Contaminated Blood Products

Baroness Ritchie of Downpatrick Excerpts

Wednesday 9th September 2015 Westminster Hall

[Ms Margaret Ritchie (South Down) (SDLP)]

I beg to move,

That this House has considered contaminated blood products.

I am delighted to serve under your chairmanship Mr Owen. I am also pleased that the Under-Secretary of State for Health, the hon. Member for Battersea (Jane Ellison), is here to respond to the debate.

To set the context—[Interruption.]

[Albert Owen (in the Chair)]

Order. Could those leaving the Chamber please do so quickly and quietly?

[Ms Ritchie]

Thank you, Mr Owen.

To set the context for this debate, it is my duty and responsibility to acknowledge the very good work of the all-party group on haemophilia and contaminated blood. One of the joint chairs of the group, my hon. Friend the Member for Kingston upon Hull North (Diana Johnson), is here today for this debate. The all-party group published its report on contaminated blood products in January and clearly outlined the requirements of Government in respect of this very vexatious issue.

I secured this debate to highlight the cause of the victims of contaminated blood and blood products, in particular my constituent, Brian Carberry, a haemophiliac from Downpatrick in South Down. Along with all the other victims, he has waited too long for truth and an acknowledgement that the Government, through the Department of Health, imported such contaminated blood products from the USA in the 1970s and 1980s. The victims have waited a long time for proper compensation and access to drugs that are currently being assessed by the National Institute for Health and Care Excellence, and they need those drugs before stage 2 of the illness, which causes liver dysfunction, sets in.

I hope the Minister can today provide a detailed outline of how she will address this issue once and for all. Two thousand people touched by this tragedy have already died, and that number is rising, as people die waiting for the Government to make a final determination. I urge the Minister today to bring this prolonged delay to an abrupt close with a programme of action, including a commencement date for the consultation, which was announced back on 17 July, and the moneys to help those who have endured endless pain, suffering and anxiety for so many years.

In the ’70s and ’80s, around 7,500 people were infected with hepatitis C or HIV as a result of treatment with blood products provided by the NHS. Many of those people were being treated for haemophilia. Those viruses did not just transform their own lives; their families’ lives were also turned upside down, and some of them, including my constituent, can no longer work.

The several thousand people treated with contaminated blood and blood products by the NHS have been denied the real financial security, and the health and social care that they need. The support currently in place is only partial and does not offer the full and final settlement that those affected and their families need to live with dignity, and it falls far below the equivalent compensation in the Republic of Ireland. The development in support, financial and otherwise, over the years has been haphazard and has been delivered much too slowly. Contaminated blood victims already face substantial financial demands because of the nature of their infections and the inadequacy of their financial compensation.

One lady suffering from the infusion of contaminated blood products told me last week that some sufferers are denied even the basic stage 1 payments, even though they have a weakened and compromised immune system, and suffer chronic fatigue, fibromyalgia, depression and unexplained rashes, with a potential link to breast cancer for women. This lady also had an ileostomy, as her bowel burst, and she had a stillborn child, with all the attendant trauma attached to such an incident. Unlike other contaminated blood patients, she has been denied stage 1 Skipton fund payments. Needless to say, she did not receive the Caxton payments either.

[Jim Shannon (Strangford) (DUP)]

Between 1970 and 1991, almost 33,000 people were infected with hepatitis C; between 1978 and 1985, 1,500 haemophiliacs were infected with HIV, and some of them were co-infected with hepatitis C as well. The issue of compensation is a big one, and I congratulate the hon. Lady on bringing it forward for consideration—the number of people here in Westminster Hall today is an indication of its importance. Does she agree that, regardless of the stage of a person’s illness, compensation should be given to them?

[Ms Ritchie]

I thank the hon. Gentleman for his very helpful intervention. That is the case that I am trying to make—that there needs to be a full and final end to this issue, with a good story for the people affected, not only through compensation, but with proper access to the right drugs that will help them and ease their journey.

In the Commons on 25 March, the Prime Minister pledged to help “these people more” after the publication of the Penrose report, promising that “it will be done” if he was re-elected. He was re-elected, but that inquiry, which scrutinised events between 1974 and 1991, has been branded as failing to get to the truth by Professor John Cash, who is a former president of the Royal College of Physicians of London and a former director of the transfusion service.

[Drew Hendry (Inverness, Nairn, Badenoch and Strathspey) (SNP)]

I thank the hon. Lady for taking my intervention, and I congratulate her on securing this important debate. I am here on behalf of several of my constituents, particularly Andy Gunn, whose whole life has been blighted by this unimaginable injustice. Despite several promises that we should expect a comprehensive Government response to the report of the Penrose inquiry, we have heard nothing regarding the time scale. Does she agree that the Government must take immediate action to rectify that?

[Albert Owen (in the Chair)]

Before the hon. Lady carries on, let me say that I understand that Members here have individual constituency cases, but this is a 30-minute debate and I want the Member who secured it to make her case as concisely as she can in the time given, and I want the Minister to have the time to respond. The hon. Lady will also have a couple of minutes at the end of the debate to sum up. Let us see how we go; I am sure that the Minister will be generous with her time.

[Ms Ritchie]

Thank you, Mr Owen, and I also thank the hon. Member for Inverness, Nairn, Badenoch and Strathspey (Drew Hendry) for his intervention, which captured the crux of the problem. We want a full and final settlement for these people, accompanied by drugs for them, because they have suffered immeasurable and unimaginable pain and grief.

It is interesting what Professor Cash—a former president of the Royal College of Physicians and a former director of the transfusion service—has said. He asserts that the Inquiries Act 2005, which defines the parameters of public inquiries, enabled the executives responsible to avoid giving evidence. Apparently, the Act meant that there was a whole area that he could not address, and that is an area worthy of further investigation. I hope that the Government will not fall short in relation to that.

