The National Health Service

Geraint Davies Excerpts

Wednesday 23rd October 2019 Commons Chamber

[Matt Hancock]

My hon. Friend is absolutely right. It was incredibly moving to meet, in my office downstairs here in the House of Commons, some children with Batten disease who needed access to world-class drugs. They are expensive drugs, but we needed to get them at a price that was affordable to the NHS. I met the parents and some of the children, and it was incredibly moving. I met some siblings—one had access to the drug and the other did not—and I saw the difference in their development. We negotiated with the company and got the drugs on the NHS. That is how we should be providing world-class drugs. That is how it has been done under sensible Labour Administrations, and I urge the Opposition to reconsider, because even if it may sound good when they look in the mirror, it is not sensible to undermine our world-class life sciences in this way. I hope they think again.

[Geraint Davies (Swansea West) (Lab/Co-op)]

On a point of order, Madam Deputy Speaker. The Secretary of State has been talking now for nearly half an hour, yet he has not really referred to the amendment in respect of the relationship between public health and trade, particularly the ability of tribunals and companies to sue.

[Madam Deputy Speaker (Dame Eleanor Laing)]

Order. That is not a point of order; it is a point of debate. I understand the hon. Gentleman’s frustration, so I will repeat what I said earlier: the Secretary of State has been, as was the Opposition spokesman, most dutiful in taking lots of interventions. I have allowed those interventions because I recognise that Members want to refer to particular hospitals and other things in their own constituencies. I allowed them, but I now encourage the Secretary of State to cease—

[Geraint Davies]

It is a point of order.

[Madam Deputy Speaker]

No, it is not a point of order if I say it is not a point of order.

I encourage the Secretary of State to make progress. I appreciate his generosity to his colleagues, but we will have to make some progress.

[Matt Hancock]

Quite right. I am voting for you, Madam Deputy Speaker.

On the point made by the hon. Member for Swansea West (Geraint Davies), to whom I will not give way—

[Geraint Davies]

rose—

[Matt Hancock]

I am not going to give way after that nonsense, but on his point, perhaps he was not here at the start, but on the first page of my speech it says that

“the NHS is not, and never will be for sale under this government. The Prime Minster and the President have made it abundantly clear that the NHS will not be on the table in any trade talks.”

How many times do I have to say it? I will say it every day of the week.

Electromagnetic Fields: Health Effects

Geraint Davies Excerpts

Tuesday 25th June 2019 Westminster Hall

[Tonia Antoniazzi (Gower) (Lab)]

I beg to move,

That this House has considered the health-related effects of electromagnetic fields.

I am honoured to serve under your chairmanship, Mr Hollobone. This Westminster Hall debate is timely. It comes on the back of an historic decision by Glastonbury Town Council to oppose the roll-out of 5G because of a severe lack of evidence about its effect on the health of those living and working around 5G sites. In the words of Martin Pall, emeritus professor of biochemistry at Washington State University:

“Putting in tens of millions of 5G antennae without a single biological test of safety has got to be about the stupidest idea anyone has had in the history of the world.”

We saw the roll-out of 5G postponed in Brussels when Céline Fremault, Environment and Energy Minister, identified that it was not compatible with Belgian radiation safety standards; and a planned upgrade to 5G in Geneva has been stopped, through application of the precautionary principle, until independent findings on possible health damage become available.

I was approached by an old friend who is now a constituent about how a sensitivity to electromagnetic fields seriously affects her health and the way she lives her life. Annelie lives in France for part of the year and has to return to Wales as her health deteriorates while working as a university lecturer. I was intrigued by the effects and wanted to know more, so I have been in contact with a number of people who either have concerns about the health-related effects or are suffering at first hand. Following discussions with others, I was keen to secure a debate on the subject, because the Government are sweeping the health concerns under the carpet and there appears to be an absolute refusal to acknowledge that the health-related effects even exist.

Initiating a conversation about electromagnetic sensitivity has had members of my own team and family telling me that it is all made up. That in itself motivated me to keep reading and to speak to as many people as I could in Wales and beyond who were suffering. What shocked me was the number of people who have ES but are too afraid to talk publicly about their illness, because they are really wary of being humiliated and ostracised.

Electrosensitivity is the symptomatic sensitivity to electric or magnetic fields of any frequency, including radio frequency transmissions. The condition was first described in 1932. It is when a person’s physiology is affected by external electromagnetic fields, giving rise to a spectrum of symptoms, which are often neurological. It is therefore an illness caused by environmental agents—essentially, an environmental toxic pollutant. The condition can arise because of continued exposure to an environment polluted by man-made EM and RF wireless signals at levels at orders of magnitude below those that produce heating effects, and it is well understood in many other countries. Symptoms include headaches, fatigue, disturbed sleep, tingling, pains in limbs, head or face, stabbing pains, brain fog and impaired cognitive function, dizziness, tinnitus, nosebleeds and palpitations. As we saw with chronic fatigue syndrome, however, there was disbelief about those presenting with symptoms of this condition. Indeed, it was construed by others, through a lack of knowledge and difficulty in diagnosis, as a psychological illness. I believe that electrosensitivity will be recognised in years to come—sooner than that, I hope—and that the Government will have to own up to their part in it.

To be honest, this is not a subject that I ever thought I would stand here and talk about, even though as a mother, I have always been keen to charge my son’s phone outside his bedroom but have never applied the same rule to myself. Parents seem to care about this in relation to their children, and we hear that masts—one was recently fitted to a school in Haringey—are no longer being put up on primary schools. There is something in this.

I also worry about the impact of social media on mental health, and about the smartphones’ increasingly addictive nature, which is impacting on the lives of the youngest of children. There is some evidence about the effects of radio frequency signals on mental health and behaviour in children and young people, but those effects are not considered in current attempts to address the increase in mental health and behavioural problems in the UK. I ask the Minister to include the effects of wireless signals when considering solutions for such problems in children and young people. The recent advice from the UK chief medical officers on screen time and wellbeing in young people has ignored evidence for the adverse effects of wireless signals.

[Geraint Davies (Swansea West) (Lab/Co-op)]

I want to ask about the wider environmental impact. My hon. Friend will know that 4G has the same carbon footprint as all of aviation, and 5G will be a lot more. What is more, we are now hearing that 5G will have a detrimental impact on insect life, which is decreasing globally at 2.5% per year. Given that insects are essential to humanity because they are required to pollinate all fruits and vegetables, does she agree that before hurtling ahead for commercial reasons, we should apply the precautionary principle until we know precisely what the impact will be on insects and our carbon footprint?

[Tonia Antoniazzi]

We do need to take climate change and insect life into consideration when we discuss the impact of electromagnetic fields.

As MPs, we have a duty of care to our constituents. There is no escaping the fact that when MPs, schools, local authorities and others ask questions about the safety of new technologies, Government’s give a standard reply. People who question the health-related effects of electromagnetic fields come up against a brick wall, and today I want to break through that brick wall and ask the Minister several questions. I like to think that the smart way to move forward is to consider safety and sustainability when developing products.

[Tonia Antoniazzi]

There is evidence about the effects on animals. I cannot quote from it now, but I have read about it. We must remember that animals do not use screens, but there is evidence of the impact on them of electromagnetic fields from things such as smartphones and 5G. I would have to find that evidence and send it on to my hon. Friend.

[Geraint Davies]

On that point, there is clear evidence that with high-frequency 5G—there is some denial about the idea that the frequency may be so high—there will be an enormous loss of insect life. To get the necessary coverage we need to place masts every 150 metres. The coverage will be enormous, and there is an incredible risk of substantial damage. Surely we should apply the precautionary principle, even if all sorts of commercial threats are being made to the Government behind closed doors about what will happen if they do not go ahead.

[Tonia Antoniazzi]

We need to apply the precautionary principle when we look at anything. Many councils and the Government have embraced 5G, which has come up on us so quickly, as a solution to connectivity. To be honest, given the potential impact, I would rather see fibre broadband—fixed, wired broadband—in all the houses in my constituency and across Wales, rather than having masts put up everywhere just because that seems to be a cheaper solution.

I will not accept the response that electrosensitivity does not exist; studies show that it does. It has many effects that are not at all subjective, including effects on proteins and DNA, cell death, altered brain activity and effects in animals, as my hon. Friends have mentioned. Those effects can be measured, and they cannot be dismissed as being all in the mind.

