Autism Diagnosis

Siobhain McDonagh Excerpts

Wednesday 13th September 2017 Westminster Hall

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I congratulate my hon. Friend the Member for Enfield, Southgate (Bambos Charalambous) on securing the debate and all the parents and voluntary groups who have clearly been galvanised and got so many Members to be in the Chamber this morning. That is a real tribute to them.

I will write to the Minister with my local examples of families with difficulties, but I want to bring the particular attention of the House and the Minister to a decision of my mental health trust, South West London and St George’s, and of the Merton CCG. Under pressure from the doubling of the number of referrals for autism assessment, the trusts decided simply to restrict the ability to refer. To combat the demand for diagnosis, they suggested that only those children displaying mental health problems would begin the diagnostic process. As we have learned in the debate, however, 30% of autistic children develop no further mental health problems. Girls in particular do not display autism until much later.

If the proposal goes ahead, therefore, a large number of my constituents will be living with undiagnosed autism. On 21 September, the five CCGs—Merton, Sutton, Wandsworth, Kingston and Richmond—will meet to decide whether a formal public consultation is needed. I ask the Minister directly to work with my local mental health trust and CCG to ensure that all those with autism in my constituency are given the diagnosis they need to receive support. They should certainly be involved in any consultation on changing procedures. Furthermore, those procedures should not change in a way that would mean that girls are less likely to receive a diagnosis.

A reduction in the diagnosis of autism in Merton would leave so many of my constituents without the specialist support they need. Such a reduction would be in the interests of no one, whether the individual or the state.

--- Later in debate ---

[Jackie Doyle-Price]

We very much send the message that parents of children with autism are entitled to good services and that is what they should expect. We need to spread that good practice and collect those data, in order to highlight exactly where it is not happening. When we look at the work that the Care Quality Commission has done to highlight good practice, we should be able to get some messages. We are looking for transparency to drive performance and to have those conversations. The NHS mandate for 2017-18 sets a priority for the NHS to reduce health inequalities for autistic people, so that is very much part of NHS England’s conversations with local CCGs.

[Siobhain McDonagh]

On that point, will the Minister refer to the issue of South West London and St George’s Mental Health NHS Trust and the five CCGs in south- west London?

Oral Answers to Questions

Siobhain McDonagh Excerpts

Tuesday 7th February 2017 Commons Chamber

[Nicola Blackwood]

AMR is a global issue. We are world leaders in this, and we are working proactively with international partners to identify new and innovative approaches to the treatment of a range of challenging resistant infections, including malaria.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

11. What assessment he has made of how the accelerated access review will improve access to breast cancer drugs.

[The Parliamentary Under-Secretary of State for Health (Nicola Blackwood)]

We are absolutely determined that we will improve access to cost-effective, innovative medicines, including breast cancer drugs. That is exactly why we introduced the cancer drugs fund.

[Siobhain McDonagh]

The Minister will know that “cost-effective” is not an easy thing to define. Many women will not get access to the breast cancer drugs they need unless there is a review of how NICE assesses cost-effectiveness. Will she support an independent review of those processes, and will she say something about off-patent cancer drugs?

[Nicola Blackwood]

The hon. Lady and I have debated this in the House before. It is worth looking at our record. The cancer drugs fund has helped 95,000 people to access cancer drugs, to the tune of £1.2 billion, and NICE has approved three breast cancer drugs, while there are others that it has not yet approved. It is important that politicians do not intervene in this debate, as these are very difficult decisions that will always be challenging in the situation where the NHS has a finite budget.

Breast Cancer Drugs

Siobhain McDonagh Excerpts

Thursday 26th January 2017 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I beg to move,

That this House notes the provisional decision not to provide the breast cancer drug Kadcyla for use in the NHS on 29 December 2016; and calls on the National Institute for Health and Care Excellence (NICE) and pharmaceutical company Roche to come together and re-assess this decision to ensure Kadcyla is kept available for patients, and consider how access to both innovative new breast cancer drugs and off-patent drugs used for breast cancer, such as bisphosphonates, can be improved.

I thank the Backbench Business Committee for the swift manner in which it allocated time to have this important debate. I want to put the spotlight on an issue that affects the lives of millions of people—those who are living with breast cancer and their family and friends. I am sure that almost everyone here today will know someone who has had this disease. My own friends have suffered from breast cancer, and I am so pleased that many of them are in the Public Gallery to watch today’s debate. I have received a large amount of communication on this, including as late as last night in a message from a Vivienne Ashley, who cannot be here today but will be watching on TV.

The disease affects people irrespective of their class or job. Many hon. Members have suffered from breast cancer, such as my hon. Friend the Member for Bristol West (Thangam Debbonaire)—also my Whip—who has had a great recovery. An Opposition Member approached me only yesterday to explain that she was receiving treatment, and that although she wanted to be involved in the debate, she felt the issue was too close to her to do so at the moment.

I am sure all Members would agree that we need a health system in which the most effective cancer treatments are available to all patients. Today, I want to let people living with cancer, especially secondary breast cancer, know that we have not given up on them and that we all want an NHS that provides us all with access to the most effective treatments.

[Sir Desmond Swayne (New Forest West) (Con)]

If the deliberations used by the National Institute for Health and Care Excellence, particularly for metastatic breast cancer, take insufficient account of the needs of young families to spend more time with their mothers, is the remedy something that NICE itself can provide by altering the way it goes about those deliberations, or is it something that we in this House and the Government need to do?

[Siobhain McDonagh]

The answer to the right hon. Gentleman’s question is both. There are issues with how NICE assesses new drugs, particularly cutting-edge drugs such as Kadcyla. He will know, because of his involvement in the last Government, that they established the cancer drugs fund. It is not an either/or, but something we all need to come together to discuss, and that people with more scientific knowledge than me might wish to consider.

[Norman Lamb (North Norfolk) (LD)]

I congratulate the hon. Lady on securing this important debate. Does she share my concern at news that the Government appear to be ready to leave the European Medicines Agency following the Brexit vote? Many people fear that that will lead to a slowdown in access to new medicines. She talks about the importance of NHS patients getting access to medicines; this could make the situation worse and leave us disadvantaged compared with other countries in Europe.

[Siobhain McDonagh]

Breast cancer knows no boundaries, whether class, social or geographic. Anything that reduces access to better forms of treatment is detrimental.

The ability to lead an enriched and longer life as a result of medical advances should not be limited only to those who can afford private healthcare. Those advances should be accessible to us all. This debate will focus particularly on the provision of the breast cancer drug Kadcyla, which is under threat. Most Members will be aware of the lease of life that Kadcyla has brought to thousands of women in England with incurable secondary breast cancer. These women rely on Kadcyla to enrich their lives and to give them extra precious years to live. Indeed, in many ways it is a revolutionary drug. By targeting cancer cells directly, it helps to reduce the number of side effects, boosting women’s quality of life immeasurably. Members who have heard these women talk about their experiences will be humbled to learn of the distress and despair that they face as a result of NICE’s decision to provisionally reject the future use of Kadcyla on the NHS.

Today we are all supporting Breast Cancer Now’s “Keep Kadcyla” campaign to encourage NICE to reverse its decision and enable continued access to the drug, which both improves the quality of life and extends the lives of thousands of women in this country, on the NHS. Since NICE’s decision was announced at the end of December, thousands of people throughout the country have had their views heard. They have signed the petition and contacted their local MPs to ask that we do not give up on women, on the children who are dependent on mothers, and on the families who want that precious extra time with their loved ones. That is why we are all here today: to raise our collective voice in support of these women and defend the treatment that allows them to live their lives.

The focus of much of what I have to say today will be on Kadcyla, but we also need to consider other specific breast cancer drugs, as well as the broader issue of how decisions about access to treatment are made. Unfortunately, we are yet to see any improvements in access to off-patent drugs, some of which can prevent the development of certain cancers, thereby saving countless lives, as well as saving the NHS a great deal of money. Just a few months ago, the front pages of national newspapers highlighted the poor access to vital bisphosphonate drugs, which can prevent women from developing secondary cancer, yet the Government have barely acknowledged the problem of access to such treatment. I look forward to hearing from the Minister about when we can expect tangible results regarding access to off-patent drugs, including bisphosphonates. To be clear, many of the women who today owe their lives to Kadcyla might never have developed secondary breast cancer had they had access to bisphosphonate drugs in the first place.

[Nick Thomas-Symonds (Torfaen) (Lab)]

I will discuss off-patent drugs in my own speech, but on bisphosphonates, which are in the category of repurposed drugs, is my hon. Friend as concerned as I am about the results of the UK-wide survey undertaken by the UK Breast Cancer Group in March last year, which showed that currently only 24% of breast cancer clinicians are offering bisphosphonates to patients? That is something that the Government could urgently address.

[Siobhain McDonagh]

I completely agree with my hon. Friend and hope to say a little more about that later in my speech.

This debate is about not just Kadcyla, but the lives of the thousands of women who rely on it to survive, so I want to share the words and experiences of two of my friends whose lives have been transformed by having access to Kadcyla. One of my friends is present today—I went to primary school with her, but I shall not tell the House just how many years ago that might have been. Her name is Samantha, and she said:

“When I got the breast cancer diagnosis, I glibly thought—oh it’s OK I’ll get cured, but sadly about 18 months ago I found out that this wasn’t the case and my cancer had spread to my liver. And that’s when I really knew that my cancer meant business!

And that is where Kadcyla comes in. You see for breast cancer, although I coped and kept going with surgery, chemo and radiotherapy, it was grim. I worked a bit, but regular chemotherapy is not a doddle. Exhaustion and hair loss is just the least of it.

Putting on a brave face and wearing a wig is just a surface issue, getting up vomiting and going to work to deal with the VAT is about the hardest thing I have ever done. It wasn’t simply because I don’t have enough sick pay at work to cover my mortgage, I actually like work—work allows me to make my contribution, and I think that’s pretty near the most important thing, making my life make a difference. And Kadcyla? Well that means that my life isn’t over, it really gives me hope.

There is a big hole where my 45 mm tumour used to be in my liver, and scar tissue and other bits, but I am cancer free without having to take another year off my life. My work is precious; I have kept the business going. Eight people are employed, because I could keep going, and Kadcyla made it possible for me.”

