O’Neill Review

Gary Streeter Excerpts

Tuesday 7th March 2017 Westminster Hall

[Mr Gary Streeter (in the Chair)]

Before I call Mr Hollinrake to move the motion, I shall let you know that eight colleagues are trying to catch my eye, in addition to the Front Benchers and the mover of the motion, so I will impose a voluntary time limit of four minutes on Back-Bench speeches. Please—I beg you—keep interventions to a minimum. We will see how it goes. I may have to impose a compulsory limit as we go along, but I hope not.

[Kevin Hollinrake (Thirsk and Malton) (Con)]

I beg to move,

That this House has considered the O’Neill review into antibiotic resistance.

It is a pleasure to serve under your chairmanship, Mr Streeter. In advance of this debate, I penned an article for PoliticsHome titled, “Antibiotic resistance—the new Black Death?” As I was writing that headline, I could sense outraged people saying, “A typical politician grabbing a sensational headline to terrify the public once again,” but it reflects the devastating conclusions of the review on antimicrobial resistance, which involved some of the world’s leading scientists, academics and economists, including its chair, Lord O’Neill, the world-leading economist and former Treasury Minister.

The O’Neill review’s report states that bacteria are gradually becoming more resistant to antibiotics, and its most grim prediction is that 10 million lives will be lost globally every year by 2050. That is more than are lost to cancer and similar to the number of deaths caused in the 14th century by the black death, which killed some 75 million people between 1346 and 1353.

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[Kevin Hollinrake]

I am grateful for that intervention and for my right hon. Friend’s work on the issue in the past. He gives me an ideal opportunity to close my comments; I know you are keen to get other Members in to speak, Mr Streeter.

The UK is a world leader on this in both words and actions, but we need to do much more. The former Prime Minister—and the current Prime Minister, I am sure—and the former Chancellor of the Exchequer are leaders on this on the world stage and have drawn it to the world’s attention, as has Lord O’Neill. It is hugely important that we maintain that leadership. I look forward to hearing the thoughts of colleagues and the clear plans of Ministers for how we will act now to meet today’s challenge, because the fear is that tomorrow will be much worse than today.

[Mr Gary Streeter (in the Chair)]

I remind hon. Members of the voluntary four-minute time limit. There are about to be Divisions in the House.

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[Patrick Grady (Glasgow North) (SNP)]

It is a pleasure to serve under your chairmanship, Mr Streeter. I was not expecting to be called so soon—[Interruption.]

[Mr Gary Streeter (in the Chair)]

Despite your pleasure, Mr Grady, there is a Division in the House.

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[Mr Gary Streeter (in the Chair)]

We will recommence even though the Minister and the mover of the motion are not present. Sir Kevin Barron will speak now, and we will come back to Patrick Grady’s speech later. The debate will end at 4.33 pm.

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[Several hon. Members rose—]

[Mr Gary Streeter (in the Chair)]

Order. I am afraid we now have to go down to three minutes per speaker. I am sorry about there being no notice of that.

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[Mr Gary Streeter (in the Chair)]

I remind colleagues that this debate must conclude at 4.33 pm. Our winding-up speeches will begin now, but I hope that we will be able to give two or three minutes at the conclusion of the debate for the mover of the motion to have a final say.

Pennine Acute Hospitals NHS Trust

Gary Streeter Excerpts

Tuesday 17th January 2017 Westminster Hall

[Mr Ivan Lewis (Bury South) (Lab)]

I congratulate my hon. Friend on securing this incredibly important debate and on his years of attempting to highlight the dreadful failure of leadership—not of frontline staff, who do a remarkable job—in the trust. We have to hope that the future is better, but being dependent on the leadership of one individual in the long term is not always the best way to turn around an organisation.

In the light of my hon. Friend’s comments about local decision making, does he believe that at a time when accident and emergency at North Manchester general is under such tremendous pressure, it makes sense for Bury CCG to press ahead with its proposal to close the Prestwich walk-in centre? At a time when patients are being told not to go to accident and emergency services, it seems absolutely bonkers to close a walk-in centre that is so well used.

[Mr Gary Streeter (in the Chair)]

Order. Interventions should be brief.

[Graham Stringer]

I agree with my hon. Friend about the closure of walk-in centres. There has always been a conflict of interest between GPs getting patients through their surgeries and walk-in centres. At a time when there is stress across the whole Greater Manchester NHS—indeed, across the NHS in the whole country—to increase that pressure by closing walk-in centres seems—my hon. Friend says “bonkers”, but I would use slightly tamer language—perverse.