We all know that decisions relating to technology can have unintended consequences. We are discussing one such consequence: the impact on our health. Similarly, it could be argued that the effects on our mental health are being caused by online contact or screen time, but in combination with studies about animals, we can see that the signals themselves have effects. Animals do not look at screens or use social media.

In the past, no matter what questions, evidence or concerns have been put to Public Health England or the Department of Health and Social Care, they have responded with their standard reply, which includes them saying that they have thoroughly assessed the evidence in the 2012 report by the independent Advisory Group on Non-ionising Radiation. The World Health Organisation International Agency for Research on Cancer classified all radio-frequency signals as possible human carcinogens in 2011, based on significant increased risks of gliomas and acoustic neuromas associated with mobile or cordless phone use in humans, as well as animal and mechanistic studies. Subsequent studies have strengthened the evidence in humans and provided clear evidence of tumours in animals. Some scientists are even calling for the classification to be upgraded to a definite carcinogen.

Why, then, has Public Health England removed all mention of the IARC classification of radio-frequency signals from its website? It informs people about other possible carcinogens. People cannot make informed decisions or protect those they are responsible for if the information is withheld. Will the Minister commit to ensuring that Public Health England informs people on its website and in leaflets, communications and presentations that all radio-frequency signals are a possible human carcinogen?

Following the publication of a paper on the AGNIR 2012 report in Reviews on Environment Health, the AGNIR was quietly disbanded. However, the inaccurate report is still on its website and is used to justify its advice to MPs and the public. When will the 2012 report be retracted because it is scientifically inaccurate and out of date?

The Department for Education in England and the Department of Education in Northern Ireland have said that it is the responsibility of schools to carry out risk assessments before technologies are introduced and used. However, schools cannot safeguard pupils or staff through a risk assessment if they have been given inaccurate information. Can schools be accurately informed about the risks, so that they can fulfil their responsibilities to safeguard children?

Schools and parents could have been informed that wireless signals are a possible human carcinogen; that there is evidence of damage to fertility; and that there are adverse effects on brain development. Schools could have been advised to use wired technologies to prevent possible harm to children’s health and development. The EU has sent a cautionary message about wi-fi in relation to schoolchildren, but only France has removed wi-fi from its primary schools.

The Cyprus Government have produced short, practical videos warning teenagers and pregnant women about the risks of radio frequency signals and offering simple actions. When will children, young people, parents and pregnant women in the UK be offered similar advice so that they can take steps to stay safer?

By denying the existence of adverse effects and providing inaccurate information, Public Health England and the Department of Health and Social Care have prevented the UK public from living and working in safe environments. When will the Government listen to the warnings from scientists and doctors to help MPs to better protect their constituents?

If we are to develop safer technologies in the future, we need to be honest about the risks. We must not ignore the fact that people have ES; those people exist, and their lives are being ruined. Others without ES also have genuine concerns about the roll-out of 5G. People do not need to suffer to be concerned, because the name 5G is deceptive: it implies a simple upgrade from the current 4G, or fourth generation, wireless, but it is so much more than that. It is a massive experiment, and the consequences of our actions are largely unknown.

One thing I feel very strongly about is that for people with ES there is literally no escape—they will have nowhere to go. Can we create safe public spaces and living and working environments so that everyone has somewhere to exist? That is extremely urgent, particularly with the introduction of 5G smart cities, smart roads, the internet of things and thousands of 5G satellites.

I would like the Government to give a commitment to creating white zones, where people can have respite when they need it; to pledge to provide up-to-date, transparent and independent research on the impact of electromagnetic fields; and to replace the 2012 AGNIR report. The science needs to be reviewed—no one can disagree that the technology moves on so quickly that there is even more need to keep up to date with the science.

Finally, I recently received a letter with a heartfelt request from a mum in west Wales:

“I’m told you think the only way forward is a white zone, I agree but also to get ES recognised as a disability. I have spoken with my MP and he agreed that if ES could be recognised as a disability, other things such as access to education would fall into place.”

I agree with Sarah. Her struggle is real, and so are the lives of many people who are largely ignored and belittled. Electromagnetic fields have had a dramatic impact on the life and health of my old classmate Annelie over the past 10 years. We can no longer hide and pretend that this is not happening. It cannot be swept under the carpet, especially in the light of the future impact of technological advances at the expense of people and our environment.

In conclusion, it is evident that the Government need to ensure that the research is independent. They need to recognise electrohypersensitivity as an occupational disease, as a French court did earlier this year, and put guidelines in place for employers to make reasonable adjustments so that their employees can continue to work in a healthy environment. I remember the days when we made plans to meet without mobile phones to say that we were running late or could not make it. Advances in technology have swept through our lives. Before I am accused of being a luddite, I stress that I think the technology is wonderful and offers a great many benefits to all, but we cannot continue to deny that there is an impact on some people’s health and wellbeing. This is not about stopping progress; it is about making sure that there are no health concerns about the technology, and about doing what is best for our constituents.

[Dr David Drew (Stroud) (Lab/Co-op)]

I am delighted to serve under your chairmanship, Mr Hollobone. My hon. Friend the Member for Gower (Tonia Antoniazzi) has done an admirable job in at least raising the issue that the precautionary principle should be paramount before we take on any new technology. As someone who represents a semi-rural area, let me say at the outset: please give me 3G. I am not worried about 4G or 5G; I just want 3G, with all the consequences it brings. My constituency still has at least one market town that cannot even get that. That was just a little plug for getting the existing technology in place.

What my hon. Friend says is worthy of debate. It should be taken seriously by the Government and should help the public to understand that their representatives are listening. Stroud being Stroud, an active campaign is already under way on 5G. People are saying, “We don’t want it and we’ll do anything to stop it, so please listen to those who have already raised concerns.”

Like my hon. Friend, I have met people who are incredibly affected by electromagnetic sensitivity—to the extent that, when they moved into their house, they had to have the smart meter taken out, and even asked their neighbour to take out theirs. Once that happened, their health dramatically improved. People say that electromagnetic sensitivity is all psychosomatic, but I have seen the evidence of people’s sensitivity to electromagnetic waves. If we ignore it, there will certainly be health and biological consequences, and there may be many more problems. Since my hon. Friend has done a valuable job of explaining the possible health and biological impacts, I will say more about planning.

It is only fair to ask the Government to at least respond to the growing evidence from the International Electromagnetic Field Scientist Appeal, PHIRE— the Physicians’ Health Initiative for Radiation and Environment—and other reputed scientists in the field, as well as from communities. Brussels has now stopped the roll-out, and so have a number of cities in California. There is growing concern, and it needs to be recognised and answered. It is a shame that we seem to be in complete ignorance of some of the effects of 5G. I have not seen proper medical studies that deal with people’s susceptibility to it. It would be right and proper for us to see those studies.

[Geraint Davies]

I apologise that I will have to leave before the end, Mr Hollobone.

Is my hon. Friend aware of the veracity of reports that 5G companies, which have enormous commercial power, have put pressure on the Government to move ahead quickly and are making threats similar to those made about the Transatlantic Trade and Investment Partnership? It may be that we have signed up already, and if we pull back on the basis of the precautionary principle and risks to human and wildlife health, the Government may end up being sued by big commercial interests. We should resist that in the interests of the public.

[Dr Drew]

I agree. My hon. Friend’s work on air quality is very important. Politicians in general are at last beginning to take note of the threats. It seems lamentable that, now that we understand the threats to air quality through pollution from cars, incineration and other things, another technology is coming in that could be as damaging. Maybe we will not see its effects for years, but will in decades unless we understand what it can do to people. It may not affect everybody—it may be down to genetic susceptibility—but we ought to listen to what is happening to those people.

It would be useful for the Government to put the studies, and their responses to them, on the record. As my hon. Friend the Member for Gower says, one problem is that, now we are into 5G, there is a view that existing masts can be added to or that additional technology can be used. I put it to the Minister that the biggest worry is that there is a view, certainly in Stroud, that lamp posts will be seen as a perfectly acceptable substitute and that, instead of putting up new masts, the technology could be added to existing infrastructure.

It would be useful to know what powers exist, because I understand that the electronic communications code has granted virtually unlimited powers to companies to construct, maintain or develop the current infrastructure without any planning permission. It is all done under delegated responsibility, which means that the general public do not even know what is going on, because normally these things are not publicised. There is little recourse unless the public take court action to stop it, but the means of doing so are limited. Even a private landowner has little authority to stop it. The matter needs to be looked into and properly investigated.