[Mary Creagh (Wakefield) (Lab)]

I congratulate my hon. Friend on securing this debate. She certainly makes a powerful speech on behalf of her friend. Does she agree that when NICE looks at the cost-value ratio, stories such as that of her friend, who kept eight people in work, should also be a factor? We should be looking at women’s economic life and economic role, in both the workplace and the home.

[Siobhain McDonagh]

I completely agree with my hon. Friend. I appreciate that the equations and calculations are difficult, and I do not underestimate NICE’s work, but it is about life and quality of life, and it is about so many more people than only those who have the cancer.

My friend Leslie said:

“In 2013 my world was turned upside down when I was diagnosed with inflammatory breast cancer, a rare and aggressive kind of cancer that develops in the lymph vessels.

After 15 months’ treatment comprising 8 chemotherapy treatments, a mastectomy, 15 radiotherapy treatments and a year of Herceptin, it appeared that the cancer had gone. However, 4 months later I noticed a rash around the scar tissue of the mastectomy and a biopsy showed that the cancer had recurred in my skin.

My oncologist told me that I was in a very tight corner. Because the cancer had returned so quickly I wasn’t eligible for the usual drug treatments, radiotherapy wasn’t an option because I had recently completed a course, and surgery wasn’t possible because of the location of the cancer. I was told the cancer was incurable and referred to the Royal Marsden. They confirmed that surgery was not feasible because the cancer had spread so quickly over a large area making skin grafts impossible. I was told Kadcyla was my best chance.

I have now been treated with Kadcyla for 22 months and I have been told of others that have been treated for 5 years. Signs of the cancer disappeared very quickly and so far I have remained cancer free. Kadcyla has enabled me to live a reasonably normal life and participate in and contribute to my local community. Kadcyla has been a life saver for me and without it my future was very uncertain. I feel profoundly fortunate to have received it and I am incredulous that such an effective drug will now be denied to other people in my situation.”

I also wish to mention Rosalie, who was featured in Friday’s Evening Standard. She is just 33 and is living with incurable breast cancer. She is a single parent to two children, aged three and six, and is terrified of a future without the option of Kadcyla and terrified of her kids’ growing up alone. These are Rosalie’s own words:

“I hate feeling like a victim. But I have to fight for my kids. They are more important than me feeling vulnerable about going public. I have to fight for life for them.”

Then there is Mani. Members may have seen her last week on the “Victoria Derbyshire” programme when she spoke so eloquently about how Kadcyla had given her hope. She said that it had improved her life both significantly and quickly, enabling her to live a much fuller and richer life, going on holiday and playing an active part in her young daughter’s life.

These are just a few of the many women whose lives have been made possible through access to Kadcyla. I am sure that many hon. Members will share the experiences of their constituents. The hon. Member for Croydon South (Chris Philp) will no doubt talk about the incredible Bonnie Fox, the face of the Keep Kadcyla campaign of Breast Cancer Now. Thanks to the hard work of Bonnie and of Breast Cancer Now, this campaign has seen more than 100,000 people sign the petition, calling for NICE and Roche to come together to reassess the decision and find a solution to keep Kadcyla available.

Bonnie is an incredible advocate for the Keep Kadcyla campaign, inspiring so many others as she leads the case for this treatment. Bonnie says that her inspiration comes from wanting to have as much time as possible with her two-year-old son, Barnaby. These are her own words:

“I already feel cheated being diagnosed with secondary breast cancer at 37 with a baby, so having a drug taken away that would potentially add years to my life and give me more quality time with my son is so cruel.”

[Norman Lamb]

I am really grateful to the hon. Lady for giving way again. She will be aware that the Government’s accelerated access review last October recommended that NICE should review its whole health technology assessment processes and methods. Is she concerned that the review of Kadcyla and other drugs under the cancer drugs fund is happening before that review takes place? We might learn the lessons about how the review process needs to improve, but we will not benefit from them.

[Siobhain McDonagh]

I agree with the right hon. Gentleman. I am sure that he knows more about this process than I do. It clearly makes sense to consider these unique, unusual first-tier drugs in the light of that reconsideration.

I hope that we will hear the stories of the many women whose lives, having been affected by secondary breast cancer, have been enriched by Kadcyla. The drug Kadcyla matters so much to all these women for one simple reason: it works. It is effective. It has already been available on the NHS for more than two years and, compared with other treatments, its side effects are limited. Today, it is nothing short of a tragedy to know that countless women who thought that Kadcyla would be the next treatment they would receive for their breast cancer are having their lives shortened before their eyes.

I ask Members to imagine this: they are living with breast cancer; there is no cure, but there is something that could give them extra time with the people they love—the people who depend on them. It could be a year, five years or even longer. If they needed the drug today, the NHS would give it to them, but if they needed it in a few months’ time, they may have lost their chance.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

My hon. Friend is making a very powerful speech. May I congratulate her on securing this debate, and say how proud I am to be a co-signatory? The phenomenon of there being drugs in the pipeline that would make a vital difference to patients, but which are being held up by conflict between NICE and pharmaceutical companies over pricing or value for money, applies not only to breast cancer but to other cancers, too. My constituent David Innes is one of 20,000 sufferers of chronic lymphocytic leukaemia. He was diagnosed in 2009, when he was 39. He was in Parliament earlier this week, making the same argument, and saying that both parties need to end the logjam and come up with a deal to ensure the availability of these drugs. They need to put patients first. Life is too short not to do so.

[Siobhain McDonagh]

I completely agree with my hon. Friend. I wish her constituent, David, all the best.

How can we withdraw a drug from the NHS that is working, especially when we are offering nothing in its place? It seems senseless to me, and it is truly devastating to those for whom it really matters. Of course, as my hon. Friend says, Kadcyla is just one drug that we need to look at. What will happen with other key breast cancer drugs now and in the future? I wish to consider just two more examples. Perjeta is currently available through the cancer drugs fund, but unlike Kadcyla it has not yet been re-appraised, although it will be soon. Perjeta is used for HER2 positive secondary breast cancer patients. In many ways it is even more effective than Kadcyla, as it enables women to live for an additional six months without their breast cancer progressing, and can extend life by an additional six months or more. However, because it is administered with two other drugs—Herceptin and Docetaxel—it would not be considered cost-effective under NICE standards even if the drug manufacturer gave it away for free.

The other drug is Palbociclib, which is used on women with hormone receptor positive and HER2 negative breast cancer. It is a new drug, which is being assessed for the first time by NICE. It is extremely effective and enables women to live for at least an additional 10 months without their breast cancer progressing. However, because women are living longer, robust overall survival data are not yet available. Perversely, that will count against it in the NICE appraisal. Overall survival data are given greater weight than progression-free survival in NICE appraisals, despite the fact that the outcome is the same—a longer, more enriched life.

We are seeing effective treatment after effective treatment being rejected or facing rejection by NICE. I want to know this: is it really right that we have a health service that plans to take away those lifelines? How is the decision to take away these life-extending drugs beneficial for people living with cancer, or for any of us who might one day need access to them? Who makes these decisions, and how can we be sure that they are the right ones?

We have a drug appraisal process, which is certainly valuable and necessary, but I question the factors that constitute that process. It is too easy to assume that the experts must automatically be right. The process is: numbers in, formula used, and then a yes or no answer. Let us not forget that we are talking about people’s lives. The lives of those affected and those for whom this decision is all too real are in the hands of a formula—the NICE appraisal process—and yet this life-changing formula has had little examination for many years. How many of us actually understand what factors are taken into account in these life-or-death decisions? The drug Palbociclib is proving so effective that, at present, it only has data on how long people are living without their breast cancer progressing.

[Julie Elliott (Sunderland Central) (Lab)]

Does my hon. Friend agree that the fact that that drug is routinely available in France, Germany, Austria and Canada shows that our appraisal system is not working in this country.

[Siobhain McDonagh]

I agree with my hon. Friend. It is amazing to think that, for this particular drug, it will take longer to get overall survival data because people are living longer without their cancer spreading. That obvious success is seen as a big disadvantage in the NICE appraisal system. The cost of Palbociclib will appear to be much higher in the NICE formula because overall survival data are given much more weight than progression-free survival. That seems illogical to me.

Consider also the criteria for determining end-of-life treatment. If a treatment is end-of-life, it is allowed double the quality-adjusted life year costings of other drugs. End-of-life is considered to be two years, but why not three? How have we ended up with such an arbitrary, fixed figure, especially when the figure in Scotland is three years? There is no cure for secondary breast cancer, but as people start to live longer it will place them at a disadvantage when accessing treatments, because it will be harder for those treatments to become approved, as they are no longer considered under the end-of-life criteria.

Therefore, how can the Minister be sure that the NICE process is still fit for purpose? Will she respond specifically on two suggestions: first, to review the weighting for progression-free survival when overall survival is not available because a treatment is so effective; and secondly, to change the criteria for end-of-life treatment to three years’ survival instead of two?

I want to return to the issue of off-patent treatments. In recent years there have been two private Members’ Bills on the topic, one of which was introduced by my hon. Friend the Member for Torfaen (Nick Thomas-Symonds). We heard many commitments from the then Minister for Life Sciences, but we have not yet seen any improvement in access, which is hugely disappointing. The Minister committed to establishing a working group to investigate what could be done to enable the routine use of such treatments. I believe that the working group is due to conclude its work next month and publish its report. Will the report introduce a clear pathway for off-patent treatments, and will the Minister write to me with the details of the pathway and state explicitly how it will work for bisphosphonate drugs for the prevention of secondary breast cancer?

Breast Cancer Now and others have been disappointed by the extremely patchy availability of this treatment for eligible women. As a result, it recently launched the “43p a day” campaign to highlight the low cost of the treatment and the fact that it would save over 1,000 lives every year in the UK if it was routinely available, not to mention millions of pounds for the NHS.

[Chris Philp (Croydon South) (Con)]

I congratulate the hon. Lady on securing the debate. I want to put on the record my support for the case she is making and draw the House’s attention to the case of my constituent Bonnie Fox—she is in the Gallery today—who is suffering in the way the hon. Lady has described, and whose life chances would be greatly improved if something more could be done to preserve the availability of Kadcyla. I once again express my support for the case the hon. Lady is so eloquently making.

