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.

Children’s Cardiac Surgery (Glenfield)

Baroness Burt of Solihull Excerpts

Monday 22nd October 2012 Westminster Hall

[Sir Edward Garnier]

I am grateful to my hon. Friend for that intervention. His support demonstrates that the issue is not only for Leicestershire, but one that affects patients from right across the east midlands and, I would suggest, from well beyond the east midlands.

Before my hon. Friend the Minister feels a little surrounded, may I thank her for being here to respond to the debate? I also congratulate her, although she must be bored of hearing congratulations, on this first step in what will be a long and successful ministerial career; I say that not as a question but as a statement of fact, and on that basis I am sure that we have won the case. I have no doubt that her response to this debate will act as an accelerant to her progress and provide great hope to those of us who want to see the Glenfield hospital’s ability to save lives continue.

Let me read out part of a letter from some members of staff at the Glenfield hospital:

“As members of the East Midlands Congenital Heart Centre team, we feel that we have a responsibility to our patients to ensure that we make clear our intentions with regards to the implementation of the recommendation of the safe and sustainable review. We are not in a position to leave our homes and families, to move to Birmingham to work. As a team of (predominantly) women, we are (predominantly) second wage earners, with husbands, children and homes. The toll of this review on both our work and home lives has been immense. It has created uncertainty and confusion, as well as intense anxiety. The repeated mantra of the review team that it will all be ok ‘with the help of the EMCHC team’ is meaningless in that we have not even been consulted. Unfortunately, we have been placed in a position where to refuse to relocate is openly criticized as being obstructive by the review. This is not the case. Our patients remain our priority within our working life, yet we have a responsibility to our families which, when push comes to shove, will over ride this.”

They go on:

“This letter is in no way representing a threat. It is an open expression of our concerns, over another assumption made by the review team, and which places us in a position where we are forced to choose between our patients and our families. We are a group of dedicated professionals, who have worked hard to achieve the excellence that we have done. Our patients deserve the best, and we fear that the recommendations will not give them that, and we will be unable to be there to support them.”

In my view, that letter speaks for them all—from doctors through to cleaners—and I hope that the Secretary of State will not forget the work that employees of the national health service do at the Glenfield unit when he comes to decide how best to proceed.

It is proposed that the number of cardiac centres in England be reduced from 11 to seven, and thus they will all be working at full capacity. Can the Minister ensure that in the event of a superbug outbreak, for example, as happened at the Belfast neonatal unit this year, or of a fire, as happened at Birmingham hospital in 2010 and in Leicester in 2011, or of any other catastrophic event in one of the cardiac units under consideration, that the remaining six will be able to cope with the pressure without endangering the lives of the critically ill children and babies in their care?

Glenfield already takes patients not just from Leicestershire, but from across the east midlands, as my hon. Friend the Member for Newark (Patrick Mercer) said. It also receives patients from Birmingham, Southampton, Northern Ireland and elsewhere in the United Kingdom—and even from Scandinavia and mainland Europe.

The Safe and Sustainable cardiac review for children in England has been under way for more than three and a half years. It proposes that the Glenfield unit be closed and its patients and neonatal and paediatric ECMO services be transferred to Birmingham. The Minister and the Secretary of State are, we now know, to revisit the medical and economic evidence that the review board has considered, but I look to them to make a different, better and more logical decision, based on the evidence that is there for all to see.

Four available options emerged from the review, and they were predicated not so much on the cost of providing children’s cardiac services—albeit that cost must play a significant part—as on their sustainability. I will not, for reasons of time, list the options or their components, but option A suggested that there should be seven surgical centres: at Glenfield, at Freeman hospital in Newcastle, at Alder Hey children’s hospital in Liverpool, at Birmingham children’s hospital, at Bristol royal hospital and at the two centres in London, each with four surgeons looking after a minimum of 400 children every year.

Following the public consultation between 1 March and 1 July this year, option A received the greatest support. The consultation was the largest ever public consultation within the national health service, with more than 75,000 respondents; nevertheless, that number is much smaller than the number of people who signed the e-petition that provoked this debate. Option A was supported by six of the 10 health regions in England. It is, at £22 million, the least expensive option—the next cheapest costs £44 million—and it has the added advantage of ensuring shorter travelling distances for families.

