Oral Answers to Questions
Stephen McPartland Excerpts(4 years, 6 months ago)
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Edward Argar
The hon. Gentleman will be pleased to hear that that is exactly what we have done with the health infrastructure plan, which involves multi-year capital funding settlements and investment in our hospitals. I am happy to discuss separately the specific example he raises.
Stephen McPartland (Stevenage) (Con)
There are more than 1.5 million people in Hertfordshire and Bedfordshire, and they have no access to a radiotherapy facility in either county. Will the Minister agree to bring cancer care closer to people’s homes and join the campaign to establish a satellite radiotherapy unit in Stevenage?
Edward Argar
My hon. Friend is a strong local champion for his constituents in Stevenage, particularly on that issue, in which he is joined by my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald), who is sitting next to him. He is right to highlight the importance of easy access to such facilities. I am happy to meet him and my right hon. and learned Friend to discuss that.
Health Inequalities
Stephen McPartland Excerpts(5 years, 1 month ago)
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Lucy Allan (Telford) (Con)
I beg to move,
That this House has considered legal duties on the Secretary of State to reduce health inequalities.
It is a pleasure to serve under your chairmanship, Mr Hollobone, and I am delighted to have secured this debate and to raise this important issue.
In 2016, the Health Committee Chair, the hon. Member for Totnes (Dr Wollaston), led a thoughtful and important debate on this issue, noting that in the Prime Minister’s first speech in No. 10 Downing Street she had put reducing health inequalities at the top of her list of priorities. But July 2016 is now a very long time ago, and since that date we have heard a great deal less about that injustice. During that time, inequality of health outcomes between those in affluent areas and those in areas of deprivation has persisted.
That injustice has been obscured by improvements in overall health outcomes—and, of course, by all the other business that has been going on in this place and distracting us from the reasons that so many of us came to Parliament. As the Government unveil the NHS 10-year plan, it is right that we make a conscious effort to revisit the question of health inequalities. I want to do so in particular because I can see unequal health spending by local clinical commissioners in my area. While decision-makers may pay lip service to tackling health inequalities, it is not the driver that it is meant to be under the law.
Of course, the primary causes of health inequalities are complex and varied, from unemployment to poor housing. While no one would suggest that healthcare spending is the answer, we must ensure that all healthcare decision-makers understand their duties and the importance of their obligation to provide access for, and direct spending toward, those most in need. Healthcare spending is the one part of the mix that Government can control, and it is right to expect healthcare spending to be focused on tackling both unequal health outcomes and unequal access to healthcare.
The allocation of funding to local commissioners, which the Minister will probably touch on, rightly includes an adjustment for health inequalities based on the mortality rate. An area with a higher mortality rate, such as my borough of Telford and Wrekin, will get more funding per head than an area with a lower mortality rate, such as neighbouring Shropshire, but that is not the end of the matter, particularly when it comes to major hospital reconfigurations, which are happening in so many places across the country.
While funding may be allocated to separate clinical commissioning groups on the basis of need, when it comes to a major reconfiguration, CCGs will group together to form a joint CCG, bringing widely disparate areas under their umbrella. The funding and resource decisions are then made by the joint CCG, without considering health inequalities between those disparate areas. That is exactly what is happening in my area.
Telford is a post-war new town, created on the east Shropshire coalfield, and it has areas that are among the most deprived in the country. It has, by every measure, significantly worse health outcomes than Shropshire, a county that has better health outcomes than the national average, and significantly better outcomes than Telford, by almost every indicator.
We are experiencing just such a hospital reconfiguration. Telford and Shropshire have combined, and funding for hospital care is allocated to the area as a whole. What we have seen is a joint CCG, representing those disparate areas, deciding to direct the bulk of its funding to the more affluent area, and to move existing resources there from an area of deprivation. That is a clear failure of the duty to narrow health inequalities.
The national health service database has the figures there for all to see. When it comes to health outcomes, Telford and Shropshire are at different ends of the spectrum. For someone living in Telford, the premature mortality rate is 25% higher than for a person living in Shropshire. Children in Telford are far more likely to suffer from obesity or to be hospitalised for dental decay. Tragically, rates of suicide and cancer in Telford are significantly higher than in Shropshire. Smoking rates, inactivity in adults and other such indicators show the very same disparity. The truth is that a shire town in rural England is healthier than a new town built in a former mining area on the east Shropshire coalfield, and NHS spending allocations are required to recognise that greater need. It is that simple—yet in practice, that is not what is happening.
The Health and Social Care Act 2012 makes it clear that there is a requirement to move towards greater investment where levels of deprivation are higher. Under the Act, that is a legal duty on the Secretary of State, NHS England and CCGs. The guidance makes it clear that inequalities
“must be properly and seriously taken into account when making decisions”.
As a former non-executive director of an NHS trust, I know that the NHS constitution requires the NHS to pay attention to sections of society where improvement in health and life expectancy do not keep pace with that in the rest of the population.
It is not enough for the Government or NHS England to hand over the cash to a joint CCG and then say, “Job done,” as far the health inequality duty is concerned. CCGs also have a duty to narrow health inequalities and, if they are not complying—as in my area they are not—I ask the Minister how we can hold them to account. What steps can be taken to enforce that requirement?
This is happening not only in Telford. Across the country, from Lewisham to Huddersfield, the NHS is carrying out controversial restructurings of hospital care similar to the one in Telford, where funding and resources are being targeted toward a single area. If what is happening in Telford is happening elsewhere, decision-makers are ignoring their duties to address inequalities—or maybe they are merely paying lip service to them. It is all very well to commit to narrowing health inequalities, but that commitment is manifested only on a spreadsheet when we do our allocations to CCGs; it is not happening in practice when it comes to spending that allocation of funding.