I ask the Government to look at how they can consult the public, because the public are getting worried. The scare stories may not have the full scientific rigour that they should have, but the public know no more than what they have been told by various experts in the field, and there are always experts on either side of the argument. Our case is that, at the very least, there should be an open, honest and transparent investigation of the health and biological impact of the new technology.

Driving forward 5G is about financial interests. It is not being done for altruistic reasons, but because an awful lot of money stands to be made out of it in a very short period. We need to look at that. It exacerbates the digital divide. As I have said, I would be satisfied with 3G my constituency.

Having listened to my hon. Friend the Member for Gower, I hope the Minister will be able to say what plans the Government have to investigate the impact on the ecosystem, which is as important as human beings. We need to keep our bugs, birds and other fauna in the state they are in, given that they are under enormous attack. We talked about that yesterday in relation to the climate change statutory instrument that we passed. We are not just talking about our own survival but the survival of other species. It would be a tragedy if we have done things to protect them and yet we let 5G come in. There are allegations that 5G has an impact on other species, particularly in rural areas where we see many living creatures.

My final point is that part of the problem is that the new technology is coming through without much questioning, or even recourse for people to question it. The biggest problem is the speed at which it is being introduced. There is no way that communities that are at best uncertain about the impact of that technology on their children, their schools and their wider community can do anything.

I ask the Government to look at this carefully, as my hon. Friend the Member for Gower said, so that we consider the implications both for individuals’ health and the wider ecosystem, and that we also take time and recognise that the precautionary principle is as important in this area as it is in general about air quality.

--- Later in debate ---

[Mrs Sharon Hodgson (Washington and Sunderland West) (Lab)]

It is a pleasure to serve under your chairmanship this afternoon, Mr Hollobone.

I start by thanking my hon. Friend the Member for Gower (Tonia Antoniazzi) for securing this debate and for her excellent speech, which set the scene and informed us all about this issue. Earlier this year, I met her to discuss it, so I am pleased that she was able to secure the debate on it.

I also thank my hon. Friend the Member for Stroud (Dr Drew) and the hon. Member for Linlithgow and East Falkirk (Martyn Day), who spoke for the Scottish National party, for their thoughtful contributions to this debate. There were also excellent interventions by my hon. Friend the Member for Swansea West (Geraint Davies); I am pleased that he is still with us in Westminster Hall, as he had said that he had to leave early.

As we have heard, the World Health Organisation has concluded that current evidence does not confirm the existence of any health consequences from exposure to low-level electromagnetic fields. I know that the Government have followed a similar line, with the independent Advisory Group on Non-Ionising Radiation concluding that although a substantial amount of research has been conducted in this area, there is no convincing evidence that electromagnetic field exposures below guideline levels cause health effects in either adults or children. However, as we have heard, concerns exist about the long-term impact of electromagnetic fields, and although my hon. Friends did not go into great detail about individual cases, I have read of such cases and I am sure that all hon. Members have also read some of the details about them. As we become ever more reliant upon modern technology, such concerns will only increase.

On a more light-hearted note, those people who have Netflix might have seen the impact of electromagnetic fields being played out, albeit in a fictional sense, in a programme called “Better Call Saul”, in which the brother of the main character is terribly affected—indeed, he is housebound—by EMF. It is often said with these types of issues that Hollywood leads the way in bringing them to the public’s attention, and this example is definitely a case in point.

International studies, such as the cohort study of mobile phone use and health, or COSMOS, and national studies, such as the study of cognition, adolescents and mobile phones, or SCAMP, exist to continue research into any possible impacts. It is important that such studies continue, so that the public can be aware of all the current advice about electromagnetic fields. As we have heard, as technology develops there will be concerns—new and old—about the impact that it could have on our health. What assessment has the Minister made of all those studies, specifically those that conclude that radio waves are carcinogenic? As we have heard, Cyprus and Austria advise children and teenagers how to limit their exposure to radio waves. Will the UK Government consider doing that, too?

Some of my constituents have written to me with concerns about the new 5G network, as also reported by other hon. Members, and I am grateful for the Minister’s response on that. I know that my hon. Friend the Member for Gower has had conversations with her constituents, who are concerned about the new technology being rolled out across the country. As she said, she would like white zones to be considered and protected. White zones give people who are sensitive to electromagnetic fields, or are concerned about their impact, somewhere to live without interference from radio waves, and that is why it is important that the matter is looked at cross-departmentally.

[Geraint Davies]

Is my hon. Friend aware of the concern that 5G cannot penetrate trees and that, as a result, we are looking at the destruction of thousands and thousands of trees? That destruction has already started around Swindon. How can we possibly be serious about our ambitions for zero carbon if we are destroying the trees and have this huge carbon footprint? It does not add up and is clearly environmentally ridiculous.

[Mrs Hodgson]

I was not aware of that, but my hon. Friend has put it out there on the record. I had heard, though, that 5G can go through us, where other things go around us, so it cannot go through trees but it can go through humans. There is a lot more we need to know about the technology.

As I was saying, anything that looks at this must be cross-departmental because of the impact on health, business, digital and the environment. Each of the Departments responsible for those areas should consider the health implications of electromagnetic fields, whether it is for a small minority of the population or the majority. Is that something the Minister has considered?

As we roll out digital technology, particularly in rural areas, the protection of white zones should be considered. We can be world leaders in digital, but that must not be at the expense of health and wellbeing. I therefore urge the Minister to ensure that all the information about the health and wellbeing impacts of electromagnetic fields is made available to the public, and kept under constant review as we find out more. I also urge her to work with her colleagues, across several Departments, to ensure that health and wellbeing is prioritised throughout the digital roll-out.

Vaccination and Public Health

Geraint Davies Excerpts

Wednesday 12th June 2019 Westminster Hall

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

It is great that the hon. Gentleman has secured the debate.

[Geraint Davies (in the Chair)]

Order. According to the rules, Front-Bench spokespeople are not supposed to intervene in half-hour debates, but if Chris Green is happy to take that intervention, I will allow it. I just thought that I needed to put that on the record.

[Chris Green]

I am happy to take the intervention.

Health

Geraint Davies Excerpts

Tuesday 14th May 2019 Commons Chamber

[Jonathan Ashworth]

As my hon. Friend indicates, government is about choices. The Government have chosen to give big tax cuts to some of the richest and most privileged people in society while cutting the public health services on which the most vulnerable rely. That tells us all we need to know about the Tory approach to the national health service.

[Geraint Davies (Swansea West) (Lab/Co-op)]

My hon. Friend has eloquently linked poverty and life expectancy. Does he agree that when we look at statistics such as the 64,000 people who die prematurely as a result of air pollution, that is focused on poorer people who live near busy roads? When we look at people who die from diabetes who have been force-fed processed foods, there is another correlation. The common theme is partly the support that the Government give to manufacturers of sugar, diesel and so on. That disproportionately hits poorer areas and ends up killing more people.

[Jonathan Ashworth]

The House has no greater champion of clean air than my hon. Friend. He is quite right—we have to tackle the wider social determinants of ill health, including pollution. We would introduce a clean air Bill. I am disappointed that the Government do not seem to agree that that is necessary.

I shall run through—[Interruption.] The Secretary of State is chuntering. He will have a chance to respond to the points that I have made. We all accept that smoking is a No. 1 cause of ill health and early death, causing about 115,000 deaths a year. Some 480,000 hospital admissions are attributable to smoking, which is an increase of 6% since 2013. That costs the NHS £2.5 billion a year—it costs primary care £1 billion and social care £760 million—but because of public health cuts, smoking cessation services in communities have faced cuts of £3 million. Over half of local authorities have been forced to cut services. Some local authorities have had to decommission smoking cessation services altogether, and 100,000 smokers no longer have access to any local authority-commissioned support. The number of people using smoking cessation services to help them quit has decreased by 11%—the sixth year in a row that the figure has fallen.

That means that smoking cessation services are, in the words of The BMJ,

“withering on the vine as councils are forced to redeploy funding to other areas”

Those cuts will lead to the risk of more people developing cancer and to higher costs for the NHS. It is a similar story with drug and alcohol services, which have seen cuts of £162 million, with more cuts to come this year.

