Advisory Non-departmental Public Bodies

George Freeman Excerpts

Thursday 26th March 2015 Written Statements

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

The Department of Health has completed its triennial reviews of the British Pharmacopoeia Commission (BPC), the Commission on Human Medicines (CHM), the Administration of Radioactive Substances Advisory Committee (ARSAC), and the Independent Reconfiguration Panel (IRP), and is today publishing the associated review reports.

The four reviews, which each commenced on 30 October 2014, consulted with a wide range of stakeholders. Their key conclusions were that all these bodies perform necessary functions and should continue to operate as advisory non-department public bodies. The review reports each contain several further recommendations, intended to further improve performance, governance and efficiency.

Copies of the four reports can be found at: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2015-03-26/HCWS500/

[HCWS500]

Health

George Freeman Excerpts

Wednesday 25th March 2015 Ministerial Corrections

The following are extracts from the Westminster Hall debate on fees paid by nurses and midwives on 23 March 2015.

[George Freeman]

My point is that it is important to understand that the reforms mean that the PSA is funded by the nine regulatory bodies. How the bodies seek to cover that cost is up to them. In this case, the NMC has decided to apply it equally across all its members.

[Official Report, 23 March 2015, Vol. 594, c. 399WH.]

…I have looked at the salary figures, and the average, ending March 2014, for nurses, midwives and health visitors—the people we are talking about—is £31,000. They will get the 1% rise, which is an extra £800.

[Official Report, 23 March 2015, Vol. 594, c. 401WH.]



…The hon. Member for Blaydon raised several questions, including whether the NMC will review its guidelines on fitness to practise, and provide guidance on fitness to practise cases. Those are all matters for the NMC as an independent body, but new legislation means that nurses can pay fees in instalments, and that fees can reflect part-time work.

[Official Report, 23 March 2015, Vol. 594, c. 405WH.]

Letter of correction from Mr Freeman:

Errors have been identified in the responses I gave to the debate on fees paid by nurses and midwives in Westminster Hall on 23 March 2015.

The correct responses should have been:

[George Freeman]

My point is that it is important to understand that the reforms mean that the PSA is funded by the nine regulatory bodies. How the bodies seek to cover that cost is up to them. In this case, the NMC is proposing not to pass on the cost to its members this year.

…I have looked at the salary figures, and the average, ending March 2014, for nurses, midwives and health visitors—the people we are talking about—is £31,000. They will get the 1% rise, which is an extra £300.



…The hon. Member for Blaydon raised several questions, including whether the NMC will review its guidelines on fitness to practise, and provide guidance on fitness to practise cases. Those are all matters for the NMC as an independent body, but new legislation means that nurses can pay fees in instalments, and that will  help those in part-time work by spreading the cost of the fee.

Nurses and Midwives: Fees

George Freeman Excerpts

Monday 23rd March 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

It is a great pleasure to serve under your chairmanship, Mr Havard, for what will be the last time in this Parliament.

I thank the hon. Member for Blaydon (Mr Anderson) for the opportunity to speak in this debate and for raising issues that many nurses and midwives want to have addressed. I congratulate them on securing the debate through the e-petition mechanism. I pay tribute to all nurses and midwives, who do such great work in our health service, alongside all the others who keep the system going on our behalf 24/7. I also thank the Backbench Business Committee for selecting the debate, in the light of the petition on the Government’s e-petition website asking the Government

“to review the Nursing and Midwifery Council…with regard to the fees…and the processes through which those fees are decided.”

As Members from across the House have pointed out, many nurses and midwives are concerned about the way in which the Nursing and Midwifery Council has proposed to handle the costs of registration and of fitness-to-practise inquiries. Hon. Members have done a great service in raising the issue and allowing both me and the shadow Minister to respond.

The hon. Member for Blaydon will be aware that the NMC is an independent statutory body and is therefore responsible for determining the level of its annual registration fee. Under statute, it is responsible to Parliament rather than to Ministers. However, as the Minister responsible for professional regulation, my hon. Friend the Member for Central Suffolk and North Ipswich (Dr Poulter), in whose place I am standing today, takes a keen interest in the performance of the professional regulators, not least because he is an NHS clinical professional himself. He has regular contact with regulators, including the NMC, on this and a whole range of other issues.

It may be helpful to set the scene by providing some background about the professional regulatory bodies and how they are structured. They are independent statutory bodies whose statutory purpose is to protect, promote and maintain the health and safety of the public by setting robust standards for their health care professionals across the United Kingdom. For the NMC, the health care professionals concerned are nurses and midwives.

Professional regulatory bodies are held to account by the Professional Standards Authority for Health and Social Care, or PSA—an arm’s length body currently funded by the Government. Hon. Members will be aware that, following the 2010 review of arm’s length bodies, the Government have taken the decision to make the PSA self-funding and independent from Government, part of a broader change to the way in which health care and clinical professionals are regulated, given the growing sophistication and expertise of the various disciplines. The powers to facilitate that change were brought into effect by the Health and Social Care Act 2012. At its heart, the change reflects the long-standing principle that the system of professional regulation in health care is funded by the professionals themselves.

[Grahame M. Morris]

I cannot argue with the Minister’s quoted definition of the terms of reference of the professional regulators, and we would all agree that that is completely appropriate; there is no disagreement on party lines about that. However, does he accept that, as a result of recent events—most notably the specific recommendations of the Francis report—we are placing additional burdens and responsibilities on the regulators? Is it not beholden on the Government to recognise that and give due consideration as to where those burdens should fall?

[George Freeman]

The hon. Gentleman makes an interesting point. As the challenges for the NMC’s members and for it as a professional body change, adapt and evolve in the new landscape of greater transparency and accountability in the public interest, one issue for the NMC as a professional body is how it deals with that internally. Members across the House have raised a number of concerns about that, and I will touch on some of those later.

The intention is that in future the PSA will be funded by a fee raised on the nine professional regulators that it, in turn, serves. It is important to note that the fee is raised on the professional regulators—the regulatory bodies—not on registrants. The formula for calculating what contribution each of the nine regulatory bodies should pay was subject to consultation. It has been based on the number of registrants, simply because it was judged that that would most fairly equate the fee to the amount of service that the PSA provides to each regulator.

The NMC has nearly 50% of the total number of registrants so its contribution to the fee equates to nearly 50% of the overall costs of the PSA. However, it is important to remember that the fee per registrant is likely to be in the region of £3, which represents only 2.5% of the NMC’s overall registrant fee of £120 a year.

[Mr Anderson]

I am trying to understand what the Minister is saying. Is it that the regulators have to pay a fee but the registrants will not, and if they do, it will be £3? Where else are the organisations going to get the money from?

[George Freeman]

My point is that it is important to understand that the reforms mean that the PSA is funded by the nine regulatory bodies. How the bodies seek to cover that cost is up to them. In this case, the NMC has decided to apply it equally across all its members.[Official Report, 25 March 2015, Vol. 594, c. 3MC.] A number of hon. Members have raised a number of issues connected to that; the point about part-time nurses and midwives was an interesting one. There are issues with how the NMC chooses to allocate the cost internally. However, I repeat the key point that the fee increase is likely to be in the region of £3 per registrant. That represents 2.5% of the NMC’s overall registrant fee, which covers a whole range of other services.

It may be helpful to the House if I set out some details about the services that the NMC provides. It is the independent regulator for nurses and midwives in the UK. Its primary purpose is to protect patients and the public through effective and proportionate regulation of nurses and midwives. It is accountable to Parliament—not Ministers—through the Privy Council for the way in which it carries out its responsibilities. It sets and promotes standards of education and practice, maintains a register of those who meet those standards and takes action when the fitness to practise of a nurse or midwife is called into question. It also has a role in promoting public confidence in nurses and midwives and in regulation.

Members from all parties would agree that we welcome the growing sophistication of the role of nurses and midwives and the extra responsibilities reflected in salaries and professional standards. That is part of the evolution of the professionalisation of standards that we all welcome.

[Grahame M. Morris]

The Minister is setting out an explanation of transparency and accountability that I do not disagree with, but if we follow the line of his logic, he is saying that the NMC is responsible not to Ministers but to Parliament in the round. My assumption—perhaps he will correct me if I am labouring under a misapprehension—was that the Health Committee performed the role of holding the NMC to account. Given that the Committee takes the trouble to hold interviews and evidence sessions, and to make specific recommendations, is it not beholden on the Minister and Government to act on those recommendations, not least in relation to the Law Commission?

[George Freeman]

The Government take recommendations from the Health Committee very seriously—we have done so on a number of issues. It is interesting to quote what the Committee has said on this matter:

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

My point is that it is the NMC’s responsibility to deal with the issue. It is accountable to Parliament, and the Under-Secretary of State for Health, my hon. Friend the Member for Central Suffolk and North Ipswich, observes its recommendations closely. However, its internal organisation is a matter for itself.

[Mr Philip Hollobone in the Chair]

[Andrew Gwynne]

The Minister is correct that the NMC is accountable to Parliament, but it has asked for legislative changes, and the legislative programme is largely under the control of Ministers, so why have the Government not acted?

[George Freeman]

It is a fair question, which I will come to, but it has nothing to do with the importance of getting this right; it is merely a matter of the regrettable constraints of parliamentary time. One reason why I very much hope my colleagues and I will be returned in May, Mr Hollobone—I was about to call you Mr Havard; I welcome you to the Chair—is that we will be able to get on with that important reform.

For the benefit of the House, let me finish summarising some of the important information about the NMC. The NMC’s total income for 2013-14 was £65 million. Its fee income was £62 million, which is quite a substantial sum. It received a grant of £1.4 million from the Department of Health and investment income of £1 million. Its expenditure totals £70 million, with £24.18 million, or 34%, going on staff. Its permanent headcount has been going up year on year. The average for the year 2014-15 was 496. The NMC had 521 permanent staff on the payroll in March 2014 and 577 in March 2015. The permanent headcount for March 2016 is projected to be 606. I merely point that out to highlight that the NMC faces some important considerations in driving productivity and efficiency internally to deliver the service it is statutorily required to deliver to its members, who fund it through subscription.

Let me turn now to the relationship between the PSA and the regulations we have introduced. The proposed change will be introduced in the Professional Standards Authority for Health and Social Care (Fees) Regulations 2015—or S.I., 2015, No. 400, with which you will be intimately familiar, Mr Hollobone, as an assiduous observer of these things—which have already been laid in Parliament. The NMC’s council meets this week to decide its policy towards them, so this debate is, again, extremely timely.

The NMC has decided to increase its fees for nurses and midwives from £100 to £120. The rise was effected through the Nursing and Midwifery Council (Fees) (Amendment) Rules Order of Council 2014, which came into force on 1 February. Although the NMC is an independent statutory agency, the Government have made it clear that they expect the NMC council to have clear justification for, and to consider nurses’ and midwives’ financial constraints when making, decisions on fees. I will say a little more in a moment about that and about the importance of the Bill to modernise the NMC’s constitution.

The NMC has consulted its registrants on the proposed fee rise, but I am aware of the strong body of opinion among those who opposed it, and that has been expressed in the debate and in the number of people who have signed the petition. The NMC says that it has not taken its decision lightly and that it has considered the responses to the consultation in detail and carefully listened to the issues raised, and I have no reason to doubt that. However, I remind hon. Members that the NMC’s first duty must be to deliver its core regulatory functions and to fulfil its statutory duties to ensure public protection, and the fee rise must be justified against its core duty.

Let me touch now on the Government grant, which is important. I appreciate that, since the NMC was established in April 2002, there have been a number of increases in its annual registration fee, and I appreciate the impact that that has had on dedicated nurses and midwives working long hours in difficult roles to provide excellent care. That is why, in February 2013—more than 10 years after the increases started in 2002—the Government awarded the NMC a substantial, £20 million grant to ease the pressure.

