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Fiona Bruce (Congleton) (Con)
I beg to move, That the House sit in private.
Question put forthwith (Standing Order No. 163), and negatived.
Health and Social Care (Safety and Quality) Bill
(10 years ago)
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Jeremy Lefroy (Stafford) (Con)
I beg to move, That the Bill be now read a Second time.
This Bill is all about patients—their care and safety. My commitment to that comes directly out of the findings of the Francis report, particularly the second Francis report, following the public inquiry into the instances of dreadful care at the Mid Staffordshire NHS Foundation Trust in my constituency. The work of Cure the NHS, led by Julie Bailey, who challenged that care, and supported by a group of my constituents and those of my hon. Friend the Member for Stone (Sir William Cash), has brought us to today’s Bill.
Sir Robert Francis, in the letter to the Secretary of State for Health presenting his report, wrote:
“In introducing the first report, I said that it should be patients—not numbers—which counted. That remains my view. The demands for financial control, corporate governance, commissioning and regulatory systems are understandable and in many cases necessary. But it is not the system itself which will ensure that the patient is put first day in and day out. Any system should be capable of caring and delivering an acceptable level of care to each patient treated, but this report shows that this cannot be assumed to be happening.”
The Prime Minister, in his reply to the Francis report, said:
“Quality of care means not accepting that bed sores and hospital infections are somehow occupational hazards—that a little bit of these things is somehow okay. It is not okay; they are unacceptable—full stop, end of story. That is what zero harm—the jargon for this—means.”—[Official Report, 6 February 2013; Vol. 558, c. 281.]
The Prime Minister’s words captured the essence of this issue precisely.
Most of the Francis report recommendations have been accepted, and many have already been implemented. In addition, other very important decisions have been taken by my right hon. Friend the Secretary of State for Health, such as the appointment of chief inspectors of hospitals, general practice and social care. Those are already having a profound effect on improving the safety and quality of care that patients receive.
Our NHS, using the best medical science and skills, combined with professionalism and compassion, delivers extraordinary repair treatment and healing to the vast majority of its patients. Yet, it can also forget that and cause completely avoidable harm to sick patients. The Bill intends to reduce, and, I hope, eliminate, its ability to do that. The Bill arises out of a determination to ensure that what happened at Stafford, and indeed elsewhere, should not be repeated. It seeks to ensure that the focus on safety and quality of care we are seeing is not only maintained, but strengthened, and, most importantly, it seeks to ensure that it cannot be reversed. Of course, legislation on its own will not guarantee safe and high-quality care—leadership, culture and resources are all vital elements—but by making it clear in law what is expected of those providing health care, the Bill will go a long way to doing so.
First, the Bill, in clause 1, changes the Secretary of State’s power to a duty, moving from a “may” to a “must”, to ensure that all those providing health and social care make zero avoidable harm their target. Patient safety is therefore put at the top of the list of what must be inspected for. One important way of ensuring that patients receive the safe and high-quality care we would all wish to see is through better integration between services, both health and social care. That is why clauses 2, 3 and 4 seek to give an impetus to integration through the requirement for a single patient identifier and a responsibility to share information. Professional bodies play a vital role in improving safety and quality of care by setting standards.
Mr David Nuttall (Bury North) (Con)
My hon. Friend will be aware of small concerns raised by the British Medical Association about some of the detail of his Bill. Is he confident that those will be able to be dealt with in Committee?
Jeremy Lefroy
I thank my hon. Friend who has shown a strong, keen and sincere interest in this Bill. Yes, I have just seen the BMA’s submission, and I recognise the concerns that have been raised. Those concerns should be listened to, addressed, and dealt with in detail in Committee. Perhaps what I am coming on to say will address some of them now. We must take extremely seriously the views of the BMA, which represents doctors.
As I was saying, professional bodies play a vital role in improving safety and quality of care by setting standards of practice and ensuring that high standards of conduct are maintained. Clause 5 and the schedule to it ensure that the professional bodies within the medical, nursing and care professions have the same overarching objectives that will benefit patients.
I propose to set out the context of the Bill and then to go into the detail of each of its three parts. In doing so, I will seek to address points that have been raised with me, especially whether we need legislation to achieve the aim of the Bill—patient safety and quality of care.
I am grateful to the team at the Department of Health that has helped in the preparation of the Bill and to the Minister, whose earlier proposals in his ten-minute rule Bill have informed the measures on the integration of services. I also thank the shadow Secretary of State and the Opposition health team for their interest in the Bill, the Chair of the Health Committee and other colleagues who have taken the time to discuss it with me, and to those in the health and social care professions who have contributed their thoughts.
I am also grateful to Ken Lownds whose work on patient safety has been fundamental to my work on this Bill and to my hon. Friend the Member for Stone who first called for a public inquiry and who has supported this work all along. I wish to thank my staff: James Cantrill, Pauline Ingall, Hetty Bailey, Alex Simpson, and Emily Mills, all of whom, but especially James and Pauline, have contributed in many ways. Above all, I wish to thank my wife, Dr Janet Lefroy, who has patiently discussed with me over many years the theory and reality of patient safety and care.
In 1863, in her preface to her notes on hospitals, Florence Nightingale wrote:
“It may seem a strange principle to enunciate as the very first requirement in a hospital that it should do no harm to the sick.”
That principle, extended to all health and social care services, lies behind the whole Bill, but particularly clause 1, to which I will now turn.
We are in a time where, quite rightly, there is increasing scrutiny of the safety and quality of care in our health and social care services. There are no accurate figures of how many people die avoidably while in the care of health or social care services in England. A recent study estimated that perhaps 12,000 people a year die from avoidable causes in hospitals alone. That is more than four times the annual number of deaths on roads in the UK. This is about not just those who die avoidably, but those who live but whose lives are profoundly affected by the avoidable errors—perhaps they are left with disability or mental scars. It is also about those who care for them who may have caused the avoidable harm and for whom it casts a shadow over their entire life.
In many cases, straightforward patient safety concern, procedures and practice would have protected both the patients and the members of staff from the consequences of avoidable harm. No patient wants to be harmed, and no one in the NHS would willingly harm them. The essence of zero avoidable harm is for the professionals and the organisations for which they work to convey to the patients, “We are health care providers because we want to treat and cure people. This is our contribution to humanity. We owe it to you, the patient, when you submit to our treatment not to harm you by being unprofessional, inattentive or negligent and also to have made all possible preparations in case we make an error so that it will not harm you. We will of course advise you of all risk inherent in what we are going to do for you.” When I speak of zero avoidable harm, that is the culture I mean.
These principles, procedures and practices for zero avoidable harm are in place in many hospitals and other care providers across the country, but they are neither universal nor standard. This is about not bureaucracy, but ensuring that health and social care has the same approach to safety as other activities in which safety is critical, such as air travel or the nuclear industry. Just last weekend, I noticed at one of the manufacturing sites in my constituency, which deals in chemicals, a board prominently displayed that said that the site had gone for more than 1,000 days without an accident. I fully acknowledge that health and social care is highly complex, and becoming increasingly so. But to those who use complexity as an excuse not to draw lessons from other professions that have had to make safety a priority, I would simply say: that is not good enough.
There is much excellent work going on in safety science, systematising and standardising many elements of health care, and indeed social care, to ensure that variability can be eliminated. Safety-critical sectors in the UK and elsewhere have for years been using what are called human factors to enable all staff to perform at their best, not only technically but also in communicating with patients and colleagues. Human factors are the key to building a culture of safety, or an open culture in which staff are able to speak up about safety—a just culture, in which blame is absent but fair accountability is the norm.
I shall now explain the detail of clause 1. At the moment regulated activities, which are defined by clause 8(2) of the Health and Social Care Act 2008 as activity involving, or connected with,
“the provision of health and social care”,
are regulated through regulations that are made under section 20 of that Act. That section provides that the Secretary of State
“may impose in relation to regulated activities any requirements which the Secretary of State thinks fit”.
Such regulations
“may in particular make provision with a view to…securing the health, safety and welfare of persons for whom any such service is provided.”
So the Secretary of State has the power—a “may”—but not the duty—a “must”—to impose regulations regarding the safety of patients. The message that this could send out is that patient safety is not essential. Of course, Secretaries of State, and most recently heads of the Care Quality Commission, have made it clear that patient safety is of vital importance, but that did not apply at Stafford hospital or, indeed, in many other places.
Clause 1 of my Bill amends the 2008 Act by substituting the following for subsection (1) and part of subsection (2) of section 20:
“The Secretary of State must by regulations impose requirements that the Secretary of State considers necessary to secure that services provided in the carrying on of regulated activities cause no avoidable harm to the persons for whom the services are provided.”
So it is now incumbent on the Secretary of State specifically to require that those providing health and social care services cause no avoidable harm. The Care Quality Commission will therefore need to assure itself, when inspecting those providers, that they have the policy systems and procedures in place that tackle avoidable harm.
As the explanatory notes to the Bill state, current Care Quality Commission registration requirements, which the Government are introducing, which will introduce new fundamental standards of care, would not be changed as a result of clause 1, as the new regulations satisfy the new duty. But the clause ensures that those regulations could not be watered down in future to reduce the emphasis on patient safety.
The Bill defines harm as being avoidable,
“unless the person providing the service cannot reasonably avoid it (whether because it is an inherent part or risk of a regulated activity or for another reason).”
It may be argued—this is one of the concerns that have been expressed by the BMA—that it is impossible precisely to define avoidable harm in every instance, and therefore that we should not attempt to do so. However, the very fact that so many cases of avoidable harm, sometimes leading to death or other serious consequences, manifestly do occur is a reason to ensure that it receives the highest possible priority, even if there may be arguments over the definition at the very margins.
Some may understandably raise the concern that the desire to tackle avoidable harm might lead to professionals simply not taking any risks. The Bill covers that by excluding from the definition harm that cannot be reasonably avoided. As in many instances, a test of reasonableness, which is included in the Bill, is a sensible way to address that.
Instances of avoidable harm would include, for instance, operations being performed on the wrong limb; patients being left without adequate hydration or nutrition; patients being left alone in A and E for long periods without any attention; poor records resulting in the wrong drugs being administered; and neglect as a result of wards being staffed below safe levels. In my experience, and I am sure in that of other hon. Members, the vast majority of instances of avoidable harm would come under one of those, or similar, categories.
There would be no questioning whether such instances had arisen because professionals were afraid to take risks; they would come from poor clinical skills, faulty record keeping, inefficient administration or a lack of care and compassion. The fact that the instances of avoidable harm vary so much across the health and social care sectors in itself shows that the problem can be tackled. How many lives would be saved if all providers had the same standards as the best in class? That is why it is so important to address avoidable harm through legislation.
I now turn to clauses 2, 3 and 4. These clauses are about continuity of information, which must be used
“to facilitate the provision to the individual of health services or adult social care in England, and…in the individual’s best interests.”
Again, this is all about the patient. There are two provisions: the first is for use of a consistent identifier for a person by the provider of health or social care; the second is to ensure that relevant information is shared in support of people’s direct care by the introduction of a duty to share information. Both provisions are designed to help with the integration of health and social care, which is greatly needed and which the Government and the Opposition have said is essential for the future.
Before I turn to the details, I should like to quote from a letter sent to me by my constituent, Mrs Janet Powell, who was delighted to hear about the Bill. She describes two recent experiences of the lack of integrated information, explaining:
“After breaking her femur in November 2013, my mother was admitted to the Manor Hospital, Walsall. In February 2014, she was admitted to Stafford Hospital suffering from heart failure. In July 2014, she went to New Cross Hospital, Wolverhampton for her cataract operation. For each of these admissions, she has a different hospital number. We have had to repeat vital information about her medical conditions each time she has been dealt with by different teams.”
Mrs Powell’s mother was fortunate to have relatives who were able to be with her on each occasion and give the vital information about her conditions, but for many people that is not the case, and even if it were, the process would still be inefficient and leave open the possibility that vital information regarding the patient and their care would be omitted.
The requirement for the use of a consistent identifier would make the accessing of accurate and timely information about a patient’s condition much easier, but clause 2 stresses in proposed new section 251A(5)(a) to the Health and Social Care Act 2012 that the requirement to use a consistent identifier would apply only if it was
“likely to facilitate the provision to the individual of health services or adult social care in England, and…in the individual’s best interests.”
As one would expect, the Bill contains provisions for the identifier not to be used in certain circumstances, including when the individual objects or would be likely to object and when the information concerns the provision of services by an anonymous access provider—for instance, sexual health services. The Bill makes it clear that the professional must still comply with the Data Protection Act 1998 and with any common law duty of care or confidence.
The introduction of a duty to share information for an individual’s care and treatment—again, only if in the person’s best interests—is aimed at ensuring that medical records are shared appropriately between the professionals in the NHS and care sectors who are responsible for the care of the patient. That is especially important when patients move between organisations along their care pathway.
The 2013 Caldicott review of information governance, “To Share or not to Share”, found that a culture of anxiety prevents information from being shared between organisations and that the legislative landscape contributed to this, with staff saying that a risk-averse attitude to sharing was a barrier to sharing in caring for people. The review said that the duty to share information in such circumstances can be as important as the duty to protect patient confidentiality. Dame Fiona concluded that health and social care organisations should have the confidence to share information in the best interests of patients within the essential broader framework of protecting personal patient data. Again, the Bill will provide the same important safeguards as those in respect of the consistent identifier.
I do not for one moment pretend that these provisions alone will make fully integrated health and social care a reality, but I believe that they will certainly help to remove some of the obstacles.
The final part of the Bill—clause 5 and schedule 1 —sets out three objectives of regulation: public protection, maintaining public confidence in the professions and upholding standards. Again, the driver for this is the safety and care of patients.
The long title of the Bill states that it would
“make provision about the disposal of cases concerning a person’s fitness to practise a health or social care profession”.
That was indeed my intention. Some of the regulatory bodies have been frustrated by the limitations on their ability to deal with a person’s fitness to practise. However, I have subsequently learned that such was the level of detail required to introduce the provisions that they would have made the legislation too long and complex for a private Member’s Bill. This Bill therefore concentrates on the vital overarching duty to protect the health, safety and well-being of the public.
When the serious failures set out in the second Francis report were debated in the other place, the noble Lord Hill, then Leader of the House, said:
“the regulatory bodies in particular have difficult questions to answer. The Nursing and Midwifery Council and the General Medical Council need to explain why, so far, no one has been struck off. The Secretary of State for Health has today invited them to explain what steps they will take to strengthen their systems of accountability in the light of this report, and we will ask the Law Commission to advise on sweeping away the Nursing and Midwifery Council’s outdated and inflexible decision-making processes.”—[Official Report, House of Lords, 6 February 2013; Vol. 743, c. 320.]
The Law Commission, to which we are greatly indebted, has produced an excellent draft Bill with an accompanying report, “Regulation of Health and Social Care Professionals”, dealing with these matters. It states:
“Given the importance of health and social care professionals regulation, it is a matter of some concern that its UK legal framework is fragmented, inconsistent and poorly understood.”
It describes the piecemeal growth of that regulation since the establishment of the General Medical Council in 1858, which has become a framework that
“is neither systematic nor coherent and contains a wide range of inconsistencies and idiosyncrasies.”
As part of its work, the Law Commission therefore proposed in recommendation 13 that an overarching duty to protect the public should be established in a single statute for all the regulatory bodies. The recommendation states:
“The main objective of each regulator and the Professional Standards Authority should be to protect, promote and maintain the health, safety and well-being of the public. The regulators and the Authority also have the following general objectives: to promote and maintain public confidence in the profession and to promote and maintain proper professional standards and conduct for individual registrants.”
It is that recommendation that will be given effect by clause 5 of my Bill.
It might reasonably be asked why we do not simply wait for the entire Bill, with all the details of changes to regulatory body powers, and introduce the overarching duty then. Let me be clear that I am a very strong advocate of introducing the Law Commission’s entire Bill at the earliest opportunity; indeed, I would urge the next Government to do so. However, I believe—this is supported by regulators who have written to me—that introducing the overarching duty to protect the public, together with maintaining public confidence in the professions and promoting and maintaining proper professional standards and conduct, is a very important matter. It should not be left any longer. The commission’s report explains why:
“fitness to practise panels have, in some cases, adopted an overly restrictive approach to the test of fitness to practise impairment… In particular, the concern is that in cases of clinical misconduct or deficient professional performance they are more likely to look at whether the instances of clinical misconduct or performance are remediable than to fully consider all of the factors, including the public confidence in the profession.”
It concludes:
“If this concern is correct, then we think that the panels in question have misunderstood the correct legal position—namely that regard must be had to all of the factors reflected in the objectives when deciding impairment, irrespective of the particular grounds being considered. Our intention is that the wording of the general objectives in the draft Bill and duties to have regard to them should help to clarify the existing legal position.”
I have enormous respect for the health care professions—in fact, three members of my closest family work in or are training for them. These professions have led the world in many ways. Indeed, hundreds of health care professionals are at this very moment showing their courage and commitment by volunteering to tackle the Ebola epidemic in west Africa. One of the most important things that we as legislators can do is to provide them with the framework they need so that poor practice will not be tolerated and the public will have the highest degree of confidence in them. Clause 5 will help to achieve this.
I said at the beginning that this Bill is all about patients. It will put safety at the heart of health care by making the Secretary of State responsible for bearing down on avoidable harm. It will help the vital integration of health and social care services, thereby improving both quality and safety by introducing a consistent identifier and a duty to share information. It will make it clear that the main objective of each regulator of the health care professions is the promotion, protection and maintenance of the health, safety and well-being of the public.
None of this will absolutely guarantee that the failure of safety and care described in Sir Robert Francis’s first report, and the failure of the NHS and regulators set out in his second, will not happen again. That depends on other things that cannot be legislated for, such as culture and leadership, and those that can, such as the commitment of resources. However, it is my belief and hope that it will make a recurrence much less likely. My constituents in Stafford, and those of my hon. Friends the Member for Stone, for Cannock Chase (Mr Burley) and for South Staffordshire (Gavin Williamson) will then know that all they have gone through over so many years will not have been in vain.
Mr David Nuttall (Bury North) (Con)
I congratulate my hon. Friend the Member for Stafford (Jeremy Lefroy) on introducing this Bill. He has set out its content comprehensively, in great detail and with great clarity. I also congratulate him on having the foresight to include as one of the sponsors of the Bill my hon. Friend the Member for Mid Norfolk (George Freeman), who is now of course the Minister speaking for the Government on it. That was a smart move.
Perhaps everyone in this country sometimes takes our national health service for granted as something that is always there. Whatever the political arguments may be about the NHS, we all know that it is part of the bedrock of British society—part and parcel of the fabric of this country. In essence, it boils down to two things. First, there is the scientific element: the technical expertise of the scientists, the doctors, and the people who put the drugs together and study the biology of the human body and the interaction of drugs within it.
There is also the human side—the care side. When someone is ill, they rely on the scientists to come up with a solution, but sometimes there is no solution and the scientists say, “We’re sorry—we can’t help you.” Sadly, even after decades of advances, there are still all too many ailments that afflict the human condition. In those cases, and in those where people, for whatever reason, may be nearing the end of their lives, it comes down to the human touch—the care and the everyday things that are not really related to science at all, just to common humanity. Regrettably, as seen most notably in the constituency of my hon. Friend the Member for Stafford—the reasons have been well explored—sometimes that care is not there. I am not going blame A, B or C for what happened—whatever happened has happened and we are where we are. Terrible things have happened and care has not been up to standard—we all accept that.
What we must now consider is whether it is possible to redesign the regulatory framework in such a way as to try to reduce the risk of what has happened in the past ever happening again. I do not pretend that this Bill will achieve that 100%. My support for it is based not on that premise, but on the premise that, on balance, it will be an improvement.
The Bill’s first proposed provision for a duty—an obligation—to inspect care makes absolute sense. Millions of people outside this Chamber will, frankly, be amazed that that is not already the case. It would be entirely uncontroversial to enshrine in law that requirement of the NHS regulator.
Secondly, the proposal for a common identifier is common sense. When members of my own family have had to go into hospital—this has happened recently and, sadly, it happens on too many occasions—they tell me, time and again, “The only thing that really annoys me is that I constantly have to give information.” Surely a common identifier would save time for our NHS. I am pleased that the professional bodies support the proposal. There are one or two technical and minor concerns, and clause 2 goes a long way to dealing with them. I am sure that any further concerns can be dealt with in Committee.
On balance, this is a sensible Bill, which has been very carefully explained to us this morning. I wish it a speedy passage through this House and the other place.
Fiona Bruce (Congleton) (Con)
May I begin by congratulating my hon. Friend the Member for Stafford (Jeremy Lefroy) on his Bill, which, if implemented, has the potential to provide significant improvements right across this country to the treatment and care of patients requiring medical assistance? Indeed, the improvements proposed by the Bill would have an immediate and real impact.
The national health service is an institution of which the whole nation can be proud. It serves our society with outstanding professionalism and admirable compassion. However, as a few specific, terrible instances have shown, there is room for improvement.
I salute my hon. Friend’s tireless work to do everything possible to ensure that this country never again experiences tragedies of the type reported from Mid Staffordshire hospital. Indeed, my hon. Friend’s constituents have cause to be extraordinarily proud of him as their elected representative and of the thoughtful, tireless and effective work he has done on their behalf in response to the issues raised at Mid Staffordshire hospital. I do not believe that any other Member could have worked harder for their constituents in this connection. He has raised their concerns in this House countless times.
The Bill is another carefully considered and utterly compassionate response—so characteristic of my hon. Friend—to those events. It is a focused, effective and, above all, practical proposal. It has one overriding focus: patient care. It deserves to be fully supported in its passage through the House. Its proposals are specific, realistic and immediately applicable. It will bring about real changes in the lives of real people right across the country at their weakest and most vulnerable moments.
As I have said, particular situations hit the headlines. Although they were extreme, the House must remember that they are part of a wider national picture. We must use the lessons to inform future policy, and the Bill does just that. It is all about patients and their care, and about promoting consistency across the country so that all patients are cared for safely, and are seen to be cared for safely, to an accepted and understood standard. The NHS is an institution that the British people own, fund and use, and it is right for us to be concerned about public confidence in the quality and safety of the care it provides.
I understand the concerns of those who say that the NHS cannot be run on the basis of public opinion—I will speak about that when I come to clause 5—but that does not negate the fact that public confidence in the NHS is an essential concern, not an optional extra. Indeed, an NHS or local hospital that loses the confidence of the public will quickly cease to be able to serve effectively the community for which it is designed.
The first purpose of the Bill is to set in stone the priority of patient safety in NHS standards not just as a power but as a duty of the Care Quality Commission, as my hon. Friend has said. We have learned from the Francis report that patient safety is not an optional extra; it is essential and should be at the heart of good health care. The recognition of every single person’s dignity and value has characterised the proud history of the NHS and must always remain central to its practice, no matter what pressures it comes under on a wider scale.
The priority of safety in the work of the CQC will help to enshrine the dignity of individuals in a system that must inevitably focus on what is efficient in the wider structural picture. Putting safety first will ensure that it is not lost within bureaucracy and procedures. The nature of the NHS clearly means that health care professionals are always under all sorts of pressures to decide how they can most effectively allocate their resources of time, expertise and treatments.
