Oral Answers to Questions

Siobhain McDonagh Excerpts

Tuesday 16th July 2013 Commons Chamber

[Dr Poulter]

The approach that must be adopted to ensure that health and social care services are joined up in the way that we need will vary in different parts of the country, and in accordance with differing health care needs and demographic challenges. I look forward to discussing that and other issues further when I meet the hon. Gentleman and my hon. Friend the Member for Kettering (Mr Hollobone) tomorrow or on Thursday.

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

9. What assessment he has made of the roll-out of the NHS 111 telephone service.

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

NHS 111 is now available in more than 90% of England. Despite some problems with the sites where it was launched around Easter, performance has now stabilised significantly. NHS 111 is now the principal entry route for access to the urgent care system, and nearly 600,000 patients accessed the service in May.

[Siobhain McDonagh]

Let me take the opportunity to make a confession to the House. Six weeks ago on Friday, I rang 111 as I watched one of my best friends vomit. She had been vomiting for 10 days, had been to see her GP four times, and had telephoned 111 on two occasions, on each of which she was told to go away and take antibiotics.

I did what no Member of Parliament wants to do. I said to the operator, “I am an MP, and I will take this up in the House if you do not deal with it properly.” Forty minutes later an ambulance arrived, and my friend was saved from a massive heart attack. What happens to people who have no one to speak for them, and no one who can say “I am an MP”?

[Mr Hunt]

The hon. Lady makes a very important point and I do not want to defend that service in the instance she cited at all. It is completely unacceptable if that kind of thing has to happen. The principle of 111—which is for people to have an easy-to-remember number and to be able to be connected to a clinician directly if they need to be, which did not happen with NHS Direct—is a good one, but it is not happening in practice as much as it needs to be. We are broadly meeting our operational standards, but it is not good enough and she has given a very good example as to why.

Oral Answers to Questions

Siobhain McDonagh Excerpts

Tuesday 11th June 2013 Commons Chamber

[Anna Soubry]

I could give my hon. Friend a long answer, but in short, the matter will be raised at the next G8 meeting. Further to that, as a result of his excellent debate earlier this year, I undertook to write, and have done so, to my hon. Friend the Minister of State, Department for Environment, Food and Rural Affairs. He has replied that the Government recognise that we should look at the guidance issued to farmers. I am more than happy to share the Minister’s letter with my hon. Friend.

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

16. What the status is of the capital programme for the refurbishment of St Helier Hospital.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I am sorry, Mr Speaker, I am all over the place and do not have now the answer to give the hon. Lady. I believe the programme was signed off in 2010—[Interruption.] In fact, I am right—[Laughter.] Well—[Interruption.] Now, now; that is very naughty from the right hon. Member for Leigh (Andy Burnham). As you get older, Mr Speaker, you sometimes start to forget things—[Laughter.] Not you, Mr Speaker, of course; you would never do such a thing, and in any event you are much younger than I am.

The Government re-approved the business case for the redevelopment of St Helier hospital in May 2010—I was right—as part of the review the previous Government’s spending commitments. As the hon. Lady knows, because of the various configurations and proposed configurations, no final decision has been made yet. We need to ensure that all the plans come to some sort of fruition.

[Siobhain McDonagh]

At my age, I share with the Minister a problem with memory loss, but I do not forget the years when we were trying to get the £219 million redevelopment of St Helier hospital agreed, or that the proposal was supported by the Chancellor in his first Budget. The money is now being used as a slush fund by Better Services Better Value, but its idea is to increase the sizes of A and E and maternity units of all the hospitals around while closing those at St Helier. Does the Minister agree that that was not the intention of the money, and that any future development plans must go back to the Department of Health for agreement?

[Anna Soubry]

I pay tribute to the hon. Lady, who campaigns hard for her hospital, and quite rightly so. I have met my right hon. Friends the Members for Sutton and Cheam (Paul Burstow) and for Carshalton and Wallington (Tom Brake) and am more than happy to meet her to discuss all the important matters she raises.

Accident and Emergency Waiting Times

Siobhain McDonagh Excerpts

Wednesday 5th June 2013 Commons Chamber

[Andy Burnham]

I agree entirely. That decision was catastrophic for the NHS. Not only did it siphon £3 billion out of the front line to pay for back-office restructuring; it took people’s eyes of the ball. When they should have been focusing on the front line and patient care, they were worrying about their jobs and which organisations they would work in. The Government were warned about this reorganisation and I will come on to that. I have new evidence, which I will put before the House today, that says that this Government were explicitly warned about the risks to A and E of proceeding with their reorganisation at a time of financial stress. It is pretty damning and I will come on to it later.

What I want to do today is achieve something for NHS staff watching this debate. Let us try to reach some agreement about the causes and the practical steps that now should be taken. First, on social care, which my hon. Friend the Member for Warrington North (Helen Jones) has mentioned, the survey of NHS financial directors says that this is the single biggest cause of the pressure. More than £1 billion has already been taken out of budgets already by this Government, and the Association of Directors of Adult Social Services says that councils are planning further spending and services cuts this year. This is simply not sustainable. It is a false economy. Social care is the preventative part of the care system. If the Government continue to hammer councils, the problem will simply end up on the doorstep of the NHS and it will get bigger and bigger. The human cost will be huge.

We heard at last week’s summit that more and more people with dementia are presenting at A and E. That is intensely sad and it is the wrong place for them to be.

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

Does my right hon. Friend agree that the most upsetting comment made at the summit was by the nurse at Kingston who told us of a lady with dementia who, when she is hungry or lonely, phones 999 for an ambulance and says that she has heart pain?

--- Later in debate ---

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

I will be very brief, as I want all Members who wish to contribute to the debate to be able to do so.

It feels as though we are telling the public that somehow they are being irrational by attending A and E. They are being entirely rational, however, if they live in urban London. They are being rational because they cannot get access to their GP services. Their GPs have contracted-in times and their walk-in clinics have been closed, so their only alternative is A and E. The 111 service is also, in effect, A and E, because it is so risk-averse. Our current system is not based on what is best for the patient; it is based on what is going to cause the least legal damage to the NHS if things go wrong.

My local hospital, St Helier, is up for closure despite the fact that its A and E is the only one in south-west London that meets the targets. Its maternity unit is also to close, even though it is the most clinically safe unit in the country. It is very difficult to explain that that is a rational decision to any member of the public, including me.

On issues to do with the NHS and how consultations are carried out, we are told and implored to see things differently. How can we see things differently when consultations do not include the public and when consultations are held over the school summer holidays rather than at a time when people and halls are available, and those of us who rely on voluntary assistance in making our arguments can get people to provide it? Better Services Better Value in my constituency intends to start its consultation at the end of the month and run it over July and August, dismissive of the arguments of the public that they cannot meet that timetable. Better Services Better Value has meetings without announcing where they are or what time they are at, and it does not even use microphones. I have been a publicly elected politician for more than 30 years and some of these NHS meetings I have attended have been the worst I have ever encountered during that time. If we wish to bring the public with us in difficult decisions, we have to be reasonable, fair and straightforward in our proposals. Nobody in my constituency understands why the solution to longer A and E waits is the closure of A and Es that are effective and actually work.

