Food Hygiene Rating Displays

Baroness Burt of Solihull Excerpts

Wednesday 7th October 2020 Lords Chamber

[Lord Bethell (Con)]

My Lords, the role of the inspectors is a local authority responsibility. While there may be national figures, I am afraid that I do not have them at my disposal, but I would be glad to write to my noble friend Lady Warsi with whatever data we have on the questions that she has asked.

[Baroness Burt of Solihull (LD)]

My Lords, could not the taxpayer get even greater value for money if the rating incorporated a rating on how well premises were adhering to Covid safety measures? That is the kind of reassurance that I would like to see before I walk through the doors of any catering establishment.

[Lord Bethell (Con)]

Well, the noble Baroness makes a strong case. I think a lot of consumers would like to see the kind of rating that she describes. I am not sure whether it is rightly the responsibility of food inspectors to provide that complex service, but we are working very closely with the hospitality sector on both tracing and the implementation of Covid-friendly measures. The response from the sector has been extremely strong, but we are maintaining a close analysis of progress.

Medicines and Medical Devices Bill

Baroness Burt of Solihull Excerpts

2nd reading & 2nd reading (Hansard) & 2nd reading (Hansard): House of Lords
Wednesday 2nd September 2020 Lords Chamber

[Baroness Burt of Solihull (LD)]

A lady local to me wrote to me about the excellent Cumberlege report. She said: “Mesh has ruined my life. I have lost my colon, appendix, cervix, uterus and parts of my vagina to mesh. I have been violated with at least two unconsented mesh procedures in my rectum and bladder—the scans don’t lie—and if I want removal, I may lose those parts of me as well. I have lost my sex life, my continence and my well-being. I have lost four jobs and I will shortly be losing my home since I cannot work.”

I shall call this lady Jane, which is my middle name, but it could be any woman in this Chamber or this country. Indeed, the online support group for women victims of mesh alone has over 8,000 members. Jane, like many others, has been brushed off, patronised and accused of imagining symptoms or being hysterical, while the perpetrators closed ranks, covered up their mistakes and made her suffer.

Vaginal mesh implants have caused women extreme pain, “like having razor blades inside them.” The noble Baroness, Lady Cumberlege, found in her report inadequately tested and poorly regulated meshes to be the cause of so much pain and misery. But the treatment of women over mesh, and the two drugs in her report, seem symptomatic of a culture of exasperation, impatience and disbelief on the part of many medical professionals when women tell them what they are going through. Barbara Ellen of the Guardian speculates about what would happen if the boot were on the other foot, and men had penis implants that felt like slashing razors. Would they be written off as “hysterics” and “whingers”?

Although I normally steer well clear of all matters medical, I cannot allow this Bill to pass without doing my utmost to ensure that women such as Jane, and all the Janes to come, will be properly protected from the inadequate testing of products, the failure to react and recognise when things are going wrong, and the cover-ups of life-ruining mistakes which have gone on without being called to account.

I am entirely in accord with the recommendations of the noble Baroness’s report and those of the Royal College of Surgeons. What we need in this Bill is proper traceability for all medical devices; a redress agency and revision of the MHRA; registries to monitor patient outcomes and spot early on if things are going wrong; and the setting up of a patient safety commissioner. Above all, we need to recognise the importance of giving primary regard to the safety of medicines and medical devices. This medical misogyny has to end.

Oral Answers to Questions

Baroness Burt of Solihull Excerpts

Tuesday 21st October 2014 Commons Chamber

[Norman Lamb]

I also praise the work of the staff at the hon. Gentleman’s local trust. There has actually been an increase of more than 2,800 practitioners in psychological therapy since 2010 as part of the IAPT programme—increasing access to psychological therapies —which I am sure the hon. Gentleman will be very pleased to hear. For the first time, this Government are introducing access and waiting time standards in mental health, and that gives us the basis to achieve genuine equality for mental health for the first time ever.

[Lorely Burt (Solihull) (LD)]

My local trust in Solihull tries to treat mentally ill patients out of hospital and at home whenever possible. That is commendable, but when a patient needs a bed they have to travel up to 200 miles because the trust operates at 100% capacity most of the time. Does my right hon. Friend agree that that is unacceptable and that more beds should be made available locally?

