Care Bill [Lords]

Sarah Newton Excerpts

Tuesday 11th March 2014 Commons Chamber

[Barbara Keeley]

I would like to think so, but I am not going to hold my breath. I think I am a lot more pessimistic than the hon. Lady. Indeed, we know that some GPs have been so alarmed that they want to opt their patients out of the scheme. They should be able to do that without penalty. It is up to Ministers, NHS England and HSCIC to rebuild that confidence, but they are not doing so at the moment. They seem to see what is going wrong as a communication or public relations problem. It is not a communication or PR problem; it is a very serious problem with regard to the integrity of what they are doing, and a lack of transparency and accountability. We cannot say that enough times.

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

I have worked alongside the hon. Lady to try to improve our social care system, so does she not agree that it is important that we work on this issue so that GPs are confident about sharing data? Otherwise, how will we enable the integration of social care with the NHS in the community to give people the sort of care that I know that she and I, through all our work together in Parliament, want to see?

[Barbara Keeley]

Yes, indeed, but I cannot emphasise enough that I do not feel much confidence at the moment and I do not blame GPs for not being confident. They are, in data protection terms, the owners of their patient data. If they do not feel that their concerns have been allayed, we have some way to go. I will touch on that point in a moment.

There are fundamental concerns on how data will be shared and the Government’s amendments do not address them. The amendments would improve Government new clause 34, but broadly it offers no further protection. It seems that data could still be released to commercial bodies, such as private health care companies that are also health insurers, the pharmaceutical industry and private health care providers. We need assurances on that. As far as I can see in this debate, we have not had them.

The Government’s new clause will actually widen the dissemination of information to include the promotion of health. Promotion of health can take in all kinds of commercial companies, for example food and drink companies that say they have a public health campaign. This will cause more problems. It draws the purposes so widely that misuses would still be permitted, and even be given a statutory basis. The requirement that the HSCIC must have regard to the advice of the confidentiality advisory group is still an inadequate protection.

I have added my name to amendments (a) and (b), tabled by the hon. Member for Totnes, because they would narrow the purposes for which data can be disseminated. However, I remain concerned about the commercial exploitation of patient data. I support new clause 25, which highlights the seriousness of the offence of misusing patient data. We need a clear disincentive for institutional abuse of confidential patient data with appropriate penalties including, as the hon. Lady said, imprisonment. Imprisonment is appropriate for the abuse of confidential patient data.

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[Jim Shannon]

The hon. Lady is right that the amendments would go a long way to addressing that issue. I hope that the Government take that on board.

In response to the fears expressed by many, several amendments were tabled to clarify the circumstances in which the Health and Social Care Information Centre will be able to release data. We need further clarification of the provisions concerning the dissemination of information, which suggest that the information centre may disseminate it only if it considers that doing so would be for the purposes of the provision of health care and adult social care. Clarification is needed for those charities that have contacted many of us in the Chamber. Cancer Research UK, among other worthy causes, would like reassurance that access to data for research is included on the

“provision of health care and adult social care”

and that access to research data will not be restricted on the basis of the amendment. That is the reason I support the proposals.

Cancer Research UK has said that it particularly welcomes the Government’s inclusion of proposals that would give the Health Research Authority the ability to accept guidance on how the governance of particular research should be handled by the NHS trusts and their duty to adhere to it. These proposals were added following calls from Cancer Research UK and the medical research sector, and were supported by many parliamentarians during the pre-legislative scrutiny of the Bill of which I, with others, was a part.

Governance continues to be the primary barrier to conducting research in the NHS. A single trial can take place across multiple trusts, so obtaining governance approvals from each participating trust, which may have different approval criteria and often duplicate checks, can cause significant delays. New clause 25 would put in the Bill the firmness, accountability and legislative control that is necessary to ensure that the leakage, for want of a better word, of information does not take place. It is important that we do that.

In conclusion, statistics indicate that by 2020 one in two people will get cancer. We had a debate in Westminster Hall this morning on cancer care; it was passionate and well thought out by many Members with personal experience of cancer in their families and their constituencies. The enormity of cancer and what it will do to society is why we have a responsibility in the House to ensure that we help. The need for research and new treatments for cancer is greater now than ever. We must ensure that while protecting people from the unsafe or mercenary use of personal information, we are not hampering the fantastic work done by these charities to discover more about cancer and to help more people win their personal battle. I support these amendments and I ask the House to do the same.

[Sarah Newton]

It is a great honour to follow the hon. Member for Strangford (Jim Shannon), who touched on an incredibly important point: we must not forget the people whose lives have already been transformed by research organisations’ access to data to find cures and prevention for diseases such as cancer. There cannot be anyone in the House who has not been touched by cancer, personally or within their families. It is incumbent on us all to do everything we can to create the right ecosystem and regulatory environment to enable research that will have a life-saving and transformative effect for people.

[Dr Wollaston]

Does my hon. Friend agree that early diagnosis is one the keys to improving cancer outcomes? By linking GP records to hospital records we can identify which practices were not referring early enough and help to improve that practice.

[Sarah Newton]

That is a very important point. Without the sharing of data, such patterns would not occur and we would have the much-talked-about postcode lottery whereby someone’s ability to get timed referrals and access to the best quality care depends on where they live and who their GP is.

I have the great pleasure and privilege of serving on the Science and Technology Committee. We have recently undertaken an inquiry into the regulatory framework for research into all sorts of diseases, including cancer. A very important finding of the inquiry was the essential role of sharing data. It is incredibly important that we come up with the right structures and protections to enable people, and GPs, to have confidence to enable the sharing of that data.

We should be very proud—we in the Chamber must not forget—of the fact that the UK leads the way in many areas of medical research; our universities, our trusts and our foundations are world leaders in what they do. That is very important in terms of our universities’ standing and important to a lot of high-quality jobs in our economy, not only for the benefit of citizens here but people all over the world. We must to do all in our power to maintain a system that enables money to be invested in research at our universities.

[Grahame M. Morris]

The hon. Lady is making a powerful case for the benefits of a system that would make it possible to identify hotspots of disease and carry out early interventions. I think that it could also be useful to studies of the long-term effects of medication. For instance, there was a long-term study of the link between the oral contraceptive and the incidence of particular forms of cancer. I think that such a database would be incredibly useful to studies of that kind, provided that there were the necessary safeguards in relation to privacy and access.

[Sarah Newton]

The hon. Gentleman has given yet another reason for the importance of collecting and sharing data in a way that helps to improve health outcomes. A further example is an inquiry into medical implants that was conducted by the Science and Technology Committee. Orthopaedic surgeons were able to keep a great many data relating to the types of implants used in, for instance, hip replacements, and to track, over time, the outcomes for the patients. As a result of that research, they were able to identify particularly problematic implants, and the information was shared among clinicians so that they could improve existing implants and develop new ones. Hip replacements have improved greatly as a result. It is vital that we establish frameworks that give confidence to patients and to medical practitioners, so that such information can be collected and used to improve patient outcomes.

[Barbara Keeley]

The hon. Lady clearly supports such uses of the databases, but, as I said earlier, there is concern about the fact that this is going global. There are memorandums of understanding between countries, and the granting of access to one organisation seems to lead to its being granted to others. The whole thing could easily spiral out of control. Does the hon. Lady share that concern? I do not know whether her inquiry established any way of describing the system that would enable people to understand it and have confidence in it.

[Sarah Newton]

In many of our inquiries, we have looked into international collaborations between universities that are tackling some of the greatest challenges of our time. One example is research into various forms of dementia, and proteins in the brain that contribute not only to vascular dementia, but even to vCJD. We have concluded that in order to meet the huge challenges that those diseases pose to the whole world, we need to pool our resources across universities and research communities internationally. There is an increasing number of well-established protocols and sensible ways of reassuring patients and others about the use of their data. Such international collaboration makes it more likely that we can make discoveries that will drive improvements in people’s outcomes.

Frameworks and safeguards exist to enable universities and academics to collaborate. We should be careful about the language that we use in this context, because there has been scaremongering, and people are identifying all sorts of potential uses for the data for which there is not much evidence. We have been reassured several times today that the information would not fall into the hands of insurance companies and be used in a harmful way.

[Mike Thornton (Eastleigh) (LD)]

The hon. Lady is making a strong point. I visited the oesophageal cancer research unit at Southampton hospital. As I am sure all Members know, oesophageal cancer is a particularly filthy disease, and is very difficult to treat. The lack of data made it hard for those in the unit to find out what was going on, and to have more information to work on. I am glad to say that they are getting there—slowly—but I think it particularly important to note that data of this kind can be used to save lives.

[Sarah Newton]

We could spend a great deal of time talking about different types of medical research that are enabling huge progress to be made with particular diseases. Given the time that is available to me, however, I now want to talk about another aspect of the importance of sharing medical data to improve patient outcomes—the integration of social care with NHS services. I am sure that everyone in the Chamber would say that that was a good thing. It is important for all the services in a community, whether provided by a local council or by primary or acute care authorities, to be joined up around patients and their families to ensure that patients receive the best possible care, whatever their long-term condition may be. That is a subject that we all discuss, and on which we largely agree. However, when it comes to practical implementation, what we hear in inquiry after inquiry is that the barrier that prevents the delivery of those joined-up, improved outcomes is a lack of ability to share data.

[Grahame M. Morris]

The hon. Lady is being extremely generous in taking so many interventions. I agree with her assessment of the value of integration and better collaboration, but does she agree with me that the most important way of getting primary care on board is winning the confidence of general practitioners? One suggestion from the British Medical Association is that the Department of Health should offer GPs an indemnity against the possibility of being sued by patients who feel that their data has been misused. Does the hon. Lady think that that would be a good way of rebuilding their trust?

[Sarah Newton]

I think that GPs are some of the most trusted people in our communities, and that the relationship between them and their patients is incredibly special and important. I certainly have not detected any lack of trust in GPs in the course of my constituency work.