A and E Departments

Siobhain McDonagh Excerpts

Tuesday 21st May 2013 Commons Chamber

[Mr Hunt]

I agree with my hon. Friend: Frimley Park is a terrific hospital and Andrew Morris a first-class chief executive. In fact, I am visiting Frimley Park in the next month and I will certainly have that discussion with him. My hon. Friend is right that one issue that A and E departments frequently raise is the tariff and the fact that they get paid only 30% of it for any A and E admissions over the 2009 baseline. That was why NHS England announced an important change a few weeks ago. Previously, hospitals had no say over how the money that is withheld from them is spent—it is meant to be used to reduce demand. We are now setting up urgent care boards, and hospitals will have a seat round the table to ensure that the money is spent in a way that reduces pressures on their A and E departments.

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

Can the Secretary of State say how the numbers attending A and E in south-west London will be reduced by the closure of St Helier hospital’s A and E department, which saw 80,000 people last year?

[Mr Hunt]

I have not seen any plans for the closure of St Helier. I know that NHS London is looking at possibilities to improve services in those areas, but, as the hon. Lady will know and should take comfort from, if a major reconfiguration is proposed and then referred to the Secretary of State by the local overview and scrutiny committee, I will not approve the change unless I am convinced that it will improve patient care.

Merton and Sutton PCT (Prescribing Policy)

Siobhain McDonagh Excerpts

Friday 1st March 2013 Commons Chamber

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

Like many Members, I have a lot of concerns about what is going on in the NHS at present. My local NHS has to save £370 million a year and two out of five of our general hospitals are about to lose both their accident and emergency and maternity units. I am sure I will want to raise my concerns about that in the future. The long-promised reopening of Mitcham’s local Wilson hospital as a local care centre has still not happened, even though it is in the Merton ward with the lowest life expectancy, while the redevelopment of the Nelson as a local care hospital in neighbouring Wimbledon, one of the wealthiest places in south-west London, is under way. Also, after one of the biggest top-down reorganisations in NHS history, GPs are being forced to become managers rather than clinicians, so I think it is fair to say I have a lot of concerns.

In the case I am raising today, however, the problem is much more fundamental. It is about the price of a man’s life. Is £5,000 too much to pay to keep someone going? It is also about a controversial drug and the terrible way the NHS deals with patients who slip between the gaps. In a small way, it is about how NHS managers avoid their responsibilities and ignore elected representatives such as me. But most of all it is about my constituent, Mr Liakuat Aziz, and whether he should be allowed to have the treatment he desperately needs.

Mr Aziz is 61 and lives in lower Morden. In December, he came to my advice surgery. He is a nice man who has worked hard, and he has a family. He has been through a lot, and just at the point he thought he was making progress, he has hit a brick wall. His story touched me straight away. Mr Aziz explained that he had had numerous long-term health conditions, although when I saw him he seemed well. In 1995 he had a coronary artery bypass graft. After the operation, he had numerous setbacks and developed severe lung injuries. He had a tracheostomy and was found to have significant restrictive lung disease. He also suffers with ischaemic heart disease and underlying emphysema. He underwent right heart catheterisation, and he had significant pulmonary hypertension.

Fortunately, Mr Aziz was placed under the care of some amazing doctors. In particular, he is being treated by Dr Stephen Brecker, Dr Phil Marino and by one of the leading practitioners in this field, Professor Brendan Madden, at the St George’s and Royal Brompton hospitals’ joint pulmonary hypertension clinic. Despite all that treatment, Mr Aziz was still in a very precarious condition, with severe pulmonary hypertension group 2 and group 3 disease. In addition, he had long-term lung fibrosis from cardiac surgery, ischaemic cardiomyopathy and a biventricular implantable cardiac defibrillator in place—that is not very easy to say, let to alone live with. By January 2011, his condition had worsened. He suffered from breathlessness and he could not get around. His doctors decided to try a new treatment—sildenafil.

To you and I, Mr Deputy Speaker, the word “sildenafil” might not mean very much, but we have probably heard of its other name—Viagra. Most people think of Viagra as a fun drug or as a relatively trivial treatment for erectile dysfunction. I do not want to go into the rights and wrongs or the merits of Viagra today. It is well known as a sex aid, but what a lot of people do not know is that Viagra is also a very effective treatment for pulmonary hypertension. It is not the only treatment, and for many patients it will not be suitable or cost-effective, but given Mr Aziz’s numerous lung and heart conditions his doctors thought that sildenafil was a solution. Indeed, numerous medical studies have shown that it has a role to play.

Professor Madden himself conducted one such study in 2006, with Allenby, Loke and Sheth. After looking at the evidence from a group of patients, they concluded:

“Sildenafil offers potential to treat patients with pulmonary hypertension by selectively inhibiting phosphodiesterase type five pathways in the lung.”

Between them, they concluded that it should be recommended for selected patients with pulmonary arterial hypertension. Every one of their patients saw reduced pulmonary vascular resistance, and all could walk further and faster as a result. The same conclusions were made by the much larger Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology, and the European Respiratory Society, endorsed by the International Society for Heart and Lung Transplantation. Their 2009 report is the basis for commissioning policy, and is responsible for the current guidelines into the treatment of pulmonary hypertension. Their conclusion was that

“Sildenafil is an orally active, potent, and selective inhibitor of phosphodiesterase type-5.”

They found that various studies

“confirmed favourable results on exercise capacity, symptoms, and haemodynamics.”

So the medical community agrees that in certain circumstances it is a legitimate treatment.

Professor Madden duly began Mr Aziz on sildenafil and, thankfully, Mr Aziz responded.

St George’s hospital’s department of cardiothoracic surgery has written to me to say that Mr Aziz

“had an extremely good symptomatic response to Sildenafil”.

By March 2012, his mean pulmonary artery pressure had dropped to just 28 from 40 the year before. His pulmonary vascular resistance was down to 2.9 Wood units from 4.5. He could walk without being out of breath and all was well, until suddenly Mr Aziz was contacted by his local GPs at the Cannon Hill Lane surgery to say that they could no longer prescribe him with sildenafil as Sutton and Merton primary care trust had instructed them to stop prescribing it.

It transpires that throughout 2012, the PCT had been advising the GPs not to prescribe the drug but Professor Madden and other doctors had repeatedly stepped in. I have been shown letters and applications on Mr Aziz’s behalf throughout 2012, one from March, one from July and one from October. I believe there are more, but in the end, despite it being pointed out that discontinuing the prescription would be

“a threat to Mr Aziz’s life”,

and despite his having been on it for nearly two years, the NHS decided it would not fund it. Viagra, even for a sick man, was not the sort of thing it wanted to be seen prescribing.

That is where I came into the picture two and a half months ago. As MPs, we see lots of people. I take up thousands of cases a year and I write tens of thousands of e-mails and letters on behalf of my constituents, but only very rarely do I get involved in such a story, which is really about life and death. I knew I had to work urgently. I wrote to all the doctors, the PCT and the NHS. Professor Madden wrote straight back, and what he said only added to the urgency:

“Mr Aziz has benefited significantly from Sildenafil therapy, and it is my opinion together with that of my colleagues Dr Phil Marino and Dr John Wort, Consultant in the Pulmonary Hypertension Unit at the Royal Brompton Hospital and Dr Stephen Brecker, Consultant Cardiologist at St George’s Hospital that Mr Aziz should continue on Sildenafil therapy.”