The Haemophilia Society was also critical of the Penrose inquiry report, saying that there had been systemic failures in public health and public oversight. Furthermore, we know that Lord Prior of Brampton made a statement to the House of Lords on Friday 17 July, which was reaffirmed in the Commons on Monday 20 July, when my hon. Friend the Member for Kingston upon Hull North asked her urgent question. However, so far neither Parliament nor the wider public, including the victims, have been told when the consultation announced on 17 July will take place. The victims of contaminated blood products are still suffering while the Government continue to procrastinate on this issue.

[Rebecca Pow (Taunton Deane) (Con)]

I just wanted to widen the debate. I have taken everything the hon. Lady has said, but I want to speak in particular for some of my constituents with contaminated blood who are supported by the Macfarlane Trust, to which I hope she might refer. My constituents are reporting that it is not working and should be dissolved, and they, too, want a final settlement so that they can live out their lives in peace. This is just one small group of people, and that the least we can do so that they can finish their lives, which were blighted unexpectedly, peacefully. I would very much like her to refer to that body.

[Ms Ritchie]

I thank the hon. Lady for her helpful intervention. The bottom line is that none of these trusts has provided adequate help or succour for those who have suffered immeasurably. These people need an acknowledgement of liability and a sum of money that will enable them to live independently and with dignity. Such a sum should be supplemented with ongoing payments to recompense them for years of lost income and for the physical and emotional trauma that the contraction of these viruses has caused.

[Huw Irranca-Davies (Ogmore) (Lab)]

I support my hon. Friend and welcome this debate. Will she stress that, although we are giving voice to people in this debate, we are unable to give their names because of the continuing stigma? Those people include the “The Forgotten Few”, some of whom are constituents of mine, who are co-infected with HIV and hepatitis C. They and their families have lived for many years with not only the financial hardship but the stigma. In every debate on this subject I have been unable to name them, but they deserve justice as well.

[Ms Ritchie]

I am grateful for that helpful intervention, which characterises the real emotional trauma and pain that people who have been given contaminated blood products have had to endure for many years. The uncertainty needs to be addressed as well. The only body and the only people who can address the problems endured by those affected are the Government.

There is concern that the compensation resulting from the consultation could come directly out of Department of Health funds. Nobody who is suffering as a result of contaminated blood products wants anyone else with any other type of illness to suffer because of a lack of resources. Dedicated funding should come out of the Government’s contingency funds for people who suffer from this ailment, because these are special circumstances.

[Sir Oliver Heald (North East Hertfordshire) (Con)]

One of the families from my constituency who are affected are present in the Public Gallery. Does the hon. Lady agree that in framing compensation it is important to look not only at the pain, suffering and misery that has already occurred, but at the future needs of those concerned?

[Ms Ritchie]

The hon. and learned Gentleman is absolutely right. People’s future lives have to be taken into account, and we must also think of those who will contract these viruses at a later stage. The Government must consider the planning of resources and the availability and approval of medicine.

[Catherine West (Hornsey and Wood Green) (Lab)]

I am so pleased that my hon. Friend was able to secure this debate and congratulate her on doing so. Does she agree that the situation is intensely difficult for families, particularly because of the lack of transparency over the years?

[Ms Ritchie]

My hon. Friend has captured the anxiety and trauma of those affected and the need for Government compassion on this issue.

I will encapsulate the principal points. We need to know the commencement date of the consultation. It was supposed to be in autumn; we are now in autumn and we have not heard anything since the announcement on 17 July. We need the Government to detail how the £25 million will be spent and whether the various trusts will be dissolved and a lump sum made available. We need to know whether the Government will acknowledge liability and provide ongoing payments for victims and for the families who have been left with nothing following the death of a family member who contracted a virus or viruses as a result of contaminated blood products.

I say again: victims feel strongly that compensation should come not from the Department’s principal budget but from the Government’s contingency fund. Victims must have access to proper medicine, and drugs are required to be prescribed at stage 1 of the illness, before the onset of stage 2, in order to prevent liver dysfunction.

The Minister said in a statement that the Penrose report,

“together with over 5,000 documents from the period 1970-85…have already been published by Government”,

and that the Government

“have also committed to releasing all additional documents from 1986-1995 late this summer.”

When is “late this summer”? When will the documents be released?

These people, who are suffering so terribly, require truth from the Government. My constituent went to the Royal Victoria hospital in Belfast for continual reviews and was told that he had to get another test. He said, “Why do I have to get another test? Everybody knows I was born a haemophiliac, along with my two brothers.” They said, “You have hepatitis C,” and he said, “How did that happen?” It was because of blood products that were imported from the United States. That was the first he knew of it, 20 years ago. Members can imagine the trauma he felt, and that of his wife, children and wider family. Those blood products have meant that he has to attend hospital on a weekly basis and is without a job. He cannot do what he wants to do most: care for and bring up his family.

For the sake of Brian and many, many others, I urge the Minister to ensure that an abrupt close is brought to this matter, that a date for the consultation is announced, that interim moneys are made available, that full and final compensation is made available out of the Government contingency fund, and that all these terrible injustices are rectified once and for all.

[Albert Owen (in the Chair)]

Before the Minister responds, she has indicated that she would like to speak for about 12 minutes. She has a little more time, so I am sure she will be generous in taking interventions.

--- Later in debate ---

[Jane Ellison]

I do intend to touch on new treatments, because that is one aspect of the landscape in this policy area that has changed profoundly for the better in recent years. I am also always happy to follow up on any issues with colleagues.

I know how much interest there is in this issue, as demonstrated by the presence of so many Members today. Many Members have heard from constituents, as have I, of the significant and devastating impact of this tragic matter on their lives. Successive Governments of all complexions have looked at and wrestled with this difficult issue. I have spoken directly to affected individuals and families and I read many letters—every single one that is sent to me—detailing people’s concerns and frustrations with the current schemes of support and the situation in general.

I assure Members that the matter of infected blood and the reform of the payment schemes continues to be a priority for me. I meet regularly with my officials in the Department of Health, including over the summer, to maintain progress towards a better outcome. As I indicated in my statement before the recess, the Government are considering the provision of future financial assistance, and other support for those affected, within the context of the spending review and in a way that is sustainable for the future. It does need to be sustainable.