Clause 1 will be a buttress to the rights and dignity of each and every individual within the larger picture. It will make sure that safety is one of the key non-negotiable factors that guide professionals and institutions as they make decisions. The clause acknowledges that there is no such thing as risk-free health care, and it allows for a certain margin when those providing the service cannot reasonably avoid risk. The responsibility that the clause will permanently place on health care professionals, institutions and those assessing the CQC should ensure that the recent tragedies in patient care are far less likely to happen in future. Ideally, no one in the House would want them to happen and to be reported again.
The second aim of the Bill relates to transparency and the integration of health care. A more integrated health care system must surely be a better system. It would promote shared expertise, shared learning and greater safeguards. The care provided for patients should reflect the fact that disconnected and fragmented health care is weak health care. These provisions will aid heath care professionals with regard to not just safety, but good practice across the board. I hope that it will simplify, rather than—as some fear—make more complex, the system of health care provision for patients. A consistent patient identifier and wider information sharing should create clearer channels for the integration of health and social care for individuals. This is the way of the future, particularly given the needs of our increasingly elderly population. I applaud my hon. Friend for those practical proposals.
As I have said, the NHS is a unique institution with a unique connection to the public. Public confidence is not an optional extra, but to achieve it requires transparency. I am sure that many health care professionals in the NHS will welcome greater transparency. The overwhelming majority of those who work in the NHS do an outstanding job, of which they—and we—can be proud.
The British Medical Association has certain concerns about the NHS number being used as a universal identifier, so I am pleased to highlight the fact that the Bill does not require any particular identifier to be used. The Bill seeks to promote the principle and merit of having an identifier, but which identifier is to be used can be left to the discretion of the Secretary of State, who I am sure will consult interested parties.
Provisions for sharing information in the Bill are also important. They will facilitate better health care treatment for every individual across all areas of their treatment, allow professionals to do a better job, and allow patients to know with confidence that those looking after them are fully informed about their care requirements before they provide treatment. Currently, patients cannot be sure that their medical and care history and priorities are being shared between professionals responsible for their care. My hon. Friend has cited cases where that has caused problems, which is no doubt typical of many.
Care must be taken to ensure that information is shared in a responsible way that upholds the privacy of the individual—that is critical. Questions of who information is shared with and how consent is assumed or obtained from patients are important, and there will be the opportunity to discuss such matters further in Committee. As the Bill rightly points out, patient data should not be shared where that is not appropriate, or in an unsafe manner—for example, where a person’s medical record contains confidential information about another person. Critically, the sharing of information must always be in the best interests of that person’s care and treatment. The Bill would not require the sharing of identifiable information for purposes other than direct care. As Dame Fiona Caldicott said:
“For too long, people have hidden behind the obscurity of the Data Protection Act or alleged rules of information governance in order to avoid taking decisions that benefit the patient. Personal data must be protected lawfully, but common sense and compassion must prevail.”
The third and final aim of the Bill is to ensure that the various health care regulators, including the Professional Standards Authority when making decisions on cases of conduct or misconduct, have consistent overall objectives in mind: the maintenance of public safety, public confidence in the relevant profession, and proper professional standards of conduct on the part of health care professionals. The proposals have not sprung up in a vacuum; they are consistent with recommendations in the Law Commission’s report, “Regulation of Health and Social Care Professionals”. It noted with concern the inconsistencies in the way different professional regulators assess individual fitness to practise. The relevant section of the Bill, recommended by experts, should ensure fewer examples of poor practice, and that it is properly addressed. Everyone—practitioners and regulators —should know the primary principles by which professional performance in the health care system is to be judged.
I understand that some professionals, and the BMA, are concerned that the link to public confidence could lead to an inappropriate link between volatile public opinion and the decision of regulators. Those are reasoned concerns but they underestimate the capacity of regulators to make appropriately sound judgments against set benchmarks. The legal position already requires attention to be paid to public confidence. The Law Commission’s report stated that
“the concern is that in cases of clinical misconduct or deficient professional performance they—”
that is the regulators, and for the benefit of the House I will elaborate a little on what “the regulators” means, because it is an extensive group of organisations—
“are more likely to look at whether the instances of clinical misconduct or performance are remediable than to fully consider all of the factors, including public confidence in the profession.”
The Bill addresses that concern.
Concerns that this will lead to inappropriate links between regulation and public opinion, perhaps especially as it relates to so-called scare stories in the press, should prove unfounded. Far from it: the Bill should encourage greater clarity and rigour in the grave task of regulators in assessing professional standards and promoting best practice. The impact of the Bill in this regard should not be underestimated. The extensive list of regulators—the bodies that regulate health and care professionals in the UK and will be affected positively by the Bill—includes: the General Chiropractic Council, the General Dental Council, the General Medical Council, the General Optical Council, the General Osteopathic Council, the Health and Care Professions Council, the Nursing and Midwifery Council and the General Pharmaceutical Council.
Jeremy Lefroy
I am most grateful to my hon. Friend for taking on the role of enunciating all the regulatory bodies. Does she agree that we would be wrong to downplay the great common sense of the British people when talking about public confidence? Public confidence in health care professionals, by any objective reasonable measure, is at a very high level and we do not just need to look at press headlines for that. Does she agree that, when it comes down to it, the British people have a huge amount of common sense and the profession should not be afraid of public opinion? It is very much on its side.
Fiona Bruce
I entirely agree. In saying what I have said, I in no way want to denigrate my hon. Friend’s intervention. I absolutely agree with him.
In closing, let me repeat my support for this profound and potentially far-reaching Bill. If passed, it would influence the life of every citizen in this country. Let me repeat my support for the excellent work my hon. Friend has done in bringing it to the House, and in working to drive up standards in the NHS, both locally in his constituency and nationally, and protect people across the country from a repetition of the sad and tragic events documented at Mid Staffordshire. The Bill will strengthen relationships between patients and health care professionals, and between the NHS and the public in general. It will help to lift confidence in the NHS even further. Most of all, it will help to ensure that every person who relies on the NHS in their most vulnerable moments will be safer wherever they live and whatever their condition. For that reason, I commend my hon. Friend’s Bill to the House.
Mr Jamie Reed (Copeland) (Lab)
The House has a lot of business to attend to today. That said, this Bill deserves consideration in some detail. It clearly has widespread support across the House, including on the Opposition Benches, and from medical professionals across the NHS. Some groups have raised a number of concerns. I know that the hon. Member for Stafford (Jeremy Lefroy) will want to address them.
The Bill is made up of three key areas. Part one relates to provision of care that avoids harm. It requires the Secretary of State to bring forward regulations setting out the requirements on providers registered with the Care Quality Commission to ensure that the services they provide do not cause avoidable harm. Clearly, that is a principle we all support. All of us have learnt the lessons of what happened in the hon. Gentleman’s constituency and none of us wants to see that repeated in any part of our health economy or anywhere in our country. We want the very best care for our family and friends. Harm-free care should be something we all strive for at all times. We know that our doctors, nurses and other medical staff work incredibly hard, as Government Members have said, often in exceptionally trying circumstances. The Government—any Government—must do everything within their power at all times to support those professionals. That is surely beyond question.
The second part of the Bill relates to the continuity of information and how it is shared between providers of care. For effective health care to be provided in the 21st century, data must be utilised as effectively as possible. I am sure the Minister shares that viewpoint. Macmillan Cancer Support has shown in north Trent that local data, when used effectively, can be used to redesign the follow-up care that colorectal cancer patients receive. On analysing the data, it discovered that more than a third of people who survived for more than five years had an additional, non-cancer complication such as type 2 diabetes or heart problems. By using these data—and, by extension, knowledge—it could better plan the future care of those patients. The principle of using complete data to identify patients’ needs must be applied more often to ensure that patients get the care they require. There are some tremendous examples of GPs in Salford deploying this care model. I urge Members to take a look at the innovative techniques being developed there.
I ask the House to indulge me for a moment. Like everyone, I understand how such data can lead to better patient outcomes. Two weeks before the last general election, as an undiagnosed type 1 diabetic, I was rushed to hospital—once again, I place on the record my gratitude to the West Cumberland hospital for saving my life—and now every day my life is governed by data: blood glucose readings, insulin ratios and so on. I want such data to be easily available to me: I want them on my smartphone, and I want them provided to pharmacists and GPs, to help me and others in my situation better to control the condition. Incidentally, such a huge innovation would also save the NHS a lot of money and improve outcomes for patients with a variety of long-term conditions. In that regard, the Bill is doing exactly the right thing.
I would be grateful if the hon. Gentleman could set out again how the Bill would make data sharing more consistent across the whole health service, because this is a challenge. Where individuals’ personal data are concerned, there are clearly issues of privacy to address. That debate rages across many sectors and is routinely discussed on and offline and in the House. I have been here almost a decade now—it is hard to believe—and issues of individual personal data have been discussed throughout that time. Nowhere is that felt more sharply than with medical data.
It was regrettable—and avoidable—that the Government failed with the care.data scheme, as it severely eroded public trust in how data protection matters are dealt with. I do not think that anybody would take issue with the principle that medical confidentiality should always be respected and protected. I hope the hon. Gentleman will outline what safeguards are in the Bill to ensure that only relevant patient data are shared. Sharing unnecessary information could undermine patient trust, particularly regarding the use of personal data, and, critically, could slow down treatment, which we do not want.
Jeremy Lefroy
I am grateful to the hon. Gentleman for setting out from personal experience how important this matter is. I can assure him that the aim of these provisions is to ensure that data are shared only for the care of individual patients. This is not about data collection, but about patient care and safety, for which, as he rightly says, data are often so important.
Mr Reed
I thank the hon. Gentleman for that response. We will drill down into this in Committee because it is important that we get the details absolutely right.
This is about the efficacy of the care provided, and if we do not get it right, we will be storing up trouble for the future. The sharing of relevant health information is already governed by professional obligation, as the hon. Gentleman will know from his marital circumstances, and the British Medical Association has said it would be unnecessary to replace that with a statutory framework without clear justification. I hope to hear some justification for a new framework. One of the lessons of my party’s time in office, and one of the lessons that should be learned by this Government, is that we need to take medical professionals with us. If we do not, we will put ourselves and patients in a difficult position. We can devise all the statutory and regulatory frameworks we want, but if we do not take medical professionals with us when we apply those strategies, we will be in difficulty.
The third part of the Bill relates to objectives for the regulation of health and social care professions. This part, and the draft order on the objective of the General Medical Council, amends the objectives of health and social care regulators and the Professional Standards Authority. Professional bodies such as the GMC and the BMA have differing views on the impact this will have in practice. The GMC states that while this Bill will not impact on the GMC per se,
“The newly worded statutory objectives in the draft order address the aim of protecting the public and set out clearly the importance of public confidence issues when deciding on appropriate action in the public interest.”
The GMC also believes that the Bill will align other regulators’ statutory purpose with their own. The BMA, however, believes that the now separate role of protecting the public while maintaining public confidence in the professions could lead to regulatory committees and panels punishing professionals who do not pose any threat to the public.
The details of this part will be subject to further scrutiny in Committee, but I would be grateful if either the hon. Member for Stafford or the Minister explained how this scenario articulated by the BMA could be avoided. Let me repeat that it is essential to take the medical professions with us on this, in view of the lack of appetite for the application of the Francis recommendations with regard to the individual duty of candour. I think this has been dropped because the medical profession did not believe it to be enforceable. The Government listened, but we should explore those concerns in greater detail.
It was disappointing that the Government did not bring forward in the Queen’s Speech a Bill to deal with the wider reform and regulation of health care professionals. An opportunity was missed, and I hope the Minister will explain why. Wider reform is clearly needed. The Nursing and Midwifery Council was disappointed not to see such a Bill in the Queen’s Speech and still says that wider legislative reform is needed. We must remember that this Bill is an essential component of the implementation of the Francis recommendations and that, without it, some of the important changes recommended by Robert Francis simply cannot take place. We support the superb efforts of the hon. Member for Stafford principally in that context. This is an issue that many in the professions wanted to see addressed by the Government in the Queen’s Speech. They should have brought forward a Bill, and it clearly cannot be through a lack of parliamentary time or because of a packed legislative agenda that no Bill has been introduced. I hope an explanation for that will be forthcoming.
Other issues need to be addressed. The principle of the Bill is one that we support and we will not divide the House on it. The details will be scrutinised further in Committee, and I hope that both the Minister and the hon. Member for Stafford will be able to deal with some of the issues I have raised.
Finally, although the Bill is an important step, cultural change in any organisation or profession is difficult and takes a long time to achieve. There is no magic bullet, as has been said, and we should always recognise that. I was grateful to the hon. Member for Stafford for mentioning the regulation of the nuclear industry, of which I have a lot of experience. I think I was the first person to introduce this regulatory example into this whole debate, and it is a very important comparison.
What is the point of the comparison? Effective regulation is an iterative process that relies on an effective partnership between the regulator and the regulated. Too often, regulatory bodies in a number of sectors can play cat and mouse or hide and seek with respect to those they regulate, which can have a serious, damaging and counter-productive effect. We are beginning to see that with Ofsted—the comparator often used nowadays for the Care Quality Commission. Of course we want to see education standards driven up; of course we want to see pupils receiving the best education in the world; and of course the pursuit of excellence must be constant and consistent. We must, however, consider what happens when regulators begin to damage the cause they exist to support. None of us wants to see the medical profession becoming as beleaguered as those other essential public servants in the teaching profession.
That said, public services exist first and foremost for the benefit of the public, not for the public servants—an essential principle. Iterative regulation is undoubtedly the way forward, as is demonstrated by the safety and performance improvements that have taken place in the nuclear industry over the past decade and a half. Those changes accompanied a major regulatory recalibration in the early part of this century. Cat-and-mouse, hide-and-seek regulations were actually making performance in the industry worse. Regulators should not wait for failure to occur and then seek to punish; they should work to prevent failure from occurring in the first place, and that requires a partnership between the regulator and the regulated.
There is a great deal in the principle of the Bill that unites the House. I am exceptionally grateful to the hon. Member for Stafford for all the work that he has done, and his Bill has the Opposition’s support.
The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)
I am delighted that this important Bill appears to have cross-party support. I strongly support it, as do the Government, and I pay tribute to the tireless commitment shown by my hon. Friend the Member for Stafford (Jeremy Lefroy) to the cause of public safety. I think that I speak for the whole House—although many Members are not present this morning—when I say that he has commanded all our respect in campaigning so tirelessly, with such good grace and diligence, and with cross-party support to ensure that the lessons of the appalling tragedy at Mid-Staffs are properly learned. He has demonstrated the integrity of that work again today, which is reflected in the degree of support for the Bill.
Let me begin by echoing the support that my hon. Friend expressed for Julie Bailey, my hon. Friend the Member for Stone (Sir William Cash) and Ken Lownds, all of whom have done a huge amount of work behind the schemes in support of the Bill and the wider cause of patient safety. My hon. Friend spoke extremely powerfully about the 4,000 unavoidable deaths and the many thousands more unavoidable incidents of harm. Such incidents will, of course, be avoidable if we are better equipped to track, monitor and collect data in the way that is proposed in the Bill, and to develop the culture of transparency and accountability for which it provides.
My hon. Friend spoke about the concept of zero avoidable harm, which sits at the heart of the Bill, and spoke particularly powerfully about the culture of health and safety. In the aviation and nuclear industries, as we heard from the hon. Member for Copeland (Mr Reed), it is a culture that involves actively looking out for near misses, and actively welcoming the reporting of problems by staff members from top to bottom of an organisation as soon as they have been identified, that has enabled those industries to develop such exemplary health and safety records. One of the great lessons that emerges, loud and clear, from the Francis report is the need for a change of culture.
My hon. Friend referred to the science of safety and the elimination of variability from the system, and to the good work that is being done in this country, not least as a result of the Francis report. That is another example of an area in which the NHS is leading in global medicine. He also spoke of the importance of integrating information and data. His account of the journey made by his constituent Janet Powell as she helped to escort her mother across the health and care landscape will have resonated with many Members. It certainly resonated with me, because over the last 18 months I have been in a similar position, supporting my own mother through a journey from primary care to hospital care to community care in Norfolk. As many Members and many millions of carers outside will know from experience, it is often the carers, parents and loved ones of patients who are carrying the best information about the patient through the system. That information is often too slow and does not keep up with the patient on their journey.
My hon. Friend spoke very powerfully about the risk-averse attitude to sharing information. That is a problem, and the Government are committed to trying to tackle it. That is another reason why we are supporting this Bill. Key to that, as my hon. Friend touched on, are the recommendations of Dame Fiona Caldicott, and I am delighted that she has agreed to take a lead role and to accept the invitation of the Secretary of State to look at the safeguards we need to be putting in place across the whole of the NHS and Department of Health care and data provisions. That will help provide a strong degree of reassurance to both Members in the House and people outside that patient concerns about confidentiality are being met.
My hon. Friend also spoke very powerfully about his support for health care professionals, and I would like to put on record my support for his comments about the NHS staff who are in Africa on the front line of the fight against Ebola. We owe them all a huge debt of gratitude.
We also heard from a number of other Members who spoke very powerfully. My hon. Friend the Member for Bury North (Mr Nuttall) was kind enough to congratulate me on my role in managing to get the data-sharing measures included in this Bill. They were raised before this House in my ten-minute rule Bill, which fell, but I am delighted to see those measures picked up in this Bill.
My hon. Friend also spoke very powerfully about the NHS as a bedrock of British society, and I could not agree more. He made some interesting points, too, about the difference between the science of health care and the human and compassionate and cultural side of health care, which this Bill goes right to the heart of. That has always been a great strength of the NHS, which in its founding charter is a scientific and research-led organisation, and which has always put compassionate care at the very top of its mission.
My hon. Friend the Member for Congleton (Fiona Bruce) spoke very powerfully and again paid tribute to both the NHS and its staff. She also spoke about the importance of transparency and of there being public confidence in the data confidentiality aspects of this Bill and more generally across the health care system.
I was pleased by the tone and spirit of the speech of the hon. Member for Copeland and to hear that there is cross-party support for this Bill. Although parliamentary time is short in this Session, I think that with that support this Bill has every chance of reaching the statute book.
I was particularly pleased to hear the hon. Gentleman’s powerful—and personal—support for the importance of data sharing in 21st-century health care. He rightly highlighted Salford as a beacon of what can be achieved, and that stands as a tribute to the NHS in the north-west, which is leading the way in the use of informatics and medical data for both research and treatment.
The hon. Gentleman also spoke powerfully about his personal experience as a diabetic patient, and about his reliance now on data as a patient and his active embrace of telehealth and the use of smartphones. He also spoke very powerfully about how that is allowing him to have better control of his condition. Patient empowerment, through data and electronic health records and putting in place a landscape so that patient medical information flows with the patient and reflects the patient journey across the system, is key to both this Bill and the Government’s wider proposals for building the integration of health and care and a 21st-century model of the NHS in which health care moves from being something done to patients when the system is able to do it to a system in which active health citizens are empowered and enabled and encouraged to take more responsibility for their health care so they can drive through the system in the way that suits them.
We might not have a packed House here on this Friday morning, but we have certainly packed in the arguments. We have heard a lot of high-quality contributions. I want to talk about the thinking behind the Bill and answer some of the key questions that have been raised.
The need to maintain minimum levels of quality much more consistently was put into sharp focus by the landmark public inquiry report, published in February 2013, on the terrible, shocking and serious failings in the care provided at the former Mid Staffordshire NHS Foundation Trust. I think everyone in the House would accept that the subsequent Francis report shook the health system to its core. Francis’s call for a fundamental culture change across the entire health and social care system that would put patients first at all times still resonates loudly in this Chamber and throughout the health and care debate.
Sir Robert Francis QC, the chair of the inquiry, made a compelling call for action across six core themes: culture; compassionate care; leadership; standards; information; and openness, transparency and candour. That is a checklist that all of us who are involved in health care need to keep close at hand. The inquiry represented a watershed in our thinking on safe and better care. That in turn is driving a culture change across the NHS as we resolve never again to allow the system to fail patients and service users in the shocking way that it did.
The Government published their response to Robert Francis’s public inquiry on 19 November 2013. That response, “Hard Truths: The Journey to Putting Patients First”, demonstrates the Government’s commitment to creating a culture of openness, with greater accountability and a relentless focus on safety in an NHS that puts compassion at its heart. In response to the events at Mid Staffs, to Robert Francis’s recommendations and to Don Berwick’s excellent review of improving patient safety, the Government have already introduced a number of measures to improve safety. First, a new statutory of candour on providers will help to ensure that patients are given the truth when things go wrong and that honesty and transparency are the norm in every organisation. This new duty will be overseen by the Care Quality Commission. It will come into force for all NHS bodies soon and for other registered providers by April 2015. We expect staff to reflect the duty in their everyday activity.
An organisation is made up of its staff, and providers will be expected to implement the new duty through staff across their organisation. Training and education of staff will also support the establishment of an open culture. The General Medical Council, the Nursing and Midwifery Council and the other professional regulators will introduce a new explicit and consistent professional duty of candour, making clear a requirement to be open, whether the incident is serious or not.
Secondly, the Secretary of State announced in March a new Sign Up to Safety campaign, a platform on which all NHS organisations and patients can share, learn and improve ideas for reducing harm and saving lives. It was launched in June, and health care leaders have been invited to set out what their organisations will do to strengthen patient safety, including by producing a safety improvement plan. Sign Up to Safety aims to achieve much more than just the numbers of NHS organisations joining; it is about motivating participants actively to get involved. The campaign will go beyond institutions and seek to sign up as many individual NHS staff as possible, and everyone who chooses to join will commit to the new patient safety ambition.
In order to realise the Berwick report’s vision of the NHS as an organisation devoted to continual learning and improvement, NHS England and NHS Improving Quality have established a new national patient safety collaborative programme. This will spread best practice, build skills and capabilities in patient safety and improvement science, and focus on actions that can make the biggest difference to patients in every part of the country. The safety collaboratives will be supported systematically to tackle the leading causes of harm to patients. The programme will include establishing a patient safety improvement fellowship scheme to develop 5,000 fellows in a national faculty within five years.
We are absolutely committed to changing the culture of patient safety through investment in leadership. NHS England is now working with The Health Foundation to help develop proposals for a safety fellowship initiative. The NHS is on a transparency journey, through the NHS Choices patient safety section, to become completely open and transparent. More information about our local health services is now more publicly available than ever before. As well as using the information to drive improvements, it is vital that a patient or member of the public can easily find and understand what it says about their local health services.
In June, NHS Choices began publishing new and existing information in a new safety section, complementing the wealth of information available about our hospitals and wards. It specifically provides information on: nurse staffing levels, including at ward level; infection control and cleanliness; CQC national standards; whether the unit is recommended by staff to their relatives and friends; patients assessed for risk of blood clots; the response to patient safety alerts; and open and honest reporting. The NHS is one of the safest health care systems in the world but there is always scope to improve health care standards universally and reduce avoidable harm further. That is why the Secretary of State for Health set the ambition to reduce avoidable harm by half and save 6,000 lives over the next three years.
As well as the devastating effect that health harms can have upon patients, service users and, as hon. Members have mentioned, their carers and families, a recent report by Frontier Economics has estimated that poor care could be costing the NHS up to £2.5 billion every year. That is why the Government have thrown their full support behind this important Bill, which will do much to improve the safety of patients.
Jeremy Lefroy
I am grateful to the Minister for the argument he is developing. Does he agree that the Bill is vital for staff? They do not want to be involved in instances of avoidable harm; it preys on their minds and can blight their careers. If the institutions to which they belong are not seeking to avoid harm, it is often the professionals, rather than the institution, who carry the can, and that is not right.