--- Later in debate ---

[Matt Hancock]

My right hon. Friend anticipates my very next point. It is important to get value for the extra taxpayers’ money we put in. I always try to refer to it as taxpayers’ money, because there is no Government money or NHS money. Every single penny we put into the NHS—rightly, in my view—comes from the taxes that people pay, and it should be treated with the respect that that deserves.

[Geraint Davies]

The thesis of a strong NHS is based on a strong economy, yet will he accept that under this Government since 2010 overall debt has gone from 45% of GDP to nearly 90% of GDP? It is not about tax; it is just borrowed money from a failing economy.

[Matt Hancock]

No. I agree with the hon. Gentleman about the importance of clean air, but I gently point out that dealing with the deficit—the annual amount by which the Government was overspending—is, and must be, the precursor to getting the debt down. Now, thankfully, the debt is falling relative to the economy, but there has been an awful lot of hard work to get us there.

Let us look at some of the things the NHS is delivering. The entire population now has access to evening and weekend GP appointments. More than a million GP appointments a month are now booked online, and consultation increasingly takes place online. More than three million repeat prescriptions are done online. There are more than 2 million more operations a year than in 2010, and we see 11.5 million more out-patient appointments than in 2010. Since last year, more than 500 extra beds a day have been freed up in hospitals.

When it comes to the future, only yesterday we announced that a new treatment aid for brain cancer can be rolled out across the country, benefiting up to 2,000 patients, all because of the extra money we are putting in. My right hon. Friend the Member for Wokingham (John Redwood) is quite right that in return for the extra taxpayers’ money we are putting in, we must get extra out, too.

[Matt Hancock]

The public health grant is settled in the spending review. The NHS settlement has come before the spending review, and the public health grant is only one part of the approach to public health. In 2015, this House agreed, with broad acceptance across parties—I know the hon. Gentleman was not in the House then—that local authorities should take responsibilities for public health, to ensure that the entirety of local authority activity could be focused on better public health.

Public health is not just what happens in the NHS, with councils or in GP surgeries or hospitals. For instance, the Government have taken a global lead in getting social media companies to remove suicide and self-harm content online because of the danger that poses to people’s mental health, and in particular that of children and young people. That is a public health issue. Likewise, the efforts we are making to reduce air pollution in the environment Bill—a broader piece of legislation than just a clean air Act—are about a public health matter. It is not in the public health grant, but it is a public health matter.

[Geraint Davies]

rose—

[Anna Soubry]

rose—

--- Later in debate ---

[Matt Hancock]

I respect the right hon. Lady’s work as Public Health Minister—she was excellent in that role—and I was going to turn to this point. It is very important that we understand the base we are starting from, but we also have the spending review, in which these budgets will be settled, and that is clearly an important cross-Government question that we will be addressing in the coming months.

Smoking cessation services have been mentioned. Now, the smoking rate has fallen since 2010 from 20.1% of the population to 14.9%, which is excellent, although it is part of a fall over a generation, not just the last 10 years. Likewise, the drug use rate has fallen from over 10% to 8.5%. We have to provide the services for those we still need to get off smoking and to support people to stop using drugs, but the number of people smoking and using drugs has fallen too.

On clean air, the World Health Organisation has called the clean air strategy we published an example for the rest of the world to follow, so I think in this area the necessary action we are taking should be being welcomed across this Chamber.

[Geraint Davies]

I know the Secretary of State accepts that the environment Bill is the vehicle to deliver cleaner air, but is he aware that, as it stands, it does not include indoor air quality? Given that we spend 90% of our time inside and that the medical research now shows a cocktail effect of outdoor dirty air conflating with indoor air that has poisons in it—from sprays, cleaning products, chemicals in furniture and all the rest—if we are to properly tackle the problem of dirty air causing 64,000 deaths a year, indoor air quality has to be included in the environment Bill. Will he press the Secretary of State for the Environment, Food and Rural Affairs to ensure that it is?

[Matt Hancock]

The Secretary of State for Environment, Food and Rural Affairs and I are working incredibly closely on this because clean air is a public health matter. The challenge is that, although measuring outdoor air quality is essentially a public matter and in public buildings it may well be a public matter, inside most people’s homes it is far harder to make a direct intervention, but I accept the premise of the hon. Gentleman’s point. It may be something we can look at in public spaces. [Interruption.] He mentions schools and hospitals. I accept the premise of that point and I think it is something we can take away. The same is true inside vehicles, but that is a wider question.

--- Later in debate ---

[Geraint Davies (Swansea West) (Lab/Co-op)]

Air pollution—the silent, invisible killer—is now leading to 64,000 premature deaths in Britain each year. The figure was thought to be 40,000 by the Royal College of Physicians, but it has now been updated by the European Heart Journal. Pollution is now the biggest killer in the world—bigger even than smoking. We know that 8.8 million people die from air pollution, compared with 7.2 million who die from smoking. People are killed, or their lives are prematurely ended by heart attacks, heart disease, lung cancer, lung disease and strokes. Air pollution is also a massive cause of dementia. Pregnant mothers have their foetuses impacted by the particulates that they breathe in, and children in so-called clean air zones have a 10% lower lung capacity and much worse mental health issues.

I am therefore pleased that The Times is now supporting a five-point action plan to tackle air pollution. It supports the idea of a clean air Act, and I have a Clean Air Bill going forward. People have a right to clean air, and it is important that local authorities and others have the resources to deliver that. It is also important that the Government get off their seat and say that, instead of banning all new diesel and petrol cars by 2040, we should do so by 2030. After all, that ambition is now held by India, China, Ireland and others, and we really need to do much more. We need to ban traffic from idling outside schools, and we need to ensure that the 40 cities in Britain that breach the World Health Organisation standards do more to stop older vehicles entering city centres and charge them. We need to monitor local levels of air pollution through local authorities and the Environment Agency, so that people have the figures and the power to campaign to stop pollution. It is also important that we stop building new schools next to busy roads.

In addition to that, my Clean Air Bill sets out a fiscal strategy for tackling air pollution. Fuel duty on diesel has been frozen since 2010. There is no differential between that and petrol, let alone electric cars. We require electric car infrastructure across Britain, but the Government have given that responsibility to BP, which of course has a vested interest in keeping fossil fuel on the road. We also need proper testing. Volkswagen was fined in the United States following the testing scandal, but not in Britain, and 300,000 VWs still have not been called back for correction. The Government are hurtling ahead with expanding airport capacity, leading to more dirty air. We need to do more on ports, with a maritime strategy that ensures that ships coming into port are connected to electric power. We should be converting to electric trains, but Swansea, which was promised electrification, is getting diesels.

It is also important that the environment Bill considers both indoor and outdoor air. I am pleased that the Secretary of State put it on the record today that schools and hospitals should be included in the Bill, and I will certainly be holding him to his word. People inhale all sorts of dangerous chemicals when indoors through cleaning agents, which may be sprayed on people’s bodies, fire retardants in sofas and so on.

We must ensure that high standards are enforced. Members will know that ClientEarth has taken the Government to court over their failure to protect people from dirty air, and we need an assurance that if we do Brexit—I very much hope that we do not—enforceable standards will be in place to ensure that people are safe. Put simply, children and the rest of us have a right to clean air, but the Government are failing in their duty to deliver that right. They need to get on and protect our public health, protect our future and deliver clean air.

Early Parenthood: Supporting Fathers

Geraint Davies Excerpts

Wednesday 30th January 2019 Westminster Hall

[Tracey Crouch]

I agree with my hon. Friend, but it is very important that we do not fall into the trap of talking about dads as weekend parents. The point of the debate is to discuss how society has evolved; there is a lot more equal parenting. I completely understand his point. I shall come on to talk about shared parenting. The take-up of shared parenting is so low that many fathers can play that meaningful role in parenting only at weekends, so we would want those services to be open. Children’s centres have an incredibly important role, which is not just about creating a connection, but also about, for example, trying to break the cycle in domestic abuse. They play a fundamental role. I know that the Stefanou Foundation is doing some excellent work in supporting such initiatives.

I accept that my own experience is based on good fortune, and that it could easily be criticised as coming from a comfortably-off middle-class professional, but we need to do so much more on shared parenting than we do at the moment. We lag very far behind other countries on shared parenting, particularly Scandinavian countries.