We will be consulting to help develop the shape and structure of any new scheme. Members know that, and we have said that before. I appreciate and share the frustration that we have not been able to move to publish a date. I cannot give Members a date today, but we still intend to consult as soon as possible.

[Ms Ritchie]

It is vital that the Minister gives us a date for the commencement of the consultation today. We are talking about a life and death issue for many, many people. I know the Minister appreciates that, but she has to understand that a date is the most compelling requirement, along with the compensation and access to drugs.

[Jane Ellison]

I am well aware of that fact, and I do not casually say that I cannot give a specific date today. The consultation will take place before the end of the year, as we have previously committed to. We are working on the detail of that, but I cannot give Members a specific date today. It is an absolute priority to bring it forward. The area is complex, both legally and in its proximity to the spending review, but we have made that commitment.

Contaminated Blood

Baroness Ritchie of Downpatrick Excerpts

Monday 20th July 2015 Commons Chamber

[Ben Gummer]

I too commend my right hon. Friend the Minister for Community and Social Care, who has done extraordinary work on this subject in the past and brings that experience and expertise to the Department.

I cannot give my hon. Friend an immediate answer on the company he mentions, but I will make sure we write to him with full details.

[Ms Margaret Ritchie (South Down) (SDLP)]

A constituent of mine, Brian Carberry, is a haemophiliac who was infected with contaminated blood products in the 1970s. He has now got hepatitis C. The one thing he wants to hear today is when there will be a full and final settlement and when the drugs will be made available, because there is little point after people get cirrhosis.

[Ben Gummer]

The hon. Lady should know that the two issues are separate. The drugs that she mentions are part of an accelerated access review, which my hon. Friend the Under-Secretary of State for Life Sciences launched recently. It will be available to all sufferers of hepatitis C, however they contracted the disease. We hope to move to that as quickly as possible, and I know that NHS England has it in hand.

A full and final settlement is exactly where we are trying to get to. The hon. Lady will be aware that this is an enormously complex area, and we want to ensure that all the concerns of sufferers and victims are taken into account in the consultation that we are going to lead, so that we can come to a final settlement that is equitable to all.

Oral Answers to Questions

Baroness Ritchie of Downpatrick Excerpts

Tuesday 7th July 2015 Commons Chamber

[Mr Hunt]

They cause a lot of grief to many people, which is why we have issued new guidance that tells people to take particular trouble for people who have to visit hospitals on a regular basis.

[Ms Margaret Ritchie (South Down) (SDLP)]

Will the Secretary of State outline when compensation will be made available to those who were infected by contaminated blood products in the 1970s and 1980s?

[Mr Hunt]

The hon. Lady is right to draw attention to this tragedy, and we will be bringing our plans forward to the House shortly.

Oral Answers to Questions

Baroness Ritchie of Downpatrick Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Mr Hunt]

I can confirm that we agree with the hon. Gentleman and the Opposition that we must consider adult social care provision alongside NHS provision. The two are very closely linked and have a big impact on each other. I obviously cannot give him the details of the spending settlement now, but we will take full account of that interrelationship and recognise the importance of the integration of health and social care that needs to happen at pace in this Parliament.

[Ms Margaret Ritchie (South Down) (SDLP)]

6. What recent discussions his Department has had with the Royal College of Emergency Medicine on the recruitment of additional middle-grade doctors for NHS hospitals.

[The Parliamentary Under-Secretary of State for Health (Ben Gummer)]

The Secretary of State meets the Royal College of Emergency Medicine on a regular basis. The number of middle-grade emergency medicine doctors has increased by 24% since May 2010. Health Education England is working with the RCEM further to strengthen the workforce to ensure that patients receive high quality care.

[Ms Ritchie]

I thank the Minister for his response, but I disagree with him. There is a shortage of middle-grade accident and emergency doctors. When will the next recruitment of such doctors take place in the Indian subcontinent and elsewhere and have all the Home Office regulations and impediments been resolved to allow the recruitment to take place?

Health and Social Care

Baroness Ritchie of Downpatrick Excerpts

Tuesday 2nd June 2015 Commons Chamber

[Jim Shannon]

I thank my hon. Friend and colleague for that comment, and the precedent has been set in Belfast in the past three weeks. I am pleased that we have set the precedent for the rest of the United Kingdom, as we often do in Northern Ireland. That legislative change has been made by local councils and I am pleased to see it.

The loss of that young man to legal highs should not be repeated. My hon. Friend the Member for Upper Bann (David Simpson) mentioned previous legislation. In a previous job, as a Member of the Legislative Assembly, I spoke about one substance that was an issue at that time, mephedrone. We changed the legislation in Stormont, but an ingredient was changed, the name was changed and all that good work was set aside. That is why we need this legislative change and why we need it urgently.

We had a rally in Newtownards organised by a teenager and his friends in response to the death of Adam Owens. It was attended by every age group, every social class and every religion, with people all there to express their concern and the need to see change on legal highs. We should bring this matter to the Chamber as soon as possible. As I said to the family, we cannot ease their heartache but we can work together to try to ensure that something worth while comes from the shock—that is, the end of legal highs. If we achieve that in this House, we achieve it not only for Strangford but for every constituency across the whole of the United Kingdom of Great Britain and Northern Ireland. That is why, although I welcome the Government’s promise to address the issue, I must ask for the timeline for the fulfilment of the promise. Perhaps the Minister can give us some information about what will happen.

As a Northern Ireland Member, I am well known for continually pressing for more funding UK-wide that is ring-fenced for the NHS and I am delighted to hear that the Government are responding to those calls and making more funding available for the NHS. Can the Minister give us some idea when the ring-fenced funding in the block grant will be made available to the devolved Assembly and whether there will be any restrictions on the use of the money?