One purpose of that grant was to allow the NMC to protect nurses and midwives—particularly lower-paid nurses and midwives—from the full impact of a proposed annual registration fee rise. The grant meant that, in 2013, the NMC was able to raise its fee from £76 to £100 and not to £120, as originally intended. With a week before Parliament dissolves, the Government have no plans to give the NMC a further grant to subsidise the 2015 registration fee increase. Given that we continue to have to make tough decisions to put the economy back on track, and that we have given the NMC £20 million, it now needs to work out internally how best to allocate the fee increase, which I should remind hon. Members is equivalent to £3 per member if it is spread equally among them.

I am pleased to say that, as part of the broader package of measures the Government are putting in place to support the lowest-paid workers in the NHS, all the major NHS trade unions accepted the Government’s pay offer on 9 March. It will be implemented from 1 April, giving more than 1 million NHS staff, including most nurses and midwives, a 1% pay rise, without risking front-line jobs or costing the taxpayer more money. That means our lowest paid staff will receive the biggest rise.

I want to update hon. Members on the changes, because they are an important wider consideration against which to view the impact of the fees. For the lowest- paid, the 1% rise will mean an increase of up to 5.6%, or an extra £800 in their pay packets. I have looked at the salary figures, and the average, ending March 2014, for nurses, midwives and health visitors—the people we are talking about—is £31,000. They will get the 1% rise, which is an extra £800.[Official Report, 25 March 2015, Vol. 594, c. 3MC.] Importantly, staff earning between £15,000 and £17,000 will get an extra £200, which is equivalent to 2.3%. Nursing staff earning up to £40,558 who are not at the top of their pay band are still eligible to receive an incremental increase.

Let me take issue with the point that the Government are not looking after the lowest-paid. The pay offer specifically makes sure that the increases the system can afford are targeted at the lowest-paid. Those earning more than £56,000 are more able to cope with the challenges of pay restraint. We are supporting the poorest in the system most, and we are making the highest-paid bear more of the burden. Finally, the bottom pay point will be abolished, seeing the lowest pay rise from £14,300 to £15,000, with about 45,000 on the lowest two pay points benefiting.

[Mr Anderson]

I am interested in the average figure the Minister cites. Obviously, if he could give us his figures now, I would be happy to look at them, but could he also put them in the Library? The average he gave seems very high, when we are talking about the lowest point on the scale being £14,500. The average is more than double that—the scale must be heavily loaded at the top, which is not my experience from working in the public sector.

[George Freeman]

I will happily make those data available to the hon. Gentleman and put them in the Library. They are from the NHS staff earnings survey’s provisional statistics by staff group in England.

It is worth noting that UK taxpayers can claim tax relief via Her Majesty’s Revenue and Customs on professional subscriptions or fees that they must pay to carry out a job. That includes the registration fee paid to the NMC. Nurses and midwives on a salary of £30,000, confronted with a fee increase of £3, can therefore claim tax relief on it. A basic rate taxpayer would be eligible for £24 tax relief on the £120 fee.

[Grahame M. Morris]

Could I press the Minister? He suggested that things are tight. We have just had the Budget statement from the Chancellor. We had a list of give-aways in Tory marginals—£2.5 million for the RAF museum in Hendon, moneys for projects in Blackpool and a new theatre in Pendle—but would that money not have been better spent helping to subsidise the registration fees of nurses working part time and of women returners, who earn considerably less than the average figure the Minister cited?

[George Freeman]

I note with relish and interest what I assume is official Opposition policy—that they do not support the Chancellor’s announcement about funding for the RAF museum. The point that I am trying to make is that he already set out in the autumn statement a serious pay commitment to the lowest-paid staff in the NHS, which I was summarising.

I am glad that the hon. Member for Easington (Grahame M. Morris) has raised the issue of the Budget. The reporting on it has made it clear that for a pre-election Budget it was, far from making give-aways, surprisingly light on them, and was very much “steady as she goes”, continuing to pare down the deficit with fair tax reform. The truth is that we have cut income tax for 27 million people, and particularly for the lowest-paid nurses and midwives. The impact of that is nearly £900 a year from changes to the personal allowance. That is not fashionable stuff that captures the top line in red-top newspapers, but nurses and midwives do not exist in isolation. They have the NHS pay deal but also the important tax allowance changes introduced by the Chancellor. The Government are taking pressure off the lowest-paid workers in the NHS and elsewhere. Viewed in the round, those changes give us a record that we can be proud of, albeit within a difficult set of funding requirements.

[Mr Anderson]

Will the Minister give way on that point?

[George Freeman]

I really need to make progress.

[Mr Anderson]

We have got an hour and a half.

[George Freeman]

I happily give way.

[Mr Anderson]

The Minister made a point about tax, and that is welcome, but does he deny the fact that overall, people, including those we are talking about, are worse off under the present Government as a result of VAT rises and other rises across the economy? People are worse off than when they came to power.

[George Freeman]

I am glad, again, that the hon. Gentleman raises that, because fortunately the Chancellor was able to confirm that the Office for Budget Responsibility has confirmed that finally people in this country are better off, after a very difficult period. I am not going to pretend that it has not been difficult. The reason was that we inherited a chronic legacy of debt, deficit and structural deficit, which was tackled by the previous Government nowhere less than in health care. That created a situation in which, despite a growing economy, we face a huge structural challenge, exacerbated by demographics.

This year there are 1 million more pensioners in the system—1 million more people needing and generating high health demand. I do not hold the Opposition responsible for that. However, the lack of reform and the structural issues at the heart of the health service, which mean that the health structural deficit is growing faster than the general economy, have left us with a challenge. We need to tackle that.

As the hon. Member for Blaydon pointed out, the NMC has stated that there has been a significant rise in its costs, because of fitness-to-practise referrals, which are up more than 100% since 2008-09. Since 2008-09 it has raised its fee by only 63%, making up the bulk of the difference in cost through a programme of efficiencies. Without those it would have had to scale back its fitness-to-practise activity, or generate additional costs earlier. The NMC has provided assurances that it is committed to continuous improvement in carrying out its regulatory functions and will continue to deliver more efficient ways of working to maximise the value of registration fees and to keep them at the lowest level possible while enabling it to fulfil its statutory duty. The NMC is a £70 million-a-year organisation with substantial opportunities to put efficiencies in place, to reduce the cost of the £3 extra cost on its members.

As to the need to update the NMC constitution, the Government have worked with it to make changes to its legislation. We have made good progress with legislative change to reform the way it operates. On 11 December 2014 an order made under section 60 of the Health Act 1999, amending the Nursing and Midwifery Order 2001, came into force. Those changes to the NMC’s governing legislation will enable it to introduce more effective fitness-to-practise processes, while not lessening the public protection it provides.

A key amendment to the NMC’s governing legislation enables it, through its rules, to delegate the decision-making functions currently exercised by its investigating committee to its officers known as case examiners. The intended effect is to speed up and therefore reduce the cost of early-stage fitness-to-practise proceedings, as it will not be necessary to convene the full investigating committee to consider every allegation of impairment of fitness to practise. That should result in financial savings to the NMC as well as greater consistency in decision making. I think we would all welcome that. The rules that bring those changes into effect come into force on 9 March.

The section 60 order has helped the NMC by providing a degree of modernisation of its legislation. However, there is still much to do and that is why we asked the Law Commission in 2011 to review the whole framework of legislation underpinning professional regulation. The report was published last year and we published the Government response in January. I am aware that the decision not to progress a professional regulation Bill to take forward the thinking in the report in the current parliamentary Session was a disappointment to the NMC, as it was to us. We want to move on, but parliamentary time, as you know, Mr Hollobone, is an eternal constraint on Government’s ability to implement. However, that decision provided an opportunity to invest time in getting that important legislative change right, for the benefit of those who will be affected by it. Of course, it will not restrict the NMC’s ability to implement its own internal modernisation and efficiency programme, or to decide how to deal with the internal allocation of its fee obligations to the PSA. It is free to do that.

[Andrew Gwynne]

The Minister will know that a number of the changes and efficiencies that the NMC would like to implement require further legislative change. With those changes, it could free up some of its £10 million reserves, to offset some fee charges. Could we give the NMC some certainty, on a cross-party basis, that, whoever forms the next Government, we will bring in those changes? That would give it the certainty that it could use the reserves to offset the fee increases.

[George Freeman]

I am delighted to confirm that the Government remain committed to introducing primary legislation to address those wider reforms to the system of professional regulation; and it sounds as though, if the hon. Gentleman and I are in our posts then, that may well have cross-party support. That would be an important measure, and our inability to pass it before the end of this Parliament is not a sign of its importance; it is merely a function of the challenge of the availability of parliamentary time.

It is worth pointing out that the performance of the NMC has been challenged and highlighted by a number of bodies, including the Select Committee, but also by some of its members—nurses and midwives. It has had a troubled past with its performance, which is why Ministers commissioned the predecessor body of the Professional Standards Authority, the Council for Healthcare Regulatory Excellence, to undertake a full strategic review in 2012. That review put forward 15 high- level recommendations for improvement in the delivery of the NMC’s regulatory functions, and set an expectation that demonstrable improvements should happen within two years.

In 2014, the NMC commissioned KPMG to undertake an independent review to assess its progress, and KPMG concluded that the NMC had made a substantial number of improvements, which cumulatively placed it in a much stronger position than in 2012. That improvement was recently recognised by the Secretary of State for Health in his oral statement to the House about the Morecambe bay investigation. However, the NMC itself recognises that there is still much more to be done, and so the processes of improvement continue. Ministers have made it clear that we expect the NMC to work towards and ensure compliance with the standards of good regulation, and to continue looking for more efficient ways to work.

Hon. Members on both sides have raised points that I want to deal with. Several mentioned how the fees of part-time nurses are dealt with by the NMC, which is an interesting point. It is not for me to tell the NMC how to deal with it. That is for the NMC to decide, as an independent body, but I should have thought that, on the basis of pure justice and equity, members who do not work full time and therefore do not earn the same as those who do, and who do not generate, even on a pari passu basis, the same level of exposure to the costs or their organisation, would not have to pay the same costs. However, that is of course a matter for the NMC.

The hon. Member for Blaydon raised several questions, including whether the NMC will review its guidelines on fitness to practise, and provide guidance on fitness to practise cases. Those are all matters for the NMC as an independent body, but new legislation means that nurses can pay fees in instalments, and that fees can reflect part-time work.[Official Report, 25 March 2015, Vol. 594, c. 4MC.] The hon. Gentleman made an important point in his speech about part-time nurses.

The hon. Gentleman also spoke about revalidation. The truth is that the majority of the cost of nurse revalidation will fall on the employers that will be responsible for supporting their staff through revalidation. The revalidation drive is an important means of raising professional standards, and it will ensure that the public have faith and confidence that we are raising standards for nurses and midwives.

[Grahame M. Morris]

The NMC sometimes takes two years to complete some fitness-to-practise cases. The Select Committee recommended that it should aim to complete them all within nine months, which is not an unreasonable request. That is an incredible amount of time and resource to spend on those cases.

[George Freeman]

The hon. Gentleman makes a really good point; I was trying to make a similar point myself. We have encouraged the NMC and made it easier to speed up its processes. Anecdotally, I know from speaking to nurses and midwives that there is a lot of frustration about the slow pace of basic procedures, such as getting registration and coming back to the profession.

