Cystic Fibrosis

Part of the debate – in the House of Commons at 4:15 pm on 10 April 2014.

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Photo of Kerry McCarthy Kerry McCarthy Shadow Minister (Foreign and Commonwealth Affairs) 4:15, 10 April 2014

I thank the hon. Gentleman for his intervention. I know that he has campaigned on this issue for many years. To people who think that early-day motions are a magic bullet that will solve things overnight, I point to the hon. Gentleman, who managed to get an early-day motion calling for the removal of prescription charges for cystic fibrosis patients. I think that his early-day motion has been No. 1 on the list for many, many years, but it has not yet managed to progress. He also had a debate on the issue last year. I sometimes use him as an example of how early-day motions do not automatically mean that the Government will sit up and listen, but I hope that the Minister will listen today and hear our plea.

The previous Prime Minister, my right hon. Friend Mr Brown, recognised this issue, and his Government committed to phasing out prescription charges for people with long-term health conditions, but we did not manage to do it before the 2010 general election.

Some people with cystic fibrosis will be forced to make the difficult decision to give up work, but research conducted last year by the Cystic Fibrosis Trust with Parkinson’s UK, the Multiple Sclerosis Society and the National Rheumatoid Arthritis Society reported that Atos found 45% of people with these progressive conditions fit to work. Obviously, it has now been belatedly acknowledged that the assessments carried out by Atos were far too unreliable. Most worryingly, some people with cystic fibrosis were given “prognosis reports” of when they would recover from the illness—an illness from which it is impossible to recover.

Critically, welfare reforms may increase the barriers to getting to work and hospital appointments—not least the new personal independence payment and the 20 metres mobility limit. A survey of people with CF found that more than a third would no longer be able to work if they were not awarded the higher rate of mobility under the new PIP, while 90% said they would find it difficult to access hospital appointments. In a survey for the Cystic Fibrosis Trust, a third said that they would not be able to attend hospital appointments. The trust also warns that patients fear isolation and loss of independence, which would affect their mental health.

When I visited the Bristol adult cystic fibrosis centre last week, it was explained to me how the trust and the centre fundraise to help the service and the patients. For instance, they buy more nebulisers to lend to patients. The ordinary nebulisers are huge and cumbersome, but the nice neat little ones are far more expensive. The trust and centre want to help patients manage their condition with the least amount of inconvenience. They fundraise to buy the smaller nebulisers. They also buy physio equipment, because it is really important for CF patients to undertake exercise to loosen up the mucus on their lungs. They buy fridges for patients’ medication and desks for their rooms—as I said earlier, patients need their own rooms to avoid cross-contamination.

The Bristol centre is clearly making an invaluable difference to its patients’ lives, but it has a growing patients list, which is due in part to the very welcome increases in life expectancy. I understand that Bristol’s patient numbers are increasing in line with the national average—by around 10% each year—and the patient case load has doubled over the past six years to around 200. I think the Manchester centre has about 600 patients and is the largest in the country.

With the Bristol centre, the transfer of patients from further afield, such as from Taunton and Swindon, has contributed to the growth in numbers. This year, it is also taking on patients from Cheltenham and Bath.

Patients are often admitted for a course of intravenous antibiotics, which they will generally need about three times a year, with the antibiotics being administered about three times a day for a couple of weeks. Some patients can self-administer at home, but that is not always appropriate or safe, depending on their living conditions and how ill they are. Sometimes it may just be that they have not been monitored by the team for a while, so they will be admitted to the centre. I met a young woman who had just started work. She had an understanding employer. She had been in her new job for two weeks and then decided that she needed to go into hospital to have the intravenous antibiotics. She felt much safer there than administering a course of treatment at home, which was her normal way of doing things. The condition clearly requires considerate employers.

It seems that hospital admissions at specialist CF centres are becoming increasingly difficult to plan for and more prone to cancellation because the units cannot guarantee a bed will be available. It seems that, particularly in winter months, the specialist beds also come under pressure from other departments, which have a shortage of beds. Ordinary patients may be put in a CF unit, and the CF patients cannot get the treatment that they need. In Bristol, the annual number of in-patient “bed days” required by patients for their IV antibiotics has increased from just over 500 in 2005 to nearly 2,500. That is due to the number of patients, and not because the length of stay is increasing.

Over the past few years in particular, there has been a steeper rise in the number of bed days at home, which is now at more than 3,500 annually. The unit is trying to facilitate more self-care at home and has developed an outreach service so that patients do not always have to travel to Bristol. It also tries to offer community liaison and health care at home, for example to help with IVs, and is developing innovative ways to help patients, including through an agreement with BUPA to deliver supplies to the homes. There can be huge amount of equipment and pills and so on, and patients who have to use public transport to get to the hospital, perhaps not feeling very well as they are travelling, do not want to have to carry huge amounts of drugs and equipment around with them. That delivery service is proving very useful. Staffing and resources, however, mean that the centre has limited capacity for outreach and community services.