What I see from my other half taking shared parenting is a very special bond between him and our son. Sadly, there are still a significant number of men who are ineligible for parental leave, and for those that are eligible there is a financial disincentive to take it. The Fawcett Society found that nearly seven in 10 people believed that men who took time off work to look after a baby should be entitled to the same pay and amount of leave as women. In Germany, fathers on leave are paid two thirds of their salary and in Sweden it is 80% of their income. Here it is £145 per week. We managed because I am paid well, but an average or low-income family would inevitably struggle, so while many might want to, it is unsurprising that take-up of parental leave is so low.

I know that much work is being undertaken to improve the situation. I thought the speeches in our debate on proxy voting on Monday evening encouraging male colleagues to take shared parenting leave were really helpful, and we could set an example in this place. I commented earlier on the wider societal and health benefits of a father’s meaningful engagement in the upbringing of a child. To me, doing more to improve our shared parenting policies is a no-brainer.

There is so much more I could have spoken about this morning, including the emerging organisations that help support fathers, such as workingdads.co.uk, which seeks employment with flexible, child-friendly hours, and the really funny social media accounts, such as Man vs. Baby, which might make light of some of the challenges that fathers face but also highlights that they exist in the first place. Ultimately, if we accept that meaningful fatherly engagement with their children is good for the health and wellbeing not just of the child but of the dad, making sure that we provide the infrastructure to support them, from neonatal to perinatal and beyond, is simply common sense, fair and equal—good economics but also really good politics.

[Geraint Davies (in the Chair)]

Order. We have six speakers, which with my maths makes about six minutes each. I would like to introduce an advisory limit of six minutes. As with the EU referendum, it is not mandatory, but I strongly advise it. I invite Paul Masterton to start.

--- Later in debate ---

[Douglas Ross (Moray) (Con)]

I commend my hon. Friend the Member for Chatham and Aylesford (Tracey Crouch) for securing this debate. She showed that the role of champion that she played in ministerial office has continued into what I hope will be the short period that she is on the Back Benches. I also declare an interest: I decided to speak in the debate as a learning exercise, because I will become a father for the first time in just over five weeks.

That brings me to the point on which I want to start. This House has finally moved into the 21st century, following Monday’s decision on proxy voting. It took an awful long time to get to that stage, but it was a welcome step forward. Last night, we had the first proxy vote used in Parliament. I hope to be the first male Member of Parliament to use the proxy voting system in early March.

I commend the CSJ report for a number of points that it highlighted. One of the most shocking was that only 60% of dads had no conversations at all about their role with midwives. I am one of that 60%; I have had none of those conversations at all. My wife has had excellent care with her midwife, usually when I am down in London, that I hear about on the phone or when I get home. I am one of the 60% who have had no involvement whatsoever.

I found some of the report’s other findings shocking as well. Only 25% of fathers felt that there was enough support to help them play a positive role in family life, while 60% felt emotionally unsupported when they first became a father. Similar research in Scotland, by Fathers Network Scotland, concluded that NHS Scotland—this is not a critical point, but highlights feelings across the country—is failing to provide family-centred antenatal, maternity and health visitor services. Unless we accept that there is a problem, nothing will change.

The Fatherhood Institute identifies that poor relationship quality and engagement from fathers is a key driver in post-natal depression, which was mentioned by my hon. Friend the Member for Chatham and Aylesford. That is surely another good reason for more involvement by father, to their own benefit and that of the mother and child, which is acknowledged by the Royal College of Midwives.

There is a local element to the issue. I was not in Parliament on Monday for the debate on proxy voting because I had stayed my constituency to attend an extremely important public meeting on our maternity services. They had been downgraded at Dr Gray’s Hospital, and we no longer have a consultant-led maternity service. A great campaign, Keep Mum, has been running for a number of months to get that service back. Although Dr Gray’s does not have a consultant-led service, a large proportion of our expectant mothers have to travel to Aberdeen to give birth—that is more than 70 miles away.

At the moment, my wife is on a green pathway, so we will not have to do that, but we might have to travel the 70 miles to Aberdeen on one of the worst roads in Scotland—the A96 across the Glens of Foudland. This morning, there is an inch of snow in Moray. As my hon. Friend the Member for East Renfrewshire (Paul Masterton) very ably put it, a father is almost dumped after his wife has given birth, and heads home, not in a correct state of mind. What state of mind will expectant fathers be in, as they drive through snow for 70 miles to go to Aberdeen, with the mother of their child potentially giving birth in the back of their car? That is what Moray constituents have to do at the moment, which is why it is so important for us to return the Dr Gray’s maternity service to a full, consultant-led one.

I will finish with a few of the important recommendations in the CSJ report. I was surprised that one even needed to be made, and it reads

“all official correspondence relating to the care and health of a child should be addressed directly to both parents”.

It is incredible that at the moment both parents are not addressed.

I was, however, reminded of a constituency case that I am dealing with at the moment, which is extremely sad and involves a child who died shortly after birth. The mother contacted me because, when she went to register the birth of their young child, who only lived for a few hours, only one parent had the opportunity to sign the register. That tends to be the mother, who has gone in to do that. She was shocked that the father, who had been so important a part of the process, was not allowed to have an acknowledgement on the death certificate that he had a part to play in the child being born and, sadly, dying. I have written about it to the registrars in Scotland.

Another recommendation was:

“NICE should review the evidence”—

the lack of evidence—

“on…the antenatal and post-natal period and produce a single set of standards for health care professionals…on the role of fathers.”

That, too, is very important.

To follow up on the point made by the previous speaker, my hon. Friend the Member for Congleton (Fiona Bruce), about a champion in Government, the report recommends that a Government “fatherhood champion” should be appointed. It adds that the champion should be either a “peer or senior MP”, so I am not auditioning for the role at the moment. It is, however, a very good recommendation. We see in our local authorities and the Scottish Parliament, where I used to sit, that where we have a dedicated champion, the issues are highlighted in Parliament and Members have the opportunity to express their views. A champion to drive things forward can be a positive step.

I am about to enter another exciting chapter in my family life, in five weeks’ time. Looking around at all the hon. Members speaking as fathers today, I can see that it is a bright future—they are all bright eyed and bushy tailed. I look forward to it, and I greatly appreciate the time that my hon. Friend the Member for Chatham and Aylesford secured today to allow Parliament to discuss this important issue.

[Geraint Davies (in the Chair)]

I am sure we all wish you and your wife very well.

Mental Capacity (Amendment) Bill [Lords]

Geraint Davies Excerpts

2nd reading: House of Commons & Money resolution: House of Commons & Programme motion: House of Commons & Ways and Means resolution: House of Commons
Tuesday 18th December 2018 Commons Chamber

[Matt Hancock]

We built the Bill on the basis of the Law Commission report, but we have put some differences into the Bill. For instance, we think the principle of prioritising people over process is important, and we have strengthened that compared with the Law Commission’s recommendations. The Law Commission improves the law but does not make policy decisions. On top of the Law Commission’s work, which is incredibly helpful, we have made further policy decisions to ensure that people are put more foursquare at the heart of the process. It is true that the Bill and the Law Commission’s recommendations are not exactly aligned, but I would strongly defend our further improvements.

[Geraint Davies (Swansea West) (Lab/Co-op)]

I have the privilege of chairing the all-party parliamentary group on speech and language difficulties. The Royal College of Speech and Language Therapists is concerned about the conflation of mental capacity with speech and language difficulties. It is important we have provision so that people with speech and language difficulties are appropriately assessed and are not banged up because they are thought to be dangerous. There should be enough training in light of the fact that 60% of people in the criminal justice system have speech and language difficulties.

[Matt Hancock]

The hon. Gentleman is absolutely right about the importance of getting highly trained social workers to make these judgments and about the importance of making sure such training is provided for and embedded in the Bill. He speaks powerfully, and I agree with how he puts it.

The Bill introduces a new liberty protection safeguards system, and it makes the authorisation simpler and more straightforward. It removes some bureaucracy and duplication, and it makes the system easier to navigate for individuals and their family. People will get their rights protections sooner, there will be greater independence when decisions are taken to restrict liberty, and the NHS and social care providers will be given a bigger role in the decision-making process so that people under their care receive the right care and their rights will be protected. It will introduce an explicit duty to consult the person being cared for and to consider their wishes and feelings.