There are many issues in the NHS that we must address. We need to address the long waiting lists that mean that people wait almost a year for simple hernia operations. Justice cannot be done to a pay rise for nurses within the current budget allocated to the Health Department, yet those men and women dedicate much of themselves to a job that most people in this room would find unbearable. It has been impossible for them to be recognised within the current budget. In addition, money should be set aside to make more cancer drugs available in all postcodes, instead of being subject to the postcode lottery that often operates.

[Ms Margaret Ritchie (South Down) (SDLP)]

I thank the hon. Gentleman for giving way in this important debate on health and social care. Does he agree that a lot of these cancer drugs are trialled in specialised labs in the oncology department in Belfast, and that it is particularly sad that they are not available in Northern Ireland because of the lack of a cancer drugs fund?

[Jim Shannon]

I thank the hon. Lady for her intervention. Clearly, that is the issue for us in Northern Ireland. We want the cancer drugs to be made available throughout the United Kingdom.

Great progress has been made in cancer drugs. In fact, 60% of skin cancer cases can now be addressed with medication and chemotherapy. Those are fantastic steps forward. The other issues are all there—for example, GPs’ surgeries and diabetes. I declare an interest as a type 2 diabetic.

There are mental health issues that we need to address, not only for everyone in society but throughout the United Kingdom and for our soldiers too. I understand that there is not a bottomless pot of money, but we must do the best with what we have. It is also important to understand that your health is your wealth, that we must invest in the health of this nation, and that it is essential that such investment is UK wide.

In closing, I am thankful that the Government pledged to prioritise health, to ban legal highs and to take action on all the other issues that have been raised, but we need to have the pledges implemented urgently. They must not be left until next year or the year after. There is good news in the Gracious Speech, but I ask for details, and for implementation to take place as soon as possible, so that every benefit can come to everyone in the United Kingdom of Great Britain and Northern Ireland.

Nurses and Midwives: Fees

Baroness Ritchie of Downpatrick Excerpts

Monday 23rd March 2015 Westminster Hall

[Mr David Anderson (Blaydon) (Lab)]

I beg to move,

That this House has considered the e-petition relating to proposed increase in fees for nurses and midwives.

It is a great privilege to serve under your chairmanship today, Mr Havard. I thank hon. Members for coming to this serious debate, and I thank my colleagues on the Backbench Business Committee for agreeing to it. I also thank the various trade unions and representative organisations in the national health service that have provided support and given me background material for the debate.

I start by reading out the petition and thanking Mr Stephen Iwasyk and the other 113,795 people who signed it, demonstrating their interest and concern about this vital issue. The petition states:

“We would like the Government to Review the Nursing and Midwifery Council (NMC) with regard to the fees charged to registered nurses and midwives, and the processes through which those fees are decided. The Nursing and Midwifery Council (NMC) recently discussed a further increase in registration fees for Nurses and Midwives from £100 to £120. The fees were increased 2 years ago from 76 to 100 following a consultation that was overwhelmingly against the rise. The NMC are, of course, obliged to consult before any further rise. However 96%+ of individuals voted against the rise last time. The Health Committee in their report earlier that year said ‘We would urge the NMC to avoid further fee rises and to consider fee reductions for new entrants to the register.’ Approximately 670,000+ Nurses and Midwives contribute £67+ Million annually to the NMC. Please sign the petition to encourage a review of the NMC and the charging of annual fees to Nurses and Midwives.”

I am grateful for the opportunity to debate an important issue that faces many of our constituents who are nurses and midwives. The petition, which had reached 113,796 signatures by the time it closed in February, relates to the proposal of the Nursing and Midwifery Council to increase registration fees for all 670,000 nurses and midwives by almost 60% in two years. The e-petition opposed the proposed fee increase and called for a general review of the NMC, and a review of the charging of annual fees to nurses and midwives.

[Ms Margaret Ritchie (South Down) (SDLP)]

I congratulate my hon. Friend on securing the debate. Does he agree that there is an urgent need for the Government to enter discussions with the Nursing and Midwifery Council with a view to reducing fees, in order to sustain the profession and keep people in it?

[Mr Anderson]

That is absolutely what the debate is about. I will point out some glaring worries that have been described to me about the capability and the effectiveness of the NMC. It is not that people do not want to pay a subscription fee; people are forced to pay a fee to be registered, and if they do not pay it, they cannot work. If they cannot work, obviously, they will not make money. The question is whether they get value for money. I am pleased that my hon. Friend the Member for Easington (Grahame M. Morris) is here, and I hope that he will talk about the findings of the Select Committee on Health, which published a report a couple of years ago that was—to put it mildly—quite critical of the NMC.

I will provide some background about what the NMC stands for, what its objectives are and why it proposed a fee increase. I will explain why the NMC fee increase was so strongly opposed by the overwhelming majority of nurses and midwives. The reasons for that opposition included the NMC’s historically poor financial oversight and management, which was highlighted in a damning report by the Council for Healthcare Regulatory Excellence in July 2012. The council criticised the NMC’s lack of focus on preventive measures to reduce fitness-to-practise referrals, the real-terms pay cut imposed by the coalition Government on hard-working nurses and midwives and the catastrophic impact that a fee increase would have on workplace planning. Finally, I will talk about the impact of future fee increases on nurses and midwives and on the care that patients will receive.

Despite heavy opposition from professional bodies and trade unions representing registrants’ views, the NMC chose to increase fees, effective from the end of last month. I want to talk about how fees could be reduced, which comes back to the point made by the hon. Member for South Down (Ms Ritchie).

--- Later in debate ---

[Mr Anderson]

My hon. Friend makes a valid point, which again comes back to what the review can look into: whether members are getting value for money. That is what we are talking about here. The NMC might think, “If we need more money, we can get it because they have got no option other than to pay.” It can hold people to ransom and, unfortunately, that is what it is surely doing. That is clear, because it has ignored the legitimate claims of those who have said, “Please, give us some relief here.” It appears that those people were told, “We’re going to ignore you, anyway.”