Stephen McPartland (Stevenage) (Con)
I am grateful to my hon. Friend for securing this important debate. In my area, East and North Hertfordshire CCG is being forced to merge its management and executive teams, but so that it does not have to consult with local people, it is going to keep three separate boards. As a result, we are concerned about how decisions will be taken going forward and, although the spending will be going to the three separate CCGs on paper, in reality one committee will be making those decisions and getting the boards to ratify them. The concerns she is raising in her area are repeated around the country.
Lucy Allan
I thank my hon. Friend for his intervention, and I am aware of the position he sets out. He is absolutely right; these problems are happening elsewhere with the combination of CCGs coming together and not being able to meet the needs of the individual areas that are receiving the funding.
In Telford, the local hospital trust serving both Telford and Shropshire announced in January, after five years of bizarrely convoluted and contorted deliberation, that it was pleased to announce its investment of a total pot of £312 million in a state-of-the-art critical care unit in the leafy, affluent shire town of Shrewsbury in Shropshire, 19 miles from Telford. In addition, the trust announced that it was pleased to say it would transfer Telford’s women and children’s unit and emergency care from Telford to Shropshire.
I have repeatedly asked the revolving door of hospital management over the past five years to explain how that proposal narrows health inequalities, how that decision improves the health outcomes of the most disadvantaged groups in the area they serve and how it improves health access for the most disadvantaged group if it is moving their provision 19 miles from its current location.
The response to my questions over a significant period has been to take no notice whatever. As an MP I have found, and I know from talking to them that many colleagues have also found, that local hospital trusts and CCGs feel no obligation whatever to respond to or even take notice of elected representatives. Indeed, my right hon. Friend the Member for Hemel Hempstead (Sir Mike Penning) noted in this place just last week, in an excellent debate on his local trust, that he had “absolutely no influence” on any decisions made by the CCG in his area.
As the Shrewsbury and Telford trust felt no obligation to respond to questions on this incredibly important issue, I asked the then Secretary of State if he could seek a response on my behalf. However, even that did not bring so much as an acknowledgement that reducing health inequalities is an important issue for the hospital trust or the CCG when making spending decisions.
The trust seems to feel entirely unaccountable to anyone. The Department of Health and Social Care says that it is accountable to NHS England, and NHS England says that the trust board is accountable to the trust chairman. In reality, there is no accountability. This subject has been raised with me over and over again by local residents who strongly oppose this reallocation of funding from a disadvantaged area to a more advantaged area.
Oral Answers to Questions
Stephen McPartland Excerpts(6 years, 1 month ago)
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Caroline Dinenage
First, I pay tribute to my hon. Friend for the sterling work he does as co-chair of the all-party group on dementia. He is absolutely right to say that Admiral Nurses do fantastic work in many parts of the country, helping people with dementia to maintain their independence, and improve their quality of life and that of their families. I very much support all the fundraising activities going on in his local area.
Stephen McPartland (Stevenage) (Con)
The Parliamentary Under-Secretary of State for Health (Steve Brine)
NHS England is working with the East and North Hertfordshire NHS Trust to determine the best way to deliver radiotherapy services to patients in Stevenage. This is part of a system-wide NHS England review of the way in which radiotherapy services are delivered.
Stephen McPartland
Hertfordshire has more than 1 million people and no radiotherapy provision. My constituents have to travel more than 80 miles for every treatment, which means thousands of miles during the course of their treatment—there is no public transport. My right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) and I have run this campaign for a number of years, and we have all the agreements from every part of the NHS. We are meeting the board of the trust on Friday, so will the Minister give them a direction to get on with building the facility?
Steve Brine
All trusts have been directed to get on with the review. The NHS England specialised commissioning team is in discussions with my hon. Friend’s local trust as it develops its five-year strategic plan for the cancer pathways. It is working with his local cancer alliance, including radiotherapy services. It is recognised that a more radical approach and a broader review of the radiotherapy options may be required in future. As my hon. Friend says, he and my right hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) have that meeting later this week, and I hope the discussions are productive. I feel sure that my hon. Friend will come back to me if they are not.
Health
Stephen McPartland Excerpts(6 years, 6 months ago)
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Stephen McPartland (Stevenage) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
Today is World Mental Health Day and the whole House will want to congratulate Time2Change on its 10th anniversary and the remarkable change in attitudes towards mental illness that it has helped to bring about. Our mental health workforce has increased by 30,000 since 2010 and another 21,000 posts are planned.
Oral Answers to Questions
Stephen McPartland Excerpts(6 years, 6 months ago)
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Stephen McPartland (Stevenage) (Con)
The Secretary of State for Health (Mr Jeremy Hunt)
Today is World Mental Health Day and the whole House will want to congratulate Time2Change on its 10th anniversary and the remarkable change in attitudes towards mental illness that it has helped to bring about. Our mental health workforce has increased by 30,000 since 2010 and another 21,000 posts are planned. [Official Report, 16 October 2017, Vol. 629, c. 4MC.]
Stephen McPartland
On World Mental Health Day, I congratulate the Secretary of State on the work he has done, especially for children. We have had 42% more children receiving care for eating disorders and over 21,000 more children have received access to mental health provision. What targets does the Secretary of State have to help to improve such provision?
Mental Health Taskforce
Stephen McPartland Excerpts(8 years, 2 months ago)
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Alistair Burt
It is already in the works. Okay, thank you. Let me say a couple of things with regard to specialist care. First, even though we want most young people to have access to care close to home, there will always be some specialist care that will require out-of-area treatment—perhaps those are the circumstances to which the hon. Lady is referring. It is then a question of getting the place.
That issue emphasises why it is so important to have the community care available. We need to be able to discharge patients and put in place a proper care package. That is precisely what the taskforce considered and made recommendations on. That work is already ongoing. As my time in office has shown me, there are variations in practice in different places. Discharges are handled better in some areas than in others. The practice of the best must become the practice for all. Everything must be done to ensure that people are treated in the appropriate place at the appropriate time, and keeping people in hospital unnecessarily is not what anyone wants. That work is already going on, and I will make sure that the hon. Lady gets an answer to her particular question.