I was shown notes that showed that before he was put on 50 mg doses of sildenafil, Mr Aziz

“experienced a marked and constant deterioration in both symptoms and functional capacity...despite aggressive optimisation of his cardiorespiratory co-morbidities.”

Before taking sildenafil, Mr Aziz had exercise tolerance of under 50 yards. According to the notes, he had

“genuinely disproportionate and at least moderate pulmonary hypertension out of keeping with his existing co-morbidities”.

He was, in short, in a very bad way.

Even after Mr Aziz was put on 50 mg doses, the doctors sought out other solutions as they wanted to be sure the treatment was not too extravagant. They twice reduced the dose to just 20 mg, but both times, according to the notes,

“he rapidly experienced an increase in symptoms and functional decline that only resolved on restoring the dose to 50 milligrams.”

It was obvious to the doctors that Mr Aziz had

“shown a clear response to Sildenafil based on symptoms, functional capacity and right heart catheter data.”

The doctors clearly concluded that, in line with the medical studies I mentioned earlier, Mr Aziz was an exceptional case and was best treated by what we would call Viagra. His course of sildenafil, which costs less than £5,000 a year, was making a difference to him and it was not insignificant.

Chillingly, Professor Madden wrote to me to say:

“We are all of the opinion that his condition could deteriorate precipitously if the medication were to be stopped, and indeed this could bring about his premature death.”

When I received that letter, it brought home to me what I was dealing with. Professor Madden, one of the most eminent practitioners in his field, had told my constituent he could die and, naively, I thought that meant that the case would be dealt with urgently, so I waited for my local NHS to get in touch.

I waited. I wrote e-mails and letters reminding the NHS that the issue was quite urgent, and I carried on waiting. My caseworker phoned virtually every day and, on 23 January, we started counting the calls. We called Ann Radmore, the chief executive of NHS South West London. She would not take our call, but her office asked us to speak instead to the chief officer of Merton’s new clinical commissioning group, Eleanor Brown. We left a message, but did not get a call back. We called Tony Foote in Ms Radmore’s office and he promised we would get a call by 30 January. We did not, so we rang and rang every day, and they said we could speak only to Mr Foote, but he was never in and he never rang back.

At one point, things looked up. On 8 February Ms Radmore’s PA actually spoke to my caseworker and promised to get back to me. But then nothing, and the waiting continued. No one answered the phone. No one got back to me. Here was a man who could die without this drug, but the bosses at Sutton and Merton primary care trust would not even deign to talk to his MP. Eventually, I had no choice. Two months after first contacting them, I raised the case at Prime Minister’s questions. I complained that I had been

“defeated in my attempts to get a response from NHS South West London”

and asked if he would help me get a response. Otherwise, I said,

“my constituent might die”.

He replied that he would

“try to get a better answer”.—[Official Report, 13 February 2013; Vol. 558, c. 853.]

I am not necessarily a fan of the current Prime Minister, but I have this to say about him: he has astonishing powers. Within five minutes of my asking him, while he was still standing at the Dispatch Box in this Chamber, my office had a call from the local NHS. Yippee, I thought. Finally someone was taking this seriously. All the stops would be pulled out. Progress would be made. Somebody would talk to me. We would clear things up. Mr Aziz would be all right. No, the caller simply said, “Ah yes, about your case. We’ll try to find out what’s going on.”

A day or two later I got a letter from Eleanor Brown. It is not a very helpful letter, but it is a classic of its kind. It starts with a belter of an apology:

“I must apologise firstly for the undue delay in providing this response.”

It continues:

“I understand that your letter was not, for reasons at present unclear to me, received in this office at the time of posting.”

Not a good start, but she goes on:

“However, once received by email . . . there were, unfortunately further delays.”

She does not specify what these were, but continues:

“Although there were certain extenuating reasons for these”—

again, she does not say what these were, but it is nice to know there were some reasons—

“this was clearly unacceptable, particularly in circumstances such as Mr Aziz’s.”

The letter goes on to say:

“Please pass my sincere apologies to Mr Aziz for any distress and inconvenience this may have caused.”

Nothing about all the phone calls, nothing about my having to go to the Prime Minister himself, but we will let that pass because at least I had been given a clear and thorough explanation of the case, hadn’t I? Well, not quite. There follow two pages of droning procedural equivocation, but no answer to the basic question: was the treatment right in this exceptional case, and is £5,000 too much for a man’s life?

Instead, I am treated to long passages of tedious linguistic somersaults desperate to pummel me into accepting that, despite all the evidence, this is not an exceptional case. For instance,

“The fact that a treatment is likely to be efficacious for a patient is not, in itself, a basis for an exception”

and

“If a patient’s clinical condition matches the ‘accepted indications’ for a treatment that is not funded, their circumstances are not, by definition, exceptional.”

There is even the most remarkable leap of logic, when Ms Brown says:

“NHS Sutton and Merton was not withdrawing funding as funding had not been approved initially.”

It seems to have been overlooked that this was a letter that would be read by a human being. The letter concludes:

“I hope I have been able to reassure you, and Mr Aziz, that in reaching the decision regarding funding all correct procedures, as used throughout the whole of the NHS South West London area, were followed and done so in a timely manner. Yours sincerely”.

Crikey. Now that I think about it, if there is one thing that has impressed me about my local NHS in this case, it probably has not been its procedures.

A number of issues remain. Professor Madden, who remains one of the most learned doctors in this field, continues to believe that Mr Aziz’s only hope is sildenafil. Professor Madden has once again re-applied for funding. He continues to argue that Mr Aziz’s case really is exceptional, owing to his heart disease, his lung disease, his diabetes, his emphysema, and so on—all his very particular conditions. Mr Aziz did receive the treatment, and it did work. Professor Madden continues to believe that without treatment Mr Aziz would deteriorate, and that the cost of his inevitable hospitalisation would far exceed the cost of the drug. According to Professor Madden, only 4,500 people in the country suffer from pulmonary arterial hypertension, and Mr Aziz’s co-morbidities are extremely rare.

I have no doubt that the NHS receives many requests for Viagra, but this one is truly exceptional. Perhaps the Minister will enlighten me—is it only my local NHS that says £5,000 is too much for one man’s life? Would Mr Aziz have a better chance if he lived somewhere else? Based on my experiences over the past two and a half months, I know whose opinion I trust. Is it that of one of the country’s leading experts in chest conditions or that of the people who lose letters, do not reply to phone calls or e-mails, specialise in extenuating circumstances and do not communicate in human?

Mr Aziz is a good man with an extraordinary medical history: group 2 pulmonary hypertension and group 3 disease, on top of massive cardiac and lung disease. He is a testament to our NHS. However, he needs a drug that most people, if they are honest, think is a bit of a joke: Viagra. He needs it not for recreational purposes, but to stay alive. My local NHS would rather let him suffer than allow him the only drug that works on him. It would cost thousands of pounds a day to look after him in hospital, but they will not provide £5,000 to keep him out. They have behaved appallingly to him and treated me and my office with a basic lack of respect.

