- [Clive Efford in the Chair]
- 3:00 pm
- It is a pleasure to serve under your chairmanship, Mr Efford. Long-term conditions need a long-term plan. We were promised one of those, and it cannot come soon enough. The Chancellor’s statement yesterday, which committed to a 3% real-terms rise in NHS funding each year, gives me enormous hope for the future of our health service. Some 70% of that funding will likely go to the treatment of long-term conditions, so it is incredibly important that we consider how we should treat them.Most of us at some point will collect a few long-term conditions. Some of us are born with them; sometimes, they are serious disabilities. I am sure that we will hear some stories of those challenges. I reached out to the people of Bury St Edmunds and Stowmarket and heard many stories about their experiences of using our NHS. All too often, it is the same story: it is those with long-term conditions, not deadly diseases, who feel most let down now. The reality for many is that by the time they reach my age, they are fortunate if they have never had to visit a clinic or see a nurse about something that is no longer working quite as well as it should. The wheels begin to fall off all of us eventually.Living with a long-term condition has a profound impact on people. It can mean lost work days, missed opportunities and, for many, being pushed out of the workforce altogether. When people are unable to work because of poor health, they are cut off from society and their quality of life obviously declines. That also has a terrible effect on the economy. It is estimated that successfully addressing the crisis in long-term sickness would increase GDP by between £109 billion and £177 billion over the next five years, generating billions of pounds of additional tax revenue. This is a growing trend and as the population gets older it will simply become more pressing. I worry that we have not truly adapted our medical system to deal with this reality.When I was a medical student, a heart attack was managed with morphine and bed rest. Things have certainly changed, and yet the NHS has not changed enough. In 1948, it was created to deal with infectious diseases and acute hospital care, but the health needs of the population have changed completely. People now live long lives with conditions such as heart disease, diabetes and arthritis. We need to focus on keeping those people in the community rather than waiting until they become so unwell that they have to be brought to hospitals.The NHS should not just be a sickness service; it should help people to manage their conditions and live much better lives. During our debate on dementia a few days ago, I heard many moving stories about families challenged by that devastating illness. Dementia fills so many hospital beds, and the cost to society is quite staggering, but the real message of the debate was about the need for better community care and greater investment in technology and research. That is true for dementia, but it is also true for many long-term conditions. We have the time and the ideas; now, we must use them.There is much talk about moving care from hospitals to the community, which is not a slogan but an absolute necessity. I have seen it work in practice: before I came here, I was involved in a project that moved care for people with hearing loss out of hospitals and into the community. Patients benefited from easier and quicker access to specialist NHS audiology and nursing services. We now need to see such an approach rolled out across the country.The neighbourhood practice model advocated by my Suffolk GP colleagues must be part of the answer, with community health hubs open into the evening, resourced with nurses and mental health services and incorporating a pharmacy, with a GP who is known to the patient and to the family. Those hubs would be the place to call when sick—a better option than calling 111 or having a long wait in A&E. They would offer access to multi-disciplinary teams all in one place, a bit like the geriatric day hospitals that my dad, Professor Derek Prinsley, a pioneer of geriatric medicine, introduced into his practice in Teesside in the 1960s.The NHS must be a neighbourhood health service, not just a national health service. That is how we join up care so that patients no longer feel like they are being pushed from pillar to post. Instead of being rushed between different appointments in hospital corridors, people should be cared for in one place, bringing lifesaving continuity of care. It is time to end the fragmented system of the past, where people ended up in A&E simply because there was nowhere else to go, and where we had older people lying in trolleys in the early hours for long-term conditions that could have been managed in primary care. A&E should be for real accidents and emergencies. That is how we must start thinking about the long-term care of long-term conditions.At the centre of our thoughts must be the patient. Health services are all too often designed to deal with patients with a single disease, but for a growing number, that is no longer a suitable model. If I have high blood pressure and asthma, I have to visit the practice three times: once for the blood pressure check and once for the asthma check, and then another appointment to see the GP. I think we can do better than that.How can we truly put the patient at the centre of healthcare? As I have said before, one answer is to embrace the digital transition and change the medical record paradigm. Let the patient have the record. Give them agency over their healthcare. If people knew a bit more about their health, they might care for it a bit better. More