Stephen McPartland (Stevenage) (Con)
I welcome the Minister’s personal commitment to this issue and the Government’s investment in this area, which demonstrates the importance of mental health issues alongside physical health in the NHS. Will the Minister clarify how he will hold the NHS to account so that the money is spent on additional mental health services as opposed to just being frittered away?
Alistair Burt
The engagement of the NHS with the taskforce needs to be recognised and emphasised. The NHS set up the taskforce because it wanted to be clear about the state of mental health services and take a five-year forward view. That is what the taskforce does, but it goes beyond that to say that it has a 10-year vision, which I welcome. Not everything can be done in neat, parliamentary-cycle chunks, so it is important that people have a continuing sense of commitment. The certainty that my hon. Friend wants is demonstrated by the involvement of the NHS, the endorsement of the recommendation by the chief executive, and the work on transparency, which is important to us, to make sure that we can all see where money has been spent. That should hold clinical commissioning groups and the NHS to account on the expenditure issue.
Radiotherapy Services (North East Hertfordshire)
Stephen McPartland Excerpts(9 years, 2 months ago)
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Sir Oliver Heald
I totally agree with my right hon. Friend. There are many arguments for the change. One patient from east Hertfordshire, who is a constituent of mine, said:
“Being diagnosed with cancer is devastating for the person and the family and to discover that part of the treatment involves regular journeys to north London just adds to the stress that family is undergoing.”
Another aspect to consider is patients with children. One constituent wrote to me about her daughter, who is in her 30s and has three children. She needs radiotherapy at Mount Vernon and will have to find someone to travel with her and someone to look after her children on a daily basis for three weeks. Her mother says:
“This all adds to the stress of having to deal with cancer, especially at such a young age.”
She ends her letter to me:
“Here’s hoping we are successful in making someone see sense.”
Stephen McPartland (Stevenage) (Con)
I congratulate my hon. and learned Friend on securing this debate, which is important to my constituents in Stevenage. He and I have secured the support of the local newspaper, The Comet, and have run a petition over a number of years to improve radiotherapy access. We have dealt with thousands of people. There is no public transport available for them to get from Stevenage in north-east Hertfordshire to Hillingdon in London, so they are very much stuck with having to have private vehicles and people to support them.
Sir Oliver Heald
That is very much the nub of the issue: there is no alternative to the car or the bus, and the bus takes a day to take patients and bring them back.
The NHS is currently mapping the country to find areas where it takes more than 45 minutes by car to reach radiotherapy, in order to assess pressing need for new and satellite centres. My hon. Friend and I have been in contact with Kim Fell of NHS England about this issue. We have arranged to meet her, Ruth Derrett, who is the head of specialised services, Dr Adrian Crellin, who is the radiotherapy clinical reference group chair, and Pam Evans of the specialised commissioning team, because they think that the journey from our area takes less than 45 minutes.
We have been told that, as part of the review, the National Clinical Analysis and Specialised Applications Team has produced a map that shows the 45-minute position across our area. Apparently, the map shows that only a small proportion of the population of Stevenage travels more than 45 minutes for treatment, and questions have been asked about whether that would generate sufficient activity for the satellite service that we are asking for.
The methodology used is clearly flawed, so we are pressing on the 45 minute figure. Even if one ignores the heavy traffic congestion in our area—my hon. Friend the Member for Stevenage and I have been campaigning for some years to widen the A1(M) between Stevenage and Welwyn because it is so congested, and we have recently got about £100 million for it—the AA, the RAC and everyone who does that journey all say that it takes longer than 45 minutes. The senior management at the trust that runs both hospitals, East and North Hertfordshire NHS Trust, allows one hour 15 minutes each way for the journey. I have done the journey only once, and it took me two hours in the rush hour. I have offered to do the drive seven times at different times of the day using the three possible routes and to report the findings to NHS England. I am waiting to hear whether it considers that to be a satisfactory methodology. My hon. Friend the Member for Stevenage and I have suggested that the key officials might like to come with us on the journey one morning at the same time as the bus, so that they can see the challenge to the 45 minute figure.
I am arguing that Mount Vernon hospital should put a satellite radiotherapy centre at the Lister hospital. We like the Mount Vernon hospital—the treatment there is excellent—so we would like it to use its staff and machines at the Lister. The machines that they use do need to be replaced from time to time, and there are currently eight of them. I am told that fairly soon an opportunity will arise when two need to be replaced. The new machines should be sited at the Lister hospital. That would leave six at Hillingdon and allow Mount Vernon to offer its expertise to an even wider area, thereby securing its position as a cancer centre. It would be able to offer services to a larger group in Bedfordshire, for example, than it currently can. That would benefit the status of Mount Vernon hospital as well as helping the patients.
The Lister hospital has recently benefited from the opening of the wonderful Macmillan cancer care centre on its site. Radiotherapy would greatly improve the support and care available to people in our area. Patients and their relatives strongly support the idea of the move, which has been described to me as “wonderful”. Another person wrote to me to say:
“It would be fabulous to have the device at Lister. It makes sense as we have just opened a great cancer chemotherapy unit”.
I hope that the Minister might intercede on our behalf with NHS England so that our case can be properly considered. The idea that it takes 45 minutes or less from our area to Mount Vernon must be reconsidered. It is time for a satellite radiotherapy centre at the Lister, but we need help to make it happen. I intend to present a petition to Parliament in March. We already have hundreds of signatures, and it can be downloaded from my website: www.oliverheald.com. I will present it on the Floor of the House. My right hon. and hon. Friends, our constituents and I feel strongly that it is time for the change to be made. It is time that those endless journeys, hour after hour, day after day, ended.
The Parliamentary Under-Secretary of State for Health (Jane Ellison)
I congratulate my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) on securing this debate on, as he pointed out, a very apt day: world cancer day. I am still getting used to the idea of the MPs’ road trip that he appears to be planning for himself, my right hon. Friend the Member for North East Bedfordshire (Alistair Burt) and my hon. Friend the Member for Stevenage (Stephen McPartland). I will come on to address the issue of access, but that certainly sounds like an offer that no one could refuse.