We all know that the NHS is facing pressures it has not had to face before, but in this case Viagra is not a sex tablet; it is a life-saver. The medical consensus is clear that in exceptional cases, such as Mr Aziz’s, it should be prescribed. I hope that the Minister will be able to concentrate her reply on this specific point: even though it is for Viagra, is £5,000 really too much to pay for a man’s life? Thank you, Mr Deputy Speaker, for the opportunity to make the case.

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

I congratulate the hon. Member for Mitcham and Morden (Siobhain McDonagh) on securing the debate and on rightly bringing this matter to the House’s attention. I hope that I can offer her, if not the answer to her question, a number of points and perhaps arrange some sort of meeting between her, the local PCT and all those involved in Mr Aziz’s care to establish why he is not receiving the treatment that he and Professor Madden believe he should have. The PCT should be held to account for why it has not provided that treatment. That really is where the problem, if it is a problem, and certainly where the responsibility lies.

The hon. Lady will know that PCTs have been around for some time. One of the reasons why the Government were so keen to introduce the Health and Social Care Act 2012 was to abolish PCTs and have exactly these sorts of commissioning decisions, which have frustrated so many Members on both sides of the Chamber, made by those best placed to make them: clinicians, effectively through GP-led clinical commissioning groups. As a result of the Act, those people will make such decisions in future.

The hon. Lady started her speech with a political point, so I will make a political point as well. We wanted to get rid of PCTs because too often they are overly bureaucratic and they are certainly not accountable. It was our desire to change that by taking the decisions away from bureaucrats and putting them back in the hands of clinicians. That was one of the fundamental underlying reasons why we were so keen to get the Act through this place and on to the statute book. Far from damaging the NHS, and far from denying patients medications and, perhaps most importantly, explanations, the Act will ensure that these types of problems no longer exist.

It is not for me, as Minister for Public Health, or through any other role that falls within my brief in the Department of Health, to make a case for or against the PCT’s decision. Its members will certainly receive a copy of the Hansard report of this debate so that they can read the hon. Lady’s remarks and mine. I understand that there is a chance that they may be watching this debate. If so, no doubt many of them will be hanging their heads in shame. If they are not, then frankly they should be, if the hon. Lady is accurate in her description. I think that she must be, because I too have a copy of the letter from the Sutton and Merton borough teams that she quoted. It seems that they have a profound problem somewhere in their system, because they clearly did not answer her letters or e-mails or respond to her telephone calls. She is the Member of Parliament. This is about her constituents and her local PCT, and if there is anybody they should respond to, it is the Member of Parliament. MPs are the people who come to this place to represent the people in their wards and absolutely to do what she has done, which is to advance the case of Mr Aziz.

For all I know, there may be a very good reason, not just financial but clinical, as to why this particular gentleman should not receive this particular drug—I know not. I know it sounds awful to say it, and I hate saying it, but it is not my job to know. It is not the job of a Minister to say that somebody should or should not receive a treatment. However, it is my job to make it absolutely clear that whoever someone is in the NHS, they should treat that person with care and compassion. That means that they should sit down with somebody like Mr Aziz and explain to him, or perhaps to his elected representative or his general practitioner, the good, solid reasons as to why or why not a particular decision has been made. It is absolutely vital for them to have the courtesy, never mind the care that we would hope for, to do that.

I admit that it might have been late in the day, but I specifically asked my officials to contact NHS South West London to obtain some sort of statement that I could present, because I do not want to do anybody any injustice—Mr Aziz or, indeed, the PCT. Unfortunately, the statement that I have is handwritten and I am having difficulty reading it, so I will not read it out. In fact, it does not tell me anything that I have not already been told.

It is important to explain that the National Institute for Health and Clinical Excellence provides the NHS with evidence-based guidance on the clinical effectiveness and cost-effectiveness of drugs and other technologies. NICE, as an independent body, makes the decisions on whether a particular drug has a clinical or cost-effectiveness basis on which it should be prescribed. Where treatments have been positively appraised by NICE, PCTs are legally obliged to provide funding for them. However, NICE has not issued any guidance to the NHS on the use of sildenafil nitrate for the treatment of pulmonary arterial hypertension. That is the problem. It is because NICE has not given that advice to the NHS that the treatment is at the discretion of the PCT and we are in difficult times. There were difficult times under the previous Administration. There always are, because we do not have a bottomless pot of money, and treatments—often brilliant treatments—increasingly cost huge amounts of money.

[Siobhain McDonagh]

On that precise point, Mr Aziz, who is here listening to this debate, said to me on the way in, “Siobhain, I have paid my taxes for 35 years. I do not want a drug that makes me look better—I want a drug that is going to save my life.”

[Anna Soubry]

I was coming to that in due course.

Apart from making these comments at the Dispatch Box, I cannot advance Mr Aziz’s case, because I do not know his case. I know what the hon. Lady has said, and I know that he has been through, to use these awful words, due process. His application has been considered. Having looked at what the PCT says in its letter, I can see that his case has been through all the sorts of processes that one would expect. I hope and pray that in the course of all that and through the various appeals that he has made, everything has been properly considered by the PCT.

It strikes me, however, that the most obvious thing that should have been done has not been done. Nobody seems to have sat Mr Aziz down—this is not the hon. Lady’s job, because she knows no more than I do—and explained things to him. If there is a good reason, he should be told. If it is about the money, we need to know exactly what the problem is. I suggest that those who may be listening, whether they be in this building or watching on television, should sit down with this man and discuss the way forward for his treatment. They should provide him with an explanation, because he is not just a human being—and it does not matter whether he is a good or a bad man—but one who is extremely ill with a life-threatening disease. Somebody needs to sit down and do a proper job on this, just like the hon. Lady has done in bringing the case to the House.

I despair—we should not have to be here, but we are. The emergence of the clinical commissioning groups will lead, I hope, to a far better system. They will make decisions based on their own knowledge and understanding as clinicians. They will also, in many ways, be far more accountable than primary care trusts have been. Every CCG will have a representative on the upper-tier local authority’s health and wellbeing board. The theory that generated the highly controversial legislation that went through this place is that it would be much better for decisions to be made at a more local and accountable level by those best placed to make them, namely health professionals.

I fear that I have not been able to answer the question asked by the hon. Lady and Mr Aziz, whom I wish well, as we all do. I hope that, as a result of this debate, which the hon. Lady quite rightly called for, people will sit down and not only perhaps have a rethink, but certainly give a human being an explanation, if for no other reason than because, at the end of the day, he pays their wages. On those somewhat positive remarks, I hope that this matter might be concluded to everybody’s advantage.

Accident and Emergency Departments

Siobhain McDonagh Excerpts

Thursday 7th February 2013 Commons Chamber

[David Morris (Morecambe and Lunesdale) (Con)]

Thank you for calling me, Mr Deputy Speaker. My constituents will be paying close attention to this debate.