[Siobhain McDonagh]

I thank the hon. Gentleman. He is very lucky to have a constituent as exceptional as Bonnie Fox, who has already been mentioned because of all her work.

As a result of Breast Cancer Now’s campaign, the Minister has said that clinical commissioning groups are responsible for commissioning the treatment for bisphosphonates. What contact has been made with CCGs on the use of this treatment in these circumstances? As I understand it, the treatment presents a challenge to existing commissioning arrangements because it does not fit squarely into either specialised services, which are commissioned by NHS England, or local commissioning by CCGs. Does the Minister agree that if we want genuine progress on the availability of this treatment, we cannot take the path of least resistance and just say, “It’s up to CCGs; CCGs are independent bodies and can make their own decisions.” That is the “do nothing” option.

Treatments do not always fit into the neat categories that we create. This is an old treatment that requires a new approach. It requires our commissioning strategists at NHS England to make a considered decision about how to commission the treatment routinely. Will the Minister agree to meet Ian Dodge, the national director for commissioning strategy, to discuss this specific case with him and will she keep Members here today updated on those discussions? Will she also agree that it is indeed worrying that a treatment that could prevent over 1,000 women getting secondary breast cancer every year is not routinely available?

Finally—I think that everybody will be delighted that I am about to finish—I hope that the Minister will consider meeting some of the women affected by the decision on Kadcyla and the women from Breast Cancer Now who are here today. I would like to thank those women in the Public Gallery for coming here to show their support for this debate en masse. I wish every single one of them well. Access to life-enhancing and life-saving drugs should be a right in the UK, not a decision based on a lottery of access to private healthcare. I sincerely hope that NICE will reverse its decision and give every woman with secondary breast cancer their future back.

--- Later in debate ---

[Siobhain McDonagh]

I thank all the Members who contributed to this debate and thank the Minister for her detailed response. Most importantly, I thank the women in the Public Gallery for coming here en masse to show their support for this debate. I wish every single one of them well, and I hope that they will join me for tea afterwards. Perhaps unconventionally, I also invite any hon. or right hon. Members here to join me and those women for tea to thank them for their campaigning efforts and to understand more about their case. I expressly invite Suzanne from the office of my hon. Friend the Member for Wythenshawe and Sale East (Mike Kane)—there is a cake in the Pugin Room with her name on it. Happy birthday, Suzanne.

Question put and agreed to.

Resolved,

That this House notes the provisional decision not to provide the breast cancer drug Kadcyla for use in the NHS on 29 December 2016; and calls on the National Institute for Health and Care Excellence (NICE) and pharmaceutical company Roche to come together and re-assess this decision to ensure Kadcyla is kept available for patients, and consider how access to both innovative new breast cancer drugs and off-patent drugs used for breast cancer, such as bisphosphonates, can be improved.

National Health Service Funding

Siobhain McDonagh Excerpts

Tuesday 22nd November 2016 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

The “South West London Five Year Forward Plan”, published last week, states its intention to save a staggering £828 million by 2020—a contribution to the attempted national saving of £22 billion by 2020. However, that draft sustainability and transformation plan, published by the south-west London partnership, does not shed much light on how it will actually be managed other than by reducing A&E attendance by 40% in three years. That is a totally implausible aim that has not been achieved by any health system in the world—let alone one so strapped for cash.

That unsustainable ambition brings us to the long-standing proposal, which has so often been denied, to reduce the number of acute hospitals in south-west London from five to four or even—God help us—three. The five acute hospitals are St George’s, Croydon, Kingston, Epsom and St Helier, whose closure I have been fighting for 18 years. Of those five acute hospitals, St George’s will rightly be protected from closure. It is also clear that Croydon university hospital or Kingston hospital are unlikely to close, which leaves just St Helier and Epsom, both of which have been under threat before. No amount of vaguely-worded statements from the partnership will change the fact that the intention is to close St Helier. The STP clearly states that the partnership needs to

“Review our acute hospitals to ensure that we meet the changing demands of our populations, and to ensure that acute providers deliver high quality, efficient care… we will need four acute hospital sites in south west London”.

It continues by stating that the partnership will

“undertake further work, including analysis of revenue implications on 3, 4 and 5 site options”.

Not only will one acute site definitely close, but commissioners are considering the closure of two sites. We know from the STP’s former iteration in 2011, the Better Services Better Values programme, that the closure of St Helier was the main recommendation. Despite that, however, colleagues on the Government Benches, including the hon. Members for Wimbledon (Stephen Hammond) and for Twickenham (Dr Mathias), have been taken in by the STP, peddling the myth that no hospitals will close.

When is a closure a closure? If A&E and maternity services, and all the associated diagnostic and other services, are removed, that is precisely a closure. I want to make it clear to the House, the Government, the partnership and, most importantly, my constituents that we have come together as a community before to fight the closure of St Helier hospital and will do it again. We will do that not only for those who use St Helier, but for those who use every hospital in south-west London. The closure of St Helier would mean the undermining of all those other hospitals.

IVF: Welfare of Women

Siobhain McDonagh Excerpts

Wednesday 20th January 2016 Westminster Hall

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I beg to move,

That this House has considered the welfare of women undergoing IVF treatment.

I want to draw attention to the Human Fertilisation and Embryology Act 1990, which is also known as the HFE Act. It contains worrying failures that are endangering women’s lives and long-term health. As a result of the failures, it is time for Parliament to take action to protect the welfare of women undergoing IVF treatment. IVF is a huge industry, estimated to be worth some £500 million, with most treatment taking place in the private sector.

The Human Fertilisation and Embryology Authority code of practice, which follows from the 26-year-old HFE Act, rightly requires clinics to take into account the welfare of the child before providing IVF treatment, but the HFEA’s narrow interpretation means that women’s welfare is not considered. IVF treatment works by stimulating the ovaries of a woman to grow multiple follicles through the use of a drug identical to the natural stimulating hormone called follicle stimulating hormone or FSH. In turn, the growth of such follicles causes a rise in oestrogen in a woman’s bloodstream.

However, if levels become too high, there can be a profound and adverse effect on a woman’s health. Indeed, extensive research has shown that the high stimulation given to women during IVF can significantly compromise their health. The most common adverse effect following the use of such hormones during IVF is ovarian hyperstimulation syndrome or OHSS, which can be mild, moderate or severe. Mild OHSS can occur in up to 33% of IVF cycles, while 3% to 8% of IVF cycles are complicated by moderate to severe OHSS. Women with severe OHSS are hospitalised, some in intensive care, needing intravenous infusions and drugs to save their lives. In its most severe form, OHSS can be fatal and women have died in the UK as a result of the complication.

[Joan Ryan (Enfield North) (Lab)]

Given the serious health risks that can arise from women being treated with too much hormone medication during IVF, does my hon. Friend agree that the HFEA must collect and publish information on the type and amount of drugs given to women so that they can make a more informed choice about the treatment they may receive?

[Siobhain McDonagh]

I wholeheartedly agree with my right hon. Friend and hope to expand on that point in my speech.

[John Howell (Henley) (Con)]

I thought I would get an intervention in while the hon. Lady was in the mood for taking them. I appreciate that she is talking about women who are going through IVF, but has she considered the health effects on women who want IVF but are prevented from doing so due to their age?

[Siobhain McDonagh]

I have no comments in my speech that address the hon. Gentleman’s concerns about age and effectiveness. I mostly want to ask the Minister, and through her the Department of Health, to consider how figures are recorded, what the practice is and how we can improve on what is now a 26-year-old Act.

It goes without saying that OHSS has a huge emotional cost to women and a huge financial cost to the NHS, but it is preventable. It is widely known that there are modern OHSS-free protocols that can entirely prevent the syndrome from manifesting, but they are underused. In a 2011 article in The BMJ, authors Bewley and Braude reported on women’s deaths as a result of the complications around IVF treatment. The article states:

“The last Confidential Enquiry into Maternal Death recorded four deaths directly related to IVF via ovarian hyperstimulation syndrome and three deaths related to multiple pregnancy after IVF. Thus, more deaths were related to ovarian hyperstimulation syndrome than to abortion…despite many fewer procedures (for example, 48,829 IVF cycles v 198,500 abortions were performed in the UK in 2007). IVF associated maternal deaths may be underestimates, because record linkage is not allowed by the Human Fertilisation and Embryology Act”.

The article worryingly concludes that:

“infertility treatment now poses a higher risk for maternal death.”

Despite the potentially fatal risks to the health of women going through IVF, there is little accurate or complete information regarding the incidence of OHSS. Instead, the HFEA records it only via a flawed self-reporting system. In practice, that means that clinics must indicate when a patient has been admitted to hospital with severe OHSS when it is entirely induced by their IVF treatment, but that system of self-reporting is inadequate, for obvious reasons. The HFEA’s own data suggest that there is gross under-reporting of the condition.

We know that the number of eggs collected is a predictor of OHSS. The collection of more than fifteen eggs significantly increases the risk of OHSS, without improving the live birth rate. Bearing that in mind, over the first half of 2013, there were over 1,700 IVF cycles in which more than 20 eggs were collected—cycles that therefore posed an increased risk of OHSS. Yet, that same year, only 46 cases of severe OHSS were reported. Between 2010 and 2012, only 60 cases of severe OHSS and 150 cases of moderate OHSS were reported. During the same period, however, there were more than 3,000 IVF cycles in which more than 20 eggs were collected per cycle. Those examples demonstrate the worrying, and dangerous, trend of under-reporting. We also know that the stimulation dose given in IVF is negatively correlated to live birth. In other words, the higher the stimulation, the lower the rate of live births. Research has also shown that a high number of eggs collected increases rates of prematurity and low birth weight in babies. The risks are clear when considering how many cycles feature high stimulation and high numbers of eggs collected.

