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20 May 2008 : Column 20WH—continued

Like the Prime Minister and the Foreign Secretary, who have both recently spoken on this subject, I am happy to celebrate this historic anniversary. As we have heard, the establishment in 1948 of a homeland for the Jewish people followed centuries of discrimination and persecution. As hon. Members have said, the holocaust was persecution at its most chillingly murderous, and the Jewish people had long suffered such hatred. In trying to describe the uniqueness of Israel, my hon. Friend the Member for Birmingham, Erdington (Mr. Simon) reminded us that the country was created out of that crucible of horror and in a maelstrom of further violence. It is a tribute to the tenacity and imagination of the Israelis that their country has, in just 60 years, developed from a fragile political novelty into the vibrant, economically dynamic and technologically
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advanced country it is today. No one mentioned it but, from a mere 650,000, Israel’s population has grown to 7 million, which includes immigrants from 96 countries, speaking 66 different languages.

My hon. Friend the Member for Grantham and Stamford reminded us that Israel’s gross domestic product per capita is comparable to that of some of the Gulf states, which is remarkable. It does not have coal, oil or gas—or only a little: perhaps some will be found offshore—so those figures are a great achievement. We have heard from hon. Members some of the details of Israel’s turbulent history. The hon. Member for Harwich (Mr. Carswell) reminded us of its great economic and scientific achievements, which were created and recorded in the teeth of wars. I am old enough to remember listening to what I think was the first account I ever heard of a war—the 1967 war, which was broadcast almost live. I doubt whether there had been a war, certainly since the second world war, with such a commentary. Yet at the same time the great achievements that the hon. Gentleman outlined were under way.

My hon. Friend the Member for Birmingham, Northfield (Richard Burden) is a doughty contributor to debates on Israel and he cares enormously about the region. He reminded us of the collective memory of not only the Israelis but the Palestinians. He told us that the Palestinians must be not only tolerated but welcomed as citizens of Israel. I have met many Palestinians in Israel who feel that they are welcomed, but I know what he means. The debate about the place of Palestinians is as active now as it was 60 years ago in the state of Israel, and it cannot be ignored. The day after Israel’s birthday party, none of the issues, such as the religious settler divide and the place of minorities—especially Israeli Arabs—appears any easier. They must be made easier—a way through must be found.

The hon. Member for North-East Bedfordshire (Alistair Burt) reminded us in a wonderfully apposite way of the military and terrorist threats that poison relations between Israel and its neighbours and affect the debate about what kind of state Israel should be. That problem has never gone away.

My hon. Friend the Member for Gateshead, East and Washington, West (Mrs. Hodgson) listed some of the Israeli state’s social, health care and educational achievements and the lessons that we might learn from them—especially those achievements generated by mass immigration of sometimes poor and poorly educated people into a small, crowded country. That involves recognition of what a great potential asset they are to the state, as the hon. Members for Harwich and for Aylesbury (Mr. Lidington) and my hon. Friend the Member for Liverpool, Riverside (Mrs. Ellman) said.

My hon. Friend the Member for Hendon (Mr. Dismore) highlighted the numbers of Jewish refugees who, in the early days, returned to what they considered to be their homeland. The story is not a simple one of the displacement of one people because another people moved in. It was a complicated time and, as I have said before, there were great hopes that people could live in one state or in a federation of nations in the region. The present situation is a consequence of a litany of war and hostility, enunciated so well by my hon. Friend the Member for Grantham and Stamford.

My hon. Friend the Member for Hendon said that Israel may have won the military wars but it has largely lost the war of public opinion, and I think that he is
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right in many ways. The war continues. There should not be a war; what is happening should be about information, and some of the tremendous achievements that we have heard about today should weigh in on the side of acceptance that a state exists that should be living in peace with its neighbours. My hon. Friend told us, as others did, of the threat to Israel and to other, Arab, states posed by Iran with its expansionist rhetoric, if not actions.