None of the four options is perfect or ideal, but the option that includes Glenfield satisfies many of the objective criteria that one would expect of a good solution—not least in respect of Glenfield’s nationally commissioned ECMO services. Given today’s letter from the Secretary of State, it is in that regard that our attention now needs to focus. Glenfield provides both cardiac and respiratory ECMO. Its national ECMO centre has been in operation since 1991, and it treats babies, children and adults from across the country and abroad.

ECMO is an invasive life-support system, which can be used on patients with severe respiratory or cardiac failure. It consists of removing blood from a patient, taking steps to prevent clots from forming in the blood, adding oxygen to the blood and pumping it artificially to support the lungs. There is an increased chance of survival of half as much again when a patient is treated in an ECMO centre rather than in a conventional intensive care unit. The Glenfield ECMO unit has the best results in the world, has more expertise and success than any other ECMO unit in the country and is the only such unit in the country to provide mobile ECMO. We have four national centres for ECMO, and the ideal scenario would be to maintain ECMO services in their current locations.

There is the fact that Glenfield’s ECMO unit was applauded by the national health service during the H1N1 crisis and that Glenfield’s ECMO survival rates are 20% higher than the United Kingdom average. Kenneth Palmer, director of the ECMO unit of the Karolinska university hospital in Stockholm and an international expert on ECMO treatment, wrote to my right hon. Friend the Member for South Cambridgeshire, the former Health Secretary, on 7 July, on learning about the proposal to shut the Glenfield unit:

“You will take over 20 years of experience from one of the world’s...best ECMO units and throw it away...to rebuild it in another place...You cannot move a unit, you can just destroy it and rebuild it with many years of decreasing survival rates and increasing morbidity”.

Mr Jim Fortenberry, paediatrician-in-chief of children’s health care in Atlanta, Georgia, also wrote to my right hon. Friend on 6 July:

“Glenfield has one of the finest ECMO programmes in the world and was the source of the recent CESAR trial, a landmark study that helped sort out the benefits of adult ECMO...The impact on care of attempting to move out this program in toto to another location would be devastating. ECMO is not merely the equipment, but the incredible collective expertise and institutional memory of its entire team”.

Glenfield has, over the years, built up a team of more than 80 ECMO specialists.

Dr Thomas Müller, ECMO co-ordinator at the university medical centre in Regensburg, Germany, wrote to my right hon. Friend on 9 July:

“Glenfield Hospital has won an excellent reputation for their expertise in paediatric and adult ECMO treatment and is deemed to be one of the world’s leading centres. The knowledge and experience of the staff in Glenfield probably is unmirrored in Europe and the US. To my knowledge, Glenfield treats the largest number of patients with severe cardiac and respiratory failure with ECMO worldwide...centres with less expertise certainly will experience a higher mortality. Therefore, in the interest of best patient care the decision to close down the most experienced centre of the UK is difficult to comprehend for somebody from abroad.”

Dr Leslie Hamilton, a cardiothoracic surgeon at the Freeman hospital in Newcastle, has also acknowledged that there is a risk in moving ECMO services from Glenfield.

Glenfield performs about 100 ECMO procedures a year, which accounts for 80% of the neonatal and paediatric activity in England and Wales. As I have mentioned, Glenfield also takes patients from other countries, including Scotland, Sweden, Finland and Ireland. The mortality rate at Glenfield is 20%, compared with 34% in the rest of the United Kingdom. Two additional surgeons have expressed an interest in going to work there. The centre is a popular place to work and can be made more “sustainable”—to use the jargon—with more surgeons and space.

In advancing the case for Glenfield, I do not need to denigrate the facilities and expertise of other hospitals. I see the right hon. Member for Newcastle upon Tyne East (Mr Brown) in the Chamber along with my hon. Friend the Member for Solihull (Lorely Burt), who no doubt represents the interests of the Birmingham children’s hospital. In advancing the case for the retention of the internationally acclaimed ECMO centre in Glenfield, I do not need to undermine the good work and dedication of cardiac and thoracic specialists elsewhere. I do not want to do that, and I would not have the time, even if I thought it a proper or sensible thing to do. It just so happens that Birmingham children’s hospital regularly refers patients to Glenfield. Why? Because unlike Birmingham, which conducts only cardiac ECMO, Glenfield does both cardiac and respiratory ECMO.