[Norman Lamb]

Yes, I agree that it is totally unacceptable for patients to be sent a long way away from home. In children’s services, we are investing £7 million extra this year to produce 50 more beds, and we are holding NHS organisations to account to ensure that they provide beds locally so that people do not have to travel long distances.

Hospital Car Parking Charges

Baroness Burt of Solihull Excerpts

Monday 1st September 2014 Commons Chamber

[Lorely Burt (Solihull) (LD)]

On the ability of trusts to make their own concessions, I want to shed a glimmer of light on an example in my own Heart of England NHS Foundation Trust. It is possible for relatives to buy 20 visit passes for £10, no matter how long they stay. All they need to do is obtain a signature from the ward sister. There are compassionate ways of treating families who need to make regular and sometimes long visits to hospital.

[Jackie Doyle-Price]

My hon. Friend highlights exactly the kind of initiative that we in this House would expect the local management of trusts to undertake. On having a fair charging policy, we should not have simple flat fees and expect all patients and visitors to pay them. We should be thinking about the best possible opportunities to enable patients to get better when they are being visited by their families and to access treatment without being worried about parking charges.

Oral Answers to Questions

Baroness Burt of Solihull Excerpts

Tuesday 1st April 2014 Commons Chamber

[Mr Hunt]

The hon. Gentleman is absolutely right. If we are going to deal with the pressures in A and E, we need to have a massive improvement in primary care access. There has been historical under-investment in primary care, going back over many years, and we need to change that. One of the ways in which we want to do that is to reintroduce GPs taking personal responsibility for the most vulnerable older people, and today’s changes will help us to move towards that.

[Lorely Burt (Solihull) (LD)]

In my constituency the success of virtual wards has decreased the need for hospital beds. That is welcome, but dementia sufferers, who sometimes need hospital treatment and specialist care to mitigate the additional confusion and anxiety that they experience, do need specialist care within a hospital. Our local dementia unit is under threat of closure. Does the Secretary of State agree that it should not be closed and that that is a wrong decision?

[Mr Hunt]

I do not know the details of that particular case, but I am happy to look into it. I would say that a quarter of our hospital in-patients have dementia, and it is incredibly important that hospitals continue with a revolution in the way they look after people with dementia. There are some fantastic examples of that around the country, and I want to give them every support and encouragement.

Accident and Emergency

Baroness Burt of Solihull Excerpts

Wednesday 18th December 2013 Commons Chamber

[Mr Hunt]

I am going to make some progress.

[Lorely Burt (Solihull) (LD)]

rose—

[Mr Hunt]

First, I want to give way to my hon. Friend.

[Lorely Burt]

We have had a very successful campaign in Solihull to restore two-member-crew ambulances being based in the constituency. However, they still face a big problem with admittance to Heartlands hospital to discharge their patients so that they can get out on the road and back to Solihull again. Can the Secretary of State suggest how the ambulance service could work in a joined-up way with hospitals in order to improve flow-through?

[Mr Hunt]

My hon. Friend raises an important point. Again, we would not hear this from the Opposition spokesman, but ambulance services across the country are making great strides. For example, in the past year there has been a 10% increase in the number of patients that ambulance services do not take to A and Es, and an 8% increase in the number of patients that ambulance services and paramedics are able to treat and discharge on the spot. Those kinds of things can make a huge difference.

Tobacco Packaging

Baroness Burt of Solihull Excerpts

Thursday 28th November 2013 Commons Chamber

[Jane Ellison]

The hon. Gentleman refers to the evidence, as have other Members. That is exactly why we have asked someone who, with all due respect, is far more expert than he is or I am to look at the evidence and report to the Government swiftly. That will be a productive way forward. It will ensure that, however the Government decide to proceed, we do so in a way that is robust.

[Lorely Burt (Solihull) (LD)]

Does my hon. Friend agree with the EU majority decision that e-cigarettes should not come under the same regulations as medicines? Does she agree that they should be subject to the same marketing controls as cigarettes, whether that involves plain packaging or not?

[Jane Ellison]

The hon. Lady will know that that is the subject of negotiations, so I hope that she will forgive me if I do not comment on it further at this point.

Tobacco Packaging

Baroness Burt of Solihull Excerpts

Thursday 7th November 2013 Commons Chamber

[Bob Blackman]

That sounds like a good idea. We are not talking about that today, but it could be included in the evidence.