During a time of continued pay restraint for hard-working nurses and midwives and ever-increasing costs of essentials such as child care, household bills and everyday items, the proposed fee increase left many registrants feeling that that was yet another attack on their standard of living.

[Ms Ritchie]

My hon. Friend is making a good point. By and large, the NMC’s members are women and some of them are in part-time employment. Does he agree that the disproportionate payment to the Professional Standards Authority for Health and Social Care will have an adverse impact on equality and could infringe equality regulations?

--- Later in debate ---

[Grahame M. Morris (Easington) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Havard; regrettably, it may well be for the last time in this Parliament.

I congratulate my hon. Friend the Member for Blaydon (Mr Anderson) on securing this debate and the Backbench Business Committee on allocating the time. It is on an important issue, and the reason I wish to participate in it is because I serve on the Health Committee and we have looked at this issue on a number of occasions as part of our annual accountability hearings. Indeed, we produced a report, which my hon. Friend referred to; it was the fifth report of Session 2013-14, and the reference is HC 699. It is an excellent piece of work. The Committee went into some detail, covering many issues mentioned by my hon. Friend the Member for Blaydon and making recommendations about how best to proceed.

I do not want to repeat the arguments, but it might be useful to put into context the report and the concerns that have been raised. Constituents of mine who are nurses and midwives have written to me individually, quite apart from the petition. I think many hon. Members throughout the country have had similar representations.

There is an issue about fairness in respect of this considerable increase in fees, and about how the increases have come about. There is also an issue about whether those who are required, by the nature of their employment, to be registered should be placed into financial hardship, as has happened in some cases, particularly with women returners who are working limited, part-time hours. We all agree with registration, to maintain public confidence and trust in the nursing profession. However, there is an issue about whether some allowance should be made for them, in terms of a reduction in their fees.

As my hon. Friend indicated, the nursing and midwifery professions are among the oldest established and longest regulated professions in the United Kingdom, with regulation taking many forms over the last century. The current regulator, the Nursing and Midwifery Council, which has given evidence to the Health Committee, has been in operation since 2002. As we have heard, it is the statutory regulator for more than 670,000 nurses and midwives. The £67 million figure relating to its income is an old one, because it now receives more than £70 million.

In 2011, the Health Committee began holding annual accountability hearings in relation to the Nursing and Midwifery Council. Prior to that, our concentration was essentially on the regulation of the medical profession, with the General Medical Council. We have since widened the scope of the annual accountability hearings. In its report on the first annual accountability hearing with the Nursing and Midwifery Council, the Committee expressed concerns

“about the affordability of the registration fee”.

This has not just popped up: we have identified it as a trend since 2011. In that report, the Committee urged the Nursing and Midwifery Council

“to avoid further fee rises and to consider fee reductions for new entrants to the register”.

However, there have been fee rises since then. When I was first elected, the fees were £76 and they increased to £100 in February 2013. The further rise to £120 a year—that would probably account for the increase in revenue—would mean a 52% fee increase, at a time when nurses and midwives are experiencing severe and unsustainable pay restraint. These problems are further compounded by the decision of the Government and the Secretary of State for Health to veto the 1% NHS pay rise, denying a pay increase to 70% of nursing staff and ignoring the view of the independent pay review body. I want to place on record that the incredible work and effort of our nurses and midwives is of great value, and I want to say how much that is appreciated throughout the country.

[Ms Ritchie]

My hon. Friend is making a compelling case for the career position of nurses and midwives. Does he agree that the Nursing and Midwifery Council, as well as the Government, should be encouraging people into the profession, rather than providing disincentives, discouraging them from joining it and from training for such vital roles that will benefit all within the wider community?

[Grahame M. Morris]

I agree wholeheartedly. All across the country—certainly in my area—efforts are made, and have been made consistently, to recruit good quality staff. Often recruitment is done overseas, with adverts being placed in newspapers in countries that train good quality nurses and midwives, but have a surplus. It often strikes me as bizarre that although we have a reservoir of women returners, we not making it as easy as possible for them to return. Doing that would be in the interests of the service and of the country. It would be a false economy to continue doing what we are doing.

Oral Answers to Questions

Baroness Ritchie of Downpatrick Excerpts

Tuesday 24th February 2015 Commons Chamber

[Dr Poulter]

I am sure that my hon. Friend will understand that it is difficult for me to comment on an individual case, but I am very happy to look into the matter and get back to him about it.

[Ms Margaret Ritchie (South Down) (SDLP)]

Given that the needs of patients must come first and that young people are not choosing to pursue GP training as much as they used to, what discussions will the Secretary of State hold directly with the British Medical Association, the Royal Colleges, the training councils and his colleagues in the devolved Administrations throughout the UK to address this issue, to prevent further congestion in accident and emergency departments?

Oral Answers to Questions

Baroness Ritchie of Downpatrick Excerpts

Tuesday 13th January 2015 Commons Chamber

[Mr Hunt]

I think it is, and my hon. Friend is right that it is a brilliant hospital; it serves my constituents as well. One of the things it is doing is helping to turn around Heatherwood and Wexham Park hospitals trust, which was in special measures, including its A and E department, which is doing much better. Sir Andrew Morris has been running that hospital for 26 years, and that kind of stability in leadership makes a huge difference.

[Ms Margaret Ritchie (South Down) (SDLP)]

On easing winter pressures in NHS hospitals, could the Secretary of State indicate when he last met the chair of emergency medicine and what steps will be taken to ensure greater accessibility to GP practices?

Oral Answers to Questions

Baroness Ritchie of Downpatrick Excerpts

Tuesday 25th November 2014 Commons Chamber

[Mr Hunt]

No, I will not support the hon. Gentleman’s Bill.

[Ms Margaret Ritchie (South Down) (SDLP)]

Given the uncertainty of the French and German Governments on the investor-state dispute settlement mechanism, as well as the indication by EU Commission President Juncker that he will not back it, why have this Government not done more to protect the health service from a practice that would leave it vulnerable to private sector intervention?