George Freeman
As ever, my hon. Friend makes an incredibly powerful point. An institution is only as strong as the staff within it, and when an institution is not taking seriously an issue that the staff confront as a daily reality, it puts them in an impossible position. He rightly says that by changing the culture of the institution, NHS staff will be able to do their jobs more easily and with more confidence, safe in the knowledge that when they raise issues that may be of concern, whether or not there is in fact a risk, they will be welcomed and supported. That culture change is vital if we are going to turn things around in the way that we are committed to doing.
There are three key sets of provisions in the Bill: the ones that will mandate patient safety as a key requirement of CQC registration; the provisions ensuring the integration of data across the health and care pathway; and the provisions dealing with the regulation of professional standards. They represent real and significant steps to support and develop patient safety in the NHS, and we are delighted to support them. Let me deal with each of the three in turn.
On the CQC requirements to include safety, clause 1 is central to the Bill’s focus on safety and quality, and, in particular, the elimination of the avoidable harm that flows from the provision of poor care in health and adult social care services. Safety is paramount and must be the focus of care providers at all times. The experience at Mid Staffs underlines the importance of that and of what can happen when providers put other priorities before safety. The CQC’s role in protecting patients is vital, and safety and the avoidance of harm are key elements of the CQC’s regulation of providers, in two key ways. First, monitoring registered providers against safety requirements and taking enforcement action when the requirements are not met is central to the CQC’s objective to protect and promote the health, safety and welfare of people who use services.
Jeremy Lefroy
Does the Minister also agree that the Bill’s provisions, in seeking to get that focus right to the top and make it the responsibility of the Secretary of State, ensure that, right here in this House, patient safety is of the essence?
George Freeman
My hon. Friend makes another important point about the role of leadership in the culture change that we are seeking to drive. I believe all hon. Members would acknowledge the Secretary of State’s personal commitment to this crusade for patient safety, and it is symptomatic of the level of leadership that is required. If the leader—the accountable senior executive—in every trust and organisation in the NHS makes clear their personal commitment to this agenda, it helps to change the culture and to create the conditions in which the reporting of patient safety issues and concerns is welcomed and encouraged.
Safety is also a critical component of the CQC’s new inspection regime and one of the five key questions the chief inspectors ask when rating the quality of services. Currently, it is at the Secretary of State’s discretion as to whether registration requirements should cover safety of care. Clause 1 removes that discretion and instead places a duty on the Secretary of State to impose registration requirements about safety of care. We welcome that duty, because it absolutely fits with the Government’s wider commitment to putting patient safety right at the heart of our health and care system. The duty will cover all providers registered with the CQC across health and, importantly, adult social care, and will help ensure that no avoidable harm will come to patients and service users when they are being provided with a regulated service. It is important to say at this point that the duty will not place an obligation on the Secretary of State to ensure that care or treatment is risk-free—no Secretary of State could ever give that undertaking. Health care provision is of its nature a risky business and can be so. Chemotherapy, for example, saves lives but can have significant side effects. A test of reasonableness must be applied in assessing whether harm is avoidable. The registration requirements that are before Parliament do cover safety and will allow the CQC to take action against poor providers in a way that has not been possible up to now. The Government therefore welcome the clause, which reinforces what the regulations are seeking to achieve and will ensure that the key message of safety and harm reduction runs consistently through the CQC regulation, and across the system as a whole, for years to come.
Clauses 2 and 3 deal with the key changes requiring a common identifier and imposing the duty to inform other health care professionals along the care pathway. Far too often in the health care system, patients lead and their information follows and, particularly as patients migrate between primary, hospital and community care, they and often their loved ones are left driving the patient journey without access to the necessary information. Too often, the health care professionals do not have access to the very latest information on the treatment that their patient has received in another part of our health and care system. That is why we welcome the clauses.
Clauses 2 and 3 concern the sharing of information by providers and commissioners to support people’s direct care and treatment, as an essential part of the delivery of safe, effective and high-quality care. The sharing of timely, accurate and relevant information facilitates the provision of integrated care and treatment tailored to people’s needs and wishes, yet we know that that sharing does not always happen as it should. Anxiety about information governance and data protection can stifle the sharing of information between staff and organisations working together to care for an individual. Clauses 2 and 3 will require that providers and commissioners of publicly funded health and adult social care share the information which is so essential to the delivery of safe and high-quality care. That will relate only to the way in which information is shared by organisations directly involved in an individual’s direct care.
Clause 2 places a duty on providers and commissioners, within scope, to record and use consistent identifiers in people’s health and care records and correspondence. There is a requirement to include the identifier when sharing information with other organisations directly involved in that individual’s care. Clause 3—
Madam Deputy Speaker (Dame Dawn Primarolo)
Order. May I say to the Minister that he does not need to explain the whole Bill; the promoter has already done that. The Government have said that they support the Bill, so I am at a bit of a loss as to why the Minister does not appear to be giving us any new information, but is reiterating what has already been said. Perhaps he could clarify some things a bit more, but we do not need a commentary on every clause.
George Freeman
I completely understand, Madam Deputy Speaker, and I do not intend to give you a commentary on every line of the Bill; that happens in Committee. However, given that the Government are supporting this private Member’s Bill, I thought it was important that, as part of our wider commitment, I set out why and on what basis we are supporting it, and give some guidance to the House on where in Committee there may be differences and where and why the Government are taking the view that they are. None the less, I will heed your comments and ensure that I keep my remarks at an appropriate high level.
Madam Deputy Speaker
Order. I absolutely agree with the Minister. We would be interested to hear any qualifications from the Government and where they were, as that would give the House time to consider what will be occurring in Committee. I look forward to hearing him say that.
George Freeman
It is important to recognise that clauses 2 and 3 relate only to how information is shared by organisations involved in an individual’s direct care. My hon. Friend made the point that this Bill is solely focused on the needs of the patient; it is not in any way about the Government or the NHS seeking to collect information for any other purpose other than to ensure that patient care is first and foremost in the system.
Clause 3 places an express duty on direct care providers and commissioners of publicly funded health and adult social care. When providing care to an individual, organisations within scope would be required to ensure that the relevant information is shared with staff within their organisation, and also within other organisations along the care pathway, where it is in the individual’s best interests. That duty would apply only if it directly facilitated the individual’s care and if it was in his or her best interest. That will not only support the delivery of safe, effective and integrated care, but improve people’s experience of their care and support, sparing them the frustration of having to tell their story over and over again as they move along the care pathway.
Simply sharing is not enough. To realise fully the benefits of sharing information, it is vital that the information shared is accurate, relevant and timely. In order to provide safe and high quality care, especially where it is urgent or where multiple care teams are involved, information needs to follow the person, so that professionals can access the right information at the right time. Using a consistent identifier is essential to that aim, as it ensures that the information being shared relates to the right individual.
A number of people have asked about the common identifier. Clause 2 places a duty on the Secretary of State to make regulations that will specify the consistent identifier to be used. It is the intention of the Government that the prescribed identifier should be the NHS number.
The universal use of the NHS number is a long-standing priority of the Department. Ensuring that records include a person’s NHS number, especially when they move between providers on their care pathway, is vital to the safety and quality of care. A number of Members asked about our view of the appropriate identifier. We believe that consistent use of the NHS number will facilitate the co-ordination of care, reduce errors and support the integration of records.
Ensuring a reliable and seamless transfer of information is all the more vital when the patient is a vulnerable person. That vulnerable person could be an elderly patient with dementia and many complex needs, for whom large institutions can be difficult to navigate at the best of times. I must stress that these duties are strictly limited to sharing for direct care purposes, with only those organisations directly involved in the provision of care, and only where it is in the patient’s interests.
Let me be clear: this will not permit or require sharing of information for any other purpose. The duty would not apply where there were good reasons for it not to apply. Such reasons could include: when an individual objects to his or her information being shared, or to his or her NHS number being used; where the individual would be likely to object; or when an individual receives, or may receive, services, such as sexual health services, anonymously.
Jeremy Lefroy
Should this Bill command the support of this House on Second Reading, does the Minister agree that one thing we would need to consider in Committee is this real issue of the mixing up of personal information and patient information within records? How best that can be addressed will require quite a lot of discussion.
George Freeman
My hon. Friend makes an excellent point. As he is aware, there are a number of initiatives on data across the health and care system, which is why the Secretary of State has appointed Dame Fiona Caldicott to advise the Government and to look at the pilots that NHS England is currently running on the care.data programme. It is important that the data provisions of this Bill and the confidentiality provisions and guarantees are closely examined in Committee and that there is no confusion over the purposes for which the data provisions are being used, which are solely to do with patient safety.
Clause 4 creates a power for the Secretary of State to make regulations to exclude certain persons or their functions that would take them outside the scope of the new duties for continuity of information. The Government intend to make regulations that will exclude providers and commissioners of children’s social care and providers and commissioners of children’s health care within the Department for Education’s purview. Those exclusions will include local authorities and other organisations exercising educational functions and children’s social service functions, children’s homes and residential family centres, fostering and adoption support agencies and certain schools, nurseries and educational institutions. I am delighted to tell the House that the Department of Health and the Department for Education are working together to support information sharing and use of the NHS number, where appropriate, by those organisations.
The use of patient data can arouse significant public concern and controversy and lead to highly charged debates. The public rightly expect to see their data held securely and used only for their benefit. That sits full square at the heart of these proposals, which is why NHS England has taken back the care.data proposals to review, revise and pilot, and why we have appointed Dame Fiona Caldicott. The information-sharing provisions of this Bill are solely concerned with the sharing of information between health and care providers where it is in an individual’s direct care interests.
To summarise, the consistent patient identifier and information-sharing provisions will support three key things: better informed care decisions, leading to care and treatment being better tailored to people’s needs and preferences, and better health and care outcomes; safer care, with a reduced likelihood of errors, adverse events and sub-optimal care stemming from a lack of information;, and improved experience of care, with individuals being called upon less often to repeat their story, and having increased confidence that the person caring for them has all the information that they need.
Let me turn now to the third and final section of the Bill, which deals with the regulation for the Professional Standards Authority and the professional regulator. We welcome these clauses, which will bring in a consistent objective for the PSA and for the regulators of certain health and care professionals, including dentists, nurses, midwives and opticians.
That will ensure that public protection is at the heart of what the regulators do. This measure is about not changing what the PSA or the professional regulators do in relation to professional regulation, but ensuring a coherent, strategic approach by them in the performance of their functions. Patients and the public need to understand the role and purpose of the organisations that regulate our health professionals in order to have confidence in what the regulators do. Having clear and consistent objectives is vital to that.
Let me touch now on the automatic erasure provisions, which my hon. Friend said had been withdrawn. The intent of the policy is to enable the regulators automatically to erase from a professional register individuals tried and convicted of certain serious crimes. However, it would be necessary to amend the existing statutory framework for each of the regulators properly to achieve the policy and would result in a Bill that is much longer and more complex than is usually acceptable for a private Member’s Bill. In the light of that, and given the complexity of the drafting required to achieve the policy, we took the position that automatic erasure should not be taken forward.
Automatic erasure was one of the areas considered by the Law Commission in its review of the regulation of health professionals. The Government remain committed to legislating on this important issue at the earliest opportunity. We have explored all other possible legislative options for taking forward issues arising from that piece of work and therefore propose to take forward automatic erasure in a future parliamentary Session alongside other measures in response to the Law Commission’s review. The long title of the Bill, which sets its scope, specifically mentions the intention to provide for automatic erasure, but I believe that my hon. Friend the Member for Stafford has indicated his intention to table an amendment in Committee to remove that from the long title.
When I talk to people about the Bill, I am asked one or two key questions, which I believe those watching the debate will want to hear us answer, and which the hon. Member for Copeland has asked me to deal with. The first is, “Are my medical records already shared with others involved in my care?” Unfortunately, the sharing of information about one’s care is not as widespread in the system as it needs to be. Those who use the NHS the most often are often those who have the most to remember. It can be very frustrating for health professionals, and too often that lack of information is involved in the misdiagnosis and the mistakes that my hon. Friend the Member for Stafford spoke of.
The second question that we are often asked is, “Don’t these regulators already put patient safety at the heart of everything they do?” The CQC and the professional regulators are all there primarily to protect us. The measures in the Bill are not a reflection of any failure in that respect. However, these organisations are given legitimacy through legislation; their remit and ability to act are defined in law, and it is important, we believe, that their legislative basis is explicit about their respective roles and duties in public safety. It is not our intention that the Bill, if it becomes law, should result in a dramatic change to the way in which the regulators operate on a day-to-day basis. We know that they are already focused on patient safety. The Bill enshrines that focus and ensures that those organisations are never hindered in their important work.
The Bill is a big step forward. I urge hon. Members from both sides of the House to support it.
Later in the year, we shall publish a comprehensive update on achievements to date and the progress towards Sir Robert Francis’s vision of a system delivering safe, compassionate care.
The events at Mid Staffs were a shocking reminder of the systemic failings in patient safety and care that occur when the culture and practice of healthcare institutions cease to prioritise the human, the compassionate and the cultural aspects of health care. I am delighted to support the Bill, which fits very well with the Secretary of State’s crusade for accountability, transparency and patient safety. It complements the measures that we are putting in place, as a Government, to support patient empowerment, to integrate health and care, and to meet the need for seamless information that follows patients, rather than patients so often traversing the care pathway without that information to hand.
There are two other questions that I was—
Madam Deputy Speaker (Dame Dawn Primarolo)
Order. With respect to the Minister, I spoke to him nearly 15 minutes ago with regard to his comments on the Bill. He has now been speaking for 37 minutes to tell us how much the Government agree with the Bill. There are other Bills to be debated this morning. I tried asking the Minister very nicely and gently. Now I am saying to the Minister directly that it is not his job to use up time in the House. Could he please conclude what are the major points on the Bill?
George Freeman
Thank you, Madam Deputy Speaker. I have concluded my prepared remarks. I just want to deal, if I may, with the questions that were asked of me in the House.
Madam Deputy Speaker (Dame Dawn Primarolo)
With respect to the Minister, he should have integrated those into his remarks on the Bill, because I presume he was listening to the comments of the other speakers. He has now been speaking for nearly as long as the rest of the debate, and this is not really acceptable, Minister, given that there are other Bills to be debated this morning, and that this Bill seems to have the wholehearted support of the Department. The word succinct must be in the Minister’s mind, which means brief, and I will interrupt him again if he is not.
George Freeman
Thank you for that clarification, Madam Deputy Speaker. In that case, perhaps it would be appropriate for me to list the questions now and then deal with them by writing to Members.
There were important questions about the Law Commission, some of which I have addressed, but I will write more fully. The hon. Member for Copeland asked me about the duty of candour dropped under pressure from professionals. If he is happy, I will drop him a line on that. The hon. Gentleman also asked about the care.data issue. I think I have dealt with that in my comments, but he should feel free to contact me if there are any omissions. There were important comments about the BMA, Madam Deputy Speaker, which I am taking your guidance to mean I should not address. Its briefing arrived on my desk this morning, and obviously I will look at it very carefully and write to Members with our position on the concerns that it has raised, although I note that its report also seems to have a lot of support for the intent of the Bill.
Lastly, there was a question about making data sharing much more consistent. I want to confirm that the Department of Health is working with our partners, and will produce guidance to support compliance across the system.
On that basis, Madam Deputy Speaker, following your guidance, I express again our support for this important measure and resume my seat.
Jeremy Lefroy
With the leave of the House, Madam Deputy Speaker.
Should my Bill receive a Second Reading today, I shall take very clearly from this important debate the points raised by my hon. Friends the Members for Bury North (Mr Nuttall) and for Congleton (Fiona Bruce), the hon. Member for Copeland (Mr Reed) and the Minister, and I am grateful to them.
There are two things that we must discuss very seriously in Committee. The first is justification of all the clauses. I believe they are justified, for the reasons that I set out in my earlier remarks; I will not rehearse them again. Secondly, we must discuss the details, particularly around privacy. With that, Madam Deputy Speaker, I thank you very much for your indulgence.
Question put and agreed to.
Bill accordingly read a Second time; to stand committed to a Public Bill Committee (Standing Order No. 63).
Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)
On a point of order, Madam Deputy Speaker. I am sorry to detain the House briefly. You may be aware that the shadow Home Secretary has asked the Home Secretary to make a statement on the publication of the Wanless report on whether the Home Office misplaced files relating to child sex abuse allegations, and yet the Home Secretary has so far declined to say that she will. This morning the media are reporting details from the Wanless report. Madam Deputy Speaker, I wanted to ask you whether, after the bungling of the child sex abuse inquiry, you think it would be appropriate and wise, given the seriousness of this, for the Home Secretary to make an oral statement on Monday, so that the House is able to have complete transparency on the important issues around the Wanless report?
Madam Deputy Speaker (Dame Dawn Primarolo)
That is not a point of order for the Chair today. I understand that the Wanless report is to be published. I am sure that those on the Treasury Bench heard the hon. Gentleman’s points very clearly. It is open to him to pursue that subsequently if he is not satisfied with the response, but it is not a point of order for me today.
Off-patent Drugs Bill
(10 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Jonathan Evans (Cardiff North) (Con)
I beg to move, That the Bill be now read a Second time.
Only a handful of MPs are ever successful in the private Members’ Bill ballot, so I am delighted and honoured that, 22 years after I was first elected to the House, and now in my final year of parliamentary service, I have at long last joined this rather select group and have the opportunity to promote a Bill on such an important matter.
First, let me thank the Bill’s sponsors, and MPs from all parts of the House, who have shown such support and interest in my Bill. The passionate welcome it has received has been truly amazing, although not surprising given the challenges it addresses.
Just yesterday, the letter page of The Times led with a joint appeal to the Minister and the Government in favour of the Bill from the Association of Medical Research Charities, the Breast Cancer Campaign, Leukaemia and Lymphoma Research, Breakthrough Breast Cancer, the Alzheimer’s Society, the Multiple Sclerosis Society, Leukaemia Care, Breast Cancer Care and the Cure Parkinson’s Trust. I should particularly like to thank Jenny Goodare and Mia Rosenblatt of the Breast Cancer Campaign for all the help they have given me in introducing my Bill.
Why question access to off-patent drugs? The problem goes back many years and is caused by a gap in the licensing system. The system is set up on the basis that a pharmaceutical company that wants to market any new drug acts as the drug’s sponsor throughout the process. That is fine and clearly understandable when the company anticipates many years of patent protection for its new product, but the essence of the problem that my Bill addresses is that no mechanism is in place to ensure the routine availability of existing drugs where patent protection has expired and where the drugs may be clearly shown later to be clinically effective but in a new way and for a new purpose.
Every time previously licensed drugs are shown to be effective for a new purpose, a new licence is needed to certify the drug’s safety at whatever the dose may be and for that purpose, and it must then be authorised to be marketed for such use. However, if a drug is no longer patent protected, no organisation or individual will take on the role of seeking any necessary licence for that treatment, because, after the patent has expired, other drug companies can produce and market generic versions of the drug, so the price of the product is driven down through the simple expedient of competition. It follows that the incentive for any pharmaceutical company to act as an advocate or sponsor for an off-patent drug and apply for a new licence is lost.
The outcome of all this is that off-patent drugs that should be routinely available at extremely low cost effectively have no sponsor. Without a change in the system, no one is ever likely to make licence applications for off-patent drugs, even when they may be effective for new purposes. In fact, it remains illegal to advertise and sell such drugs for such purposes if the drug is not licensed. What this all boils down to is that off-patent, repurposed drugs are not routinely available on the NHS, despite minimal costs to the taxpayer and the clear, clinically proven health benefits.
We may hear mention today of the ability of general practitioners to prescribe a drug outside the terms defined by the licence, which is known as off-label prescribing—in fact, Madam Deputy Speaker, given our earlier experience today, we may hear a lot about that—but the reality in clinical practice is much more complex and there are many disincentives to prescribing off label. A small number of clinicians may well be comfortable prescribing drugs off label in certain limited circumstances, but we know from the chemoprevention example, which the Minister quoted in the earlier debate, that this is not happening on any substantial scale. We also know that the absence of a licence is deterring many clinicians and GPs from prescribing these life-saving drugs in their new indications. Medical charities and senior distinguished clinicians have said that it is just not good enough to rely on the promotion of better information about off-label indications between clinicians.
Bob Stewart (Beckenham) (Con)
Are off-patent drugs likely to be found in a chemist’s shop? Do chemists keep stores of these drugs?
Jonathan Evans
Invariably, such drugs have been licensed for other uses, but it transpires that they are being researched, as I will outline in my further remarks, and that research is showing that they can be used effectively in another way. The kernel of the problem that I am seeking to highlight is that, without licensing, they are not being used in that way.
A licence gives a clear indication to GPs that a drug is both safe and effective, so it is preferable that indications that could achieve such a licence are supported. We face an unacceptable situation where cost-effective drugs are not made routinely available for new and proven effective uses. Although a small number of people might be fortunate enough to get the drug, a far greater number with exactly the same condition, in exactly the same clinical circumstances but with a different GP, will not. That is the worst form of inequality.
I want to highlight one scandalous example of the failure, red tape and bureaucracy of our current licensing system. The passive approach to the flaw that I have highlighted has meant that, for all of 15 years, the chemoprevention drug tamoxifen was routinely available to women in the United States of America to prevent the development of breast cancer but not to thousands of women at risk here in the UK, not because the research evidence is any different in the United States of America and the UK but because under our licensing system there is just no one to request that this treatment should become routinely available. So for 15 long years nothing whatsoever happened, and thousands of women here in Britain were denied treatment that it has been clinically proven could have prevented the development of breast cancer in many cases.
It was not until 2013 that the National Institute for Health and Care Excellence—NICE—eventually recommended the use of tamoxifen in the UK in its guidelines on the management of familial breast cancer, but that still stopped short of licensing, because of the flaw to which I have referred. As a result, the NICE guidance has proved insufficient to ensure equal access and there is no evidence that it has significantly changed clinical practice. The uptake of these treatments is lower and less uniform than if the drug were licensed. Furthermore, owing to the infrequency with which NICE guidelines are updated and their impact, this mechanism could not be widely employed to make off-patent drugs available, and I believe that the example of tamoxifen starkly confirms this.
Graeme Morrice (Livingston) (Lab)
I entirely agree with what the hon. Gentleman has said so far. Indeed, I want to lend my personal support to his private Member’s Bill and wish him well on its Second Reading. Several dozen of my constituents have contacted me in support of the Bill and specifically asked me to come along today to represent them in the Chamber and to vote for the Bill on Second Reading if, indeed, there is a vote. I certainly hope that his Bill is not talked out.
Jonathan Evans
I am grateful to the hon. Gentleman for that contribution. If he will forgive me, I will not go further down the path of responding because of the point that he made at the end.
Sadly, all existing off-patent drugs that reduce the risk of people developing breast cancer fall into this category. The leading proven chemoprevention drugs are tamoxifen and raloxifene. These drugs, which reduce the risk of breast cancer developing in high-risk women by around a third, are not licensed for this purpose. With nearly half a million women in England and Wales eligible for these low-cost treatments, there is an urgent need to address the barriers to chemoprevention drugs being prescribed. The cost of tamoxifen is 6p a day; the cost of raloxifene is 61p a day. A third chemoprevention drug, anastrozole, originally developed as a hormone therapy, has been shown to reduce the risk of breast cancer developing by a half, and with fewer side effects. The evidence is there, but what action can be taken to ensure the routine availability of these treatments? The answer is none, or very little.
Bob Stewart
Without trying to talk out anything, may I say that I totally support what my hon. Friend is trying to do? Could NICE not do this sort of thing?
