Oral Answers to Questions

Debate between Baroness Keeley and Anna Soubry

Monday 12th May 2014 Commons Chamber

[Anna Soubry]

My hon. Friend raises a good point. The Big Lottery Fund effectively provides the funding and has worked with the Royal British Legion to make sure that the money available will include, most notably, the high cost of insurance. If there is any difficulty, I am sure that my hon. Friend will come to see me about that, because it is imperative that there are no bars to our great veterans being able to attend these D-day commemorations.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

19. This 70th anniversary might be the last chance to celebrate with veterans what they did in fighting on D-day, given that there are fewer of them and it is harder for them to travel. As it is so vital to recognise the service and sacrifice given on D-day, can more be done to support veterans and their families in attending various events in this country? So many of them will find it hard to travel to Normandy.

[Anna Soubry]

I am absolutely assured that everything has been done with all the relevant authorities that one would expect to be done to ensure that our veterans can attend. The funding allows family members, carers and supporters, not just the veterans, to attend. That is presumably why 500 veterans have already told us that they are attending, with 4,000 of their carers and friends. There has been some publicity about a form that people have to fill in. They do have to fill in a form, of which I have seen a copy, and it is very sensible. It is not lengthy or complicated, and it will provide us with excellent information so that we can ensure that our veterans take a full part in the commemorations. Unfortunately, as we know, for many of them this may be their last opportunity.

Tobacco Products (Plain Packaging)

Debate between Baroness Keeley and Anna Soubry

Tuesday 3rd September 2013 Westminster Hall

[Anna Soubry]

I suppose that I am sort of grateful for that intervention. It was not the most helpful, but it was a fair one and it is a good point that needs addressing. I have no difficulty in waiting for the evidence to emerge from Australia. It is on that point that I agree with the hon. Member for North Antrim (Ian Paisley). However, it is the only point on which we agree on this matter. It is important that we consider the evidence. Of course we know that the Irish Government have also said that they want to introduce this measure. Again, we will wait and see. It is no simple matter to introduce standardised packaging. There will be many challenges that the Irish will face in their attempts. It is right and fair that we wait to see all of that as it develops.

[Barbara Keeley]

rose—

[Anna Soubry]

May I make some progress, because it is really important that I make the matter clear? The coalition Government have made no final decision. As I have said, we wait to see the evidence as it emerges from both Ireland and Australia. It is important to say that standardised packaging is no silver bullet. There is no simple solution to the problem of persuading both the remaining 20% of the population to give up smoking and our youngsters not to smoke.

I want to deal if I may with some of the excellent points that have been made. I, like many other Members, have talked about the power of the package. The hon. Member for Vale of Clwyd (Chris Ruane) helpfully brought in some packets. He mentioned the cigarettes that are deliberately targeted at young women. My hon. Friend the Member for Banbury (Sir Tony Baldry) asks why children, in the face of the overwhelming evidence and the health messages, take up smoking. He is right to say that we need to do more research. We know many things.

We know, for instance, the power of parents. If a child is brought up by parents who smoke, they are likely to smoke because they will see it as the norm. One of the great benefits of the legislation that was introduced by the previous Administration—I pay full credit to them for introducing that ban on smoking in open places—was that it made smoking less socially acceptable. Effectively, it turned many of us into modern-day lepers. If we wanted to smoke, we were reduced to standing outside, ostracised from our workmates, and that was a powerful reason why so many of us gave up smoking. Many of us remember with shame, as I do, sitting in restaurants thinking that we had some God-given right to smoke next to people who rightly found it deeply offensive, and who were trying to enjoy their meals. It is astonishing to look back at films and television programmes of only a few years ago to see how acceptable smoking was and how the previous Parliament changed that.

I absolutely agree with all those who are trying to nail the falsehood in two important parts of this argument about standardised packaging. The first is whether it is plain. I concede that one of the great failings of this debate is to explain what we mean by “standardised”. That goes back to the point that was inaccurately made by my hon. Friend the Member for Bury North. I never said that packaging would be glamorous or glitzy, but that, as I think my hon. Friend the Member for Harrow East also tried to say, under the regulation and legislation holograms can be put on standardised packaging—not to be attractive but as part of the argument against the claim that anybody will be able to counterfeit it.

