Sunday, June 18, 2017

Influencing Government Policy

Taken a break from writing my blog while I've been engaged in campaigning for the right to represent Montgomeryshire in the House of Commons for another five years (or however long the current Parliament lasts). Personally, I reckon it will last much longer than some seem to think. Anyway a friend of mine asked me tonight to start blogging again. So here goes with what I was just thinking about.
It was an unusual election, in that I've not before seen so much rubbish doing the rounds on the Internet. Generally it was stuff intended to cause me electoral damage. My policy is that it's best just to totally ignore it, letting the 'keyboard warriors' talk amongst themselves. Whatever, it doesn't seem to had much negative impact!

Now there's no point in trying to justify in the face of this stuff, unless there's a purpose - such as trying to explain how Westminster works. It can be a bit of a mystery. Anyway, this stemmed from a casual comment by me that I was, in general, quite devolutionary. The keyboard warriors went to town, listing all the occasions I've voted against devolving more powers to the Welsh Parliament. I also pointed out that because further devolution is not that popular, these accusatory posters, intended to damage me, were more like.y to have the opposite effect. But on to the point I want to make about process.
Over the last year or so, as PPS in the Wales Office, I've been involved in taking the Wales Bill through Parliament. In general the Wales Act, passed earlier this year devolves more powers to the Welsh Parliament. What happened (as always happens) is that other parties during the various Parliamentary stages put down amendments to amend, or strengthen the Bill. They don't expect these amendments to carry, usually just putting down markers or making points. Government accepts some of them, puts on some itself, while other amendments are withdrawn. A few are pushed to a division, where Government invariably votes them down. It how legislation is debated and developed. The Wales Bill, very unusually, became an Act without and amendment succeeding in either the Commons or the Lords.
But this process means there are many amendments I vote against, giving 'keyboard warriors' who have time on their hands to trawl the Internet, putting together 'evidence' that I am anti devolutionary. So happens, I usually have far more politically damaging criticism that I am too devolutionary - which is why in this instance the 'keyboard warriors' were inadvertently being helpful. I particularly enjoyed that! But this post is to explain one aspect of how a bill makes its way to the statute book.

Thursday, May 25, 2017

Conservative Manifesto on Funding of Care for the Elderly.

There has been quite a bit of negative publicity about proposed changes to support of the elderly in the Conservative manifesto. Personally, I think it unjustified. But let's  consider it in more detail - starting with the background policy context. We have a Prime Minister who is committed to governing in the interests of everyone. I share her commitment. I also have a long standing personal interest to supporting the frail elderly, the number of whom is increasing very quickly indeed. We cannot carry on as we have been doing over recent decades. The system of care will collapse. The voice of the frail elderly is not being heard. The challenge is to create a care system that is both fair and sustainable. 

There are three changes in future policy written into our manifesto which affect the elderly. Let's consider them in turn. Firstly, we want to introduce a system of financing domiciliary care similar to the current rules on financing residential care - only fairer. For my constituents in Montgomeryshire, its important to note that no change is proposed in Wales, where social care is devolved to the Welsh Government. As the changes affect England, two crucial points are being ignored. Firstly care will be free to anyone worth £100,000 or less. And no matter what value assets anyone has, there will be a maximum total payment (suggested in recent years as likely to be about £70,000).

Secondly, it is proposed that what is known as the 'triple lock' on state pension increases is being replaced by 'a double lock'. The state pension will not automatically increase by 2.5% if inflation is lower. So while inflation is 2.5% or above, which it currently is, the change has no effect whatsoever because it will rise by inflation anyway. In future, there will be a 'double lock' which guarantees that the state pension will increase by inflation or increased level of earnings, whichever is the higher. The problem to be addressed was that following the long period of very low inflation, a degree of inter generational unfairness developed, creating unacceptable pressure on young families and support payments. The 'triple lock' has the potential to divert too much of the welfare budget into the state pension at the expense of everything else. Adopting a 'double lock' is a small change which will deliver more fairness in the long term.

The third change relates to the Winter Fuel Allowance, which will in future be means tested and will continue unchanged for those who need it. Over recent years I've received many emails calling for this change, usually from people who have given their allowance to charity because they felt they had no need of it.

I simply cannot agree that the Prime Minister is being unfair. She, and I are both focussed on fairness, creating a sustainable affordable system of welfare payments and a manifesto which is open and honest about future policy.

Saturday, April 15, 2017

Should farmers grow trees post Brexit.