[Lorely Burt (Solihull) (LD)]

I fully endorse my hon. and learned Friend’s comments about Glenfield. Indeed, one of my youngest constituents, Yvie Beards, would probably not be here today were it not for Glenfield. However, does my hon. and learned Friend not agree that the type of expertise that we have in Leicester should be replicated in other parts of the United Kingdom? Although the Birmingham children’s hospital has one of the best child treatment centres, it could also contribute to that same level of care for children and others in the west midlands.

[Sir Edward Garnier]

I am sure that my hon. Friend is right, but we do not replicate what goes on in Glenfield by closing down Glenfield. If she and I are right about this, we need more Glenfields, not one fewer. We certainly do not need Glenfield itself to be closed.

Glenfield has this year opened a paediatric intensive care unit—a PICU—which will also become unviable as a result of losing paediatric cardiac surgery. Currently, 71% of those in the PICU are cardiac patients, so closing it down will no doubt affect the non-cardiac patients whom the unit treats. The loss of the ECMO service would also make the adult ECMO unit unviable. As of 18 October, option A is supported, on the e-petition, by about 103,000 signatories.

The Guardian, not necessarily a newspaper that a Conservative Member of Parliament leaps to quote from, pointed out on 28 April 2010:

“There has been a wealth of clinical evidence for many years that specialist clinical services, such as stroke, trauma and heart surgery, should be concentrated in fewer centres… Survival and recovery rates would improve markedly with many lives saved.”

The ECMO unit at Glenfield works: it helps children survive and, as we just learned from the Prestatyn case, it helps adults survive. The medical evidence shows that the ECMO unit works, and now it is up to the Secretary of State to understand that and let both the unit and the children it treats survive.

Oral Answers to Questions

Baroness Burt of Solihull Excerpts

Tuesday 21st February 2012 Commons Chamber

[Mr Burns]

Very briefly, Mr Speaker, I can say to the hon. Lady that a number of the organisations that she mentions are trade unions that do not represent the views of GPs up and down the country who are actually engaged in implementing the modernisation by commissioning care for their patients.

[Lorely Burt (Solihull) (LD)]

12. What steps he is taking to improve the standard of dementia care in hospitals.

[The Minister of State, Department of Health (Paul Burstow)]

As many as four out of 10 people in hospital have dementia, and people with dementia stay longer in hospital. We know that there is much room for improvement. That is why we have set a new national goal for hospitals actively to identify people with dementia.

[Lorely Burt]

According to the Royal College of Psychiatrists’ report on dementia care in hospitals, only one in three staff said that they felt that their training and development in dementia was sufficient. What action is the Minister taking better to equip staff to be able to take care of dementia patients in future?

[Paul Burstow]

I am grateful to my hon. Friend. Training is certainly one of the issues highlighted by the audit. We are taking a number of steps. We are working with the Royal College of Nursing, which has developed an online dementia information resource; we have been working with Skills for Care and Skills for Health to provide a series of training workshops for staff; we have been working with Oxford Deanery to trial a new approach to dementia education and training for GPs; and we are funding another audit to make sure that we keep track of the improvements that we expect to see across the NHS.

NHS (Private Sector)

Baroness Burt of Solihull Excerpts

Monday 16th January 2012 Commons Chamber

[Frank Dobson (Holborn and St Pancras) (Lab)]

I agree with a substantial number of the points made by the hon. Member for Southport (John Pugh). The Government claim that their proposals are just an incremental extension of the Labour Government’s involvement of the private sector, bringing private patients into NHS hospitals. In fact, they are nothing of the sort; they are dramatically different in nature and scale. To justify them, the Government grossly exaggerate the contribution the private sector has made.

I am sorry that the right hon. Member for Charnwood (Mr Dorrell) has left the Chamber, as in 1997 when I took over from him as Secretary of State for Health, the NHS was carrying out 5.7 million operations. By the time Labour left office, the figure was 9.7 million—4 million more than when he was in charge. Of those 9.7 million operations a year, 9.5 million were being carried out in NHS hospitals and the private sector was doing 200,000, or 2.1% of the total. So much for its massive contribution to improving the service for ordinary people.

The private sector cherry-picked operations and patients, yet now we have the proposition that things will be franchised out; it was to be to “any willing provider,” but now it is to “any qualified provider.” Recent events suggest that it will be to any willing profiteer—to people who are good at the sales pitch and say that they can keep costs down and are superior to the NHS. They will be the people who use the cheapest breast implants and when things go wrong expect the national health service to bail out the patients they have harmed. They are a bit like the bankers: they are in favour of competition and a free market, but when things go wrong, they say, “Will the taxpayer please bail us out?” That is what we are seeing.