For some weeks the press in my constituency has been awash with allegations about both maternity and accident and emergency services at our local NHS trust. What concerns me is not that the services will change, but the scare stories surrounding all this. I have received a letter from Jackie Daniels, the chief executive of the trust, confirming that it will not shut the A and E department at Royal Lancaster Infirmary. She wrote:

“‘The A and E at the Royal Lancaster Infirmary serves the population of Lancaster and surrounding areas and treats in the region of 50,000 people each year. Whilst it would be wrong of me to second guess the future, I personally find it hard to imagine Lancaster not having emergency services. Let me be clear, we do not have any plans to shut the Accident and Emergency department in Lancaster.

We are deeply concerned that these continual rumours are undermining confidence and frightening the public. We will continue to work with the public, staff and stakeholders to better understand the review of services to help allay these concerns.”

So the chief executive of the trust has said that not only has she no plans to close the A and E, but she cannot even imagine a scenario in which anyone would close it, not least because it serves 50,000 people a year.

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

May I urge the hon. Gentleman to be careful about this? Most Labour Members face closures of A and E departments that serve twice that number of people.

[David Morris]

I shall come to that in my speech.

A concerted Labour campaign has been mounted by local party members who actually work in the NHS to make people believe that the A and E department is likely to close. The campaign involves press briefings, an online petition, a Facebook group, and even people walking around the centre of Morecambe with clipboards inviting people to join it. I want the e-petition to be removed from Directgov, and I have written to the Cabinet Secretary asking him to intervene. We cannot allow a dishonest campaign to be fought on Directgov e-petition platforms. If the A and E department is not under threat, it must be concluded that people are being frightened for the purpose of political advantage, which, in my view, is morally wrong.

Perhaps it is time to admit the truth: the trust is getting better under the present Government. A new and better management was introduced by the former Secretary of State. Only a few weeks ago, the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter) opened a new minor injuries unit in my constituency. A new health centre in Heysham, costing £20 million, was opened last year, and four new wards have just opened at Lancaster hospital. I pay tribute to my hon. Friend—for he is my hon. Friend outside the Chamber—the Member for Barrow and Furness (John Woodcock) for ensuring that maternity services in Barrow remained secure.

All that was paid for by a 2.8% increase in funding for the NHS under the present Government. This debate is part of a national campaign to scare people into believing that the NHS will be deconstructed.

--- Later in debate ---

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

I join this debate as another Member whose A and E is targeted for closure. My local NHS says it needs to reconfigure services because it has to deliver £370 million of savings each year—a reduction of around 24%, or how much it costs each year to keep St Helier hospital going. A programme has been set up, laughingly called “Better Services, Better Value”, to decide which of four local hospitals—St Helier, St George’s, Kingston or Croydon—should lose its A and E department. That is despite the fact that, across south-west London, the number of people going to A and E is going up by 20%, and that the birth rate in our part of London continues to rise.

Last summer, the bad news came that it would be my local hospital, St Helier, that would lose its A and E, maternity, intensive care unit, children’s unit, renal unit and 390 in-patient beds. To be honest, it has all been a bit of a shambles. NHS South West London was due to rubber-stamp the proposals in July, but the decision was unexpectedly postponed. Then, in September, it proudly press released that a decision was imminent and that the public consultation would start on 1 October. One doctor was quoted as being

“excited by the huge potential of the BSBV programme.”

The decision was put off. I would love to say that it was because of what local residents had to say, but actually it was because of a scathing national clinical advisory team report on the plans, which mocked BSBV’s claim that an astonishing 60% of emergency patients would use primary care instead of A and E, saying:

“The Assumption that 60%...can be managed by clinicians from primary care demands…local analysis. 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.”

What really put a block on the plans was the sudden collapse of another nearby hospital. Epsom hospital has long had financial troubles. In the 1990s, they were so bad that it was forced to merge with the more financially viable St Helier to form the Epsom and St Helier University Hospitals NHS Trust. The merger was never ideal, as Epsom has more in common with other Surrey hospitals than with St Helier. In 2011, it was finally decided that the Epsom and St Helier should de-merge and that Epsom should merge with a hospital in Surrey—Ashford and St Peter’s hospital.

All was going well until last year, when it was revealed that Epsom’s debts were far worse than originally thought. The merger deal with Ashford and St Peter’s collapsed, and Epsom was left out in the cold. This made Surrey panic about what BSBV was planning. After all, if St Helier lost its A and E and Epsom collapsed, there might be no hospital between Tooting and Guildford—so BSBV was put on hold again. In retrospect, that only made matters worse. Instead of closing one A and E out of four hospitals, the local NHS has just decided to close two out of five. That will be catastrophic.

We all know that Epsom, with its MP in the Cabinet and its wealthy population who can afford a judicial review, will put up a big fight, so the consequences for south-west London will be disastrous. There are parallels with what happened in Lewisham. Patients will suffer because of the financial problems of a hospital miles away. We thought things were bleak before; they are even bleaker now. With St Helier singled out for service closures even before this latest development, it is going to be even more difficult for our community than ever before. The argument remains the same, and my local community will not stop arguing. Closing services at St Helier is a false economy, as 200,000 people will have further to go in an emergency.

If things were bad enough even before Epsom’s problems were thrown into the mix, we will now find that an A and E will close, even though A and E visits are due to go up 20% in the next five years, and a maternity unit will close, with thousands of patients giving birth further from home, even though birth rates will go up 10%. Even when just St Helier was under threat, the National Clinical Advisory Team said:

“Successful implementation…depends on a multitude of supporting improvements”

and these

“are not well defined in the proposals.”

It concluded:

“The reconfigurations are based on an optimistic view of capacity”.

Next Monday, I will host a meeting for my local constituents to try to update them about what is going on. Obviously, the fight goes on.

The NHS admits it must save £370 million in my part of London alone. The UK Statistics Authority has made it clear that the Prime Minister has broken his electoral pledge to increase health spending. Demand for A and E is up, and the birth rate is up; but instead of focusing on improving the NHS, this Government have focused on top-down reorganisations. If St Helier goes the way of Lewisham or worse, and loses its A and E and countless other services, my constituents will know why. My constituents are very angry: they know this will not work, and they want to hear from the Minister today that it will be stopped.

--- Later in debate ---

[Mr Gareth Thomas (Harrow West) (Lab/Co-op)]

I greatly enjoyed the speech of the hon. Member for Ealing Central and Acton (Angie Bray) and share many of her sentiments, but I hope she will forgive me for saying that her contribution lacked a sense of regional and national context. Despite the pretence of a national review, to which my hon. Friend the Member for Ealing, Southall (Mr Sharma) alluded, closing substantial numbers of A and E units is clearly now Government policy. Professor Matthew Cooke has been advising the Department of Health on A and E issues—he did so last year, at least. He has spoken to NHS North West London, supporting its plans to close four of our nine A and E departments, and he was reported in the Daily Mail as saying that those plans were in line with national Government policy.

At the 2010 general election, the Conservative party manifesto promised to stop the closure of A and E departments. Indeed, I think the Prime Minister insisted there would be a moratorium to stop further A and E closures. If I remember rightly, during the election campaign the Prime Minister visited Chase Farm A and E department in London and Queen Mary’s A and E department in Sidcup, promising to stop their closure.

[Siobhain McDonagh]

And Kingston, too.