than one in five patients with a long-term condition has said they do not have enough information to manage their condition. That is 5.5 million people across the country who are not confident that they can manage their condition, so let us have the doctor ask the patient for the record, not the other way round. That would be a revolutionary change.I would like to talk about medical research. Of course, our country has an incredible record of medical research: Jenner, who devised vaccination; Lister, who invented antisepsis; and Fleming, who discovered penicillin—British doctors who saved unimaginable numbers of lives. Then there is Dr John Snow, who removed the handle from the water pump in Broad Street, near to where we are sitting today, ending the cholera epidemic and founding the field of public health. It is on scientific advances like those that we mostly depend as we fight many long-term conditions. We will hear of artificial pancreas pumps to treat diabetes and genetic treatments to cure sickle cell disease and arthritis, but let us not take that progress for granted. We should support medical innovation and put the best technology into the hands of our doctors.I am proud that the Government are boosting investment in diagnostic machines in hospitals across the country, because I have been told by constituents about the struggle of misdiagnosis—months and years spent unsure what is wrong with them, with doctors unable to shed any light. We are rolling out artificial intelligence and improving diagnostics across the country, and the Government have promised to support that further.Improving researchers’ access to medical data will be part of the approach. Let us imagine the scientific advances we could make if researchers could conduct studies on sample sizes of 67 million people. Scientific and medical advances depend on our brilliant young people, who must be funded and supported as they embark on research careers. The number of clinical academics is in decline, which is a particular worry of mine. We should challenge that and reverse it. The NHS is easily the biggest employer in our country—perhaps one of the biggest employers in the whole world—but what are we doing to ensure that its people can best support us?A failure to tackle long-term conditions is significantly impacting the NHS’s own workforce. Musculoskeletal conditions, rheumatoid arthritis and osteoarthritis are leading causes of absenteeism among NHS staff, with ambulance and clinical support staff particularly affected, but we also hear many examples of terrible workforce planning. We learn of nurses and midwives graduating from colleges carrying large debts, after working for thousands of hours on placements for free, only to find a recruitment freeze in the very hospitals that desperately need their skills. Instead, hospitals are spending huge sums on agency staff. This is not a long-term plan; this is short-term thinking of the very worst kind.I am glad that agency spending fell last year. We must make sure that we spend wisely on newly qualified nurses and midwives, which will end up saving the NHS enormous sums. We also ought to do something about their student debt. Why not write it off if they commit to working for five years in our NHS, giving them security? Our health service needs their expertise.What about the young doctors, of whom I have spoken before? We need enough GPs, nurses and clinicians to help people to get well, but every year, thousands of UK doctors qualify with debts of up to £100,000. Many are then sent far from home, family and friends just as they begin their careers, and after two years they face intense competition for higher training against thousands of international doctors who fill up our hospital rotas and keep our services running. Some young doctors find themselves repeating their foundation years or going overseas, and others leave medicine altogether. This is certainly not a long-term plan.We must do better. I have seen for myself that our hospitals can run better with the resources they already have. At my West Suffolk hospital I saw the results: corridor care has been abolished and long-term waits in A&E are now a thing of the past. That has been done by taking a whole-hospital approach to improve the patient experience and ensure that the appropriate health professional is dealing with the patient at the earliest opportunity. That does not cost more, the staff are happier and the service is massively better. That is what happens when we put people first, work together across the disciplines and take real responsibility for change.Mr Blair once spoke of dealing with crime and the causes of crime; today I speak of dealing with diseases and the causes of diseases. Poverty, poor nutrition and poor housing are at the heart of so much of our country’s ill health. Those are not just background factors; they are the root cause of suffering and long-term conditions. If we are truly committed to a healthier society, those are the challenges we must address.The mission of our party and our Government is to lift millions out of poverty, tackle deep inequality and shape people’s health from cradle to grave. We will not accept the shocking housing conditions endured by so many of our fellow citizens. These are not simply political and economic problems; they are the underlying causes of much disease and misery, and many avoidable deaths.There is much for us to do, but I am convinced there is much that we can do to create easier access to NHS services, improve primary care and support those who want to conduct groundbreaking medical research. I hope the Government will look to tackle our long-term conditions crisis.