Stephen McPartland
NHS England has refused us on several occasions. We keep pushing, so we would be grateful if the Minister could persuade it to accept the offer to embark on our road trip.
Jane Ellison
I will certainly draw NHS England’s attention to the force with which the invitation was put in this debate.
Let me say a few words about the bigger picture on cancer before we go into the detail in the contribution by my hon. and learned Friend the Member for North East Hertfordshire. The Government are committed to improving cancer outcomes and matching the best in Europe. As Members are aware, we do not match the best in Europe; we were certainly lagging behind some important countries when the Government came to office in 2010.
The 2011 strategy, which was backed by £750 million, set the ambition of saving an additional 5,000 lives a year. We believe that we are on track to save an additional 12,000 lives a year, far exceeding that ambition. Much of the focus has been on early diagnosis and awareness. Given the clear interest in cancer that Members have expressed by being here, I hope that they will join me in welcoming the announcement of NHS England’s cancer taskforce, which is charged with designing a new cancer strategy for the NHS to take us through to 2020.
I thought Members might be interested in the statistics for East and North Hertfordshire NHS Trust over the last 12 months. Some 2,881 more patients with suspected cancers were seen than in 2010—a 49% increase. In addition, 239 more patients were treated for cancer than in 2009-10—an 11% increase. Local NHS staff, to whom I pay tribute, are therefore doing a good job of seeing more people.
Jane Ellison
I completely understand that point. I expect local clinical leadership to understand the expertise and staffing available. All those factors will be taken in the round and looked at, because the work is specialist. I would expect the NHS to look at things such as his suggestion about the new machines at Mount Vernon. I will of course write, drawing attention to the particular concerns of my hon. and learned Friend and of my hon. Friend the Member for Stevenage about access and the travel distances. They, however, would in turn expect the local NHS to look at issues such as the distribution of expertise to ensure that the continuity of expertise was available.
Stephen McPartland
I am grateful to the Minister, who is being generous in giving way. The local Lister hospital in Stevenage is part of the same trust as Mount Vernon. The chief executive and the cancer surgeons of the local hospital support the concept of a satellite radiotherapy unit, so the local NHS supports having such a unit in Stevenage, or nearby in Hertfordshire. The issue we have is with NHS England getting on and commissioning it. The problem is that we cannot understand how the NHS is getting travel times of 45 minutes.
Jane Ellison
I have certainly picked up from the debate the importance of the issue of travel times. I will make a particular point of drawing that to NHS England’s attention.
It is always heartening to hear that colleagues are so engaged with their local health leaders as to be working together on such things. I am sure that that will all be fed into the process of making a decision. That will have to look at the implications for the whole cancer pathway, and all the other patients who receive services as part of the cancer network.
My hon. and learned Friend the Member for North East Hertfordshire, my right hon. Friend the Member for North East Bedfordshire and my hon. Friend the Member for Stevenage are hoping to meet the local NHS, as they detailed. Again, it sounds as if all the right people will be at that meeting. I strongly encourage colleagues to continue such meetings. Such a high level of engagement with local clinical leaders can only be to the benefit of their constituents. They will want to get the best and safest services for their constituents.
I congratulate my hon. and learned Friend the Member for North East Hertfordshire, who was supported by other right hon. and hon. Friends, on the debate and on their interest in the issue, which they are championing on behalf of their constituents. It is great to hear that they have the local newspaper, The Comet, involved, because it is always good for local newspapers to be involved in health campaigns, drawing attention to and explaining the issues to their readership. It sounds like a real commitment to fighting cancer in their part of the country. I commend them. I will draw the debate to the attention of those who will be interested, including NHS England. I am happy to continue to liaise with Members, and to hear how they get on with their discussions and the eventual outcome of the local review.
Question put and agreed to.
Respiratory Health
Stephen McPartland Excerpts(9 years, 2 months ago)
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Stephen McPartland (Stevenage) (Con)
It is a pleasure to serve under your chairmanship, Ms Dorries. I would like to talk about respiratory disease, which affects one in five people in the UK, is responsible for about 1 million hospital admissions and costs the NHS almost £5 billion a year. It is also the third biggest cause of death in the UK. It is the poor relation compared with the investment that goes into tackling the other four big conditions. To put that into context, in 2012, respiratory disease killed 80,000 people—that does not include lung cancer, which killed an additional 35,500 people.
The UK also has the highest mortality rate for respiratory disease among the OECD nations, double that of countries such as Poland and Germany and treble that of countries such as Estonia and Finland. Sadly, the worst thing about those statistics is that many of the deaths would be preventable with the right care. I understand and welcome the announcement by the Secretary of State that he is making it a priority for NHS England to prevent people from dying prematurely from respiratory disease. His ambition is to make us one of the best in Europe for survival rates by improving prevention, diagnosis and treatment. That is a very big statement and a huge aspiration when we are talking about reducing respiratory deaths in this country by almost two thirds.
I want to focus my remarks predominantly on asthma and chronic obstructive pulmonary disease—known as COPD—which together affect almost 6 million people in the UK, including me. I am chairman of the all-party group on respiratory health. With the support of Asthma UK and the British Lung Foundation, we conducted an inquiry into respiratory deaths in an effort to help the Government and the NHS to understand why so many people are dying from these conditions and what can be done to prevent that. I am grateful to the other members of the all-party group for their support, and for the amazing contributions that we receive from patients.
Sir Oliver Heald (North East Hertfordshire) (Con)
I pay tribute to my hon. Friend for his work as chairman of the all-party group. What does he make of the NICE evidence that about a third of the people who are receiving treatment should not be, while there is such a lot of undiagnosed asthma? That seems very odd.