The HFEA database demonstrates that, between 2008 and 2013, more than 20 eggs were collected per egg collection procedure in more than 18,000 IVF cycles, more than 30 eggs were collected in 2,285 IVF cycles, and more than 40 eggs were collected in 313 IVF cycles. It cannot be stressed enough that those figures show a very worrying trend in IVF treatment in the UK, potentially placing women in real, and avoidable, danger. The evidence also demonstrates the pressing need for a change in legislation and for reliable data to be collected by an empowered regulator.

Furthermore, research from last year has observed an increased risk of ovarian cancer among women undergoing IVF in the UK compared with national averages. That was based on the HFEA database of more than a quarter of a million women who have received IVF treatment between 1991 and 2010. Similarly, a large Dutch study from 2011 of 20,000 women who had received IVF treatment concluded that ovarian stimulation for IVF may increase the risk of ovarian malignancies, especially borderline tumours. The link between ovarian cancer and IVF treatment, as well as the many health risks I have outlined, so obviously justifies the collection of reliable data by the HFEA.

As if the risks were not enough, several clinics are using a cocktail of drugs off-label in a manner for which they were not intended. It is most common in the use of drugs and intravenous infusions during IVF treatment and pregnancy that affect a woman’s immune system. However, they are often used without any supporting scientific evidence, posing significant risks to women. Both the Royal College of Obstetricians and Gynaecologists and the US Food and Drug Administration have issued warnings about the use of drugs off-label. The HFEA, while stating on its website that there is no evidence to support such practice, has admitted that it has no powers to stop it from happening despite being aware of the considerable potential harm posed to women. That clearly needs to change.

Despite the potential threat to women’s safety, the HFEA states that it does not have the statutory authority to take action in the so-called areas of clinical judgment and drug administration. Indeed, in relation to the HFEA’s limited response on the incidence of OHSS, the Minister stated the following:

“They have no express powers concerning the administration of drugs, which is a matter of clinical judgment. Although the HFEA does not collect data about the overall incidence of OHSS, clinics are asked to report when a cycle has been abandoned because of risk of OHSS. Severe OHSS is treated as an incident and depending on the nature of incident and the patient outcome, the HFEA will either expect an incident report or conduct an incident review itself”.

Given the severity of the risk to women that I have outlined, however, that response is clearly inadequate.

Considering the evidence, the absence of comprehensive data collection seems to be the result of a bizarre regulatory remit. That limited remit seems to see the safety of women as secondary. The McCracken review into the HFEA, the recommendations of which were entirely accepted by the Government, argued that the balance of HFEA activities was unacceptable. Recommendation 10 stated:

“The HFEA should conduct a review of the balance of its regulatory focus to ensure that it reflects the relative risks of the different activities that it oversees. Its approach should reflect the relative maturity of the sector it regulates…the need to ensure appropriate oversight of technical developments in the field of ART”—

assisted reproductive technology—

“the need to ensure that appropriate standards of practice are implemented consistently throughout the sector, and the continuing need for a high degree of public assurance regarding the sensitive activities that it oversees. This should not lead to any overall increase in regulatory activity or cost, but a rebalancing of activity.”

Further, as part of the preface to the recommendation, McCracken stated:

“Similarly where there are well known side effects of ART techniques, such as…OHSS…the HFEA should make sure that appropriate standards in managing them are being adopted across the sector...It is worth noting here that the work that the HFEA led in reducing multiple births, the ‘One at a Time’ project, is universally praised and may provide a model for addressing some of these other topics.”

To reiterate, the report states that reviewing the HFEA remit should not lead to an increase in regulatory activity or cost, but simply a rebalancing of its activity. However, the HFEA has not taken any specific action on OHSS or on the other interventions so desperately needed. That is why we need Parliament to act.

What can be done? I have a number of recommendations that I hope the Minister will be able to implement to address the risk to women’s health. First, an explicit commitment to the protection of the welfare of women urgently needs to be added to the Human Fertilisation and Embryology Act 1990 in order to give powers to the HFEA to regulate and monitor drug administration to safeguard the short and long-term health and welfare of women undergoing IVF.

Secondly, the HFEA must immediately start collecting information about all drugs, dosages—whether daily or cumulative—and off-label drugs administered to women during IVF treatment and pregnancy. The HFEA already collects extensive data about embryos, including the use of consumables or culture medium. In other words, what is administered to eggs, sperm and embryos is regarded as of primary importance, but what is administered to women is deemed to be of limited importance. We urgently need to redress that imbalance. Adequate information is desperately needed to gauge the adverse effects of the drugs on gametes and embryos, and to assess their threat to women’s health. Those data are already collected in the USA, Australia and across Europe. It is about time the UK followed suit.

Thirdly, the HFEA should introduce a campaign and licence condition expressly focused on reducing the incidence of OHSS, which can be fatal. That could be modelled on the HFEA’s successful multiple births minimisation strategy.

Finally, the HFE Act should be amended to link the HFEA registry with the hospital, cancer and death registries. That would allow accurate recording and publication of the links between IVF treatment and incidence of severe OHSS, cancer and mortality among women. The HFE Act has typically used patient confidentiality as a reason to have a hands-off approach to collecting important information. Links between IVF treatment and such incidences, however, have already been established in other developed nations by using such data. I am sure the Minister will agree that the more we understand such links, the more we can do to prevent unnecessary harm to women.

We urgently need a regulatory body that has the powers to monitor drug administration during IVF treatment, and to take action where needed to protect the welfare of women. We need to have adequate information to assess the safety of fertility treatments. Indeed, it seems absurd to have a regulator that is dedicated to licensing and monitoring clinics that carry out IVF, but that is unable to take action because it lacks statutory authority.

According to the McCracken report, such changes can be cost-neutral, and the HFEA has already achieved success in other areas. By including the welfare-of-women protection in the HFE Act, alongside the “welfare of any child”, we can finally act on the issue. By doing so, Government can oversee the collection of information about drugs administered to women during IVF treatment and pregnancy. What I am calling for is not unusual elsewhere in the world, and such systems of data collection are prevalent in so many developed countries. Changing the Act will also enable the HFEA to implement fully the recommendations of the McCracken report, in particular that

“appropriate standards in managing…are…adopted across the sector.”

That should include the use of modern OHSS-free protocols that prevent the incidence of potentially fatal OHSS.

Patients undergoing IVF treatment are often vulnerable, forced into paying for treatment themselves, and they desperately need someone to protect them. As more and more people use IVF treatment, the issue is no longer one for only a minority. It is time to give the safety of women the recognition that it desperately deserves in the Act. Let us not sit back and allow another woman to suffer or die unnecessarily during IVF treatment.

In the HFEA, we have a body dedicated to regulating IVF. Let us give it the tools to fulfil its duty. Twenty-six years since its creation, it is time to maintain what is good about the HFE Act and to reform what is inadequate. I hope the Minister will recognise the opportunity for the Government to pioneer a new chapter in the young history of IVF treatment.

Sight Tests in Special Schools

Siobhain McDonagh Excerpts

Tuesday 3rd November 2015 Westminster Hall

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I beg to move,

That this House has considered the provision of sight tests in special schools.

Every child has the right to a free NHS sight test. It is vital that all children have their sight assessed regularly and early on, as undetected problems can lead to deterioration or even permanent loss of vision. For a child with learning disabilities, it is an even more pressing issue. A relatively small number of students attend special schools, but they are the most in need when it comes to eye care. Those children also have a right to free eye tests, but often experience serious obstacles to getting the eye care they need. In fact, children with learning disabilities are 28 times more likely to have serious sight problems, and about half the children in special schools need glasses, but about 40% of children with learning disabilities have no history of sight tests. Many have to go to hospitals for specialist eye examinations, meaning more medical appointments and more time out of school. Those appointments are also more expensive than routine eye checks and, for those not under the care of a hospital, attending a high street optician can bring a whole new set of challenges.

In the very worst cases, children with learning difficulties who cannot access the eye care they need can eventually suffer from ultimately preventable sight loss. They are unable to make the most of their vision and are losing out, when a good pair of glasses could radically improve the quality of their lives. Therefore, I call on the Government, the NHS and the Department of Health to deliver eye examinations and dispense glasses to children in their special schools.

I draw the attention of hon. Members to the excellent work of the charity SeeAbility, which has worked extensively on this matter. The charity exists to support people with sight loss and multiple disabilities. Established in 1799 as the Royal School for the Blind, it now provides a range of services including residential care and supported living, and speech, language and rehabilitation services. Since 2005, it has run projects to address the health inequalities faced by adults and children with learning disabilities. Indeed, its “Children in Focus” campaign has attracted thousands of petition signatories and support from well-respected, professional bodies including the College of Optometrists, the Faculty of Public Health, and the National Association for Special Educational Needs. SeeAbility’s work is vital for so many reasons—most significantly because those children, who are most likely to suffer from the most serious sight problems, face the greatest challenge in accessing eye care.

Although the recommended guidelines for all children to be vision-screened at the school entry age of four to five need to be followed, the issue is significantly more pressing for children with special needs. When a child has a severe or profound disability, or multiple disabilities, they might not realise that they have a sight problem. They might not be able to tell a carer or a parent about it, or their sight problems might be overshadowed by other, more obvious needs. All of that means that parents, teachers, GPs and others might not realise that there is a problem.

SeeAbility has piloted an excellent project to offer sight tests for children in six special schools in London. It has used its own charitable funds and specially trained optometrists and orthoptists to visit those schools, including Perseid school in my constituency of Mitcham and Morden, to test sight and dispense glasses. Children, parents and teachers are all seeing the benefit of that work. Perseid school is a community special educational needs school that is rated as “outstanding” by Ofsted. It offers an exceptional, supportive atmosphere for children aged three to 19 who have severe and complex learning difficulties, including learners with an additional diagnosis of autism, or physical or sensory disabilities.

SeeAbility went to Perseid school with its proposal in May 2013, after consulting the eye clinic at Epsom and St Helier NHS Trust. One of the aims was to pilot the provision of eye examinations in the school for those who the clinic felt it was not necessary to see in hospital. It was after I visited the project at Perseid lower school in September 2015 that I felt compelled to table this debate. The visit was eye-opening in so many ways. I discovered just how much eye health and vision information a skilled optometrist can get from a child who may not be able to respond verbally, or to read. It was a real education to see the techniques that Marek, the SeeAbility optometrist I met, used to judge whether a child needs a pair of glasses or whether their vision is in more serious need of treatment. He was absolutely fantastic with the children.