Two articles of interest to me in today's Telegraph. Firstly, an article about challenges facing farming post-Brexit. And secondly, a report, of dubious provenance that UK is to scrap EU renewable energy targets. Let's consider the future economics of farming first. Its all conjecture at this stage of course. We have no real idea of what the position will be.

There are two main concerns facing the farming industry. Firstly there is the annual subsidy payments, guaranteed up to 2020, but not afterwards. The background to this policy of subsidy was the then Govt's 'cheap food policy' after the Second World War. Over recent years it's become an essential support to farming. Many farms would not be viable without the subsidy payment. It's not a healthy position for any industry to be dependent on subsidy into the far distance but a cliff-edge cut off in 2020 would be devastating. Let me take a guess at what might happen post Brexit. Subsidy will gradually move from being universal to being paid for a specific 'public benefit' - principally environment enhancing payments. It's moving that way already. Perhaps this could involve planting up land, currently used for arable or livestock, with trees. I've long thought a forestry expansion programme to make sense, economically and environmentally. Support guarantees would have to be long term, include for public access for recreation - walking, biking activities etc.. Whatever, most switched on farmers are already looking at diversification of one sort or another.

The second concern for farmers, especially sheep farmers in Wales is access to EU markets at nil or manageably low tariffs. Wales is particularly dependent on lamb exports. All the current talk by the NFU about 'food security' doesn't apply here. Hopefully, there will be a UK/EU deal which covers lamb exports, but in the longer run, we could see development of other markets or a gradual move from sheep farming to forestry perhaps.

Now for the possible link with the other Telegraph story - about the UK abandoning EU 'renewable energy' targets. We are legally obliged to access 15% of our energy from 'renewable sources' by 2020. I've always thought trans-EU targets as a nonsense. This 15% target doesn't include energy efficiency, carbon capture or nuclear power. That's makes no sense. While I think the UK will be well rid of EU targets post Brexit, we will need low carbon targets of our own. We need to think laterally. From a global perspective, we would acheive more cost benefit by investing in solar energy in a hot African country than ploughing money into solar in the UK. Such a policy could be linked with our foreign aid commitments. Let us use our UK resources to develop battery technology, carbon capture or hydrogen/electric cars rather than ploughing resources into second rate established technologies which put up the bills of energy customers.  Or maybe more biomass from the millions of acres of extra trees we might grow, rather than import timber great distances from faraway countries, as if carbon emissions are not a global issue. We could have a UK renewables policy suited to our own circumstances.

This is all very early consideration of how we might change policy to cope with Brexit. I expect to return to these issues from time to time - and don't rule out having an entirely different perspective next time. We live in uncertain times.

Friday, April 14, 2017

Hospitals row is built on misunderstanding.

Its many years since I concluded that the NHS hospitals structure that most Montgomeryshire patients depend on, (located in Shropshire) is unsustainable. For years it's been clear that two major hospitals providing all NHS services is unsustainable. It leads to a poorer standard of service, costs more to manage and delivers less satisfying outcomes for patients. It's been clear for years that one hospital should be 'hot' and the other hospital should be 'cold' - one hospital should deal with 'emergency' care and the other hospital should cover 'planned' care.

For some unthought through reason a pubic battle, complete with campaigns, shouting matches, public marches and political manoeuvrings has focussed on 'winning' the 'hot' services. All I care about is putting in place the best service - for my constituents and for Shropshire and Mid Wales as a whole. A few years ago I wasn't certain whether Montgomeryshire patients would benefit more from 'hot' or 'cold'. Unfortunately, a chief executive named Adam Cairns arrived in Shropshire and made a total pigs ear of things (before clearing off to Cardiff and then the Middle East) . To an extent we are still clearing up the ill-considered mess he left. From a Montgomeryshire perspective I asked people whether they wanted 'emergency' care (hot) or 'planned' care (cold) in the nearer hospital at Shrewsbury, or at Telford. Telford would be 20 minutes further away for emergencies ((under blue light) and more like 45 minutes further for planned care. They all wanted emergency care at Shrewsbury. Fair enough, but I always thought it was a marginal call. Illogically, the NHS care commissioners based at Telford and Wrekin wanted the 'hot' site in Telford. Deeply regrettably, the Council has become involved and made it a 'political' issue rather that a 'patient benefit' issue. The people of Telford have been misled (in my opinion) about what the planned care option means.