Stephen McPartland
My hon. and learned Friend makes an incredibly important point, to which I will return later. The information that has come out of NICE is sadly testament to the complacency that we see regarding the effects of respiratory disease, and to how some professionals and patients treat the condition, ultimately resulting in those patients’ deaths.
Contributors to the all-party group’s report include health care professionals, charities, patients, families and professional organisations, as well as a range of other people who contributed both written and verbal evidence. I will read the story of one of those people a little later, but first I want to look at chronic obstructive pulmonary disease, which is an umbrella term for a set of conditions that includes bronchitis and emphysema. Combined, such conditions kill more than 30,000 people a year in the UK—around 5% of all deaths in the UK from all causes. A COPD patient’s journey is often punctuated by multiple exacerbations, which are sudden worsenings of the symptoms, often triggered by external factors such as infection and problems with air quality, that often lead to hospitalisation.
To put it into context, people suffering from COPD exacerbations are the second most common cause of emergency hospital admissions in this country, the biggest being ischaemic heart disease, which is effectively coronary heart disease—heart attacks and strokes. It is estimated that COPD leads to 94,000 admissions a year, with cold weather often a major contributory factor. The direct costs on the NHS are more than £800 million a year, so COPD is causing a huge problem in terms of the costs for the NHS and the impact on individual patients. One of the worst statistics that the all-party group’s inquiry came across was that 50% of people who are admitted to hospital with severe COPD die within four years—once it has reached the stage of their being admitted to hospital, they sadly have a life expectancy of four years.
Caroline Nokes (Romsey and Southampton North) (Con)
I congratulate my hon. Friend on having secured this debate. Does he agree that there is a real problem with undiagnosed COPD, which is contributing to those hospital admissions? People are presenting for treatment only when they are in crisis.
Stephen McPartland
My hon. Friend makes an important point. In fact, we believe that more than 2 million people in the UK have COPD but are completely undiagnosed. The British Lung Foundation has done a great deal of work to try to raise the profile of COPD. It has also done a great deal of work on pulmonary rehabilitation with its “Breathe Easy” groups, which help people who are suffering from COPD to access support networks and improve some of the scarring and problems that they have with their lungs. A recent study of more than 39,000 COPD patients showed that more than half had symptoms for six to 10 years before the diagnosis was made—my hon. Friend’s point is powerful—and 42% had has those symptoms for up to 15 years before being diagnosed.
I want to tell the story of Neil, 50 years old and from Norwich. He was continually misdiagnosed by doctors despite being at high risk of lung disease and showing signs of the condition throughout his 30s. By the time he was finally diagnosed, he had lost most of his lung capacity.
Neil was a long-term smoker who worked for many years in cold and dusty conditions. When he was younger, he visited doctors regularly and had breathless attacks that sometimes required emergency treatment in hospital. However, he was never offered a lung function test by his doctor, and he felt that his smoking habit was used as a reason to dismiss his symptoms and not investigate them fully. At the age of 39, he finally managed to see a specialist in the hospital, but his symptoms led doctors to think that he had asthma.
When a doctor told him the extent of the scarring and damage already done to his lungs, Neil decided to quit smoking on that very same day. He also cut back on some work to improve his working conditions. Five years ago, he developed two bouts of pneumonia. His health deteriorated: he felt constantly breathless and could barely walk 50 feet. Even at that stage, Neil was not given a lung function test or information about how to manage his condition; instead, he was told that he could expect to recover soon. He was forced to give up work completely and his wife Wendy had to start caring for him.
Eventually, a doctor told Neil that he had COPD. He had lost 70% of his lung function by the time he was told that he had COPD. He was able to speak to a specialist nurse at his local surgery who took the time to work with him and got him referred to pulmonary rehabilitation, and he became a member of one of the British Lung Foundation’s “Breathe Easy” groups, which are support networks that help people with COPD to come together to improve their conditions and exercise levels, to move forward and to improve themselves all round.
Neil can now talk quite a bit, and he speaks at length about his condition. He has decided that everyone who attends a “Breathe Easy” group becomes an expert on respiratory health and care. Fortunately, his experience was positive in the end, but he had lost 70% of his lung function before he was diagnosed with COPD—that could have been done five or 10 years earlier. Sadly, Neil’s story is a classic example of what is happening right now in GP surgeries and hospitals throughout the country. People have a right to know if they develop such a condition, and they must believe that they will receive the treatment that they want and deserve when they come forward with it.
A big Public Health England awareness campaign is due to take place in the east of England, involving a breathlessness exercise. I did it myself last year in Stevenage—although I would urge Members not to look at the photograph on my website that shows me taking the test because it was a bad hair day and it is an odd photograph—and the nurses were able to tell me that I had asthma, which is very well controlled. Throughout the day, they diagnosed a number of people with COPD, asthma and a range of other respiratory diseases. Had that bus not turned up in Stevenage and those volunteers had not been given those tests, a large number of those people would not know that they had a respiratory disease. Fortunately, the campaign will be rolled out across the whole of the east of England, so I hope that the Minister will visit it and identify whether it is a positive thing that could be rolled out throughout the country.
The NHS health check for those between the ages of 40 and 74 does not include a lung function or respiratory disease test, but 13% of all people over the age of 35 already have COPD. A lung function test should be included because, as my experience on the breathlessness bus in Stevenage showed, such a check would pick up large numbers of people, enabling them to get the care that they need. They will then be able to push on with their lives, instead of having to wait 10 years and only being told, when they are admitted to hospital with the possibility of dying within four years, that they might have COPD.
I am passionate about the need to improve basic care for people with asthma, and I join Asthma UK in highlighting the seriousness of a condition that affects 1.1 million children and 4.3 million adults in the UK. The sort of headlines that we saw last week, which were referred to by my hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald), are unhelpful when we know that too many people are complacent about asthma. Every 10 seconds, someone in the UK has an asthma attack. Every single day, on average, three people die in the UK from an asthma attack. The national review of asthma deaths, which was led by the Royal College of Physicians, suggests that two out of three of those deaths are preventable.
