response.

I recently read a report stating there is a real danger that palliative care and palliative medicine will be the least evidence-based subjects in medicine in a few years’ time unless vastly more research is done. While palliative care is vital, research is equally important, so perhaps the Minister can give us some thoughts on that.

I hope we are all blessed with young children and grandchildren who are bubbly and full of life, but some families are not. Those families have to live with a child who is ill, and it is tremendously heartbreaking to acknowledge that. Before yesterday’s debate on rare diseases, the Teenage Cancer Trust sent us some information saying that 30% of children with life-threatening diseases will die before they reach the age of five. Again, that puts things in perspective.

Macmillan nurses told me that the sufferer’s mood is affected by their family. If the parents are content and relaxed, the child is likely to reflect that. This is about the family and everyone involved. It is also about the day trips and the residentials, which the hon. Member for Pudsey referred to.

We have fantastic charities, such as the Make-A-Wish Foundation, that help children with terminal illnesses live a dream. However, that in no way absolves us, as MPs, from our responsibilities to the families, and nor does it absolve the Government or the regional Assemblies from theirs.

Together for Short Lives has also highlighted an issue to me. Will short breaks for children who need palliative care be fairly and sustainably funded from ring-fenced funding allocated to local authorities for short breaks? We look forward to the Minister’s answer, and I trust it will be yes.

Another issue highlighted to me was benefits for families. As soon as the child is taken to the next scene of life—as soon as they leave this life—the parents are left to deal with their grief and their debt. Sometimes, handling the first overrides handling the second. There must be some leeway over cutting off benefits, so that the family has time to realise their financial situation and handle it accordingly. The Minister does not have direct responsibility for the benefits system, but will she say how we can help families get through the switchover at a time when grief is the ultimate driver of where they are? What can we do to ensure that they are entitled to time off and that their benefits are reduced gradually?

Care Bill [Lords]

Robert Flello Excerpts

Monday 16th December 2013 Commons Chamber

[Barbara Keeley (Worsley and Eccles South) (Lab)]

The Care Bill already seems like a wasted opportunity. I worked for four months, alongside right hon. and hon. Members of this House and Members of the other place, on the Joint Committee that scrutinised the draft Care and Support Bill, and I pay tribute to its members for their work. We now have a Bill that contains some measures that are welcome but others that are seriously flawed.

I will talk first about the burdens the Bill places on local authorities and argue that they must be resourced by the Government. Some people—Ministers or Government Members whose southern local authorities are not being cut in the same way that ours are, for instance—might think that perhaps times are okay, but there could not be a worse time to place extra financial burdens on local authorities. Indeed, the situation for my local authority, Salford city council, will be even bleaker in 2016, the planned date for implementation of the Bill’s reforms. As I said earlier, Salford has already lost £100 million in funding since 2010, and it knows that it will lose another £75 million by 2016. I hope that the Minister is listening—he does not seem to be—because funding for adult social care in Salford has fallen by 20%, from £67 million in 2010 to £53 million this year.

[Robert Flello (Stoke-on-Trent South) (Lab)]

My hon. Friend has already alluded to the fact that that is the picture up and down the country. The Special Interest Group of Municipal Authorities has said that Stoke-on-Trent has been hit the hardest, but the impact is on constituents across the country.

[Barbara Keeley]

I agree with my hon. Friend.

Changing eligibility from “moderate” to “substantial” this year will mean that the number of people in Salford receiving council-funded care packages will fall by 1,000, to 7,500. To give credit to Salford city council—my right hon. Friend the Member for Salford and Eccles (Hazel Blears) has already done so—it held off making the eligibility cut until the third year of Government budget cuts, but now it must join the nine out of 10 local authorities setting eligibility at the higher level. I am afraid that the Secretary of State’s earlier claim that they do not have to set it at that level will have sounded very hollow indeed.

Talking of things that sound hollow, the new rights for carers set out in the Bill will sound very hollow to carers in my constituency at a time when many of them are losing the few hours of support they have that give them a break. I want to cite the example of an elderly couple in Salford who have cared for their adult son for over 30 years and who have relied upon respite care for a rest or a break. At the last review of their son’s care package, the respite care element was reduced, which has had a detrimental effect on their physical and mental well-being. They are now not even sure whether they can carry on caring for him. I fear that my right hon. Friend the Member for Salford and Eccles and I will hear many more such cases as 1,000 people in Salford lose their care packages over the next year.

Many organisations involved in social care have raised fears about the crisis in care and their view that the eligibility level should be set at “moderate”, rather than “substantial.” Over the past five years, the number of people over 65 receiving publicly funded care has fallen from 1.2 million to less than 1 million, and for people aged 18 to 64 it has fallen from £570,000 to £470,000. That is a serious fall in the number of people receiving care. Some of those who have lost publicly funded care have funded the care themselves, but in other cases the care workload will have fallen on unpaid family carers.