[Mr Thomas]

Yes, and Kingston, too. Both Chase Farm and Queen Mary’s A and E have either closed already or are earmarked for closure this autumn.

My hon. Friend the Member for Ilford South (Mike Gapes) referred to the planned closure of A and E services at King George hospital in Redbridge, and Epsom and St Helier hospital in Sutton, which has also been mentioned, is also set for closure.

We have all heard about the scandal of the events in Lewisham, where doctors do not support the closure of the A and E department, but it is still going to close. I thought the whole point of the recent NHS Act was to give doctors control over service delivery. That has clearly gone out of the window now.

--- Later in debate ---

[Mr Charles Walker (Broxbourne) (Con)]

rose—

[Siobhain McDonagh]

rose—

[Gavin Barwell]

I shall give way to my hon. Friend, because I promised that I would.

[Gavin Barwell]

My hon. Friend has put the case for his local hospital firmly on the record. I do not know the detail and would not want to comment. I shall try to make time to allow the hon. Member for Mitcham and Morden to intervene once I have advanced my argument a little. I referred to her, so it is only fair to give her that opportunity.

The point I am trying to make is that there is a need for balance. Constituents want to be able to access facilities at a local hospital, both from their own point of view and because if they have an extended stay they want friends and relatives to be able to come and visit them easily. There is a balance to be struck between convenience and quality of treatment. For example, my hon. Friend the Member for Banbury (Sir Tony Baldry) referred to someone with a serious aortic problem who was able to go to a hospital with specialist expertise.

Let me make a couple of points about improving the quality of care, which was also touched on in the “Better Services, Better Value” review. One concerns the European working time directive’s impact on the NHS. The review states:

“The implementation of the EWTD has resulted in shorter sessions of work with complex rotas as well as more frequent handovers. Resulting difficulties in maintaining continuity of care can have implications for patient safety.”

The review also contained some powerful findings about the four-hour target, introduced by the previous Government for laudable reasons, which included wanting to monitor the level of care people received. The data for south-west London show that A and E admissions spike between 245 and 260 minutes in all south-west London acute trusts, suggesting that internal standards are aligned solely to the four hours rather than other quality issues.

There are a range of issues relating to A and E in south-west London. I want to say a brief word about Lewisham, but first I shall give the hon. Member for Mitcham and Morden a chance to intervene.

[Siobhain McDonagh]

Last year, 90,000 people turned up at St Helier’s A and E, 26% of whom were admitted to a bed. The idea that we can condescend to 90,000 people and tell them that they turned up in the wrong place is untenable. They are making an entirely rational decision to go to A and E because there is nowhere else to go. The GP out-of-hours service is woeful, its standards are poor and as long as there are no alternatives, people will continue to go to A and E whatever the hon. Gentleman says or does.

[Gavin Barwell]

I am grateful to the hon. Lady for that point. She said earlier that “Better Services, Better Value” talked about a figure of 60%, but she was actually misleading the House—unintentionally, I am sure—as the report specifically rejects that. It states that

“there is no firm evidence”

to support the Healthcare for London figure. It conducted a local study across south-west London that found that 48% of all activity was coded as minor and that 40% of patients were discharged with no follow-up treatment required. The conclusion was that they could be dealt with in an urgent care centre, which could be attached to the A and E. That would mean we could ensure the provision was available to deal with such cases.

Let me comment briefly on Lewisham. I listened with great sympathy to the arguments made by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock) and the hon. Member for Lewisham West and Penge (Jim Dowd), who is no longer in the Chamber. I have constituents who work at Lewisham hospital and feel very angry, as the right hon. Lady does, about what has happened there. Let me make one point, which I tried to make to the hon. Gentleman in an intervention: we have a national health service and as a consequence when things go wrong in a neighbouring area it has a knock-on effect.

health

Siobhain McDonagh Excerpts

Tuesday 18th September 2012 Commons Chamber

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

My local NHS says that it needs to reconfigure services because it has

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

As a result, it plans, through a programme ironically called “Better Services Better Value”, to close a wide range of services at my constituency’s local hospital, St Helier. Most of the controversy has focused on the closure of our A and E and maternity units, but we also face losing our intensive care unit, neonatal ICU and renal unit, as well as about 50% of St Helier’s 390 in- patient beds.

Since I last raised this subject in the House in July, a number of interesting things have happened. First, the right hon. Member for Sutton and Cheam (Paul Burstow)—whose constituency, like mine, is on the borders of St Helier—lost his job as a Health Minister and launched a withering attack on the plans, describing them as “dangerous and flawed”. As a Minister in the Department for Health, he would know; although I imagine that he wanted to stay and to continue to be collectively responsible for St Heller’s demise.

Then the right hon. Member for Carshalton and Wallington (Tom Brake), whose constituency contains St Helier, decided that he was so upset about the plans that he would take a principled stand by joining the Government as deputy to the man who is responsible for what has happened in the NHS over the past two years. Congratulations are due to him for showing his disapproval so strongly.

Ten days ago, Michelle Baker and Karen Russell, mums from my constituency and part of the Save St Helier campaign, organised a picnic with a purpose outside the hospital. Thousands of local residents joined in, and although it was billed as a fun day, we were deadly serious. The leader of Merton council, Councillor Stephen Alambritis, a former football referee, was cheered as he brandished a red card at the plans, while the medical director of “Better Services Better Value” was booed as he was handed our petition, signed by more than 30,000 people.

In other developments, it is becoming increasingly clear that, behind the scenes, the case for the closure is falling apart. NHS South West London was originally due to rubber-stamp the proposals in July, but the decision was unexpectedly postponed at the last minute. Then, last month, the team proudly issued a press release stating that a decision would be made on 27 September and that

“the aim is for it to go out to public consultation from 1 October”.

Dr Finch said that he was

“excited by the huge potential of the BSBV programme.”

Now even that decision has been put off for at least another month. Perhaps the delay is connected to polls of GPs and patients that showed that a majority were against the closure, but I suspect that that it is mainly due to the publication of the National Clinical Advisory Team’s report on the plans.

NCAT reports represent a key step in any hospital reconfiguration and need to be properly scrutinised, so on 17 July I requested a copy of the report under the Freedom of Information Act. Under FOI rules, I should have received a copy by 14 August, but it was not until a week later that I received one, along with a press release claiming that NCAT had

“given the Better Services Better Value review the green light to move forward”,

and that

“we are very pleased that the NCAT team have agreed that our proposals should be supported”.

However, although the press release gave the impression that everything was running smoothly, that impression was extremely misleading.

The most fundamental criticism of the closure plan is that it is predicated on the assumption that 60%—yes, 60%—of emergency patients can use primary care instead of A and E services. Obviously, it is very much in GPs’ interests for BSBV to succeed. It is led by local GPs, and they clearly have an interest in ensuring that more patients use primary care rather than hospitals, whether or not that is what patients want, because the money follows the patient.

NCAT has looked at the 60% target and, ever so politely, has laughed it off. The report says:

“The assumption that 60% of ED”—

emergency department—

“patients have conditions that can be managed by clinicians from primary care demands detailed… analysis. Elsewhere in the UK a consistent finding is…far lower, usually in the order of 15-20%. Reconfiguration based on the higher figure may not achieve the anticipated benefits.”