I will finish with some questions for the Minister. Part of the plans that Sir David Dalton and his team have in place, which involve separate management teams for the three major hospitals—putting Rochdale in with Bury—will require investment in the short term in 24 new beds for intermediate care and hopefully, in the medium term, the demolition of more than half of North Manchester general, which is a 19th-century workhouse, to turn it into a completely modern hospital. What will help staff morale most is a commitment to the future of the hospital on that site, dealing with a community with some of the country’s worst mortality and morbidity statistics. The Minister might not be briefed on this because it happened relatively recently, but the paediatric audiology unit has failed its accreditation assessment. If he does not know about that—I would not necessarily expect him to—will he write to tell me what the response will be and whether paediatric audiology will continue on the site?

On 13 December 2016, in a statement on the NHS deaths review, the Secretary of State, while recognising the difficulty in doing so, committed to trying to understand which of the highlighted cases were avoidable deaths and which were not. It is important for both the families and the public to know which of them could have been avoided and which were, unfortunately, the kind of unavoidable hospital death that takes place when someone is very sick. Was it a mistake to remove 31 medical beds from the hospital just over 12 months ago? As a result, the number of people being admitted into North Manchester general is lower, because there simply are not enough beds. What is happening to the people who otherwise would have been admitted?

Those are the detailed questions. The real question for the future is whether the Minister will give a long-term commitment to the hospital and to its moving into the Manchester hospital system. Given the statistics showing that men from north Manchester are likely to have lives that are six years shorter than those of men in the rest of the country, and that women’s lives are likely to be about 4.4 years shorter, is there a commitment to quality care and investment in the hospital for the future, to ensure that those rather damning statistics are changed?

[Several hon. Members rose—]

[Mr Gary Streeter (in the Chair)]

Order. The winding-up speeches will begin no later than 10.40 am and four colleagues wish to catch my eye, so the maths does itself.

Junior Doctors Contracts

Gary Streeter Excerpts

Monday 25th April 2016 Commons Chamber

[Mr Hunt]

We are taking serious action to bring that deficit down. In particular, one thing we need to do to do that is to reduce the use of agency staff. That will help with the provision of more full-time staff in the NHS, which will be good for the junior doctor workforce.

[Mr Gary Streeter (South West Devon) (Con)]

I commend my right hon. Friend for the way he is conducting himself in this matter. Will he remind the House of when the BMA’s junior doctors negotiating committee first refused to meet him because it wanted to achieve a political outcome rather than a resolved settlement?

[Mr Hunt]

Regrettably, there has not been only one occasion. In the October before the election, the junior doctors committee walked out of talks after extensive efforts to negotiate a new contract. We then had the independent pay review body process. Then—this was the most shocking thing of all—we had the decision of the committee to ballot for strike action before it had even been prepared to sit down and talk to me about what the new contract involved. That has been at the heart of so many misunderstandings about this contract and has led to so much disappointment on all sides. If the committee had sat down and talked to us, it would have discovered that we all want the same thing: a safer, seven-day NHS.

Community Pharmacies

Gary Streeter Excerpts

Tuesday 23rd February 2016 Westminster Hall

[Derek Thomas]

I am pleased that we are so supportive of the community pharmacists, and hopefully we will get a good result from this debate.

I have three straightforward questions and a personal plea to put to the Minister, if you will bear with me, Mr Speaker—[Interruption.] Sorry, Mr Gary Streeter. [Laughter.]

[Mr Gary Streeter (in the Chair)]

It is okay, I will let you off.

[Derek Thomas]

Have the Government made any impact assessment in relation to their position of reducing community pharmacy numbers and the impact that this change might have on the health, and economic and social wellbeing of people living in our area? What assessment have the Government made of the impact that such a reduction would have on the workload of GPs, those in A&E and those providing out-of-hours services, if patients cannot access their regular pharmacy and then visit these other services?

[Caroline Ansell (Eastbourne) (Con)]

I congratulate my hon. Friend on securing this timely debate on an important issue that could have far-reaching consequences, should the decision go through. Equally, I join him in urging the Minister to ensure that during the consultation—we understand that there is still to be consultation with patient groups—we will take, to echo a comment by a former Member, a constituency-by-constituency approach. I am sure that everybody will bring to the fore the particular characteristics of their own constituency. My constituency has the record number of octogenarians in the country and the fastest growing town in the south-east, and it routinely hosts tourism-driven events such as Airbourne, when 600,000 people come into the town. Pharmacies are a sometimes uncelebrated and unseen force that we rely on.