[Mr Hunt]

This is what the EU chief negotiator said to the former Labour shadow Health Secretary, who is chair of the all-party group on TTIP:

“the rights of EU Member States to manage their health systems according to their various needs can be fully safeguarded…There is no reason to fear either for the NHS as it stands today or for changes to the NHS in future as a result of TTIP.”

It could not be clearer than that.

Ovarian Cancer (Gene Testing)

Baroness Ritchie of Downpatrick Excerpts

Tuesday 4th November 2014 Westminster Hall

[Ms Margaret Ritchie (South Down) (SDLP)]

I am pleased to serve under your chairmanship, Mr Caton, and I am grateful to have secured this vital debate on ovarian cancer, and more specifically on the implementation of genetic testing techniques for every woman diagnosed with the illness. Ovarian cancer affects more than 6,500 women in the UK each year, making it the fifth most common cancer among women. In fact, more than 150 women a year are diagnosed with the disease in Northern Ireland alone. It is most common in women—

--- Later in debate ---

On resuming—

[Ms Ritchie]

Again, it is a pleasure to serve under your chairmanship, Mr Caton. I am pleased that the Minister is here to respond on this delicate, critical and vital issue for women.

Ovarian cancer is most common in women who have had the menopause, but it can affect women of any age. Notably, the symptoms can be difficult to diagnose, as they are common to many other less serious ailments. Sadly, that leads to many women not getting the treatment they need quickly enough. It is the most aggressive gynaecological cancer. Only about 40% of women are still alive five years after being diagnosed, according to research in the British Medical Journal.

[David Simpson (Upper Bann) (DUP)]

I congratulate the hon. Lady on securing this debate. As she knows, I do a lot of work in my constituency with the Mandeville cancer unit. When I visit it, I see a lot of younger women who have the disease. Hospital staff tell me that early intervention is one of the ways that it can be resolved, so I fully support the hon. Lady in her bid today.

[Ms Ritchie]

I thank the hon. Gentleman his intervention. I agree that it is all about early diagnosis. Women who are diagnosed in the early stages of ovarian cancer have a 90% chance of surviving the next five years, but if the cancer is found at a later stage the five-year survival rate is reduced to 22%—quite a startling statistic. Clearly, early diagnosis and treatment is vital.

[Jim Shannon (Strangford) (DUP)]

I thank the hon. Lady for bringing this important issue to the House’s consideration. Some 39% of women carry the harmful BRCA1 gene and up to 70% carry the BRCA2 gene. Does the hon. Lady think that those with a family history of the disease should be tested earlier to ensure they have regular check-ups and screenings? Does she also think that those outside that 39% should have checks?

[Ms Ritchie]

I thank the hon. Gentleman for his intervention. I agree that early diagnosis of ovarian cancer is the key for women.

UK survival rates for ovarian cancer are among the lowest in western Europe, with one woman dying every two hours from the disease. Sadly, according to the Department of Health in Northern Ireland, survival rates for the cancer have not improved significantly since the early 1990s. Dr Miriam McCarthy of the Public Health Agency in Northern Ireland pointed out at a recent hearing in Stormont that the northern European and Scandinavian countries have five-year survival rates above 40%, so we could clearly do more to combat the cancer.

Anybody who has personal or familial experience of this dreadful illness knows the devastating impact it has. In Northern Ireland, a lady called Una Crudden courageously documented her fight with the disease and inspired many others to do the same. I know of a young lady, a teacher in my constituency called Oonagh Carson, who died last year shortly after diagnosis, which took her a long time to get.

[Paul Burstow (Sutton and Cheam) (LD)]

I congratulate the hon. Lady on securing this debate. My aunt died of ovarian cancer some years ago.

One of the areas that I am sure the hon. Lady wants to highlight is the role of genetic testing for ovarian cancer and the BRCA gene. Is she aware of the work that is being led by the Institute of Cancer Research in conjunction with the Royal Marsden on mainstreaming genetic testing in this area? That programme has already produced a free-to-access pathway that has already enabled 200 women to be tested and could be rolled out to other hospitals. It has been shown not to cost any more, but it can save many lives.

[Ms Ritchie]

I thank the right hon. Gentleman for his useful intervention, which highlights the need for genetic testing and the good pilot work that is being done at the Royal Marsden. It is a pity that that work cannot be rolled out in England, Northern Ireland and Wales. We must not forget that such work has already been executed in Scotland.

By better informing the public and GPs and implementing modern genetic testing techniques we can prevent many more women and their families having to live through the trauma of ovarian cancer. I want to focus on genetic testing techniques that have become available and will have a key role in the battle against this dreadful disease. Genetic techniques have rapidly moved out of the realms of science fiction and are having a significant impact on the way we approach and treat illnesses. Without overstating scientific advances and promising miracle cures, we have a responsibility to utilise those groundbreaking new techniques in everyday medicine. As we learn more about the genetic basis for diseases and certain cancers, this becomes not only a medical issue but an issue for society as whole.

There is an onus to manage and develop new information in a responsible, morally sound way that informs people, rather than distressing or panicking them. The public have been made more aware of those techniques by high-profile figures telling their stories. For example, Angelina Jolie has spoken about the tragic death of her mother from ovarian cancer and her decision to have preventive surgery. Mainstream awareness can only be a good thing, but we must harness it positively to empower women to make informed choices about their treatment. Speaking about her experience of genetic testing and of dealing with the illness, Angelina Jolie said:

“Wherever I go, usually I run into women and we talk about health issues, women’s issues, breast cancer, ovarian cancer. I’ve talked to men about their daughters’ and wives’ health. It makes me feel closer to other people who deal with the same things and have either lost their parents or are considering surgeries or wondering about their children.”

In the same way, women in Northern Ireland and elsewhere in the UK who have or are at risk of the disease are desperate to have access to the information that advanced genetic testing can reveal. The genetic testing normally involves having a sample of blood or tissue taken. The sample will contain cells containing DNA, which can be tested to find out whether someone is carrying a particular mutation and is at risk of developing a particular condition or illness.