- Several hon. Members rose—
- I remind Members that they must bob if they want to take part in the debate.
- 3:12 pm
- It is a real pleasure to serve under your chairship, Mr Efford. I thank the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for his learned and absolutely excellent speech. I will focus on my profession as an NHS optometrist and discuss the impact of sight loss from long-term conditions.Let us imagine a young mother-to-be sitting in my consulting room glowing with excitement, whose joy turns to fear as I gently explain to her that her sight is deteriorating—all of a sudden it becomes a race against time; she may never be able to see her baby clearly. Or let us imagine the teenage boy with dreams of a rugby career who leaves my room with the life-changing knowledge that he is losing his vision. Unfortunately, those are not extraordinary cases; they are everyday tragedies in my workplace.These long-term conditions are often framed in terms of physical health, but as someone working with patients losing their sight, I see—as the hon. Member already eloquently articulated—the more profound, layered consequences everyday: the emotional trauma, isolation and loss of independence, and the inevitability of declining mental health, which I want to concentrate on.For example, macular degeneration is the leading cause of blindness in the UK. It does not just take away people’s central vision; it also affects their ability to read, recognise faces and drive. That means grandparents may never be able to see the faces of their grandchildren; tears are a natural result of such a devastating awareness. There is also a condition called glaucoma—generally diagnosed later in life—known as a thief of sight, because it creeps up on someone silently, often unnoticed, until irreversible damage has been done. It steals more than vision; it robs people of confidence, safety and the ability to live independently. For many, the diagnosis comes too late, and with it comes a slow loss of identity.
- 3:17 pm
- It is a pleasure to serve under your chairmanship, Mr Efford. I thank my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing this extremely important debate. He speaks from a position of great experience. He rightly points to a holistic approach, putting the patient at the centre of their treatment.By 2035, two thirds of the UK population aged over 65 are expected to be living with two or more long-term conditions, whether chronic obstructive pulmonary disease, Parkinson’s, diabetes or epilepsy. Living with an LTC can significantly reduce a person’s quality of life.I rise to speak on behalf of those living with a condition that affects approximately 1.5 million women in the UK: endometriosis. This chronic condition, whereby tissue similar to the lining of the womb grows outside the uterus, causes debilitating pain, fatigue and often infertility, yet despite its prevalence it remains under-recognised and undertreated, like so many conditions that affect women. The average time to diagnose in the UK is more than eight years. Many women visit their GPs multiple times before receiving a referral, and some are forced to turn to private healthcare due to the lengthy NHS waiting times. That delay not only exacerbates the condition’s physical symptoms but impacts mental health and quality of life.Endometriosis is not merely a health issue for women; it is a public health issue that costs the UK economy. Over half of those affected have taken time off work due to endometriosis, and many fear job loss or reduced income.My constituent, Angela Tiernan, has thoracic endo-metriosis, a rare form of the condition where tissue similar to the uterine lining grows in the chest cavity, commonly affecting the diaphragm and lungs. Angela recently found out that planned surgery to confirm her diagnosis and reformulate a treatment plan would no longer be going ahead as the specialist Oxford University Hospitals has stopped commissioning the surgery, as have other specialist centres in London and Bristol. Angela has told me that patients are being advised to go private to access required treatments and surgeries that were previously available through the NHS, but have since been cancelled by the hospital. My constituent Angela and other women are now left in a position with no diagnosis and no access to investigation, care or treatment unless they can afford to go private.
