NHS: Long-term Strategy

Tahir Ali Excerpts

Wednesday 11th January 2023 Commons Chamber

[Valerie Vaz (Walsall South) (Lab)]

It is a pleasure to follow my friend the hon. Member for Winchester (Steve Brine), the new Chair of the Select Committee. My hon. Friend the Member for Ilford North (Wes Streeting), the shadow Secretary of State, is right about Government mismanagement of the NHS since 2010. As a member of the Health Committee from 2010 to 2015, when it was chaired by the right hon. Stephen Dorrell, the former Health Secretary, I want to set out why this crisis has been brewing since 2010. Incidentally, Stephen Dorrell has noted five mistakes that the Government have made and should look at.

The Health and Social Care Act 2012 prevented integration. It made the NHS not the first and default option, and it was opened up to privatisation, fragmented and destabilised. The reorganisation was described as so big that it could be seen from space, and it was opposed by so many that it had to be paused. Despite the pressures of the pandemic, we had a further reorganisation with the Health and Care Act 2022, under which we will not have CCGs any more, but integrated care boards.

His Majesty’s Opposition have been pushing integrated care since before 2010. Our Select Committee visited Torbay in 2009, during the last Labour Government. We saw the single-point entry of Mrs Smith, who could be tracked from the start—from a single phone call—to hospital and out again, with any of her needs met by an upscaled, co-located team. However, the 2012 Act stopped that pooling of resources. Integrated care can only work if there are adequate resources for local authorities. Austerity measures since 2010 have starved local authorities and other public services of funding. Clinicians should be at the heart of the NHS. People who use it or work in it do not get a say.

In 2016 the then Secretary of State, now Chancellor, picked a fight with the junior doctors. I met them outside Richmond House. We have had more mismanagement, with £347 million for a covid testing contract to Randox, which then had to be recalled because of concerns about contamination. Now we have PPE Medpro, and today the Public Accounts Committee said the Government have mismanaged the economy by losing £42 billion in uncollected taxes. There is money, but not the will to find it.

Nurses went on strike in December, yet in the first statement the Secretary of State has made since—he is not in the Chamber, but he said that we did not mention his statement—he did not mention the workforce at all. In fact, he gave an understatement of the figures for people with delayed discharge. He said that there were just 6,000 cases in June 2020. Last year, there were 12,000 to 13,000 a day. The Government knew the figures, but they did nothing—they had no plan.

Not talking to a workforce who stepped up into the unknown during the pandemic is mismanagement. Stopping nurses’ bursaries was mismanagement. Not holding cross-party talks to solve the care crisis when we urged them to—the Health Committee report was in 2012—was mismanagement. The Government dismantling a health service that had its highest satisfaction levels in 2010, when Labour left office, is mismanagement.

[Tahir Ali (Birmingham, Hall Green) (Lab)]

On the workforce, existing nurses are underpaid, but the serious number of vacancies that existed in September—47,000, as reported by Nursing Times—must also be addressed adequately and immediately. Those vacancies are putting pressure on nurses, on top of the pay awards they are after.

[Valerie Vaz]

My hon. Friend is absolutely right and puts the point perfectly. I have questions to ask the Minister. Are the recommendations on safe staffing levels made by Sir Robert Francis being followed now? Will the Secretary of State consider a patient discharge dashboard so we can see the figures on a weekly basis? Where is the accountability for the £500 million in the discharge fund? Are the 42 NHS system control centres mentioned in the statement just the ICBs by a different name? Our shadow Secretary of State for Health has outlined a plan for training more doctors, paid for by abolishing non-doms, and I am with him on salaried GPs as a step in the right direction.

Nye Bevan heard the cries of his community in the valleys. He said:

“No society can legitimately call itself civilised if a sick person is denied medical aid because of lack of means.”

He turned his dream into a wonderful service that is free for all of us. We will not let this flailing and failing Government destroy our NHS.

Urgent and Emergency Care

Tahir Ali Excerpts

Monday 5th September 2022 Commons Chamber

[Steve Barclay]

My hon. Friend is absolutely right that a central role for the integrated care systems in future is to look at how they best use the better care fund, how we better integrate around step-down provision, and how we ensure that best practice is being followed through the delayed discharge, including regarding some of the additional pressures that Warrington faced specifically, as I know from when we spoke over the summer. He will also know that there had been additional funding for new capacity at Warrington, which strangely was not highlighted in the media coverage that I saw.