Firstly, the Princess Royal at Telford will continue to be an A&E for about 60% of the people who pitch up at at A&E now. It will perform 28,000 day case and inpatient procedures per year. Cancelled appointments would largely disappear as the priority given to emergency cases would cease (since they would be taken to a new emergency unit at Shrewsbury. It will provide several specialist services and, most importantly, there would be more specialist consultants on site. There would be the same no of beds as now. Most children's and women's services would remain in the Princess Royal, included most maternity, (Though not the most complex cases). Majority of orthopaedics would be in Telford and a new purpose built Edoscopy facility. There would be Centres of Excellence in Bariatric and Breast Services and chemotherapy services would be in the Princess Royal as well. The proposed new NHS Structure to serve Shropshire and Mid Wales would be based on two sustainable complemtary major hospitals, capable of attracting new services and consultants to our area. It can only go ahead with investment of around £200million in the two hospitals. We have a very short period to commit to this new arrangement. If we don't commit very soon, the investment will be lost to compelling cases elsewhere. It will be an absolute tragedy for Shropshire and Mid Wales and the patients living in the area if the bickering, the dithering  and political posturing prevents it going ahead.




Thursday, April 13, 2017

'Avoidable Deaths' in Shrewsbury and Telford Hospitals.

The dominant UK story today of interest to me has concerned 'avoidable deaths' of babies at or soon after birth, under the care of doctors and midwifes based at the Royal Shrewsbury Hospital and the Princess Royal Hospital in Telford. The BBC have given this issue a very high profile - a bit  surprising to me because there was nothing I didn't know already. It's a very emotive issue. Every death of a baby at birth is a personal tragedy for the affected family. It must seem much worse if it's concluded that the death was 'avoidable'. I find it difficult to grasp just how sad and tragic losing a baby in such circumstances must be.

When first contacted by the media to comment on this story yesterday, I was very reluctant to become involved. Certainly did not wish to comment on any individual case. That would be for the family involved. Initially, the media was unsure what this story had to do with Wales. I had to explain that there are no consultant led maternity services in Montgomeryshire, and the majority of mums cross the border into Shropshire for hospital based births. Any births expected to carry extra 'risk' will take place at the new Women's and Children's Hospital at Telford. Today, I agreed to be interviewed by BBC Wales, by Newyddion and by Post Prynhawn on Radio Wales. I believe both TV channels also interviewed a Newtown family who lost a child.

Over the last 15 years, I've taken a very keen interest in the delivery of secondary care services in Shropshire. Montgomeryshire depends on them. The reason I was not surprised by today's news story was that I was involved in detailed discussions with the Chief Executive of the SaTH (Shrewsbury and Telford NHS Hospitals Trust) last month. We all welcomed the decision taken in January by Secretary of State for Health, Jeremy Hunt to ask NHS England and NHS Improvement to investigate each case over recent years where the death of a baby was judged to be 'avoidable'. SaTH has also asked the Royal College of Obstreticians to review its entire maternity service, and return six months later to assess progress against any targets set. It's so important to SaTH that it's maternity services is top standard and known to be top standard.

A real worry to me arising out of today's publicity is the negative impact it may have on the thinking of consultants who might think about coming to work in Shropshire. There is already serious pressure on some services arising from an inability to attract consultants to Shropshire. Inevitably, insufficient consultant cover means clinically unsafe services and then the migration of services out of Shropshire altogether and further away from Mid Wales. That's why a proper response to the 'avoidable baby deaths' issue is so crucial. Over the last few months, I have developed a growing respect for the current SaTH management, and expect a response based on fulsome apologies to every family affected, an intense investigation into every case and total transparency. It's the only response that will be acceptable.


Wednesday, April 12, 2017

Dithering over Shropshire NHS Reform.

This week it's my turn to write the 'Politically Speaking' column for the County Times. So I've decided to get a few things off my chest. As follows;

Not for the first time, my 'Politically Speaking' column concerns the Shropshire NHS services available to patients in mid Wales. The current position is deeply worrying.  In 2014 all management groups in Shropshire and Mid Wales agreed reform of A&E service provision has to be reformed to remain clinically safe and sustainable. Both Clinical Commissioning Groups (CCGs), SaTH (Shrewsbury and Telford NHS Hospital Trust, and Powys agreed to set up an organisation called 'Future Fit' (a weird confusing title) to recommend how reform should be taken forward. They decisively recommended that there should be one Emergency Centre, located at Shrewsbury, which would handle about 20% of those currently turning up at A&E - the 20% that are life-threatening emergencies. It would also handle complex births and paediatrics. 'Future Fit' took 3 years and investment of £2 million pounds to arrive at its recommendation - only for Telford and Wrekin CCG to reject it last Christmas. This was a stunning blow to those of us who want to see thriving hospitals at both Shrewsbury and Telford, serving Shropshire and Mid Wales patients.