NCAT goes on to say:

“The ED consultants interviewed suggested that the primary care workload in their departments is in the order of 15-20%”

and that

“The estimate of 60% is often derived from coding data...patients who have no x-rays, no specific treatment, no follow up and are not admitted are regarded as ‘minor’ and therefore it is assumed that they could be seen by primary care clinicians. It is recognised throughout the NHS and particularly in emergency care, that such data lack reliability”.

The report also questions the assumptions behind the proposal that St Helier could be saved by becoming South West London’s elective hospital. It is hard to see why any patient would choose to travel so many miles from Croydon, Wandsworth or Kingston to a hospital that had lost so many services, to receive treatment that they could receive at their local hospitals, or why any ambitious staff member would want to work there.

NCAT says:

“The concept of a planned in-patient care or elective hospital serving the whole area was generally supported”

by clinicians. It continues:

“However there was no evidence that this would free enough in-hospital capacity to absorb the additional acute workload for the remaining three hospitals.”

The report adds:

“There was concern that the links between acute medical services and the community were not dependable.”

NCAT admits that, although most experts consider it a bad thing for maternity units to deliver more than 6,000 babies a year, South West London’s three remaining maternity units would have to deliver 6,500 babies each—in addition to the 2,500 babies delivered in midwife units and the 880 delivered at home.

NCAT concludes:

“Successful implementation…depends on a multitude of supporting improvements in primary care, community services and professional practice that are not well defined in the proposals.”

Worse, it admits:

“The reconfigurations are based on an optimistic view of capacity, recruitment, meeting increased demand in primary and community care and the challenges posed by the introduction of new ways of working.”

I could go on and on.

On the basis of such optimism, 200,000 people will have to make longer journeys to hospital in an emergency. An A and E department will close, although the number of A and E visits will rise by 20% in the next five years. Tens of thousands of women will have to worry about how they will give birth at hospitals further from home, and a maternity unit will close, although the number of births will rise by 10%. Thanks to the combination of cuts and GP commissioning, a flawed decision to close St Helier is about to happen. It will not work, and it must be stopped.

Health

Siobhain McDonagh Excerpts

Tuesday 17th July 2012 Commons Chamber

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

In south-west London, the NHS has just proposed to close the A and E, maternity unit and various other services at my local hospital, St Helier. It will take 200,000 people longer to get to hospital in an emergency. On its website, outlining why it is doing this, NHS South West London states that providers

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

Yet thanks to birth rates, an ageing population and poor health due to poverty, A and E visits will go up 20% in five years and births will increase by 10%. The area’s four hospitals are overcrowded now, so let us try cramming the same number of patients into just three.

What is worse is that there is no extra funding for the hospitals that remain. In no way do I support the hospital closures in north London, but at least that area gets an extra £138 million for “out of hospital” care to cope with the closures. Down in south-west London, we will get nothing. If St Helier loses its A and E, visits to the remaining three hospitals will rise by a third. Many will have to be admitted, but, with no extra funding, where can they go? Will they go on to the corridors, as in the 1990s?

It is claimed that 50% of A and E patients will go to GPs or community services instead, but even the report by the watchdog, the national clinical advisory team, does not believe that they could cope. That is a key paper and no cuts should take place without the public knowing what the watchdog thinks, so it should be published immediately. NCAT is right to be sceptical about whether GPs can halve the numbers going to A and E. Clinical commissioning obviously makes that very attractive for GPs, but for most people in my constituency it is easier to go to a walk-in centre or A and E than to a GP, so A and E visits have continued to rise year after year. The fact that GPs, who are making all the financial decisions, will get more funding if there are fewer A and E visits, does not mean that people will stop going. Apparently, some GPs now realise that those plans are looking very dodgy. A poll of Sutton’s GPs has shown a majority against the closure and a similar poll is taking place of Merton’s GPs that will, I am sure, show the same.

It is not just St Helier’s A and E that is under threat—so is its maternity unit. However, of the four hospitals, St Helier has the only maternity unit that meets clinical standards. If we lose St Helier, the other three hospitals will need to deliver a third more babies than they do now. It is widely accepted that maternity units delivering more than 6,000 births a year are a bad thing. It is far better, and far safer, to have slightly smaller units with good midwife cover, but not in south-west London, it seems.

We will lose our children’s unit and other services, such as intensive care. The “Better Services Better Value” review states that, to compensate, GPs will force patients from all around south-west London to go to St Helier for minor, planned treatments, but who would want an operation, even a routine one, in a hospital as depleted as St Helier? What is more, making people in St Helier drive across the suburbs for A and E and maternity and making people drive to St Helier for routine operations will add literally millions of miles of journeys to our already congested roads. No, the impact of that is not considered.

The other obvious questions have not been asked. Why would a patient from Kingston want to drive the best part of an hour to St Helier for a treatment they can currently get in Kingston? The other three hospitals do not like the idea either, as they cannot afford to lose the income from those planned treatments.

These plans are all over the place; they are a total shambles. Next Thursday, NHS South West London was due to rubber-stamp St Helier’s closures. It booked a big theatre in Croydon in readiness, but now it has put the decision off. Good, but this is obviously not the end. St Helier has been under threat before, but now it is under threat again from a combination of cuts and GP commissioning. The demands on our four hospitals are growing, not shrinking. I hope the Minister will reassure me, and my constituents, that that disaster will not happen on his watch.

--- Later in debate ---

[Mr Burns]

I think I can assure my hon. Friend that the IRP will have available to it all the evidence, in all shapes and forms, to help it to form its final opinion of the complaint referred to it. I hope that that reassures him. I say to my hon. Friend the Member for Loughborough and the hon. Member for Leicester South that the same can apply with regard to the decision about ECMO. I have no doubt that Leicester city council will give consideration to that.

I shall briefly respond to the remaining issues. My hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) made several extremely interesting suggestions. Some of them might not be in line with current Government thinking, but I shall certainly refer her ideas and views to the Under-Secretary of State for Health, my hon. Friend the Member for Guildford (Anne Milton), who deals with our alcohol strategy. Similarly, my hon. Friend the Member for South West Bedfordshire (Andrew Selous) raised an important issue, and again I will refer it to the Under-Secretary of State.

The hon. Member for Mitcham and Morden (Siobhain McDonagh) mentioned the potential reconfiguration at St Helier hospital. As she will know, the proposals are still being worked on. There has not yet been a consultation process, but the decisions have been taken locally by the local NHS. I trust that, if and when there is a consultation process, she will get involved.

[Siobhain McDonagh]

Absolutely.

[Mr Burns]

I thought she would say that. That is very good. After the consultation, the due processes of reconfiguration can move forward.

My hon. Friend the Member for Hendon (Dr Offord) asked about Avastin. A study is being done into its effects. We are following that closely, and when we find out more we will consider the matter and potentially reach a judgment, but I cannot give him any commitments at the moment.