--- Later in debate ---

[Geraint Davies (Swansea West) (Lab/Co-op)]

I speak as the chair of the all-party parliamentary group on speech and language difficulties, so my primary concern is that people will have their freedom taken away simply because they cannot be understood rather than due to a mental capacity problem. The Minister will know that this is a big problem, with something like 10% of children entering school having a speech or language difficulty. Some 60% of young people in the criminal justice system have a speech or language difficulty, and yet speech and language therapy reduces reoffending from 39% to 26%, so it is a cost-effective intervention at that stage and would be even more cost-effective beforehand. Some 81% of children with emotional and behavioural disorders have unidentified language difficulties. Left untreated, 33% of children with speech and language difficulties develop a mental illness, and half of them commit crimes.

In other words, it is important to identify and provide support for people in such situations because, as we have already heard, it can cost £13,000 a week to keep someone incarcerated, but that may be happening simply because they have not been properly understood and have not received the support they needed. There is therefore a financial and moral onus on us to identify and provide therapy to reduce and reverse the development of mental health problems linked to speech and language difficulties.

The situation at the moment—it will be the same under the Bill—is that assessors often will not and do not recognise speech and language difficulties or cannot differentiate between them, and they often do not know how to support the client and communicate their needs.

[Rebecca Pow]

I support all the hon. Gentleman’s comments. He is making a strong case. Does he believe that staff training on communication ought to be included in the Bill, and that speech therapists should be included in the list of approved mental capacity professionals?

[Geraint Davies]

I was going to make precisely that point. The Royal College of Speech and Language Therapists has said that the list of professionals should include such therapists and that all professionals carrying out assessments should have speech and language training so that they can identify the issues that they currently do not identify and provide clients with support. I ask the Minister to consider the Mental Capacity Act (Northern Ireland) 2016, which requires that support must be provided for communication.

When people are deprived of their liberty, that comes through their lack of capacity to consent, which is questionable if there has been no proper assessment of speech and language difficulties. The person may have a mental disorder, and the action that is taken must be necessary and proportionate. If they object, a review is carried out, but there is no requirement that a speech and language therapist should be involved in the review, which is another change that needs to be made.

The central point is that speech and language problems do not mean a problem with mental capacity, but they are commonly misread as such, which obviously costs the public sector a fortune and costs thousands of people their liberty. As has already been asked, I ask the Minister to look carefully at these issues over a longer timeframe, because we are in danger of rushing this through under the heat and smoke of Brexit, and everything else, and we risk denying the liberty of people whose liberty should not be denied and costing the public sector a fortune when that money would be better invested in preventive treatment such as early intervention for speech and language problems.

NHS Whistleblowers

Geraint Davies Excerpts

Wednesday 18th July 2018 Westminster Hall

[Geraint Davies (in the Chair)]

I call Dr Philippa Whitford to move the motion. I know it is a bit early, but we are all here.

[Dr Philippa Whitford (Central Ayrshire) (SNP)]

I beg to move,

That this House has considered NHS whistleblowers and the Public Interest Disclosure Act 1998.

It is an honour to serve under your chairmanship, Mr Davies. Gosport, Morecambe Bay, Mid Staffordshire and Bristol Royal Infirmary are NHS scandals that all have quite a few things in common: they went on for a long time and often whistleblowers who might have brought the issue to an end and saved lives were punished or ignored. They were certainly intimidated. The anaesthetist who raised the issue of baby cardiac surgery at Bristol Royal Infirmary ended up in Australia.

The term “whistleblower” suggests a pressure cooker—a build-up of pressure to the point where someone cannot resist it any longer and feels the need to come forward. We are trying to decompress some of that impression by having audit of patient safety through such systems as Datix, where staff get used to reporting every little aspect that does not go smoothly, which therefore creates the habit of coming forward. We still have issues. They often relate to the whole system, the trust or perhaps the behaviour of certain medical or clinical staff. There is no easy way to come forward, and the people seeing that behaviour take a long time to be listened to or to step up.

In the investigation into Mid Staffordshire, which was the worst NHS scandal, Sir Robert Francis’s report spoke about developing a “freedom to speak up” culture, to make doing so normal. Sir Robert suggested only minor changes to the Public Interest Disclosure Act 1998 but, as I will come on to later, I think it needs major change because it underwrites everything else.

East Midlands Ambulance Service

Geraint Davies Excerpts

Wednesday 21st February 2018 Westminster Hall

[Several hon. Members rose—]

[Geraint Davies (in the Chair)]

Order. Five people want to speak, so I am going to impose a time limit of five minutes so that there is enough time for wind-ups. I call Dr Caroline Johnson.

--- Later in debate ---

[Matt Warman]

I agree, of course, that we need the resources and reform package that will put us where we need to be. As my right hon. Friend the Member for South Holland and The Deepings has said, the issue is not solely about money—though to be fair to everyone present, I do not think that anyone is pretending otherwise —but of course proper resources are a big part of the equation.

Sensible moves on a blue-light combination would be a logical thing to do. I also think that one of the problems we face—this relates both to the issue of handover and to the number of ambulances waiting outside hospitals—is in large part due to the recruitment and retention challenges we have in Lincolnshire. A medical school in Lincolnshire would play a part in solving some of those problems. I say that in part because we need to recognise that this is a system problem, not solely an EMAS problem.

In conclusion, I was all set before the debate to stand up and say that successive Governments have not managed to get a grip on this problem—

[Geraint Davies (in the Chair)]

Order.

[Matt Warman]

Do I not get an extra minute?

[Geraint Davies (in the Chair)]

It was a five-minute limit and I did give you some 45 seconds’ discretion.

[Karen Lee (Lincoln) (Lab)]

I personally have witnessed how hard EMAS staff work. I pay tribute to their professionalism and dedication.

On 18 January my right hon. Friend the Member for Islington North (Jeremy Corbyn) came to Lincoln and we visited the call centre up at Bracebridge Heath. We saw at first hand what was happening. We were told that the single biggest problem in the increase in response times is when the ambulances get to hospital and cannot hand patients over. The day before I went out with an ambulance crew, there had been a seven-hour wait to hand over and at 7 am the next morning 22 patients were still waiting in A&E for a bed. As I have said, during my right hon. Friend’s visit we talked to ambulance crews and the handover time at hospital is causing the problem and increasing response times.

On 3 January I went out on my own with a crew—I, too, am a healthcare professional: a nurse. Ordinary people were phoning for ambulances. An elderly gentleman called one because he could not breathe and was terrified —he actually had a chest infection, so he was given a nebuliser and did not have to go to hospital, but he had not been able to get a GP appointment. We went to an old lady who had fallen and was on the floor. The paramedics dealt with her and within an hour we left her—she stayed at home and did not need to go to hospital. Our ambulance services deal with all sorts of cases.

A more personal example is my mum, who has mental health problems—she had a breakdown a few years ago. The Friday before Christmas, at half-past 4 in the afternoon, I was called from my office to go to her. I went, called 111 and got her assessed by about 6.30 pm or 7 o’clock. I did not get an ambulance until quarter to 1 in the morning. She just had to wait. There was a bed at Witham Court, but we could not get an ambulance. My mum was getting increasingly distressed—she was in a right state and I had to sit with her. If I had not been there, my stepfather would have had to deal with her, and he has dementia. I was wandering around Tesco at 2 am on the Saturday before Christmas because I had had to stay in to look after my mum—another ambulance wait.

Other examples are personal to me because I am a cardiac nurse. When my right hon. Friend the Member for Islington North came to Lincoln, we went to the heart centre. I am also aware of stuff that has come through my post bag about people with chest pains waiting two and a half hours for an ambulance. The figures for issues such as door-to-balloon time are all going up at Lincoln County Hospital because people who are actually having heart attacks cannot get an ambulance. They are at risk of going into an arrhythmia, whether it be VT or VF—ventricular tachycardia or ventricular fibrillation—because they are having a heart attack. They are not getting the treatment they need, because they are waiting for an ambulance.

Our NHS is in crisis. It is time that the Government acknowledged that. If A&E is so packed that ambulances cannot hand over, the NHS is in crisis—please admit that and let us do something about it. What is happening with EMAS is symptomatic of the situation. NHS workers are underpaid right across the board, with a pay cap, and they are understaffed. All those things work together. I feel sorry for EMAS—at the moment it is set up to fail and there is nothing it can do about that. I am sorry, but this is utterly political: why do we starve public services of resources? It is all right to say that we are giving them money, but we are not giving them enough money. When we do not give them enough money but cut taxes, frankly that is immoral.