My hon. Friend the Member for Congleton (Fiona Bruce) cogently and clearly told the story of one of her constituents, a nurse, and spoke about the bureaucratic and clumsy registration processes. There is a common message for the NMC: it has a £70 million budget, so it ought to be able to run a less inefficient, quicker organisation and direct resources away from bureaucracy and towards dealing with fitness to practise, in which there is likely to be a growing public interest. It is good that the public want to drive up standards and be clear about patient safety across the professions.

On the issue of revalidation, we believe that nurses and midwives have some of the most important jobs in the NHS. They care for patients every day, so it is crucial to ensure that they are up to speed with the standards that the public and patients expect. We support the NMC in its drive to introduce revalidation, which will improve safety and the quality of care. It will reassure patients that nurses remain fit to carry out their vital work.

The challenges of the serious debt and structural deficit inheritance that we as a society are confronting mean that everyone in our public services has to deliver more for less within the current financial constraints and to ensure that standards continue to improve. Across our public services—indeed, across our general economy—there are extraordinary levels of productivity gain day in, day out. The general economy runs at 2% to 3% productivity growth every year with its eyes shut. The challenge is to create in the public sector the right climate and leadership conditions so that our great public servants can deliver similar productivity.

That said, we recognise the importance of the level of the NMC registration fee to all its registrants, which is why the Government have assisted the NMC to introduce rules that will allow registrants to pay their registration fee in instalments. Those rules came into effect on 9 March, and they enable the front-line nurses and midwives who have to pay the £3 extra fee to schedule payment of the total £120 annual fee across the whole year.

To maintain the NMC’s independence from the Government, its registration fee must cover the full costs of its regulatory activity. I am sure that nobody in any corner of the House believes that we should downscale or curtail the quality of that regulatory work merely on the basis of members’ unwillingness to pay. The principle is that health care professionals should fund the regulation of their profession to maintain the confidence of the public and patients. However, it is for the NMC to decide how to meet its statutory functions and protect patients and the public, which is our paramount consideration. The NMC recognises that it needs to do more to maintain the confidence of registrants, patients and the public in its performance, and to continue to improve its operation, effectiveness and efficiency.

I am grateful for the chance to correct the record and clarify that the Government are prioritising the lowest-paid workers in the NHS; we applaud and support their commitment. I want to take this opportunity to reaffirm the Government’s gratitude, thanks and support for their work. Despite the difficult funding constraints, in this Parliament we have consistently supported the lowest-paid workers in the NHS, rather than the best-paid, and we have reflected that in the latest pay settlement.

At the heart of this measure are some important points that need to be reiterated. There is a long-standing convention that health care professionals pay their own professional registration fees. The reform will increase the registration fee paid by nurses and midwives, whose average salary is £31,000, by £3, against their annual registration fee of £120. The Government have given the NMC a £20 million grant to help to offset those costs. The NMC has made it clear that it is able to pay for a substantial element of the increases through its ongoing efficiency programmes. The principal driver of cost is the growing public interest in fitness to practise and the cost of handling such cases. We are helping the NMC, not least by helping it to deal with those cases much more quickly, as the hon. Member for Easington highlighted.

We should not hold back the public’s interest in fitness to practise. It is part of a new culture of transparency and accountability across the system, post the Francis report, and the Secretary of State and many others want to encourage it in the modern NHS. The NMC is an independent statutory body that is accountable to Parliament, not Ministers.

I welcome the chance to inform the debate, particularly for NMC workers and for the many nurses and midwives who have taken the time to sign the Government’s e-petition form and, through the Backbench Business Committee and Members in the Chamber, to bring this issue to the Floor of the House. We as Ministers are very aware of the needs of the lowest-paid NHS workers, who do an extraordinary job for us. That is why, in the latest pay deal, we reflected that, with a 5.6% increase for the lowest earners and a 1% pay rise, which equates to £300 in the pockets of the nurses and midwives we are talking about.

The measures in the Budget and the Chancellor’s wider tax reforms, such as raising the tax threshold for the lowest-paid workers, will take more than 4 million of the lowest-paid workers out of tax altogether. The lowest-paid nurses and midwives are now £900 a year better off as a result of the increase of the personal allowance to £11,000. That is a substantial sum, compared with the £3 fee increment. The hon. Members for Denton and Reddish (Andrew Gwynne) and for Blaydon are eloquent and persuasive men, but even they cannot suggest that a £3 fee on health care professionals earning £31,000 represents a crisis in the NHS. They rightly said that it is important that the NMC quickly develops its efficiency and upgrades its internal mechanisms, and they made a number of interesting points about how that can be done to maximise fairness for the lowest-paid workers. I want to take the opportunity to repeat that the Government are absolutely on the side of those workers.

[Mr Philip Hollobone (in the Chair)]

It was a real treat for me to have been in the Chair to hear the Minister’s response, but a great misfortune not to have been in the Chair to have heard the introductory remarks of the hon. Member for Blaydon (Mr Anderson). As recompense, he now has two or three minutes to pithily sum up the debate, largely for my benefit.

Oral Hormone Pregnancy Tests

George Freeman Excerpts

Thursday 19th March 2015 Ministerial Corrections

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

I am delighted to report that I have met colleagues from across the House and patient representatives of that campaign on a number of occasions. We have appointed the chair and made sure that the terms of reference for the inquiry are clear and comprehensive. It is not, I stress, a judicial inquiry; it is a medical inquiry looking at the evidence.

[Official Report, 24 February 2015, Vol. 593, c. 194.]

Letter of correction from George Freeman:

An error has been identified in the response I gave to the hon. Member for Livingston (Graeme Morrice) during Topical Questions to the Secretary of State for Health.

The correct response should have been:

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

I am delighted to report that I have met the all-party parliamentary group on oral hormone pregnancy tests about the inquiry. We have appointed the chair and made sure that the terms of reference for the inquiry are clear and comprehensive. It is not, I stress, a judicial inquiry; it is a medical inquiry looking at the evidence.

Women Entrepreneurs

George Freeman Excerpts

Wednesday 18th March 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

It is a pleasure to serve under your chairmanship, Mr Robertson in the closing phase of this Parliament. I congratulate the hon. Member for Feltham and Heston (Seema Malhotra) on introducing this debate on Budget day—an important day, when attention will be rightly focused on the Government’s initiatives to support business and entrepreneurship. As a Business Minister, it is a pleasure to be here and to be able to respond to the debate. I pay tribute to the Members who have spoken today. We heard powerfully from the hon. Member for Strangford (Jim Shannon) on some of the good practice in Northern Ireland. I was there recently celebrating and supporting the Northern Ireland life sciences cluster. He made a powerful point about the importance of rebalancing the Northern Ireland economy from public to private sector and the role of women entrepreneurs in that. He also made an important point on mentoring—I would be interested to look at the scheme he mentioned—and also touched on child care.

The hon. Member for Feltham and Heston made a number of points and I will try to deal with them in my speech, as well as to answer some of her specific questions. I pay tribute to the large number of women who have contributed to the driving of the agenda outside this House. A number of pioneering entrepreneurs and women in policy have been mentioned today. It is another area where more needs to be done. I am proud of what this and the previous Government have done, but the Government agree that we need to keep our foot to the pedal and keep at it.

I particularly thank and congratulate those behind the Aspire fund, the taskforce and the Women’s Business Council for their work. The subject is close to my heart, partly because I have a 14-year-old daughter whose career I take a close interest in, and partly because I come from a 15-year career in the entrepreneurial sector in Cambridge and elsewhere around the country starting high-growth technology companies, particularly in the life sciences. In that sector, I am glad to say, there is a proud record of women achieving very highly both in our larger companies—I recently met a delegation from GlaxoSmithKline, and Members will be delighted to know that all five representatives were women—and in the smaller companies. There are huge opportunities for women in life sciences, both at the bench and in driving small businesses.

Women and entrepreneurship is also an area of interest from a policy point of view. Through the 2020 Conservatives group, I have set out a number of measures on how, in driving the rebalanced economy and the long-term economic plan, we have to liberate the entrepreneurial talents of all our citizens, and in particular reach into those areas where we have not properly unleashed them before. It is clear from what Members of all parties have said this morning that there is a lot of latent entrepreneurial talent in our female community. In our inner cities and our black and minority ethnic communities, there are incredible rates of entrepreneurial activity that we have not recognised, properly reached into and supported. Family finance supports a lot of our small businesses in some very business-hostile environments in some of our inner cities.

In the public services—before the shadow Minister leaps to her feet, I do not mean privatisation—we should unleash the spirit of entrepreneurship and the talents of people in the public services to deliver more for less. The economy nationally needs a strong focus on unleashing that spirit of enterprise. That does not always mean for-profit or very acquisitive, venture capital-backed businesses; it means a culture of delivering more for less and innovating. We need that to modernise our public services and to continue to drive the recovery that we are leading. The subject is close to my heart, and on Budget day it is close to the Government’s mission more widely.

The truth is that small businesses are the lifeblood of our economy. Every village, town and city in Britain contains shops, garages, cafes, manufacturing firms, hairdressers and so on. We take those small businesses for granted, but they are backed by enterprising and hard-working people who are taking risks to run those businesses. Responsible society depends on the ties that bind us, and as well as the economic benefits it brings, an entrepreneurial, small business economy does something else: it builds the ties and social capital that link communities.

[Jim Shannon]

The Minister is making a powerful response, saying what he feels he can do. One of the growth industries in my constituency and across the whole of Northern Ireland, particularly among ladies, has been the craft industry, where there are special talents and the ability to create products for sale. The Minister mentioned shops, small businesses and restaurants and so on, but the craft industry could release enormous talent and job opportunities across the whole United Kingdom. What are his thoughts on that?

[George Freeman]

The hon. Gentleman makes an important point. I was about to talk about the importance of small business in driving innovation if we want an innovation economy. Small businesses tend to be quicker to adopt innovation and to drive it. They are a force for insurgency in the economy. In tourism and crafts, we should not forget that small businesses are important in our theatre, media, digital and tourism sectors. A culture of empowering people and unleashing the talents of women in every walk of life is incredibly important if we are to build a diverse and strong economy and a strong and linked society.

That is why I am absolutely delighted that the UK is a truly great place to start a business. This year we have seen data confirming that 760,000 small businesses have been created in this Parliament since 2010. We are backing business every step of the way, making it easier to start, succeed and grow. We will hear about more such measures in the Budget later today, I have no doubt. I am delighted, too—but not complacent for a minute—that in 2013 there were more women-led businesses in the UK than ever before: 990,000 of our SMEs were run by women or a team that was more than 50% female, an increase of 140,000 since 2010. We know that more needs to be done, and we need to build on that positive momentum. I am also delighted that in the UK, women-led small businesses are contributing £82 billion to the gross value added of the UK economy.

Before the debate, I looked at the latest data, which are even more encouraging. The data from the Office for National Statistics for October to December 2014 show that there were 1.45 million self-employed women in the UK, which is 42,000 more than in the previous quarter and 281,000 more than in May to July 2010. Some 672,000 of those self-employed women were working full time and 778,000 were part time.

I pay tribute to the work of the Women’s Business Council and the important policy work that it has done and intends to follow up. It has rightly, as a number of Members have highlighted, pointed out that if we had women starting businesses at the same rate as men, we would have up to 1 million more entrepreneurs. That is a good reminder of the latent potential that we need to continue to drive at.

One or two Members asked about the Government’s commitment and which Minister is responsible for this. I am delighted to say that a number of Ministers are responsible. The Minister for Business and Enterprise leads on enterprise policy for the Government. The Secretary of State for Education is also the Minister for Women and Equalities. The Under-Secretary of State for Women and Equalities at the Department for Education is also an Under-Secretary of State for Business, Innovation and Skills. They are all working to develop joined-up policies with the Government Equalities Office. We take it seriously as part of our commitment to social justice and to the long-term economic plan.