The number of unpaid carers caring for more than 50 hours a week has increased by over a quarter in the past 10 years. As my right hon. Friend said, Carers UK has told us that 1 million carers have given up work to care, which costs the Exchequer £1.3 billion a year in extra carer’s allowance and lost tax receipts. I believe that reliance on unpaid family care with those heavier carer workloads might also have an impact on the health of those carers, particularly those caring at the heavier end.

The Government plan to set the national eligibility threshold at “substantial”. The Care and Support Alliance says that this means that 105,000 working age disabled people will be left without the support they need to live independent lives. That issue was raised by my hon. Friend the Member for Stretford and Urmston (Kate Green), and she is right to do so. We focus an awful lot on adult social care and older people, but we need to think about working-age disabled people as well.

--- Later in debate ---

[Meg Munn (Sheffield, Heeley) (Lab/Co-op)]

Members on both sides of the House agree that we need to reform and improve how we provide care to those who need it. In the words of the Law Commission, our current legal framework is a complex and confusing patchwork of legislation that is in desperate need of modernisation. However, the premise on which part of the Bill is based is simply outdated. It tries to focus the debate on residential and nursing care costs, which directs our view of care on to issues of the previous century when this should be a Bill for the landscape of the 21st century.

Only a small percentage of older people need to be in residential or nursing care and, thankfully, most of them for only a relatively short period at the end of their lives. Most people want to stay in their own homes if they can. Consequently, it is right to develop care services that make that happen, such as ExtraCare homes, whose options for meals and support for residents can change as their needs change.

Our care system is there not just for when people hit crisis point; it should be preventive, ensuring that those who need moderate care and support can receive it in their own homes. Yet, as we have heard time and again in this debate, because of the Government’s savage cuts to local authority funding, 85% of local authorities now provide care only to those whose needs are assessed as substantial. If the level is also set at substantial in relation to the proposed national eligibility criteria in clause 13, people with moderate care needs will continue to be ignored. Their needs will inevitably move to severe, which will mean even greater cost to both the individual and the state. My hon. Friends have given examples of that.

As has already been said, the vast majority of care in this country is given by family and friends, who provide not just physical care but emotional support. Most do so willingly, but many would benefit from some support through the provision of low-level services, such as a sitting service to allow them time to themselves, or a cleaning service to allow them to concentrate on providing more personal help. Put simply, a small amount of support for those whose needs are at a lower level would lever in a large amount of care by families, who would also be enabled to continue to provide support over a longer period, so saving on much more expensive services.

[Robert Flello]

On the theme that my hon. Friend is developing, quite a lot of carers are almost borderline in their need for care themselves. What is her view of the fact that without that extra bit of support for carers’ needs, there may be the double hit of two people needing care from the state?

[Meg Munn]

My hon. Friend is absolutely right. I managed care services when, not the previous Government but the one before that, brought in a health and social care Act. Within the first six months, we found that every single person who ended up in residential care did so because of carer breakdown, as the carer was not getting support. That is why this support is such an important part of what we should deliver.

Care services must be personalised: they have to be about choice, as well as need. If we are to make such personalisation a reality, we need further integration of our health and social care services. The duty on local authorities under clause 3 to promote the integration of care and support with health services does not go far enough in that respect. Indeed, a recent survey of health and wellbeing boards found that most local authorities have not identified integrated care as a priority. Clearly, we must do more to drive forward the development of integrated care. Without such an approach, we will return to the days that I remember well, when there were fruitless arguments about whether a service such as bathing was required on social or health grounds.

The integration of health and social care services is crucial to ensure that we provide carers with sufficient support. As a patron of Sheffield Young Carers, I feel privileged to have seen at first hand the selfless role that even very young carers undertake in our communities, and they should be valued.

As has been said by the right hon. Member for Banbury (Sir Tony Baldry) and my hon. Friend the Member for Worsley and Eccles South (Barbara Keeley), the Bill places a duty on local authorities to have regard to the importance of identifying carers, but that is not good enough. Some 80% of carers have contact with a health care professional, and it makes absolutely no sense to leave the NHS out of the duty to identify carers.

That matter is especially worrying as regards young carers, who quite often need a lot of support. The Children and Families Bill will strengthen young carers’ rights by providing that when a child is identified as a young carer, the needs of everyone in the family should be considered. That of course presupposes that young carers will be identified in the first place. If we do not place a corresponding duty to identify carers on health authorities, we risk young carers falling through the gaps, and we cannot continue to leave them without support.

My remarks would be somewhat lacking if I did not refer to the funding or, perhaps more accurately, the lack of funding that underpins our social care system. The proposals outlined in the Bill primarily concern redistributing the costs of care, and they will not bring any extra funding into the system.