Far from being a counterfeiter’s charter and dream, standardised packaging is a counterfeiter’s nightmare. I wish that I had with me some of the packets that have been produced by Australia. If we had them, Members would see that they are far from plain. On the contrary, they have colour in them, but they have the standardisation, which takes away this incredibly powerful marketing tool and the attraction for young people.

[Barbara Keeley]

On the point about waiting for the evidence, it is not 20% of people who smoke in Salford but 25%, and much more in some areas, and it is 1,000 children. As we wait, 1,000 children every year will start smoking in Salford. Why are we waiting?

[Anna Soubry]

I think I have explained why we have waited. My understanding of the statistics is that it is 20%, but it differs in different parts of the country. I also want to make the point that the Government have not stepped away from taking action against the harmful effects of tobacco. We have a tobacco control plan for England that sets out our national ambitions and our comprehensive evidence-based strategy of national and local actions to achieve them, including high-profile marketing campaigns. Our Stoptober campaign, which was hugely successful last year and which we will be running again this year, provided help and assistance to smokers, the majority of whom want to quit.

I also want to pay tribute to local authorities, which now have responsibility for public health. I have met members and representatives from councils in the north-east who are doing some terrific work persuading people to stop smoking or not to take it up, and that shows good local action.

As ever, the clock is against me, but I hope that I have made the Government’s position absolutely clear. I congratulate again everybody who has spoken in this debate. My own views are clear, but it is right to wait to see the evidence. I assure Members that the wise words from so many different parties today will be taken back to the Government and will be listened to. It is to be hoped that in due time, standardised packaging will be introduced.

Tobacco Packaging

Debate between Baroness Keeley and Anna Soubry

Friday 12th July 2013 Commons Chamber

[Anna Soubry]

If I were in court, I think I would have to plead guilty to that one, Mr Speaker. In all seriousness—it is a very serious point—one of the things in the EU directive that we specifically looked at was the percentage of the package that should contain health warnings. It is now going up to 65%. There will be no flavourings. Again, this is very important in tobacco products. All this is designed for the next generation.

It is really important to add this: standardised packaging was about making cigarette smoking unattractive to young people. It is the next generation; that is the fundamental aim. That is why it is really important, even for those who use that aim to argue in favour of standardised packaging, that we find out what the evidence is in Australia, which is doing it. That is why my hon. Friend is right to say that good, evidence-based legislation is always the best.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

I am proud that the Labour Government in 2006 gave a free vote on the legislation for smoke-free workplaces. That was an important step forward. Perhaps the Minister should be thinking in those terms now, because today’s decision to take no action will really disappoint the 190 health organisations, including the royal medical colleges and the World Health Organisation, that have supported the move to standardise packaging on tobacco products. Will they not now be drawing the conclusion that the Government, as my hon. Friend the Member for Hackney North and Stoke Newington (Ms Abbott) has said, have given in to vested interests and entirely lost their way on public health?

[Anna Soubry]

I do not give in to pressure from anybody, and neither does anybody else in my Department or indeed in my Government. We have taken a decision to wait for the emerging evidence from Australia, and that is the right thing to do.

Oral Answers to Questions

Debate between Baroness Keeley and Anna Soubry

Tuesday 11th June 2013 Commons Chamber

[Anna Soubry]

I pay tribute to my hon. Friend’s campaign, which he has been running for some time, and to all the great work that he does for Lister hospital. I am slightly worried that if I give him any support it might be the kiss of death for his campaign, but I wish him all the very best and all power to his elbow.

[Barbara Keeley (Worsley and Eccles South) (Lab)]

One group of people greatly affected by a cancer diagnosis are the carers who suddenly find themselves to be carers of people with cancer. Yesterday I met some people who are carers of people with cancer, and they told me that they did not get the information, advice and support that they needed to tackle that important caring role. Does the Minister agree that it is about time that we recognised those carers and started to give them the advice and support that they need because they suffer financial loss, hardship, loss of career and impacts on their own health?