Jonathan Evans
My hon. Friend, yet again, anticipates another part of my remarks. The second part of my Bill is about giving a certain responsibility to the Secretary of State to encourage NICE to promote technology appraisals. I will deal with that in a little more detail in due course. He is quite right, but not exclusively: licensing is the major problem.
Major new research will be published in the next few months that provides evidence that bisphosphonates—drugs that were originally licensed for the treatment of bone fractures in adults with advanced cancer—are effective in the early stages of breast cancer in reducing the risk of the disease spreading to the bone in post-menopausal women. That analysis of phase 3 clinical trials is likely to show that, in post-menopausal women with early breast cancer, this therapy reduces the 10-year risk of breast cancer spreading to the bone by 34% and the risk of dying from breast cancer by 17%.
I should like us to reflect on that for a moment: a 17% reduction in the risk of women dying from breast cancer. What would be the cost of any new treatment that could deliver such results? It would probably be tens of thousands of pounds, and we would want to pay that for such impressive results. However, zoledronic acid, a type of bisphosphonate drug, can be given to post-menopausal women every six months for three to five years, and that can reduce the risk of breast cancer spreading to the bone by a third and the risk of death from breast cancer by a sixth, and it would cost less than 5p a day.
Yet bisphosphonates are off-patent drugs that are produced relatively cheaply by numerous pharmaceutical companies as generic drugs, as my hon. Friend the Member for Beckenham (Bob Stewart) mentioned earlier. It is therefore pretty certain that under the current flawed licensing system no organisation would seek a licence to use that treatment in preventing secondary breast cancer, even when the evidence is published, so the drugs will not be routinely available to the women who clearly need them.
I want to pay tribute to the distinguished breast cancer clinicians and researchers who have been speaking out about this issue for years. Sixteen of them wrote to The Times on the day of the Bill’s First Reading, stating:
“For some time it has been clear that there is a real barrier to licensing old drugs for new purposes, even when there is evidence that they are effective. This means that treatments which could bring real benefit to the lives of people and in some cases be life-saving, with minimal cost, are not routinely available”.
It is not just access to cancer treatments at stake; the current system will fail us for any medical condition in future if we do not correct the flaw. The Multiple Sclerosis Society makes it clear that strong preliminary evidence has shown that a number of repurposed medicines could be effective in the treatment of multiple sclerosis, but the UK currently lacks a system by which old drugs can be relicensed. In the past week the society wrote directly to the Minister in support of my Bill, in a letter co-signed by Professor Sue Pavitt, chair of the UK’s MS clinical trials network, and other leading specialists in the field. They cited the example of simvastatin, a drug originally licensed for treating high cholesterol that has been shown to be effective in slowing brain atrophy in secondary progressive MS by over 40%. Although final evidence from a phase 3 clinical trial is required to confirm those results, if successful that drug would address a significant unmet need, as there is currently no treatment that can slow or stop the deterioration seen in progressive MS.
The MS Society has pointed out that, given that simvastatin’s patent has expired, the treatment would require a licence in order to be made widely available on the NHS to people with multiple sclerosis, and it argues that the mechanism to achieve that just does not exist, despite the repurposing of previously licensed drugs being a fast and cost-effective way to provide new treatments. Those eminent clinicians and the MS Society strongly support my Bill and the mechanism it would create to provide access to medicines that could help tens of thousands of people with untreatable multiple sclerosis.
The treatment of Parkinson’s disease could greatly benefit from the Bill. I know that Tom Isaacs, president and co-founder of the Cure Parkinson’s Trust, has written to the Minister in the past week to point out clearly the charity’s full support for the Bill. Tom has said:
“Parkinson’s may not be a death sentence, but at the moment it is a life sentence. There is increasing evidence that a number of off-patent drugs have the ability to slow, stop or reverse our condition. Under these circumstances, the ability for patients to have a clearly defined way to make these medications accessible is now imperative.”
I think that it is now appropriate to turn to the detail of the Bill, given that the Minister might do so, Madam Deputy Speaker. To address the anomaly I have outlined, the Bill introduces a new advocate—the Secretary of State or a body appointed by him—for off-patent, repurposed drugs in the existing UK licensing system. The advocate would have to act in the public interest, and in circumstances where no other body had taken on the role of seeking a licence. The level of evidence required to trigger the advocate to seek a licence for an off-patent drug in a new indication would have to be significant. The treatments referred under the mechanism would be required to meet exactly the same standards for a licence for any other treatment, so nobody is lowering the bar in the licensing process. The Bill does not seek to make any unproven treatments available to patients; it simply seeks to address a clear market failure in the current system and to allow proven drugs to be considered for a licence after their patents have expired.
Clinicians have also suggested the supplementary provision in the Bill for NICE to appraise off-patent drugs in new indications where these are unlicensed—the point made earlier by my hon. Friend the Member for Beckenham, who sadly is no longer in his place. It is anticipated that that exceptional route would be used rarely. Regulations would outline the specific and significant standards that would need to be met before the provision was triggered. Although it may already be possible under existing legislation for NICE to appraise drugs for an unlicensed indication, the Bill would simply place a duty on the Secretary of State to direct NICE to conduct a technology appraisal for an off-patent drug in a new indication that satisfies the evidence threshold.
The Minister has stated publicly:
“The Government firmly believe that cost-effective, clinically appropriate drugs and devices should be routinely available to NHS patients.”—[Official Report, 1 September 2014; Vol. 585, c. 141.]
I recognise and applaud the admirable steps that this Government have taken to improve access to new cancer treatments. The cancer drugs fund has been established for England and now has a budget of £280 million a year. It is an incredible scheme that has improved access to treatments for thousands of patients in England, and I have seen for myself the disadvantages that my constituents have faced by not having an equivalent fund in Wales.
On the CDF, we are currently spending millions on new treatments, so why not improve access to treatments that cost just pennies but that we know can save or improve lives? In future there will be drugs for other conditions, including Parkinson’s, multiple sclerosis, breast cancer and Alzheimer’s, that could benefit from the Bill. We cannot wait 15 years longer than other countries for our constituents to get these treatments, as happened with tamoxifen, and then tolerate a postcode lottery in their availability to our constituents.
Mr Christopher Chope (Christchurch) (Con)
I congratulate my hon. Friend on bringing forward this brilliant Bill. If it does not succeed today, it will certainly succeed in future, because it seems to be based on unanswerable logic. Can he explain why he thinks the Government are against it?
Jonathan Evans
It will be for my hon. Friend the Minister to make the Government’s case, although I certainly hope that he will not be lengthier than I am being in endeavouring to make my case.
It is simply not acceptable to sit back and hope for the best: we will let our constituents down by taking such a stance. I have heard it said that the Bill is not necessary and that better information for GPs and clinicians may be the answer, but the reality is that addressing the licensing flaw in the current system, as I have outlined, is the only way to tackle the issue effectively.
I say to colleagues, let us take this opportunity to act and deliver real change for those affected by cancer, multiple sclerosis, Alzheimer’s, Parkinson’s and so many other conditions. That is what the charities supporting them, and the senior clinicians specialising in treating them, are asking for. If we take forward this Bill, we can save and improve lives. If we tinker at the margins, we will not. For those who really want change, who really want people in this country to have access to the best treatments available, the answer is before us and it is clear. A legislative solution is necessary. By passing this Bill, we have an opportunity to change and save our constituents’ lives. I hope that we take it.
Mr Jamie Reed (Copeland) (Lab)
I congratulate the hon. Member for Cardiff North (Jonathan Evans) on introducing this excellent and concise Bill, which Opposition Members support wholly. I will keep my remarks brief, because I think that there is plenty of time for us to do the business with the Bill this morning.
The principle of the Bill is one that the Labour party supports. We must do all we can to ensure that patients have timely access to safe drugs. As the hon. Gentleman has pointed out, the Bill would benefit very many people indeed. There is no doubt that the subject of off-patent drugs needs to be debated and, more importantly, requires action from this House. Now that we are aware of the issue, it would be remiss of us not to do something about it. We will support this Bill to ensure that people who are at risk of, or have been diagnosed with breast cancer, multiple sclerosis, Parkinson’s disease, Alzheimer’s, leukaemia and many others—as well as all those who may be diagnosed with any of these conditions in future—have access to treatments that they would otherwise be denied: treatments that are effective and low cost, and change lives.
I hope that the Government are also going to support this potentially life-saving—as the hon. Gentleman pointed out, life-changing—Bill. The Minister himself has stated that a central part of his mission
“is to accelerate the discovery, design and adoption of new drugs in the NHS, making the UK the best place in the world to discover and design 21st-century health care technologies”,
and for Britain to be
“once again the best place in the world to discover new medicines and to be treated by them.”—[Official Report, 1 September 2014; Vol. 585, c. 141-144.]
That is an aim we all share. We have our work cut out, but it is achievable.
Existing drugs can demonstrate great benefits but do not have licences under which to be marketed, meaning that access to them is low. Often a repurposed drug offers the best hope of a step change in treatment and therefore should not be forgotten or deprioritised. The views of clinicians on this issue have been exceptionally powerful. I will quote just a few. Harking back to the previous debate, we should listen to medical professionals when they are giving us advice that is, frankly, beyond dispute. Professor Anthony Howell, professor of medical oncology and research director of the Genesis breast cancer prevention centre at the University Hospital of South Manchester NHS Foundation Trust, says:
“Clinically-proven therapies to reduce the risk of breast cancer developing and spreading could bring a step change in breast cancer survival rates, but without the Bill we will not see a step change in the availability of these treatments.”
Professor Robert Coleman, Yorkshire cancer research professor of medical oncology at Sheffield cancer research centre, says:
“Repurposed bisphosphonate drugs could significantly reduce the risk of breast cancer spreading, and ultimately killing women, and would cost the NHS very little. However, without the Bill we are unlikely to see the wholesale change in prescribing behaviour that would be required to make these drugs routinely available.”
Dr Jeremy Chataway, consultant neurologist at the National Hospital for Neurology and Neurosurgery, University College London Hospitals NHS Foundation Trust, and St Mary’s hospital, Imperial College Healthcare NHS Trust, says:
“There are currently re-purposed medicines that have shown strong preliminary evidence that they could be effective in the treatment of multiple sclerosis (MS), however the UK is currently lacking a system by which old drugs can be re-licensed for new purposes. This Bill would create a mechanism to potentially provide access to medicines that could help tens of thousands of people with untreatable MS.”
It is also powerful to see that, as the hon. Member for Cardiff North pointed out, the Bill is supported by a whole spectrum of medical charities: the Association of Medical Research Charities, the Breast Cancer Campaign—I praise it for its absolutely phenomenal work on the Bill—the Multiple Sclerosis Society, Cure Parkinson’s Trust, Breakthrough Breast Cancer, Breast Cancer Care, Leukaemia CARE, the Alzheimer’s Society, the Teenage Cancer Trust, and Leukaemia & Lymphoma Research. All agree that we have a one-off opportunity to change the law and would like the results of research to be translated into clear, demonstrable, deliverable patient benefit.
We are talking about clinically proven drugs that cost virtually nothing but could bring a step change in survival rates. Zoledronic acid costs less than 5p a day per patient and could reduce the risk of death from breast cancer in post-menopausal women by 17%. This Bill is not about bringing untested drugs forward for use in the NHS—it is about ensuring that the drugs that can benefit patients, but in which pharmaceutical companies have no commercial interest, are available to treat myriad conditions and bring real patient benefits.
We must remember, though, that drugs are not the only tool to fight these conditions. With specific regard to cancer, we must ensure that bringing new drugs through is not to the detriment of patient access to radiotherapies and surgeries. We should remember that it is crucial that patients can get tested quickly if cancer is suspected. That is why a future Labour Government will guarantee that NHS patients will wait no longer than one week for cancer tests and results by 2020. Labour supports the principle behind the Bill, and we will support its Second Reading.
There is something else to consider. This Bill provides a simple remedy to an obvious and avoidable problem. It is underpinned by irresistible logic. To thwart it would represent an act of vandalism. Right now, our country is facing a collective nervous breakdown. Faced with internal separation and separation from the European Union, fear and loathing stalks this septic isle. Every day, people ask themselves, “What is the point of politics? What is the point of Parliament?” Unless we act to address these legitimate concerns, this place will drift towards not only irrelevance but illegitimacy. The purpose of each of us in this House, on both sides, is to make better the lives of the people who sent us here. That is our principal aim. I urge Members in all parts of the House, and the Government, to do what we were sent here to do—act to make life better and to demonstrate that Parliament, and politics, can work.
Mr David Nuttall (Bury North) (Con)
I congratulate my hon. Friend the Member for Cardiff North (Jonathan Evans) on bringing this fairly short, but very important, Bill before the House. I am delighted to be named as one of its sponsors. I have to say that I am perhaps the least well qualified of them all. My right hon. Friend the Member for North Somerset (Dr Fox) and my hon. Friends the Members for Bracknell (Dr Lee) and for Totnes (Dr Wollaston) are all real doctors. The fact that they are real doctors and have felt it appropriate to lend their names to this Bill is, in itself, something of which the House should take careful note.
This Bill is required because when a drug whose patent has expired is found to be effective in treating a different condition from that for which it was originally licensed, doctors are reluctant to prescribe it because it is not licensed for its new use. As I understand it, the Bill would put the onus on the Secretary of State to take steps to secure licences for clinically proven off-patent drugs for their new use when no other body has taken on that role.
In essence, the Bill would put an end to a postcode lottery. Patients are left in limbo. Until they go to their GP, they do not know whether they are registered with a GP who is prepared to take this risk. The Bill would remove that postcode lottery and give security to millions of patients. If the process has been followed and the drug licensed for its new use, whichever GP they are registered with will have the confidence and security of being able to prescribe it for its new use.
I am pleased to say that the Bill has the support of many charities: the Association of Medical Research Charities, the Breast Cancer Campaign, Leukaemia & Lymphoma Research, Breakthrough Breast Cancer, the Alzheimer’s Society, the Multiple Sclerosis Society, Leukaemia CARE, Breast Cancer Care, and the Cure Parkinson’s Trust. That is a wide range of charities, all of which, for their own individual reasons, can see the sense of having a new procedure in place to bring back to life drugs that are found to be of new use but are off-patent.
The Bill also has the support of many of my constituents. I thank all those who have taken the time and trouble to write to me personally to express their support for the Bill and to urge me to continue to support it. I am delighted to do so.
Bob Stewart
A lot of us have received letters from constituents, including me, and I am absolutely delighted that we are here to support the Bill and get it through as fast as possible.
Mr Nuttall
I am grateful to my hon. Friend for that intervention.
This Bill will cut through the red tape that exists at the moment. It aims to get drugs off the shelves and into the hands of the patients who need them. I hope it receives the wholehearted support of this House.
The Parliamentary Under-Secretary of State for Health (George Freeman)
I am delighted to have the opportunity to address the Bill. I start by congratulating my hon. Friend the Member for Cardiff North (Jonathan Evans) on bringing it before the House and raising this very important issue. As he has said, he and I have met Department officials and we very much agree on the Bill’s objective to promote off-label use of medicines. The only disagreement is on the mechanism to achieve that and whether the mechanisms proposed by the Bill are the right ones. That disagreement continues, and for that reason the Government want to work with my hon. Friend and the campaigners and charities that support the Bill to find a way to achieve our agreed aims.
I want to set out some of the background, outline my proposals and explain why the issue is not quite as straightforward as we would all like to think it is. If only we could legislate to get the right drugs into the right patients at the right time, the world would be a lot easier, but we are not able to do that.
Bob Stewart
Do I take it from what the Minister has just said that the Government support getting through the Second Reading as fast as possible?
George Freeman
Let me be clear. What I am saying is that the Government support the intention behind the Bill, which is to achieve greater use of off-label drugs in different indications, but we disagree with the Bill’s proposal for legislation to require the Medicines and Healthcare Products Regulatory Agency to license them. For reasons that I will set out, we do not think that is the problem or, therefore, that the proposal is the right solution. Nevertheless, I welcome the fact that the issue has been raised. It sits foursquare with my mission as the Minister with responsibility for life sciences. I am already working on it and am very keen to make sure that the active work streams I am pursuing embrace the intent behind the Bill.
I pay tribute to my hon. Friend the Member for Cardiff North for his work. The House has often debated this issue and I am well aware of the strength of feeling among Members of all parties about the importance of, and urgency involved in, getting both new and existing medicines to patients more quickly.
I should also like to take this opportunity to pay tribute to my hon. Friend for his service in this House. As he has said, this is his last year, and I am sure I speak for all of us in paying tribute to and thanking him for all he has done, not only in contributing to the quality of this institution, but in campaigning on this issue.
As my hon. Friend and others may know, I came to this House and my ministerial position after a career in biomedical research—a subject that is very close to my heart—so I am delighted to be able to discuss it and the Bill this morning. During my 15 years working in biomedical research, I saw first hand the serious challenges involved in bringing a new drug to market. I want to address how the landscape of drug development and discovery is changing; the profound way in which technology is changing what is possible; how the economics of 21st-century drug discovery are changing; and the resulting challenges and opportunities for us to do exactly what my hon. Friend seeks to promote, which is greater and more novel use of existing drugs for those patients who will benefit. I will then deal with the key points raised by him.
A rapid transition is taking place from a model of 20th-century drug development whereby the NHS, patients and the health system waited passively and all too patiently for the introduction of new drugs that had been tested, proven and developed with the claim that they would work and were safe for everybody. Over the past several decades, the regulatory barrier required to justify that claim has got higher and higher, as have the costs of developing drugs. On average, it typically takes 10 to 15 years and £1 billion to £1.5 billion to develop a new drug.
My hon. Friend referred to patent life. Members will know how the industry works, but it is worth repeating that, in order to justify the enormous sunk cost of the billions of pounds required to bring a new drug to market, the law provides for the inventor of a new drug to have a patent for 20 years. That mechanism ensures that those who successfully bring an innovation to market are able to get some exclusivity on sales, which allows them to pay for those sunk costs. When a drug becomes off-patent, the generics market kicks in and anybody can make the drug, provided it is made to the right standard and is safe, which allows all of us to benefit from that drug at a vastly reduced price. Indeed, one of the major challenges facing the sector is that, as the cost and time taken to develop a drug increases, the pharmaceutical industry’s pipeline of new drugs is not sufficient. The problem is referred to as the patent cliff, and the sector is going through a radical transition to try to deal with it.
The problem is that the more we know about genetics and the way in which different patients respond to different drugs and diseases, the more we realise that the blockbuster, one-size-fits-all drug that we have got used to the industry giving us is not what we need. What we need are drugs that are much more targeted at patients and their underlying genetic and pharmacokinetic profile. We want drug discovery to be driven by our increasingly sophisticated understanding of how different patients respond to different drugs and diseases.
Underlying that problem is an extraordinary opportunity for this country. In order to reorientate drug discovery around patients, we need an infrastructure that allows people to work in world-class research hospitals with access, at the very highest ethical and regulatory level, to tissues, biomarkers, electronic patient data and longitudinal cohort studies. Nowhere in the world is better equipped to lead that model of translational, personalised and stratified medicine than Britain with the NHS, and through my appointment the Government have signalled their commitment to exploit that opportunity.
We believe there is a real opportunity for the UK and the NHS to lead in the emerging field of stratified and targeted medicines, because no other territories in the world have our 50-year history of an integrated public health system, the records that go with it, its ethical and regulatory standards or its world-class centres of research excellence. If we embrace that model, using genomics and data to understand better how different patients respond, we will also be able to look back at the pharmacopoeia of known and existing drugs and re-profile them for use in particular patient groups, because it will have become clear that they will be effective for them.
My hon. Friend might be interested to know that the re-profiling of drugs is itself a major subsector of the life sciences sector. Whole companies, analysts and investors are devoted to mining the pharmacopoeia to find secondary uses, with the intention, of course, of re-patenting the secondary, novel use of an existing drug through tweaking the chemistry and providing the basis for a proprietary claim. Good luck to them—I wish them well—but what my hon. Friend and I want to see is the ability better to use that information in order to find existing drugs which, in their current form, would have a benign impact on a particular patient group. Doctors are perfectly free to use those drugs at the moment.
The truth is that whichever model of drug discovery we pursue, any drug has to be licensed as safe by the MHRA—or, in Europe, by the European Medicines Agency—and then NICE carries out a technology appraisal and makes a recommendation to the NHS about whether such a drug or device has a sufficient cost-benefit to be worth using. Despite all that, the decision on what to prescribe in the end rests, rightly, with clinicians. We cannot and should not legislate to tie clinicians’ hands. Rightly, it is up to clinicians to decide what to use for their patients.
I want to submit to the House and to my hon. Friend that the challenge does not relate to passing legislation to require the MHRA to license the new use of an existing drug, because the lack of a licence is not the restraining factor. In this landscape, the restraining factor is the lack of information for clinicians about off-label use. We need to encourage greater off-label use through NICE, and to have a culture within our health system that actively supports it. In a moment, I will talk about what we are doing and might do to encourage that.
I want to pick up the confusion that may exist about the difference between off-patent and off-label drugs. A drug is off-patent when its patent protection has expired, which means that anyone can produce an identical drug at their own cost. A drug is off-label when it can be used for a new indication for which it was not originally intended. However, clinicians are perfectly able to use drugs for off-label purposes: we do not require the MHRA to license drugs for such a reason, and many drugs are already used in that way.
Let me assure my hon. Friend and other hon. Members that, as the new Minister for life science, I have responsibility for the National Institute for Health Research, which underpins clinical research in the NHS with £1 billion a year. It looks not just at new drugs, although we are very good at that, but at the whole pharmacopeia and how existing medicines are used, and provides research on side effects, efficacy and outcomes for the MHRA and NICE.
We have created a new department at the heart of the Government to tackle precisely the issues that my hon. Friend has raised. I have been in post for only 100 days, but I want to talk about what we are doing to try to accelerate access for patients to new medicines, and to existing medicines with novel indications. I am sure that he is delighted to know that, as the hon. Member for Copeland (Mr Reed) reminded the House, my principal mission is to accelerate access to new drugs, including to new uses for existing drugs, for the benefit of NHS patients.
My hon. Friend the Member for Cardiff North was kind enough to refer to the Government’s commitment to the cancer drugs fund. He rightly identified that our real commitment is to ensure that if patients suffer because of NICE recommendations in relation to particularly expensive drugs, additional money is made available to prevent that from happening. The problem is one of health economics and NICE appraisals, rather than of licensing by the MHRA.
My hon. Friend made a very eloquent case, which I support, for the use of off-label drugs. We disagree not on the aim of promoting off-label use, but merely on the mechanism for doing so. As the Minister with responsibility for NICE, I am delighted to assure him and the House that we already have the power to instruct NICE to undertake technology appraisals. I hope that what I will say in a moment about how we intend to use that power and about the work we are doing on a series of ways to accelerate access to new drugs will reassure him that, far from our having any sense of complacency, we are bending our backs to consider every avenue in order to find value within the current pharmacopeia and to support clinicians actively embracing innovative uses of drugs.
It is for that reason that we have decided—controversially in some quarters—to support Lord Saatchi’s Medical Innovation Bill, which is in the House of Lords. It seeks to contribute to this landscape by making it clear in statute that clinicians have the freedom, and should be supported in using the freedom, to embrace innovative uses of both existing and new drugs in the treatment of cancer. His Bill is about making very clear that those freedoms exist, and that clinicians have a duty, under their Hippocratic oath, to explore every innovative opportunity that there is a good clinical basis for believing will be safe and to the benefit of their patients.