Let me tell the hon. Gentleman about a wonderful initiative that is taking place in Cornwall as part of the Government’s pioneer programme. Many organisations in various parts of the United Kingdom applied to the Government to become integration pioneers, and 14 areas were chosen. I am very proud that Cornwall was one of them.

We are blessed with a unitary authority and a commissioning group of GPs, the Kernow commissioning group. They are full of great ideas about working in new and collaborative ways to improve health outcomes in Cornwall: they are truly dedicated individuals, with an inspiring programme of change. However, all that depends on data sharing. If patients in Cornwall are to be given the joined-up care that they need, general practices must be able to share patient information with other organisations in Cornwall—organisations such as Peninsula Community Health, a social enterprise that is delivering most of our community services alongside the acute hospital, Royal Cornwall hospital, and voluntary sector organisations. They are leading the way in our pioneer bid to enable patients to live independent, good-quality lives at home.

All that great work is underpinned by the need of all those people, working together to bring about health improvements in Cornwall, to share patient information. At present the Cornwall pilot is going very well, is growing, and is supported by both GPs and patients. That leads me to believe that the relationship between GPs and others is different from the relationship described by the hon. Gentleman, in that it is based on trust.

[Grahame M. Morris]

I apologise if I did not make my point very well. I was suggesting not that there had been a breakdown of trust between patients and GPs, but that there was a tension between GPs and the Department of Health—or, at least, NHS England—over the way in which the scheme was being administered, and that there was an opportunity for that to be corrected. That was my simple contention.

[Sarah Newton]

Again, I thank the hon. Gentleman for his intervention and I am sure we are going to hear more from the Minister, although we have already heard a great deal from him, about the sorts of reassurances GPs and other people have been seeking about how the data are going to be used.

It is essential that we address the fears and concerns that have been so well raised today, particularly by my hon. Friend the Member for Totnes (Dr Wollaston), because it is vital that people do not opt out. For all the benefits we have heard about today in improving care in our country by integrating the NHS with social care and in making sure we get the benefits from our first-class medical research, we have to have a data capture and data sharing set of regulations and behaviours among the people who are making those decisions that gives us all confidence so that we truly do derive the benefits we have heard about today.

[Several hon. Members]

rose—

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[Dr Poulter]

As a Member of the previous Government, it is a pity that the hon. Lady did not take these issues more seriously at the time. It has been left to the current Government to fix the problem through the 2012 Act and the amendments that we have tabled today. That is not good enough and she knows it. It is also the case that she has not read the 2012 Act properly, because I have just outlined the section 245 powers that the Secretary of State has. That is parliamentary oversight in anyone’s terms.

Finally, let me turn to amendment 29 tabled by the hon. Member for Copeland (Mr Reed). As he has said:

“The importance of such data in medical research, and in the synthesis of new treatments and better care, cannot be overstated. In research terms, more information about how people with certain conditions react to treatments can led to better research being undertaken, which uses resources more efficiently and improves a patient’s quality of life.” ––[Official Report, Care [Lords] Public Bill Committee, 30 January 2014; c. 513.]

I completely agree with that. It is important that we uphold a person’s right to confidentiality while enabling the use of information to improve the current and future health and care of the population, with appropriate safeguards to protect confidentiality.

The Health Service (Control of Patient Information) Regulations 2002 made under section 251 of the National Health Service Act 2006 modify the common law obligations of confidentiality. It allows researchers, public health staff and other medical practitioners to access information where there is no reasonably practicable way of obtaining consent to use such information for the purposes of medical research. That is in the interests of improving patient care or in the public interest.

Amendment 29 requires the Secretary State to give approval for the processing of confidential patient information for research purposes. In January 2011, the Academy of Medical Sciences published a review of the regulation and governance of health research. It criticised the complexity of the arrangements for regulating the use of patient information, saying that they are a significant barrier to research. None of us in this House wishes to put barriers in the way of medical research. The Secretary of State has already delegated the function of the approval of processing confidential patient information for research purposes to the existing Health Research Authority special health authority. The 2002 regulations as amended by this Bill would give the new HRA this function directly.

Under this Bill, the HRA would be responsible for overseeing the ethical review of health and adult social care research. As access to patient information may involve the consideration of ethical issues, it makes sense for the HRA to make decisions on applications for access to confidential patient information for research purposes.

Robust legislative safeguards ensure approval for access to patient information for research purposes is given appropriately by the HRA. These include a condition that the HRA may approve processing of patient information for research purposes only if approval has been given by a research ethics committee, established or recognised by the HRA, and a requirement that the new HRA appoints an independent committee to provide advice on applications to process patient information. This provides continuity for the committee known as the confidentiality advisory group, which I spoke about earlier in my opening remarks.

[Sarah Newton]

rose—

[Dr Poulter]

If my hon. Friend will forgive me, I will not give way. I have only two minutes left, and I want to address some of the other points made in the debate.

The HRA was set up to streamline approvals for research. The Academy of Medical Sciences has said that the transfer of responsibility for the research use of confidential patient information to the HRA provides a good opportunity to reduce the complexity in this area of regulation and governance that has in the past led to conflicting interpretations of it by researchers, trusts, patients and other stakeholders. It brings important clarity to the people whom we care about the most—the patients and the users of our health and care services.

Given those reassurances, I hope that the hon. Member for Copeland (Mr Reed) will withdraw his amendment and that Members will feel able to support the Government’s revised clauses in the interests of bringing greater clarity to safeguard patient confidentiality in the use of health and care information.

I am also grateful to my hon. Friend the Member for Totnes and other colleagues for tabling amendments (a) and (b) to new clause 34. It is clear that we share the desire that the huge wealth of data available through the health and care information system must support research to improve health and care. Although I welcome the intention behind amendment (a), which is to clarify that data should generally be disseminated only for purposes that improve health and care, the proposed wording would have the unintended effect of closing down access to data for some wholly legitimate purposes. For example, it might effectively block the Health and Social Care Information Centre from disseminating data that could be used to ensure that a particular health care service change will not have a negative impact on current levels of safety and quality of care or, worse, on the prevention of harm. I am sure that we would all want to avoid such an unintended consequence in the wake of the Francis report and the need to use health and care data properly to expose the rare examples in our NHS and care system of care that does not meet the standards we expect.

I have done my best to address many of the concerns raised in the debate. The care.data programme is a good one that we should all support. This Government, unlike the previous Government, are ensuring that we have proper safeguards in place to protect patient confidentiality.

Question put and agreed to.

New clause 34 accordingly read a Second time, and added to the Bill.

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[The Secretary of State for Health (Mr Jeremy Hunt)]

I beg to move, That the Bill be now read the Third time.

The Bill will bring about the most profound change in the care system for a generation. It provides certainty on care costs that has never been available before; independent and transparent inspections to drive up the quality of care; integration of the health and social care in a way that has been talked about for years but never delivered; and real patient empowerment to put people firmly in the driving seat for their care planning.

The Bill will also implement or help to implement many key recommendations made in the Francis report following the shocking failings at Mid Staffordshire NHS foundation trust. We are also establishing vital new principles for dealing with failure where it occurs, most notably the requirement and ability to deal with unsafe care quickly before lives are lost unnecessarily.

I thank all those who have been involved in considering and scrutinising the Bill, including my predecessor, who was responsible for originating it, together with my right hon. Friend the Member for Sutton and Cheam (Paul Burstow). I particularly wish to thank the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), and the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) for their herculean efforts in Committee and today to ensure that the Bill returns to the other place in the best possible state. There was a well-informed and rich debate on this landmark piece of legislation, for which I thank Members on both sides of the House.

We know that in the next 20 years, 1.4 million more people are likely to need care and support. The Bill prepares our country for that change with the most comprehensive reform of social care legislation in more than 60 years, creating for the first time a single, modern statute for adult care and support that is focused around the person, not the service. Meanwhile the new £3.8 billion merger of health and care services will allow the delivery of seamless, co-ordinated, whole-person care for those in need. In doing so, we will be realising a vision that was talked of for 13 years by the previous Government and actioned in three by this one.

Crucially, these reforms make a reality of the proposals of the Commission on the Funding of Care and Support, chaired by Andrew Dilnot. Many older people and people with disabilities face catastrophic and potentially ruinous bills for their care and support. The Dilnot commission judged quite simply that the current funding system is not fit for purpose. The Government have listened to the commission’s advice, have acted, and are implementing its recommendations. For the first time, a cap on care costs at £72,000 in today’s prices will provide protection to every single person in England. People who have worked hard all their lives need no longer fear that they will lose everything just because they are unlucky enough to develop care needs beyond any reasonable budget.

The difficult decisions the Government have taken on public spending have enabled us to pledge £2 billion per year to fund this cap, from which more than 100,000 people will directly benefit financially. What is more, we are raising the threshold for the means test for help with residential care, so that in 2016-17 alone, up to 35,000 more people will receive support with their care costs. Our universal deferred payment scheme will put an end to people being forced to sell their homes in their lifetime to pay for their care.

People often enter care at a point of crisis, and at a time of great distress. These reforms will create a better, fairer system, enabling people to grow old, safe in the knowledge that they will receive the care they need without facing unlimited costs. Combined with the Government’s wider moves to protect pensions and improve care standards, we are determined to fulfil our vision to make Britain the best country in the world to grow old in.

[Sarah Newton]

I had the great privilege to serve in Committee, during which the Minister of State, Department of Health, my hon. Friend the hon. Member for North Norfolk (Norman Lamb) expressed support for my view that if the pilots prove successful, we should be able to provide free social care at the end of life to allow more people to die with dignity at home. Would my right hon. Friend commit to that this evening?

[Mr Hunt]

I thank my hon. Friend for her work in Committee. That is an aspiration that we all share, and some of the results from the pilots are extremely encouraging in terms of the extra care and support we are able to give people. End-of-life care is a priority for everyone, so I share her enthusiasm that we can make progress on that very important area.