Research by the Enterprise Research Centre has shown the challenges that confront women entrepreneurs, but in many ways they are similar to those facing men.

[Seema Malhotra]

The Minister has acknowledged the important work that the Government Equalities Office has been doing and the different Departments involved, but he has not been so clear on who is actually in charge of the policy area. Having many people involved is good, but who is in charge? Also, he has not mentioned what plans the Government might have for the Women’s Business Council and whether they think its role needs to be strengthened. Should it be looking at more diverse aspects of business? Should it be put on a statutory footing?

[George Freeman]

With eight days of this Parliament left, perhaps I could undertake to write formally to the hon. Lady to confirm the various initiatives that we have running. I assure her that if this Government are returned on 9 May, we will continue to keep our foot to the pedal and drive on this agenda. She would not expect me to commit now to what that might look like, given the uncertainties that we all face.

A number of colleagues mentioned access to finance, which is rightly regarded as a major obstacle preventing women from starting and growing a successful enterprise. It is worth pointing out that access to finance is an issue for all businesses, but although it is in many ways gender neutral, the truth is that women perceive higher financial barriers and the evidence shows that they are more likely to be discouraged, particularly by some forms of borrowing. Sources of finance for male and female-led businesses are similar, but studies show that women-owned businesses start with lower levels of overall capitalisation, use lower ratios of debt finance and are much less likely to use private equity or venture capital.

Encouraging women to start their own business is a key part of our long-term economic plan, which his why we have put in place a range of Government initiatives to support women. Through the GREAT website, we have brought together in one place all the relevant Government advice, guidance and support, but there is more to do. I am delighted that, this week, we in the Office for Life Sciences have redone our business support portal to make navigation easier for those outside the system. The Department for Business, Innovation and Skills has also launched a range of new measures, including a new web page specifically aimed at potential and existing female entrepreneurs.

The Government’s “Business is GREAT Britain” campaign has been highly effective at making small businesses aware of the range of support on offer to help them to grow. Specifically for women, we have committed additional funding to understand in communications terms the particular challenges that female entrepreneurs face, and we are making sure that existing activity is widely promoted among women. We have managed to match up experienced business women with those new to enterprise and invested £1.9 million in the “Get Mentoring” project—a number of colleagues mentioned mentoring. That project has recruited and trained more than 15,000 volunteer business mentors from the small business community, 42% of whom are women, I am delighted to say; that is more than 6,000 mentors trained specifically to support female entrepreneurs. Owing to the success of that project, the Government recently announced an extra £150,000 to host 12 “Meet a Mentor” roadshows throughout the UK for female entrepreneurs.

[Seema Malhotra]

The Minister mentioned the GREAT Business website, which I referred to, and said that it has been successful in raising awareness among small businesses. Has there been any formal evaluation of how successful it has been?

[George Freeman]

The process of evaluating the BIS portals has been taking place only in the past few months. Perhaps I could come back to the hon. Lady with the latest details of that assessment.

[Stella Creasy]

Will the Minister give way?

[George Freeman]

If I can just finish this section of my speech, I will happily give way.

We have invested in the women’s start-up project to provide opportunities for young women studying in the creative industries and the leisure and tourism sectors to start their own businesses. This pilot project, in partnership with Young Enterprise, will see the Government provide funding of up to £50,000 for teams of young women aged 19 to 24 studying at undergraduate level to set up and run their own businesses. We have also provided £2 million for small grants of up to £500 for those wishing to set up new child care businesses—help with child care is of course a major part of support, and I will say more about that in a moment. In the autumn statement, the Chancellor announced that that scheme would be extended until March 2016, with a further £2 million made available for next year.

As a number of colleagues have mentioned, we have provided a £1 million women and broadband challenge fund to help women to move their business online and take advantage of superfast broadband. Sixteen local authorities have been awarded a grant to support actions to encourage women’s enterprise in areas where superfast broadband is being deployed. I want to touch on the particular challenge faced by women entrepreneurs in rural areas such as my own.

[Stella Creasy]

Will the Minister give way?

[George Freeman]

I will just finish my point, then I will give way.

The Government are actively addressing a number of additional barriers for women in rural areas. We have provided £1.6 million to support women’s start-ups in rural areas, including improved access to transport links, virtual assistants for those in the most remote areas, online help, and local business support through mentoring, skills training and networking.

[Stella Creasy]

Before the Minister moves on from discussing Government support to women’s business, I want to press him on the Aspire fund—I hope that he has just received a note on it from his officials. He mentioned a number of different pots of money that are being given out to support women in business in various ways—for example, the broadband challenge. The Aspire fund was set up with £12 million to support high-growth women-owned ventures, but six years on, only £4.7 million has been invested. Will he say more about why that is the case and what the Government are doing to reduce the gap? If that money is there to support women’s business, surely we should ensure that it gets to women in business.

[George Freeman]

With her typical prescience, the hon. Lady anticipates the next paragraph of my speech. We recognise that the sector needs particular support, which is why we are so keen on the Aspire fund, which makes equity investments of between £100,000 and £1 million on a co-investment basis and is designed to help female-led businesses that aim to grow. The fund invested £1.3 million and supported £5.5 million of investment in 2013-14, and it has a total of £12.5 million to invest.

It is worth remembering that the fund was not intended to fund a large number of businesses; it is there as a beacon project to support women-only businesses and catalyse the sector. I am delighted that we have also made additional investment available to businesses led by women, as well as those led by men, through the £100 million business angel co-investment fund. We must not forget that although we are catalysing and driving women-only entrepreneurs, the whole range of business support mechanisms we have put in place—including the seed investment enterprise scheme and the expanded enterprise investment scheme—are all available to women entrepreneurs.

[Stella Creasy]

Will the Minister give way on that point?

[George Freeman]

I just want to finish this point about funding.

Without the right funding, it would be hard for anyone to realise the potential of their ideas. The Aspire fund is one of a much larger range of measures. Women are also benefiting from the full range of start-up loans and the new enterprise allowance. More than 25,000 loans worth more than £160 million have now been made, with 37% going to women. The 25,000th loan was given to a female entrepreneur.

To help more parents to start their own business, from autumn 2015 tax-free child care will be available to nearly 2 million households to help with the cost of child care. That will enable more parents to go to work and, unlike the current scheme—employer-supported child care—it will be available to self-employed parents.

[Stella Creasy]

There is a £7 million gap between the £12 million that has been made available for women’s businesses and the money that has actually been drawn down. I take the Minister’s point, and I am not suggesting that that is the only funding available for women entrepreneurs, but compared with other Government-led schemes, there is a substantial disparity. Why does he think that is? Why has the Aspire fund not been able to lend at the same rate as the other available start-up funds? Will he commit the Government to monitoring across the piece the gender of those to whom they are lending through start-up schemes? The Government have not always monitored that, but they must do so to truly understand what we might have to change about finance for women to ensure that they all get the support that they need.

[George Freeman]

It is important to realise that we do not want the investment funds that take equity stakes simply to shovel the money out of the door irrespective of the quality of the bids. The decisions have to be based on proper investment criteria, and it is not for me or the hon. Lady to second-guess such judgments. I am pleased to see that after an initial period during which the rate of investment was slower, it has picked up. We are actively monitoring and supporting the fund, and our ambition is for it to be spent and invested, but it is important that we send a signal that the money is going into high-quality business propositions.

As we have all acknowledged this morning, there is a challenge in trying to observe the wider cultural point made by my hon. Friend the Member for Cambridge (Dr Huppert). He said that we must promote world-class, aspirational, high start-up businesses that are capable of receiving that sort of venture capital. It is not for us to signal that the money should be pumped out of the door irrespective of the quality of the bids. It is for the fund manager to ensure that they are picking the right investments.

I have tried to be generous in giving way, but time is running out, so I want to complete my remarks. For all the reasons I have outlined, and because we agreed that we must do more, in April 2014, my right hon. Friend the Secretary of State appointed my hon. Friend the Member for Solihull (Lorely Burt) to the role of women in enterprise champion, to promote the support available to women starting a business. In February, she presented her report on how the Government could boost support for female entrepreneurs, and we agree with much of the thinking and analysis it contains. I cannot be expected to commit the Government to agree with every single one of the recommendations, but we are actively looking at them and working on an implementation plan.

I want to pick up on some of the comments. My hon. Friend the Member for Cambridge focused in particular on science and start-up companies. I join him in paying tribute to the people in the high-tech and life sciences sector, which we both know well from Cambridge, and to entrepreneurs such as Julie Deane of the Cambridge Satchel Company. He made a number of interesting points about cultural attitudes and the need to ensure that, in what can sometimes be the quite macho world of finance, the quality of women entrepreneurs and of women in science is properly recognised.

My hon. Friend also talked about the importance of getting schools better connected to businesses. We can all do something about that in our own constituencies. Tomorrow night, the Norfolk Way is launching our first innovation awards for Norfolk, linking up science teachers and students in schools with local businesses in the area. He made an important point about 8% of venture capital funding but 41% of crowdfunding going to women-led businesses. That sends a signal about the power of some of the new financing mechanisms to support women’s businesses. Although the Enterprise Research Centre has shown that there are no specific obstacles to access to finance for women, strong perceptions have a powerful effect, and that is something we need to monitor.

My hon. Friend made a particular point about STEM. Since 2009-10 the number of women starting engineering in manufacturing apprenticeships has increased threefold, which is a real success for the coalition’s apprenticeships policy in that we are getting more and more women in the STEM subjects. More action is necessary, but with the apprenticeship ambassadors STEMNET programme we are making progress. The Your Life “Call to Action”, part of the campaign launched by the Chancellor and the Secretary of State for Environment, Food and Rural Affairs, has brought together employers, educators and the professions to make concrete pledges to increase the number of women in engineering and technology. I am delighted that more than 200,000 organisations have now pledged to create in excess of 2,000 entry-level positions, including apprenticeships, graduate jobs and paid work experience posts, as well as action to support their female work force.

[Dr Huppert]

The hon. Member for Feltham and Heston (Seema Malhotra) talked about mentors and I could not remember a name. I hope that the Minister will join me in congratulating Roma Agrawal, who worked on the Shard and has a website, romatheengineer.com, which promotes females going into engineering.

[George Freeman]

I absolutely join my hon. Friend in paying tribute to another beacon project that is sending out such a powerful signal to girls and women about opportunities available to them. I am delighted, too, that we allocated a further £20 million in the engineering skills fund to help employers to tackle skills shortages in engineering, including to develop women engineers.

Finally, my hon. Friend made a point about enterprise education. I am delighted to confirm that we are working actively with schools, colleges and higher education institutions to encourage and promote entrepreneurial attitudes and skills training, as well as providing mentors and role models and improving access to finance support.

I want to deal with the questions about child care and women on boards. A number of colleagues asked about child care support. The Government have increased the number of funded hours of free child care from 12.5 to 15 hours a week for all three and four-year-olds, saving families an additional £425 a year per child. Since September 2014, we have funded an additional 15 hours a week of free child care for the 40% most disadvantaged two-year-olds, saving families £2,500 a year per child. We have also increased child tax credit well above inflation to £2,780 a year, which is £480 more a year than at the beginning of the Parliament. All families under universal credit will be able to receive 80% support for child care costs, which is up from 70% under the existing working tax credit system. The introduction of tax-free child care could also save a working family up to £2,000 a year per child. In addition, we have committed an extra £50 million to introduce a new early years pupil premium in 2015-16 to support the most disadvantaged three and four-year-olds to access Government-funded early education. That is important if we are to support our entrepreneurs and innovators in all walks of society and to ensure that entrepreneurship is not the preserve of the well-off.