[Anna Soubry]

I very much do agree. That is why I am so pleased that the Care Bill that is making its way through both Houses has special provision for people who are caring for others with cancer in the way that the hon. Lady describes.

Accident and Emergency Waiting Times

Debate between Baroness Keeley and Anna Soubry

Wednesday 5th June 2013 Commons Chamber

[Anna Soubry]

That sort of cheap comment does the hon. Lady no justice whatsoever or credit. Let me explain to her—I was here for the debate, and she was not—that I did not in any way blame women doctors. As someone who has worked as a woman professional all my life, I really do not want to hear any lessons from Opposition Members. What I did was echo the comments of the president of the Royal College of General Practitioners, and I paid tribute to all our GPs for their hard work and dedication to our NHS, and to their patients.

There are immense pressures on the NHS as a whole, and on A and E in particular. Our A and E departments are dealing with 1 million more people than they did when the previous Government were in power. The causes of that increase in demand are complex: a long, cold winter; an ageing population; and more people with long-term conditions. The system itself, let us be honest, has not helped, from poor integration between health and social care to the lack of public confidence in out-of-hours primary care services. We can have an argument about the 2004 GP contract, but as the hon. Member for Southport (John Pugh) rightly said, it has not helped. Today, we have a situation in which, if people do not know where to go, or they are not sure that they will get a good service, they go to A and E. In a recent hearing by the Select Committee on Health, Dr Patrick Cadigan, a registrar from the Royal College of Physicians, set out the position perfectly:

“Patients will go where the lights are on. In many of these alternatives, the lights are not on after five o’clock in the evening or at weekends.”

That presents a set of challenges that the Government are determined to address. First, it is important that we deal with the current situation, and we are.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No.

Already, emergency departments have recovered from the dip in performance over the winter. [Interruption.] The hon. Member for Denton and Reddish did not give way, and I am adopting his admirable approach in this debate.

For each of the past five weeks, the four-hour waiting time target has been either reached or exceeded. The average wait in A and E is currently 50 minutes. More importantly, we are making the NHS fit for the future: a future where care is designed and delivered around the specific needs of an individual patient; where care is integrated across primary and secondary care and across health and social care; and where local clinicians, not national politicians, decide what is best for their communities. The Government have taken tough decisions that will create a strong and sustainable NHS, now and for generations to come. The Health and Social Care Act 2012 has finally brought local health and social care communities together to design integrated services around the needs of their patients, building in strength for the future. So if more services are needed outside hospitals, local clinicians working with community partners can make those decisions, without having to wait for a Minister to tell them what to do.

We have not stopped there. We have provided £7.2 billion to local authorities for social care. We have given hospitals the ability to carry over underspends—free to pool their budgets locally to improve care for patients. We have new urgent care boards which will use the savings from the marginal rate emergency tariff to reduce pressure on A and E. The NHS Medical Director, Sir Bruce Keogh, is currently reviewing the provision of urgent and emergency care. This autumn the vulnerable older people’s plan will set out how we will improve primary and out-of-hours services for the frail and the elderly and how we can remove barriers to integrated care. At every step of the way we are putting local doctors and nurses in charge and designing care around the patient.

I shall deal briefly with some of the very good speeches that were made on both sides of the House. We heard first from two former Secretaries of State for Health, the right hon. Member for Holborn and St Pancras (Frank Dobson) and my right hon. Friend the Member for Charnwood (Mr Dorrell). Both were eloquent and informed. I have to say that the speech and the comments of my right hon. Friend found more favour with me. The hon. Member for Lewisham East (Heidi Alexander) asked for a grown-up debate, and we had a good contribution from my hon. Friend the Member for Totnes (Dr Wollaston). I have addressed the unfortunate remarks that she made, perhaps not having read Hansard, if I may say so.

I turn to other valuable contributions. The right hon. Member for Cynon Valley (Ann Clwyd) made a contribution, as we would expect. Then we heard from my hon. Friend the Member for Brigg and Goole (Andrew Percy), who spoke briefly about his local experience in his constituency and brought those experiences, rightly, into the debate. He touched on walk-in centres, an issue that was raised by—I nearly said my hon. Friend; I beg his pardon if that is in any way disparaging to him—the right hon. Member for Rother Valley (Mr Barron), who beautifully forgot that any decision about the future of any walk-in centre is a local decision. It is for local people—[Interruption.] I am not knocking anybody; I am explaining the facts. I appreciate that the right hon. Member for Leigh (Andy Burnham) has a problem with the facts, but the facts are that these are local decisions made by local communities and local clinicians.