Financial security must be combined with confidence in the standard of care received. A year on from the Francis report, we are debating a Bill that will help us to deliver 61 commitments that we made in response to it. We are restoring and strengthening a culture of compassionate care in our health and care system.

Robert Francis’s report said that the public should always be confident that health care assistants have had the training they need to provide safe care. The Bill will allow us to appoint bodies to set the standards for the training of health care assistants and social care support workers. These will be the foundation of the new care certificate, which will provide clear evidence to patients that the person in front of them has the skills, knowledge and behaviours to provide compassionate high-quality care and support.

New fundamental standards will ensure that all patients get the care experience for which the NHS, at its best, is known. In his report, Robert Francis identified a lack of openness extending from the wards of Mid Staffs to the corridors of Whitehall. We want to ensure that patients are given the truth when things go wrong, so the Bill introduces a requirement for a statutory duty of candour which applies to all providers of care registered with the CQC. The Francis inquiry also found that providing false or misleading information allows poor and dangerous care to continue. We want to ensure that organisations are honest in the information they supply under legal obligation, so the Bill introduces a new criminal offence for care providers that supply or publish certain types of false or misleading information.

The care.data programme will alert the NHS to where standards drop and enable it to take prompt action. To succeed, it is vital that the programme gives patients confidence in the way their data are used. For that reason we have today amended the Bill to provide rock-solid assurance that confidential patient information will not be sold for commercial insurance purposes.

Patients also need to have confidence that where there are failings in care they will be dealt with swiftly. At Mid Staffs that took far too long. That is why the Care Bill requires the CQC to appoint three chief inspectors to act as the nation’s whistleblowers-in-chief. Their existence has started to drive up standards even in the short time they have been in their jobs.

Perhaps most fundamentally, the Bill re-establishes the CQC as an independent inspectorate, free from political interference. The Bill will remove nine powers of the Secretary of State to intervene in the CQC to ensure that it can operate without fear or favour. The Bill will also give the CQC the power to instigate a new failure regime and will give Monitor greater powers to intervene in those hospitals that are found to be failing to deliver safe and compassionate care to their patients. For the most seriously challenged NHS providers, there needs to be a clear end point when such interventions have not worked. The Bill makes vital changes to the trust special administration regime, established by the Labour party in 2009, to ensure that an administrator is able to look beyond the boundaries of the trust in administration to find a solution that delivers the best overall outcome for the local population.

Care Bill [Lords]

Sarah Newton Excerpts

Monday 10th March 2014 Commons Chamber

[Paul Burstow]

The hon. Lady is not a convert. She has been consistent and clear in her pursuit of this provision, both with her own Government and with this Government, and I hope that eventually her persistence will pay off. It has persuaded me, along with many carers’ organisations, of the need for such a change.

Institutionally, the NHS is not good at grasping the different responsibilities it has towards carers compared with those who are its immediate concern—the patients. As a result, it lets carers down institutionally, and that is what the new clause says we need to address. We need to change the NHS’s mindset institutionally to make sure that it recognises its responsibility for millions of people with caring responsibilities and asks the necessary questions. Macmillan Cancer Support has found that 78% of health care professionals have come across a cancer patient who has been admitted because their carer could not cope at home. Here is why the NHS must fully engage with carers: only one in three professionals who sees an accompanied patient always goes on to check whether the person with them is their carer.

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

I, too, have supported my right hon. Friend’s new clause, because this is an essential point. This Government should be proud of the support that they have introduced for the legion of unpaid carers who do such a fantastic job, but if their doctors, district nurses and health care professionals do not let them know about these rights, they are not really worth having.

[Paul Burstow]

That is absolutely right. This is not, as it can sometimes be portrayed, a case of “Let’s just have a tick-box”; it is about signalling a set of changes that need to happen in the culture of the organisation, so that when a patient visiting their GP or a consultant is accompanied by a member of their family or someone else who is supporting them, that instinctively forms part of the conversation about signposting and information about carers.

At the moment, just 7% of practitioners always signpost for a carers assessment. That is why we need to make sure, through this new clause, that we place a simple duty on the NHS so that it plays its part in identifying carers. One of the most shocking statistics is that 64% of health professionals think that that is necessary. They think that it will help them in their day-to-day practice and in ensuring that the issue is put up the agenda.

Oral Answers to Questions

Sarah Newton Excerpts

Tuesday 14th January 2014 Commons Chamber

[Dr Poulter]

I make two points. First, the eligibility criteria began to change under the previous Government, so it is wrong of the hon. Lady to try to make political points which do not stand up to scrutiny. Secondly, I am disappointed that she is unable to recognise that there is very good integration of health and social care in Salford, in her own constituency. That is a model that we could look at to see how good care can be delivered elsewhere.

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

I am delighted that Cornwall has been chosen as a pioneer area for joining up health and social care. It is the only pioneer area to be led by the voluntary sector. Will the Minister meet me and the Cornwall team to enable us to deliver that care in Cornwall?

[Dr Poulter]

I can confirm that the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb), will be delighted to meet my hon. Friend to take that further, and that he and I will be visiting Cornwall in the next few months to see at first hand the excellent work that is being done there.

G8 Summit on Dementia

Sarah Newton Excerpts

Thursday 28th November 2013 Commons Chamber

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

I, too, congratulate the hon. Members who secured the debate on their relentless tenacity, because they always provide us with opportunities to talk about this incredibly important issue. I do not think that it is an exaggeration to say that it is one of the largest public health challenges facing the world in the 21st century.

Although I would love to take a few minutes to celebrate the work I have seen in my constituency, with constituents responding so positively to the Prime Minister’s challenge to come together as a community of health professionals, voluntary sector organisations and businesses to make it a very friendly place to live in, and to celebrate many of the improvements in the local NHS and care sector, I want to draw us back, because I will probably be the last Back-Bench Member to speak, to the particular challenges and opportunities that the G8 summit presents. I will recap on the aims of the summit, because it is very much about the research. They are to identify and agree new international approaches to dementia research; to help break down barriers within and between companies, researchers and clinicians; and to secure the type of collaboration and co-operation that he been mentioned so far.

I will focus on what more we can do on the science. The Government have committed to spending a lot more money, and we have heard about other countries committing considerable sums of money to research, but, as in so many other areas, it is about more than just the money. It will be vital at the summit to listen to the expert evidence that will be considered from clinicians, the pharmaceutical industry and researchers and to look at what the barriers are to better and more effective use of the funds available for the prevention, diagnosis and treatment of dementia.

[Steve Rotheram]

The hon. Lady is of course absolutely right that the science is the most important part of this, but, as I mentioned, there are also non-pharmaceutical interventions that are equally important to people who are suffering until, I hope, we can find the cure that we would all like to see.

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[Sarah Newton]

rose—

[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. Hon. Members ought to note that if they wish to hear what the Minister and the Opposition Front-Bench spokesman have to say about the debate, they should not take any further interventions.

[Sarah Newton]

I am a member of the Science and Technology Committee, and I am delighted that my Chairman, the hon. Member for Ellesmere Port and Neston (Andrew Miller), is here and has intervened. I would like to draw the Minister’s attention to some excellent work that our Committee has been doing this year. I think that some of the reports we have published will help him to prepare for the summit. We undertook a very good investigation into clinical trials and also produced a report called “Bridging the valley of death”. Both reports highlighted a very significant issue facing research, not only in the UK but globally.

As Members will know, we have an absolutely world-class science base in our country. The main challenge facing it is to overcome regulatory environments, many of which are international, to enable it to take its first-class research across the valley of death and into the development of ways of diagnosing dementia and therapies for treating it. It is very important to learn the lessons from our very extensive inquiries to enable more of this research to be commercially developed in order to find its way into the marketplace.

[Andrew Miller]

Does the hon. Lady agree that it would be helpful if the Minister could revisit the Government’s response to our inquiry on clinical trials, because we could then be a world leader and show real leadership at the summit?

[Sarah Newton]

Only yesterday, we took evidence from Professor Collinge from University College London and Professor Ironside from Edinburgh, who are leaders in the field of degenerative brain disease. They provided us with even more compelling evidence of the increasing difficulties of getting from the research stage to being able to secure enough commitment from the pharmaceutical industry and other bodies that fund research into developing the science into diagnostic and therapeutic techniques. They reported that the pharmaceutical industry, which is a massive investor in research and its outcomes, is getting far more risk-averse and, as a result, is putting many more burdens on to the research of scientists in universities—burdens that they are not really capable of taking on board. The G8’s focus on getting the companies and clinicians, as well as researchers, around the table to look at the pathways from the science into scaleable, commercialised solutions is vital.

It is important that we do this not only in our own country but internationally, because most of the regulations are international. Where there is not international agreement, that in itself becomes a barrier to research and its commercialisation. The work done at the G8 will enable there to be much larger markets, meaning that very many more people will be helped and that money will flow into the research and make it more widely available.

The transcripts from our findings yesterday will be available in a couple of days’ time. That should give the Minister a good opportunity to look at the evidence we were given by those very eminent researchers, who are undertaking research into prions, as well as looking into developments on variant CJD, which is a form of dementia, and how that links to other types of dementia such as Alzheimer’s. We need that sort of joining up across the process to enable diagnostic and preventive procedures, and therapies, to be developed. All the various scientists—

[Madam Deputy Speaker]

Order. The hon. Lady heard me say that if Members wished to hear the Minister and the Opposition Front-Bench spokesman there should be no further interventions. She took a further intervention and she will have to conclude very quickly.

[Sarah Newton]

My last point is to urge the Minister to look to ensure at the G8 that the various scientists and the various disciplines work together.

Carers

Sarah Newton Excerpts

Thursday 20th June 2013 Commons Chamber

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

I am pleased to have the opportunity to speak in this debate. I pay tribute to my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), who has made a huge contribution not only today but throughout his parliamentary career—as a Minister and now from the Back Benches—in raising these issues.

