This Week: Sir Mike Penning, Conservative MP for Hemel Hempstead
Why he matters: A former soldier, fireman and journalist, Sir Mike was elected as an MP in 2005. He held five ministerial posts in five different departments between 2010 and 2017. Now a senior backbencher he is active on many fronts, including the legalisation of medicinal cannabis.
There is a narrative which runs strongly through debates among NHS leaders about service reconfiguration. In a nutshell it suggests change is made difficult by timid MPs, unwilling to risk upsetting their constituents.
Sir Mike Penning snorts in derision at the idea and declares: “I’d like to see an ounce of evidence for that.”
His experience is that the NHS normally says: “We’d like you politicians to come along with us on this. But, by the way, don’t worry if you can’t. You can kick off as much as you like Mike, your A&E’s going.”
I don’t have any way of bringing NHS [providers and commissioners] to account as a constituency MP. They’ll give me lovely platitudes, but they’re not accountable to anybody
The Hemel Hempstead MP suggests the only way to stop unwanted service change is to hope the NHS slips up on process.
“We had a judge in my particular area who said: ‘You win on ethical, moral, every ground possible, but not legal because they can do what they want’.”
His frustration clear, Sir Mike declares: “I don’t have any way of bringing NHS [providers and commissioners] to account as a constituency MP. They’ll give me lovely platitudes, but they’re not accountable to anybody [as far as] I can work out, including the secretary of state.”
At this point, many HSJ readers are no doubt screaming at their computers or smart phones something along the lines of “it was your bloody reforms that created this f**k up”.
Those who remember that Sir Mike was a shadow health minister for four years at the end of the last decade – when Andrew Lansley was dreaming up his reforms - may feel he has a fine cheek to make such complaints.
Sir Mike does not duck the accusation.
“I’m probably guilty as charged”, he admits. “Looking back, it was - from a democratic point of view - a step too far, not least in one lurch.”
He says that he and other colleagues did warn Mr (now Lord) Lansley that he was pursuing his reforms too rapidly.
Sir Mike muses: “Could I have held him back at bit [if he had been appointed a health rather than a transport minister in 2010], the answer is ‘no’.”
‘Screaming for years’
The former health secretary was “set” on delivering his reforms, says his former colleague, and no-one around him was able to challenge his expertise.
“It was the most unbelievable experience to walk around a hospital with him - he was an anorak”.
Sir Mike also points out that various medical and health bodies had been “screaming for years” for the kind of devolution of control and depoliticisation of the NHS the reforms tried to deliver.
The long-serving Tory MP acknowledges that many service decisions pre the reforms were made for overtly political reasons but says the pendulum has now swung too far in the opposite direction.
As for the suggestion that MPs are afraid to deliver hard truths for fear of criticism, he says his job already involves being “crucified every day of the week”
He notes that when he asks ministers a question, he rarely gets a specific answer, “not because they don’t want to answer it”, but because they do not want to admit that responsibility has been devolved.
He also claims that even the health secretary’s ‘sign off’ powers are illusory as they would not dare gainsay “expert advice”.
As for the suggestion that MPs are afraid to deliver hard truths for fear of criticism, he says his job already involves being “crucified every day of the week”.
Sir Mike claims he is no NIMBY, pointing out that he favours a reconfiguration of services in West Hertfordshire which would see Hemel Hempstead hospital significantly downgraded. What he finds, however, is an unwillingness of the NHS to engage with an idea which has emerged from outside the service.
Sir Mike also claims he rarely gets the kind of support he needs from the NHS.
He has asked NHS organisations on his patch many times to field clinicians who will publicly support their proposals.
“The people running the acute trust said: ‘Yes. We will do that’. So, the [trust’s] head nurse and the medical director wrote me a letter. I didn’t ask for that. I wanted the consultant running orthopedics. [But] no consultant in my trust – and just one GP – has ever put his head above the parapet [and supported service change].”
Politicians did the right thing
“We have faced closed minds, closed doors and closed wallets”, says Sir Mike on the latest stage of his campaign to increase the use of medicinal cannabis.
The Hemel Hempstead MP got involved in the issue when he was police minister between 2014 and 2016. He even went as far as threatening to travel to Holland to buy medicinal cannabis products for severely epileptic children, telling the House of Commons he was likely to be arrested on return (and therefore miss a key vote).
However, having fought hard to get the products legalised on 1 November last year, he has found the battle is not over.
“Politicians did the right thing, but the medics don’t think we did - these kids are not getting medicinal cannabis.”
Sir Mike says the NHS’s chief pharmacist told him prescribing medicinal cannabis products would be a “normal procedure” and that “everything will be fine”. Despite this he claims just two out of the “hundreds” of children that could benefit have got “prescriptions paid for by the NHS for medical use of cannabis”.
Something, he says is “seriously wrong”, before setting out what he believes are the three reasons behind the failure to get cannabis products used more widely.
The first barrier is the complexity and conflicting priorities of NHS bureaucracy.
“I had a GP say to me on the phone this afternoon, ‘I know this helps [my patient] but I can’t prescribe it [because my CCG] won’t authorise it’.”
Insular and controlling
He is not sure whether this was for financial reasons but claims that the use of medicinal cannabis can reduce the cost of care.
The consultant treating Alfie Dingley, the most well-known of the children helped by Sir Mike’s campaign, was told by their trust they would not authorise the cannabis products they had prescribed.
The second reason he believes is that the medical establishment is sore that it was politicians and not medics who answered the calls of the public to act.
He accuses the “very insular and controlling” medical royal colleges and associations of taking umbrage at “politicians poking their nose in.”
The third, connected, reason is a fear felt by individual medics of breaking professional ranks and potentially being sued as a result.
“We’ve had a consultant prescribe [cannabis products], write the script, then receive an email, and physically take the script back saying that if they did not it would ’destroy my career’.”
The MP is still unsure whether the email was from a professional body or a warning from his insurer.
Other consultants have advised parents to travel to Holland to buy the products themselves and bring them (illegally) back into the UK.
He remembers “one young child in intensive care” whose doctors refused to administer the medicinal cannabis he had been prescribed. He falls silent for a moment, before sighing,” you couldn’t make it up if you tried.”
He notes that medics tend to complain about the lack of randomised controlled trials for the medicinal use of cannabis, but counters this would be very hard to do given the rareness of the conditions many of the children he campaigns for suffer from.
Sir Mike says that he often points out to medics that many of them are happy to prescribe “off label”, where potential risks can be much higher than is the case with medicinal cannabis, and that many existing medications appear to have side-effects much worse than those caused by medicinal cannabis.
Acknowledging there are some “very brave” doctors out there, he would nevertheless like more clinicians “with spine” to say “sod you” to the medical establishment and do what they think is right.
But he also thinks there needs to be a concerted effort by the Department of Health to educate medics and to provide more explicit legal advice on when medicinal cannabis can be safely prescribed.
[If you are interested in medicinal cannabis, this BBC article provides a useful overview]
Next week: Commissioner turned Labour MP, Dr Paul Williams
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