My hon. Friend the Member for Islington, North (Jeremy Corbyn) always takes part in debates on Israel. He reminded us that there will be a Select Committee hearing this afternoon on the occupied Palestinian territories and aid from this country, which is very extensive, as is aid from the EU. He reminded us of the destruction of villages and, most vividly, of the dreadful humanitarian situation in Gaza. He is right to bring that to the debate, because there will not be peace in the area until the problems are solved. The humanitarian situation in Gaza is shocking, and I know that my hon. Friend understands full well the tensions generated not just by what he describes as the fence of barbed wire and blockades around Gaza, but by rockets being fired out of Gaza and bombs hitting it. That is an intolerable situation, which must be resolved.

My hon. Friend the Member for Grantham and Stamford reminded us of one of the reasons for what is happening. I, too, can think of very few peoples who have been as badly served by their leaders as the Palestinians. It is dreadful. I remember when I began to hear the first stories of the corruption of the Arafat regime. I suspect that that corruption continues to this day, and it has done no good to the reputation of the Palestinian leadership.

John Barrett: Will the Minister add something about what the former Prime Minister Tony Blair has added to the mix in his new role as peace envoy to the middle east?

Dr. Howells: I was going to come on to that, because I wanted to answer some of the comments made by the hon. Member for East Dunbartonshire (Jo Swinson).

My hon. Friend the Member for Islington, North is right to highlight the matter of the 71 Palestinian parliamentarians who remain in jail. They should be either charged and tried, or released. It is as simple as that. It does Israel’s reputation no good when that story circulates continuously through the Arab streets.

My hon. Friend the Member for Liverpool, Riverside enunciated some great achievements and contrasted them well and sharply with the cult of death and the absurdity of wallowing in the notion that suicide bombing is somehow a redemption of what has happened to the Palestinian people. Suicide bombings are obscenity, and that philosophy should be resisted at all times.

The hon. Member for East Dunbartonshire spoke of Israel’s remarkable achievements, but I do not agree with her that the Quartet is driven by the US. I have had the privilege of taking part in Quartet meetings and the US is one player, along with the UN, the EU and Russia. Those representative bodies are not easily pushed to one side. I have had the privilege of travelling extensively across the region and speaking to Arab leaders and ordinary citizens, and I believe that Tony Blair was a good choice as an envoy. He is capable of making a
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difference in helping to mobilise the economic potential of the region. I remind the hon. Lady that the Quartet met the United Arab Emirates, Egypt, Saudi Arabia and Jordan in London on 2 May. Those were useful talks and, like the hon. Member for Aylesbury, I hope that, as part of the Annapolis process, they succeed.

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NHS (Elderly People)

11 am

Mr. Richard Benyon (Newbury) (Con): It is a pleasure to be under your watchful eye, Mr. Atkinson. I recognise that I must approach this important subject with a degree of caution. If my remarks are not balanced, it will diminish the arguments that I seek to make. I shall therefore start by putting on record the fact that millions of elderly people are treated successfully every year in the national health service. Staff across the NHS do heroic work to care for people whatever their age, and we owe those dedicated professionals our profound thanks. My family and I have received superb care from the NHS, and while spending a day as a porter at my local hospital, the Royal Berkshire hospital, I witnessed superb care being given to elderly patients.

However, I would not want that glowing accolade to cover up the key point of this debate, which is to show that there are problems with care for the elderly in the NHS. I aim to draw to the House’s attention the plight of a minority for whom hospital is a frightening and often unpleasant place. I am sure that I am not alone in finding in my postbag and hearing in my surgeries increasing concern about the negative experiences of elderly patients in hospital. That does not necessarily apply only to my local hospitals; people come to us to talk about the treatment of relatives all over the country.

The moving force behind my application for this debate was a well-known constituent of mine who contacted me. The name Jenny Pitman will be familiar to anybody who has been involved or has an interest in racing, but her name has gone further. She is not just a successful trainer of grand national winners; she is a woman of huge strength of character and forthright views. Having recovered from cancer herself, she knows all about how the NHS works. Her elderly but hitherto healthy father died of clostridium difficile in a local hospital. That tragedy prompted her to make some remarks that hit the national press. After that, she was deluged with letters and e-mails from around the country detailing horrific cases of appalling care standards and neglect. She has shared that correspondence with me. I have some of it with me today, and I intend during this debate to give voice to the many families who have experienced the distress of witnessing a loved one die through neglect or receive treatment that falls short of the standards that we all expect. I shall detail some of those tragic cases in order to highlight the range of ways in which elderly patients are being failed by the NHS, outlining problems with hygiene, a lack of basic care and respect for patients, poor nutrition and, perhaps most importantly, a lack of specialist training in dealing with the elderly, particularly those with dementia.