I had the great privilege of being parliamentary ambassador for carers week for the Conservative party, along with my coalition partner, my right hon. Friend the Member for Sutton and Cheam. Rather than trying to cover what was an encyclopaedic summary of the issues affecting carers, the excellent research communicated during the week or, indeed, many of the points made by colleagues on the Opposition Benches, I would instead like to back up everything that he said in describing so well the challenges and opportunities and summarising the Government’s position. I will then make some reflections and observations on my time as an ambassador.

I would like to congratulate the organisations that came together to form carers week, because they achieved something quite remarkable. More than 26,000 organisations across the UK came together and put on more than 100,000 events. Why is that important? From the events I attended, I realised it was vital to raise awareness of the services and financial help available for carers. Like many other Members, I am sure, I often find in my casework and when visiting organisations in my constituency that those who most need help are often the least likely to access it, and we have to work hard to ensure that the legislation, the benefits and the rights that we provide for in the House get into the hands of the people who really need it.

When attending the events in my constituency, I was struck by a fundamental problem touched on by the hon. Member for Ceredigion (Mr Williams): many carers do not identify themselves as such. I spent some time in the lobby of the Royal Cornwall hospital trust alongside volunteers and care support workers from the Cornwall Rural Community Council. They would approach people who were clearly carers—elderly people pushing people in wheelchairs, coming into hospital, attending appointments or leaving hospital—and ask them, “Are you a carer?” They would ask them very nicely and in a friendly manner, with a view to engaging with them to ensure they were getting the help to which they were entitled, but the people would hurry on saying, “No, I’m not a carer.”

If, however, we asked whether they looked after someone—a husband, wife, child or loved one—they replied yes. If we asked them, “Do you regularly provide support perhaps through cooking meals or going shopping?”, they replied yes. We need to think about that a bit more in our desire to find out who carers are and ensure they get the support they need, whether from the NHS, councils, employers or the voluntary sector and wider community. We need to think about how we frame the conversation to enable people to identify themselves as carers, because most of the people I spoke to said, “Well, I’m just doing what any family member would do. This is what families do.” If somebody is ill or has a disability or care need, families gather round. I took that from my meetings last week, and it is particularly important in literature. Central Government produce a lot of literature, and a lot of benefits leaflets go out through the Department for Work and Pensions and throughout the health service, so we should think about the terms we use and how we can engage with people in that literature.

Another thing I reflected on after speaking with carers last week—this came out in the reports—was the evidence on the number of people who gave up work to care. This can have a detrimental impact on the carer: they miss the social contact provided at work and can feel quite isolated and often trapped at home, especially in remote rural areas, such as those in my constituency, where it is difficult to use public transport and connect to wider society. It also has a detrimental impact on household incomes and pension provision. The main question that Carers UK is asking the whole nation is the right one: are we prepared to care? It is a question for the whole of society. Are employers prepared to provide those flexible working opportunities to enable people both to attend to their caring responsibilities and to work?

We have to be realistic, however, because many people are worried about their job at the moment, and so, for fear of losing their job, are unlikely to talk to their employer about the need to work flexible hours. The Government need to engage with employers—there are exemplars, such as BT, with a long track record of recruiting and retaining older workers and enabling flexible working—about the research and the issues and to get them thinking about making it easier for their staff to request flexible working. The huge triumph in employment in the past century was to enable women to juggle caring responsibilities for children and work. In this century, as we respond to significant demographic changes, we need a massive shift to enable workers of all ages to combine other caring responsibilities. For older people and people with disabilities, that is a very important lesson from carers week.

Carers told me that even if they wanted to carry on working—if they had the income and were prepared to pay for care, or have a mixture so that they would do part of the caring but pay for people to come into the home to support them, and their loved ones agreed to that—they were anxious about the quality of the care they would be inviting into their homes. All of us were horrified by recent revelations about some of the carers going into people’s homes, whether they were paid for by individuals or local authorities as part of their domiciliary care service. Until we crack the nut of ensuring that high-quality, well-trained and well-paid carers are going into people’s homes, people will have a great fear and reluctance to try and combine caring responsibilities with employment.

We find a sad position in too many local authorities. We all understand that councils’ budgets are under a lot of pressure. I was a councillor and I know that it is difficult to balance all the needs of one’s community with conflicting demands on what the council should be spending its money on. No two people agree on what a council’s priority should be. For me, it is straightforward: a council’s responsibility, like central Government’s responsibility, is to prioritise the care of the most vulnerable people in society. However, in contracting for domiciliary care, local authorities are cutting their payments so low that it is difficult for private care providers to provide a good quality of care while remaining economically sustainable. That reduces the options available for the vast majority of people who self-fund care.

[Norman Lamb]

I agree very much with the points my hon. Friend is making. Instead of commissioning on the basis of a quarter of an hour and a race to the bottom with the lowest bidder winning the contract, does she agree that commissioning that provides incentives to improve the well-being of the individual being cared for—maintaining their mobility and improving their capacity to remain independent—is the way in which local authorities should be contracting providers of care at home?

[Sarah Newton]

I absolutely agree that local authorities should be remorselessly focused on the best possible outcomes for the people they have a duty to provide care for. They should also understand that while the vast majority of people are not eligible for local authority care, local authorities have a responsibility as market shapers in their localities to ensure that private, third and voluntary sector organisations are able to provide the care services that most people pay for themselves. By constantly engaging in a race to the bottom, they are undermining the ability of those organisations to provide services to the community. Most private or third sector domiciliary care providers need a certain amount of contracts or business from the local authority.

[Paul Burstow]

My hon. Friend is making an important point about the patchy quality of domiciliary care. There are good examples, such as in Wiltshire, where the service has been remodelled to focus on outcomes. However, there is an issue about whether the Government have the necessary powers to ensure that where poor commissioning practice is allowing contracting by the minute, which is resulting in sub-standard care to an individual, they can ensure good quality commissioning practice in the future. The Joint Committee on the draft Care and Support Bill has recommended a change in the law and the Government are doubtful of its need. Does she agree that the Government need to keep thinking about that and perhaps come back with an amendment?

[Sarah Newton]

I back what my hon. Friend says. The Joint Committee’s report was excellent and showed Parliament at its best. People with tremendous experience from the House of Lords and this place worked together to scrutinise and improve that excellent Bill. The Government should be commended for introducing it at a time of economic restraint, especially as it has financial consequences: spending more money on supporting carers is a bold thing to do at the moment and it underlines the great value we put on carers. I back my hon. Friend in his call for an amendment, because if local authorities are tempted to avoid doing what we would all regard as the right thing—to look after the most vulnerable people in our society—we need to tighten up the law to remove that temptation from them.

I would like to share another issue that was raised in carers week. The strong message from carers was that they do not always feel involved in the decisions made by professionals about the people they are caring for. The Government have, rightly, enshrined in their health and social care reforms the principle that “No decision should be taken about me without me.” I would like to extend that so that “No decision is taken about the person I am caring for without me.” I have heard far too many cases, in my own case work and during carers week—particularly from parents caring for children with disabilities—where substantial decisions, on whether their children should be cared for away from their home many hundreds of miles away, were considered without proper discussion with the parents. That is absolutely wrong. There is a prevalent attitude among some professionals that they know best: “Trust me, we know what is best for your child. Trust me, we know what is best for your wife or your husband.” While I would like to be able to trust all professionals—we think that by and large they do have the best interests of people at heart—there should be openness and transparency. Carers should be involved in decisions, so that there is a joint agreement and an understanding about what is in the best interests of the person being looked after.

On a more positive note, I would like to share some of the good practice I saw during carers week. I saw great examples of innovation involving the voluntary sector, in particular. We have talked about statutory provision and what employers can do, but broader civil society and the voluntary sector have an enormous role to play too. I would like to share two examples from Cornwall, one of which is from my own constituency.

A group of people in Falmouth in my constituency responded to the Prime Minister’s dementia challenge by wanting to ensure that everybody in the community supported people with dementia. More than 200 organisations in Falmouth got together to make it a dementia-friendly community. I was proud, in my hometown, to be at the launch a couple of weeks ago, and I was proud that it was the first town in Cornwall, and probably one of the first in the country, to be a dementia-friendly community.

What does it mean to be a dementia-friendly community? It means that the shopkeepers in the high street have gone through awareness training. It means that we have dementia cafes and that the people in the youth centre are aware of people with dementia. Overall, it means that people who suffer from dementia, or are caring for someone who suffers from dementia, can go into Falmouth with confidence, knowing that they will receive a warm welcome in the shops, libraries, public spaces and the youth centre. The people there will understand more about dementia and some of the behaviour that comes with it. Some people might find that behaviour a little bit challenging and scary, which often makes the people who care for someone with dementia want to stay at home. They can be fearful of the response they will receive in a public space and end up becoming isolated. I can honestly say that people with dementia will receive a very warm welcome in Falmouth, thanks to the huge amount of work done by a small group of volunteers ably led by the Bridges, who are Rotarians in Falmouth.

The whole community has got behind this exciting project—indeed, so much so that another group of people in Falmouth, led by a former nurse, Lisa Dann, has been working with Dementia UK over the last year to raise enough money for two admiral nurses. For those who do not know, admiral nurses, who are similar to Macmillan nurses, are specialist nurses who work alongside those with dementia and their carers, providing a lifeline for people coping with what can be a very difficult condition. Lisa was motivated to set up the charity and raise funds because of the poor support that her mum and her family received when her dad was suffering, before sadly dying from dementia.