[Tahir Ali (Birmingham, Hall Green) (Lab)]

Two weeks ago, in the west midlands, it was being reported that some were waiting as long as 17 hours to receive service from an ambulance. It was also reported that at least 68 people have died since April while waiting for an ambulance, although that number was backdated to last August. It is now clear that our NHS is at breaking point due to a decade of Tory cuts; welcome to backlog Britain thanks to 12 years of Conservative Governments.

Trusts in the region report being poorly equipped for the burden of treating patients, with many reporting delays due to a shortage of beds. This crisis will only get worse in the coming months as we enter the cold period—a winter in the midst of one of the worst crises in living memory. What measures will the Secretary of State introduce immediately in response to the increased pressures that our NHS is facing, which are costing lives? Will he provide the extra measures that the NHS desperately needs to deal with this crisis—a crisis that was made by 12 years of Conservative Governments?

[Steve Barclay]

I fear that the question was written before the statement. In the course of the statement, we have covered the significant additional funding that is going in, whether that is in primary care with the £1.5 billion on GP capacity, the £450 million on A&E capacity, the £150 million on ambulances, the £50 million on 111 call-handling or the £30 million on St John auxiliary ambulance capacity—to name just a few areas.

As to the hon. Gentleman’s wider charge on Government funding for the NHS, I remind him that health funding is on track to be £4 in every £10 of day-to-day Government expenditure, which is a significant increase on 2010. We have also just been through a pandemic in which the fiscal response, as the former Chief Secretary to the Treasury, my right hon. Friend the Member for Chelsea and Fulham (Greg Hands) will know, was about £400 billion. Significant funding has gone in, and the statement today has shown that a number of factors, in particular the integration between social care and the NHS, are at the heart of solving the issue of delays on ambulance handovers.

Access to GP Appointments

Tahir Ali Excerpts

Wednesday 12th January 2022 Westminster Hall

[Theresa Villiers]

I think that is right, which is why it was a good decision in the Government’s October announcement to focus on an upgrade to phone systems. I really hope that the Minister will update us on how that is going and when it will be delivered, so that our constituents can experience it directly.

Returning to the issue of GP paperwork, a Barnet GP told me that

“the amount of bureaucracy and red tape has increased exponentially despite various assurances that this would be cut. Increased regulation and monitoring, whilst important from a governance point of view, seems to have generated endless form filling, policy updating, mandatory training, appraisals and paper chasing.”

When this issue was debated in this Chamber last October, the Minister repeated promises that paperwork and form filling would be reduced. Has that happened? If not, why not? It is far better for a GP to spend time with patients, rather than writing sick notes or ticking boxes.

The third element of the Government’s plan seeks to strengthen the multi-disciplinary teams in general practice, so that, where appropriate, patients can seek other professionals such as nurses, pharmacists or physiotherapists. This is intended to free up GP time for them to see sicker patients. I welcome the fact that 10,000 new staff have been recruited of the 26,000 promised in the Conservative manifesto, and I commend the work of North Central London clinical commissioning group, which is due to recruit 177 more primary care staff under the programme. However, more could be done, for example, to enable pharmacists to take a bigger role, including in prescribing. We must also ensure that GPs have a strong voice in the new integrated care boards, so that primary care is at the heart of NHS decision making. It is vital that part of the massive capital investment that the Government have promised for the NHS goes into improving GP surgery premises, which in some instances are just not fit for purpose or not physically large enough to cope with increased healthcare demand.

[Tahir Ali (Birmingham, Hall Green) (Lab)]

Many of my constituents, and constituents across the country, are concerned about how quickly they can get face-to-face appointments, especially those mentioned earlier: the vulnerable, the elderly, and those who cannot do online or telephone appointments. The investment in surgeries is most welcome, but we need immediate action to address the shortfall in patients being seen by doctors where they need to attend a face-to-face surgery.