I also met a super little girl, named Ellie, and her mum, Alyson. In so many ways Ellie is just like any other nine-year-old girl. She is active and sociable, loves music and chocolate, and her favourite colour is pink. Ellie was one of the first appointments of the day. She cannot speak and relies on her eyes to communicate by using eye gaze technology. Because of her condition, she has been attending hospital eye clinic appointments to ensure her sight is regularly checked. Her vision is her primary means of communication, but it is vulnerable to deterioration, making check-ups absolutely crucial.

Ellie gets very stressed having to go to the hospital for her sight checks. Taking time out of the school routine, and having the pressure to arrange it alongside her many other medical appointments is a logistical nightmare. She also uses a wheelchair and is now tube-fed, which add to the practical barriers she faces to access the eye care she needs. I heard from Ellie’s mum, Alyson, who said that SeeAbility’s work at the school has removed all that stress, and she has the comfort of knowing that Ellie is getting good eye care in school. Ellie can get her eyes tested, and glasses dispensed and fitted at school by SeeAbility, in a much more familiar, comfortable and convenient environment.

After I met Ellie, a little boy who is autistic came in for his eye test. He is nine years old and suffered sight loss in one eye in early childhood. Despite very little co-operation from the boy—who spent most of the time walking around the room—Marek, the specialist optometrist, was able to assess that his one good eye was focusing well and that he did not need glasses.

It is clear that it would be very difficult indeed for a standard community optometrist to assess the sight of children with special needs, such as the children I saw. Community optometrists rarely see a child with profound disabilities and may not command the necessary experience and skills, or have access to the specialist equipment that is so important. Furthermore, a child may become distressed in an unfamiliar dark room with lots of lights and menacing-looking equipment. In stark contrast, SeeAbility’s regular visits to Perseid school provide the children with the safe environment they need to have their eye sight assessed. The team can introduce themselves and become familiar with children in the weeks preceding an appointment and during regular visits. Furthermore, a child can have parts of their sight test on different days, if necessary, in the event that they need more time to become familiar with the process. It is even possible, if a child is very anxious, to complete tests in the classroom or in a sensory room, where they often feel more comfortable.

Testing vision in the schools is not only more familiar and reassuring to the children. It also reveals so much to the teaching staff and parents about how the children see, which can really maximise the potential of children with special educational needs. The project is now well embedded in Perseid school and the visits fit in well with the school’s day. The school’s fabulous headteacher, Tina Harvey, said:

“It has been fantastic to work with SeeAbility and we fully support this initiative. Our pupils can’t necessarily tell us what they can or can’t see in the classroom and now we have that information. And parents aren’t having to worry about how to get their child to yet another medical appointment outside of school.”

As the Minister’s portfolio includes eye care, I sincerely hope that he accepts SeeAbility’s recent invitation to visit one of the special schools that it is working in and to discuss the detail of its proposals, as I have done. I assure him that such a visit would be a greatly inspiring experience.

The work at Perseid school strengthens the case for national reform of eye care for children with learning disabilities. Having provided 600 eye tests, SeeAbility’s pilot, with the help of Cardiff University’s school of optometry and vision sciences, provides the most comprehensive study of eyesight in children at special schools in England. The sight of vulnerable children is being failed again and again. The early vision screening programme should be available to all young children when they first start school, but present provision is subject to a postcode lottery.

Furthermore, suggesting the use of hospital examinations as an alternative for children with learning difficulties is not good enough. Hospital appointments mean more medical appointments, more potentially distressing locations and more expense for the NHS. For instance, the average reference cost of a paediatric ophthalmic appointment is £115, and SeeAbility has found that 75% of children who have been discharged from a hospital eye clinic have had no follow-up sight tests in the community, leaving those children lost to the system. The compromise is unacceptable. If children go without sight tests, the tragedy is that they can suffer unnecessary sight loss and live their lives with poor vision just for want of a decent pair of glasses.

Hon. Members may be surprised that the appropriate checks are not already happening in schools. A few health bodies fund local NHS services similar to the one provided by SeeAbility, but the vast majority do not, which means that appropriate care for such children is limited. I am sure the Minister will agree that it is not acceptable for those children, who are so much more likely to have serious sight problems, to be reaching their teenage years having never had a sight test or the opportunity to see clearly. We need a more preventive and beneficial method, and we need to commission a new national programme of eye examinations and direct dispensing of glasses for children and young people in special schools.

The Minister may highlight that it is for NHS England to decide its priorities on eye care commissioning. To their credit, NHS England officials have been engaged in SeeAbility’s work. However, the Department of Health plays a crucial role in shaping legislation and establishing a payment regime for sight tests. The Department does the latter under the general ophthalmic services—GOS—contract, but the associated contract fee rates for sight testing are compounding the inequalities in eye care that I have described, which does not sit well with the fact that addressing the health inequalities of people with learning disabilities is a shared priority for both the Government and NHS England. Indeed, it sits well within the Health Secretary’s legal remit.

In August 2015, SeeAbility was awarded a GOS contract to run NHS sight tests in the special schools in which it works, but the contract provides only a £21.31 payment per sight test. That is the amount paid for a routine test in a high street optician, but SeeAbility estimates the actual cost of its tests to be some £85, which means that the charity is having to fundraise to keep this important project going. The GOS contract provides only a quarter of the actual cost of delivering eye examinations for children with learning disabilities.

As I have described, the sight tests provided by SeeAbility and others are specially adapted to the needs of children with learning disabilities and require specialist expertise and equipment. Furthermore, skilled orthoptists who can assess unusual and uncommon abnormalities of eye movement, and specialist dispensing opticians who are experienced in fitting glasses for children with special facial characteristics, are often needed. Can we truly accept such an inadequate fee that represents only a quarter of the overall cost of providing such adapted tests? The overall costs include the cost of what is often a longer, specially adapted test and any repeat visits to a child in a special school.

The current status quo ill-advisedly applies a one-size-fits-all approach to a complex issue. The needs of children with learning disabilities are varied and often unique, and such children need eye care provision that reflects that. We all know there are funding pressures on our health and social care systems, but the eyesight of children with learning difficulties is not a sacrifice that should be made.

In a few instances, there is already some recognition that those adjusted and specialist sight tests need proper funding. That extra, local support sometimes comes from local commissioners paying optometrists an additional £60 towards supporting someone with a learning disability to get a sight test. Although that is a good step forward, it occurs in only a handful of areas. Furthermore, the Department of Health has set enhanced fee rates for disabled adults to receive a sight test at home if they cannot leave the house unaccompanied. Clearly, some officials already recognise that specially adapted tests cost more. I sincerely hope that the Minister will acknowledge that his Department has set an NHS payment of £21.31 that does not cover the cost of those tests.

I hope the Minister will agree to open a consultation, as is happening in Wales, on how to cover the shortfall between GOS contract payments and the cost of providing such a specialist service. The provision of a reliable long-term alternative is essential. The relatively small number of children in special schools should mean that a fully funded NHS programme to address their needs is wholly realistic. Indeed, the quality of vision, and quality of life, of those 100,000 children should not be left to a postcode lottery in our 209 clinical commissioning groups.

Children with learning disabilities need a one-stop shop for the input of optometrists, orthoptists and dispensing opticians, as needed, with glasses provided on site, breakages repaired quickly and good links to hospital eye clinics if necessary. In turn, a fully comprehensive and tailored system would help to reduce NHS costs from unnecessary hospital visits. The programme should also be wholeheartedly supported by the Department for Education, which purports to help children with special needs to achieve their full potential. Let us be clear that the target will not be met if children are not provided with the best possible eye care.

SeeAbility and I eagerly await the Minister’s indication of support for a nationally funded programme of sight tests in special schools and a commitment to meet us to discuss those plans further. I urge all hon. Members to consider signing early-day motion 629, which supports the provision of such sight tests. The eyesight of children with special needs has been let down for too long. We look forward to this vital issue being treated with the seriousness it truly deserves.

NHS Specialised Services

Siobhain McDonagh Excerpts

Thursday 15th January 2015 Westminster Hall

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

I too congratulate you on your knighthood, Sir David. I am not quite sure what it is about Essex MPs and knighthoods, but perhaps we could be let in on the secret. I congratulate the hon. Member for St Austell and Newquay (Stephen Gilbert) on securing the debate. I would like to start with an apology, because it always seems a good thing to start with: I am sorry, but I will not be present for the wind-ups due to a long-standing agreement. However, I will be really interested to read the report of what everyone has to say.

I would like to concentrate my comments on brain injuries and the way in which any reconfiguration of commissioning might affect brain injury services. In addition to representing people in my constituency who have been affected by a brain injury, my interest is twofold. First, I was a member of the Health Committee when it conducted its inquiry into head injury rehabilitation. Our report was published in 2001, and our findings demonstrated the importance of good quality rehabilitation in improving patient outcomes. Rehabilitation can also save the NHS money by enabling people to move along the care pathway from acute care services, when appropriate, and, in the longer term, by reducing ongoing dependency and care costs. It is a shame that rehabilitation services remain under-funded all these years later. That must be addressed, regardless of commissioning arrangements.

My second interest is that my constituency contains the London office of Headway, the brain injury association, the estimable chief executive of which, Peter McCabe, has been my friend, colleague and constituent for longer than either of us would care to remember. The charity supports individuals and families affected by brain injury and, as such, is ideally placed to comment on the discussion on commissioning arrangements. As many of us know, brain injuries can leave people with a broad range of cognitive and physical issues, including communication, memory, emotional and mobility problems, each of which requires specialist yet integrated treatment and rehabilitation from the earliest possible stage to enable the best recovery.

In such a complex area of health care, the views of organisations such as Headway that provide services to people with brain injuries are of vital importance in discussions about how specialised commissioning might be reconfigured. Headway’s front-line services include a nurse-led helpline that takes thousands of calls each year, and acute trauma support nurses who provide valuable assistance to families of loved ones in the acute stage of care. It also has an emergency fund that provides vital financial support to families who are unable to afford to visit their loved ones in specialist brain injury units, which are often many miles from the family home, along with a network of more than 125 groups and branches across the UK that provide local support and services to brain injury survivors and their families.