My hon. Friend the Member for Bracknell (Dr Lee) gave a thoughtful and challenging speech, and I hope that many will take that away and listen to what he said. I shall deal briefly with the comments of my hon. Friends the Members for Lancaster and Fleetwood (Eric Ollerenshaw) and for Stevenage (Stephen McPartland) and the hon. Member for Cheltenham (Martin Horwood), who spoke about some of the difficulties that we have with the recruitment of doctors. Departmental officials have met. We know that it is a problem. We have worked with the College of Emergency Medicine and we know that we need to tackle the problem. We did that in 2011 and those issues will in due course be considered. I hope we will see some changes.

The hon. Member for Mitcham and Morden (Siobhain McDonagh), as ever, championed her local hospital, as I expect her always to do, but she spoke about a lack of public consultation and many of us will take away her wise observations on that. It is important to remind the House of the comments of my hon. Friend the Member for Lancaster and Fleetwood. He, like others in the debate, reported that his constituents get a good service from good staff. All of us should remember that.

To conclude, in challenging circumstances, and with this Government’s support, the people of our NHS are performing admirably. There are over 400,000 more operations now than under Labour. The proportion of cancellations remains unchanged. Fewer than 300 people—276—are waiting more than a year for an operation, compared with 18,000 under the Labour Government. Some 8,500 more clinical staff are working in our NHS, including 5,700 more doctors. MSRA rates have halved. Mixed-sex wards have been practically abolished. We are finally moving towards a paperless NHS by 2018. In addition, in stark contrast to the Labour party’s plans, we now have a protected NHS budget, with real terms—

111 Telephone Service

Debate between Baroness Keeley and Anna Soubry

Wednesday 5th June 2013 Westminster Hall

[Barbara Keeley (Worsley and Eccles South) (Lab)]

rose—

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

Will my hon. Friend give way?

[Miss McIntosh]

If I may, I will give way first to the hon. Member for Worsley and Eccles South (Barbara Keeley).

--- Later in debate ---

[The Parliamentary Under-Secretary of State for Health (Anna Soubry)]

It is a pleasure to serve under your chairmanship, Mr Robertson, for what I believe is the first time.

My hon. Friend the Member for Thirsk and Malton (Miss McIntosh) made an admirable speech, raising many points and asking many questions—some of which, I will say bluntly, I will not be able to answer in my speech. I assure her that she will receive an answer to those by way of a letter. Before I discuss her speech, I want to deal with the points raised by the hon. Member for Copeland (Mr Reed). It does neither him nor his party any credit to use the serious problem in A and E as a political device to attack the coalition Government. It is not as simple as that. To suggest that the problem has been caused by the Government is plain, simple rubbish. It is accepted that there are many complex reasons for the situation, although I am reliably informed that the number of people being seen within the four-hour target is improving and that many accident and emergency departments are achieving the target, and have been doing so for some weeks. Some, indeed, are exceeding it.

There is much evidence emerging that a firm grip is being taken on the situation, but things are complex. There is no magic bullet. It does not matter which party is in power, the Government would face the problem that we have, because there are many causes. One of them, which people on all sides of the argument have identified, is the fact that we do not have the out-of-hours service we want.

[Barbara Keeley]

The Minister says that the issue is complex and accuses the shadow Health Minister of making political points. It is about time that Health Ministers stopped making excuses. They have been in office three years and it is time they started to take responsibility for what they are doing.

I have gathered evidence, and the causes of what has happened clearly include insufficient call handlers, which is not complex—it is just a shortage of staff. Another factor is the replacement of trained nurses and trained clinician input for phone triage with computer-led or non-clinician advice. Those things are not complex. They are just wrong.