During covid-19, elected Members received an uplift to our budgets to help us to deal with our constituents. The same needs to be done for GPs, who are under huge pressure to deliver services, and that needs to happen now rather than later, because such investment can take time to come through and we do not have time.

[Theresa Villiers]

I agree that we need action now to make it easier to get GP appointments, and we also need action for the longer term. Even if everything that I have spoken about is delivered, and the October package is delivered in its entirety, we still need more GPs—it is as simple as that.

It is really welcome that this year more people have entered training to become GPs than ever before, because the Health Committee identified workforce shortages as the “key limiting factor” in tackling the covid backlog successfully. In its annual report on the state of health and social care in England, the Care Quality Commission concluded that by mid-2021 there were likely to be fewer full-time equivalent GPs in total per 100,000 patients than there were in 2017.

In July 2021, the then Care Minister commissioned Health Education England to review long-term strategic trends for the health and social care workforce. That review is very welcome, but we need to see it deliver results. As the Health Committee has called for, we need an objective, transparent and independently audited annual report on workforce projections that cover the next five, 10 and 20 years, including an assessment of whether sufficient numbers of staff are being trained.

Covid-19 Update

Tahir Ali Excerpts

Wednesday 8th December 2021 Commons Chamber

[Sajid Javid]

When we set out plan B for the autumn and winter in respect of the challenges we would face, whether from covid or flu, we set out in that plan how and why we thought vaccine passports could help in certain circumstances. Also, it is not straightforward to compare different countries. Different countries have taken a whole host of different measures at different points in time—for example, there can be huge differences in vaccination rates or in respect of other measures that may or may not be in place—so I caution my right hon. Friend in comparing, for example, France with the UK.

[Tahir Ali (Birmingham, Hall Green) (Lab)]

What advice does the Secretary of State have for our constituents who have not been able to visit their loved ones in times of illness, death or for a family event like a wedding in Kashmir, Pakistan, India or Bangladesh? Many of them will have planned a visit during the school holidays; do they go ahead with that? If not, what advice does the Secretary of State have for them? If further restrictions come in once they are over there, that could prevent them from coming back into this country for a length of time. They should not be put through that, especially if the advice is clear from the outset.

[Sajid Javid]

When it comes to travel measures such as the recent announcements in respect of the red list, I think the hon. Gentleman will understand why the Government took that action to buy time and to try to slow any incursion of this new variant. I am afraid it is just not possible to give a guarantee for any particular country that there will not potentially be any future measures. As he has raised the important issue of travel measures, one thing I would say is that very soon, in the days and weeks that lie ahead, if, as I think is likely, we see many more infections and this variant becomes the dominant variant, there will be less need to have any kind of travel restrictions at all.

Medical Cannabis under Prescription: Children with Epilepsy

Tahir Ali Excerpts

Wednesday 3rd November 2021 Westminster Hall

[Alberto Costa]

I am not sure, but I doubt that our constituents would have to put their hands in their pockets to the tune of £2,000 a month to pay for any other medication that was extremely important for their severely ill children. My constituents, and indeed all Members’ constituents who have children in this situation, should not have to pay for this medication themselves.

Medical cannabis has had lots of benefits for Maya, including preventing her from having prolonged seizures, which has meant less time in hospital. Medical cannabis has also improved her alertness and engagement. She used to spend a lot of time asleep during the day, but she is now able to attend school, which she very much enjoys.

Both I and colleagues have lobbied the Government tirelessly to widen access to this life-changing and life-saving treatment. I am sure that I speak for many Members here today in expressing delight that medical cannabis was made legal in specialist cases in November 2018. This week marks three years since that law change.

I welcome the new Minister to her place and the good progress that the Government have made on widening access to medical cannabis. I am also grateful to her for agreeing to meet me, as co-chair of the all-party parliamentary group for access to medical cannabis under prescription, along with my colleague the hon. Member for Gower (Tonia Antoniazzi), later this month. I look forward to discussing the issues in greater detail with her.