Importantly, the University Hospitals Bristol NHS Trust is working with the centre and has increased funding for specialist staff but, more generally, the Cystic Fibrosis Trust told me that specialist CF centres around the UK are reporting that resources, personnel and space provision are inadequate and warns that in light of the increasing patient numbers nationally the lack of capacity for in-patient beds, combined with a lack of funding for out-patient staff, threatens to curtail the clear progress made over the past few decades. I would therefore be grateful if the Minister could update us on the Department of Health’s plans to ensure that CF services are equipped to keep up with increasing patient numbers and the complexity of the condition and assure me that she will work with the Cystic Fibrosis Trust, the specialist centres and their expert staff. Will she also consider the issue of co-ordination between trusts? For example, CF patients who phone an ambulance will often not be taken to the specialist centres even though their consultants recommend it.

Some patients will be assessed and referred for a lung transplant and, as the Minister will be aware, last month the Cystic Fibrosis Trust launched its “Hope for more” campaign. Although a lung transplant is not appropriate for everyone with CF and does not cure it, it can mean the priceless gift of a few more years for the patient and their family. Tragically, though, one in three people with CF on the lung transplant waiting list will die before they can receive one, so the Cystic Fibrosis Trust is campaigning to maximise the use of organs and increase the number of organs available for transplant.

One tragic case was that of Kerry Thorpe, a very brave young woman who became the face of the organ donor campaign. She died only a few weeks ago at the end of March at the age of 23, because new lungs could not be found for her. She spent seven years on the waiting list. Today, I was sent an account from the Daily Record of another 23-year-old, Lynette Armitage, who had a lung transplant in December in an eight-and-a-half-hour operation. She asked surgeons whether she could have a photo of her old lungs when they removed them, but they told her that the lungs had completely disintegrated when they had taken them out. They were only held together by her rib cage and the surgeons said that if she had not had a transplant within the next two weeks, she would have died. The lungs got to her just in time. It might be that she lives for another seven years or so, which is the average, but some people who have had transplants can live into their 50s or 60s. She is talking about having a normal life, having children and looking forward to going to T in the Park this year. That just shows what a difference can be made if lungs can be found: two 23-year-olds with very different outcomes.

There are a number of ways to reduce the length of time people are waiting and, critically, to reduce the number of deaths. That includes increasing organ donation rates and promoting more public discussion on organ donation. Less than a third of donors are registered, so it is not necessarily an obstacle if someone is not on the register. The Cystic Fibrosis Trust reports that the UK has one of the highest rates of family refusal in the western world. I am not suggesting that this is an easy decision for bereaved families to make during such a difficult and emotionally charged period, particularly if the family member has died suddenly, but it is nevertheless an indication of the need to focus on consent as well as registration and to ensure that more people understand what an incredible and generous gift they can give to other people if they sign up to be donors.

The organ donation taskforce led to a 50% increase in the number of deceased donors and a 30.5% increase in transplants in the five years to 2013. That was important progress, but I am sure the Minister will agree there is still more to be done. I would be grateful if she could update us on the “Taking Organ Transplantation to 2020” strategy and the latest assessment of the case for an opt-out system. I know that Wales is moving to a system of presumed consent next year.

As the Cystic Fibrosis Trust has highlighted, it is not only a case of increasing donor rates, as significant numbers of donor lungs are not used, despite the next of kin giving their consent. Lungs from fewer than 25% of donors after brain death are utilised in transplantation. Medical innovation means that more lungs could be used, and the trust has called for more transplant surgeons to be trained in downsizing donor lungs. It has also funded a study at the university of Newcastle on ex-vivo lung perfusion, a technique for the assessment and potential repair of sub-optimal lungs. That was explained to me as a service where damaged lungs are reconditioned so that they are fit for use in transplants. I urge the Minister to consider the results of that study, and whether such techniques could increase the number of suitable donor organs.

In recommending the development of a national lung allocation system, the report focuses on a concern amongst the cystic fibrosis community about the equity of lung allocation, and whether they go to those most in need, irrespective of where the person lives. I am aware that NHSBT has developed a new super-urgent group, separate from the main waiting list, but the Cystic Fibrosis Trust emphasises that that is unlikely to have a significant impact on people with cystic fibrosis waiting for a transplant. It also highlights the evidence from the USA, where the introduction of the lung allocation system led to an increase in the number of transplants and a significant reduction in the number of people with cystic fibrosis dying while on the waiting list.