[Mr Gary Streeter (in the Chair)]

Order. Interventions should be brief.

[Derek Thomas]

I thank my hon. Friend for her intervention and she is absolutely right to say that in a tourist area, where the population increases dramatically at times, we need to be careful that the core services are available for everyone who needs them.

My second question is: what assurances can the Government give to independent community pharmacists? The third question is: what consultation has been conducted with pharmacy patients, and what would their concerns be if community pharmacies were to close?

My personal plea to the Minister is please not to write pharmacies off until they have been given the resources to realise their full potential in society. I feel excited about the potential opportunity that exists for the NHS through the proper use of community pharmacists. While reforms to NHS services are essential and the way that community pharmacists are utilised needs to be reviewed, a blanket removal of funds to pharmacies will only hinder progress and limit this opportunity.

[Several hon. Members rose—]

[Mr Gary Streeter (in the Chair)]

Order. We have six colleagues trying to catch my eye and roughly 40 minutes. If they could show self-restraint and limit themselves to seven minutes each, that should see us through.

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[Mr Williams]

The hon. Gentleman is right. That has been the message of many contributions. The work of our community pharmacies complements the work of the national health service. When the hon. Gentleman’s constituency is hit in the way that it has been, that represents the proverbial nail in the coffin of decent community-based services for his constituents.

On the urban point, to reiterate the point made by the right hon. Member for Rother Valley (Kevin Barron), we are talking about well-established community businesses that impact on many people in the locality. Two or three businesses clustered in the same area doing a generally good job will have an impact on the local economy, but the rural point is fundamental. We have heard about the pressures on GPs and the difficulties in getting appointments. In my vast rural constituency of Ceredigion, we have a district general hospital in Aberystwyth: Bronglais hospital. We have a good many GPs throughout the county. We also have a network of very effective pharmacists, and it is a jigsaw that works in providing good services. There are 716 community pharmacies in Wales—in high streets, villages and towns—with 50,000 people visiting those facilities every single day, proving the efficiency of the much-maligned Welsh national health service and bridging the real difficulty that people have in visiting the closest hospital or a GP for something as routine as blood pressure or cholesterol checks. It is really important that the outcome of the debate is that we support community pharmacies. That is fundamental.

In Wales we have developed our services. I visited the pioneering pharmacy of Mr Richard Evans in the town of Llandysul 11 years ago. He was clearly of the view that we could develop services much more, to relieve pressure on the national health service, and he achieved that. In Wales pharmacies have offered NHS flu jabs for at-risk groups for the fourth winter running. Almost 20,000 people in Wales benefited from that last winter. After four years of that provision in Wales, the NHS in England introduced the same service for the first time. Community pharmacies in Wales can treat about 30% of the common ailments that people would normally go to a GP for. That is a huge saving for the national health service. Pharmacies also promote meaningful public health campaigns. I visited the pharmacy in Borth, where there is a campaign on Parkinson’s disease. The staff are doing a good job talking with victims of Parkinson’s disease about their medication, and promoting awareness in the community.

Finally, having praised what is being done in Wales, in a rural area, I want to seek an assurance from the Minister that if his consultation has an effect on the three levels of services in the framework, there will be meaningful consultation with Assembly Ministers in Cardiff, and that any negotiations on changes to the contract will involve Welsh Government officials at the negotiating table. This is one of the small areas where health is not devolved, and that is particularly relevant on the Welsh border; it requires the respect agenda, on anything that the Minister concludes.

[Mr Gary Streeter (in the Chair)]

As a reward for his patience, Mr Graham Jones has eight minutes.

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[Alistair Burt]

That working with the sector is ongoing. That is what the negotiations with the Pharmaceutical Services Negotiating Committee are all about. I take the hon. Lady’s point, but those discussions are under way. We are consulting with a wide range of groups, not just the PSNC, including patients and patient bodies.

As part of what we are doing for the future of pharmacy, we want pharmacists and their teams to practise in a range of primary care settings to ensure better use of medicines and better patient outcomes and to contribute to delivering our goal of truly seven-day health and care services. As part of that, I want to work with NHS England to promote local commissioning of community pharmacy within the health community, so that we can ensure the best use of this valuable resource. That is why we are consulting on how best to introduce a pharmacy integration fund to help to transform the way pharmacists and community pharmacy will operate in the NHS of the future. By 2020-21, we will have invested £300 million in the fund.