We have an opportunity to debate these issues. As my hon. Friend the Member for Reading West (Alok Sharma) said, we must take an evidence-based approach. The widespread consultation that the Department of Health conducted over the summer found a welter of evidence supporting the standardisation of packaging and its impact on the numbers of people taking up or giving up smoking. I am secretary of the all-party group on smoking and health and I regard tobacco control as a very high priority for any Government, and an issue that cuts across party lines and creates different views. I welcome the fact that members of the APPG from all parties are here to debate the issue.

[Lorely Burt (Solihull) (LD)]

I entirely agree that any standardised packaging to which we agree should be evidence-based. We have looked at the results from Australia after nine months. The anecdotal evidence so far suggests that although people have switched to cheaper brands, the volume of cigarettes being sold has not altered. What does the hon. Gentleman make of that?

[Bob Blackman]

The issue for us is that we want to remove the last aspects of advertising that are available to the tobacco industry. At the moment, there is still an attractive promotional aspect of tobacco, which is the packaging. We want all tobacco packs to be uniform, including the colour of the pack, and to allow the promotion of strong anti-smoking and pro-health messages. Evidence is emerging from Australia, but other parts of the globe are going ahead with standardisation of packaging, including Ireland.

Tobacco Products Directive

Baroness Burt of Solihull Excerpts

Monday 28th October 2013 Commons Chamber

[Lorely Burt (Solihull) (LD)]

I add my welcome to your elevation to the Chair, Madam Deputy Speaker. This is the first time that I am benefiting from your wise direction; I am sure it will not be the last.

This is an opportunity to put the case for small retailers, who are caught between a rock and a hard place when it comes to the sale of tobacco. A few weeks ago, I was visited by a delegation of small retailers, a number of whom were my constituents who were supported by the publication Asian Trader. Also at the meeting, and uninvited by me, were representatives of Imperial Tobacco. I was surprised to see them and wondered what role they had to play in the proceedings. They were attending, I was told, in a spirit of helpfulness, and offered their “help” to me until I explained in no uncertain terms that I was not a friend of the tobacco lobby. However, their presence did lead me to consider the amount of influence tobacco companies have in the retail industry, and the kind of messages they are giving to tobacco retailers.

Tobacco companies have a lot of money—it is a huge industry—but as purveyors of substances that kill one in two long-term users, they do not tend to be the most popular lobbyists around. I received an e-mail from a Liberal Democrat councillor, John McClurey, who has been a newsagent for more than 30 years. He suggested that the tobacco companies were using the good names of the small retailers to lobby Parliament with their own promotional messages. He also suggested they were circulating misinformation to tobacco retailers, with the aim of scaring them into becoming a voice for tobacco manufacturers.

When I met the retailers, there was no doubt in my mind that they believed passionately in what they were telling me, but knowing the involvement of the tobacco lobby led me to re-examine objectively what they were saying in the light of wider evidence. For example, on the European tobacco products directive, my retail friends told me that banning smaller quantities of tobacco—packs of 10 cigarettes and 20 grams of loose tobacco—was wrong because it discriminated against smokers on a tight budget and smokers aiming to give up. It undoubtedly does. However, it also discriminates against minors, who are extremely sensitive to price changes. These packs of 10 cigarettes have been dubbed “kiddie packs” because they are so popular with teenage smokers.

My retail friends also believe that smuggling is a growing scourge that will be made worse by the advent of plain packaging and ever-increasing duty. According to Her Majesty’s Revenue and Customs, tobacco smuggling has more than halved in the past decade to 9% of total sales. I am not saying that 9% is not far too high, or that general statistics will help my friend Paul Cheema at his newly opened Kwik Save in Solihull if smuggled tobacco is being sold from a van near his shop. Nevertheless, despite tax hikes on cigarettes to the extent of 88% of the recommended retail price, the amount of tobacco smuggling has continued to decline. The tobacco multinationals’ concern about illicit trade needs to be evaluated in the light of their having paid billions in fines and payments to settle cigarette-smuggling litigation in the EU and Canada. They are being prosecuted for smuggling their own products, so their trying to unsettle small retailers, when some of their number are perpetrators of the problem, sounds a little hollow.

Is “plain packaging” not a misnomer, given that recent EU votes have confirmed that 65% of the packaging surface will have to carry writing and pictures warning prospective customers of the health dangers of the product? Other distinctive markings will also be required. The Government are therefore confident that plain packaging will be no easier to counterfeit when it comes under the scrutiny of government officials.