[Geraint Davies (in the Chair)]

I call Ben Bradley. Is he here? He has just walked out, has he? He was here. I am sorry about that. I will call the first Front Bencher instead.

[Justin Madders (Ellesmere Port and Neston) (Lab)]

Thank you for calling me to speak, Mr Davies. Perhaps the hon. Member for Mansfield (Ben Bradley) had a call from his lawyers.

[Geraint Davies (in the Chair)]

He has called an ambulance, I should think.

[Justin Madders]

I congratulate my hon. Friend the Member for High Peak (Ruth George) on securing this debate. She has again shown that she is a strong advocate for issues in her constituency. She described the ambulance service as the glue that binds the NHS together; I would go further and say that all the staff are that glue who bind the service together.

My hon. Friend reeled off a whole range of statistics about performance in EMAS. The ones that stuck out for me were the nine-hour wait for an ambulance and the queuing times at hospitals, which were also mentioned by a number of other hon. Members. She talked about the risk-averse approach of 111; although clearly no one wants that to go too far the other way, I know that more clinicians are now working for 111. I will be interested to hear whether the Minister feels the balance between clinicians and non-clinical staff in that service is now right.

We heard from a number of Members, but unfortunately I will not have enough time to go through all the contributions. In a very thoughtful and relevant speech, the hon. Member for Sleaford and North Hykeham (Dr Johnson) made some interesting points about whether staff are utilised as effectively as we might like.

My hon. Friend the Member for Bassetlaw (John Mann) made some interesting points about geography—he should look at some of the sustainability and transformation plans too, to see whether the geography there makes any sense—and privatisation, which probably got a fairer hearing from Members on our side of the Chamber than those on the Government Benches, but that is something we need to examine closely.

We also heard from my hon. Friend the Member for Lincoln (Karen Lee), who spoke movingly and passionately from her personal and professional experience. We heard about people with chest pains waiting two and a half hours for an ambulance—we can only begin to imagine how stressful that must be.

As a number of hon. Members said, geography is clearly a big issue. As we also heard, the trust is one of the most poorly performing in the country. The sparsity of population is clearly driving that problem. The staff are not to blame. Last year the Care Quality Commission report expressed serious concerns but also commented on

“caring, professional staff delivering compassionate, patient focussed care in circumstances that were challenging due to the continued demand on the service.”

It is important to remember that across the whole of the NHS, providers struggle to meet the demands.

The financial squeeze has been pointed out on more than one occasion, not only in this debate but by many politicians, patients and staff, and by the assistant coroner for Nottinghamshire, Heidi Connor, in her comments in the regulation 28 reports to prevent future deaths, all of which have been sent to the Department of Health and Social Care, NHS England and NHS Improvement. As Members know, the reports are made when a coroner believes that action should and can be taken to prevent future deaths. In May 2016, in the second of two reports expressing concern, she said:

“The issue in this case…was essentially a matter of resource. In essence, I found that there is only so much an ambulance service can do where they simply do not have an ambulance to send. Demand is clearly greater than the resources they have most of the time”.

We have heard that echoed by Members.

We know that there will be occasions when demand peaks, but Heidi Connor makes it clear that that is not an exceptional spike in demand but a situation that exists most of the time. She goes on to say:

“I consider that there is a risk of future deaths...unless an urgent review of resources is undertaken”.

Will the Minister confirm what specific steps were taken by the Department in response to the regulation 28 reports issued on 11 and 26 May 2016?

Those statements are not the only ones we have heard about the resource situation. After the 2017 CQC report, the chief executive of the service said:

“EMAS was not commissioned to meet the national performance targets during 2016/17, and therefore was not resourced to do so”.

As my hon. Friend the Member for High Peak said, there can be no doubt that finance is the root cause of the issues we are hearing about today. We are in the longest and most sustained financial squeeze in the history of the NHS, and that is having real consequences. The fact that EMAS receives the second lowest urgent and emergency income per head of population in the country is a challenge, in particular given the sparsity of the population and the geographical challenges, as we have heard.

Despite the pressing need to invest more in frontline services, I am concerned that EMAS is having to service debts that have increased from £35,000 to £376,000 in the past year as a result of a loan taken out from the Department of Health in 2015-16. How can the service deliver the improvements we all want when it has to divert money to repay debts, just to keep things on the road?

It is true that EMAS’s performance is below average; it is also true that trusts have deteriorated significantly in their performance since 2010. The same is true of all targets in every part of the NHS. This Government have failed to hit any of their NHS ambulance targets since May 2015. The truth is that underfunding of the NHS has pushed ambulance services to the brink and left record numbers of patients everywhere suffering in discomfort and in terrifying circumstances, as we have heard today.

New performance standards are an opportunity to build a system that has the support of paramedics and patients alike. I conclude by asking the Minister to give an assurance that the new series of standards are based on the best clinical evidence and not just designed to obtain what is achievable with the money that the Department has allocated.

[Geraint Davies (in the Chair)]

Minister, we will end at a quarter to, so you will have time to allow a couple of interventions should you wish.

--- Later in debate ---

On resuming—

[Geraint Davies (in the Chair)]

Order. Minister, over to you; if you would like, you could allow a couple of minutes at the end for the mover.

[Stephen Barclay]

I will be happy to, Mr Davies. As I was setting out before the votes, a number of key measures have been announced. I will elaborate on those further, but, before I do, I will address some of the points raised by colleagues across the House in this constructive and well-supported debate.

The hon. Member for High Peak very reasonably opened her remarks by putting some of the challenges in the context of the good work being done. She cited in particular the case of her constituents, Vinnie and Jo, which illustrates the fantastic work done alongside some of the challenges that we will come on to. She also mentioned specific issues faced in terms of geography and low population density.

The hon. Lady mentioned empowerment of 999 call staff as a specific issue. My understanding is that revalidation can be done by call handlers where they are clinically trained, but not where they are not. Even where they are clinically trained, it cannot be done if the initial 111 call is either a life-and-death call—a category 1 or category 2 call—or where the initial assessment has been done by someone from 111 who is clinically trained. There is a framework there, but I am happy to have a further conversation with the hon. Lady if she has areas of specific concern about how that guidance is operated. She will be aware that, in any event, only 12% of NHS 111 calls are referred to ambulance trusts, so the 12% is a subset initially; within that, there is a subset of those who are clinically assessed and what power there is. I am, however, very happy to have a further conversation.

The hon. Lady also mentioned funding, which I will come on to specifically. The trust has had additional funding, but on the challenges set out by colleagues from across the House, the trust is undertaking a demand and capacity review that will determine the level of additional resourcing required. That will inform the commissioning for 2018-19. Of course, it will have taken note of the concerns raised.

The hon. Member for Great Grimsby (Melanie Onn), who is no longer in her place, raised a point about whether there are peaks of demand linked to drug and alcohol-related calls. I am happy to pick that up as a specific action and investigate that further.

As so often when we debate matters of health, my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson) brought a much-valued practical experience to the debate. I was particularly struck with her comparison between the one-to-one staffing rate in intensive care and her concern about the number of crews, and how that interplays with the handover at hospital. As she will be aware, a lot of work is happening on hospital ambulance liaison officers and how hospitals deal with ambulances. NHS Improvement and NHS England are looking at that issue specifically in relation to this trust, but again she made a helpful contribution. I know she mentioned that she had spoken to the Secretary of State about the issue.

Medicines Regulation

Geraint Davies Excerpts

Tuesday 21st November 2017 Westminster Hall

[Justin Madders (Ellesmere Port and Neston) (Lab)]

It is a pleasure to serve under your chairmanship, Mr Davies. I congratulate my hon. Friend the Member for Bishop Auckland (Helen Goodman) on securing this extremely important debate. It is sad there are not more Members here, but—as always—there are competing interests. She has been assiduous in asserting the rights of Parliament to scrutinise the terms of our exit from the European Union, and today’s debate is no exception to that.

In common with the vast majority of Members—whatever our views on the European Union—my hon. Friend spoke with a genuine desire to ensure that our departure happens on the best possible terms. I am sure we can all see that one priority is to ensure that our economy is able to thrive and that patients are able to access all the medical treatments that they need, as every hon. Member has said. Most of them also mentioned the decision to relocate the European Medicines Agency from London to Amsterdam. I do not know whether the debate was timed with that in mind, but it is certainly apposite.