For a few days the two CCGs and 'Future Fit' were like rabbits in headlights. Eventually it was decided the only way forward was to commission a report to establish the credibility and soundness of the 'Future Fit' report which had been rejected. This should have been produced many weeks ago, in order that the next stage of public consultation could begin. We are still waiting! I become increasingly fearful that the Chief Executive of 'Future Fit' is not capable of delivering this report in time. The current dithering and delay is simply not acceptable. Unless there is real progress in the next week or two, the Chief Executive of 'Future Fit' should be replaced. The NHS serving Shropshire and Mid Wales is too important to be left floundering because of a failure to deliver. We have waited long enough. Patience has been exhausted.

And another important change is needed. The two CCGs who could not reach agreement should both be scrapped, and replaced by one Shropshire CCG. It seems that this change is on the agenda, but it should happen now. It's clear that the territorial instincts inherent in the current CCG structure is incapable of making decisions for the overall benefit of Shropshire and Mid Wales patients. If it's accepted that merger is the only way forward, and I think it is, why not get on with it and sort it now. While all this dithering and posturing continues, it is the patients who suffer.

In situations like this, it's easy to just let things drift. But 'drift' has serious implication for the NHS serving Shropshire and Mid Wales. The refusal to commit to reform which all the clinicians, (and those not seeking to pursue political interests) know are crucial to a safe and sustainable future, make both Shrewsbury and Telford Hospitals look unsustainable to the rest of the UK (even the world, where quality consultants often come from). They will not come to work in Shropshire. We know that two weeks ago, neurological services for all new patients were transferred with immediate effect to Wolverhampton. I'm president of both the local branches of Motor Neurone Disease and Parkinson's so appreciate the implications of this. The reason is inability to attract suitable skilled consultants. More and more services will be transferred to Stoke, Wolverhampton and elsewhere. It’s happening now. 

And finally there's the availability of Government money to finance the reform of emergency services. It will need around £200 million. Currently, we have a small window of opportunity to access the money. Further delay will see this window close, see reform stifled for the long term, and Shropshire hospitals lose services to further afield. And it's the injured, the seriously ill and the frail who will pay the price for dithering. It's utterly shameful.

Tuesday, April 11, 2017

World Parkinson's Disease Day

Despite having no family history of Parkinson's Disease or Motor Neurone Disease, I'm president of local Montgomeryshire branches of both. So called today by a PD lunch at the Royal Oak where members were enjoying a lunch to mark the 200th anniversary of an essay written by Dr James Parkinson on The Shaking Palsy, the first recognition of the condition Peter to be named after him. He observed that if a patient placed a trembling arm on a table and it stopped shaking, the patient did not have PD, or what he called The Shaking Palsy. If it continued to shake, the patient did suffer from the condition. I'm sure Dr Parkinson would be disappointed if he were alive today to observe that there is not a total cure for the condition. There have certainly been improvements in treatment, and better controls enabling many who live with PD to enjoy much more full and active lives. April 11th is still designated World Parkinson's Disease Day because it was Dr Parkinson's birthday.

The cause of Parkinson's was not established until the 1950s, when it became understood that the cause is cell damage in the mid-brain leading to a decrease in the amount of dopamine produced. This causes neurones to fire uncontrollably which leads to the patients loss of control. Since then drugs have been developed to correct the dopamine difficiency, and later a procedure known as 'deep brain stimulation' further improved treatment. Dr Parkinson might have hoped for more in 200 yrs.

Through my involvement with people living with neurological diseases, I've learned quite a bit about them. Many have become good friends. I'm sure there will someday be a complete treatment which reverses the progression of PD and not just controls it. Coincidentally, there is discussion in today's news about promising research which may deliver progress. I've read this sort of report before. We will have to wait and see.

And finally, I never fail to be emotionally effected by just how accepting of the condition those living with PD are. Invariably they just get on with life and make the best of it. When I accepted the wonderful Ann Smedley's invitation to be president of the Montgomeryshire branch of PD, I had not realised how rewarding it would be.