The European Parliament has voted for a ban on packs of 10 cigarettes; for a minimum weight of 20 grams for “roll your own” cigarettes; for banning characterising flavours, such as menthol, which are also particularly attractive to young people and women; and, as I just mentioned, for 65% of the surface carrying words and pictures informing people of the dangers of smoking. That is not in dispute. It has also voted against plain packaging; against the ban on slim cigarettes, which we know are particularly attractive to younger smokers and women; and against the ban on sales displays.

We await the final recommendations of the Government’s two consultations this Parliament, and we know that they are waiting for the results of the Australian plain packaging experiment, but will the Minister say how long she considers a reasonable time to wait before it can be evaluated? When will the Government report be published, and can the Minister give any insight into the Government’s thinking on plain packaging, slim cigarettes and sales displays? As I said, retailers are stuck between a rock and a hard place—between the health lobby and the need to trade—and so are the Government, but any indication she can give of what the future is likely to hold would be much appreciated.

The EU recently voted against prohibiting the purchase of e-cigarettes alongside tobacco and against registering it as a medicine. That is a sensible measure. Many former smokers attest that e-cigarettes have helped them to give up when nothing else had worked. Furthermore, making them a medical product would likely have increased their cost and reduced their availability. What is the thinking in the Department of Health on e-cigarettes? Will we follow the EU in not medicalising them, and if so, what product safety standards will be put in place?

Finally, I want to discuss proxy purchasing. Interestingly, there is no age in the UK at which the smoking of tobacco products is illegal, if children can get their hands on them. The legal age for purchasing a packet of cigarettes is 18, and retailers can be subject to serious penalties if caught selling tobacco to under-18s. Proxy purchasing—when an over-18 buys cigarettes for an under-age smoker—is illegal in Scotland, but not in England and Wales, so in the latter, the retailer can be prosecuted, but the proxy purchaser cannot.

Aman Bhura, from News and Booze in West Bromwich, says that now is the time for the Government to take the lead in the enforcement of illegal sales of tobacco. He says that

“we retailers are being forced to become the policing arm of the government... Responsible retailers will have staff trained to detect proxy selling, but it is an act which is extremely difficult to judge and prove”.

It is clear that tobacco retailers are more than prepared to measure up to their responsibilities in respect of proxy selling to under-age youngsters, but without a legal constraint to back them, what can they do? Will the Government not strengthen their arm by making proxy purchasing illegal, as it is in Scotland? Will the Minister consider changing the law to make proxy purchasing of tobacco products illegal in England and Wales?

I will leave the final word to Councillor McClurey:

“I make more profit from selling a 50p packet of chewing gum than a packet of 10 cigarettes. Sale of cigarettes represents 50% of my turnover but only 14% of my gross profit. If my customers stopped buying cigarettes and bought a packet of chewing gum instead I would be a wealthier shopkeeper.”

I look forward to the day when our retailers make a much healthier profit, when they sell fewer cigarettes and more of other products that have a better sales margin. That would be a good deal and a fair deal for everyone.

--- Later in debate ---

[Jane Ellison]

Yes, I share that concern. I saw a presentation only last week with some of those adverts and imagery. As I said, it is a key priority of ours to prevent children and young people from taking up smoking, so anything that might contribute to their taking it up is extremely worrying.

The UK’s support for the general approach agreed at the June Health Council was important in securing the qualified majority needed to avoid losing hard-won negotiated improvements to the text of the directive. Hon. Members will also be aware that the European Parliament has been scrutinising the proposal, and this is obviously where we have had some recent pushback in some areas. We were pleased to see that, on 8 October, the Parliament agreed with the Council and voted to ban packs of cigarettes with fewer than 20 sticks, to increase health warnings to 65% of the front and back of packs, to make pictorial warnings mandatory throughout the EU—as they are already in the UK—and to prohibit characterising flavours.

It should be noted that the Council and the European Parliament rejected the Commission’s proposal to ban slim cigarettes, so that will not form part of the final revised directive. As the new Minister, I made inquiries into why that was the case, and I understand that there was not enough support among EU member states or parliamentarians for such a ban. We in the UK felt that we had to go with the majority to ensure the progress of the directive, as it will be good for public health overall. That was a pragmatic decision. Like the hon. Lady, I believe that this package of measures will help to reduce the number of young people who take up smoking in the UK.