Women on boards is an important subject. A lot of our entrepreneurial companies do well and go on to become substantial, significant companies quoted on the stock market. We are ensuring that, at that point, women continue in leadership roles. Following Lord Davies’s recommendations in the 2011 “Women on boards” report, the Government are committed to achieving the target he set for the end of 2015 of 25% of FTSE 100 boards being women. We also want to increase the number of women on FTSE 250 boards. The graph that I have in my hands shows a line slowly climbing from 2004 to 2011, but then turning sharply upwards, going from 12.5% of women on the boards of FTSE 100 companies to 20.7% at the end of 2014. We are making a real impact and we must continue to do so. I am delighted that now 22.8% of FTSE 100 board members are women and that women now account for 28% of FTSE 100 non-executive directorships and 8.5% of FTSE 100 executive directorships. There is much more to do, but we are making real progress.

[Stella Creasy]

Does the Minister share the view of his colleague, the Minister for Business and Enterprise, that it is unacceptable that boards are only appointing women to non-executive positions and that what we need therefore is a target not only for women on boards, but for women in decision-making positions? Also, will the Minister answer the questions about the Women’s Business Council and about the supply chain? It would be incredibly helpful to hear his response on those issues as well.

[George Freeman]

I do share the ambition and desire of my fellow BIS Minister, my right hon. Friend the Member for West Suffolk (Matthew Hancock), to see a continuing increase in the rate of women being appointed to the boards of our top companies. The hon. Lady is right to highlight that we do not want women only to be in non-executive roles; they must be in executive roles as well. That is why I was saying that we are very much focused on that. We are pleased with the progress, but we need to go further—not, I hasten to add, because of a politically correct desire to hit some quota, but because women are talented and represent more than half of our work force. By not giving women fair representation in the leadership positions of our great companies, we deny those companies their talents. We are being hard-headed and not only concerned with social justice. It is in the interests of the country in every way. I am glad that we agree on that.

In closing, I want to return to the point with which I started. Many of the arguments used in the Chamber today relate to the economic contribution of women in entrepreneurship and start-up businesses and to the need to unleash the talents of women, because that is so important to our economy, but I want to highlight the importance of a small business and entrepreneurial economy to the wider stock of social capital and the ties that bind us. I am absolutely certain that if we are to rebalance our economy in the broadest sense, we need to create one in which small business not only contributes to economic success, but helps to bring communities together. Give me a deal between two small companies any day of the week and I will show people a deal that includes not only an economic deliverable, but a contribution to social capital and to building trust between communities. In many of our small towns, neighbourhoods, villages and inner-city communities, small businesses working together produce and deliver so much more than just economic growth. It is vital that we build women into that network as well.

For those reasons, I am delighted that, while there is not a shred of complacency in the Government, we are making real progress. We now have 1.45 million women enjoying the freedoms and flexibilities of self-employment, which is 42,000 more than in the previous quarter and 281,000 more than in 2010. We also have 900,000 SMEs run by women, more than at any time in our history. I am not complacent, but the Government are making progress.

[Stella Creasy]

Before the Minister closes, I wanted his response to two specific questions about the future of the Women’s Business Council and the supply chain. His own Government adviser on women-led businesses has suggested that the Government should monitor women in the procurement supply chain. Will he commit the Government to that, yes or no?

[George Freeman]

I have taken a lot of interventions and questions, but I will happily get back to the hon. Lady in detail. She made an interesting point about procurement. Through the work of the Cabinet Office, we are driving hard to ensure that we use every procurement power to support innovation throughout the economy. That is an important part of it and I will happily come back to her on it later.

The 900,000 SMEs run by women in our economy, the highest number in history, suggests that we are making real progress. I am not complacent for a moment, but we are on the right track.

Children’s Palliative Care

George Freeman Excerpts

Tuesday 3rd March 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

It is a pleasure to serve under your chairmanship, Mrs Main. I congratulate the hon. Member for Birmingham, Selly Oak (Steve McCabe) on securing this debate and for his gracious recognition of the Government’s commitment to, and good faith in, trying to get this right. I begin by paying tribute to the efforts of the thousands of people who work so selflessly for children’s hospices across the country. Without their efforts supporting the most gravely ill children and young people, we would not have our world-class hospices and palliative care services. I thank my hon. Friends the Members for Worcester (Mr Walker) and for Pudsey (Stuart Andrew) for their comments in support.

We are fully aware that the reliance of children’s hospices on volunteers and charitable fundraising reflects their comparatively recent historical development. They do not receive as significant a proportion of their funding from local health and social care commissioners as their adult counterparts. That is a long-standing anomaly that many in the sector perceive as threatening the sustainability of children’s hospices. Since taking office, the Government have taken that extremely seriously. As has been mentioned, we made a commitment in the coalition agreement specifically to place hospice funding on a more equitable and sustainable footing through the development of a new per-patient funding system for all hospices and providers of palliative care for adults and children. That would provide a transparent basis for local commissioning of palliative care services.

I am proud to say that that process has been accompanied by unprecedented direct investment in children’s hospices. We pledged in the coalition agreement to continue the annual allocation of £10 million to children’s hospices, and I am delighted to say that that was increased by 7% in 2012 to take account of new providers. Now allocated by NHS England, the grant has been increased again to £11 million. In addition, there were ad hoc grants of £19 million in 2010-11, and more than £7 million in capital grants in 2013 directly to children’s palliative care. We should not lose sight, however, of the fact that the annual allocation is a central grant in lieu of consistent, locally based commissioning, and it is to that which we need to move, not least because local commissioners have a better understanding of local need and how palliative care services can be integrated with other care.

The 2011 independent palliative care funding review highlighted the absence of good data on the costs of palliative care and proposed the collection of data on an unprecedented scale through a series of pilots, one of which looked specifically at children’s palliative care. Since the pilots concluded in April 2014, the considerable data generated, which cover all aspects of contact between someone being supported with care and the professionals delivering that support, have been analysed with the aim of identifying a currency that captures patients’ clinical and resource needs.

Hon. Members will understand that a useful currency has to group health care into units or packages that are broadly similar in terms of what is provided and the resources required, and that provide a common language for discussing the commissioning and delivery of palliative care. Ultimately, the aim is to give local commissioners the basis for discussions with providers about what is needed and how it is to be resourced, and clear, reliable data on the complex care that is provided to severely ill children. Good progress has been made in developing the currency, although none of the many providers and professionals that have been involved have been under any illusions about the complexity of the task or the importance of getting it right.

A document setting out currency units has been published and engagement has taken place with clinicians, providers and commissioners to test it out. The currency units are being developed into a currency framework that can be used locally by health economies for further testing. NHS England intends to make that available for 2015-16, along with supporting guidance. Hon. Members will note that we have not rushed into imposing a new funding system on the palliative care sector. We have worked extremely closely with many different providers in taking the work forward.

I know that unease is felt in some quarters about the prospect of a sudden transition to a new funding model. However, as we have previously placed on record—I am happy to do so again today—our aim is for the commissioning of children’s and adult hospices to be fit for purpose. That can be guaranteed only by testing the implications of a new funding approach with palliative care services themselves and by exploring locally how that would support more effective local commissioning, including how it must dovetail with other local services. There must be a planned and gradual transition to a new system, with clinical commissioning groups supported and able to take a strategic view of how palliative care for children fits into other services for children with complex needs, such as special educational provision and social care.

I entirely agree with the concerns that have been expressed about the commissioning of different services for children with life-limiting conditions and their families being integrated as much as possible, although we believe that there must be flexibility as to how different commissioners work together to co-ordinate provision. Supporting that joint working, and exploring how to effect the correlation of specialised and local commissioning of palliative care with social care, will be an important part of the guidance and other support made available during transition. It would be up to NHS England to consider what direct financial support might be necessary for hospices and other providers. That decision cannot be made before the thorough testing of the currency has enabled us to understand the implications. Clearly, appropriate guidance and case studies of good practice will be an important part of that, as the hon. Gentleman said.

On future allocations, just as we do not wish to see an abrupt transition to a new funding system, we do not intend to end abruptly the existing financial support provided to children’s hospices. We are committed to ensuring that children’s hospices are properly supported in a fair and sustainable way, which means ensuring that, when the time is right, there is a planned transition from a central grant to local funding. NHS England has responsibility for determining the future of the allocation to children’s hospices, and I know that that allocation has been prioritised as a commitment for 2015-16. Although it has not happened yet, when the route towards the implementation of the new currency is clearly mapped, I expect consideration to be given to the effect of transition on providers and how that might be reflected in any allocations made centrally during that period. A decision on programme budgets more generally is expected before the end of March.

The hon. Gentleman asked about transition. Of course, ensuring the sustainability of funding is not the only issue facing the children’s palliative care sector, as we have heard. My hon. Friend the Member for Worcester mentioned that as increasing numbers of young people with life-limiting conditions are benefiting from advances in medical science, allowing their condition to be stabilised, there is a growing demand for the more effective management of the transition to adulthood. Palliative care is not only about end-of-life care; it can provide vital support for living one’s life, but the setting must be age-appropriate and geared towards supporting the move to independent living, further education and employment. Typically, adult hospices do not provide the right environment for that, and children’s hospices are often not resourced to provide a separate and markedly different type of care for young adults, although I know that some people are developing facilities that cater for independent young people.

We know from the Care Quality Commission’s report that there is a pressing need for action across the NHS as a whole to improve how we meet the challenges of transition. Our system-wide pledge, “Better Health Outcomes For Children And Young People”, which the major health organisations signed in 2013, includes the ambition to secure care that is co-ordinated around the individual young person with complex needs in order to deliver a positive transition to adult services. There is undoubtedly more to be done, and it must be taken forward as part of a co-ordinated approach to meeting the needs of young people with complex needs.

There is increasing emphasis on the integrated commissioning and delivery of public services by the NHS and local government. We have recently introduced a new statutory framework for the integrated support of young people up to age 25 with special educational needs or a disability, which brings together the local authority and CCG to drive the co-ordinated assessment of need and planning for the individual child. Arguably, the role of palliative care for young adults should be fully integrated into such a framework of holistic support. It goes without saying that that would go beyond a narrowly medical model of care.

We would all agree that developing a new currency and a new funding framework for children’s palliative care is only part of developing more integrated services for children and young people. I would highlight that from 2011 to 2015-16 we have separately invested £54 million in the children and young people’s improving access to psychological therapies programme, which intervenes to help children and young people who have been affected by family bereavement.

The hon. Member for Birmingham, Selly Oak mentioned short-break services, which remain a key priority for the Government. We are very much aware of the invaluable support that they provide to disabled children and their families, including those who need palliative care. That is why, between 2011-12 and 2014-15, £800 million has been made available to local authorities through grants for short breaks. We have also introduced a short-breaks duty that requires all local authorities to provide a range of short-break services for disabled children and young people, and to publish a short-breaks statement explaining what is available locally and how it can be accessed. I would be happy to consider how we might ensure that local authorities are fully aware of the role of children’s hospices in acting as potential providers of short breaks.

In the final few minutes of the debate, I want to try to deal with all the questions raised by the hon. Member for Birmingham, Selly Oak. If I fail, perhaps I can undertake to write to him to address them properly. He asked what is going to happen to the hospice grant and whether it will continue. NHS England has made it a priority for next year. It has not yet formally agreed its programme budgets, but, going by the undertakings I have received, I believe we can be confident that it will continue as it is.

The hon. Gentleman asked about support for voluntary providers. It is clear that that will emerge from the testing of the currency—there is no dispute about it being included. He asked about plans to provide models of practice: yes, guidance on implementation will cover that. He asked about how data quality will be maintained: the testing of currency will include built-in quality assurance.