That review by the Royal College of Physicians was the first such review in this country. It was begun in 2012 and lasted a year, and it was published in May 2014. It found that 57% of people who died from asthma were not recorded as receiving specialist care 12 months before their death; 47% of those who died had a history of hospital admissions; and 21% had attended A and E within the previous 12 months. A written asthma action plan is a step-by-step guide to managing asthma and provides individuals with guidance on what to do if they have an asthma attack, but only 23% of the people who died had an asthma action plan, so more than 75% did not have one.
The Royal College of Physicians found that many asthma deaths could have been avoided had staff received better training. In fact, the expert panel found that 46% of such deaths could have been avoided had the existing asthma guidelines been implemented. The review also found evidence for both over and under-prescription of reliever inhalers, the blue bronchodilators. On average, someone should receive 12 inhalers a year; a number of people are receiving far fewer than 12 and, among a variety of other figures, some are receiving up to 50 inhalers a year. Just from the number of prescriptions, we can identify the target audience of people who will be seriously at risk of dying from an asthma attack.
The statistics and the all-party report both make it clear that too many people are not getting the basic levels of care and that there is great variation in the standards of that care across the country. It is essential that clinical standards are followed consistently. I have asthma myself, so I understand that the condition is complex and variable and should be taken seriously. People with asthma should continue to use their inhalers routinely and ensure that they attend their annual asthma review, at which they may discuss their diagnosis, medications and written asthma action plan.
Last year, more than 1 million people who have asthma did not turn up to their asthma review. I did, because my wife, my mum and my asthma nurse all gang up on me and force me to go every single year. They almost insist on me having my flu jab twice a year. In Parliament, I normally host a session for people with respiratory conditions to have their flu jabs each year. Unless I provide a picture of myself receiving the needle at that session, I am required to have another at my GP’s surgery in Stevenage. So I have to smile at the camera while the lady enjoys stabbing me with a needle—I am sure she takes a little longer than she should. I do that every year.
Let me tell the House about my experience of asthma. I was diagnosed with it when I was eight, and I am now 38 years of age. The Minister will be shocked and disappointed to know that my treatment has not changed in 30 years. The experience at the doctor’s that I had when I was eight is exactly the same as my experience now, except that nowadays I see an asthma nurse, whereas then it was a doctor. The asthma nurse takes the time to go through my peak flow monitor with me, and she weighs and measures me—I think I get shorter every year, and a little heavier—but in effect that is what the doctor was doing when I was eight, although then I was getting slightly taller, if slightly heavier too. The reality is that things have not changed at all.
I was one of those children who was diagnosed with bronchitis from the age of about five until I was eight. The doctors thought, “Oh no, it hasn’t gone in three years, so he must have asthma”, so I was given my inhalers. If I turned up to the doctor’s and said, “I have got this or that”, they would say, “Are you using your inhalers?” I would reply, “Yes, I am using my inhalers.” They would say, “Why don’t you take your blue reliever inhaler”—they call it a Ventolin bronchodilator—“a little more?” That would be my treatment. I have not had antibiotics, but if I were younger, they might have given me a two-week course of them and told me to come back if whatever it was had not cleared up. In effect, that is what I got when I was eight and what I get now when I am 38. That is why we have the highest rate of respiratory deaths among the OECD countries—the treatment for asthma for people at GP surgeries up and down the country has not really changed. It is exactly the same.
There has been some progress. I am delighted to report that after a campaign of three and a half years by myself, other Members of Parliament and Asthma UK, for the first time we can now have asthma inhalers in first aid kits in schools. It took us three and a half years, which is ridiculous, because those inhalers are prescribed medication, which could not simply be given out by a teacher.
Sheryll Murray (South East Cornwall) (Con)
My hon. Friend might be aware that before I came to this place, I was a receptionist for a GP. One of the biggest problems that parents find is that they do not have two inhalers prescribed at the same time for their child, so that one can be kept at school and one at home. That is one reason why we need to ensure that all schools have an inhaler for use in an emergency.
Stephen McPartland
My hon. Friend makes an important point. I suffer from that myself, so I have an overnight bag in Parliament in case we get stuck here until 4 or 5 in the morning, and it has an inhaler in it. I had to get that inhaler off my dad, because I could not get another one off my own GP. I am a Member of Parliament, but I could not get myself an extra inhaler, so I am not sure what chance a child has of persuading an extra inhaler off the doctor, which his mates will probably just play with. I understand such problems, which is why I said earlier to the Minister that the treatment for asthma has not really changed in the 30 years that I have had it. There has been progress and good news—a number of children will not now die of asthma attacks in school over the next five to 10 years, because those inhalers are in first aid kits. Instead of a mate lending one, it will now be a matter of simply getting it out of the first aid kit, which is good news.
We are seeing great examples of innovation and high-quality asthma care throughout the country, with health care professionals working tirelessly to improve outcomes. They are looking for a cure for asthma. There are centres of excellence, such as the Royal Brompton hospital in London, which provides life-saving specialist care for people with severe asthma—I hope I never have to visit the place. The UK has some of the best asthma researchers, changing the way we think about the causes of asthma. In my constituency thousands of GlaxoSmithKline scientists are working on managing the condition of respiratory diseases on a daily basis; they are leaping forward with the ways in which we can manage such conditions. I thank them all for their brilliant work.
I am sure the Minister is aware that we have some recommendations and questions for him. Shockingly, the NHS does not track its own performance on asthma care. Despite asthma being one of the most common long-term conditions in the UK, no robust data are available. We would like to see a national clinical audit for asthma. Will the Minister commit to supporting such an audit and raise the matter with NHS England? An audit has the potential to stop people needlessly dying from asthma attacks, to improve the quality of life for people with asthma and to reduce costs for the NHS significantly. Such audits are already well established for other long-term conditions such as diabetes.