While it is understandable that the focus of most colleagues’ comments today was access to existing services, little was said about where pharmacy might be going and what new opportunities there will be. That is part of the overall development that we are hoping to achieve, which will include the work not only of the access fund, but of the integration fund.

Colleagues asked several questions about access. I want to provide some reassurance. We recognise that some of the Government’s proposals have caused concern, and that will take some time to distil as the negotiations are worked through. We are committed to maintaining access to pharmacies and pharmacy services. We are consulting on the introduction of a pharmacy access scheme, which will provide more NHS funds to certain pharmacies compared with others, considering factors such as location and the health needs of the local population, both of which were raised today. Qualifying pharmacies will be required to make fewer efficiencies than the rest of the sector. We certainly recognise that rural pharmacies will need to be considered in that, and we want to ensure that location matters in areas of sparsity. That work is ongoing.

In conclusion, the process has some way to run. I simply put it to colleagues that, in relation to good community services on the high street, there is more for modern pharmacy to do. Looking at the proposals of the past, we hope that the profession shares the Government’s determination to move pharmacy into a new future, and I am convinced that the future will be good.

[Mr Gary Streeter (in the Chair)]

Derek Thomas has 40 seconds in which to respond coherently.

Cancer Drugs

Gary Streeter Excerpts

Tuesday 19th January 2016 Westminster Hall

[Nick Thomas-Symonds (Torfaen) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Streeter. I congratulate the hon. Lady on securing this important debate. Another example of a drug that has been delisted, causing similar frustration, is Abraxane, which is used in the treatment of advanced pancreatic cancer and was removed from the Cancer Drugs Fund in November. First, does she share my concern that although the delisting applies only to England, it causes worries across the rest of the UK as to whether the drug will become unavailable there, too? Secondly, although of course a consistent set of rules must be applied, one of the issues with pancreatic cancer is that 80% of patients are diagnosed when the cancer has already spread. Although Abraxane may only give a few weeks more life, those weeks may double life expectancy.

[Mr Gary Streeter (in the Chair)]

Order. Interventions must be brief.

[Pauline Latham]

I accept what the hon. Member for Torfaen (Nick Thomas-Symonds) says. I have also campaigned for Abraxane to continue because, very sadly, a former Member of this House died from pancreatic cancer in the last Parliament. He had very few weeks to live once he was diagnosed, so it is a particularly unpleasant disease.

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[Pauline Latham]

My hon. Friend is absolutely right. NICE has not done what it should have done. I hope that the Minister will be able to rectify that failure in the system.

Resolving data collection issues, negotiating value for the taxpayer and making the NICE assessment process flexible for innovative new drugs and drugs designed to treat only a small number of patients are vital for the fund to work successfully when it re-launches in April. Will the Minister please look again at the delisted drugs and give hope to people such as Graham that they can spend longer with their loved ones? Failing to do so will not help those whom the fund is designed to help most: cancer patients and their families.

[Mr Gary Streeter (in the Chair)]

Colleagues, we have 40 minutes until the winding-up speeches begin at 3.30, so we are looking at six-minute speeches, by voluntary submission. I will call Jim Shannon first, as he has to go and chair an important all-party parliamentary group; I hope that colleagues will accept that. He has promised to speak for no more than five minutes.

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[Danny Kinahan (South Antrim) (UUP)]

I too thank the hon. Member for Mid Derbyshire (Pauline Latham) for obtaining the debate. I feel that I am the most inexperienced of the Members present on this subject, having never been on a health committee, but having been lobbied hard; but I lost my sister some 25 years ago, and I know that everyone has either lost a family member to cancer or knows someone who won, and was cured.

There is a key thing to get across today. Every MP needs to realise the limitations on funding and what we are learning, so that we can all lobby, and help to find a better way forward. I was particularly impressed when President Obama said he wanted all cancers to be cured. I am not sure that that will always be possible, but it is the right aim with which to go forward.

As I have been trying to learn about, and get myself briefed on, the topic, I have realised that we need a more dynamic and flexible approach to what we are doing. It is right to have a fund that allows everyone to get to it, but we must find a way in which everyone does get to it—to the drugs. Taking drugs off the list seems to be the wrong way forward. Can we look for some form of flexibility, so that with drugs that have been removed there is perhaps a different way of getting at them, one step back?

I had two main reasons for wanting to speak today. One, which has been touched on by my colleagues, is the difficulty that comes from Northern Ireland being treated as a devolved country with its own cancer. As we have heard, only £1.5 million is being put forward and the cost of cancer is a phenomenal chunk out of a small budget. People often have to travel elsewhere in the UK to get the drugs and the cures they need.