We are currently considering the detailed amendments that the European Parliament would like to make. We were disappointed that the Parliament did not support the regulation of nicotine-containing products as medicines. We believe that the medicines regulatory regime, applied with a light touch, is the best fit for these products. Although I cannot say too much more about that now, we recognise that there is a lively ongoing debate on that subject, and it is one that we are engaged in. It is also vital that we maintain momentum on the overall negotiations over the coming months, so as to finalise the directive as soon as possible.

The hon. Lady devoted some time to considering what the tobacco products directive will mean for small retailers. As a Back Bencher, I was co-chairman of the all-party parliamentary retail group, and I heard many of the same representations that she mentioned. I recognise those concerns. We recognise that some of the proposals will have impacts on tobacco retailers in regard to the range and pack size of tobacco products that they will be able to sell. During the negotiations, as with all of our tobacco control measures, we continue to consider the impacts on all areas of society, including businesses large and small.

I share the hon. Lady’s doubt that introducing the proposed revised directive, if and when agreed, will have any immediate or drastic effect on small retailers. As she said, retailers face an ongoing challenge to diversify the range of products that they sell so that they are not over-dependent on tobacco sales. British retailers are, and always have been, the most innovative in responding to consumer needs and diversifying. The earliest any new requirements would be likely to take effect in the UK would be 2016, meaning that shopkeepers have time to start making changes now.

The hon. Lady made some interesting points on illicit tobacco. Like her, I have heard that some tobacco manufacturers and retailers believe that certain measures in the proposed directive could drive more smokers to purchase illicitly traded tobacco products. We are not aware of any peer-reviewed and published studies that show that that would happen. However, we are not complacent when it comes to counterfeit or non-duty-paid tobacco products in the UK. The illicit tobacco market is complex and decisions by individuals to get involved in purchasing illicit tobacco depend on a range of factors. The proposed directive envisages a Europe-wide tracking and tracing system for tobacco products, the details of which we are still negotiating in Brussels. The European Commission says that that will reduce the amount of illicit products in the EU. Security features against counterfeiting will also allow consumers to verify the legal status of the products. The hon. Lady suggested that we were perhaps paying insufficient attention to the security features on the packaging, because they are often not very plain at all.

I am glad that the hon. Lady has pointed out that the illicit market in cigarettes and roll-your-own has diminished significantly since the launch of the first Government tobacco strategy in 2000, with the mid-point estimate of the tax gap for illicit cigarettes decreasing from 21% in 2000-2001 to 9% in 2012-13, for example, according to Her Majesty’s Revenue and Customs data. The UK’s success in reducing illicit tobacco is in no small part due to successive Governments’ commitment to, and investment in, enforcement, and that remains a key part of our policy. We should also see further progress on illicit tobacco on a global scale when the new framework convention on tobacco control protocol on illicit trade is implemented.

The hon. Lady made some interesting points about proxy purchasing. Obviously that is something that, as a new Minister, I have just begun to look at, and I was glad that she explored some of the arguments. I want to emphasise the valuable contribution that the majority of retailers make to ensuring that legitimate tobacco products are sold according to the law, including by not selling tobacco to people under 18 years old. Retailers get frustrated that we hear only about the occasional instances of poor practice that hit the headlines, and that decent, ordinary retailers do not get any credit for the way in which they uphold the law. I want to place on record my thanks to all those retailers who make strenuous efforts to uphold the law and who do not sell tobacco products to children.

I sympathise with the difficulties retailers face in ensuring that they do not make sales to under-age people. I also understand why some retailers feel that buying tobacco on behalf of a child should be an offence. However, we need to think carefully before introducing a proxy purchasing offence. I understand that the supply of cigarettes to children is a problem, but an offence of proxy purchasing would not necessarily tackle the wider problem of supply.

[Lorely Burt]

Will the Minister tell us whether any lessons have been learned from Scotland’s introduction of an offence of proxy purchasing that might be transferrable to the rest of the UK?

[Jane Ellison]

I was going to say that we are interested to see what will happen in Scotland. It is relatively early days yet, but I am certainly interested in looking at that.