Lisa has created a fantastic legacy in recognition of her father by raising enough funds—£60,000 in one year, which is a great credit to her, her team and the community—for the whole of Cornwall to have two admiral nurses. Her group is working innovatively in a partnership with a large social enterprise in Cornwall—Cornwall Care, which is the largest independent care provider in the county—to make the scheme sustainable. The group will be raising more money for more admiral nurses, which will provide a huge amount of support for carers, as well as people suffering from dementia. That is a good example of how the voluntary sector and volunteers can create a caring environment for carers.

[Norman Lamb]

I came across another example in my hon. Friend’s county called Changing Lives, where GPs work together—

[Sarah Newton]

I was just about to come to that.

[Norman Lamb]

I very much agree with my hon. Friend about the role of civil society. That will be a vital collaboration if we are to meet the challenge, given the rise in the number of people who need care.

[Sarah Newton]

rose—

[Madam Deputy Speaker (Dawn Primarolo)]

Order. When the hon. Lady addresses that point, will she also pay attention to the fact that there are other Members who wish to speak and that she has been speaking for nearly 18 minutes?

--- Later in debate ---

[Sarah Newton]

I am grateful for your advice, Madam Deputy Speaker, and I am sorry. It is just that I am so passionate about this subject that I have lost track of time.

I am pleased that the Minister remembers that experience—this was the final point I was coming to—and has agreed to meet Tracey Roose from Age UK and Ian Jones from Volunteer Cornwall quite soon to take forward what he experienced first hand in Cornwall with some more ideas. Changing Lives is a fantastic example of how volunteers can work with GPs to ensure that people have access to all the care and support that they need to live happy, fulfilled lives in their communities. The pilot in Cornwall has had some quite dramatic results, not only in terms of carers feeling better supported and the vulnerable, frail older people concerned having a better quality of life, but in huge savings for the NHS, with 30% fewer unplanned admissions in our acute trust.

These are all the things that we instinctively and intuitively know—that if people get good advice, the help and support they need and opportunities to play their part in society, they can live independent lives at home. The Government can be proud of much of what they are doing, but given the concerns of carers we have heard throughout the week there is clearly still much more to do. I for one look forward to supporting the Government’s efforts to make this a proud country and a great place to grow old and care for people.

Budock Hospital Site

Sarah Newton Excerpts

Tuesday 11th June 2013 Commons Chamber

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

Although this is not the sort of thing one must declare, I declare an interest as I am proud to be a former pupil of Falmouth school. It must be the only school in the country to have a former hospital in the centre of its campus. Budock hospital was for people with psychiatric care needs or significant learning difficulties. The top half of the former hospital site houses the buildings, and the lower slopes—known locally as Trelawney’s field—were originally jointly managed by the school with NHS social services and a farm project for young people with learning difficulties. I have fond memories of volunteering for that project as a sixth-form student.

The current head teacher has been in place for 12 years or more. Throughout that time, Cornwall council has had various conversations with the NHS to try to secure the lower part of the site for educational purposes, facilitating access to the playing fields on the far side of the hospital. The hospital was demolished, and the whole site was reclaimed and fenced off by the NHS in 2008. The school has had an overgrown and derelict site at its centre for five years, which presents significant safeguarding concerns for the school.

The NHS had several schemes to relocate health services to the site, but they have never materialised. The schools, local sports groups and the wider community in the town have no access to floodlit all-weather sports facilities—groups must travel to Penryn, Truro and Redruth to access such facilities when there are available slots.

On 8 February 2012, the head teacher wrote to NHS Cornwall to register an interest in purchasing the hospital site if and when it goes on the market. At a subsequent meeting, a Mr Wakeham said he would take the school’s interest to the NHS board. Despite follow-up calls, no decision was made.

In April 2012, the school appointed a land agent to negotiate with the NHS on its behalf to try to secure the purchase of the site. The agent had numerous discussions with the NHS, but no resolution was secured. In May 2013, after several letters from me, the school managed to meet representatives of the newly formed NHS Property Services company and its agents, BNP Paribas, Origin 3 planning consultants and Cyril Sweett quantity surveyors. It was made clear at the meeting that the NHS and its agents felt bound by Government requirements to secure the highest price for the site on the open market without consideration of community benefit. We know that that contravenes the Government’s policy and guidelines. The school presented the proposed plans for development and the local planning officers explained the local planning framework progress and emerging needs for the town. Those points seemed to be of little interest to the agents, who reinforced the fact that their clients were interested only in securing the best price for the land.

On 24 May, BNP Paribas released the site to the market with “residential potential”. That would make Falmouth school probably the only school in the country with a housing estate right in the middle of its campus. The council, as landowners, has advised that the local planning framework has earmarked the site for educational purposes. The school is prepared to pay educational land value for the site.

Falmouth school’s current site is fragmented. The aim is to consolidate it and make significant improvements to benefit the whole community. One satellite field of the school at Union corner is inaccessible for curriculum use owing to its location across a busy main road into the town. The school is proposing to sell that field to raise the funds to buy the hospital site and install a full-size, 3G all-weather pitch for school and wider community use. The two sites—Union corner and Budock hospital—are similar sizes.

The architect confirms that approximately 90 to 100 houses—a mixture of terraced, semi-detached and detached, and the appropriate number of affordable housing—could be built on the Union corner site. Approximate valuations from the council suggest that the school’s estimate of £2 million as a receipt for the site is realistic.

The local planning framework proposes approximately 3,200 new homes in the immediate area of Falmouth and the school, and there will be a need for a further 400 secondary school places in the medium term. Consolidation of the site and improved sports facilities represents best value for the taxpayer, because it will allow the existing school to meet the needs of more students —there are currently just over 1,000 on the roll. If the project does not go ahead, the school will not be able to grow, and the council could be forced into a building a new school, or parents and council might have to pay for transport to schools some distance from Falmouth.

There is also the implication of the essential road junction improvement at Union corner, which needs this land. The infrastructure is essential for delivering wider growth for the town. The road scheme has secured essential and substantial part-funding towards its delivery. The road will become the main artery, making access to the school’s satellite field even more difficult. The scheme submitted to the Department for Transport totalled £2.23 million, and it has secured just under £1.6 million through pinch-point funding—we were delighted to receive that news two weeks ago. It is also included in a bid for £500,000 of round 4 of the regional growth fund. Cornwall council is currently waiting for approval, which is expected in mid-July. The remainder funds have already been allocated from the council’s local transport funds.

Cornwall council will still seek to claw back funding from future developments given their impact on this junction, but the funding will be used to deliver the wider improvements identified in the Falmouth and Penryn strategy. The published local plan document highlights the hospital site as being required for development. Cornwall council’s draft infrastructure development plan emphasised the need for the sports facility. It described it as essential as Falmouth continues to grow.

The school has consulted the Education Funding Agency regarding the sale of the Union corner site to acquire the former Budock hospital site. As the school will meet all the conditions in section 77 of the School Standards and Framework Act 1998, it will achieve this consent. The council suggests that the educational value of the Budock hospital site is approximately £750,000. A full-sized, 3G all-weather pitch costs about £800,000, although there may be some unknown ground works to contend with.

The school has consulted the newly elected local Cornwall council members, and all support the project, as do the newly elected town councillor for the ward, the mayor of Falmouth and the town centre manager. A public meeting was held on 16 May 2013 and all present supported the scheme. Falmouth university supports the project. Sports groups pledging their support include: Cornwall Squash and Rackets Association, Cornwall football association, Falmouth hockey club, Falmouth Road Runners, Falmouth Town football club, Falmouth United football club, Falmouth cricket club and Falmouth rugby club—we have a thriving sporting community in Falmouth.

The school council has been consulted and the wider school population has been advised, and all are excited about the prospects. Today I received a letter from the Minister saying that the former hospital site will be taken off the market. I cannot thank the Minister enough for his intervention. The headmistress and the whole school community wanted me to pass on their thanks for his helpful intervention to help us find a resolution to this situation. I am very pleased that it has been taken off the market, so that we can have another meeting and get around the table with the NHS property company, the district valuer, the whole council and myself. This is welcome news.

I was, however, slightly concerned by something in the letter. The NHS property company is advocating the original offer from some time ago, of a land swap option to resolve the issue. This is no longer the best outcome. Let me explain why. Approximately 15 months ago, the primary care trust and the school were in talks regarding a straightforward land swap, as the size and value of the two sites were relatively similar. However, because of the changes to the planning framework, which I have already outlined, the hospital site is designated as educational, while the Union corner playing field is now clearly designated as residential. This changes the value of the two sites. As a result, the land swap would not be the best use of public money or of these two sites. I am grateful that NHS Property Services has signalled that it is prepared to get around the table—this recent change of attitude is very welcome. Although I do not think the swap is the best way forward, I am sure that, with the Minister’s support, we can find a sensible solution that works for the NHS—hard-pressed as it is and in need of every penny to invest in front-line services, as we all appreciate—for Falmouth school, for Cornwall council and for the wider community.

In conclusion, this is an immensely important scheme for Falmouth. It will be an Olympic legacy in terms of improved sports facilities for the whole community. It will put the school on a secure footing for generations to come and contribute to the economic redevelopment of this part of Falmouth, bringing much-needed affordable homes and supporting exciting new and growing companies in the area. Having received the Minister’s support in his letter today, I now seek an assurance that the land swap will not be the only option. If following the meeting on 21 June with all the parties concerned, which I am chairing, we can make a sensible case for giving significant funds to the NHS while enabling us to realise this important project, we will be very content indeed.

Health and Social Care

Sarah Newton Excerpts

Monday 13th May 2013 Commons Chamber

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

The inclusion in the Queen’s Speech last week of a Care Bill in this new Session of Parliament is nothing short of a landmark occasion. Those of us who have been concerned with the reform of our social care system for decades know that those desperately needed reforms, which are well summarised in the Bill, have repeatedly been kicked into the long grass or filed under “Too difficult to do”. Finally, however, we are making progress.