Ahead of this debate, Headway reported to me that it has had discussions with experts in the field of acquired brain injury about the proposals, and that there are differing views as to whether changing the way in which brain injury services are commissioned would be beneficial or detrimental to brain injury patients. Some have questioned the wisdom of another reorganisation at this stage, yet most accept that encouraging those with commissioning responsibility at both a national and local level to co-operate and develop joined-up pathways of care for patients could provide real benefits. There is a great deal of concern, however, that the driving force may be to reduce expenditure. I seek assurances from the Minister that the potential reconfiguration of commissioning is about improving patient outcomes rather than cost-cutting.

The present level of detail on how brain injury commissioning changes may work in practice is also of concern. Without that, it is difficult for organisations representing patients to provide views as to what such changes might mean. Experts suggest that it could be helpful if it led to more investment in rehabilitation services. That is supported by an article in the Evening Standard this week quoting Robert Bentley, director of trauma at King’s College hospital, who explains that trauma units can struggle greatly to move patients back to local rehabilitation due to a lack of rehabilitation beds, and that that leads to a blockage in trauma units. Rehabilitation services must be invested in at a local level to encourage patient flow at a national, regional or tertiary level.

I ask that NHS England provides more detailed information on how any reconfiguration of commissioning may impact on survivors of a brain injury. I also ask that any move to restructure is subject to consultation with appropriate and relevant organisations; it is important that experts and patient groups are able to feed into the plans, so that the interests of patients are protected and consideration is given to the law of unintended consequences.

It is also important to state how imperative it is that CCGs, if they are to become more involved in the commissioning of specialist services, are supported to increase their expertise in these areas of health, so that they are able to make effective and well-informed decisions. That would also help to ensure a consistent quality in services across the country.

To pick up on the points made by my hon. Friend the Member for Poplar and Limehouse (Jim Fitzpatrick), I note that the Neurological Alliance highlighted that only 26.2% of CCGs responded to its audit looking at what specialist levels of understanding they have in that area of care, and that just 20.4% had explored the number of people using local neurological services. If the approach to commissioning services for these conditions is to be changed, CCGs will need to increase their knowledge of the level of need in their areas and the types of provision required. That might benefit from input from experts and patient groups, and should brain injury services move to a different form of commissioning, organisations such as Headway and its local groups should be engaged as part of the process.

I conclude by saying that the detail of these plans and how they are executed if they are put in place are of vital importance—as is always the case, the devil will be in the detail. The reality is that any one of us may suffer a life-changing brain injury. Those facing such difficulties need the assurance that they will receive the best possible acute care and rehabilitation to maximise their recovery, regardless of who commissions or pays for it.

Health

Siobhain McDonagh Excerpts

Monday 9th June 2014 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

Today I would like to add my voice to those of all who have expressed disappointment and surprise that the Queen’s Speech contained not one word about the NHS. Last month’s local elections in Mitcham and Morden, and in large parts of London, were dominated by the issue of health. The verdict was overwhelming: overnight, Merton went from no overall control to Labour control, with the people of Mitcham and Morden electing 30 Labour councillors out of 30 for the first time in history. In large parts of Merton one issue stood out: the future of my local general hospital, St Helier. Anyone driving through Morden will see hundreds of signs in front gardens and windows—yellow signs with a red heart in the middle, all saying “Save St Helier.”

The Government should have used the Queen’s Speech to listen to the people. Labour would introduce an NHS Bill; the Government included not a word about the NHS. During the local election campaign, Merton’s Conservatives said that, no ifs, no buts, St Helier was safe. Their leader proclaimed that

“St Helier Hospital has been saved”,

but St Helier has been under attack for years under this Government. In 2011, the local NHS said the Government had told it to

“deliver £370 million savings each year...around 24% in their costs.”

A new body called Better Services Better Value was set up. It announced it would close A and E and maternity units across south-west London and Surrey, and St Helier would also lose its intensive care unit, paediatric centre, renal unit and 390 in-patient beds. A save St Helier campaign was launched, and the petition has now been signed by more than 13,000 of my constituents. Three local campaigners—Sally Kenny, Stan Anderson and Mary Curtin—decided the issue was so important that they should stand in the local elections in Lower Morden as residents whose primary aim was to save St Helier. Given the backing they had from Councillor Stephen Alambritis, the Labour leader of Merton council, they stood for Labour. Just before the election, doctors in Surrey, where Epsom hospital was also threatened, vetoed the plans. BSBV was wound down in ignominy. It seemed we had won a reprieve, but when the huge banner covering the front of St Helier hospital that said

“Coming soon—We’re spending £219m on a major development”

was taken down, residents realised that victory was only temporary.

The best any of us could hope for was a few years’ peace and quiet. As it happened, the reprieve lasted until only five days after the election, when the local NHS published a new five-year plan that it says will

“change the way we deliver health services”.

Far from listening to the people, who voted in unprecedented numbers to save St Helier, it ignored the verdict of the people. The plan describes the

“likely need to reconfigure maternity and neonatal services”.

Of course, “reconfigure” is just a euphemism for closures, and it suggests that A and E units will be downgraded by 2018, with what it describes as the introduction of two levels of emergency departments—major emergency centres and emergency centres. The plans do not say which maternity units will be “reconfigured” or which A and Es will be downgraded to emergency centres, rather than full-blown A and Es, but, after years at risk, nobody thinks St Helier’s future is secure.

The leader of Merton council, who won an overwhelming mandate just weeks ago, is so angry that he has told the chair of Merton’s clinical commissioning group, who has headed the local NHS throughout BSBV, that the people had spoken and his job was no longer tenable. Councillor Alambritis said:

“BSBV has been a fiasco and the voters of Merton delivered a devastating verdict...Ultimately, responsibility lies with the Chair, and he has to go…Merton’s residents have demanded change, and the Chair needs to respond to that”—

and so should the Government. They have spent the last four years undermining, rather than strengthening, our NHS.

In 2010, the Conservative party manifesto said it would stop the centrally dictated

“closure of A&E and maternity wards, so that people have better access to local services, and give mothers real choice over where to have their baby”.

The people of Merton remembered that quote, and it is no wonder they voted the way they did a fortnight ago.

This is a democracy. The Government should respect the ballot box. My constituents do not want a Queen’s Speech that has not got a single word to say about the NHS. They want a Queen’s Speech to save St Helier, and save our NHS.

[Jackie Doyle-Price (Thurrock) (Con)]

I have reflected on the comments of the hon. Member for Mitcham and Morden (Siobhain McDonagh) and I really must tackle head-on the belief that because there is no Bill on the NHS, that is a weakness. The reality is that the NHS does not need more legislation. What it needs is good leadership and good performance management so that it delivers what we want it to deliver for our constituents. We will not improve the care of patients by sitting on these Benches and pontificating and giving the benefit of our experience. What we need to do is empower real practitioners to actually deliver change.

[Siobhain McDonagh]

May I inform the hon. Lady that many of my constituents in Mitcham and Morden believe the withdrawal of clause 119 from the Care Bill would have done a lot for their NHS?

[Jackie Doyle-Price]

I cannot agree with the hon. Lady. The important thing is that Government Members make it clear to the NHS that we expect it to put the interests of patients at its heart. I want again to draw attention to what has happened in Basildon and Thurrock university hospitals trust because it is perhaps the best example of the profound change we have had in NHS culture over the last five years. We now have a Government, and leaders within the NHS, who are finally prepared to face up to what is going wrong and to deal with it, rather than to cover up, be complacent and say, “We’re no worse than anyone else.”

I have to say that it has been a turbulent journey for those of us involved in Basildon hospital over those five years. The shadow Health Secretary, who is not in his place, will recall coming to this House in 2009, at the same time as he spoke about Mid Staffordshire, to highlight exactly what was going wrong at Basildon. Since then I have had a number of conversations with senior managers in which I was told, “Well, we’re no worse than anyone else. You’ll find this everywhere.” That was not good enough, but after two and a half years of not making any progress at all, Members of this House had very robust discussions with Monitor and said, “This needs proper intervention.” That led to a complete change in the leadership. A new board was appointed that was more inclined to give challenge where it was due. We had a leadership team that put stronger emphasis on good clinical leadership, and a chief executive was appointed who was determined to make sure that Basildon hospital delivered the standards of care that all patients deserve. What we have had is cultural change, and cultural change comes from leadership; it does not come from legislation. As I have said in many contexts, any organisation is a creature of the person at its top, so when we get good leadership in individual hospitals we get a step change in performance.

I also wish to pay tribute to the Secretary of State for the continued emphasis he places on patients, because when the head of the NHS—the person operationally responsible here in Parliament for performance—is articulating that, it will spread the cultural change which will deliver the real change in performance. I pay tribute to Clare Panniker, Basildon hospital’s current chief executive, who has delivered this significant change in the 18 months she has been in post. She has taken Basildon from being one of the worst performing hospitals to a position where it is coming out of special measures. She has been ably supported by the chairman of the trust, who has also been prepared to give a robust challenge and to stand behind her when she was doing so. Most of all, I wish to pay tribute to all the staff at Basildon. It has not been easy for them—it has not been good for their morale to see in the newspapers regular reports of the latest horror story of poor care within the trust—but they have reacted to the cultural change that Clare Panniker has brought. They have bought into it and given good, honest feedback, and I no longer get whistleblowing letters from staff about the latest incident. They have procedures to act on things and the management then implement that change. It says a lot about the commitment of the staff in that hospital that they have bought into that process and delivered us to where we are now. We all need to learn that sunlight is indeed the best disinfectant. It is not good enough to pretend that there is not a problem when there so clearly is, and it is important that we continue to put patients at the heart of the NHS. Only by doing that will we be able to ensure that the incidents witnessed at Mid Staffs and Basildon will become a thing of the past.