The truth is that the problem is as much cultural as legislative. That is the principal reason why the Government are not able to support this Bill, but very much support its aims. I want to say something about what we propose to do to achieve the progress that we all want more quickly and effectively.
So that there is no doubt, let me say that our position is basically that the Bill is not needed. Anyone can apply for a licence for a medicine, and doctors can already prescribe medicines for uses outside their licence, where that is in the best interests of their patients. Doctors do so every day: when they make such a judgment, it is safe, legal and right for them to do so if they feel that they have a basis for doing so.
The truth is that licensing gets a medicine licensed; it does not get it into clinical practice. Whether clinicians use the medicine is driven by NICE guidance, and doctors ultimately decide what is best for their patients. That is why pharmaceutical companies invest so heavily in promoting their products. In turn, NICE exists, as an independent source of advice in the NHS, to provide our clinicians with independent, world-leading advice on the cost-effectiveness and the clinical cost-benefits of new drugs.
If we want to accelerate the uptake of innovative medicines, I suggest that we focus our efforts on NICE guidance and on supporting our medical profession to adopt innovation. Our concern is that the Bill may, completely inadvertently, impede progress on that by making doctors feel that they should not use medicines except for their licensed indications, which is the opposite of the message that we want to send. I understand that that is not the intention of the Bill, but we believe that it might be an inadvertent side effect.
What are we doing? The Government believe that the real issue involves better informing and enabling clinicians to embrace new indications, not dealing with a supposed problem of licensing. We are taking steps with NHS England and NICE to support local drugs and therapeutics networks, and improve how they pick up new evidence and translate it into clinical practice. Indeed, one role of the NIHR is to gather data—that word again—on which drugs are working and on outcomes across the system, and to feed such information back into guidance that is continually updated.
We are also working with hospitals and GPs to support them to work together on delegated prescribing, and to consider how they can change clinical pathways to reflect the very latest evidence across the system. The truth is that we need more evidence about what is working, and we are now gathering that evidence through the NICE associates network and our contacts with local clinicians.
As I have explained to my hon. Friend in our meetings and conversations, we will set up a round-table discussion in the new year, alongside NHS England and NICE, to bring everyone together, review the evidence and agree a strategy and a timetable for action. I am more than happy to extend an invitation to him and those supporting his Bill, as well as Association of Medical Research Charities, to engage actively in that process and to help us to develop a strategy for achieving what we all want, which is the greater use of off-label medicines in areas where the evidence suggests that they can deliver patient benefit.
I can go further and confirm that that is part of a major piece of work that I am leading on how we can and should reissue and revise our guidance to NICE and the MHRA—and review our ambitions as a country in this 21st-century landscape—to make Britain genuinely the best model of patient-centred research. Through the NIHR and our NHS infrastructure, we want to be the best place in the world for people to come to and develop new medicines, or indeed new uses for existing medicines. We want specialist tertiary research hospitals with cohorts of data, to develop new models of commissioning through evaluation, and evaluation through commissioning—two sides of the same coin—so that we can get drugs to patients far quicker than under the traditional model of 10 to 15 years and the £1 billion drug development.
There are undoubted benefits to the use of off-label drugs where there is evidence about their safety, efficacy and side effects. Guidance from the MHRA and the GMC is clear that there is a hierarchy in the use of medicines. In treating patients, clinicians must first consider using a licensed medicine within its licensed indication. If that will not meet the patient’s needs, clinicians can consider a licensed medicine outside its licensed indication. Only if that is not suitable should they consider a medicine that is not licensed at all. A great many medicines can offer benefits to patients when prescribed outside their licensed indications—my hon. Friend has already mentioned tamoxifen and raloxifene for the prevention of familial breast cancer.
My hon. Friend also rightly identified that there can be delays and barriers to using off-patent drugs for new indications. The reasons for that are complex—if only they were so simple that we could solve them with one private Member’s Bill—and in part relate to reluctance by some clinicians to prescribe drugs for conditions for which they are not licensed. There are also issues about the system’s ability to pick up emerging evidence and translate it into new guidance and clinical practice, and about how hospital specialists and GPs can work together to achieve that, by adapting pathways where needed.
What the Bill seeks is already allowed. That is the key reason why, despite agreeing with the Bill’s aim that patients should have access to appropriate drugs, the Government are unable to support it. Medicines are already prescribed legally, safely and appropriately outside their licence indications to large numbers of NHS patients, both in hospitals and in general practice. No funding, legal or regulatory barriers in the system prevent patients from being prescribed a clinically necessary medicine that is not licensed for the treatment indicated. Indeed, doctors regularly prescribe drugs outside their licensed indications. For example, many medicines prescribed to children are unlicensed for paediatric use because historically they have not been formally trialled in children. Two key conditions must be met in such prescribing. First, the clinician must be satisfied that the unlicensed indication meets the clinical needs of the patient and that no suitable licensed alternative is available. Secondly, he or she must explain to the patient that the drug is not licensed, so that they are clear about that.
Evidence suggests that patients trust their clinicians, and that those who are suffering actively embrace research medicine and are keen to be made aware of available drugs that may be not have been originally licensed for that purpose, as long as there is good evidence for it and the clinician supports its use. That position is well established and supported explicitly in guidance to prescribers by the General Medical Council and the Medicines and Healthcare Products Regulatory Agency. Therefore, if a doctor chooses not to prescribe a medicine off label where one is indicated for the patient, that is unlikely to be simply because of the medicine’s licensing status. If a clinician believes that the lack of a licence prevents them from prescribing a drug, that is a different issue to which I will return in a moment.
Under the law regulating medicines, anyone can apply for a licence for a new use for an existing out-of-patent medicine. The Bill seeks to place that responsibility on the Health Secretary, so that he either takes steps to secure licences for off-patent drugs and new indications, or appoints a body to do so. In truth, licensing gets a medicine licensed, but it does not do what we want, which is get it into clinical practice. That requires clinicians to use and prescribe drugs, which is why we have NICE guidance.
The Department of Health holds a small number of licences for anthrax vaccine in the case of national emergency, but the Government rightly view that very much as an exception. Our concern is that if the Secretary of State were to become a routine applicant, or instructed someone else to do that on his or her behalf, they might be open to accusations of interfering in the market and a conflict of interest. There might even be a case for claiming a conflict of interest between the Secretary of State’s role as an applicant competing in the medicines market, and their statutory role as overseer of the system. Ultimately, we worry that that could compromise the Secretary of State’s responsibility for the UK medicines licensing system, were they to become a regular applicant. The idea of a body set up by the Secretary of State to apply for licences does not seem proportionate to the scale or nature of the challenge. If the issues under consideration will not be resolved simply by granting more licences—I do not think they will—there is no need for such new bureaucracy.
We believe that the provisions on NICE in the Bill are unnecessary. The fact that NICE has recommended the unlicensed use of tamoxifen and raloxifene in its clinical guidance should reassure hon. Members on that point, and I stress that we are actively discussing that matter with NICE and wish to promote it. I know my hon. Friend is concerned about the level of uptake of those drugs, despite NICE’s approval, and by focusing on the NICE appraisal process and guidance with an associated legal funding requirement, the Bill seeks to remove a perceived funding barrier to the implementation of off-label drugs that are proven to be clinically and economically effective. However, we believe that in practice it is unlikely that drug costs will be the key factor determining prescribing behaviour, when we are talking about generic drugs that in many cases will cost a few pence a day.
The framing of NICE’s clinical guidelines reflects the strength of the underpinning evidence. For example, where evidence strongly supports the use of intervention, NICE often states that that should be offered to patients. On the other hand, where the evidence of benefit is less strong, NICE typically states that intervention should merely be “considered”. It is entirely appropriate that the uptake of NICE’s recommendations reflects the strength of the evidence base. For the two drugs mentioned by my hon. Friend and me, NICE concluded that the evidence strongly supports their use for women at high risk of breast cancer, but was less strong for women at moderate risk. As such, its recommendations are worded differently, depending on a woman’s risk levels. Specifically, and importantly, NICE states that the drugs should be “offered” to women at high risk, and “considered” for women at moderate risk.
The Bill would require the Secretary of State to ask NICE to appraise certain new indications for off-patent drugs, whether licensed or unlicensed, rather than issue any form of guidance. Again, the Government believe that that is unnecessary, as there is currently no legislative barrier to Ministers asking NICE to appraise drugs outside their licensed indication. We tend to do so only exceptionally where there is clear evidence that that is the right course of action—an example would be drugs used to prevent transplant rejection in children. More frequently, NICE looks at the off-label use of drugs in the context of its clinical guidelines across the whole care pathway. Guidelines are generally considered a more appropriate vehicle for guidance on off-label indications, as they can set use more clearly in context. The question of mandated funding is unlikely to be critical if the drugs concerned are older or lower cost generics. NICE recognises the primacy of the medicines regulator in matters of safety and efficacy, and liaises with the MHRA in developing any clinical guidance recommendations relating to off-label use.
Let me explain why I am concerned that supporting the Bill could be counter-productive. That is not my hon. Friend’s purpose or intent, but it is a possible accidental side effect. The Government are concerned that the Bill could lead to clinicians and patients being concerned that something is not right about the use of a medicine outside its licensed indication, and that clinicians may be deterred from prescribing a drug, and patients from taking it. As I have explained, off-label prescribing is safe, legal, and when it is the right clinical choice for the patient, that is the right thing for the clinician caring for them to do. Given the large amount of such prescribing that goes on in the NHS every day, seeking to license every drug for every indication or each potential combination would be a gargantuan task. In many cases, the formal evidence base may not exist in a form that would support a licensing application.
Access to medicines that are important to patient care could be impeded because we worry that we would be seen to have set a new higher threshold for their use. That is precisely the opposite of what the Bill is seeking to achieve. We are, however, keen to take proportionate action to investigate whether non-legislative improvements can be made to support the use of appropriate medicines and benefit NHS patients. I was struck by the opinion and evidence that has been presented on access to medicines, such as the potential issues in transferring care from a specialist to a GP.
I might add that such issues are in no way unique to unlicensed medicines’ use. There are areas where there is far too much variation in the use of licensed NICE-appraised medicines. We are working hard with the NHS to address that, but there is no single magic bullet.
George Freeman
I am not sure it is quite as simple as that. There is a significant and substantial ongoing series of discussions in the sector at the moment on issues such as the cancer drugs fund, specialist commissioning and whether we should be ring-fencing different medicines and therapeutic areas. The truth is, for reasons I described earlier, that the landscape is changing dramatically. I totally understand that charities that rightly support greater use of off-label medicines would like to think it is possible for us to legislate for these drugs to be put into use, but from the conversations I have had, it is apparent that clinical opinion is very varied. Nobody I have spoken to in the clinical profession wants the Government to go down the slippery road of starting to legislate for particular uses of particular drugs, which is effectively what this mechanism seeks to begin to do.
I commit today to working with NHS England, the MHRA, NICE and patient and professional groups to explore in depth the issues around the cultural challenges on unlicensed and off-label prescribing in general. We know that we need to look at the issue of clinical leadership. We need to take steps to improve how new evidence is translated into prescribing practice, and how hospitals and GPs work together and how that works within the care pathway. I am absolutely committed to doing what needs to be done and what can be done now within the existing system, and to looking at the evidence to ensure we adopt the approach most likely to succeed. Most trusts have robust governance arrangements set up to consider innovative treatments that clinicians may want to prescribe. A trust’s drug and therapeutics committee, or indeed the clinical ethics committee, provides an opportunity for doctors and pharmacists to explore the clinical and patient safety implications of doing so.
I am delighted to confirm that we have begun to work with NHS England and other stakeholders including NICE to get a handle on this and to accelerate the use of off-label drugs. I restate the invitation to interested Members to come and join the project. We are absolutely committed to looking at why there may be delays in translating new evidence and research into clinical practice, including why some clinicians are reluctant to prescribe drugs outside of their licensed indications when many others are not, and to consider what further arrangements might be put in place to assist in implementing new evidence into care pathways. This is a problem we face across the system, with variable uptake of NICE guidance. It is one of the central objectives of my new role in the Department of Health to drive consistency of uptake across the system.
I believe this offers the prospect of a more appropriate, sustainable and rapid approach to this problem that can apply to a range of different drugs and clinicians.
Mr Nuttall
The Minister has just used the word “rapid”. How quickly will these drugs become available?
George Freeman
I am not clear which particular drugs my hon. Friend is referring to, but let me answer in a generic way. I would like us to become a place where, instead of it taking 10 or 15 years and $1 billion to bring innovative drugs to market, we use the NIHR platform and our investment in genomics to become a country where for some cancers we could be getting drugs to the most needy patients through the early access to medicine scheme that I have been championing and that the Department launched earlier this year. Potentially, we could be getting drugs to patients five, six, seven or eight years earlier than would normally be the case through the traditional model of phase one, two, three, four.
Jonathan Evans
The drugs the Minister is talking about are new drugs. They are not a mechanism for using existing licensed drugs for which the patent has expired, which, under current circumstances, are not being prescribed to people who need them. That is what this debate is about.
George Freeman
I well understand that. The off-patent is a distraction; it is the question of off-label. The truth is that clinicians are free today to do it. My hon. Friend’s point about timing is very well made. I would merely say that at this stage, with the working party I am putting together and the strategy I would like us to launch—I would very much appreciate his input—I think we should be looking at setting some very clear goals and targets for speeding up that use. In particular, we should ensure that where there is evidence of an innovative and new use for an existing drug off label and there is good evidence to suggest it, we roll it out across the system. It is both the speed of first adoption and the speed of roll-out across the system.
This offers the prospect of a more appropriate and sustainable approach that can apply to a range of different drugs. We can use it to tackle this problem much more quickly and to get new drugs into use much more effectively. More specifically, we are looking to gather further evidence around potential barriers by focusing first on NICE’s updated guidelines on familial breast cancer, through the NICE associates network, and asking it further to promote its implementation. I will also ask NICE whether it would be prepared to use one of the patient decision aids it is piloting for further support.
To draw all the strands together and look at the issues at national level, we plan to arrange a national round table of the key stakeholders to be co-hosted by my Department with NHS England and NICE. We intend to use the initial meeting to identify what the various participant stakeholders might usefully do to help to address the cultural and clinical leadership issues and what other practical steps might help. The request I make to those who support the Bill is that we review the need for any further guidance or legislation in the light of that work when it has been completed. I am delighted to extend an invitation to my hon. Friend to be a part of that.
In conclusion, I very much appreciate the points that have been made today. I recognise the very real concerns that have led to the drafting of the Bill. I am absolutely committed to investigating and getting to the bottom of the reasons why new evidence is not being picked up and implemented consistently, as well as why some clinicians may be reluctant to prescribe in this way, and, crucially, the important role of NICE in supporting that with updated guidance. I am committed to doing so with the involvement of all interested parties.
The Government remain firmly of the view that improvement in this area can best be achieved through a combination of measures, and that resorting to legislation to demand regulatory measures is not a magic bullet. It will not solve the issues we believe are actually responsible for this problem, and it carries the risk of some serious and unintended consequences. It is for those reasons that the Government cannot support the Bill. However, I reiterate that we support the intention of promoting greater use of off-label medicines. We are committed to looking seriously at this and to launching a strategy and a work plan, with specific targets for increasing the rate of use of off-label medicines, with all the key agencies and to invite stakeholders in the sector, in particular medical research charities and the AMRC, to help us with that. New uses for existing drugs is something we actively support. The truth is that, as much as we would love to, we could not and should not go down the slippery road of starting to legislate for the use of medicines that should be, and are rightly, a matter for clinicians.
Jonathan Evans
I thank all who have contributed to the debate, including the Minister. In fact, other than the Minister everybody has spoken in favour of the proposition contained in the Bill. I am especially grateful to my hon. Friend the Member for Bury North (Mr Nuttall), who has been involved from the inception in supporting the Bill. I am grateful for the intervention of my hon. Friend the Member for Christchurch (Mr Chope), who has been such a source of great support in this process, which, even after 22 years, is relatively new to me. He, of course, is something of a Friday expert. I am also grateful to my hon. Friend the Member for Beckenham (Bob Stewart) for his interventions and his clear articulation of support for the Bill. Let me also thank the shadow Minister and those on the Labour Benches who have made it clear to me and to the charities their complete support.
The problem is that the Government take one view on the Bill, whereas charities, clinicians and others are saying that the current situation is unacceptable. It is not good enough to argue against going down the road of legislation, given that we already have a legislative process for licensing. For instance, it is the law that if a drug has not had a licence, it cannot be effectively marketed in the UK. The reason GPs often do not routinely prescribe life-saving medicines is that the rules in essence make it illegal to market them in that way. It is not surprising, therefore, that GPs, given that legislative background and the litigious world of the medical and legal profession, decide to avoid something unless it is licensed. It is not as though the charities sector has not provided the Department with a welter of information on why GPs are not doing it. The lack of licensing is at the core of it.
As the Minister knows, I respect him and his background career, and we have had several conversations about the Bill, but the proposition that passing the Bill would damage the current situation is simply laughable. I do not know who wrote that line for the Minister, but that proposition needs to be re-examined. Nothing in my Bill would cause a GP to say, “Well, actually, I was going to prescribe something, but I’m not going to now.” With due respect to him, that was the weakest of his arguments.
We heard earlier from the Labour Benches that several colleagues have received representations on the Bill from a wide coalition of charities covering a range of medical conditions. Yesterday, I spoke to several of my colleagues on a day trip to a constituency in southern England, and everyone spoke of having 50 or 60 constituents urging them to support the Bill and of being pleased to have received a response saying that the Government were speaking to me as the Bill’s promoter. Many people interpreted that to mean that the Government would be broadly supportive of the Bill.
For that reason, I am deeply disappointed to hear now that the Government are opposed to the principle of the Bill. I do not need to rearticulate its provision—it is a very simple Bill—but it says that in the absence of somebody applying for a licence, the Secretary of State has the duty to make that application or to appoint another public body to do it. Thereafter, the Bill makes provision for the drafting of regulations that present widespread opportunities for the Minister to address his concerns.
George Freeman
To clarify, we agree with the objective of the Bill, which, as I understand it, is to get greater off-label use of medicines for new indications, but we disagree about the mechanism. The Bill is very clear on the mechanism: it is to pass legislation to require the MHRA to issue licences. We believe that this is the wrong solution, but we are in alignment on the problem that needs to be solved.
Jonathan Evans
That is very helpful. I have always understood that a Second Reading debate is on the principle of the Bill; we then deal with the detail in Committee, and then we proceed to Report. Ever since I was first elected 22 years ago, that is how I have understood it to work. If my hon. Friend is saying, “We are not against the principle, but against the mechanism”, that is a reason to support the Bill on Second Reading and then to debate in Committee how we adjust it to take into account his concerns.
George Freeman
I congratulate my hon. Friend on making an extremely eloquent argument, but I cannot let that go. The point is that the principle to which we object is the passing of legislation to require the MHRA to issue licences. That is more than a vague guiding philosophy; it is the mechanism suggested, and that is why we are opposed to it. I genuinely believe we will make more progress in the next few months using my office and the organisations for which I am responsible, working with the supporters of the Bill, to drive forward these measures.
Jonathan Evans
So we are back to the Government being opposed to the principle of the Bill. It might have helped if Ministers had said, in response to those Members who wrote to them saying they were aware of my Bill, that they were opposed to the principle, as we have just heard from the Minister. Members were led to believe that the Government were not against the principle but were discussing these matters and that we might ultimately reach an accommodation. Now we understand that the Government are opposed to the principle.
The principle is one advanced by the clinician community and the AMRC and supported by editorials in leading newspapers in the UK this week. It is not surprising that almost every leading newspaper has urged the Government to pay attention to the arguments. The hon. Member for Copeland (Mr Reed) highlighted how people outside the House look at what we do here. As I said in my opening remarks, it is important that we pay attention to the clinician community and the AMRC. For that reason, I hope the House will support the Bill.
Question put, That the Bill be now read a Second time.
Mr Jamie Reed
On a point of order, Madam Deputy Speaker. I seek your guidance on whether or not it is in order for Government Whips to instruct their own Members not to vote in order to ensure that the Division was not quorate.
Madam Deputy Speaker (Mrs Eleanor Laing)
I understand why the hon. Gentleman wishes to draw the House’s attention to what happened, but he knows as well as I do that the behaviour and actions of Government Whips is no business of the Chair.
School Admissions Bill
(10 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Mr Christopher Chope (Christchurch) (Con)
I beg to move, That the Bill be now read a Second time.
This is a very small Bill. It consists of two clauses, the second of which merely deals with the extent, commencement and short title, and the first of which is also very short. Gaps, anomalies, inconsistencies and injustices in the law or regulations are often brought to our attention as a result of constituency cases, which is what happened in this instance.
The Bill deals with the very narrow issue of whether
“pupils with a parent with a terminal or seriously disabling illness”
should
“receive priority in the admissions process to maintained schools”
in the same way as, for instance, looked-after children. It arises from the case of my constituents Mr and Mrs Amey. Mrs Amey is extremely unwell: she suffers from what is thought to be a terminal condition. She was distraught when her son George was unable to join his sibling at Mudeford infant school, which said that it had no space for him. An appeal was made through the county council system, and was rejected.
I took the view, on behalf of my constituents, that that was absurd. I was able to secure the support of the then Secretary of State for Education, who very helpfully wrote to the county council saying that he agreed with me that the situation was wholly unsatisfactory, and hoped that the council would do something about it. The council set up another appeal hearing, the outcome of which was that George Amey was able to go to that school. However, a similar problem arose earlier this year, when George wanted to move to Mudeford junior school. I will not go into all the details, but ultimately, after an enormous amount of anguish, he has obtained a place there.
Looked-after children are given special priority when it comes to school admissions, and I do not criticise that at all. They are given special priority because they live with foster parents or are in the process of being adopted, which means that they may need to move to a different catchment area. If the adoptive parents of a looked-after child are unable to get the child into the local school, all sorts of additional problems will be created as attempts are made to ensure that the child can have as normal a life as possible.
I think that giving such children priority is perfectly sensible, but I think that it is also sensible to take account of the circumstances of children whose parents are terminally ill or suffer from a seriously disabling illness. The journey to school may be much more burdensome for such a parent, and the child will be under a lot of pressure because of the parent’s illness. A parent with a disability may have to move away from the catchment area of a school that is already attended by his or her child’s elder sibling in order to live in specialist housing such as a bungalow, so that there is no need to climb stairs. Accommodation of that kind may not be available in the catchment area. As a consequence, the child will lose its priority in the system.
I know that the principle of my short Bill has been accepted by the former Secretary of State for Education, because it was on the basis of the very narrow anomaly with which it seeks to deal that he intervened so helpfully in the case of Mr and Mrs Amey and their son George. It seems to me that one way of resolving that anomaly would be to ensure that, as clause 1 proposes,
“Any reference to a looked after child in the Schools Admission Code issued under Section 84 of the School Standards and Framework Act 1998 shall be taken to include a reference to a child with a parent or guardian who is terminally ill or suffering a seriously disabling illness.”
I do not think that there is any need to elaborate on that.
Mr David Nuttall (Bury North) (Con)
Does my hon. Friend think that one way of resolving the problem would be to clarify the existing code by ensuring that it includes those crucial words when it is next issued? Perhaps the Minister could give such an assurance.
Mr Chope
I agree with my hon. Friend, and I thank him for his intervention.