It is important to note that older people are the main adult users of most NHS services. However, it is clear that the NHS is not organised with older people’s needs at the forefront. That is not just my view; it is also the view of Age Concern. Recent research by the British Medical Association showed that doctors believe that health care services for elderly people are simply not good enough. The research found that eight in 10 doctors believe that health care services for older people are not up to scratch, and only one in 10 believes that enough money is being spent on care for the elderly in the NHS.

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Mr. Andrew Smith (Oxford, East) (Lab): I congratulate my near neighbour on securing this debate on an important issue. He referred to the level of resourcing; we are all aware of the challenge presented by an ageing population. Does he agree that many instances of inappropriate care or lack of adequate nutrition—constituents have certainly drawn to my attention cases of people not being fed properly in hospital—have less to do with the level of resourcing than with the need to improve training and supervision in hospitals on day-to-day care, such as actually feeding people rather than just putting a tray in front of them? That is something that we all want to see.

Mr. Benyon: I agree entirely. The right hon. Gentleman makes a good point. Nobody in this House would deny that enormous resources have been put into the NHS. I am simply voicing doctors’ opinions on resources as expressed through the British Medical Association. He is absolutely right: the problem is often not financial but cultural, the result of individual, fairly low-level managerial decisions, and it can be rectified without any great call for new resources. However, I shall come to that in a minute.

On 13 March in this Chamber, Members debated the 2007 report of the Joint Committee on Human Rights on the human rights of older people in health care. The report—this is the point that the right hon. Gentleman alluded to—found that a complete change of culture is needed to protect the human rights and dignity of older people in the NHS. Health care professionals as well as patients are speaking out, and it is important that the Government not only listen but act.

Our ageing population is arguably a product of the NHS’s success in other areas. There are just under 5 million Britons aged 75 and over, and the number of people over 85 will double nationally in the next 20 years. In my constituency, and possibly that of the right hon. Gentleman as well, it will double in the next 10 years. Unless we address the problems now, we face a demographic time bomb that will cause huge problems for future health care provision. With more elderly people in the UK relying on the NHS for treatment, it has never been more important that the problems with standards of care for the elderly are addressed.

I should like to extend this debate to the issue of care for those with learning difficulties, but I recognise that an important inquiry is going on in the Department of Health involving six cases, one of which occurred in my constituency. We await the report, which is the product of important work by Mencap, but it is vital to recognise that too many cases of unforgivable neglect occur because staff have not had the time, training or ability to attend to their patients’ most basic needs. That must change.

It is clear from reading just a few of the letters that Jenny Pitman and I have received from people whose elderly relatives have had unpleasant or upsetting experiences in our hospitals that the problem—when it occurs; it is important to make that point—lies in an absence of the most basic care. Nursing staff are clearly overstretched. There are far too many patients per nurse. As a result, the most fundamental aspects of care, such as feeding, changing and bathing, are being overlooked.

I spoke this weekend to a nurse who discussed the shortage of nurses going into geriatric care. She told me how an average shift is structured. It is not unusual for
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half of it to be taken up with—I shall choose my words carefully—bodily functions: bedpans, soiled bed linen and so on. It is not glamorous work. It can take about 45 minutes to feed a patient. While doing their best to keep the ward clean, cater for new admissions and handle patient crises, NHS staff just do not have the time to give the level of care that most of them would like to give.

One constituent told me of the experience of his father, Mr. Albert Unwin, who died earlier this year. Mr. Unwin went into hospital for treatment for a knee injury. He was left in a side room, unable to get out of bed and with his urine bottle and emergency alarm out of reach, for long periods. On one occasion, Mr. Unwin grew desperate and, hearing voices outside the room, started shouting to get a nurse’s attention. Twenty minutes later, and growing increasingly desperate, he was forced to use a Marmite jar left beside his bed to bang on his metal rails to draw someone’s attention. Another 20 minutes later, a nurse came in and chastised him for making such a racket. Where is the dignity and, more worryingly, the care, in that?