The hon. Gentleman also asked about whether we would commit to maintaining the NHS England children’s hospices grant until a new system is in place. I can guarantee that we will ensure that children’s hospices continue to be supported in their work. There is no question of the grant stopping before alternative arrangements are in place. NHS England has made it a priority, but has not yet agreed its programme budgets.

Finally, the hon. Gentleman asked about the new funding system for palliative care. We have published the currency document and commenced testing locally. We do not want to rush into a system that is not fit for purpose; we want to work with local providers and commissioners in order to empower them to have effective commissioning discussions.

I hope that I have provided some reassurance to the hon. Gentleman that the Government are firmly committed to seeing the children’s hospice sector supported. Given the strength of cross-party feeling on the importance of these issues, as highlighted today by the contributions of my hon. Friends the Members for Pudsey and for Worcester, I would expect any future Government to continue that and, in particular, to continue the work that we have commenced in providing a stronger local basis for the commissioning of children’s palliative care. I will happily write to the hon. Member for Birmingham, Selly Oak to respond to any points that I have not been able to address properly in this short debate.

Oral Answers to Questions

George Freeman Excerpts

Tuesday 24th February 2015 Commons Chamber

[Stephen Mosley (City of Chester) (Con)]

3. How many CT scans were performed at the Countess of Chester hospital in (a) 2010 and (b) 2014.

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

I am delighted to report to the House that the number of CT scans performed at the Countess of Chester Hospital NHS Foundation Trust increased by 67% between 2010 and 2014. In December 2014, only 0.6% of patients waited more than six weeks from referral to test at the trust—that is rather better than the figure we inherited in 2010 of 4.9%, and I hope that the Opposition will welcome it.

[Stephen Mosley]

I welcome those fantastic figures at the Countess of Chester hospital. Will the Minister confirm that early and accurate diagnosis is crucial for dealing with many conditions, and that we are seeing the results of that in improved survival rates for conditions such as cancer?

[George Freeman]

My hon. Friend is absolutely right to say that diagnostics play a key role in our drive to improve cancer survival, which is why we have committed £750 million to deliver our cancer strategy, including £450 million to achieve better diagnosis of cancer, and better awareness and access to diagnostic tests. Projections show that that is working; we are on track to see 12,000 more cancer patients a year surviving for at least five years in 2015, which is more than double the target of 5,000 we set ourselves in January 2011. I hope that the Labour party will agree that these are real benefits for cancer patients in the NHS today.

[Mr Speaker]

Order. That was a considerable essay to which a pithy but comprehensive response is expected. The House seeks it.

[George Freeman]

I admire the hon. Gentleman’s chutzpah but it ill behoves him to talk to us about privatisation; it was his party that led to the increases and it is this Government who have stopped it, and he needs to acknowledge that. On the facts, in December the NHS in England performed more than 130,000 more diagnostic tests compared with December 2013. I note that he did not talk about Wales, where 24% of patients have waited more than eight weeks for their diagnostic test—the comparative figure is 2% of patients in England.

[Mr Speaker]

Order. The question was about Chester, so there was no particular reason to talk about Wales.

--- Later in debate ---

[James Morris (Halesowen and Rowley Regis) (Con)]

8. What assessment he has made of the potential of the genomics programme to improve cancer treatment.

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

The Government’s £300 million genomics England programme, led and announced by the Prime Minister as part of our life science strategy, has the potential to improve dramatically cancer diagnosis and treatment. By sequencing the entire genetic code of 100,000 NHS patients and volunteers and combining the data with their clinical records, and launching a genomic medicine service—a world first for the NHS—we will be able to understand the genetic triggers of disease, unlock new diagnostics and identify better treatments from existing drugs.

[James Morris]

The number of people being treated for cancer successfully and getting appropriate diagnostic treatment in Dudley and Sandwell has increased substantially in the past five years, but does the Minister agree that harnessing genomic medicine is key to the future, and that we need to drive innovation in this field over the next 10, 20 and 30 years?

[George Freeman]

My hon. Friend makes an excellent point. He is absolutely right: cancer is a genetic disease, and the more we know about genetics, the more we discover about different patients’ predisposition to different diseases and drugs. That is absolutely key, and nowhere more clearly so than in breast cancer, where the HER2-Herceptin breakthrough and the BRCA2 gene are allowing us better to screen, predict and target treatment of breast cancer, freeing women from the choice of mastectomy, which has been far too dominant, and enabling us to treat breast cancer as a preventable disease.

--- Later in debate ---

[Neil Parish (Tiverton and Honiton) (Con)]

17. What assessment his Department has made of the future role of community hospitals.

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

Community hospitals can play a hugely important role in the 21st-century NHS. The NHS “Five Year Forward View” explicitly recognised the role of smaller hospitals, including community hospitals, as part of the new care models towards which we need to evolve. Specific local commissioning decisions are rightly taken by local clinical commissioning groups, reflecting local need.

[Neil Parish]

We have excellent hospitals in Tiverton, Honiton, Axminster and Seaton, and there could be a much greater link between them and the Royal Devon and Exeter NHS Foundation Trust. For example, patients could be moved to the community hospital in Axminster after acute operations, thereby creating space at the RD and E and keeping Axminster hospital open with beds, which the population is keen to see.

[George Freeman]

I pay tribute to my hon. Friend for his tireless work on this matter. I know that he recently met the Secretary of State to discuss it and that he has been very active locally and here in Parliament. He is right that local community hospitals can play a key role in supporting patient convalescence, providing particularly good care in the community close to home, which is convenient for elderly patients, and relieving pressure on acute hospital beds. You do not have to take it from me, Mr Speaker; take it from Simon Stevens, the chief executive of NHS England. He recently said:

“A number of other countries have found it possible to run viable local hospitals serving smaller communities than sometimes we think are sustainable in the NHS…The NHS needs to abandon a fixation with ‘mass centralisation’”.

I hugely welcome that.

[Mr Andrew Robathan (South Leicestershire) (Con)]

18. With reference to the recent Francis report, if he will investigate (a) the case of Meirion Thomas at the Royal Marsden hospital and (b) cases where staff have been disciplined or required to sign confidentiality agreements.

--- Later in debate ---

[Graeme Morrice (Livingston) (Lab)]

T7. My constituent Wilma Ord was prescribed Primodos in the 1970s, an oral hormone pregnancy testing pill that she blames for her daughter’s birth defects. As the Secretary of State is aware, it was announced back in October that an inquiry would be established to look into the whole issue. What progress has been made in setting up the inquiry and what assurances can he give my constituent, and the many other women and families affected throughout the country, that the inquiry will be fully comprehensive, transparent and independent?

[The Parliamentary Under-Secretary of State for Health (George Freeman)]

I am delighted to report that I have met colleagues from across the House and patient representatives of that campaign on a number of occasions. We have appointed the chair and made sure that the terms of reference for the inquiry are clear and comprehensive. It is not, I stress, a judicial inquiry; it is a medical inquiry looking at the evidence.[Official Report, 19 March 2015, Vol. 594, c. 1MC.]

[Tim Loughton (East Worthing and Shoreham) (Con)]

A constituent of mine has pointed out that, despite it being a long-term condition, drugs for cystic fibrosis are not subject to an exemption from prescription charges, apparently because, when it was first diagnosed, it was considered to be only a children’s disease. Will Ministers look into this anomaly?

--- Later in debate ---

[Mr David Anderson (Blaydon) (Lab)]

Despite assurance from the Prime Minister, it is now clear that the drug Translarna will not be available until after NHS England has concluded its internal consultations. The Secretary of State and others have told me repeatedly that they have no control over the issue, but can the Minister give the House any idea when the drug will be available for young boys suffering from Duchenne muscular dystrophy in this country, in the same way as it is across Europe? The drug is saving young boys from going into wheelchairs earlier. Does the Minister have any idea when it will be available?

[George Freeman]

I have had a number of meetings with patient groups, campaigners and charities over recent months, and the hon. Gentleman will appreciate that due process is important. NHS England is looking at whether to make an interim ruling on the drug in advance of a decision by the National Institute for Health and Care Excellence, and I have worked with NICE to ensure that its process is accelerated. We should get a decision from NICE this summer, and I hope that NHS England will make a rapid decision based on that judgment.

[Several hon. Members]

rose—

Respiratory Health

George Freeman Excerpts

Tuesday 3rd February 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

It is a pleasure to serve under your chairmanship, Ms Dorries.

Let me start by thanking and congratulating my hon. Friend the Member for Stevenage (Stephen McPartland) for securing the debate and highlighting this incredibly important issue. His leadership of the all-party group is to be commended, as is the report it produced under his chairmanship last year. I also acknowledge his successful advocacy of his town of Stevenage as a life science cluster and hub—I can testify to that as the Minister responsible for life sciences.

The all-party group report identified a number of key areas for action, which colleagues have eloquently highlighted this afternoon. They include implementing the outcomes strategy for COPD and asthma; investing in medical research; improving awareness and diagnosis; better case finding; and ensuring that the NHS work force, from top to bottom, have the right skills to treat people with respiratory disease. If time allows, I will attempt to give detailed answers to my hon. Friend’s specific questions. If I am defeated by the clock, perhaps I could write to him. I very much look forward to meeting him in due course to pursue these issues.

Before I turn to those questions, perhaps I could say a few words about the scale of the challenge we face and what the Government are doing to confront it. The seriousness of the challenge posed by respiratory illnesses must not be underestimated, and it will not be shocking news if I say that it is accepted that they have been treated as something of a poor relation in many ways. They affect one in five people in the UK, they are responsible for about 1 million hospital admissions a year and they are the third biggest cause of death in the UK.

As the report from the all-party group’s inquiry into respiratory deaths said, UK death rates from respiratory disease compare poorly with those in other developed countries. In 2010, the UK had a higher rate of respiratory deaths than any other country in the OECD. The Government acknowledge that that situation is simply not acceptable, and we are working hard to improve it. Let me say something about how we are doing that.

The NHS outcomes framework for 2015-16 sets out the Department’s priority areas for the NHS and includes reducing deaths from respiratory disease as a key indicator. It also highlights the need to reduce unplanned hospital admissions due to asthma. In addition, the Government’s mandate to NHS England sets out the requirement for it to improve outcomes in a range of areas. That includes preventing premature deaths from the biggest killers, including respiratory disease, and supporting people with long-term physical and mental health conditions.

We published our “Living Well for Longer” document in April last year. It sets out the health and care system’s ambition to reduce avoidable deaths from the five major causes of death, which include respiratory disease. We set the ambitious target of making England among the best in Europe, to which end there is a lot to be done.

The Department has supported a number of initiatives to help to improve outcomes for people with respiratory disease. In July 2011, we published an outcomes strategy for people with COPD and asthma in England, setting out six high-level objectives to improve outcomes in those areas through high-quality prevention, detection, treatment and care services. The Department also supported the publication of a good practice guide on services for adults with asthma in 2012.

In addition, NICE, for which I have ministerial responsibility, has published quality standards for COPD and asthma, setting out the markers of high-quality, cost-effective care. Their implementation will raise the standard of care that people with such conditions receive.

In the Department of Health, I have responsibility for research. I am proud to say that the National Institute for Health Research has increased funding on these issues by 50% in the last five years, from £16 million in 2009-10 to £24 million in 2013-14. I accept that there is more to be done, but that is a significant start. The NIHR is investing nearly £22 million over five years in three respiratory biomedical research units. The NIHR clinical research network is setting up, and recruiting patients to, nearly 200 trials and studies in respiratory disease. That is some indication of the work that the NIHR and the Government are doing to prioritise this issue.