Many children who smoke get their cigarettes from friends and family, and from other children who share cigarettes in parks and playgrounds. An offence of proxy purchasing would be unlikely to stop family members or friends giving cigarettes to young people. The offence was introduced in Scotland, where there is a slightly different regulatory regime, as part of a package of measures. Also, we cannot draw a comparison with alcohol because the regulatory regimes for the sale of alcohol and tobacco are different.

Enforcement of a good deal of tobacco control legislation, including age of sale, is the responsibility of local authority trading standards officers. I have asked questions about the capability of enforcing any such rules introduced. Currently, the Trading Standards Institute, while supportive in principle of any additional measures to tackle under-age access to tobacco, has told us that experience with the alcohol offence shows that there are likely to be difficulties enforcing a proxy purchase offence for tobacco. In practice, it is sometimes difficult to prove the offence and effective enforcement would entail surveillance of shopper and retailer behaviours, which can be time consuming and resource intensive. As I say, I am aware that, since 2011, there has been a proxy purchasing offence in Scotland, which was brought in as one of a number of changes—and we will keep a very close eye on how it has been implemented.

Having heard what the hon. Lady has said tonight, I would encourage Members who have evidence about the potential impact of introducing an offence for proxy purchasing to write to me, particularly if they have feedback from their local trading standards officers about the realistic potential for effective enforcement.

Let me finally touch on a couple of further points that the hon. Lady raised. As I have mentioned, the tobacco products directive does not seek to introduce standardised packaging, but it would allow the UK to proceed with that if we wanted to do so. The Government published a summary of the consultation responses, issued a written statement earlier this year and responded to an urgent question. As the hon. Lady knows and as I mentioned several times at Health questions last week, the Government have decided to wait before making a final decision on standardised packaging. The policy remains under very active consideration and the Government have not ruled out its introduction. We are assessing all the information available to us from Australia and elsewhere. I cannot give the hon. Lady a time frame, but I repeat the fact that the policy is under very active consideration. Some interesting information is coming in from around the world, not just from Australia.

We want member states to have the flexibility to make further progress on domestic tobacco control measures in certain key areas, potentially going beyond the new directive, and we have been helping to shape the final text of article 24 to try to achieve that as an objective. I hope the hon. Lady agrees that it is sensible to see what we can learn from other countries’ experience, but it is hard for me to speculate about what different impacts might be seen and when.

It has been a key strand of the Government’s commitment to reducing the take-up of smoking among young people that the display of tobacco has been prohibited in large shops such as supermarkets since April 2012. That display consultation happened under the previous Government. In April 2015, legislation extending the covering up of tobacco in all retail outlets will come into force.

I have endeavoured to try to cover all the points that the hon. Lady raised in her very thoughtful speech. As she recognises, the topicality of this debate is notable; many of the issues are being debated here and in the European Parliament. We are very much engaged in that debate. I look forward to hearing what other Members think and to hearing further from the hon. Lady on the important subject she has raised.

Question put and agreed to.

Oral Answers to Questions

Baroness Burt of Solihull Excerpts

Tuesday 15th January 2013 Commons Chamber

[Norman Lamb]

The hon. Lady has raised a really important point. One of the consequences of the responsibility deal is that by 2015, 1 billion units of alcohol—about 2%—will be taken out of the market, and that will help some problem drinkers significantly. Moreover, the money that the Government are investing in public health gives local authorities an opportunity to invest in prevention services in order to deal specifically with the core group of people to whom the hon. Lady has referred.

[Lorely Burt (Solihull) (LD)]

13. What plans he has to review urgent care services.

[The Parliamentary Under-Secretary of State for Health (Dr Daniel Poulter)]

The configuration of urgent care services is a matter for the local NHS, and commissioners should ensure that there is provision of appropriate urgent care services locally to provide safe and effective care for patients.

[Lorely Burt]

A review of urgent care services by the new GP-led clinical commissioning group for Solihull is causing consternation as it is throwing the future of our highly regarded walk-in centre into doubt. Does the Minister agree that users must be properly consulted, as services must be designed around patients, and that allocation to cost centres must come second to delivering services?

[Dr Poulter]

I agree with my hon. Friend. Where there are well-functioning local services that have local support, commissioners should recognise that in their decisions, but it is also important to highlight that any reconfiguration of local services has to meet the four tests laid down by the previous Secretary of State: support from GP commissioners; strengthened public and patient engagement; clarity on the clinical evidence base; and support for patient choice. I hope that reassures my hon. Friend.