- 3:21 pm
- It is a delight to speak under your chairship, Mr Efford. I thank the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing this important debate.Many of those living with long-term conditions are people who live happy and enriched lives. They are supported not only by wonders in medical advancements, but by the communities of people—friends, family or incredible NHS and care staff—who support them week in, week out, day in, day out. But for some, the consequences when those support networks fail can be catastrophic. I would like to use this opportunity to raise awareness of the plight of my constituent, Andy.Andy has been living with a benign brain tumour and functional neurological disorder for nearly a decade. In that time he has been treated in various medical settings. By 2022, he had been transferred from the care of London hospitals to medical facilities closer to home in my constituency of Eastbourne. Following an initial appointment there in April 2022, he was told that there would be a follow-up six months later. Outrageously, due to human error, the follow-up was not held until November 2024, a staggering two and a half years after his initial appointment. I hear of cases like that again and again, disproportionately from patients experiencing long-term health conditions. It seems there is no parity of esteem between people suffering from these kinds of conditions and people suffering from shorter-term, more emergency-based conditions.If that was not bad enough, Andy was subsequently informed that the services and expertise needed to treat his condition, which he had been referred to Eastbourne for, were not available locally, so one has to ask why that transfer happened in the first place. But the wider question, which goes to the point made by the hon. Member for Bury St Edmunds and Stowmarket, is why towns like Eastbourne are denied such important services locally. It cannot be right that people living with long-term conditions sometimes have to travel dozens or in some cases hundreds of miles to access the care that they deserve and rightly expect.
- 3:26 pm
- It is an honour to serve under your chairmanship, Mr Efford. I thank my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing this debate. This is also an appropriate time to acknowledge his more than four decades of service as a surgeon in the NHS.I want to use my time to talk about strokes, because I, like millions of people across the country, have a personal account of dealing with this life-altering medical condition. At 11 am on 13 August 2013, I received a message from a relative saying, “I think your dad has been in a crash. The car is all smashed up and the doors are wide open outside the house.” I was at work in Cambridge that morning, and my parents’ house was back in Norfolk. Not being able to reach my dad, I managed to get a message to my sister to go round. She found my dad in bed.Unbeknown to any of us, including my dad, he had been having a stroke all morning. Getting ready for work, he struggled to put on his coat. He forgot to pick up his car keys and initially left the house without locking the door. My mother did not think too much of it. He then somehow managed to drive her to work and drove himself to his engineering factory just a bit further down the road. When he got to work, they sent him home. They thought he was drunk.On the way home, my dad crashed into a parked lorry. Dazed and confused, and in the midst of his stroke, he drove home and took himself to bed, thinking he had a cold. If he had not left the car abandoned outside the house, and if that relative had not raised the alarm, he would have been in bed for the rest of the day alone and he likely would not have survived. As it turned out, we were able to get him to hospital and we managed to have a further 10 years with him. My dad was 55 when he had his stroke. He was fit and healthy. He worked full time. He showed no warning signs, and then—wham. He had a full-on, major stroke from nowhere.
- 3:30 pm
- It is a pleasure to serve under your chairship, Mr Efford. I thank the hon. Member for Bury St Edmunds and Stowmarket (Peter Prinsley) for securing the debate and, like the hon. Member for South West Norfolk (Terry Jermy), I thank him for his service. I did not know he was a surgeon —I thought he was a GP—but whatever it was, I thank him. We are all indebted to him for his contribution.It is great to speak in this debate as the Democratic Unionist party health spokesperson, and as an MP who has many constituents suffering from long-term health conditions. I frequently meet them to discuss the issues they face and, more often than not, the issue is benefits and help to fill in their benefit forms—I have a staff member who does nothing else but that. We are, then, face to face with those with complex and chronic long-term conditions. It is important to come here and make the case for them.I declare an interest as a type 2 diabetic. Believe it or not, this thin young man—he is not young no more, by the way—used to be 17 stone. He is now down to just over 13 stone. Whenever I was told I was diabetic, the doctor was very clear that I really had to do something. A sweet trolley was going by the table—I remember that well; it has stuck in my mind all these years—and he phoned up to tell me. I went to see him because I thought there was something wrong, and there was something wrong, but thank goodness it was not what I thought it was at the time. He said, “You’re diabetic. The one good thing is that you’ve got a heart like an ox.” That was perhaps the one good thing out of it all.I lost weight and was able to control my diabetes for four years or thereabouts, but then it got worse. I am now surviving with nine tablets in the morning and five at night. That keeps the condition subtle and manageable. This is not about me, but I wanted to tell that story because many people who are diabetic do not know they are. We always talk about early diagnosis, as the hon. Member for Bury St Edmunds and Stowmarket and others will know.