The Department has collaborated with the national review of asthma deaths, which examined the circumstances surrounding deaths from asthma from 1 February 2012 to 30 January 2013 and reported on its findings in May last year. The lessons learned about the factors that contribute to asthma deaths will inform the NHS about what constitutes good care and encourage the development of appropriate services for people with asthma. NHS England is supporting clinical commissioning groups to improve out-of-hospital treatment for those with asthma by giving doctors more control over the commissioning of asthma services and improving information links between GPs and hospitals.

I am delighted that last week NICE published draft guidelines on the diagnosis and monitoring of asthma. They are out for consultation, and no doubt the all-party group will have comments to make. Roughly 1.2 million adults in the UK may be wrongly receiving treatment for asthma. The guidelines set out the most effective way to diagnose asthma, and how health care professionals can help adults, children and young people control their symptoms better. The draft guidelines stress that to achieve an accurate diagnosis, clinical tests should be used as well as checking for signs and symptoms.

My hon. Friend the Member for Stevenage described how for too long innovation has been lacking in the diagnosis and treatment of the diseases in question. I am delighted about innovations that are coming. The guidelines recommend that health care professionals should ask employed people how their symptoms are affected by work, to check whether they may have occupational asthma. Other guidance is currently in the pipeline, including clinical guidelines on the management of asthma, consultation on which will start in April, and guidance on the diagnosis and management of bronchiolitis in children, which is due to be published in May.

Importantly, NHS Improving Quality, in collaboration with PRIMIS, has developed the GRASP suite of primary care audit tools to help GPs improve the detection and management of COPD, in addition to two other long-term conditions, atrial fibrillation and heart failure. All the GRASP audits, including GRASP-COPD, are funded by NHS IQ, and they run on all clinical systems and are free to use for GP practices in England. Like the other toolkits in the GRASP suite, GRASP-COPD contains a case finder, which helps GPs to identify the number of patients who are at risk of COPD or who have items on their electronic record that suggest possible COPD. It also contains a management tool that compares current management of diagnosed COPD patients with NICE guidelines.

The shadow Minister mentioned smoking, which is an important issue. It is welcome news that the number of smokers is down to its lowest ever level, which means fewer deaths and fewer people living with the disabling consequences of smoking, such as COPD. However, about 8 million people in England still smoke, and it is right that we maintain a commitment to effective tobacco control. Ministers are clear about wanting both to reduce the number of young people who take up smoking and to help those who smoke to quit. That requires action on a range of fronts, nationally and locally, as with so much in the public health arena.

There is no simple, single solution. However, we are taking action. We introduced a package of measures in the Children and Families Act 2014 aimed at protecting young people from tobacco and nicotine addiction and the serious health harms of smoking tobacco. We have also laid regulations to end smoking in private vehicles carrying children, a measure that I am particularly proud of. Subject to parliamentary approval, those regulations will come into force in October. We are changing the law to ban the sale of e-cigarettes to under-18s and have consulted on draft regulations. We will implement the prohibition of proxy purchasing of tobacco by adults on behalf of under-18s, and we will bring forward legislation for the standardised packaging of tobacco products before the end of this Parliament. For the avoidance of doubt, I support that measure, and I shall urge colleagues who care about health to do the same. In 2014-15 Public Health England ran two major campaigns: Stoptober 2014, a nationwide 28-day quit event in October, and the current health harms campaign to prompt attempts at quitting. Public Health England is also running its breathlessness campaign, to raise awareness of the importance of breathlessness and respiratory disease more generally.

My hon. Friend the Member for Stevenage raised several questions, which I want to address. I particularly want to pay tribute to Neil from Norwich, whose story he shared with us, including the extent of his suffering with COPD and asthma. My hon. Friend the Member for South East Cornwall (Sheryll Murray) mentioned the importance of wider allergy risk, and I am delighted to say that I recently visited a centre of excellence at Addenbrooke’s in Cambridge, which is pioneering a new method for detecting and treating allergies. It is an area of immunotherapy in which this country leads. My hon. and learned Friend the Member for North East Hertfordshire (Sir Oliver Heald) and the hon. Member for Cheadle (Mark Hunter) made important observations about that.

My hon. Friend the Member for Stevenage asked about the importance of a national clinical audit. I could not agree more about the importance of properly measuring and tracking performance. He knows that I am passionate about doing that across the system. NHS England is considering it in this area, among several potential new areas. I will highlight its importance in Parliament, along with the Under-Secretary of State for Health, my hon. Friend the Member for Battersea (Jane Ellison), who is responsible for public health, and I urge the all-party group to do the same, through our offices and independently.

I have provided some answers to the questions that my hon. Friend the Member for Stevenage asked about research funding. We have increased the funding by 50% in this Parliament. However, I urge him to raise the matter directly with the National Institute for Health Research, and to continue campaigning in Parliament.

We support the work of the European Asthma Research and Innovation Partnership, and although it is clearly a matter for the competence of the EU, I assure my hon. Friend that the Public Health Minister and I, and the Department, will do anything we can to support the application. As for the creation of a world-class asthma review, NHS England is currently working to ensure that everyone with a long-term condition has a personalised care plan and that treatment for asthma and COPD improves. The Public Health Minister and I will make clear the levels of parliamentary support for that, following this debate.

Finally, my hon. Friend asked whether we could include lung function in the NHS health check for those over 40. Requests for such additional content will be considered by the NHS health check’s expert scientific and clinical advisory panel. I will happily make representations after the debate. I am sure hon. Members know that the Public Health Minister tenaciously advocates pursuing public health measures such as those on respiratory disease, including in the Tea Room, and she will take the matter seriously.

I will conclude, Ms Dorries, within the time that you mentioned, by paying tribute to my hon. Friend the Member for Stevenage. On this issue, as well as on other life sciences issues, he has brought together the views of Members of different parties. Ministers will take the points that have been made, and we will do all that we can in the short time available in this Parliament to ensure that they are properly addressed by the relevant agencies.

Adult Social Care

George Freeman Excerpts

Wednesday 21st January 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

I thank the hon. Member for Leeds East (Mr Mudie) for raising the important issue of the reorganisation of care pathways in Leeds. I prepared a speech dealing with the reorganisation of health and care and their integration in the town, but I only have nine minutes left and I need to deal with the questions raised by the hon. Gentleman. Perhaps I can write to him with the detail of some important reforms going on in the city.

First, I want to take on the hon. Gentleman’s questions. I reassure him that the reforms in the city are absolutely not the result of any diktat by Ministers. They are in fact being led by hard-working and pioneering health, NHS and social care leaders in Leeds, to whom I pay tribute. My right hon. Friend the Minister of State, who is responsible for care, has publicly commended the work that they are doing locally. They are doing pioneering work in the important mission of integration.

In much the same way that NHS England is autonomous and responsible for delivering health services locally, local authorities are responsible for providing social care services for their communities. As autonomous public bodies, they are best placed to decide the needs of local people. I support the work done in so far as it encourages people locally to contribute to that democratic process.

The hon. Gentleman made some important points. First, he asked whether the proposed closure is due to cuts in Government funding. The answer is no. Public finances are in a precarious position. This year the deficit is still, despite the best efforts of this Government, projected to be over £100 billion. I remind him that when we came to office, debt interest alone was running at £70 billion a year. In Labour’s last year, one in every four pounds spent by the Government was borrowed. We had to get that under control.

It is true that priorities have to be set across the local authority system, but the vast majority of local authorities have prioritised social care. Indeed, in Leeds, work has been done to allocate priorities appropriately. The evidence is encouraging. Despite difficult public spending constraints, spending in Leeds on adult social care is up 3% in cash terms. Importantly, satisfaction with levels of care and support is up 10.8%. I do not recognise the picture of catastrophic collapse that the hon. Gentleman painted.

Secondly, the hon. Gentleman asked whether the Government are doing enough on accident and emergency and about the extent to which that is being driven by the problem in social care. The truth is that we ring-fenced a grant for £25 million to help councils with hard-pressed hospitals. An ageing population—there are 1 million more pensioners this year—is driving increased pressure on A and E. We have set up the Better Care Fund, which I will say a little bit about later.

I cannot let the allegation about privatisation go without a response. Labour’s scaremongering about privatisation has been discredited as a myth by just about every health commentator, including the King’s Fund. Our Health and Social Care Act 2012 made it illegal for any Government to drive the private sector into the NHS, as happened under the Labour Government. It was Labour, actually, that was prepared to pay private sector providers 11% more than NHS providers, and under this Government, led by my right hon. Friend the Secretary of State for Health, that has been made illegal. Under Labour, independent provision comprised 5% of the NHS, but under this Government it is now 6%, which is not an increase of the order that the hon. Gentleman described. Spending on private providers for general and acute secondary care increased by twice as much under Labour as it has under the coalition.

The health service has always been a mixture of private, public and voluntary providers. It ill behoves the Opposition, just before the election, to scaremonger on privatisation. That does not support patients and it is not what the people who work in the health service want to see.

In the few minutes I have left, I want to say something about the reforms to adult social care and the integration of care, and about the work that Leeds has been doing. I know how difficult it can be for elderly patients when health and care services are reformed and changed. That is why it is important that it is done locally, with consultation and led by local professionals.

This morning, I spoke to the interim director of adult social services for Leeds, who assured me that no decision has been made on these proposals. They are still being consulted on and they are part of the council’s wider six-year programme to move more services into the community. I understand that there is plenty of alternative capacity in the area: 123 independent sector care homes in the Leeds area alone would be able to accommodate anybody moving. Furthermore, he tells me that the council has successfully closed a number of its care homes, so if a decision is made to close other care homes, it will use that previous experience to handle those closures sensitively and appropriately.

I want to say something about the context of and pressure on social care and how it is changing. Above all, I emphasise the importance of all services, not just social care, adapting and working together to meet the needs of an elderly population in the 21st century. We are living longer, healthier lives and that is something to be celebrated. The fact that many of us can look forward to reaching 85 and over and many of us—perhaps not me, but perhaps the hon. Gentleman—will live to be 100 is a fantastic achievement. However, it puts pressure on the system. Historically, health and care costs have risen by about 4% every year in real terms. The number of people living with three or more long-term conditions is set to increase from 1.9 million in 2008 to 2.9 million in 2018. One of my former ministerial colleagues, my right hon. Friend the Member for Sutton and Cheam (Paul Burstow), has talked about how care homes need to be made

“fit for the rock and roll generation”.

That is why we have been pushing the integration of health and care and the changes set out in the Care Act 2014.

It would be remiss of me not to admit that in recent decades we have allowed ourselves to tolerate a care system that too often steps in too late and picks up when there is a crisis, rather than acting to prevent one; a system in which there are still too many barriers stopping people getting the integrated care they need; and a society, for which we all take responsibility, that, despite the best efforts of those working in the care sector—professional and voluntary—increasingly has tolerated too much loneliness and isolation.

The case for reform and integration of the care system is not just serious, it is overwhelming. That is why this Government have put such emphasis on integration. People worry that care services will not help them regain their independence and maintain a decent quality of life. It is in all our interests to integrate health and care better. That is why we created the Better Care Fund, the biggest ever financial incentive for the integration of health and social care, providing £5.4 billion of investment in better integrated care from 1 April 2015. Never before has there been a clear legal duty to focus on prevention. The Care Act fills that gap.

I pay tribute to the leaders in social care and health in Leeds, because they are doing great work as a pathfinder area and the Government have supported them. It is a Labour-run council, but it is doing good work in the integration process. I understand that Leeds is opening 37 open access neighbourhood networks. Those schemes are helping around 22,000 older people every year with a range of activities; they have prevented 1,400 older people from going into hospital; and they have supported over 600 older people when discharged from hospital.