Specifically, BRCA1/2 gene testing, which was referred to by the hon. Member for Strangford (Jim Shannon), has emerged as the leading genetic test related to ovarian cancer. We all have these genes, but a mutation on them can increase the risk of developing ovarian cancer from one in 54 to approximately one in two. Evidence shows that one in five women with non-mucinous epithelial ovarian cancer, which accounts for 70% of all cases, carries the BRCA1 or BRCA2 mutation, which dramatically increases their risk of developing the disease. The BRCA gene test at a time of diagnosis offers patients the best guidance for their treatment and should be a matter of priority to ensure that the optimal treatment pathway is selected, whether that is drugs or preventive surgery.

Critically, a BRCA test at a time of diagnosis can change the management of their treatment and save the lives of relatives, who can also be guided toward taking the test. Women in possession of this knowledge are able to make better decisions on their own treatment, as can their close relatives. They can make better informed decisions on surgical and drug treatment options. Indeed, the presence of the mutation points to a form of the disease that responds better to PARP inhibitor drugs, such as the new drug Olaparib, on which the European Commission is considering a recommendation for approval. Dr Sadaf Ghaem-Maghami, senior lecturer and honorary consultant in gynaecological oncology at Hammersmith hospital in London, has stated:

“PARP inhibitors are more effective at killing cancer cells and shrinking tumours in patients with BRCA 1/2 than those without. They are particularly important for BRCA1/2 patients who have a recurrence of ovarian cancer, and for whom there might not be many options.”

In short, I contend that it is clear that we need to implement a system across the UK and Northern Ireland where women diagnosed with ovarian cancer automatically receive a BRCA gene test and have the option for close relatives to take that test as well. I have no doubt that that would save lives and put women in a position where they can make decisions based on all the available scientific evidence. What is the Minister’s position on that?

On cost and commissioning, such techniques have unfortunately not received the attention or funding they deserve from NHS commissioners or the Department of Health in England and Wales or the Department of Health, Social Services and Public Safety in Northern Ireland. Despite qualifying under National Institute for Health and Care Excellence guidelines and despite the introduction of mandatory testing in Scotland, the tests are not uniformly available across the UK. It is also evident that clinicians and practitioners in Northern Ireland and England are unclear who is responsible for commissioning BRCA testing. Can the Minster provide clarification on those arrangements and confirm that testing qualifies under NICE guidelines?

BRCA testing has been highly selective and based largely on family history, which risks missing out on three out of four people with the gene, according to the charity Ovarian Cancer Action, which I commend on its work. It published a report some time ago and has been at the forefront of this campaign. It argues that all women with non-mucinous epithelial ovarian cancer should be considered for the test on diagnosis. It should be clarified and reiterated that the procedure is already in place in Scotland. Trials at the Royal Marsden hospital, which were referred to by the right hon. Member for Sutton and Cheam (Paul Burstow), show that such testing could be extended in a cost-effective manner to England, Wales and Northern Ireland.

[Paul Burstow]

The hon. Lady is absolutely right to emphasise that point. The research evidence shows that productivity is increased by doing the testing as part of an oncology appointment, rather than as something separate. The trials are delivering that in a way that is not costing the NHS more, and it is having huge benefits.

[Ms Ritchie]

I totally agree with the right hon. Gentleman. It is estimated that a BRCA1/2 gene test for someone already diagnosed with ovarian cancer costs the NHS between £600 and £850. Associated counselling can cost between £250 and £500. Together, that can amount to approximately £1,000 a patient. Some 15% to 20% of those tested are likely to receive a result that shows they have the gene mutation. There are likely to be additional costs for resulting tests on close family members, but the early diagnosis and treatment of those individuals will be especially beneficial. The evidence shows that BRCA gene testing is cost-effective in other countries. Modelling conducted in association with NICE guidelines on familial testing suggested that BRCA1/2 gene testing versus no gene testing was particularly cost-effective in women aged 35 to 55.

In conclusion, this disease is one of the most prominent threats to women’s health. It is particularly difficult to diagnose and treat early, and it is obviously devastating and very sad for sufferers and their families, but we are on the cusp of being able to treat it more effectively. Through the introduction and implementation of genetic testing on diagnosis, we can make a significant impact on survival rates and familial guidance. Will the Minister inform us what the Department’s position is on automatic BRCA gene testing for women diagnosed with ovarian cancer? What discussions has she had with NHS Scotland about its existing programme? What discussions does she plan to have with counterparts in Northern Ireland and Wales about such measures? It would be welcome if she could provide clarification on who is responsible for implementing BRCA testing, as there is a degree of confusion over the current arrangements.

In bringing forward modern genetic testing techniques, we can improve survival rates for this terrible and sad illness and put us, as women, in a more empowered position where we can make the best informed decisions on our treatment and the well-being of our close relatives. I look forward to the Minister’s response to the various issues I have outlined.

[The Parliamentary Under-Secretary of State for Health (Jane Ellison)]

I thank the hon. Member for South Down (Ms Ritchie) for bringing this important issue to the House today. She has a long-standing interest in health issues and she has made the case very well for why we need to look closely at this important disease. I will come back to her after the debate on any point that I am not able to respond to now, particularly the technical aspects. I want to give the House a bit of the picture on what else is happening on ovarian cancer, as well as addressing the specific issues that she raised.

As the hon. Lady said, ovarian cancer is the fifth most common cancer for women in the UK. The current five-year survival rate is 44%, but we know that if we get the critical early-stage diagnosis, up to 90% of women survive for at least five years. We know that we could save 500 additional lives each year if we matched the best European survival rates. The debate comes at a poignant time for me, because I lost a very dear friend to ovarian cancer less than three weeks ago. I am well aware of the pressure that the disease brings to bear on the families of those affected. We are investing an additional £750 million over four years in England to improve early diagnosis, and I will discuss the details of that and of treatment later.