I have a great deal of respect for my hon. Friend the Member for West Worcestershire (Harriett Baldwin), who I see is sitting in the Minister’s place. I am not sure whether she is, in fact, now a schools Minister.
The Lord Commissioner of Her Majesty's Treasury (Harriett Baldwin)
Let me reassure my hon. Friend: I am not only a Minister in Her Majesty’s Government, but the Whip for the Department for Education.
Mr Chope
I am grateful to my hon. Friend for her clarification. As you will know, Madam Deputy Speaker, there is a difference between being a Whip and being a Minister. I am delighted to know that my hon. Friend, who is a very distinguished Whip, has the responsibility of being the Whip for the Department for Education. She has more credibility on the Front Bench than, for example, a Whip dealing with a different Department would have. When she responds to the debate, she will obviously be able to speak with more authority on behalf of the Secretary of State for Education, which is what I wanted to ensure would happen.
Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)
It is a rare honour and privilege for me to speak from the Dispatch Box. Indeed, it is first time I have had that honour and privilege. I hope that Members, including the hon. Member for Christchurch (Mr Chope) and the Minister, will indulge me if I make any mistakes.
It has been a privilege to listen to the hon. Member for Christchurch—who has a long and distinguished history in the House, and whom I have heard speak on many occasions—and to learn about some interesting and concerning cases and some of the discrepancies that exist in the school admissions system.
The hon. Gentleman also compellingly set out the circumstances that face children and families where a parent has a terminally or seriously disabling illness. I know from my own constituency the impact of such circumstances on many aspects of the lives of families and children. They not only impact on educational provision and travel to school, but many of the young people take on caring responsibilities, which have very significant impacts on their lives.
As many Members on both sides of the House will know, school admissions come up time and again in our constituency surgeries and in our inboxes. The School Standards and Framework Act 1998 remains to this day a signature piece in the last Labour Government’s reform agenda. It enshrined in law a limit of 30 on infant class sizes. Unfortunately, we have seen a 200% rise in the number of infants taught in classes of more than 30 since the formation of this coalition Government and following their decision to relax the rules on infant class sizes.
The legislation we passed in 1998 abolished grant-maintained schools, prohibited the expansion of partial selection and, crucially for this debate, introduced an admissions code and the Office of the Schools Adjudicator. We are proud of having taken that step forward, putting fairness into the system and seeking to ensure that every child got a fair start.
Labour Members welcome the recent decision by Ministers, although late to the party, to allow all schools, including maintained schools, to prioritise admission for children who are eligible for free school meals—those in receipt of the pupil premium. My hon. Friend the Member for Liverpool, West Derby (Stephen Twigg) made the case for that in June 2013, and we have committed to going further, because while we have seen big improvements following the last Labour Government’s reforms, we can be confident that although the letter of the code is enforced, it is not always followed in spirit.
In the last report from the schools adjudicator published last November, Elizabeth Passmore concluded that the system is so complicated that parents may need to study for several years before applying for a case. I therefore ask the Minister what action the Government are taking to address the complications presented by the schools adjudicator?
As I said, we have gone further. The appeals process for academies and free schools is at present too opaque. Many academies will have nothing to fear, but to ensure greater transparency and parity Labour has committed to extending the powers of the local government ombudsman to investigate academies and free schools on admissions, because parents should not have to write to the Secretary of State to complain about the processes of a local school. Under Labour, local authorities will also have the power to direct all schools to admit hard-to-place children, and to ensure that all schools fulfil their commitment to equitable access—both to the letter and the spirit.
I thank the hon. Member for Christchurch (Mr Chope) for bringing forward this Bill and for raising this important issue, and I ask the Minister to respond to the following questions. First, what consultations and discussions have Ministers and officials had with the groups representing children with terminally ill or seriously disabled parents, and with organisations representing children with caring responsibilities? Secondly, during recent revisions of the code undertaken by this Government, what consideration was given to this specific group? Thirdly, are the Government undertaking, or do they plan to undertake, scoping work to determine the feasibility and merits of making the changes suggested by the hon. Gentleman? There are some important questions here, and the hon. Gentleman has raised some important cases, and I am grateful for the fact we have had the time to debate this matter today.
The Lord Commissioner of Her Majesty's Treasury (Harriett Baldwin)
It is a great honour for me to respond to the Bill on behalf of the Secretary of State for Education, who specifically requested that I do so. I thank my hon. Friend the Member for Christchurch (Mr Chope) for raising what is a very important issue. His constituents in Christchurch and Mudeford are fortunate to have as their MP someone who is a doughty champion of local issues on their behalf. We heard evidence of that in his opening remarks; he has already achieved a fantastic result for his constituents, Mr and Mrs Amey. I am sure they are delighted that their son, George, has been able to join his sibling at the Mudeford junior school, and I am pleased to hear that that constituency case was resolved on appeal.
I must also pay tribute to my hon. Friend for being legendary in this House for using the vehicles available to all Back Benchers in the form of private Members’ Bills to raise substantial and important issues on behalf of his constituents. Even today he has demonstrated his ingenuity in this regard by having not just this Bill on the Order Paper, but several further Bills: the Illegal Immigrants (Criminal Sanctions) Bill, whose Second Reading debate was adjourned on 24 October; the House of Lords (Maximum Membership) Bill, which he hopes will have its Second Reading today; and the EU Membership (Audit of Costs and Benefits) Bill, which is also due its Second Reading. That is just a small sample of the various different Bills on important issues he has been able to raise on behalf of his constituents through his great knowledge and understanding of parliamentary methodology.
As my hon. Friend said, the Bill before us is fairly short even by the standards of brevity we often see with private Members’ business. In its two short clauses it makes
“provision to ensure that pupils with a parent with a terminal or seriously disabling illness receive priority in the admissions process to maintained schools in England.”
The word “England” is used because my hon. Friend makes very clear in his Bill that his proposed changes would extend to England only. It is important to highlight that, as it shows how much proposed legislation, particularly on education, now comes forward that covers only England. I know he shares my enthusiasm for ensuring that we as a Parliament are in future able to ensure that those who represent English constituencies, such as Christchurch, can carry forward legislation that applies to England only.
I would like now to set out the Government’s views on the Bill before us. We believe my hon. Friend’s proposals are already covered by the existing provisions in the statutory schools admissions code and its supporting legislation. I have with me a copy of that code, published in February 2012, and I would like to draw his attention to paragraph 1.16, as it is important that we look at exactly what the code currently says. This effectively gives some discretion to local authorities but encourages them to take into account social and medical need in a situation such as the one he so eloquently described, where a particular set of circumstances needs to be taken into account.
Paragraph 1.16 of the school admissions code states that, if admission authorities decide to use social and medical need as an oversubscription criterion, they
“must set out in their arrangements the criteria against which places will be allocated at the school”.
They must state how they will define the need and give clear details of any supporting evidence that will be required, such as a letter from a doctor or social worker. They must then make consistent decisions based on the evidence provided. In the example given by my hon. Friend, I believe it would have been possible for Mr and Mrs Amey to provide that level of medical detail in order to support the case of their son, George.
As I have said, the school admissions code was published in February 2012, and the Government consulted on further, limited revisions to the code this summer. I note that one of the respondents to the consultation was my hon. Friend’s own county council. He did not respond to the consultation in person, however, and I regret to tell him that it closed on 29 September. I confess I do not have a copy of the response of Dorset county council children’s services in front of me, but evidence will be available on the Department for Education’s website. I would be happy to let my hon. Friend know what his county council’s response was, if it did not send him a copy at the time, in order to reassure him that it is engaging fully with the Department and is keen to ensure, as he is, that his constituents are able to access their preferred school.
Mr Nuttall
My hon. Friend mentioned the fact that the Government carried out a consultation on the content of a revised code between 22 July and 29 September. Given that the Bill was ordered by the House of Commons to be printed on 7 July, which I think would have been the date of its First Reading, will she tell us whether the consultation took its content into account?
Harriett Baldwin
I thank my hon. Friend for his pertinent question. I understand that the Bill received its First Reading earlier this year. One would like to think that, although the views expressed in the Bill were not formally a part of the 444 responses to the consultation, they would none the less be taken into account by the Department. I am sure that my hon. Friend the Member for Christchurch will also have sent a letter on behalf of his constituents under the previous Secretary of State. The 444 responses are listed in the back of the Government document. I looked through it earlier to see whether the Bill was included in the responses, and I can confirm that it is not specifically mentioned in the Government’s documentation. However, he has used the mechanism of this proposed legislative change to make his views known.
I can summarise the results of the consultation for my hon. Friend. They have resulted in the Government proposing specific, limited revisions to the admissions code. As I have said, 444 written responses were received by 29 September, and the Government have held discussions with interested groups. The hon. Member for Cardiff South and Penarth (Stephen Doughty) asked whether discussions had taken place with people with specific caring responsibilities. Having looked through the list of 444 responses, I note that none of the organisations stood out as the kind of organisation that he would put into that category. I can assure him, however, that discussions are ongoing with all the interested groups with a view to meeting their needs for the admission code. I hope that that answers his question.
The overriding aim of the code is to ensure that admission authorities have clear, objective and fair oversubscription criteria. It is for the authorities themselves to decide which criteria to adopt, but the code sets out the most common ones, including giving priority based on social and medical need. I have drawn the House’s attention to the fact that that is set out in paragraph 1.16 of the code.
The Government want children to be able to attend a school of their parents’ choice whenever possible but, when a school receives more applications than it has places available, we believe that those places must be allocated in accordance with the school’s published oversubscription criteria. I am pleased to say that the vast majority of parents are offered a place for their child at their preferred school. In the most recent entry year, 2014, 86.5% of parents in England were offered a place at their first preference school. In addition, 95.6% of children—so nearly 97%—were offered a place at one of their top three preferences, and 96.6% were offered a place at any of their preferred schools.
The Government have just agreed to some specific, limited revisions to the code. They are designed to improve the fair and open allocation of places and, it is worth emphasising, to support fair access for the most disadvantaged children and provide additional clarity to some provisions that had not been found to be completely clear. The limited time scale did prevent more substantial changes from being considered but, subject to parliamentary approval, which we hope is imminent, the revised code will come into force on 19 December.
Harriett Baldwin
I thank my hon. Friend for, again, being assiduous on behalf of his constituents on that drafting. He has a copy of the code in front of him, as I do. I have read the wording from paragraph 1.16 into the record, and it is my view that individual schools would have some latitude on taking into account social and medical need because of the following wording:
“If admission authorities decide to use social and medical need”.
He would like things spelt out in statutory legislation, but the wording allows admission authorities some leeway without putting things on to a statutory footing. I reassure him that we will evaluate the impact of the new proposals once they have come into effect, and will certainly do that ahead of any future revision of the code. We will examine his proposal, along with any others made as part of the process. On the question raised by my hon. Friend the Member for Bury North (Mr Nuttall), one thing that my hon. Friend the Member for Christchurch has clearly done by highlighting this issue today is ensure that the circumstances he has described so eloquently are fed into that ongoing review of the code.
The hon. Member for Cardiff South and Penarth (Stephen Doughty) touched on other aspects of the code. The code requires only that priority be given to a specific group of vulnerable people: those with a statement of special educational needs or an education, health and care plan naming the school; looked-after children; and previously looked-after children. Beyond that, the code states that admissions authorities must have their oversubscription criteria clearly, objectively and fairly set out. It is for admission authorities to decide exactly which oversubscription criteria to adopt, but the code does set out the most common criteria.
The Government believe that paragraph 1.16 is a broad provision, which can be interpreted to cover the social and medical condition of the child, the parent or both. We have no definitive data on this, but we do know anecdotally and from correspondence to the Department that a number of admission authorities do use social and medical criteria in their oversubscription criteria. At this point, I cannot say from the Dispatch Box whether Dorset county council is one of those, but I would be happy to follow this up and write to my hon. Friend the Member for Christchurch about it. We believe it is for admission authorities to decide whether to adopt these criteria and, where they do, to decide what ranking they should have, based on local needs and circumstances.
Any proposal requiring that all admissions authorities must give priority to pupils with a parent with a terminal or seriously disabling illness would require a change to the statutory code and the supporting legislation. It is not the Department’s intention at the moment to do that, other than in terms of the minor adjustments the Government have agreed to in the consultation that has just been responded to.
The overarching aim of our changes is to improve the fair and open allocation of school places. The changes are intended to provide greater freedom to schools and to clarify some of the existing provisions. For example, they allow all state-funded schools to give priority in their admission arrangements to children eligible for pupil or service pupil premium funding. In this of all weeks, it is important to emphasise the way in which the Government have tried to make it easier for the children of our armed forces to get an education in the school of their parents’ choice.
The changes also allow all admission authorities of primary schools to give priority in their admission arrangements to children eligible for the pupil or service pupil premium who attended a nursery that is part of the school. As part of that change, barriers to schools offering optional wrap-around care will be removed or reduced by ensuring that any charges paid by parents for such child care would not prevent their children from being prioritised.
The Government intend to make the following minor changes: to revise the timetable for admission arrangements; to bring forward dates for admission authorities to consult locally and to reduce the duration of such a consultation from eight weeks to just six weeks; to require the admission authorities to amend their admission arrangements to comply with the code within two months of a decision by the school’s adjudicator where the adjudicator rules that the arrangements are unlawful; to clarify the provisions relating to the admission of summer-born children to aid decision-making for admission authorities. I am sure that everyone is familiar with the particular challenges faced by children who are born towards the end of August, and the question over which year at school they should be entered. Madam Deputy Speaker, I note that you are vigorously nodding your head in agreement. I am pleased to draw your attention to that particular clarification.
Other minor changes include: extending priority for admission to all previously looked after children—I am talking about children not only who are currently being looked after but who have previously, at any time, been looked after—and making a number of minor technical drafting changes to improve the clarity of certain existing provisions. For example, we wish to make it explicit to parents that their child is entitled to a full-time place in reception.
I have run through some of the minor changes to the admissions code that the Government will bring forward. I hope that I have reassured my hon. Friend the Member for Christchurch that his case is exactly what paragraph 1.16 of the code is designed to address. I know that he has been fantastically effective at not only representing his constituents in this particular case but using the vehicle of the private Member’s Bill and the full armoury of this House to raise, on behalf of his constituents as their voice in Parliament, these important matters. Having outlined the limited changes that we propose to make to the code, which will take effect on 19 December 2014, I hope that my hon. Friend will see that the case and the circumstances of his constituents are exactly those that the code is designed to cover.
I am happy to go through some more examples that would be covered by the school admissions code. I think I have answered the questions of the hon. Member for Cardiff South and Penarth, and of my hon. Friend the Member for Christchurch.
Given the comprehensive nature of my remarks, I hope that I have convinced my hon. Friend that we do not need to move forward on a legislative basis. The extensive school admissions code, which runs to more than 38 pages, covers the situation that he described on behalf of his constituents. I therefore urge him to withdraw the motion.
Mr Chope
With the leave of the House, Madam Deputy Speaker.
I shall respond briefly to my hon. Friend the Minister. I had not realised that she was, effectively, a fully fledged Education Minister. Certainly her performance this afternoon would suggest that she has years and years of experience of speaking at the Dispatch Box on these important matters. I congratulate and thank my hon. Friend for what she has done to serve the House today. She asks whether I am convinced and the short answer is that I am convinced, and it is not often that I can say that in response to a Minister.
My hon. Friend has given a full and constructive response, and has helpfully put on record the Government’s view that when we define “social and medical need” in paragraph 1.16 of the school admissions code, we are referring not just to the social and medical need of the child or children but also to the social and medical need of the parents. That is an important point of clarification, and will be useful to admissions authorities when they consider whether to adopt the provision.
I am with my hon. Friend on the need to combine as much permissiveness as possible with the minimum amount of prescription. It seems, on the basis of the code, which is to be revised and brought into effect on 19 December, that the Government have managed to establish a balance between those two sides. I am delighted that we have been able to make progress on the general application of an issue arising from a specific constituency case and I am sure that will give my constituents substantial reassurance.
I beg to ask leave to withdraw the motion.
Motion and Bill, by leave, withdrawn.
Football Governance Bill
Damian Collins (Folkestone and Hythe) (Con)
I am grateful to Members for enabling us to make enough progress, on this day of private Members’ business, to reach the Football Governance Bill.
The Bill has been a journey for me as a Member of this House. It started with my involvement with the Culture, Media and Sport Committee’s 2011 inquiry into football governance. The Committee’s work in that inquiry built on a number of reports that had been produced by the all-party football group, and by other Members of Parliament dating back very many years. Although I have sought to bring forward some measures that I believe will help in the administration and good governance of football in England—I shall go through those briefly—I would say that the Bill is the architecture of many hands in this Parliament.
When I presented the Bill I was grateful for the support of Members from across the House, many of whom have taken a particularly strong interest in issues of football governance because of problems in their constituencies.
Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)
I should be grateful for some clarification. The hon. Gentleman mentioned football governance in England, but obviously his Bill also extends to Wales and Scotland. That is crucial, because many of us in Wales have had very similar concerns to the ones that he has outlined.
Damian Collins
I am grateful to the hon. Gentleman. The 2014 Bill is an England Bill, largely because I was advised that in Scotland and Wales these were devolved matters. My original version of the Bill was a Scotland and Wales Bill too, and I believe that this Bill’s provisions could easily be extended to Scotland and Wales as well. I look forward to hearing Members’ remarks on that in Committee; I would welcome their views.
I want to mention the support for the Bill, when it was presented, of the hon. Member for Coventry South (Mr Cunningham), who has done much to highlight the plight of Coventry City football club in Adjournment debates; of a former Minister for Sport, my former colleague on the Select Committee, the hon. Member for Bradford South (Mr Sutcliffe); and of my colleagues on the Government Benches. My hon. Friend the Member for Portsmouth North (Penny Mordaunt) has been tireless in her campaigning to relieve the plight of Portsmouth football club. My hon. Friend the Member for Hereford and South Herefordshire (Jesse Norman) has raised issues to do with governance in non-league football, particularly in the case of Hereford United, which is one of the worst examples of a failure of football governance that could be seen. A great and fighting football club with a proud tradition has been completely trashed by its poor ownership. I am also grateful for the support of my hon. Friend the Member for Maldon (Mr Whittingdale), the Chairman of the Select Committee.
The Bill seeks to address what I believe are some of the major failings in the governance of football. I do not believe that it is the role of the Government or Parliament to seek to regulate and control football, which is a private enterprise. Football clubs are private organisations; they are community-based and run; and the Football Association is rightly an independent body. I do not believe that it is necessarily the role of the Bill or Parliament to seek to regulate and control football. A series of failures in governance has led to recurring problems, certainly with the failures of ownership and the financial control and regulation of football. The Bill proposes some measures that would address that and that are relevant to some of the issues that football clubs have faced.
Clause 1 deals with the public declaration of the ownership of football clubs. During our Select Committee inquiry, no one knew who the leader of Leeds United football club was. In fact, the club’s then chief executive—Mr Shaun Harvey, who is now chief executive of the Football League—told me in a Committee hearing that not even he knew who the club’s owner was. Since then, the Premium League requires the public declaration of the ownership of football clubs, but the Football League does not require that public declaration.
Such public declaration should be mandatory because fans have the right to know who owns their football clubs. We should have the right to know what other interests, either in football or outside football, that the owners of football clubs have, particularly as we have recurring problems with the business interests of football club owners seeming to prejudice their suitability to be the chief executives or presidents of football clubs. I therefore believe that, with public declaration, fans and investigative journalists can see and inquiries can be made into the nature and interests of the owners of football clubs.
Coventry City, I believe, has been poorly served by an ownership model whereby it was owned not by a named individual but by an investment trust. That club has been badly run and it is still trying to overcome some of the many issues that it has faced. I am pleased that Coventry City have returned to playing football in Coventry, but many of the issues about its running remain of grave concern to its fans.
I believe in such public declaration of interest in and ownership of football clubs. Anyone who has a 1% stake in a football club should be on a public register. That is in keeping with the reforms that the Government have put in place to ensure that the beneficial owner of any UK-registered company must be declared at Companies House, and it would ensure that football continued to fall in line with that requirement.
Clause 2 deals with the fit and proper person test—the owners and directors test—which has continued to be a problem for football clubs, and Leeds United is a particularly topical example. Massimo Cellino—a business man from Italy, with previous convictions for fraud, whose case relating to tax evasion is going through the Italian courts—sought to buy and take control of Leeds United football club. The Football League objected to his acquisition of the club. He successfully challenged that in the courts and was allowed to acquire it.
The football bodies have a real problem in that they have no discretionary power over how they administer the owners and directors test. If someone has convictions, such as Mr Cellino’s, for fraud-related offences, some people might think that they are unsuitable to own a football club. If the offence is considered spent in UK business law, there is no barrier in law to anyone taking over a club. The Football League would probably have been challenged in the courts had it sought to stop Mr Cellino taking over the club in that way. The club’s ownership could still be in balance. The fate of Leeds United could rest in the appeal courts of the Italian legal system: a final ruling against him would mean that he is in breach of the owners and directors test and unable to take over the club.
Many Leeds United fans are concerned about Mr Cellino’s background and whether he is a suitable owner. The Football League clearly had concerns but no power to do anything about them, and the Football Association seems to have no power to intervene either. I believe that here is a clear example of where some statutory underpinning of the owners and directors test would be of huge benefit to football as a whole to help to keep out bad owners.
I suggest in my Bill that the Football Association act as the governing body of football—all football clubs need to be members of the Football Association to play in the upper football leagues in England—and that it have a discretionary power similar to that exercised by Ofcom under the 1990 and 1996 Broadcasting Acts. Ofcom applies its own fit and proper person test to the issuing of a broadcasting licence. It has the power to remove broadcasting licences from broadcasters who have fallen foul of that test—indeed, it has done so. It is a discretionary test based on its view of whether a licence holder has complied with UK broadcasting regulations and whether it is likely to do so in the future. I believe that the Football Association, based on its own memorandum and articles of association, should have the same power when looking at a potential owner of a football club; to be able to say that in its view that person is not a fit owner.
We have had problems with people who are not considered fit owners. Carson Yeung, former president of Birmingham City football club, is a good example. He was found guilty of money laundering offences in Hong Kong, so it was ruled that he could not hold an executive office within the club, but the rules do not stop his son or other business associates being on the board. I believe that the Football Association should have the power to step in and say, “No, we do not feel this is right. We are not happy with this ownership model, so we will not allow you a licence to own this football club.”
There is also a question about new owners coming in. In the recent debate in the House on non-league football, the hon. Member for Wrexham (Ian Lucas) asked whether there should be a process of prequalification, whereby someone must be declared a fit owner before taking on the ownership of a club. I think that would have stopped many of the problems we have seen. I also agreed with the view, expressed by my hon. Friend the Member for Hereford and South Herefordshire, that there should be transparency when the Football Association investigates an owner under its own owners and directors test, and transparency on the outcome so that fans know what it is. I think that is very important. To set up those powers would give the Football Association, and with it the Football League and the Premier League, the power to have tighter controls over who comes into the game.
Mr Yeung’s money-laundering offences certainly make him a poor owner, but they also highlight a grave area of concern. Many people have raised the concern that football is open to abuse from money laundering. It is a sport and an industry that deals with assets of intangible value, with cash transactions through the gates, so tracking the money that flows through football is very important. We should rightly be very concerned about someone who has been convicted of money-laundering offences owning a football club. We should also be concerned about whether someone has heavy interests in gambling or other sporting interests around the world that might lead us to question their suitability to take on the ownership of a football club. This Bill would give the football bodies in this country discretionary power to intervene and prevent poor owners from coming into the game.