All too often, it seems that older people are being made to feel invisible in our hospitals and driven to “misbehaving”—that was the word that the nurse used in that case—to get the attention of staff when in urgent need of assistance. Cases such as Mr. Unwin’s prove that simple elements of care, such as ensuring that a patient’s emergency alarm is within reach, are not being carried out, resulting in unnecessary distress to patients. Just last month, the Department of Health released figures on its website revealing that despite massive investment in the NHS, the patient experience is actually getting worse. Hospital standards have slipped on cleanliness, friendliness and comfort from last year.

A student nurse wrote to Jenny Pitman outlining her own experience working in a hospital. She exposed massive understaffing resulting in the gross neglect of elderly patients, and recorded incidents of patients being left sitting in their own faeces and ending up with severe bed sores, of rough and disrespectful treatment of patients while washing and of a shocking lack of attention to cleanliness, whereby wash bowls were not changed or properly cleaned between patients—that means patients having their faces washed in a bowl that had cleaned previous patients’ bodies. Nobody can read that e-mail without being profoundly shocked. I recognise that it is an exception, but even with that caveat it is absolutely disgraceful that such things happen in this day and age.

Unfortunately, such reports of a lack of attention to hygiene are a recurring theme in letters that I receive. As we know, hospital cleanliness is of the utmost importance, particularly for elderly patients, who are known to be the most vulnerable to superbugs such as clostridium difficile and MRSA. According to the Health Protection Agency, in 2007, there were an estimated 49,785 record cases of C. diff across the UK in patients aged 64 and older, and 6,383 reports of MRSA between 2006-07. Professor Brendan Wren, from the London School of Hygiene and Tropical Medicine, claims that 6,500 people die of C. diff in UK hospitals every year, which is the equivalent of one person dying every hour in our hospitals. In 2003-04, there were 7,700 reported cases of MRSA, which means that there would have to have been a total of 3,850 or fewer cases of MRSA last year to meet the Government’s target. However, HPA figures released in
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April showed that there were 3,471 cases in the first three quarters, meaning that we really must question whether the Government are meeting their target for controlling such hospital-borne infections.

Frankly, infection control in hospitals needs improving, and the lack of management of infection control in some hospitals, wards, and hospital facilities needs to change. Although it is encouraging that work is being done by PCTs and trusts to tackle the issue of cleanliness in hospitals, more needs to be done. I accept that we are deep cleaning our hospitals, but there is no evidence that this is a long-term solution. What really needs to be addressed is the attitude of staff to hygiene through managerial support and appropriate training, so that cleaning wash bowls, for example, becomes a priority, rather than something that can be overlooked owing to lack of time. Regular hygiene control must become a habit, rather than a one-off.

I have tabled some written questions on venous thromboembolism, which is known as the silent killer, cases of which have increased dramatically—in fact, my predecessor but one as the Member for Newbury, died of just that condition. I feel very strongly about it, and we are starting to see an increasingly huge number of claims against the NHS. It is an area of concern that will mirror concern about MRSA and C. diff in coming years.

An issue that seems disproportionately to affect older people in hospitals is the lack of dignity that they are afforded. The fact that grown adults, who have worked all their lives, brought up and supported families and even fought for their country are being left in their own faeces for hours on end, or told off for trying to draw someone’s attention to the problem, is a national disgrace. Unfortunately, however, that is not the only way in which an older patient’s dignity can be taken away. There are more subtle, but always equally upsetting, ways in which older people are being degraded while in hospital.

The Healthcare Commission reports that the three most common causes of complaint in relation to dignity were patients being addressed in an inappropriate manner, being spoken about as if they were not there and not being given proper information. Those seemingly small things combine to make the experience for vulnerable, older patients not only degrading but often frightening and upsetting. One case of best practice that I particularly liked, which I heard about from the same nurse at the weekend, was the displaying of photographs of patients by their beds, showing them in younger years. She described someone near to the end of her life—a husk of a body—next to whom was a photo of her, in earlier years, as a head teacher of a much-respected local school. All around the ward, there were pictures of patients as soldiers, parents and pillars of the local community. That brought home to the staff working there that they were dealing with real human beings who deserved the respect that they were giving them.

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