We also see in the proposals that the NHS hospitals should in future be able to undertake up to half the work on private patients. The right hon. Member for Charnwood talked about increased revenue. This year sees the 200th anniversary of the birth of Charles Dickens. He had a character called Mr Micawber, and he would have noticed that it is not the revenue that counts, but the revenue against the cost of providing the service. If the cost of providing the service to private patients is greater than the revenue that comes in from private patients, we are running at a loss and the NHS is subsidising them.

I say that about the Royal Free hospital, which does a very good job in serving my constituency. It just so happens that I have its figures, because I asked for them. In the last year for which figures are available, the Royal Free hospital took in £17.3 million in revenue from private patients. According to the figures it gave me, the cost of providing those services was £15.6 million—an apparent gain of £1.7 million. However, it went on to say that “costs are estimated” and

“not all costs are split between private and NHS patients in this way”.

The costs are not clear. It might look as though the income is clear, but I then asked what the private patient debt is from those people.

[Lorely Burt (Solihull) (LD)]

Will the right hon. Gentleman give way?

[Frank Dobson]

No, I do not have time and others want to speak.

The answer is that, over the past five years, private patient debt has never been lower than £6.4 million, against an income of £17 million. They are not exactly subsidising NHS patients out of the private sector income at the Royal Free, because they do not have enough income to subsidise them.

I recall years ago, when I was shadow Health Minister, running a campaign on this issue. The Tory Government said that they would change the rules and introduce a system, backed up by the National Audit Office, as it is now called—then, it was the Comptroller and Auditor General’s office—that ensured that any private sector contribution produced a surplus. No such arrangements were put in place, and I challenge the Minister to identify what the position is with all those private patients in NHS hospitals. How many are running a surplus and how many are running at a loss?

Manufacturing

Baroness Burt of Solihull Excerpts

Thursday 24th November 2011 Commons Chamber

[Guy Opperman]

I will give way again.

[Lorely Burt (Solihull) (LD)]

The hon. Gentleman has obviously excited a lot of interest with his suggestion. Will he consider the American model of community banks, which have stood the test of time and served their communities?

[Guy Opperman]

My hon. Friend anticipates my next move, which is to say that such matters are already road-tested in other jurisdictions in other countries. Sadly, the FSA is reluctant to change its regulatory system. I have heard other examples of its failing to meet individuals who want to provide local financing—something that would be immensely good for local communities and could provide a flexible approach. Instead of being stuck with a loan from Barclays, for example, people would have a much lower flexible interest rate and adopt a much more interesting way to recuperate their finances at a later stage when the company was in profit. Banking would be local. We all know what happens when we are approached by a constituent when a business is in trouble. The decisions in relation to such financing are made not in Hexham or Newcastle or even in the north-east, but in a place such as Nottingham or Leatherhead or, ultimately, in London. That must change.

--- Later in debate ---

[Gordon Birtwistle]

I am grateful to the Minister for that assurance and I hope that that continues.

When I started in manufacturing some 53 years ago, manufacturing was 40% of the country’s gross domestic product and a balance of payments surplus was delivered every month. What on earth would the Chancellor think of having a constant balance of payments surplus now rather than the negative position we have? As manufacturing was so big, lots of apprenticeships were available through local companies that delivered the products that the country needed. The unemployment rate for young people was very low. When I left school, I applied for many apprenticeships throughout Lancashire. Most young people with whom I went to school achieved an apprenticeship in some industry or other. The vast majority of people in those days did not go to university; many people would have liked to have gone, but they could not, so they spent their time being apprentices and learning skills in the old-fashioned way by making things and having a trade.

I do not want to make this political, but I have to point out that under the last Labour Government, manufacturing fell from 22% to 11%. Even Mrs Thatcher did not achieve such a drop—she only managed to get it from 25% to 21%. Manufacturing has a number of variables to overcome. They include how the industry is perceived by young people, the lack of skills, and the lack of investment and of research and development. One of the biggest challenges to manufacturers in my constituency is finding enough skilled workers to carry out the incredibly technical jobs that are available. More must be done to change the image of industry to make it attractive to young people. I know that those who undertake skilled apprenticeships will end up with great jobs working on interesting projects, earning decent salaries and probably with a job for life.