[Anna Soubry]

I am not for a moment saying that there are not difficulties and problems in 111. We know there are, but if only the issue were as simple as solving the 111 problems. The out-of-hours service is just one of many factors. [Interruption.] I want to make some progress on this point: 111 is one factor among the failings in relation to the sort of out-of-hours service that people want. We have also had the difficulty of a long, cold winter, which has added pressures—that is something that often happens. Also, there are 1 million more people attending A and E. That is not the fault of the Government. We have not suddenly caused it. It is because of changes—

--- Later in debate ---

[Anna Soubry]

I will not accept any of what the hon. Gentleman says, because he does his cause no service when he makes cheap political points. The matter is hugely complex, but it is wrong to say that the Government caused the problems in A and E. He is wrong in that. It is difficult and complex.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No, I will not. The responsibility, if we are honest—would not it be refreshing if we could for once have an honest debate about the national health service?—probably goes back 10 or 20 years, a period encompassing Governments of different political colours. I am happy to say that—by which I do not mean I am happy that those Governments have failed, but people may think the honesty is refreshing.

I want to deal now with the excellent speech of my hon. Friend the Member for Thirsk and Malton. I pay tribute to her and her work in this place, but also to the considerable efforts and work of her late father. I am sure that if he could have heard his daughter’s speech he would have been very proud. I remember my own father saying that out of all evil comes some good, and perhaps some good may come from her late father’s terrible experience of 111 and the fact that he died shortly thereafter.

I pay tribute to all GPs. There are huge difficulties with the GP contract, which was introduced in, I think, 2004. The consequences have included the loss of the out-of-hours service that I enjoyed as a child, teenager and young woman. With few exceptions, we have wonderful general practitioners, and many whom I know, including my own, and others who are friends of mine, work long, difficult hours. It is important to make that point.

As you know, Mr Robertson, during the recess, far from enjoying holidays, as the popular press makes out, we go back to our constituencies and use the time to make or renew contact with, for example, our local clinical commissioning group or ambulance trust. Alternatively we just go out and about, as I have done, knocking on doors and talking to people. One of the things I did during my recess was meet the head of the A and E department of the Queen’s medical centre, which is the local hospital in my constituency of Broxtowe in Nottingham. The head happens to be one of my constituents, and they tell me that there is much improvement at the Queen’s medical centre, as I know from the stats and so on. I also talked to GPs, and the CCG in my constituency now opens its doors for Saturday morning surgeries, which do not replace any other surgeries; they are extra facilities. The CCG has done that for two simple reasons: first, to improve the service it gives to its patients, and, secondly, in recognition of the need to reduce the pressure on the A and E department of the Queen’s medical centre.

It is right and fair to say that many GPs look with concern at what is happening in many of our A and Es, and with 111, which is commissioned in some areas by CCGs and in other parts of England by clusters of GPs. They are by no means fools. What motivates anyone to enter the medical profession, in my experience, is a real desire to serve people. They want to help and treat people. They are motivated by the very best of motives, so of course our GPs are concerned about the situation.

There is much work to be done with the GP contract to improve out-of-hours service, but we also have to be honest in this debate. There are often urban myths and anecdotes, but it is a fact that many GPs have already said that, far too often, people who come to see them in their surgeries, who attend A and E or who dial 999 or 111, are calling when they do not need to make that call or that appointment. They might be better off making their pharmacist their first port of call.

--- Later in debate ---

[Barbara Keeley]

The Minister talked earlier about the issue being about out-of-hours service. The NHS 111 problems in Greater Manchester put greater pressure on our out-of-hours service. She said there was a long winter, but 111 was rolled out at the end of March. Does she think that was a sensible time? It was not even the end of a very hard and long winter. Finally, she said that we have had more A and E attendances, but the problems have caused further pressure on A and E. The point many hon. Members have made, which I hope she accepts, is that the chaotic launch of NHS 111 in the end part of winter caused more problems than it solved.

[Anna Soubry]

Again, I do not think it is as simple as that. Of course we have not been happy with the roll-out of 111, which is accepted. The service has not been the success that we had hoped. We agree on that.

[Barbara Keeley]

Will the Minister give way?

[Anna Soubry]

No; forgive me. The most important thing, though, is that things are improving.