- It is an honour to intervene on the hon. Gentleman. I am the chair of the all-party parliamentary group for diabetes and I want to emphasise the point about early detection. A family recently got in touch with me who tragically lost their daughter because she had not been identified as a type 1 diabetic and ended up in diabetic ketoacidosis. Does the hon. Gentleman agree that we need to do more to identify people and screen them for chronic, lifelong conditions?
- If I could ask for one thing in this debate, it would be that—it is important.I should have welcomed the hon. Member for Wellingborough and Rushden (Gen Kitchen) to her position; apologies for not doing that at the beginning of my speech. It is a real joy to see her there. It is better than whipping, I am sure she knows. This is two debates in two days running in which we have had Parliamentary Private Secretaries and, in this case, a Whip in the place of Ministers. I wish her well in her role today.Many of the people I meet every day have diabetes, dementia, Alzheimer’s, multiple sclerosis, Parkinson’s, osteoporosis or chronic obstructive pulmonary disease. COPD has been more prevalent this last while than it has been in the past. It is an accumulative disease, of course—it comes at the end of a person’s life, unfortunately —and it catches up with people, in many cases. It is not just about the long-term physical conditions; it is the depression, the anxiety and the mental health effects, as well as the pressure of life. The physical pressures are part of it, but the mental pressures come off the back that. Many of the people I speak to have complex needs, and might have one, two or perhaps three of those conditions, which adds to the issue.Ahead of the debate I met representatives from the Cystic Fibrosis Trust and spoke to them about the effect of cystic fibrosis on people. This week, I celebrate the people, like the trust, who have responded to cystic fibrosis by trying to find a cure. CF is a chronic, life-limiting genetic condition without a cure. It affects more than 11,000 people across the UK, with approximately 500 of those diagnosed back in Northern Ireland. I meet some of them regularly in my constituency. For those living with the condition, medication and general health must be considered when planning the simplest of projects or activities—even getting out of bed, for goodness’ sake, or going down the stairs or making breakfast. Going shopping is a no-no for most of them, and interaction with family is another issue. Being unwell can interfere with work and education every day. Research has highlighted the intense financial costs of the condition, which causes an average loss in income of nearly £6,800 a year.
- 3:41 pm
- It is a pleasure to serve under your chairmanship, Mr Efford. I was a bit anxious, because I do not think I have ever followed the hon. Member for Strangford (Jim Shannon) before, and people are normally leaving as he sits down. But there we are.I congratulate my hon. Friend the Member for Bury St Edmunds and Stowmarket (Peter Prinsley) on securing such an important debate. He clearly demonstrated why he was the best person to bring this issue forward, given his years of experience.I declare an interest: I was a physiotherapist for 32 years. I was also used to dealing with long-term neurological conditions such as stroke, MS and Parkinson’s, and respiratory conditions such as asthma and COPD. They are all really important. Of course, I also dealt with long-term musculoskeletal conditions such as arthritis.For the sake of balance, I should say that my daughter is a resident doctor. I had to mention her, otherwise she would tell me off. As people can imagine, we have a very balanced debate about whether a doctor does better than a physiotherapist. We have a lot of interesting debate about that.I must thank Versus Arthritis, representatives of which I met earlier this week to talk about various conditions and the economic impact of arthritis. They reminded me about this debate. I was late asking to speak because it had completely passed me by.It is really important that we acknowledge the fact that, as other hon. Members have said, there are many people in this country living with long-term conditions and living very successful lives. We must make sure that we enable them to carry on in that way.Arthritis impacts over 20 million people in this country, which is a lot of people. Whether it is osteoarthritis or rheumatoid arthritis, nearly one in six of us is living with arthritis. Arthritis affects all ages, not just the elderly, as we tend to assume, and effects children, too. Juvenile chronic arthritis is well known, and at least 10,000 children are currently living with that condition.