One such case is this. I was sitting on a train once—before I ended up here—listening to two Northern Irish people speaking loudly about how useless all politicians were, not just here but also in Northern Ireland, because no one had helped them with their cancer. I interrupted them, and it turned out that a politician from the Social Democratic and Labour party was the only person who had, in fact, helped them. One of them had had to sell his house and use all his savings to get the cure he needed, which was available only here in London. My main point is that we have to find a more joined-up way of doing this, so that the drugs are available for everyone, everywhere. Can we consider an approach that includes all four countries?

We have heard from others that we have an extremely good Queen’s University link-up with Almac and with other countries, and we also have, in my patch, Randox. We have fantastic pharmaceutical companies leading the way in Northern Ireland. However, it was from a meeting with one of those companies that a story we have touched on today emerged. The company tried to sell the diagnostic system to our local NHS, but it could not. It sold it to a company in America, which repackaged it, and the Northern Ireland health service then bought it from that company for an extra few million. We have heard about the difference in costs between Spain and Britain. There must be a system for looking at the procurement process, to ensure that we are more dynamic in how we buy things, so that the drugs are there and available to everyone.

Those are the two main points I wanted to make. Let us work it all together and get a better use of drugs. I am glad that we have had the debate today, and I am thankful for having had the chance to speak.

[Mr Gary Streeter (in the Chair)]

Thank you, colleagues, for your co-operation. We now turn to our winding-up speeches, and it is a pleasure to call first, for the Scottish National party, Marion Fellows.

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[Marion Fellows]

Where cost is a factor in prescribing drugs it is important that we consider ways of lowering it. The pharmaceutical price regulation scheme could be used. When a drug’s spending threshold is reached, a rebate is paid. In England, it goes back to the Treasury but in Scotland it goes on to further new drugs.

The delisting of cancer drugs because of cost causes untold heartbreak to patients and families—the very people we all represent—and the time has come to find a way of making new drugs accessible to, and affordable for, the NHS by considering arrangements such as multi-year budgeting, which would allow for a lower initial price. Pharmaceutical companies would hopefully be open to that in exchange for getting their drug into use at an earlier stage.

It is important to understand that drug companies fund drug development research for years before they even know if the drug is worth licensing. Many potential drugs fall by the wayside and, as the public purse would never be able to fund such a level of risk, it is necessary that pharmaceutical firms see a return on their investment, to secure ongoing research. That goes back to why some drugs are delisted because of their cost. However, there must also be recognition of the support provided by universities in Northern Ireland and Scotland, and in England, which get Government funding to help towards researching new drugs.

Off-patent drugs can also be used in cancer treatments, usually through repurposing. It is important that we consider that, as it could also lead to a cost—[Interruption.] I am sorry, I will just wind-up my speech. Some of the barriers to treatment can, however, be broken down through negotiation between all interested parties. The aim would be a system that worked equitably for all stakeholders, from patients, doctors and the NHS to Governments and the pharmaceutical industry.

[Mr Gary Streeter (in the Chair)]

As a Front Bencher, the hon. Lady has 10 minutes if she wants them, so she should need not rush her important peroration.

[Marion Fellows]

It is fine. Thank you, Mr Streeter. I managed to get through my speech, with a rush at the end.

[Mr Gary Streeter (in the Chair)]

Thank you very much. I call Andrew Gwynne.

NHS Success Regime

Gary Streeter Excerpts

Thursday 4th June 2015 Commons Chamber

[Ben Gummer]

The hon. Lady should not be confused because the success regime is indeed dealing with local failure and we intend to turn it into a success. That is the point of what we are doing. We have made these decisions where the NHS has assessed areas as having quality and financial problems. We intend to address them rather than just talk about them, which is why I am so glad that this will be locally led, finding local solutions to local problems.

[Mr Gary Streeter (South West Devon) (Con)]

This intervention affects every one of my constituents, and if it improves their patient care of course I welcome it. The Minister has done extremely well from the Dispatch Box in one of his earliest outings, but can he tell us the timescale of this intervention and how we will measure whether or not it has been a success?

[Ben Gummer]

I thank my hon. Friend for his kind comments. He should be aware that success regimes will begin imminently, but we have no set timescale for them yet, because that will be determined by the plan drawn up in the initial stages by local commissioners. Again, that goes to the root of what we are trying to do; this is going to be a plan led by local clinicians, commissioners and providers, in order to provide a local solution.