There should also be greater investment in asthma research. Research into the treatment and care of asthma and other lung conditions is chronically underfunded compared with other conditions such as the other four big killers. The amount of money committed to researching asthma simply does not match the burden it places on the NHS. In spite of that, amazing breakthroughs are taking place and there is potential. Asthma UK is working with the European Asthma Research and Innovation Partnership to establish a new fund to research and develop asthma drugs, with the ultimate aim of finding a cure for asthma. Will the Minister meet me and Asthma UK to explore how the Government can support the European innovation fund?
A variety of asthma research demonstrates that many people have allergies. Of those who have asthma, 50% are more than likely to have some kind of allergy that causes an asthma attack—we call them triggers. We do not have the lung function or capability that those without asthma have, so we have to learn quickly what our triggers are and avoid them. One of my triggers is pets, so although I am 38 I have never had a pet, which is quite sad.
We would also like to see written asthma action plans. The Secretary of State for Health has made a positive commitment to ensuring that every asthmatic has a written asthma action plan, so will the Minister tell us what plans the Government have in place to achieve that commitment? Once someone has an action plan it helps to reduce the seriousness of their attacks, because they learn quickly to manage their own condition. It is a serious condition, and people have to work on improving things such as their peak flow. There are bits and pieces that doctors and asthma nurses do with asthma sufferers—we compete with ourselves to try to improve in our asthma action plan.
We believe that there should be world-class asthma reviews containing key components; that is an item that came up in the national review of asthma deaths. It could result in a nationwide improvement in asthma. A variety of organisations are ready to help to develop the idea and work with the Department of Health and NHS England to make it a reality. The national review found that many asthma reviews did not include key components—only 27% of people had their asthma control assessed, only 42% had an assessment of their medication use and only 71% had an assessment of their inhaler technique. People are using their inhalers in a variety of ways, and could be losing between 40% and 60% of the medication’s effectiveness if they are using them incorrectly, yet almost 30% of people are not being assessed on an annual basis on how they use their inhaler. That could reducing the effectiveness of their medication.
We would like the Minister to support the creation of a world-class asthma review and to encourage NHS England to get on and actually do it. We know that NHS England is working on an improvement programme for children’s asthma, and we would like him to commit to continuing to resource that project into 2015-16. We have already seen significant successes in secondary and tertiary care for children.
It would not be a debate on asthma without a call—I have to declare an interest here—for free prescriptions for those with asthma; all asthma sufferers would like that. People suffering from many other long-term conditions receive free prescriptions for their inhalers, but asthmatics do not. If asthmatics do not take their inhalers they end up in an A and E facility receiving oxygen, normally after an ambulance crew has transported them there, giving them oxygen on the way. That costs a huge amount of money.
My final point is that smoking is a contributory factor in more than a third of all respiratory deaths. The health impact of smoking on asthma sufferers is enormous, so I personally call on the Government to get on and do all they can to push forward standardised packaging for cigarettes as soon as possible.
National Health Service
Stephen McPartland Excerpts(9 years, 3 months ago)
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Stephen McPartland (Stevenage) (Con)
I am proud of the NHS and I am proud of its staff. The Lister hospital in my constituency is very large and employs thousands and thousands of staff who, I am proud to say, save lives on a daily basis. The hospital is one of the NHS’s big success stories, as it is currently undergoing a £150 million redevelopment.
I spend a lot of time at the hospital, because I am always opening things and looking at new plans and buildings, which include a new endoscopy unit and theatre, a new A and E unit and a new theatre and ward block, none of which have as yet been fully opened. I have opened a variety of other units, including new scanning units. Some £150 million has been invested in the NHS in Stevenage, which is the biggest ever investment in the NHS in Hertfordshire’s history. As the county predates the Norman Conquest, Members will understand that that is a pretty big investment.
Sir Oliver Heald
I congratulate my hon. Friend on the investment and the fantastic facilities of his hospital. In my neighbouring constituency, we say that if someone wants to find the Lister hospital, they should look for the cranes, which are there for the construction of all the new buildings. Does he agree that it has taken a Conservative-led Government to make those improvements?
Stephen McPartland
My hon. and learned Friend is correct, and he supported me all the way as I fought with the Treasury, the Department of Health and every single system to ensure that we got the deals signed, sealed and delivered and the buildings constructed on time. I am proud of the investment and the staff who work in the hospital, but I am concerned about the way that Members talk down the NHS. Thousands of NHS workers in my constituency feel very depressed about the situation. They put in a huge amount of hours and a great deal of effort, and what happens at the end of the day? People say that their A and E is in crisis. That is completely unacceptable. Last week, the A and E department in my constituency saw 93.7% of people within the four-hour target. This week, it is on target, with nearly 95% of people, which is down to those doctors and nurses working their backsides off on a daily basis to ensure that they save lives.
Rehman Chishti
I pay tribute to the work my hon. Friend does in his constituency. I often see it on Facebook and read about it on the internet. He is a tireless campaigner for the health service in his constituency. He mentioned the A and E in his constituency. A linked issue is that of resources. In my constituency, £13.4 million has just been invested in resources for the A and E department—
Mr Deputy Speaker (Mr Lindsay Hoyle)
Order. I do not want such long interventions. If the hon. Gentleman wishes to speak, we can always put him on the list. If he wants, he can save something for later.
Stephen McPartland
My hon. Friend makes a fantastic point, and he is a fantastic campaigner, too. I am sure that that money would not have arrived without a huge effort on his part.
The Leader of the Opposition was in my constituency last week, and we were grateful to him for his visit. He came and celebrated the £150 million investment that I had secured for my hospital. He can come as much as he likes, because I got more donations, supporters and volunteers from his visit. Perhaps he could come on a weekly basis. Incidentally, let me talk about the Lister treatment centre, which the right hon. Gentleman visited. It was privatised under the previous Government. I ran an 18-month campaign to have this private facility returned to the NHS, and I succeeded. I am probably the only Tory MP in history who has managed to renationalise a part of the NHS that had been privatised under a Labour Government. I worked very hard on that campaign, but it was lonely work. The local Labour council did not back me; the local Labour candidate did not back me; the Labour shadow Secretary of State did not back me; the Leader of the Opposition did not back me; but the GMB union did and for that I am very grateful.