I have been disappointed by the response to the Bill from Labour Members, who know as well as I do how welcome the proposals are, and what a step forward they will represent for the quality of life of many thousands of people in this country. It was a courageous decision by the Government to introduce the Bill at this time, given that public finances are under enormous pressure as we try to clear up the mess of the financial legacy bequeathed to us by the Labour Government, because the reforms will require additional public finances.

In the last Session of Parliament, excellent work was done by the group of Members of both Houses in undertaking pre-legislative scrutiny of the draft Bill. That was a good example of how people can bring the experience they have gained outside Parliament into their work as legislators. I am grateful for their consideration of my contribution and the subsequent inclusion in their report of my recommendations. The recommendations resulted from work undertaken with a number of Members across the political parties who worked with the charity Macmillan, looking at what could be done to improve the quality of care of people who want to stay at home at the end of their lives. Ensuring people have a genuine choice over where they die is of particular importance to me.

Last year, I chaired a round table event in Parliament, organised by Macmillan Cancer Support, which brought together carers, health and social care professionals and policy makers to discuss how to enable more people to be cared for at home until they die, if that is what they choose. The expert attendees were clear that access to basic social care support can make the difference between somebody dying at home surrounded by their families or dying in an expensive hospital ward. All too often, however, patients and families cannot access the support because of a lack of integration of health and social care systems or because they cannot afford to pay for it.

I believe that removing the social care means test for people on the end-of-life care register would lift a significant barrier to the integration of care, allowing many more people to access the support they need and to exercise choice, which could also save the considerable costs of people being in hospital. The Government’s commitment, made in the care and support White Paper, to assess free social care at the end of life through the palliative care funding review pilots represents very good progress. However, with the Care Bill likely to become an Act before the pilots finish in 2014-15, it is also crucial that the Bill allows for the delivery of free social care at the end of life. This would enable the Government to implement the policy without delay, once the pilots report.

I understand from the responses I have received to written questions that the Minister is undertaking a review of the pilots this year. I very much hope that clauses will be added to the Bill to enable free social care for those at the end of life. Such a step forward would be welcomed by professionals and families alike. It would make such a difference to families at such a difficult time of their lives.

Another specific aspect of the Bill I would like the Minister to consider—together with the Under-Secretary of State for Work and Pensions, the hon. Member for Wirral West (Esther McVey), who has responsibility for disabilities—is social care for working-aged adults with disabilities. The debate about the future of our adult care system has very much focused on the elderly and their family and carers. I am as guilty as anyone else of focusing on the injustices in the current system for elderly people and the need for a fairer and better system, but the care system has another group of people who need support: adults who acquire a disability through an accident or an illness. They might not have been working long enough to have savings that they can spend on their care needs and they might have a degenerative condition that has prevented them from working full time. For them, reform of the current system is less to do with how they can protect their assets or how they can pay for care without selling their homes than with how they can get the help they so desperately need.

The definition of eligibility for care within the Bill is of greater importance than the means-tested threshold and the caps on personal expenditure. We must have a realistic threshold of eligibility, so that people can participate in society as a whole—in education, as volunteers or as employees.

As the Minister will be aware, some local authorities have, sadly, chosen not to spend the money provided by central Government on the adult social care budgets and have been increasing the eligibility criteria. The Dilnot commission highlighted this concerning trend, and I know that Ministers listened. I understand that the Department of Health is working on amendments to the fair access to care criteria currently used by local authorities. The amendments are reflected in the Bill, which includes new interim eligibility criteria. Concerns have been raised, however, that the interim criteria will not address the continuing shift of social care provision away from those with moderate needs. Research undertaken by the London School of Economics indicates that 105,000 people could lose eligibility if the Government move ahead as proposed.

[Mr Ward]

Is the hon. Lady aware that in 2005, 50% of local authorities were setting the level at a substantial 84% for the move from “moderate” to “substantial” needs?

[Sarah Newton]

The hon. Gentleman makes a very good point, which illustrates the findings of the Dilnot commission.

I urge the Minister to consider this further and to ensure that the final interim criteria agreed upon, which will be in the Bill, recognise the very real care needs of those who fall into the moderate care category within the current fair access to care system. We found from the report we received on Friday on the Government’s consideration of what improvements might be put into the Bill that they have agreed to look at the eligibility criteria and to fund the proposals under the June comprehensive spending review. All that is very welcome. I hope that, once the criteria and the funding to support it have been agreed, the money passed over to local authorities will be ring-fenced for a period, perhaps up to three years. The Government have done that for public health, and doing it in this instance would enable the estimated 105,000 people who have moderate care needs to receive the funding and to continue with their working and volunteering lives, playing their full part in society.

I am sure that the Minister of State has been listening closely to the organisations that represent people with disabilities. I am also sure he supports the excellent vision and work of the Minister with responsibility for disabilities that aims to enable people living with disabilities to play as full a part in society as possible. I very much hope that, as this Bill passes through the House and is further scrutinised and consulted on, we will address the concerns of these groups of people who all too often fail to have their voices heard.

The Government have listened hard to the needs of elderly people and have produced a good way forward. These straightforward and common-sense improvements will make a hugely positive contribution to the lives of people at the end of life and those of working age who are living with disabilities. Those people are often living out of sight; we must show them that they are not living out of our minds.

Medical Implants (EU and UK)

Sarah Newton Excerpts

Wednesday 6th March 2013 Commons Chamber

[Andrew Miller]

The hon. Gentleman, who works hard on the Select Committee, is absolutely right in what he says. I stress to the Minister that not only was this report unanimously endorsed by the Committee members, but we were angry at the lack of available information. That was no fault of the Minister or his predecessors; it resulted from a system that had grown, as the use of implants had grown, into a mechanism that was not fit for purpose. The Minister is rightly participating in the process of revising the directive, but some urgent requirements mean that he has to take a proactive approach and encourage—indeed, instruct, if he has that power—procurement offices of the NHS to set a new standard. They should simply require anyone tendering for a product in this category to provide, as part of the tendering process, totally transparent information about the process and the regulatory regime it has gone through.

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

Perhaps the hon. Gentleman will elaborate on some of the positive examples that the Committee found, which included the groups of orthopaedic surgeons who voluntarily shared information on different hip replacement devices and could contextualise the outcomes. The implant itself is not always responsible for the outcome—that could result from other factors to do with the medical condition of the patient or all sorts of other circumstances—but these people were able to contextualise that information in large enough sample sizes to help other surgeons to come to the right decisions about the right implants for their patients.

[Andrew Miller]

The hon. Lady, another hard-working member of the Committee, is absolutely right and that could take us on to a much more complex debate about how we move from where we are in today’s medicine to future developments in stratified medicine and so on. The way in which our medical profession works in such a strong collegiate manner helps to maintain standards at the highest level. Lessons can be learned in that regard that underline the importance of the NHS as the lead body in this area.

Post-market surveillance is a crucial element of the regulatory system and is technically the responsibility of the manufacturers. However, the notified bodies also have some oversight through auditing. The Medicines and Healthcare products Regulatory Agency investigates adverse incidents once they have been reported. Again, we called for greater transparency by recommending that manufacturers publish the results of post-market surveillance studies. We proposed that a system such as the MHRA’s black triangle system, which flags up new medicines approved on limited clinical data, should be adopted for devices approved on equivalence alone. We found some evidence that clinicians under-report adverse incidents, so we wanted the Government to consider making reporting mandatory.

One place to keep post-market data is a registry. The National Joint Registry for England and Wales—meaning joints in the body, not joint between England and Wales—is a success story. It collects data on all joint replacements in the NHS and the private sector and is the biggest such register in the world. The NJR provided data on the DePuy metal-on-metal hip implant, which was then recalled worldwide in 2010.

Registries do not always succeed. Between 1996 and 2003, we had the national breast implant registry, but that failed, partly because of the unwillingness of patients to give follow-up information. Nevertheless, our colleagues on the Health Committee called for Sir Bruce Keogh to pursue the creation of a register of breast implants in his review of PIP implants. I hope that the Government will put in place measures to ensure that any new registry learns lessons from the NJR’s successes.

I recently went through a minor medical procedure and was asked to provide data as part of a broader clinical dataset and to allow them to be used. The form started off by saying how to opt out of providing that data, rather than explaining to me as the patient why it was beneficial for those data to be collected. When such registers are produced, I hope that the Minister will agree that the starting point should be that the authorisation form should not start with the negative procedure of how to opt out but start with positive information about why such data are beneficial to the individual and to society more broadly.

--- Later in debate ---

[Mr Jamie Reed (Copeland) (Lab)]

The report of the Science and Technology Committee was produced under the chairmanship of my hon. Friend the Member for Ellesmere Port and Neston (Andrew Miller). I congratulate him on the work of the Committee and on an excellent report. He is known in this House for his diligence and attention to detail, and the report illustrates those instincts. It is also a pleasure to follow the hon. Members for Southport (John Pugh) and for Strangford (Jim Shannon), who have made telling and important contributions.

The House has demonstrated not only a shared understanding of the issues before us in this brief debate on medical implants, but a welcome unity of purpose. The House is at its best when it acts in such a fashion. Debates like this allow us to break through what actors call the “fourth wall”. I hope that anyone who is watching this debate can see that, as should always be the case, we are not making by-the-numbers political arguments, but are making a sincere effort to address the issues before us for the benefit of the people who send us here.

In health care regulatory systems, medical implants and devices hold a unique status. The synthesis of new medicines and other pharmaceutical products is done through highly precise chemical processes, whereas implants are developed largely through an iterative engineering process. As we can see from the Committee’s report, that presents unique challenges. The bulk of the regulatory framework for medical testing focuses on the side effects and efficacy of new drugs. Although the emphasis is on medicines, there need to be mechanisms for the effective regulation of safe medical implants, given the fundamental differences between implants and medicines.