I wish to turn my attention to another issue that was not mentioned in the Queen’s Speech but which is on the Government’s legislative timetable for the coming year: the plan to introduce standardised packaging for tobacco products. I have to say to the Minister of State, Department of Health, my hon. Friend the Member for North Norfolk (Norman Lamb) that it is a very bad idea. I fully support the policy objectives of tackling tobacco consumption and, in particular, of dissuading and preventing children from ever taking up smoking, but I have worries that this tool is not effective and that its unintended consequences may bring about worse health outcomes than doing nothing at all. Sir Cyril Chantler is said to have examined that as part of his review, but I am not persuaded of the evidence. In particular, I believe that introducing standardised packaging will worsen the public health outcomes if unregulated illicit tobacco products replace the regulated ones. We all know how toxic regulated cigarettes are, but when unregulated products enter the market the health outcomes will be very much worse.

Sir Cyril Chantler has concluded that Her Majesty’s Revenue and Customs has been very effective in tackling contraband and illicit tobacco, and he has cited figures going back to 2001. Although they show an improvement, the nature of the problem has changed over that period. European Union enlargement took place during that time and there was an immediate rise in the amount of illicit tobacco, but that has been tackled, mainly through co-operation with tobacco manufacturers. That illicit tobacco was also a legal product, whereas the illicit tobacco coming into this country today is not from Europe and it is not from regulated markets; it tends to be made in places such as China and Indonesia. Some of these products are extremely nasty, with tobacco rolled with whatever is available and containing high levels of tar. I commend The Sun for the exposé it ran last week in which an illicit producer from Indonesia explained just how toxic some of his products are and how standardised packaging will help him make money by reducing the costs of production.

St Helier Hospital

Siobhain McDonagh Excerpts

Monday 10th March 2014 Commons Chamber

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

At the beginning of this month, on a crisp, cold Saturday morning, I joined a group of residents outside our local St Helier hospital to mark a sad moment in its history. For the past four years, St Helier has been adorned by a 1,000-square-feet banner, proudly saying, “Coming soon—We’re spending £219m on a major development of St Helier hospital”. The residents and I were there to see that banner taken down, and to mark the promise of a better hospital finally being taken away. The story of St Helier is a long one. I have raised it in this House on several occasions. This was a low point, but I fear that it may get lower, and the result of today’s debate does not exactly inspire confidence.

St Helier was built in the 1930s, at the same time as the St Helier housing estate that encompasses it. At that time, it was the biggest housing estate in Europe. The hospital was built there for a reason: it was where the health needs of the surrounding community were. St Helier hospital has had an interesting history. In the second world war, its bold white exterior was painted green owing to concerns that German bombers would use it for target practice or to line up their bombing missions on London. Although neighbouring buildings were destroyed by bombers, St Helier thankfully survived and has continued to serve the community ever since.

St Helier has had its troubles. In the mid-1990s, there was outrage when it was discovered that people were left to die on trolleys abandoned in the corridor. Back then, under-investment in the NHS of the John Major Government was not unusual. If it was bad on the wards, however, what was happening behind the scenes was almost as disturbing.

Even though Mitcham and Morden has always been the most deprived part of the old health area of Sutton, Merton and Surrey, it has always been the poor relation. In my almost 17 years as an MP, and for many before that, I have never known of anyone living in Mitcham and Morden to sit on the board of any NHS body. As a result, we have always had a Cinderella service. No one speaks up for our patients, and we are always first to lose out and last to gain. It was no surprise, therefore, when I discovered recently that health bosses had held secret meetings in the mid-1990s to discuss plans to close St Helier and move services to Croydon. Thankfully, once Labour came to power in 1997, this went no further, but the tone was set.

Not long afterwards, it was suggested that St Helier should merge with the hospital in Epsom. Such a merger was a little unusual, but Epsom was struggling financially, and we were persuaded that a merger would make both hospitals more resilient. The two hospitals were not a great match. People living in Epsom are relatively wealthy, and a little older. The area around St Helier is more urban, ethnically mixed, younger and has more health problems associated with poverty. Nevertheless, we accepted the advice, but it soon became clear that we had been sold a pup.

A new review, “Better Healthcare Closer to Home” was launched. This was in a time of plenty, the early 2000s, when health spending was on the rise, so a grand scheme was drawn up, in which St Helier and Epsom would both close, replaced by a new state-of-the-art hospital in Belmont, a very leafy, very wealthy community two miles south of Sutton. Aside from the terrible impact of closing St Helier, I never thought that the scheme was workable; it was too big, too unrealistic and lacked one key ingredient—any public demand for it.

Various bureaucrats argued that the site of a hospital is not important, because new community primary care services, such as GPs and local care centres, would see the patients that normally go to hospitals instead. The public never agreed, and in fact the reverse has happened: the number of people who would rather go to hospitals is rising. The public consultation at the time clearly showed that the most popular site for a hospital with an A and E was St Helier. The public knew that the people who need hospital the most are the most disadvantaged, with the worst health. They are the most likely to need A and E and the most likely to need acute maternity services.

Everyone could see that St Helier was the best location for a hospital if we wanted to reduce health inequalities, and it was backed by all the MPs in Sutton, Merton and Wandsworth. Local managers overruled us and, even though their initial assessments showed that St Helier was a 7% better option than Belmont, they voted for Belmont instead. Thankfully, in those days we had a Secretary of State for Health who was prepared to step in and stand up for the NHS. The health managers’ decision was finally called in by Labour councillors in the London borough of Merton, and the then Secretary of State decided to save St Helier, recognising that the area around St Helier had the greatest health needs in the whole catchment area and people there had up to 10 years’ less life expectancy. In contrast, Belmont is one of the wealthiest areas in the country. Indeed, people living there also made it clear they did not want a major new hospital built in their backyard. So we were all delighted when the then Government came down firmly on the side of reducing health inequalities and chose St Helier.

In early 2010, that decision was further boosted when a subsequent Health Secretary, my right hon. Friend the Member for Leigh (Andy Burnham), announced the £219 million renovation. At the time, we were all very aware that the economy could no longer afford the same generous public sector funding we had in the mid-2000s. Decisions had to make financial sense and, in the case of the £219 million, the numbers stacked up. As well as improving people’s health, the scheme was shown to offer value for money. It would mean new wards, with single rooms to cut down on infections and improve patient privacy, along with various other improvements. The scheme was so well thought out that just months later it also gained the support of the new coalition Government—the Chancellor still includes the funding in the Treasury’s books—but it was not long before St Helier’s future was again at risk.

In 2011, the local NHS admitted that it had received Government instructions

“to deliver £370 million savings each year...a reduction of around 24% in their costs.”

A new body was soon set up, this time called Better Services Better Value, or BSBV— it might properly be abbreviated to just BS for all the good it has done. Its task soon became clear: to close services such as accident and emergency, and maternity units, in one or more hospital. At the same time, finally recognising that they served different demographic groups, the St Helier and Epsom hospitals started to de-merge from the trust. Both had found new trusts willing to merge with them, St Helier with St George’s Healthcare NHS Trust and Epsom with Ashford and St Peter’s Hospitals NHS Trust, but, thanks to BSBV, those new mergers soon broke down. Nobody wanted to merge with a hospital that was under threat, particularly when it was revealed that Epsom’s debts were far worse than originally thought.

Originally, BSBV would look only at south-west London, covering St Helier, Kingston, Croydon and St George’s in Tooting; one of the four would lose its accident and emergency unit. But after the de-merger fell apart, the review was extended into Surrey, and two out of five hospitals were to be downgraded—inevitably, BSBV recommended that St Helier should be one. Not only would its A and E and maternity units go, but so, too, would its intensive care unit, paediatric centre, renal unit and 390 in-patient beds.

I have always said that the sums do not add up. Some 82,000 patients go to St Helier’s A and E each year, with the NHS saying that figure will rise by 20%—100 emergency patients are admitted every day. Neighbouring hospitals are already overcrowded, and are more expensive per patient, so it was never clear how the other hospitals could meet clinical targets, let alone cut costs, if they had to treat St Helier’s patients as well as their own. Figures quoted by BSBV—that an astonishing 60% of patients would use primary care instead of A and E departments—were ridiculed by the National Clinical Advisory Team, who said:

“Elsewhere in the UK a consistent finding is...far lower, usually...15-20%. Reconfiguration based on the higher figure may not achieve the anticipated benefits.”

In fact, NCAT went a lot further than that, saying:

“Successful implementation...depends on a multitude of supporting improvements...that are not well defined in the proposals.”

Given the growing birth rate and the higher cost of giving birth in all other hospitals, closing St Helier’s maternity unit was also never going to deliver clinical targets or cut costs. Experts say that maternity units should not deliver more than 6,000 babies per year. However, if St Helier closed, the remaining hospitals would have to deliver 6,500 babies each per year, plus 2,500 in midwife units and nearly 1,000 home births. It was no surprise, therefore, that NCAT said the plans were

“based on an optimistic view of capacity.”

Everyone in my local community knew the plans were bonkers. Local campaigners such as Sally Kenny, a former deputy head and Lower Morden resident, set up local groups to fight the plans. Sally has printed thousands of “Save St Helier” posters that are currently in windows across Morden and St Helier. People cannot drive through the area without seeing the words “We Love St Helier” displayed on garden stakes.

As well as a petition signed by more than 30,000 people, thousands of local residents attended a protest picnic organised by local mums, where the leader of Merton council, Stephen Alambritis, a former football referee, waved a red card at the plans. Merton council has always shown its support. Last year, it passed a strongly worded motion backed by Labour, Liberal Democrat, Conservative and Independent councillors, saying any decision on St Helier must go to the Secretary of State. Thankfully, salvation came from an unlikely source—a clinical commissioning group in Surrey.

In Merton, the new system of CCGs has not been a great advert for the Government’s reforms. Last May, I attended one of the worst public meetings I have ever been to—and that is really saying something. Merton’s CCG was due to decide St Helier’s future, but it would allow only a handful of the hundreds of people who came to the meeting into the public gallery. The chair would not allow cameras or recordings, and the microphones did not work. Members of the CCG refused to register their personal interests, even though it was alleged that some would gain personally if St Helier were shut and services were moved to other providers such as private companies or GP surgeries. Then, just as they were due to make a decision, they suddenly walked out of the room to boos and shouts of “cowards”. Some said that they had adjourned the meeting to a quiet staircase, others that they went to the kitchen. Wherever they went, they made the decision there, in secret, without any public witnesses, to accept plans to close services at St Helier and to go to public consultation.