That point is particularly important when we look at clause 3, which deals with something called the football creditors rule. The Select Committee examined that in great detail during our inquiry and strongly recommended that it be abolished. Ministers have agreed at the Dispatch Box that the football creditors rule has had its day. It has been challenged by Her Majesty’s Revenue and Customs in the High Court, unsuccessfully against the Football League. It remains a grave anomaly and, I believe, a shame on football in this country.
Football in this country has never been wealthier; there has never been more money in the game. The Premier League, in particular, is a great success. It has taken the English game around the world and brought huge amounts of money into football in this country, and I would not for one moment decry it. However, since the Premier League was founded, over 40 of the professional clubs in the 92 top positions in the football leagues have gone into some form of administration. There is a problem at the heart of finance in football that creates a lot of the problems we have in club ownership today, and it is the fans and the communities who suffer and have to pick up the cost of the poor regulation of football finance.
I welcome the measures on financial fair play that have been introduced into football, particularly as a consequence of UEFA requiring anyone playing in its competitions to comply with financial fair play, but I think that we need to go further. I believe that getting rid of the football creditors rule will be an important step forward. It cannot be right that when a football club goes into administration, the football debts are honoured in full, whether debts of transfers to other clubs or payments to players, in order that the club can carry on playing, but any other debts that are owed, particularly to businesses in the community, are settled with whatever is left. A company that maintains the grounds or prints matchday programmes, for example, might get a penny in the pound or less, whereas all football debts are honoured in full. That is morally wrong. The former chairman and chief executive of the Football League told the Select Committee in evidence that there was no moral justification for the existence of that rule. Nevertheless, it persists.
I believe that the football creditors rule also has an important knock-on effect: it does not encourage any sort of financial responsibility in the way clubs deal with each other. A club selling a player on to another club, perhaps at an inflated price in the transfer market— most of the money that comes into football goes back out through transfer fees and payments to players—would not really be concerned about whether the other club could afford the transactions it had entered into. If the club was going to pay a transfer fee in instalments, it would not be worried about whether it could really afford to pay it, because it knows that the football creditors rule effectively guarantees it the value of the transfer fee. If there were some element of shared risk between football clubs, there would be more honesty and transparency in transactions, and they would require more public declarations from each other as to their true solvency. This could be an important measure to stop clubs getting into the sorts of financial difficulties that we want to avoid.
I have raised this matter with the Department for Business, Innovation and Skills, which oversees the Insolvency Service, which, ultimately, is the responsible body that would look into the football creditors rule. There are grounds for amending insolvency legislation, as set out in the Bill, to get rid of this power so that the administrators of a football club would have the right and the power to settle all debts equally. It would then be a matter for the football creditors to come to an understanding with the football club on how outstanding debts were settled and whether it would be over a future period, but at least all existing debts should be settled equally so that local communities do not lose out when their football club goes into administration, getting nothing while the football players, the other football clubs and the football agents get all the money. That cannot be right.
Clause 4 deals with the ownership of football clubs. I suggest that there should be no bar to community trusts owning and running football clubs in the upper leagues and that any restrictions in that regard should be lifted. I would welcome the views of other MPs on what we can do to encourage more community ownership of football clubs. Ultimately, we cannot and should not seek to impose ownership models on football clubs by legislation, but it is worth bearing it in mind that the community supporters trust is an excellent model that has served many football clubs in the lower levels extremely well. AFC Wimbledon and FC United of Manchester are great examples of clubs that have been transformed through fan ownership. Clubs that have previously got into difficulties, such as Exeter City, have been transformed by fan ownership. It is a very good model that we should look to progress.
I greatly support the view expressed by Supporters Direct that we should see whether there can be incentives in the tax system to give non-league football clubs a similar status to community amateur sports clubs. At the moment, because of the level at which they may pay their players, even if it is as little as £100 a week, they may fall outside the threshold. It would be good to give clubs the opportunity to enjoy some of the status of community amateur sports clubs as an incentive for them to adopt a proper, robust supporters trust model of ownership. I have suggested a starting point for that process, but, again, I would welcome the contributions and ideas of other Members as the Bill progresses.
The Government have been looking at football governance for some time. The previous Sports Minister, my right hon. Friend the Member for Faversham and Mid Kent (Sir Hugh Robertson), took up the challenge in response to the Select Committee inquiry. The time has come for the House to set out its own proposals and measures. I hope that I have started that process with this Bill. I certainly look for the contributions of other Members as it progresses. I believe that it would send out a clear message to the football authorities that unless they finally act on these measures, this House will intervene, as it has the right and the power to do. I commend the Bill to the House.
Stephen Doughty (Cardiff South and Penarth) (Lab/Co-op)
I now find myself on the Back Benches. I do not want to detain the House long, but I feel particularly passionate about this issue. I pay tribute to the hon. Member for Folkestone and Hythe (Damian Collins) for bringing it before the House. I know of the extensive work that he and many other hon. Members have done. I pay particular tribute to my hon. Friend the Member for Eltham (Clive Efford)—the House will enjoy hearing from him shortly—who has set out an extraordinarily ambitious and progressive agenda for supporters’ involvement in their football clubs. I very much hope that that comes to fruition.
I should put on record a declaration of interest as a member of the Cardiff City supporters trust, Cardiff City supporters club, and Supporters Direct. As a Labour and Co-operative MP, I find this issue particularly interesting. I am a big supporter of community trust models and co-operative and mutual solutions in a whole series of areas, whether football or others.
I have a particular interest because of the recent, but also longer-term, experiences of my own football club, Cardiff City, which I have supported for 28 years this year, and for which I have been a season ticket holder. My father was briefly its club secretary during a quite turbulent period of ownership. The hon. Member for Folkestone and Hythe is probably aware of the series of owners the club has had over a number of years, all of which have involved significant ups and downs, including Tony Clemo, Rick Wright, the Kumar family, Sam Hammam, Peter Ridsdale and, more recently of course, Vincent Tan, who is widely known across the country and in football circles. He has made significant changes to the club, particularly to its colour, its badge and many other aspects of its heritage. Personally, I opposed those changes and I have made that clear to Mr Tan and in public. Indeed, I spoke about it in my very first speech in this House, when I made clear that my colours remain as deeply blue in my football as they are red in my politics.
A number of the issues addressed by the Bill are crucial and closely related to the ambitious plans that my hon. Friend the Member for Eltham has set out recently. We have to look at how fans and community figures can engage much more positively with clubs, so that they are not just left to those with the money and resources. I was reminded this week of one of the founding figures in Cardiff City’s history, Lord Ninian Crichton-Stuart, who was a predecessor of mine as a Cardiff Member of Parliament and who was sadly killed in the first world war while still serving as an MP. He is remembered fondly and his name was given to our original club home, Ninian Park. He was known as not only a great benefactor and fan, but a keen community supporter who engaged in the governance of the club. It is a shame that we have moved away from that sort of local involvement and understanding of the local heritage and the concerns of fans, and towards the current governance models and the challenges outlined by the hon. Member for Folkestone and Hythe.
As I have said, specific issues have included the change to the club’s shirt, colours and badge, and now red seating is being installed in the new stand being erected at Cardiff City football club, even though the traditional colour is blue. Cardiff City fans care deeply about such things and they go to the heart of the matter.
Many of us welcome the investment that Mr Tan has made, as well as his business acumen and a number of things he has done in the community. Indeed, he generously donated £1 million to local charities, which was a compelling offer. On other issues, however, including regular consultation with fans and the engagement of club officials below Mr Tan and the board, there has, sadly, been a lack of understanding. That makes me very sad, because, although Mr Tan has shown business acumen and invested money, and although he remains committed to the club, which is a positive thing, at the same time the heritage and history of the club have faced huge challenges and changes.
As the hon. Member for Folkestone and Hythe has said, we have to get the balance right between the principle of the rightful autonomy of owners and businesses to go about their business and the retention of the crucial involvement of fans and communities in their clubs. Football clubs are not like any other business: they are part of the heritage, community and history of many areas and are deeply related to other concerns in the local area, including those of the communities that immediately surround them. For example, I often deal with parking problems around Cardiff City stadium. Clubs also engage with local charities.
Unfortunately, we do not seem to be getting the balance right. That represents a contrast not only with the German model, where there is 51% ownership by fans’ organisations, but—I rarely praise other clubs in Wales, certainly not on the pitch—with the different approaches taken by Swansea, Merthyr, Wrexham and Newport.
I do not want to make the speech of my hon. Friend the Member for Eltham for him, but we have set out ambitious plans, which I thoroughly support. The plans have been welcomed by many supporters trusts across the country. Indeed, they were developed as a result of a very strong and lengthy consultation with those trusts and other organisations. The Cardiff City supporters trust welcomed them and I am sure the measures proposed by the hon. Member for Folkestone and Hythe will also be welcomed.
As I asked in an intervention, will the hon. Gentleman, when he responds to the debate, clarify the extent of the Bill? The Bill clearly states, if I have an accurate version, that it
“extends to England and Wales, and Scotland.”
It also makes it clear that it relates to English football authorities and the Football League. Cardiff, Swansea and other clubs are in an unusual situation in that they are based in Wales but play in the English football pyramid, as they have done for many years; Cardiff is the only club to have taken the FA Cup out of England, geographically, as it famously did in 1927. It would be useful to understand such issues, but they can perhaps be explored in detail in Committee, should the Bill reach that stage.
I certainly want many of the hon. Gentleman’s measures to apply to Welsh clubs, and I am sure that my hon. Friend the Member for Eltham does as well. I pay tribute to the hon. Member for Folkestone and Hythe. Such concerns matter very much to the people of Cardiff, Cardiff City fans and the Bluebirds alike. I very much hope that the Bill and the wider discussion can proceed apace in the House, and that some serious changes are made to get the balance right and to increase fans’ involvement in the ownership and operation of their clubs.
Clive Efford (Eltham) (Lab)
I congratulate the hon. Member for Folkestone and Hythe (Damian Collins) on his Bill. I commend him for his consistency on this issue—he has frequently spoken out, particularly on the football creditors rule—and for being a consistent fighter on behalf of football clubs and fans.
I also congratulate my hon. Friend the Member for Cardiff South and Penarth (Stephen Doughty) on his speech. I am grateful to him for his comments about our policy, which we announced a couple of weeks ago, on fans’ involvement in the management of football clubs. As he said, we undertook an extensive consultation over a long period.
Like the hon. Member for Folkestone and Hythe, we concluded that fans should be given more powers, and that they should at least be represented at board level in football clubs. That is not to give fans a veto over what an owner does with their club—that would be foolish—but to give them a voice. In our consultation, they were quite clear that they wanted to be heard, so we concluded that they should have the power to elect representatives to the board of directors of a football club. They should be able to elect up to 25% of the members of the board, and be able to remove them when necessary.
We recognise that it is a two-way street: the policy is not just about giving fans the keys to the sweet shop; they must be held responsible. We have spoken to fans about that. They must ensure that they have a proper democratic process, and that the people they elect are representative. They must be responsible in carrying out the functions of a board member, and they must respect the confidentiality of matters that are under negotiation. We are very much in tune with the hon. Gentleman, and our proposals have been very much welcomed by fans, trusts and supporters groups across the country.
We have also said that fans should have the right to buy a stake in their club. When 30% or more of a club is up for sale, fans should have the right to buy up to 10% of the shares on offer until they own up to a limit of 10% of the club. That cannot be used as a means to take over a club, but it is a means of taking a stake in it. In our consultation, fans were quite clear that they wanted to be able to do that. We would welcome such a right.
We welcome the fact—I am sure that the hon. Gentleman, a former member of the Culture, Media and Sport Committee, does so too—that the Government have finally set up the expert working group. They said they would do so in their response to the Select Committee’s report in 2011, but it took three years to the month for them to do it. We have all been very patient, and it has finally been set up.
In their response, the Government said that they would investigate and deal with the issue of fan ownership. Just before the announcement about the expert working group, the Minister said that it would also look at ticketing and ticket prices, seating, the naming of grounds and so on, but those consumer issues were not part of the original proposal. Will he shed some light on the scope of the expert working group, and about whether it will consider the issues raised by the hon. Gentleman in his Bill? I am sure we would all like to know whether the Government intend to deal with those issues.
On the detail of the Bill, the hon. Gentleman is right to call for a declaration of ownership of football clubs, because there is widespread concern about people who are completely anonymous—as he pointed out, at one stage the chief executive of Leeds United did not know who owned the club he was running. That is a ridiculous situation, and it is a surprise that football associations have not tried to sort it out before. The hon. Gentleman is right to try to move clubs down that road with this Bill, and he has Labour’s full backing.
I agree with the hon. Gentleman about the fit and proper person test. Mr Cellino was able to enter into a financial arrangement with Leeds before it had been determined whether he was acceptable to the Football League. I am sympathetic to the view that we should have some sort of pre-test. We should be able to determine whether somebody is acceptable as an owner of a football club before they enter into any financial transaction, because football authorities have to make a decision about whether they plunge the club back into more financial turmoil, or accept the person who has already put money into the club, as seems to have been the situation with Leeds at that time. I am sympathetic to the idea of having some sort of pre-examination of whether someone is a fit and proper person, and I look forward to considering that in detail in Committee—I sincerely hope that the Bill makes it that far.
On the football creditors rule, the hon. Gentleman makes the powerful point that extraordinarily wealthy footballers can be further ahead in the queue than some local small business person. That cannot be right or fair. There are always unintended consequences to changing rules such as this, but the hon. Gentleman has raised an important point that is worthy of further examination and discussion with the leagues and football authorities, while we deliberate on the matter in Committee. Current arrangements frequently fall into disrepute when clubs go into administration, and there is clearly a strong moral case for changes to the rules. We can examine in detail what those changes may be in Committee, and the hon. Gentleman is right to raise the issue. It has been Labour policy to encourage more fan ownership of clubs through co-operatives or provident societies, and we are sympathetic to and welcome clause 4 on the community trust aspect of that.
I commend the hon. Gentleman for introducing this important private Member’s Bill. He raises a number of issues that are worthy of detailed discussion, and I look forward to having those debates in Committee should the Bill make it that far.
Madam Deputy Speaker (Mrs Eleanor Laing)
I call the Minister, Eddie Vaizey.
The Minister for Culture and the Digital Economy (Mr Edward Vaizey)
Thank you, Madam Deputy Speaker. Your use of the name “Eddie” indicates how long we have known each other. I have gone from being Edward at school, Eddie at university, to Ed today, as Hansard will record. [Interruption.] As the hon. Member for Cardiff South and Penarth (Stephen Doughty) says, it is no doubt only a matter of time before I move on to Teddy.
This has been an important and lively debate on an important subject, and I register my interest as the president of Didcot Town football club, the winners of the FA Vase in 2005, and now flying high in their league following an astounding 7-0 victory against one of their opponents the other day. As many in the House have already done, I pay tribute to my hon. Friend the Member for Folkestone and Hythe (Damian Collins) who has done such an amazing job over the past three years to bring this issue to the attention of the House. As he knows, I take a keen interest in all his constituency work. I will not repeat the joke I normally trot out about his appearance in Folkestone with Prince Harry. I was tempted to repeat it simply to prove that almost anything said in this House never gets noticed, and it would be treated as a new joke, but I will not do that. I will, however, commend him for his ability to tweet about the Folkestone job fair he hosted and attended yesterday while also speaking in the Chamber on the matter of football governance. If anyone underestimates the talent and ability of my hon. Friend, that is proof of his phenomenal ability to be present in the digital and physical worlds at the same time.
My hon. Friend will also know that the other reason I take a keen interest in his constituency is my passion for culture and the work of Roger De Haan on the Folkestone Triennial, which sadly I missed this year. Given that it only comes around every three years, that is a pretty poor show by me. I had not quite got the dates in my head. Funnily enough, I was planning to visit last Monday only to find that it had closed on the Sunday. Such is life.
Damian Collins
Does the Minister agree that it is a matter of great regret that the Banksy artwork was removed from Folkestone, instead of being on public display?
Mr Vaizey
Yes, I do agree. Sometimes it makes one wonder about the motivation of one’s fellow man that, when Banksy is prepared to be public spirited enough to create community artwork in public spaces for the benefit of the local population who take it to their hearts, somebody should seek to use that windfall because it happens to be on their private property. I very much hope it will be returned and donated to the community in Folkestone and Hythe, showing the same public-spirited approach that Roger De Haan has shown in supporting and regenerating Folkestone.
My hon. Friend has made football governance, which is so close to his heart, such an important subject that I sometimes wonder whether, if he wanders into a football stadium, the fans start chanting, “There’s only one hon. Member for Folkestone and Hythe, there’s only one hon. Member for Folkestone and Hythe.” That may not happen because, of course, he is a Manchester United fan. We know that Manchester United fans do not sing, because very few of them actually come from Manchester. The point is well made by my hon. Friend, who grew up in Hereford and represents a constituency on the south coast, yet claims to support Manchester United. Leaving that aberration to one side, there will be a lot of sympathy for the motivation behind the Bill. The examples of Leeds and Coventry have been mentioned. Transparency in our national game is of huge importance for the health of the sport, the fans and those participating at the grass roots.
The Under-Secretary of State, who has responsibility for sport and tourism, meets the Football Association regularly to talk about a whole range of issues, including governance. Recently, she heard updates on the steps taken to ensure clarity on ownership of football clubs at all levels. She has been updated on the cumulative progress in the handling of the thankfully increasingly rare number of clubs going into administration, the adoption of the financial fair play rules and improving the financial monitoring of clubs, particularly in the lower leagues where clubs are often operating in the most challenging financial circumstances. She also asked for further consideration of the owners and directors test, the current mechanism by which potential owners are approved by the football authorities.
Individual clubs must play their part in the ongoing stewardship of their heritage. I note what the hon. Member for Cardiff South and Penarth said about the interesting developments in the heritage of the great football team of Cardiff. I think all of us were interested to see that the colour of the football shirt was changed at the behest of the new owner. Certainly as a supporter of Chelsea football club, another great team that plays in blue, I would be surprised and perturbed should an owner decide to change the strip to red, but I digress.
It is critical that football authorities continue to play their part in protecting our long-standing clubs from undesirable owners. Most recently, the Government launched an expert working group to consider the barriers to supporter ownership and engagement. The group was developed in partnership with Supporters Direct, whose mission is to increase the influence of supporters through ownership and involvement in their clubs and with the support of football authorities, and relevant experts and stakeholders will be called on to contribute to the discussion of the group’s agreed priorities—I hope that the hon. Member for Eltham (Clive Efford) will take part in that discussion and bring to it the benefit of his considerable expertise, gained over many years.
The sport and tourism Minister will continue to press football authorities for reform, and she will support their ongoing efforts, but she stands ready to legislate should they fail to deliver progress. It is important to make that point—that we would be prepared to legislate—and that is why the Bill is well made in principle. I echo the hon. Gentleman’s comments that we stand ready to intervene, but in the first instance we want the football authorities to get their own house in order. We believe they need more time before legislation is considered appropriate.
Use of the football creditors rule is in decline, because all the relevant football authorities encourage a more responsible framework of financial operations. We have considered a thorough exploration of the barriers to supporter ownership and continue to discuss wider governance reform with the football authorities. These measures show significant progress and we are confident at this stage that we should continue to work with the football community, rather than bring in legislation.
Damian Collins
On the scope of the Bill, this version was intended to apply to England only. I was advised by the Public Bill Office that these were devolved matters, and I would not seek to interfere with the devolved Administrations in Wales and Scotland. However, I believe that the provisions could easily apply across the whole of the UK, and I would certainly welcome the views of the House on that.
I am grateful for the support of the hon. Member for Eltham (Clive Efford) and to the Minister for saying that the Government supported the principle of the Bill but wanted more time to work with the football authorities. I hope they will continue this active dialogue, but I think it would be helpful for the authorities to see the collective view of the House. It was the opinion of my right hon. Friend the Member for Faversham and Mid Kent (Sir Hugh Robertson) that a football Bill need not be a Government Bill, but could be a private Member’s Bill with cross-party support, and it would now be helpful to see how the Bill takes shape in Committee so that the football authorities can see the will of the House and understand its desire to see action taken and to legislate if the authorities do not deliver that reform. I will be the first to applaud them if they act without Parliament’s needing to intervene, but so far they have seemed reluctant to do so. Therefore, I ask the House to give the Bill a Second Reading.
Question put, That the Bill be now read a Second time.
Road Traffic Regulation (Temporary Closure for Filming) Bill
Iain Stewart (Milton Keynes South) (Con)
I beg to move, That the Bill be now read a Second time.
I am grateful for the opportunity to present the Bill, not just as one with a long-standing interest in transport measures, but as the representative of the great town and new city of Milton Keynes. It may not immediately be thought of as a great film venue, but I shall seek to correct that misapprehension. Next week a great film, “The Imitation Game”, part of which was shot at Bletchley Park in my constituency, will be on general release, and many other big Hollywood films, including “The Fourth Protocol” and one of the Superman films, were shot in Milton Keynes. For those two reasons, I seek to introduce this measure.
Before I move on to the substance of the Bill, I would like to thank Creative England, Film London and the British Film Commission, who have shown strong support for the Bill. Finally, I would like to thank the councils in London, Kent, Hertfordshire and Buckinghamshire, who have all shared their wisdom and expertise and helped to prepare for it.
The film industry is hugely important to the UK economy and contributes over £1 billion a year to GDP. We want to ensure that the industry continues to grow and that it maintains its competitive edge, and remove barriers to growth. This Bill seeks to do just that by amending the Road Traffic Regulation Act 1984. It will make it easier for traffic authorities in England and Wales to close roads for the purposes of facilitating filming. Importantly, these powers already exist for other types of road closures, such as street parties and road cycle events, but there is no express power to close a road for those who want to shoot a film.
Some local authorities, including in Greater London, Kent and Hertfordshire, have already realised the benefits of this and have sought their own powers through local Acts of Parliament to enable them to close roads for filming. My right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) has brought forward a private Member’s Bill for that purpose covering Buckinghamshire. My Bill will provide a national provision for all traffic authorities in England and Wales to prohibit or restrict traffic for the purposes of facilitating filming or reducing disruption to traffic likely to be caused by filming.
The current law is unsatisfactory. My Bill will provide a sound legal basis on which all local authorities can act, as well as remove the burden from local authorities of taking forward their own private Bills, which are both costly and time consuming. The Bill will create a level playing field for all local authorities. It will benefit the film industry and the economy, making it easier for film production companies to shoot in areas outside London and other selected areas. It will also make the UK an even more attractive filming destination for domestic and inward investment productions.
Such laws already exist for other purposes. This is a simple measure that will bring the laws into line, and it will also boost the film industry, and I therefore commend the Bill to the House.
Mr Christopher Chope (Christchurch) (Con)
I had not intended to speak for long on this subject, but as my hon. Friend the Member for Milton Keynes South (Iain Stewart) says—I congratulate him on bringing forward this Bill—the Buckinghamshire filming Bill is a private Bill which is currently going through this House and is due to have its Third Reading on Monday, or perhaps Tuesday, next. That is the right way to deal with Buckinghamshire, rather than through a piece of national legislation. When that Bill gets on to the statute book, Buckinghamshire will be able to carry on filming in accordance with the provisions of that Bill.