You may be interested to learn, Ms Bardell, that since the very welcome law change three years ago, which should have improved the lives of children who suffer with rare and intractable forms of epilepsy, only three prescriptions have been issued on the NHS—only three prescriptions. At this point, I would like to clarify that we are talking about whole-plant extract. This type of medical cannabis, containing CBD and THC—cannabidiol and tetrahydrocannabinol—together with many other active ingredients, has been life transforming for a small cohort of families and their children. It is vital that that point is understood, as there have been several hundred prescriptions for a fully licensed paediatric drug known as Epidiolex, but that is primarily CBD-only. There is an acknowledgement that that drug has a role to play, but it was not the subject of the appeals that were so eloquently and passionately made by the families concerned when they visited Parliament at the start of this week.

Access to medical cannabis was legalised after high-profile campaigning by me and other Members across the House, who are here today, and the hard work of the group End Our Pain. It and other campaigners, along with some of my colleagues, worked with the then six-year-old Alfie Dingley, who also suffers from rare, intractable epilepsy, to help him secure access to medical cannabis. In 2018, after intensive campaigning, Alfie was granted the first ever long-term licence for the type of medical cannabis that is life transforming. Medical cannabis subsequently became legalised in specialist cases on 1 November 2018. Since Alfie secured the prescription, his transformation has been significant. He has gone from suffering up to 150 life-threatening seizures a day to recently celebrating being 500 days seizure free. The change in health and quality of life for Alfie is nothing short of transformative, and that transformation has been evident in many others, too.

I am very grateful to the Secretary of State for Health and Social Care, who in 2018 was the Home Secretary who granted the licence for medical cannabis to Alfie Dingley. I know that my right hon. Friend cares deeply about this issue. Now that he is Secretary of State for Health, I urge him to consider the recommendations that I am mentioning today on what further action could be taken to help children like my constituents to access medical cannabis on the NHS. The law change has been a change in legislation, but not in practice. That has been reflected in the number of NHS prescriptions that have been issued. My constituents and many others were greatly reassured by the steps that this Government took to legalise these treatments in 2018, but they are understandably dismayed that actions have not followed words in this case.

There are a few reasons for this blockage on NHS prescriptions. At the same time that the law changed, a number of bodies issued guidance on how and when medical cannabis should be prescribed. Those bodies included the British Paediatric Neurology Association, the General Medical Council, the National Institute for Health and Care Excellence and the Royal College of Physicians, but let us be clear: nothing—absolutely nothing—in any of the guidance states that it is wrong or not allowed to prescribe this medicine, either privately or on the NHS.

However, I am advised by the families and advocates on this issue that the guidance paints a somewhat confusing picture. In my capacity as co-chair of the APPG, I have attended a number of meetings with senior NHS leaders. In those meetings, they tell me that if an NHS consultant wishes to prescribe medical cannabis, they are able to do so. The British Paediatric Neurology Association does not currently support the use of whole-plant medicinal cannabis, which includes the THC ingredient, and has published guidance stating that only neurologists should be allowed to prescribe cannabinoids containing CBD. That guidance has been criticised for being overly restrictive.

The high level of caution in the guidance issued is likely to have played its part in preventing the prescribing of those products and making NHS trusts unwilling to provide funding. Currently, there are only three paediatricians in Britain who prescribe the whole-plant oil to children with drug-resistant epilepsy, and one of them is to retire imminently, meaning that families are at risk of losing their prescriptions.

A few months ago we had a breakthrough, as NICE issued clarification of its guidance relating to the use of medical cannabis for drug-resistant paediatric epilepsy. It has now made it clear that clinicians can prescribe medicinal cannabis in appropriate cases. However, even since the clarification of the guidance, the hesitancy among the medical profession remains.

I am aware that this issue continues to receive a high degree of media, public and political attention, and I am concerned that some of those involved—perhaps some of the medical professional bodies such as the BPNA—may be experiencing a temptation to entrench and dig in. If that is the case, I make a plea to them and their medical professional colleagues to reject that temptation and instead to reach out to work with the Department of Health and Social Care, the Minister and her colleagues, the families and interested politicians to find a way forward to help these vulnerable families and their children.