A lot of damage has been done over the past 10 years to the image of manufacturing and vocational courses. A priority for the Government and for our successful and well-known manufacturers is changing the perception of manufacturing, especially among the young. We have become a country relying on a fragile financial sector and on the service industries. If young people were asked what they thought manufacturing was, they would probably respond that it is dirty and grimy. That is not the case. We need to show young people that there is more to manufacturing—that it is about maths and science, about design and innovation, about robots and computers. Manufacturing and technology in the food industry, for example, are phenomenal. There are so many different areas in the manufacturing sector and they are all innovative and exciting sectors to work in.

Controlling the supply side of our skills deficit is but part of the problem. As important is ensuring that both new entrants and existing employees in manufacturing are sufficiently upskilled to meet the demands of British employers. The preparation work needs to begin in schools. We know, for example, that pupils who take three separate science subjects at GCSE are more likely to study science, technology, engineering and maths later in their educational careers. If we can tackle the problem at source, and improve the rigour of the subjects and the number of pupils studying them, it will have a cumulative impact on the calibre of graduates entering the job market.

[Lorely Burt]

Does my hon. Friend agree that a great way to get youngsters more excited and involved is to have closer collaboration between employers and schools, so that children can see what it is they aspire to do, and therefore choose to take the subjects to which he refers?

[Gordon Birtwistle]

I totally agree with my hon. Friend and I will come on to an initiative in my constituency related to that suggestion.

In my constituency we have Burnley college, a joint FE-HE campus working with local firms to train highly skilled youngsters to be ready for the world of work. We are also getting a university technical college that will bring young people into the industrial life. Burnley college has made huge leaps in changing the perception of manufacturing locally among young people, and if the model the college uses were introduced across the UK, it would go a huge way towards really changing the perception of manufacturing at a national level. More schools and colleges need to start joining up with local businesses to provide youngsters with the knowledge and experience that will help them in the world of work. Too many children do not have any experience of working, or of the personal and other skills required. I will continue to encourage the Government to introduce impartial careers advice from the age of 11. Indeed, we should start careers advice long before young people go to secondary school.

Oral Answers to Questions

Baroness Burt of Solihull Excerpts

Tuesday 18th October 2011 Commons Chamber

[Anne Milton]

I draw the hon. Lady’s attention to the fact that the Health and Social Care Bill proposes for the first time a duty on the Secretary of State to have regard to health inequalities, which, I repeat, widened under the previous Government. I also point out to her that the letter to peers signed by Professor Marmot and others welcomed the emphasis on establishing a closer working relationship between public health and local government. I suggest that the hon. Lady gets out more, because she would hear from public health doctors and local authorities on the ground who welcome these changes.

[Lorely Burt (Solihull) (LD)]

5. What steps he is taking to reduce the burden on NHS hospitals of (a) PFI repayments and (b) debt.

[The Minister of State, Department of Health (Mr Simon Burns)]

A study conducted by the Treasury has identified savings opportunities of up to 5% on annual payments in NHS PFI schemes. The Cabinet’s Efficiency and Reform Group is rolling out a programme of work to secure savings of up to £1.5 billion across the 495 PFI contracts in the public sector in England.

[Lorely Burt]

Contrary to the earlier complacent comments of the Opposition spokesman, some national health trusts are paying up to 20% of their revenue to PFI contracts. What steps can we take to ensure that the payments are reduced and that the same terrible financial situation never happens again?

[Mr Burns]

I am grateful to the hon. Lady. I, too, recognise the small number of organisations that are reporting financial challenges. The Department is continuing to work with strategic health authorities to ensure that those organisations have robust plans in place for financial recovery, while ensuring the quality of services for patients.

Maternity Services

Baroness Burt of Solihull Excerpts

Tuesday 1st February 2011 Westminster Hall

[Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)]

I wanted to have today’s debate on maternity services for three reasons. One is the confidential inquiry into intrapartum-related death, conducted by the Perinatal Institute in Birmingham in October 2010. Incidentally, its director is one of my constituents, which, of course, adds to the quality of the report.

Secondly, I vividly remember an article in The Sun during the election campaign in 2010, in which the right hon. Member for Witney (Mr Cameron) clearly promised 3,000 extra midwives. The third reason is last night’s debate on the Government’s health reforms. The three are unfortunately related.