As the Committee’s report highlighted, there are weaknesses in the current regulatory system. As Members have mentioned, those have been highlighted by the recent PIP breast implant scandal and by faulty metal-on-metal hip replacements. In looking at those high-profile scandals, we must recognise the role of criminal activity, especially in the PIP scandal. In that case, it quickly became apparent that the company that manufactured the implants was engaged in a clear case of fraud. There is no reasonable and workable system that could prevent such cases. That fact is recognised by many in the industry and, I am sure, by Members across the House.

Although the PIP scandal was caused by criminal activity, it presented the opportunity for us to take a deep look at our regulatory framework and to assess its strengths and weaknesses. The system is obviously not perfect, as I am sure Members across the House will agree, and improvements need to be made. The case of the DePuy metal-on-metal hip implants shows that faulty products have been certified under the current system.

There is a fine balance to strike when debating the regulatory framework of medical impacts because it is essential that all products are safe, and that they bring only benefits to patients and are not harmful. It is also necessary for access to products to be improved and expedited. The ideal is to bring safe medical implants to patients in an efficient and timely manner, and that is the sole purpose of a regulatory system in this context.

We must be increasingly aware of how the regulatory system can affect the entire health economy. To emphasise the importance of that let us consider a condition that poses enormous public health, policy and financial questions, as well as questions of patients’ rights and expectations: type 1 diabetes.

I declare an interest as a type 1 diabetic who was diagnosed through diabetic ketoacidosis just two weeks before the 2010 general election—ideal preparation, I must say. I raise the issue not to bore the House with my personal interests but because figures released this week by Diabetes UK show that the number of people in the UK who have been diagnosed with diabetes has reached 3 million for the first time. That is an increase of 132,000 over the last year and a further 850,000 people are now believed to suffer from undiagnosed type 2 diabetes. Each year an estimated 24,000 people die from diabetes-related medical conditions and the situation is expected to worsen—I know the Minister is aware of the figures. Barbara Young, the chief executive of Diabetes UK, has called the situation a “public health emergency”, and she is right.

It cannot be stated enough that type 1 and type 2 diabetes are different conditions and differ in many ways. Type 2 diabetes is often the result of lifestyle circumstances or choices, but type 1 diabetes is a genetic, sometimes hereditary auto-immune condition that is not related to the lifestyle of an individual. The latest breakdown of figures that I have comes from 2009. Research undertaken by the university of Birmingham and the National Institute for Health Research showed that at that time, 488,089 people in England and Wales had type 1 diabetes, some 15,000 of whom were children and young people between nought and 24 years of age. In 2009-10, 27,200 hospital admissions and 96,651 bed days were due to type 1 diabetes in England. To be blunt for a moment, apart from concerning ourselves with the needs of the patient, that is costing the NHS a fortune.

Also this week the US-based Diabetes Research Institute announced details of its research into what it describes as a “quantum leap” towards a biological cure for type 1 diabetes with the development of its BioHub—a bioengineered “mini-organ” that mimics the pancreas. It contains real insulin-producing cells that can sense blood sugar and release the precise amount of insulin needed in real time. In short, if successful, such a treatment could transform the lives of 500,000 people in England and Wales, save the NHS a fortune that could be spent elsewhere, and help begin to meet the challenge of the public health emergency we face. With that case study we see that the improvement of a system that expedites access and demonstrates the safety of medical implants for patients could not be clearer or more important.

The report covers four main points, and I will take each one in turn. First, I will discuss the system of pre-market approvals and the difficulties surrounding them, before looking at transparency in the regulatory system, post-market scrutiny of products and international co-operation. Pre-market scrutiny of medical products is the minimum prerequisite when it comes to health care products, whether medicines or implants, but there are fundamental reasons why there is no one-size-fits-all system for testing them. With medicines, doses can be reduced and increased to test for side effects and efficacy, but, as I am sure all Members will recognise, it is impossible to change the dosage of a hip replacement. Furthermore, once an implant has been placed, it is difficult to remove it.

Similar issues present themselves with clinical trialling procedures. Medicines pass through the body relatively quickly, meaning that medicinal trials can be conducted within a reasonable time frame. A hip implant is typically designed to last over 10 years, and to obtain reliable clinical data that can withstand proper scrutiny, trials on those implants would have to last a number of years, which in many cases is simply not practical. A system has therefore developed that uses different types of clinical evidence to assess safety and efficacy. Where possible and practical, clinical trials on products should take place, but for implants, regulatory bodies will take what are known as equivalence data as the basis for their decision making. That was mentioned by my hon. Friend the Member for Ellesmere Port and Neston and is covered extensively in the report. These are data obtained from similar products. As I have said previously, products are developed in an iterative process and these data can be from earlier iterations that may have been available to patients for a number of years.

There are a number of issues with this method. First, the British Medical Journal has argued that, owing to the progression of new products and advances in this field, regulators may have difficulty assessing which products, and therefore data, are equivalent. This difficulty is, to some extent, surmounted by the differing regulatory requirements of different classifications of medical devices. Most medical implants are categorised as class 2b and class 3. These are the higher risk categories and this ensures that extra safety checks are in place.

Class 2b manufacturers are subject to annual detailed assessments of their facilities, practices and staff training levels to ensure they are performing to a high standard. With class 3 products, notified regulatory bodies also have access to technical documentation to ensure safe practices. So the difficulties inherent in the pre-market assessment of medical implants mean that post-market scrutiny and surveillance of products are essential in maintaining standards in the industry and in improving future regulatory regimes.

The Medicines and Healthcare products Regulatory Agency and other groups agree that this is one of the most important tenets of a regulatory system. It is almost impossible, and certainly not accurate, to predict the medical performance of devices after a considerable number of years. Continued, randomised testing of devices should form part of the regulatory processes and should make a keen contribution to assessing the efficacy and safety of products.

Looking at the level of international co-operation when it comes to regulating medical devices, it is crucial to realise that this is now a global industry. The EU Commission has recommended greater co-operation between member states in this field. It recommends that there should be a European body responsible for dealing with notifications of devices prior to market entry. I understand the Committee’s report does not accept this recommendation as it would lead to another layer of bureaucracy and delay. However, greater harmonisation of practices to ensure high standards are met by manufacturers throughout the world is interesting, and this is an issue that needs to be looked at in greater detail.

[Sarah Newton]

Another important reason we decided it would not be in the national interest to support that recommendation is that we believe that it contained the potential for a race to the bottom. Other European countries do not regulate as well as we do, and effective regulation is really important. We felt that a lowering of standards in other European countries might mean that implants could get in through the back door.

[Mr Reed]

The hon. Lady makes an excellent point. The Committee’s thinking on that point is clearly justifiable and robust. It also raises another issue. We all need to ensure that the industries we are talking about have a predictable, stable and safe environment in which to operate so that they can innovate, attract investment and continue the advanced manufacturing processes we need to secure advances in treatment and more.

It is important, however, that the focus upon constant improvement should be one of the core underpinnings of any regulatory framework and this is sadly lacking in the system at present. The key to improving the regulatory framework—and in many ways the key theme of the Committee’s report—is transparency. The BMJ acknowledges that there are

“many vested interests that disincentivise manufacturers and clinicians from highlighting problems”.

Commercial confidentiality is another stumbling block. This need not be the case as a more open system, with more published information and greater access to assessments of products, will foster greater trust in the system, which will then translate into wider public trust of the industry and of manufacturers within it.

An article in The Lancet from June 2012 argues that patients and medical professionals should have a greater role in reporting adverse effects from their devices. Who could disagree? It should be clear to everyone that the fairest and safest way of assessing medical products is to allow experts access to as much information as possible. The Committee’s report makes it clear that the default position on information should be transparency and openness, and should be confidential only in extreme circumstances. It is right that the MHRA has a specialist committee to assess the safety of products: the committee on the safety of devices. What is totally wrong, however, is that it works in secret. The Select Committee expressed its disappointment at not being able to evaluate the work of the CSD, and it seems impossible to evaluate the system as a whole when such a key part of it appears to be shrouded in secrecy.

The Committee’s report does not advocate widespread changes to the system, but it rightly recommends a significant improvement in the transparency of information available to medical professionals. In medicine, negative data, as the hon. Member for City of Chester (Stephen Mosley) said, are as crucial as positive data in assessing what is right for a patient. I assure the Minister that the Government will have the support of the Opposition if they wish to make quick progress on improving transparency in the system.

Dementia

Sarah Newton Excerpts

Thursday 10th January 2013 Commons Chamber

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

I listened with great pleasure to my hon. Friend—I hope I can call her that—the hon. Member for Worsley and Eccles South (Barbara Keeley); I have the privilege of serving as her deputy on the all-party group on social care. I wish to echo the point she has just made, which was also so well made by my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch), who played such an important role in securing today’s debate.

This is a very important occasion for us to show the collective will of hon. Members—there are so many here today—to hold the Government’s feet, and indeed the Opposition’s feet, to the fire. We need urgently to come to an all-party agreement on how to fund properly the future of care and social care in our community. I also wish to thank the right hon. Member for Salford and Eccles (Hazel Blears) for her contribution. I am sure that she will indulge me as I thank the chair of the all-party group on dementia, Baroness Greengross, who has dedicated her whole life, both in the other place and outside Parliament, to raising issues affecting older people, their families and carers so well. I thank the right hon. Member for Salford and Eccles for her part in securing this debate, which gives us such an important opportunity to de-stigmatise dementia and other mental illness.

I remember only too well that when I was a child growing up people would not talk about cancer; it was whispered about or called “the C word”. Thankfully, we can now openly talk about cancer, which is to the great benefit of sufferers, their families, their loved ones and their carers. We must quickly move to the same position for people suffering from dementia, Alzheimer’s and a range of other mental health conditions.

[Neil Parish]

I agree very much with my hon. Friend that cross-party support on how to provide long-term care for people with dementia is essential, because our population is ageing. Better medical care means that people are living longer, but of course it also means that we will have more people suffering from dementia. It is right that we accept that situation as being part of society and as something we must deal with, but we must have a way of providing the funding so that we do not take away everybody’s assets to pay for treating dementia.