If Merton’s CCG was not exactly the blueprint of an open, transparent community service, thankfully others did not follow suit. Having seen the power of GPs in Lewisham, the CCG in Surrey Downs, recognised that BSBV was barking up the wrong tree and voted no. As a result, earlier this year, BSBV was wound up; it will not be mourned. However, the threat still hangs over us.

I have been shown a letter from NHS England to the CCGs complaining about their decision not to approve closures at St Helier. The letter says:

“Your approach carries significant and unacceptable risk, both financially and clinically.”

Castigating the CCGs for their decision, it goes on:

“We consider your proposed approach would make it difficult for South West London CCGs to formulate a coherent strategic plan.”

According to NHS England, the decision

“carries unacceptable risks to your ability to develop and deliver a strategic plan. We also believe the approach carries significant operational risks. Firstly that your providers will not be able to meet the London Quality Standards...Secondly, that providers will not be able to recover their costs against income and therefore...will be unable to become Foundation Trusts.”

Most damning of all, it says:

“This could be interpreted as commissioners planning for clinical and financial failure in some of its providers.”

That letter is very revealing. It proves that those in charge still cannot bring themselves to rule out the possibility of St Helier closing. They are planning to fail, and if they do not fail, they will not allow St Helier to become a foundation trust anyway. Either way, the hospital will fail. That indicates that the announcement not to close St Helier is not real. As if we needed more evidence that the Government are not committed to St Helier, we heard, just a few weeks later, that the £219 million had been withdrawn. After I had repeatedly asked about the lack of progress, the head of Merton’s CCG finally conceded the truth. Ruefully, she admitted that the work was now “probably unaffordable” and no longer featured as

“one of the...scenarios being worked up by the Trust at this stage.”

The whole community knows what is going on. St Helier is not “safe”. It does not have the Government’s backing. If the Government truly still supported St Helier, why is it not full steam ahead with a scheme that has funding from the Treasury and that has proven its clinical value? They are failing to plan, and planning to fail. All this ends in one place: the demise of St Helier. If St Helier loses emergency services, 200,000 people will face longer journeys in an emergency. A and Es across south London will struggle to cope with the extra workload, and that will affect millions of patients, including the Minister’s constituents.

The Minister has a chance today to offer some hope. She is a significant person. A word from her could make all the difference. All she has to say is that St Helier will stay open and that she will not allow it to lose its A and E, its maternity unit or any of its other services. She can say today that the £219 million must be spent. When that money was announced four years ago, construction was due to begin in 2012. Nothing has happened, but this evening she can turn nothing into something with just a word. She will probably say it is for others to decide, but that is her decision. A decision not to act is just as much a decision as any other. What she should do is show leadership, because leaders decide. Without ministerial commitment to St Helier, it is clear where this will end. They are planning to fail, and that is why the fight goes on.

All the while, the population in south London is rising, demand for hospital services is increasing, demand for A and E is going up by 20%, and the birth rate is rocketing. Doctors oppose the closure of services, Merton council unambiguously opposes any closure, and all parties want to save St Helier. We thought things were bleak before; they are just as bleak now.

All the while, instead of focusing on improving the NHS, this Government have focused on top-down reorganisations. The UK Statistics Authority has made it clear that the Prime Minister has broken his election pledge to increase health spending. If St Helier loses its A and E or countless other services, my constituents will know why. They are angry. In Mitcham and Morden we demand nothing less than a moratorium on A and E closures. We want our hospital, St Helier, to continue. The German bombers never destroyed it, nor should this Government. The Minister needs to say, “Yes, the £219 million is still there, and yes, the building work will start now.”

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

I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing one of a number of debates that she has led in the House on this issue. I know that it is important to her—we have had many private conversations about it over the past few years—and to her constituents. She has great faith in my powers, but I fear that so soon after the collapse of Better Services Better Value, I am inevitably not in a position to say anything particularly definite to her tonight. However, I will try to respond to some of the points she makes and explain to the House what the road map ahead now looks like. Overall, although I understand her frustration, which is felt by many of us who represent south-west London, I think her analysis is a little bleak, but I will try to give her some assurance about the potential for the future, if not about some of the specific points that she asked me to address.

Before I comment on the issues that the hon. Lady has raised, I want to pay tribute to all those who work in the NHS in her constituency and in all our constituencies in south-west London. Throughout all the uncertainties of the past few years, they have continued to show their commitment to providing first-class services to all those in their care. For that, we thank them.

As I said, I share the hon. Lady’s frustration about this programme—I say that straight away on the record—as, I am sure, do all those of us affected in the area covered by the six clinical commissioning groups. For many of us, having spent so much time in consultations, meetings and discussions, it is, to say the least, very frustrating to find ourselves in this position on BSBV.

I give the hon. Lady the assurance that the Department of Health remains committed to investing in NHS infrastructure. The most recent Government spending review has ensured that capital spending in the NHS is protected in real terms. That means that the NHS will be getting a real-terms increase in spending in 2015-16 compared with 2014-15. There is, therefore, money available for capital infrastructure, but I realise that the hon. Lady’s interest is in her own local capital investment.

At the same time, I fully understand the hon. Lady’s disappointment that Epsom and St Helier University Hospitals NHS Trust has been unable to progress its plans for developing St Helier. However, as the hon. Lady knows, the problem is that in the absence of a local agreed strategy for south-west London and a decision on which services will be located at the redeveloped site, the trust has recently decided to reconsider the scheme.

As the hon. Lady is also aware, the proposed redevelopment has been closely linked to Better Services Better Value and the review of clinical services right across south-west London. That has gone on for so long that, in many ways, events have overtaken it and there is now a need to look at it afresh.

The six clinical commissioning groups in south-west London announced on 18 February that they did not propose to continue with the BSBV programme or to consult on the options that emerged from it, so they have now been withdrawn. As a result of that decision by the CCGs, the trust now needs to reconsider the business case for the hospital redevelopment and it plans to work with the local CCGs to see whether they can agree a level of investment in the hospital that is affordable and that ensures that the services provided are sustainable.

The trust has confirmed that over the next five years it plans to invest up to £78 million in modernising its estate, improving facilities for patients and updating IT systems and equipment. I think, therefore, that the picture the hon. Lady painted was a little bleak, because it suggested that there was to be no investment at all, when in fact the trust has announced that it intends to go ahead with plans that will enhance some of the services for her constituents.

[Siobhain McDonagh]

It is my understanding that any capital works of that size would have to be approved by the Department of Health and the Treasury, and as yet I do not believe they have been drawn up to the extent that they have any such permission, so at the moment this is wishful thinking on the part of the trust.

[Jane Ellison]

The trust has announced its intentions, and a proper process will be followed. I am trying to make the point that it is wrong to suggest that there are no plans to invest in and enhance services at St Helier. That process will be followed and we will respond in due course. That is my understanding of the trust’s plans and it wants to progress with them.

Accident and Emergency

Siobhain McDonagh Excerpts

Wednesday 18th December 2013 Commons Chamber

[Mr Hunt]

Well, the hon. Gentleman should listen to the Royal College of General Practitioners if he does not want to take it from me. This morning, its chair, Dr Maureen Baker, said that Labour’s

“proposal to bring back the 48-hour target for GPs is an ill-thought out, knee-jerk response to a long-term problem.”

Unlike Labour, we listen and act when doctors tell us that Government targets are harming patient care.

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

If the right hon. Gentleman feels that scrapping the 48-hour rule for GP appointments was wrong, what would he say to my constituent Mr C, who has e-mailed me today imploring me to get an appointment with his GP because his wife needs a new prescription for her blood pressure drugs and he has spent the past 48 hours on the phone attempting to gain one? How could he help my constituent?

[Mr Hunt]

I would urge him to urge his own MP to back this Government’s initiative to introduce seven-day GP surgery opening in pilots in every single region of the country, and to back plans like those in north-west London, where seven-day GP opening has been introduced—for which we have not had support from Labour.

--- Later in debate ---

[Siobhain McDonagh (Mitcham and Morden) (Lab)]

The public look with incredulity at many issues relating to the Government and public services, but highest on the list is the proposal to close A and Es in our NHS when demand for them is becoming greater and stronger.

St Helier hospital in my constituency has asked for evidence and proof of why its A and E department—which sees 90,000 people a year, meets its four-hour target and has a great safety record—should be closed. We are told by the medical establishment that it will be much better for everyone and that primary care will take up the slack. At no point are the public told—I am sure this is also true of other reconfigurations—where their care will be provided, which GP practices will stay open for longer and which extra services will be available. The public, therefore, are being asked to make a leap of faith and lose their A and E, which they know is there for them in times of desperation and need, in favour of wishful thinking that things will be different in the future. The gap between the Government’s credibility and the public is growing.

What evidence do the Secretary of State and the Government have that closing A and E departments that nobody believes to be small will provide better medical services? No research shows that to be the case. All the work done by the university of Sheffield and—I never thought I would say this—The Mail on Sunday in its campaign indicates that wholesale A and E closures, not only in rural areas, but in built-up urban areas such as mine, are not in the best interests of patients, and not just in terms of waiting times, but in terms of outcomes.

We all accept that some specialist services, such as the stroke service, should be concentrated, but there is no evidence to suggest that that needs to happen for what most people go to and A and E for. For those attempting to get a GP appointment in my part of south London, the situation is desperate. I have already referred to an e-mail I received from a constituent only today. It has come to something when constituents are contacting me to ask whether I can get them a GP appointment.

I challenge the Secretary of State to explain why his holy grail of closing A and Es is a good or wise decision. For as long as those GP services are not available, and for as long as the public do not know which surgery to attend or which services will be provided, they will never accept changes. There must be a presentation of the facts, not just a hope that somehow GPs will do more.

St Helier hospital is supported by everyone in my area—not just those who use it, but those who understand that demand on St George’s and Croydon university hospitals will increase should it close. For everybody, A and E is a safety valve to the NHS—it is there when other services are not—and for as long as that is the case, we need to keep our local A and Es.