Oral Answers to Questions

Robert Flello Excerpts

Tuesday 26th November 2013 Commons Chamber

[Norman Lamb]

The Government’s response to the Francis report demonstrated that openness and transparency are critical. As a result of the steps that we have proposed, this will be the most open health system anywhere in the world. That is something we should be very proud of.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I need to press the Minister on this. Does he really expect people to believe that cutting £1.8 billion from local authority care budgets—Stoke-on-Trent has lost a third of its overall funding—will have no impact on the A and E crisis?

[Norman Lamb]

Labour still seems to be in complete denial about the crisis in public finances that we inherited in 2010 owing to failures by the Government whom the hon. Gentleman supported in managing public finances. What we are doing is introducing a £3.8 billion fund to pool health and social care. It amounts to a substantial shift of resources to preventing ill health and it will do exactly what we need to do for social care.

Mid Staffordshire NHS Foundation Trust

Robert Flello Excerpts

Tuesday 19th November 2013 Commons Chamber

[Mr Hunt]

That is a very good point. I will take it away and look at whether that will be possible, because there is a powerful logic behind making that happen. As my hon. Friend has mentioned health care assistants, I would like to highlight the brilliant work they do, along with so many NHS staff. It has been a very challenging year for them to read about these examples of poor care, which are as shocking to them as they are to us. I agree that now is the time to get behind the people on the front line, who really want to change the culture for the better.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I, too, welcome the Secretary of State’s statement and the observations made by my right hon. Friend the shadow Secretary of State, but my constituents will be concerned about the impact of whatever the trust special administrator decides is right for Mid Staffordshire on the university hospital and the care they will receive there. Whether as a result of pressures from Cannock Chase or other areas, there is the risk that work will go to the university hospital but that it will not be fully recompensed for what is needed and that—this is a terrible thing to talk about in these terms—the profitable work that would otherwise cross-subsidise that might well go to other areas. Will the Secretary of State look carefully at ensuring that the university hospital is not penalised as a result?

[Mr Hunt]

We want to ensure that no hospitals are penalised and that we end up with a solution for the whole local health economy that is sustainable for the long term. The comfort that I think the hon. Gentleman can draw from today’s announcement is that, as a result of the openness and transparency and the rigorous independent inspections that will be happening at all the hospitals his constituents use, poor care, where it exists, will come to the surface and be dealt with much more quickly.

Oral Answers to Questions

Robert Flello Excerpts

Tuesday 11th June 2013 Commons Chamber

[Norman Lamb]

I applaud the work that Mind is doing to demonstrate the stark differences between the treatment of people with mental health problems who are in crisis and that of people with physical health problems. Its work demonstrates that without proper liaison services, people end up in hospital, at increased cost to the NHS. I have asked all the relevant bodies to get together to agree a plan to ensure that there is urgent crisis care for people with mental health problems, like that experienced by people with physical health problems.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I am most concerned that as well as the problems at the crisis level, there is not enough support for people with low-level mental health issues so that they do not get into crisis. Although I welcome what the Minister has said about improvements by 2015, does he not agree that we need stronger and more defined targets to get the progress that is needed towards the mental health services that are required across the country?

[Norman Lamb]

I agree that the more we invest in preventive care, the more we will save problems down the track and stop people’s health deteriorating. Areas that have managed to integrate mental health with primary care have seen good results, with better treatment, quicker access to treatment and less deterioration of health. That is the approach that we need to take.

Accident and Emergency Waiting Times

Robert Flello Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

The room went quiet when the nurse spoke at the summit. I pay tribute to my hon. Friend for being at the summit during the parliamentary recess to hear that nurse. It was a valuable event. My hon. Friend is absolutely right: the loss of simple support in the home for people such as that woman means that they are left with no alternative but to go to A and E or the hospital as the last resort. That is the false economy that I am talking about. By ransacking council budgets to pay for their NHS spending plans, the Government have left this system with major problems that they urgently need to address. The worst thing of all is that they have left older people with no option but to end up in hospital.

[Robert Flello (Stoke-on-Trent South) (Lab)]

I am grateful to my right hon. Friend for giving way; he is being very generous with his time. He is absolutely right: areas such as Stoke-on-Trent have had their budgets slashed and destroyed year on year under this Government. In Stoke-on-Trent, which is the third hardest hit area, the local authority is expected to spread the money it does have even more thinly across a population that is not only deprived, but ageing. The sniping and comments from those of the Government Front Bench are totally inappropriate. Does my right hon. Friend know when the Government got the NHS to write to accident and emergency departments to ask for their plans?

[Mr Deputy Speaker (Mr Lindsay Hoyle)]

Order. A lot of Members want to speak, so we need very short interventions.