[Sarah Newton]

My hon. Friend makes his point well. I know that other hon. Members have very worthwhile points to make, so I do not wish to take up too much of the limited time available. However, I wish to make just a few points about how we in Cornwall are rising to the Prime Minister’s dementia challenge. It is right for us to set strategies nationally and to agree nationally on the overall frameworks to tackle one of the greatest challenges of our century. However, it is also important to look for the solutions locally. We should set the strategies nationally but enable everybody in communities around the country to come together to find their solutions. As the right hon. Member for Sutton and Cheam (Paul Burstow) rightly said in his opening remarks, we will all have to rise to the challenge. Every single part of society and every part of the public sector has its role to play. Indeed, as my hon. Friend the Member for Chatham and Aylesford said, the private sector, including supermarkets and other organisations in the public domain, has an important role.

What have we done in Cornwall of which I am so proud and which I want to share with right hon. and hon. Members? Let us start with the NHS, because when people seek a diagnosis that is where they start off on their journey with dementia. We have set up the Kernow clinical commissioning group, which is very successful and has got off to a flying start. It has attracted a large sum from the dementia challenge—well over £500,000. What is it doing with that money? It is working very effectively in partnership with other parts of the public sector, voluntary organisations and other parts of the NHS to ensure that there is an integrated, joined-up approach in Cornwall.

The CCG has targeted an issue mentioned by many Members, which is the need to ensure that everybody working in health and social care is properly trained, from carers through to doctors and nurses in the acute sector, to ensure that they are aware of dementia and how to talk to and relate to the people with this condition with whom they come into contact, as well as their families, friends and informal carers. The group is also using the money to ensure, among other things, that from the moment of diagnosis of dementia through to the end of life, sadly, there is a named individual available for that person and their family and carers. Obviously, it is early days as it just got the funding in November, but its ambitions are very important and will make a real difference to the quality of life of families in Cornwall.

Another issue that has been mentioned today is the lack of care from some nurses in parts of the acute sector. I want to share with hon. Friends a great initiative in the Royal Cornwall hospital, which is our only acute hospital in Cornwall. The friends of the Royal Cornwall hospital, who have worked so well with nurses, doctors and managers over a long period, are addressing some of the issues raised today. They have a very good system of mealtime companions, specially trained volunteers who work alongside care assistants and nursing staff. When the staff are too busy, they provide the extra time, care, compassion and consideration that needs to be given to a range of patients, including those with dementia, to ensure that they have a drink and something to eat. The hospital is also open to family members and others at mealtimes. I recommend that hon. Friends take that issue up with their hospital trusts and use the example of Royal Cornwall, which has clearly found a way around the problem.

The voluntary sector and society as a whole will have a hugely important part to play. Like many other hon. Members who have spoken, I am involved with the memory café in my constituency, in Falmouth. There are 24 other memory cafés in Cornwall and they are really important. People with dementia and other memory loss conditions, their families and their carers can come along to a safe, supportive environment, have some fun and do some interesting activities, talk to each other and get information. That is very important.

In Cornwall, we are fundraising for Admiral nurses. Those Members who have Admiral nurses in their constituencies will know the very important work they do to support families in much the same way as Macmillan nurses support cancer patients and their families. Admiral nurses provide an invaluable service for people with dementia and I shall be working hard alongside those who are fundraising so that we soon, I hope, have Admiral nurses in Cornwall.

I could talk about a lot of things, but for the sake of brevity let me simply say that many of the activities I have mentioned must be co-ordinated and planned. I want to reassure my Opposition colleagues that that is possible. Our health and wellbeing board in Cornwall has got off to a really good start. It works very closely with public health providers and all the different parts of the community, from housing to environmental health, to pull together a strategy for dementia and turn the good ideas and aspirations into action. I see the reforms to the NHS giving a great deal of power to doctors, other health professionals and people across the public sector to come together to work in partnership to deliver local solutions that work for communities. Salford is quite different from Cornwall and we all need to work together to find what works in our communities.

A great deal of good work has been going on in Cornwall and will continue in years to come, but I am not complacent. We are a part of the country with a fast- ageing population and have yet to find ways to diagnose dementia accurately. We have some of the lowest levels of detection of dementia. I will work hard with colleagues in Cornwall in all sectors to drive that up.

[Hazel Blears]

Like the hon. Lady, I am keen to foster the sense of consensus and cross-party working on this essential issue, but the elephant in the room in this debate is the severe cuts that have had to be made to local authority social care over the past three years—nearly £1 million in Salford. I wonder how in her community in Cornwall, which will be facing similar issues, she is dealing with the impact of substantial cuts in day-to-day care.

[Sarah Newton]

I thank the right hon. Lady for that question, because it gives me a good opportunity to praise Cornwall council. Undoubtedly all local authorities are facing tough decisions as a result of having to make cuts. There have been no politics in this debate so I will not go on to say why we are faced with the mess and why we have to make those difficult decisions, which I am sure we would rather not have to make. Cornwall council has not cut at all its expenditure on adult social care.

It gives me great pride to be able to stand up here and publicly thank Cornwall council for that. It is making sure that every penny that it receives from the Government—every single penny of the extra money to integrate NHS services with Cornwall council’s adult social care service—and the entitlement money and the money for carers’ respite is being spent. The council is not cutting front-line services for the most vulnerable people. The current settlement coming from the Government is increasing the amount of money into Cornwall for further improving and integrating the quality of care between adult social care and the NHS.

Those of us who have been around this subject and who have been campaigning on it for years, which includes many of the Members in the Chamber, know that the future lies in joined-up, integrated services. It is not about throwing ever more millions of pounds at the problems. It is about being smarter and wiser and linking all those services around the patient, the carers and the families. That is what is going on in Cornwall.

To summarise, I am in no doubt about the challenges that we face and I am not at all complacent. We need to build on the very good momentum and leadership shown by the Prime Minister on the issue to ensure that every family and everyone suffering from the condition gets the best possible care from us.

NHS Funding

Sarah Newton Excerpts

Wednesday 12th December 2012 Commons Chamber

[Stephen McPartland (Stevenage) (Con)]

Thank you, Mr. Speaker, for giving me the opportunity to contribute to this important debate. Let me first pay tribute to the impassioned speech made by the right hon. Member for Cynon Valley (Ann Clwyd). The tales that she told almost left me in tears, and it is hard to imagine how difficult it must have been for her to read so many stories of that kind, given the unfortunate position in which her own family have been. I know that there are a number of nurses in the Chamber today, and in my constituency, who would be horrified to hear what happened to those individuals, and to the right hon. Lady’s family. No one would want anyone to be treated in such a manner. I think that her speech illustrated the difficulties involved in arguing about whether 0.1% is an increase or a decrease, and underlined the fact that today’s debate should focus on whether or not we provide good-quality patient care.

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

Will my hon. Friend join me in praising NHS members of staff, including nurses, who are brave enough to come forward and express concern to the senior management of hospitals and in other settings when they see that their colleagues are not putting patient care first and are providing poor-quality care, so that appropriate action can be taken and atrocities such as those about which we have just heard can be prevented?

[Stephen McPartland]

I entirely agree. My hon. Friend has made an important point about the courage of staff whom many would describe as whistleblowers, and who are getting into a great deal of trouble not only with their management for casting light on what is going on in a particular hospital, but with their colleagues for telling tales.

I am proud of the NHS, I am very proud of the staff who work in it, and I am proud to have the Lister hospital in my constituency. We have heard much impassioned talk about the NHS throughout the Chamber today. I think it is fantastic that Members on both sides of the House, and all Members individually, do all that they can to improve the NHS and the service with which their constituents are provided on a day-to-day basis. I know how proud I am of the doctors, nurses and clinical staff who save lives every day in my constituency, and I know that the headlines only appear when things go wrong.

In my constituency there is an organisation called POhWER that provides an advocacy service to some of the most vulnerable individuals who are having difficulties with the NHS. It now has contracts for London, the south-east, the midlands and the east of England. It was created many years ago by a group of service users who were severely disabled and had difficulties daily in interacting with their NHS and other services. They created this charity and are its trustees. It has helped hundreds of thousands of people. It launched a telephone service in the middle of last year, and it has already received 30,000 telephone calls. I had the great pleasure yesterday of taking those involved to see the Minister with responsibility for charities, The Party Secretary, Cabinet Office, my hon. Friend the Member for Ruislip, Northwood and Pinner (Mr Hurd), to demonstrate some of the work they are doing.

Every Member, irrespective of party, wants their NHS to be the best it can be and to provide the best possible care to their constituents. We can all make political points, and my hon. Friend the Member for Southport (John Pugh) referred to the fact that the Whips on both sides put out lots of statements for us to use to attack each other. We could argue that spending in the health service in Wales is going down by 8% under the Labour Administration there, but I do not want to put that case.

Instead, I want to say how much I respect the right hon. Member for Leigh (Andy Burnham). It was refreshing to hear him say he felt he did all he could in terms of NHS spending given the constraints of the budget he had. I do not want to cast political aspersions, because I have a great deal of respect for the right hon. Gentleman. I believe he wanted to improve the NHS every bit as much as our Secretary of State and Ministers want to do so. I dearly wish the NHS was not a political football and we did not bandy about figures and information.

A great deal has been said about the first and second part of a sentence in a letter from Mr Dilnot. I have read the letter. I imagine most people would not really care about whether 0.1% less or more money was going into the NHS. They are interested in the fact that £12.5 billion extra is going in over this Parliament. The Health Committee Chairman, my right hon. Friend the Member for Charnwood (Mr Dorrell), made a powerful and eloquent speech—it was far more eloquent than mine. He explained that revenue expenditure has been growing modestly over the past couple of years, and that is the expenditure that the day-to-day care delivered to patients in the NHS comes from.