Finally, I turn to my constituency neighbour, my hon. Friend the Member for Witham (Priti Patel). I am sorry to hear about the problems that she highlighted on behalf of her constituents. I do not want to disappoint her, because she is my neighbour and I have to live with her on a weekly basis, but given the background to the case, I think it is a matter for the GP practice as the employer of the GP whom she mentioned. I encourage her to engage with Mid Essex PCT, even though it has no direct powers or role in this matter, and the clinical commissioning group in the mid-Essex area, because they are best placed to address the concerns about the provision of services for her constituents, which I know she is fearless in defending, protecting and promoting.

NHS Risk Register

Siobhain McDonagh Excerpts

Wednesday 22nd February 2012 Commons Chamber

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

I wish to share with the House a cautionary tale and to suggest that the publication of the risk register might be in the best interests of all hon. Members and all parties, because it will allow us to stand back and look at the consequences of the changes.

The London experience—certainly the south London experience—is that the changes will lead to a wholesale closure of general hospitals in urban settings because they confuse the roles of providers and commissioners of services. I am in a fortunate position. After 13 years of argument, one of the last acts of the previous Labour Government was to agree to spend £219 million on the rebuilding of St Helier hospital. Thankfully, the current Government agreed those plans—it was one of only three capital programmes of its size in the country.

St George’s hospital in Tooting, which is known to many, was to merge with St Helier to make St Helier large enough to become a foundation hospital. After those years of argument, the programme was going well until St George’s hospital looked at the GP commissioning plans in my area, which suggested that they would reduce services at St Helier hospital by £40 million over the next five years. St George’s, the only hospital interested in merging with St Helier, backed away immediately, because it knew it could not make the figures stack up.

We now have a £219 million capital programme for a hospital that, as it stands, is completely unviable. I should not be admitting that to the Government because they might think that they do not want to spend that money. I want them to spend it, but I want them to spend it on a viable hospital, because the demand and the need are there.

I can understand why GPs, who are private practitioners, want to provide more services. My argument is in favour of the consumer—the patient. Patients might not want to get up every morning to try and make a GP appointment and not get in that day. They might not want or be able to take a day out of their working lives or sustain the consequences of doing so to get a GP appointment. They might not want to wait a fortnight for a blood test, as I am doing. They might choose to go to their local hospital for that service. I believe it is the right of NHS patients to make those choices, but they are the choices that we will deny to people if the Health and Social Care Bill is passed, because it imposes a 19th century health model on the 21st century. Our experience in London is that walk-in clinics provide for many, but not for everybody, better services than GPs.

We have heard about the relationship between the patient and the GP. In south-west London, people are grateful to see any doctor when they go to the GP service. That relationship does not exist. I appreciate that the experience of people in market towns outside London might be entirely different, but from a London perspective, the changes will have an enormous impact on patients, including the most disadvantaged patients who live in our capital city. As a consequence, enormous numbers of hospitals in suburban areas will face reductions and closure. MPs of all parties must consider whether that is what they want. It is beginning to happen. On a BBC regional programme recently, the medical director of NHS North West London said, quite openly, “Yes, we will see the closure of many hospitals.” Is that what we want? Are we prepared to support that? Is it in the best interests of our constituents? I do not believe so.

Diabetes (Young People)

Siobhain McDonagh Excerpts

Wednesday 15th September 2010 Westminster Hall

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

I can assure you, Mrs Riordan, that I will not speak for that long.

I want to highlight the impact that diabetes, like all chronic conditions, has on not only the individual, but their family, friends and community. That is particularly relevant, given the age at which people are being diagnosed with type 1 diabetes and the huge increase in the number of children who are diagnosed with it. About 25,000 children in the UK have type 1 diabetes. Some 98.6% of children and young people with diabetes have type 1. The incidence of type 1 diabetes increases by about 4% each year. The biggest increase is in children under the age of five, among whom there has been a fivefold increase in the past 20 years.

When children are diagnosed with diabetes, it has a profound effect on their families. The parent group, Children with Diabetes, did a survey of parents, in which 85% said that their household income had gone down; 83% said that they had problems with their marriage and family life; 84% said that their child’s treatment was affected by where they lived; 71% said that they were concerned about long-term complications; 60% said that their children were most worried about being seen as different, as the hon. Member for Torbay (Mr Sanders) said; and 50% reported that their children had been bullied at school as a result of suffering from type 1 diabetes.

My right hon. Friend the Member for Knowsley (Mr Howarth) asked me to contribute to the debate because of its importance to him as an individual. That made me think about constituents I have seen and the problems that they have had. My hairdresser, who is a very important person in my life, told me that his niece, Sophia, was diagnosed with type 1 diabetes at the age of five. There was no history of diabetes in the family. The family spent ages completely terrified, wondering what the problem with their young daughter was, only to find that she had type 1 diabetes. Her mother, Nicole, tells me that she came home on the day of diagnosis with a load of equipment, not knowing what to do or understanding the consequences. She knew that she had to give up her employment, because she could not control the diabetes and did not know the consequences for her daughter. Her husband had to accept the fact that, unlike other married couples, they could not leave their daughter with other people, because those others were frightened about knowing how to care for her. Nicole was concerned about just not knowing how the family would approach routine family life, celebrations, festivals and even Christmas.

Nicole told me today that the single thing that was of benefit to her was the recently set up parent group at St. George’s hospital in Tooting. The scales fell from her eyes as the clinical paediatric nurse, Richard Todd, told her how she could cope with Christmas—all the food and treats of the period—and how she could have access as a carer to discount cards, which no one had told her about in the past, although her daughter has had type 1 diabetes for seven years. She could also just meet other families and mums, and discuss the consequences, for them and their family, of their children’s diabetes. If there is anything I would ask the Minister to do, it is to consider the fact that St. George’s will not carry on the parent support service, because it does not feel able to keep Mr Todd’s services. I am sure that there are many demands on the hospital, but that parent group—just from one parent’s perspective—had an enormous impact.

The other time when a problem begins to arise in a family’s life is when children transfer from primary to secondary school. While having a pacemaker, or another condition, might affect a child’s school preference place, despite having type 1 diabetes Sophia did not obtain a school place in the Minister’s constituency, although her mum and dad wanted her to go to school there so that they could be close at hand if anything happened and so that all the burden would not fall on the school. At the school, in turn, there was a fear about having Sophia there. Of course, with the transfer to secondary school the issue of puberty comes into play, with its impact on the treatment of type 1 diabetes, and the need to understand whether mood changes result from the illness or the normal changes that any teenager goes through.

Having a child with type 1 diabetes can also have a financial impact. I know from other families who have been to see me that that can involve simple things such as school uniforms. One mum who came to see me bought the uniform for her daughter who was going to secondary school, only for her to be diagnosed with the condition over the summer holidays; in that period she lost two or three dress sizes. Apart from the sheer fear that that must have created, the financial impact for a single mum on benefit is huge. There are implications for all the things that we would want to happen: getting mums back into work; flexible working; the need to work close to home; and the need for the wider family to understand things. I am sure that that is only a small and perhaps secondary consideration, but in the treatment of this chronic disorder, diagnosed in children so young, it has a huge impact for the wider family. The soft services of parent groups, which might be seen as less important in times of financial restraint, are crucial in enabling parents to understand the difficulties and problems, and in preventing some of the problems that other families have probably been through.