I will begin with the report. An enormous amount of good work is being done in maternity services and provision, and the Birmingham women’s hospital in my constituency provides excellent care. The west midlands should not feel that it is being singled out. It was simply the first area that took a good, honest look at what is happening and, therefore, has produced figures from which the rest of the country can learn. The west midlands is an area of huge diversity, both in income and ethnic background. Roughly speaking, it has 70,000 deliveries a year, which account for 10% of live births in England and Wales. It also has about 10% of babies who die from intrapartum-related causes—that is, events surrounding labour and child birth.

In 2006, the chief medical officer highlighted the fact that one of his areas of particular concern was intrapartum-related death. In a national report in the 1990s, that was continually highlighted as requiring more attention, but the figures did not show any particular improvement. For that reason, the Perinatal Institute decided to look at that area. We know that in politics to be described as “brave” sometimes means “foolhardy”. However, in this case the institute was brave to look at the figures honestly. It looked at 25 cases that caused concern. The full report is available on the institute’s website. It found that of those 25 cases, in four there was substandard care and different management would have made no difference to the outcome.

[Lorely Burt (Solihull) (LD)]

As another west midlands MP—the Heart of England trust covers my constituency—I wonder whether the hon. Lady has noticed any problems with care of parents after neonatal death. I have the charity Stillbirth and Neonatal Death Society, SANDS, in my constituency—as I expect she has—and it is most concerned about the quality of care for parents following the death of a baby.

[Ms Stuart]

I have come across SANDS. The Heart of England trust did some work, which I will consider later, whereby it looked at midwives’ case load and found it to be far higher than required. Incidents are spread across an area and each of us probably sees only one or two cases occasionally. The real problem comes when we look across the city and the west midlands. We should pay tribute to SANDS and its work and to the bereavement nurses it has now put in hospitals. They are in east Birmingham and in my patch. However, that is not good enough.

Coming back to the 25 cases, in four cases of substandard care, different management would not have made a difference. In five cases, it might have made a difference to the outcome, but in 16 cases, different management would reasonably have been expected to make a difference to the outcome. In other words, 84% of the deaths were considered potentially avoidable. The overall conclusion that the report reached looking at the west midlands was that many deaths were avoidable and need to be avoided. That is why we need to discuss this report and decide what to do about that.

This is not a particular west midlands problem; it is just that the west midlands has been the first to take an honest look.

--- Later in debate ---

[Ms Stuart]

I am sure the Minister will be grateful for that helpful intervention. However, have we not been told that the NHS is ring-fenced? That is how I understand it. Therefore, the financial argument really does not hold.

I would like to analyse what the Prime Minister said a little more. He went on:

“It doesn’t have to be like this…First, we’re going to create new maternity networks…Second, we are going to make our midwives’ lives a lot easier. They are crucial to making a mum’s experience of birth as good as it can possibly be, but today they are overworked and demoralised. So we will increase the number of midwives by 3,000. This is the maternity care parents want: more local and more personal. And under a Conservative Government, it is what they’ll get.”

[Lorely Burt]

As the Prime Minister said, the aspiration should be for more local and more personalised services. However, in my local hospital at Solihull, the full maternity service has unfortunately been downgraded as a fait accompli, and instead of 2,700 births a year, we are led to expect only 300. Does the hon. Lady agree that that hardly offers the choice, localism and personal service that we should seek to achieve anywhere in the country?

[Ms Stuart]

I will respond to that point before returning to my favourite subject of the Prime Minister’s promises. The hon. Lady is right: there is always a huge tension between local and more centralised delivery. My first Adjournment debate in this Chamber as a junior Minister was about the closure of the William Courtauld maternity unit in Braintree in Essex. It had about 300 deliveries, and there was always a tension about whether services should be offered there or in Colchester. We need both. However, when campaigning to keep local maternity units, we should note that the Royal College of Nursing looked at changes in maternity care. It stated that, apart from the rise in numbers, there are more older mothers with higher rates of complications, and there is a higher rate of multiple births and more obese women who are less fit for pregnancy. More women survive serious childhood illness and go on to have children, and they need extra care during pregnancy and childbirth. There are also increasing rates of intervention.

Therefore, apart from social and ethnic diversity, some births are becoming increasingly complicated. If the hon. Lady were to go to the Birmingham women’s hospital, where women who have had heart transplants give birth, she would see that a safe delivery might require not only the expertise of the women’s hospital, but that of the Queen Elizabeth hospital next door. There is always a natural tension between localism and the best care. The real answer is that we need both.