Time is against me. I want to close by highlighting the fact that these are not easy issues. The integration of NHS and care services is a challenge across the country, in my constituency as well as the hon. Gentleman’s. The Government have inherited a legacy of neglect in recent decades: I do not just blame the Opposition. We have not integrated properly and we have allowed this problem to go on too long. I believe this Government have attempted to tackle the deficit responsibly. Of course, we all have to tighten our belts.

We have ring-fenced health expenditure. In an integrated system, putting more money into health and driving integration means that there is more money indirectly for social care. The statistics in Leeds simply do not represent this catastrophic picture of privatisation, which has been discredited, or of crisis in the system. I do not pretend for a minute that everything is perfect, but I do believe that we, working with local authorities, are putting the right solution in place for the longer term.

Question put and agreed to.

Drugs (Ultra-rare Diseases)

George Freeman Excerpts

Tuesday 20th January 2015 Westminster Hall

[The Parliamentary Under-Secretary of State for Business, Innovation and Skills (George Freeman)]

I congratulate the hon. Member for Leeds North West (Greg Mulholland) on his tireless work on this issue, and colleagues across the House, including the hon. Member for Blaydon (Mr Anderson), my right hon. Friend the Member for Chesham and Amersham (Mrs Gillan) and others here today.

I thank the hon. Member for Leeds North West for his kind words about the work that I have been trying to do for him, and about the Prime Minister’s signal of support. The issues are incredibly complex and do not lend themselves to an easy waving of a ministerial wand, but we are committed to finding a solution.

The hon. Gentleman has been tireless in his support of one of his constituents, six-year-old Sam Brown from Otley, who has the very rare Morquio syndrome. A new treatment is now available called Vimizim, from which Sam has already benefited as part of a clinical trial. I wish to state my support for Sam and his family, and for all those who suffer from the disease, including those in the trial who have access to the drug when others currently do not. I also pay tribute to the hon. Gentleman’s support for the family of another young boy, Archie, who has Duchenne muscular dystrophy, a very rare form of muscular dystrophy that affects only boys. Archie’s family want him to be treated with a new medicine, Translarna.

I will say a little about the background to the diseases and what we are trying to do about them. Both conditions are very rare—there are about 80 children living with Morquio syndrome in England, and about 140 boys with Duchenne muscular dystrophy—so we are talking about a very small number of children with those life-limiting conditions. However, rare diseases are not rare: there are between 5,000 and 10,000 known types of rare disease, and an estimated one in 17 people will be affected by a rare disease in their lifetime, amounting to some 3 million suffers in the UK alone.

The truth is that the more we know about the human genome and the behaviour of genes in disease development, the more we understand its complexity. In cancer particularly, we know that the tumour itself mutates at different stages of the disease. The more we know about genetics, the more we discover that diseases that we thought yesterday were one disease in fact break down into different bundles of rare disease. New knowledge, technology and advances in biomedicine are a wonderful thing, but that does not detract from the fact that the NHS operates with finite resources and that difficult funding decisions must be made daily.

I was delighted to meet Sam’s mother and Archie’s family early in December, along with the hon. Gentleman and representatives of the Society for Mucopolysaccharide Diseases, to whose work I pay tribute, and of the Muscular Dystrophy Campaign. As the hon. Gentleman mentioned, we had a number of meetings over the Christmas period. I was delighted to meet patient groups and the manufacturers of Vimizim and ataluren just before Christmas. In that meeting, I asked the patient groups and companies to set out their proposals, which they have now done. I am grateful to them, and I have passed on that information to NHS England.

This morning, I met NHS England’s clinical director of specialised services, James Palmer, and its director of specialised commissioning, Richard Jeavons, and I will convene a further meeting shortly to pursue the issues that the hon. Gentleman has raised this morning. Since he first made me aware of this issue, I have been absolutely determined to bring as much ministerial focus to it as I can. I am also grateful for his acknowledgement of the Prime Minister’s support. The Prime Minister and I are both determined to ensure, without compromising due process, that the case for these children and their families is properly heard, and that the system works as it is supposed to.

I am acutely aware of the urgency behind the hon. Gentleman’s comments today and that is why I have taken the unusual step of trying to broker an agreement on what we might do to help children affected by these diseases, but I must stress that it is for NHS England, which in the end is the responsible commissioner, to make any decisions about making funding available so that the treatments are available on the NHS. It will act on the best clinical advice from the UK’s specialist body, the National Institute for Health and Care Excellence.

I will say a little more about the options for accelerating that process in a moment, but first I will talk about our approach to improving access to treatments for rare diseases generally, because I know that this debate is being watched closely by others who have an interest in a number of other drugs and conditions, in the commissioning process, and in NHS England’s prioritisation and decision-making framework. In setting the scene, I remind right hon. and hon. Members of the pressures that the NHS faces, particularly on budgets for rare diseases. The emergence of new treatments, the increasing personalisation of medicines, the end of the one-size-fits-all model and the possibilities offered by the rapid advances that we are making in genomic medicine and diagnosis are all putting immense pressure on NHS England’s resources for the commissioning of services for rare conditions.

Ideally, of course, we would want to fund all the treatments that are shown to benefit patients in any way, but we have to make difficult decisions about how we spend the money that we have available. That is why we have put clinicians in charge of the process, so that they can make decisions based on patient benefit and on the best health economic assessments that we can make. The painful truth is that with finite resources, when we make a decision in one case to accept a drug, we will make a decision elsewhere to reject, and we have a duty to all to ensure that we make those decisions fairly.

For people with rare conditions, their families, carers and clinicians, having access to the latest and most effective treatments is obviously critical, and I am absolutely committed to ensuring that patients with rare diseases have access to the latest and most effective treatments that represent value to the NHS and the taxpayer, as well as delivering benefits to patients. That is why we recently introduced the early access to medicines scheme, which aims to give patients with life-threatening or seriously debilitating conditions access to medicines that do not yet have a marketing authorisation or licence where there is clear unmet medical need. I am delighted that initial products have been brought forward in the last six months under that scheme.

More generally, our strategy for life sciences sets out an ambitious longer-term plan to improve the wider environment for health and life sciences companies in this country. Recently, I launched a major review of the landscape in the UK for bringing innovative medicines and medical technologies to patients much more quickly, and I will soon announce the chair, the terms of reference, the scope and the timetable of that review.

We are not in any way complacent. The truth is that the challenges in this sector, which are being driven by the pace of technological change, demand that in our policy-making framework, in the Department of Health and in NHS England, we adapt the way in which we handle these processes. Because of their rarity and the low patient populations, services for rare conditions are directly commissioned nationally by NHS England as specialised services. They account for approximately 14% of the total NHS budget and represent spending of about £14 billion a year. Both Morquio syndrome and Duchenne muscular dystrophy fall within these national specialist commissioning arrangements.

As right hon. and hon. Members are aware, NHS England is considering draft clinical commissioning policies for both Vimizim and ataluren. I understand that they are being considered as part of NHS England’s wider prioritisation process for funding in 2015-16. NHS England’s clinical priorities advisory group formulates recommendations on the commissioning of new treatments for rare diseases in England. It is made up of clinicians, patient representatives and commissioners of health services.

In summer 2014, a decision-making aid for the prioritisation of new interventions and treatments was developed by a partnership of stakeholders, including more than 250 patient representatives. It was due to be used for the first time in early December 2014, but on 28 November 2014 NHS England decided to postpone its introduction, in response to concerns that some patients affected by rare diseases might be disadvantaged by its application. The legal process about that must now run its course. I understand that NHS England is, rightly, reviewing the appropriate approach to prioritising new treatments and interventions within specialised commissioning in response to those concerns. A 90-day consultation on the prioritisation framework and decision-making process for commissioning decisions on new treatments will be launched by NHS England shortly. This morning, I again raised the importance and urgency of that consultation process.

I know that patients and their families are understandably concerned that it may take a long time for a decision to be made by NHS England on whether it will fund the drugs, and that in the interim the children affected will not receive them. However, I am delighted to say that NHS England has assured me that the consultation will have no impact on the decision-making timetable for commissioning NHS services from April 2015 onwards. In addition, it has assured me that existing treatments will continue to be commissioned, ensuring that support for patients is maintained. NHS England understands that the manufacturer, Bio Marin, is providing Vimizim under an expanded access arrangement to those patients who are on the clinical trial until an NHS England policy decision has been made.

Since April 2013, NICE, which is responsible for the evaluation of selected high-cost low-volume drugs under its highly specialised technologies programme, has been playing an important role in ensuring that commissioning decisions are based on a robust and thorough assessment of the available evidence. NICE has recently been asked to evaluate Vimazim under this programme, and it is also considering whether to develop guidance on Translarna. That is a very positive step, and I look forward to receiving NICE’s proposals on future topics that will be considered. I know that NICE will also be keen to learn lessons from its recent experiences with the new highly specialised technologies process, to make that process as efficient and effective as possible.

For my part, I am absolutely determined to continue playing the active role that I have taken on in the last few months, to drive this process and give it the focus that it requires. I am delighted to have confirmed with NHS England that it will continue to meet the treatment costs. I have signalled, and will continue to signal, to NICE, without compromising its processes, the strength of the case that has been made by Members and patient groups to put Translarna on the list, and to consider whether it can expedite its process in any way, but I do not want to compromise that process in any way. I will also ask NICE to ensure that it uses its review of the experience of the HST programme to explore how we can speed up both this process and others in due course.

Finally, I am committed to continuing to work with the companies to see whether I might be able to help broker some kind of planning arrangement that might encourage NICE to make the decision that I know everyone in Westminster Hall today would like to hear.

[Mrs Gillan]

I am grateful to the Minister and I congratulate him on taking up the cudgels on this issue and trying to move it forward. The Muscular Dystrophy Campaign has asked whether the individual funding requests from patients would be a route to secure access to Translarna while the Minister is waiting for due process to take its course, because I am afraid that muscular dystrophy waits for no man and no process.

[George Freeman]

I understand; my right hon. Friend makes an important point. In fact, I raised it this morning in my meeting with NHS England. My understanding is that NHS England will continue to consider individual applications for Translarna through its individual funding request process from patients who may be exceptional. However, my understanding is that such cases really do have to be exceptional. In reality, the members of the whole group that we are considering are more or less suffering from the same condition and therefore they may not qualify under those criteria. I merely share that with my right hon. Friend because I myself raised that point this morning with NHS England.

[Greg Mulholland]

I stress to my hon. Friend the Minister that we are discussing two conditions and two drugs, Translarna and Vimazim. I also have to say to him again that we understand that NHS England has to put a process in place; of course it does, because the process it had put in place was not fit for purpose. Does he accept that NHS England has a legal, as well as a moral, responsibility in this regard? It certainly has a moral responsibility. Having said that the decision will be made on 15 December, NHS England cannot now hide behind saying, “There needs to be a new process,” when this situation is its fault in the first place. We are now a month on from that initial deadline, and there needs to be an interim solution to somehow allow these 138 children to access the two drugs in the meantime, and before that process is complete.

[George Freeman]

I certainly accept the moral case; I think that everyone would accept that there is a moral duty to get this matter right and to try to make these decisions on the right basis and on the basis of the right evidence. The legal position, given the legal challenge, is more complicated, and it has triggered a formal process of reappraisal. As I have said, I will meet NHS England officials to urge them to try to expedite that process as best they can. However, I must stress that I do not want to get into a situation where we compromise due process and inadvertently undermine a case. What I want to see is a NICE decision being made as quickly as possible, and I will urge NICE to expedite that process in every way it can, so that we get the right decision that we all want.