The hon. Lady’s speech focused on testing and the BRCA1 and BRCA2 genes. As she rightly said, a family history of cancer is one of the most important risk factors for ovarian cancer, with about one in 10 ovarian cancers being caused by an inherited faulty gene such as the two to which she referred. Incidentally, the genes also increase the risk of breast and prostate cancer. We know that women with a mother or sister diagnosed with ovarian cancer have three times the risk of ovarian cancer of women without such a family history.

NICE’s most recent guidelines recommend offering genetic testing to people with a 10% risk of carrying a BRCA mutation, which is lower than the 20% risk previously recommended. I remind hon. Members that NICE clinical guidelines represent best practice and that we expect NHS organisations in England to take them fully into account when designing services to meet the needs of the population. As a result of their complexity and the different states of readiness for implementation in the NHS, clinical guidelines are not subject to the same statutory funding regulation as technology appraisals. Clinical guidelines therefore have a slightly different status, but it is none the less important that NICE has revised them. NHS England is considering the new recommendation in developing and publishing a single national clinical commissioning policy to confirm the routinely funded NHS threshold for testing.

Like the hon. Lady, I thank Ovarian Cancer Action for all its work in this area. The recently released report on BRCA testing raises important issues, some of which were aired in the hon. Lady’s speech and in interventions. NHS England has said that moving to routine testing at a 10% risk would require a significant capacity and funding investment in genetic testing, diagnostics, counselling and treatment. NHS England is currently considering the potential for funding a revised 10% testing threshold in 2015-16 as part of its annual funding prioritisation process. I will draw NHS England’s attention to the strength of feeling in this debate and to the interesting points that my right hon. Friend the Member for Sutton and Cheam (Paul Burstow) and the hon. Member for South Down made about cost-effectiveness. I will also stress that Parliament continues to have considerable interest in the subject.

The hon. Lady touched on groundbreaking techniques, which provides me with an opportunity to refer to the 100,000 genomes project. We can see the potential of genomics to understanding cancers and rare illnesses and finding new treatments. In 2012, we launched the 100,000 genomes project, through which 100,000 whole genomes from NHS patients will be sequenced by 2017. The project will focus on patients with a rare disease and their families, as well as patients with cancer. Ovarian cancer is in the programme’s scope, and it will hopefully enable us to continue our record of groundbreaking cancer research here in the UK.

I will update hon. Members on the two major screening trials for ovarian cancer taking place in the UK. The first is looking at two possible techniques: trans-vaginal ultrasound and a blood test for cancer antigen CA125. Both of them are being tested as part of the UK collaborative trial of ovarian cancer screening. The study is being funded by the Medical Research Council and Cancer Research UK, with the Government funding the NHS costs of the study. The first phase of results was promising for both techniques, and the final results are due in January 2015. The UK National Screening Committee, which advises the Governments of England, Scotland, Wales and Northern Ireland on screening matters, is preparing to assess the results of the trial against its internationally recognised criteria for a screening programme and to make a recommendation on that basis, which could be a significant move forward. A second study, the United Kingdom familial ovarian cancer screening study, which began in 2005, is also looking to develop an optimised screening procedure for ovarian cancer in high-risk women, such as those to whom the hon. Lady referred.

Returning to early diagnosis, there is cause for encouragement, but we must continue to consider early diagnosis at every possible moment. The hon. Lady is right to draw attention to the impact of early diagnosis on survival rates. The Government have committed £450 million to achieving earlier diagnosis and improving survival. The funding supports improved direct GP access to four key tests, including non-obstetric ultrasound, to help with speedier diagnosis of ovarian cancer. Those tests are being used; in June 2014, GPs requested more than a quarter of all tests that may have been used to diagnose cancer under the direct access arrangements. The test with the highest proportion of GP referral was ultrasounds that may have been used to diagnose ovarian cancer, 46% of which were requested by GPs.

I also want to update the House on the “Be Clear on Cancer” preventive work in England. We want to improve outcomes for women, which is what Public Health England is working towards. With the Department and NHS England, it ran a regional “Be Clear on Cancer” ovarian pilot campaign early this year to raise awareness of the symptoms of ovarian cancer. Like other cancers with poor survival rates, many of the early symptoms can be similar to those of benign conditions, making early diagnosis difficult. The next step is to assess thoroughly the data from the regional pilot, which will help us make informed decisions about which cancer and symptom-awareness campaigns to take forward in 2015-16.

On research, the National Institute for Health Research’s clinical research network is currently recruiting patients to more than 30 ovarian cancer clinical trials and studies. In partnership with Cancer Research UK, the NIHR is also funding 14 experimental cancer medicine centres across England, six of which have a focus on ovarian cancer. A good amount of research is ongoing.

In addition to giving some sense of where NHS England is on BRCA testing, I hope that I am also providing a rounder picture of what else is going on in the field, including screening, diagnostics and awareness campaigns. It is important that the matter gets this level of attention.

[Ms Ritchie]

Has the Minister had any discussions with the NHS in Wales and in Northern Ireland? Like her, I have personal experience from knowing people who have died. Perhaps their situation could have been made easier had they had much earlier diagnosis.

[Jane Ellison]

Although the decision is one for NHS England, the debate has highlighted the fact that interesting work is going on in Scotland. The scale of the challenge is smaller in numerical terms, but I am interested in finding out more about what is going on. I will certainly initiate a conversation to understand what is going on in the four countries of the United Kingdom. I have regular conversations with Health Ministers from other nations for other reasons, as the hon. Lady knows. It may not be possible to raise this specific issue in those conversations, but I will ask for more information to see whether lessons can be learned and to understand the points identified in studies about the cost-effectiveness of early testing, in order to ensure that we have bottomed that out.

I hope that this short debate has served to highlight the issue’s importance. I am always grateful for an opportunity to discuss such important issues and to ensure that the House expresses its interest in making better progress on cancers with the poorest survival rates. I hope I have also updated the hon. Lady and other interested Members on what else is going on to try to improve outcomes for family and friends and to achieve better results in future. I thank for bringing the debate to the House today.