What I do not like about my hon. Friend’s Bill is the power it gives to repeal or amend other local Acts. He referred to the Kent county council highways Bill and provisions in place in London, and I think it is important that those authorities who have tailor-made legislation on the statute book in relation to filming should be able to keep them in place. We should not pass legislation that says the Secretary of State can, by regulations made by statutory instrument, amend or repeal any provision of a local Act. That would be a dangerous precedent.
I also think such measures on closing the highway for particular purposes should be brought forward by the Government—if they want to change the primary legislation and impose that change on the whole of the country—and I think some other Bills on the Order Paper today should be brought forward by the Government, too, so they can be properly considered by this House with sufficient time. It is not my hon. Friend’s fault that we have only limited time to discuss his Bill today, and I hope that in due course there will be more time available so that we can go into more detail. Unlike the School Admissions Bill which we were discussing earlier, this is not a short Bill. The explanatory notes alone extend to six pages, and there is an impact assessment that sets out the effects of the proposed legislation. The Bill needs to have a lot more scrutiny—
Business without Debate
(10 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Hon. Members
Object.
Bill to be read a Second time on Friday 21 November.
House of Lords (Maximum Membership) Bill
The Minister of State, Cabinet Office (Greg Clark)
I have it in command from Her Majesty the Queen to acquaint the House that Her Majesty, having been informed of the purport of the Bill, has consented to place her prerogative and interest, so far as they are affected by the Bill, at the disposal of Parliament for the purposes of the Bill.
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 21 November.
Wild Animals in Circuses Bill
Motion made, That the Bill be now read a Second time.
Mr Christopher Chope (Christchurch) (Con)
On a point of order, Madam Deputy Speaker. On my Order Paper, we have next the EU Membership (Audit of Costs and Benefits) Bill.
Madam Deputy Speaker (Mrs Eleanor Laing)
The hon. Gentleman’s point of order has been noted. The Clerk will now read Bill No. 8 on the Order Paper.
EU Membership (Audit of Costs and Benefits) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Debate to be resumed on Friday 21 November.
Wild Animals in Circuses Bill
Motion made, That the Bill be now read a Second time.
Stafford Hospital
(10 years ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Jeremy Lefroy (Stafford) (Con)
It is a great pleasure to see the Under-Secretary of State for Health, my hon. Friend the Member for Mid Norfolk (George Freeman) back in his place this afternoon. I apologise for bringing him back to the House. In fact, I do not apologise, because this is a matter of great importance and I know that he shares my interest in it and my concerns.
On the first day of this month, Stafford hospital, now the County hospital, became part of the University Hospitals of North Midlands Trust together with the Royal Stoke University Hospital. The Mid Staffordshire Trust which had run Stafford and Cannock Chase hospitals was dissolved. I wish to speak first about the new arrangements, secondly about the transition and finally about the services that I and my constituents strongly contend are needed in Stafford. I welcome the coming together of our hospital into the larger university trust. I am also very pleased that Cannock Chase hospital will continue to offer an important service as part of the Royal Wolverhampton Hospitals NHS Trust.
Mr Aidan Burley (Cannock Chase) (Con)
I congratulate my hon. Friend on securing the debate and on his herculean efforts to support his local hospital. I have no doubt that those efforts will be rewarded at the next general election by his constituents. He has mentioned Cannock Chase hospital. Does he agree that it is important, in this transition phase, that all the services currently provided at Cannock should remain there and be increased and improved as we move towards the new model of ownership under the Royal Wolverhampton Hospitals NHS Trust? Will he also join me in congratulating the new Conservative candidate for Cannock Chase, Amanda Milling, on all her campaigning efforts to ensure that those services stay at Cannock?
Jeremy Lefroy
I am most grateful to my hon. Friend for fighting alongside me for the preservation of the Stafford and Cannock hospitals. We said at the time that there was not a cigarette paper between us because, when people were saying that one or other of the hospitals should close, we said, “Absolutely not. Both are essential for our communities.” I thank him for that work.
Stafford becoming part of a university hospitals trust brings many opportunities for patient services, for staff training and development and for the NHS in my constituency. The same opportunities will now be available to Cannock Chase hospital under its new arrangements in the Royal Wolverhampton Hospitals NHS Trust. Our hospital will receive substantial capital investment, resulting in refurbished theatres and wards, chemotherapy and dialysis wards and a larger accident and emergency department.
After the tragic events examined by Sir Robert Francis in his two reports, there has been a great deal of improvement at Stafford. That is not in any way to be complacent, but it is a measure of the hard work of the staff, under Antony Sumara, Lyn Hill-Tout and Maggie Oldham as chief executives, and the chairs, Sir Stephen Moss and Professor John Caldwell. I also pay tribute to the governors and directors of the trust, who have put in so much time and effort in these difficult times. However, the staff must receive the most credit. They have worked tirelessly, under great strain and tremendous scrutiny, to provide excellent care. With so much focus, and rightly so, on our NHS, it would be easy for people to walk away from serving in difficult situations, but most in Stafford have not done so. They wish to serve our community through thick and thin, without much recognition and sometimes facing criticism.
In the past few years, I have heard several predictions about Stafford hospital: that it would close; that it would be privatised; and that it would become a “cottage” hospital. None of those has come to pass. Through the determined efforts of staff and the local community, in particular, through the hard work of the Support Stafford Hospital group and others, and their representatives, we have shown the Government and the NHS that a district general hospital can and must thrive in Stafford, retaining accident and emergency and acute services. As a result, we will see unprecedented investment in Stafford, funded not through an expensive private finance initiative, but directly by the NHS, with refurbished theatres and many other things that I have already described. That is in addition to the new endoscopy unit, which I visited just two weeks ago. It is three times the size of the old one, which I experienced as a patient, with state-of-the-art equipment, and it was designed in full co-operation with the staff.
The investment we are receiving is much greater than was originally proposed; and I wish to pay tribute to the work of all involved in making the case: the University hospital of north Staffordshire, the trust special administrators and Mid Staffs. I have gone on record before, and will continue to do so, about the grave shortcomings of the TSA process, which I would wish on no one in its current form, but the TSAs did fight the corner for Stafford and Cannock, and achieved more than at one stage had seemed possible. The Prime Minister, the Secretary of State and Ministers at the Department of Health have also been extraordinarily supportive, even when being bombarded by e-mails, letters and demands for meetings from me, my hon. Friend the Member for Cannock Chase (Mr Burley) and other parliamentary and council colleagues from around Staffordshire.
The transition period is critical and presents many risks. We have been assured that no service will be moved from the County hospital, Stafford to the Royal Stoke, or indeed from Cannock to Wolverhampton, until it is safe to do so. That means that there should be not just sufficient capacity at the Royal Stoke or Royal Wolverhampton to receive patients, but adequate ambulance capacity to deal with many more patient journeys. I understand that emergency surgery and consultant-led maternity services are likely to be transferred early in 2015, possibly in January. In order for that to happen, we need firm assurances from the hospitals that the capacity is in place and from the West Midlands ambulance service that it will be able to cope with the additional journeys. We have been assured by the University Hospitals of North Midlands NHS Trust that a “double lock” will be put in place to ensure that, first, staff and management and, secondly, an outside independent body, including the clinical commissioning groups, approve any transfer of services and say it is safe for patients. The double lock is essential to public confidence in the process, especially the independence of the independent review—it is vital that we get it right.
The Royal Stoke university hospital’s A and E department has been at level 4— the highest alert—because of bed shortages, several times in the past few weeks. The main reason is that patients cannot be transferred out as there are insufficient step-down and community beds, or social care places. The additional acute beds being added at Stoke are welcome; but they will need to be operating before any service transfer happens. The problems with transfers out will also have to be dealt with. The board papers for the Stafford & Surrounds CCG meeting on 21 October show that the ambulance red 2 indicator—category A calls resulting in an emergency response within eight minutes—for the year to date is at 69.7% against the standard of 75%, and has been below the standard in each month since September 2013. The red 1 indicator has improved in August, but is at 66.7% for the year to date—again, that is against a standard of 75%. Will the Minister confirm what additional vehicles and paramedics the West Midlands ambulance service will have to ensure not only that it can bring its performance up to standard, but that it will be able to deal with extra journeys arising from the transfer of some services away from Stafford? Will he also confirm how closely the Trust Development Authority, to which the University Hospitals of North Midlands NHS Trust is accountable, is monitoring the transition period as County hospital, Stafford becomes part of the expanded trust? What support is the TDA giving to the University Hospitals of North Midlands to cope with any unexpected eventualities in the transition?
Finally, will the Minister also confirm that all the clinical commissioning groups in the area served by UHNM will be supported, too? Some of them, including Stafford and Cannock, face substantial underlying deficits of several million pounds per annum arising from what can only be described as unfair funding formulae. They are working hard to become ever more efficient, but what has been asked of them is almost impossible.
The transition period, which will last up to three years, is therefore extremely challenging. We have a newly expanded trust that is in deficit, an ambulance service that is failing to meet its current red 1 and red 2 targets, and CCGs that are underfunded. I firmly believe that we will succeed in seeing a stronger acute trust in Stoke and Stafford at the end of this, but the problems that I have set out must be addressed.
Finally, I turn to future services at the County hospital, Stafford. As a result of the campaign that we have all fought locally, the vast majority of services will remain. It is estimated that 91% of patient attendances will still take place there, as there will be an A and E department and in-patient beds for acute medical patients. But there are areas in which I will continue to make the case for improved services. The first is to return the A and E department to a 24/7 operation. Even now, staff are attending to patients up until the early hours of the morning. It would not take a great deal to extend the cover so that the A and E can remain open between 10 pm and 8 am.
I have heard of a number of cases of elderly patients who are so concerned about travelling what they see as a long distance, away from their friends and family, that even in emergencies they resist travelling, preferring to wait until the A and E in Stafford opens at 8 am. One such case in particular had tragic consequences.
There is welcome news that a doctor-led overnight service is likely to open early in 2015 at the County hospital, Stafford. That should enable those with non-999 emergencies, including those involving children, to receive advice and some treatment locally. But I see it as a stepping stone back to the service that my constituents need, which is a 24/7 A and E department.
I will also continue to argue for A and E services for children, with the ability to keep them in hospital for a period until they are ready either to return home or to be transferred to a specialist unit. It is vital that, wherever possible, children above all are treated near to or at home—close to their family and friends. It cannot make sense for a parent, who has other children and possibly no private transport, to have to arrange child care and undertake a round trip of perhaps three to four hours by public transport to visit a child who is in hospital but who does not need the most specialist care. I urge the Department of Health and the Royal College of Paediatricians and Child Health to look closely at that matter.
The in-patient paediatrics department in Stafford is not one of the smallest in the country, yet it will go next year, despite the fact that the cost per child is significantly lower than that at surrounding hospitals where they will now be sent. Will that really be the way forward for many other such departments? Surely there is a way to rethink in-patient care for children who do not need specialist treatment and who are likely to be in hospital for only a short period. At the very least, a 24/7 A and E department with a paediatric assessment unit staffed by paediatrically trained consultants would make sense.
Finally, there is the question of consultant-led maternity services. Originally the TSA proposed removing all births from Stafford. As a result of our campaign, it changed that proposal, and our hospital will remain with a midwife-led unit. When the Secretary of State announced that there would also be an NHS England-led review into the possibility of retaining consultant-led services at Stafford, we welcomed it. Stafford’s unit is small, but it is by no means the smallest in England. We contend that, in a network with the larger unit at Royal Stoke university hospital, it should be possible to maintain our unit and thus offer women who need obstetrician-led care the choice of giving birth in a smaller unit, as they do in most other European countries. When it comes to maternity services, I will continue to argue that big is not always better.
The review that was promised has not yet started, although I understand it will happen soon, but it will report after our consultant-led unit has closed. I would like an undertaking from the Minister that if the review recommends that smaller units such as ours should remain, it will reopen at Stafford and the resources will be made available for that.
I should also like the Minister to confirm when the review will begin, who will be doing it and how long it is likely to take. It is also essential that the review of Stafford and surrounding services only takes place first, and as soon as possible, to be followed by a national review coming later. The last thing that the expectant mothers of Stafford need is a long drawn-out process. I was promised a review, as were we all, of Stafford’s maternity in this House, and I should be grateful for the Minister’s confirmation that the commitment stands.
Maternity services, I believe, need to be commissioned more widely than just by CCGs. Government policy is to give women a good choice as to where they have their baby, and I welcome that, but CCGs in places like Stafford are too small to support the commissioning of a local unit. The original intention, I believe, in the run-up to the Health and Social Care Act 2012, was for maternity services to be commissioned by NHS England, not CCGs. That would allow the development of a proper national policy of choice for women, and I would ask the Minister to consider that very carefully.
In Stafford, great progress has been made in recent years. I am determined to do all I can to ensure that we, together with the Royal Stoke university hospital, have one of the finest acute trusts in the country. The retention of the County hospital, Stafford as a district general hospital with acute services and accident and emergency gives us the chance to show that a local acute hospital is not an outmoded institution which, as it was predicted only a few years ago, would soon be extinct. Instead, we can become a prime example of a thriving local acute hospital for the future.
The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)
It is an absolute pleasure to be back at the Dispatch Box this afternoon. It is a tribute to the tireless commitment of my hon. Friend the Member for Stafford (Jeremy Lefroy) that, not content with successfully piloting the Health and Social Care (Safety and Quality) Bill through its Second Reading this morning, he has called me back this afternoon for a debate on services at Stafford hospital. I think I speak for the whole House, including Members not present today, when I pay tribute to his tireless commitment, both to his constituency and to the local NHS in his area. The way in which he has gone about it has commanded respect across the House.
My hon. Friend raised many important points, as did my hon. Friend the Member for Cannock Chase (Mr Burley), in support of new investment, importantly paying tribute to the work of the staff as well as the directors and governors. On behalf of the Department, I would echo his comments. He also raised important points about the transition period, the specific needs of children, the ambulance service and the review of maternity services, and the significant point that Stafford appears to be demonstrating that it is perfectly possible to be a thriving local acute hospital. I shall try to deal with all my hon. Friend’s points, but If I do not, perhaps he will be good enough to allow me to write to him and deal with them properly that way.
The configuration of health services is an important issue for many hon. Members across the House and their constituents, particularly those who have previously experienced poor care from local health services. We all agree that all patients should receive high-quality, compassionate care. That is why the Secretary of State has made care a crusade in his leadership at the Department. We are all aware of the appalling lapses of care that were all too often received by patients at Stafford hospital in that terrible period.
The first of November marked a new beginning for local health services, with the dissolving of the Mid Staffordshire NHS Foundation Trust and the launch of the new University Hospitals of North Midlands NHS Trust. Over £250 million of investment is being put into health services in Staffordshire, including significant investment into County hospital.
Past events at Mid Staffordshire will not be allowed to cast a shadow over the future of health services in Stafford. Thanks to the hard work of many, not least my hon. Friend the Member for Stafford, County hospital has a bright future and will offer modern, safe, sustainable services for local people now and in the future. As my hon. Friend has said, much progress has already been made and significant investment is being made in health services in Staffordshire to ensure that that progress continues. The current service specification at University Hospitals of North Midlands NHS Trust is that recommended by the trust special administrator and has been subject to consultation and endorsed by the Secretary of State for Health. Changes to the service specification will only occur on the grounds of patient safety.
Let me reply to the specific points made by my hon. Friend the Member for Stafford. Accident and emergency departments are often the most visible hospital service, and local people therefore often focus on A and E services when looking at changes to their local hospital. Local protests have been held on the grounds of County hospital against the transfer of services. There has been some speculation that A and E at County hospital will be downgraded. Let me take this opportunity to say that that is not the case.
The A and E service will continue to operate 14 hours a day, seven days a week. In fact, thanks to significant investment, the A and E department at County hospital will double in size and have a dedicated space for treating children. That expansion will address overcrowding. The number of staff working in A and E will increase and all consultants working in the department will be trained in paediatrics.
I understand that my hon. Friend and some of his constituents would like County hospital to operate a 24-hour A and E service. It is important to note that the A and E in Stafford has operated 14 hours a day since overnight services were removed in 2011. Of course the decision to close A and E overnight was taken in the interests of patient safety.
Work by the trust special administrators has confirmed that a 24-hour consultant-led A and E remains unsustainable at this time. However, a GP-led service is planned to operate overnight in County hospital from April 2015. Therefore, those patients with conditions that are not life-threatening but that require medical treatment or advice will not need to travel outside of Stafford, no matter the time of day or night. I understand that work by local commissioners is under way to look at the possibility of an interim solution until 2015.
Investment is being made to improve A and E performance across the University Hospitals of North Midlands NHS Trust. Indeed, £80,000 of winter money has been allocated to an improvement plan that aims to have the trust consistently meeting the A and E target by March 2015. In total, £4.5 million will be invested in supporting A and E performance at the trust and a further £4 million across Staffordshire.
My hon. Friend mentioned the West Midlands ambulance service. The continued good performance of that service will be important to ensure success in both service transitions and to improve A and E performance. WMAS has been thoroughly involved in planning, and my hon. Friend has had regular and productive meetings with Dr Anthony Marsh, the trust’s chief executive.
Of course, as with all other ambulance services, WMAS is dealing with increasing demand, but I can assure my hon. Friend and his constituents that WMAS is fully engaged in the changes across Staffordshire. As he knows, A and E hours were reduced in 2011 in the knowledge that the ambulance service could and would ensure that patients were taken to neighbouring hospitals.
Jeremy Lefroy
I am grateful to the Minister for that reassurance. I pay great tribute to the staff, paramedics and everyone at WMAS—they do a fantastic job—but sometimes what is said at the top of the service and what is actually going on at the bottom are slightly different. I am not trying to point the finger at anyone. Everyone is trying to do their best. People do not want to admit sometimes that there are real capacity problems, because they want to be seen to be getting on with the job. I ask the Minister to look at this case quite closely, particularly as the indicators have been red for so long.
George Freeman
My hon. Friend makes a really important point, and I shall be happy to look at it, as he suggests.
Ambulance diversion from Stafford to larger hospitals for life-threatening conditions—stroke, cardiac arrest or serious trauma—had been in place for some time before the overnight suspension, as my hon. Friend will know. In other words, the ambulance service already has a number of years’ experience of these arrangements. The local clinical commissioning group commissioned additional ambulance service provision to cover both overnight and daily divert activity. That extra provision will remain in place.
Stafford & Surrounds CCG reports that the ambulance service’s performance on the red 1 target in its local area has shown a general upward trend. The target was met in six of the eight months between January and August 2014, and the figure was 77.8%, against a 75% standard, in August 2014. The red 1 target measures performance on the most critical calls that the ambulance service receives: calls to patients in immediately life-threatening situations where a rapid response is vital.
Across the whole trust area, the service met all three performance targets in September 2014, the latest month for which centrally verified data are available. Its performance on red 1 calls was 83%, against a 75% standard. It also met the red 1 and category A19 standards in the six months between April and September.
As I know from my Norfolk constituency, rural areas, such as those served by large parts of Stafford & Surrounds CCG, present challenges to ambulance services across the country. West Midlands ambulance service and local commissioners are working together to ensure that the ambulance service continues to cope with the changes in Stafford and the wider challenges of serving a rural region at a time of increased ambulance pressures across England.
I will touch on the transfer of maternity services. Early next year, in line with best practice guidelines, some services will transfer from County hospital to the Royal Stoke University hospital. That will begin on 16 January 2015 with the temporary transfer of consultant-led maternity services. A stand-alone, midwife-led maternity service will open at County hospital.
Jeremy Lefroy
We were given assurances that no services would be transferred without the double lock, which assures that the capacity and safety of the services would be guaranteed in the case of transfer. We now have a specific date for the transfer of services. When can we see the evidence of the double lock for safety and capacity?
George Freeman
My hon. Friend makes a good point. I will undertake to look into that and get back to him.
Women who require care provided by an obstetrician or anaesthetist will be cared for in Stoke, and transport between the two hospital sites will be improved. Those changes to maternity services are temporary, as I have stressed, pending the outcome of the review, which is due to report in June 2015. Other services will transfer permanently to Stoke, including acute and emergency surgery, which will move in February 2015. In-patient paediatrics, including in-patient paediatric surgery, will move by the end of March 2015.
These decisions are made in the interests of patient safety. Let us not forget that the root of past problems was unsafe services at Stafford. The local NHS, led by local doctors, has therefore made the decision to transfer services based on clinical evidence, with patient safety rightly at the forefront of all decision making.
Consideration has also been given to patients’ wider needs and travel distances. For example, the movement of in-patient paediatric services will create access to high-dependency services and intensive care and to tertiary specialist opinions, reducing the need for patients to travel to Birmingham. Provision will also be made for parents to accompany their children to Stoke when travel is required out of hours, including supplying accommodation if needed.
It is understandable that people have concerns when change is proposed. I have no time for those who want to frighten patients in the face of change. It is important to remember that change is sometimes needed to ensure the best outcomes for patients. We know that there were serious failings at Stafford, and it is important that the University Hospitals of North Midlands NHS Trust is able to make changes to services where they will benefit patients and ensure that County hospital provides the high-quality, safe care that local people deserve.
Turning to the future of County hospital, over £250 million is being invested in health services in the years ahead. The hospital’s A and E department will double in size and see an increase in its staff numbers. Out-patient facilities will be expanded, particularly for emergency access clinics. Wards and operating theatres will be refurbished and upgraded to be fit for 21st century medical care. There will also be new services, including a £1.2 million MRI scanner that will offer advanced diagnostic services in Stafford for the first time, which means that more than 6,000 patients who currently travel to Cannock and Stoke will be treated closer to home. Eye surgery, orthopaedics, dermatology and a new assessment unit for frail elderly people are also services that County hospital will begin to offer.
Progress is already well under way. On 1 November the Mid-Staffordshire NHS Foundation Trust was dissolved and County hospital joined the Royal Stoke University hospital under the new University Hospitals of North Midlands NHS Trust. Thanks to the hard work of many people, the process of transferring County hospital to the new trust has gone smoothly. A number of assurance processes were in place leading up to the transfer, including oversight and scrutiny of the quality and safety handover documents. That process has been overseen by the local transition board, chaired by Sir Neil McKay, an independent chair who is accountable to the CEO of the NHS Trust Development Authority. The local transition board will continue to provide oversight to ensure the safe implementation of the new service model at the new trust.
Finally, turning to CCG funding, in December 2013 NHS England adopted a revised funding formula for local health commissioners that more accurately reflects population changes. The new funding formula is based on up-to-date and detailed information and takes into account the three main factors in health care needs: population growth, deprivation and the impact of an ageing population. All CCGs have received a funding increase matching inflation for 2014-15.
The people of Staffordshire were badly let down by the local NHS in the past. The appalling difficulties that were too often uncovered gave people in the area reason to fear for the future of the hospital and to be very disappointed, rightly, at the level of service that was provided. The local NHS has worked hard to address the failings in care and to bring about substantial improvements. I pay tribute to the work it is doing. The opening of the new trust on 1 November marked a new beginning for the NHS in Staffordshire. I want to put on record the debt we owe to all those who have worked so hard to get the hospital turned around.
There is still work to be done to ensure that services in Staffordshire are of high quality and sustainable. My hon. Friend has encouraged his constituents to support County hospital and to access local treatments where appropriate, and I give the same message here today. Local engagement and support are key to the development of local services. I assure him that if his constituents are anxious about the quality of services, they can be sure that County hospital in Stafford will be under a level of public scrutiny that nowhere else in the NHS has seen. In my hon. Friend, the people and patients of Stafford could have no more doughty a champion.
Question put and agreed to.