I also strongly encourage the Government to ensure better education for paediatric neurologists on whole-plant extract medical cannabis and its benefits for children with drug-resistant epilepsy. I am aware that the previous Secretary of State for Health and Social Care tasked the NHS with undertaking a review of the blockage on NHS prescriptions. The review reported in August 2019 and made two main recommendations: first, that an expert panel be set up to advise on the prescription of medical cannabis in cases of paediatric epilepsy; and secondly, that a trial should be set up to inform the evidence base on safety and efficacy, and to act as a way of getting these families access to the medicine for free.

The families and campaigners have told me that those recommendations offered them great hope and a way forward. However, things have not worked out as the families hoped. Yes, the expert panel was set up; it is called RESCAS—the refractory epilepsy specialist clinical advisory service—and its members are indeed experts in paediatric epilepsy, but as far as the families can see they are not experts in the way that whole-plant extract has worked both here in the UK and overseas.

Imagine, then, the enormous disappointment when one of the very first cases considered was turned down for medical cannabis. The young boy in question is experiencing a life transformation similar in positive impact to that which Alfie is experiencing. The panel is not working. I know the Minister cares deeply about this matter. I hope she will agree that the make-up and terms of the panel are in need of urgent review so that it includes expertise not just in the condition itself, but in the medicine too.

The other main recommendation of the August 2019 review was the establishment of trials. I understand that the Government’s position is that there needs to be more research in the area before prescriptions can be available more freely. The proposed trial was to be observational, which meant the children could continue on the medicine and their condition be evaluated by medical professionals. It soon became clear last year that plans for the observational trial had been dropped and replaced with a randomised control trial. RCTs are not appropriate in this case, as I am sure hon. Members agree, as they require some of the cohort to be taken off the medicine and given a placebo.

That is simply not possible, and we have to ask ourselves why anyone would take their children off a medicine that was already working for them and improving their quality of life. RCTs can also be incredibly costly and take years to complete. That is time that my constituents and others do not have. I therefore suggest that the Government consider conducting an observational trial or an alternative study as a means of enabling the children to have continued access to medical cannabis at no cost. That would be possible for the Secretary of State, and the Under-Secretary of State for Health and Social Care, my hon. Friend the Member for Lewes (Maria Caulfield), here today, to commission under the National Health Service Act 2006.

[Tahir Ali (Birmingham, Hall Green) (Lab)]

The cost of having medicinal cannabis for children is astronomical, at between £800 and £2,000, and that is for those who can afford it. The very children who need the medicine to improve the quality of their lives where it has been proven to be effective and who cannot afford it cannot be put on the scrapheap to further delay. Does the hon. Gentleman agree?

Covid-19 Update

Tahir Ali Excerpts

Monday 14th June 2021 Commons Chamber

[Matt Hancock]

I understand entirely the point that my right hon. Friend is making in terms of these restrictions and the impact on businesses and, in particular, the link to those in rent arrears. That is something I have been discussing with the Communities Secretary, and I am very happy to meet her to discuss how in the short term we can ensure that businesses, such as the one in her constituency that she mentions, get the support they need.

[Tahir Ali (Birmingham, Hall Green) (Lab) [V]]

The Secretary of State refers to Captain Hindsight as cheap political point scoring to deflect from the seriousness of the debate. May I suggest that he refers to the cartoon character—much suited to his own Government—of Danger Mouse? Can the Secretary of State explain why India was included on the travel red list a full two weeks after countries with much lower rates of infection? This decision came almost immediately after the planned visit by the Prime Minister to India was cancelled. In my constituency of Birmingham, Hall Green, many residents believe that the decision to include Pakistan and Bangladesh as red list countries was politically motivated. To restore public confidence, can the Secretary of State indicate when countries such as Pakistan and Bangladesh will be removed from the red list and put on the amber list?

[Matt Hancock]

The hon. Gentleman refers to political point scoring, and then makes points that he knows are not supported by the facts. As I have said to this House before, when the decision was taken on the 2 April change to put Pakistan and Bangladesh on the red list, test positivity of travellers returning from Pakistan was 4.6%—three times the 1.6% positivity of returning travellers from India. Those are the facts—the basis on which the decision was taken. I am not quite sure, but I think the hon. Gentleman asked at the end of his question whether we can now take those countries off the red list and put them on to the amber list. I do not support that approach, because it is important to keep this country safe.