Three people died in that facility and 8,500 patients’ records were lost. It was a complete and utter shambles. Clinicenta Carillion, the organisation that was responsible for running that facility, destroyed the lives of thousands of people in Hertfordshire; that must never be repeated. That is what we talk about when we talk about the NHS. Who did I stand up for? I stood up for the patients, for the staff and for their families. Where did I get my information from? From members of staff who were working in that facility daily, under huge pressure, suffering and working as hard as they could to provide the best service they could. They could not do it, because their hands were tied behind their back—the contract was so bad. The local hospital was not even allowed sight of the contract until it was signed, sealed and delivered by the previous Government. They did not even know what they were being signed up to, which is a disgrace. I am proud of my hospital and the staff who work in it, but we must always remember that, at the end of the day, these are human beings, who are working incredibly hard to deliver real improvements in services.
Fortunately, that facility is being handed back to my local hospital. The Secretary of State for Health worked with me. He allowed me to come and see him, and we had a variety of meetings. I argued with the Care Quality Commission. I was very lonely throughout that campaign, but at the end of the day the Secretary of State worked with me and he nationalised that private facility, which the previous Government—disgracefully—privatised. I am proud of the Secretary of State, and I am only sorry that he is not in his place, because I wanted him to come and open one of our wonderful new facilities in February. The Prime Minister can come in March.
The facility that I was discussing got so bad that GPs lost confidence and wrote to each other saying, “Do not refer patients to this facility or you will put them at risk.” The CQC started proceedings to revoke the licence. That facility was falling apart—a facility that was privatised by the previous Government. It was nationalised by the Conservatives.
So I am proud of the NHS and proud of the staff who work in it. I am proud of the £150 million development in my constituency, which is making my hospital one of the most modern facilities in the UK. I am disgusted that the Leader of the Opposition wants to weaponise our local NHS and never once backed my campaign to bring that shameful private contract back to the NHS. The Labour party should apologise to my local community for playing Russian roulette with our local health service and politics with my constituents and patient safety.
Surrogacy
Stephen McPartland Excerpts(9 years, 6 months ago)
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Stephen McPartland (Stevenage) (Con)
It is a pleasure to serve under your chairmanship, Sir Edward, and to follow my hon. Friend the Member for Watford (Richard Harrington) who, as always, has given an impassioned defence of his constituents’ interests. I congratulate my hon. Friend the Member for Erewash (Jessica Lee) on calling this important debate.
Surrogacy is a complex minefield, as we are all aware. Many Members of Parliament are concerned about the issue but, as we can see from the Chamber today, they are not keen on speaking about it publicly, because it is complicated, with many facets and problems. There are some religious undertones to the subject. I am pro-life and support all life. As a Catholic, I know that some Churches do not support surrogacy, but my view is that, whether or not it is supported, there is a system in place that we need to try to fix, as the exploitation of people using surrogates must stop.
Some of my constituents have fertility problems. They have looked into surrogacy as an option, but they have found it to be such a minefield that they do not wish to pursue it, despite the fact that having a child is their lifelong dream. At the moment, there is a real problem that is affecting our constituents.
As technology moves on, the way in which surrogacy is done has evolved over the years, but essentially we are still talking about a woman carrying and giving birth to a child for somebody else. There are a huge range of problems. For example, in the United Kingdom, we do not know how many children are conceived through surrogacy. We are a 21st-century modern democracy, but we do not have the full figures. There are no official records apart from the parental order register. To put that register into context, an estimated 1,000 children are born through Indian surrogacy each year, but in 2012, the family court granted only 213 parental orders. That suggests that there maybe thousands of children in the UK living with adults who are not their legal parents.
That may not be an issue for many people, but let us consider what my hon. Friend the Member for Watford said about families wanting to do what is legally correct and best for those children. As my hon. Friend the Member for Erewash stated, many of the children are born stateless. If they try to get into university, for example, which type of fees will they pay—the fees for foreign students or those for domestic students? How will they access and enter higher education in the United Kingdom? What if they have a problem accessing benefits in future because of some of the changes that we have made to access to benefits—if someone is considered stateless, how will they access benefits? Surrogacy impacts on a huge range of issues for families. As we change laws in the UK, the impact on those families will get bigger and worse. We need to look at that and work out a way of moving forward and creating some kind of international agreement.
My particular passion is to ensure that those families are safeguarded against exploitation. However, I would not wish to push too hard on that matter: as my hon. Friend the Member for Erewash clearly stated, there have been only two recorded cases of surrogates changing their mind in the past 30 years, but thousands of surrogates who, because they have enjoyed carrying a child for somebody else, have happily given the child over and helped the family to have another child. That is important, and I would not wish to scaremonger. However, it is incredibly important to me—as it is to my hon. Friends the Members for Erewash and for Watford—that surrogates are safeguarded and that the families who use surrogates are not exploited.
My hon. Friend the Member for Erewash raised the issue currently in the news of families who are being broken up, and she mentioned the case of the two children. Whoever is right or wrong, the reality is that the case has been a huge problem for the families and countries involved because there is no way of dealing with the situation or of identifying whether any law—rather than a moral and ethical code—has been broken. The issue needs to be looked at, and I support my hon. Friend’s wonderful campaign for some kind of international agreement on surrogacy.
I also want to make a plea to the Minister on parentage. At the moment, the surrogate and her husband are considered to be the child’s parents. That leads to the problem of statelessness that we have mentioned and the problem that my hon. Friend the Member for Watford raised concerning his constituents, where one parent was kept separate from the family for many months—in some cases, no doubt, it is for years. We need to tackle that, as it has a detrimental effect on our constituents and our society. I congratulate my hon. Friend the Member for Erewash on her wonderful campaign, and I thank her for raising the matter in the House.