When my hon. Friend began her speech, she said there had been no explanation, no policy statement, no impact assessment and no opportunity to debate the many issues we have discussed today. Of course, she has a considerable constituency interest in this subject area, but, as we have heard from most Members, the issue affects every single person in this country. The importance of it cannot be downplayed.

My hon. Friend said that regulation is one of the major costs to the industry. I share her frustration that we do not have a clear steer from the Government on what the future of that vital component of the industry will be. As she said, investment decisions are being made now and we are already beginning to lose out. I totally agree with her that the Minister should make it clear that we are putting patients and public safety first.

My hon. Friend the Member for Lewisham East (Heidi Alexander) gave a passionate and well-informed speech on the merits of the EMA. She summed it up very well when she said that the EMA’s leaving us is bad, but our leaving the EMA will be far worse. She was right to highlight the risk of delays for patients accessing new medicines. She said that business and patients need clarity, which is something that has come through clearly from all the Members who spoke today.

My hon. Friend the Member for Barrow and Furness (John Woodcock) spoke with great sincerity about the important business in his constituency. He is a fervent advocate of other businesses and sectors there, so we know that he will not let the matter lie. The announcement in the summer must have come as a real blow, given that Ulverston, and his constituency, are quite isolated from other populations, and in the light of the potential for damage to the local economy when so many high-skilled jobs are at risk. My hon. Friend will obviously want to ask the Minister to be clear about the assistance necessary to get the best from a pretty bad situation. The conversations that he will want to have with Ministers will be similar to those that every Member will have about industries in their constituencies affected by the Brexit decision.

The hon. Member for Central Ayrshire (Dr Whitford) spoke, as always, with great authority on health matters. She highlighted the fact that we are already slipping down the pecking order, and spoke from personal knowledge. In addition to the certainty that patients and businesses need, she highlighted the fact that universities, as well as EU nationals, need certainty. We should not forget, either, the 61 people working for the EMA who may be transferring to Amsterdam. They, too, need certainty about their future. The hon. Lady noted the risk of tariffs being introduced on drugs that have come into the market in the past seven years, if we crash out of the EU on WTO terms. It would be useful to hear from the Minister whether any assessment has been made of the potential cost of the tariffs, and whether he envisages that that cost would be dealt with by the Department of Health, or that individual patients would be expected to pay more for the inevitable additional cost of the drugs.

I doubt whether, when our constituents cast their votes in the referendum, the many issues that we have discussed today would have been at the forefront of their minds. Regulation of medicine is an integral part of our relationship with the EU, but it was not mentioned on any buses. The closest that we got to any debate on the impact of Brexit on the health sector was the £350 million a week that would be spent in addition to existing expenditure. It is sad to see that no advocates of leave are here today to explain how the situation fits into the big picture that they were so keen to propound at the time. Of course it has become apparent since June 2016 and from today’s debate that there is a threat to jobs and investment in the science and research sector. As my hon. Friend the Member for Torfaen (Nick Thomas-Symonds) succinctly pointed out at the start of the debate there is also a threat to access to new medicines; that is a serious unintended consequence. I certainly have not heard any Brexiteers suggesting that our current system is not advantageous to us as well as the other 27 EU member states. It is therefore difficult to overstate how critical the future of medicines regulation is to the economy and, more importantly, to the millions of patients in the UK who will need the medicines whether we leave the EU or not.

It might seem a long time ago now, but in July last year, just after she was appointed to her present role, the Prime Minister said:

“It is hard to think of an industry of greater strategic importance to Britain than its pharmaceutical industry”.

That of course remains very much the case. As my hon. Friend the Member for Bishop Auckland said, we have been exceptionally successful in that sector. The industry has a turnover of more than £60 billion per year, generates exports worth £30 billion and gives us a trade surplus of £3 billion. It employs 220,000 people in this country, and 25% of the world’s top prescription medicines were discovered and developed in the United Kingdom. It is of huge economic importance, and it says something about the sorry state of affairs we are in that Members feel the only way to get any clarity on the future of that vital industry is to have Ministers come to Westminster Hall to debate the issues.

Together with the direct economic impact is the effect on millions of patients, who rely on our co-operation with the rest of the EU to get access to safe, effective and affordable medicines. As we have heard, 45 million patient packs of medicine a year move out of the UK to the EU and 37 million move in the opposite direction. That is an awful lot of movement on which we need the Government to provide clarity. Those benefits, and others that hon. Members have spoken about today, are under threat not only from the relocation of the EMA, but from our exit from the EU if that is not handled more carefully.

Losing the EMA from London is of course a huge blow, not just to the economy of London but to our pharmaceutical sector more widely, for the reasons we have heard. The benefit that it brings to any national economy is evident from the fact that 19 other cities across Europe were in the running to become its new host. In addition to the loss that we will experience from the agency’s physical removal, it also poses a number of challenges and threats to medicines regulation across the EU. Indeed, The Pharmaceutical Journal recently warned that

“a worst-case scenario could permanently damage the medicines regulatory system, leading to a public health crisis”.

Although the EU27 decided not to relocate the EMA in eastern Europe, after a survey of staff found that an alarming 70% to 94% of them would not be willing to relocate there, the move to Amsterdam could still present a risk, in the sense that the survey found that up to 40% of those currently employed at the agency would not be prepared to move.

As my hon. Friend the Member for Lewisham East said, it is not an easy process to move an office wholesale. Some things will stop, and there will be a loss of some highly skilled specialist staff, who will be difficult to replace. An EMA spokesperson said that

“while some job losses can be absorbed within the business continuity plan...beyond a critical threshold, the Agency will no longer be able to fulfil its mandate to protect the health of European citizens.”

I am sure that no one voted for that on 23 June 2016. Good staff will inevitably leave the EMA rather than relocate their homes, their children’s schools and the careers of their partners. That will be an important factor. As the journalist Dr Ben Goldacre put it,

“these highly specialist staff are like trees: they take a long time to grow, and they put down roots.”

In the short term we may benefit from some of those specialist staff staying in the UK, possibly at the expense of the EMA and the future success of European regulation; but let us be in no doubt that in the long term it will be to our detriment, because we will struggle to attract the best.

Before the Brexit talks even move on to the future of medicines regulation, the Government have a duty to act now to protect our vibrant life sciences sector. One of the key reasons why so many countries were competing to host the EMA is that its presence makes pharmaceutical companies far more likely to locate in the host city. Many of those companies will have a UK base, and, as has been mentioned, will be beginning to think about future plans; so what steps are the Government taking today to persuade those companies to stay in this country, and not just to retain their staff but to make investment decisions that will benefit the economy? As my hon. Friend the Member for Bishop Auckland said, the industry is international and highly mobile, and we cannot afford to lose investment through the big hole of current Government policy. When we leave the EU, we will potentially face a divergence from the current medicines regulation system across Europe. The challenge for the Government is to keep that divergence to a minimum or eliminate it altogether.

One of the first issues, which we have already discussed, is the likelihood that the Medicines and Healthcare Products Regulatory Agency will lose up to a third of its income, as that comes from its work as a rapporteur body for the EMA. Can the Minister confirm that that funding gap will not have to be bridged from the existing, already insufficient Department of Health budget? What estimate has been made of additional resources that may be required in the worst-case scenario?

We have already heard that in July a letter from the Health and Business Secretaries in the Financial Times confirmed that the Government will prioritise achieving regulatory co-operation in the article 50 negotiations, and that was welcome, although, as the Financial Times is not a party to the negotiations, it could be argued, from a cynical point of view, that it was merely window dressing. We take it at face value, however, and as a clear commitment to try to achieve as much co-operation as possible. Perhaps when the Minister responds he will say what progress has been made since that time. Will he also say whether Ministers or officials from the Department of Health form part of UK representations in negotiations with the EU? I appreciate that he will not be able to go into some of the details, but given the shared desire across the House to make progress and achieve as much harmony as possible in that area, can he put some flesh on the bones and say what exactly the Government will seek to achieve as we move forward? The Minister will understand that the big pharma companies are looking for a clear indication of the likely shape of the future relationship as soon as possible, and as we have heard, decisions are being made now. I hope that he can shed some light and provide clarity on that when he responds.

Will the Minister address Members on the jurisdiction of the European Court of Justice? If it cannot be used to adjudicate on licensing appeals, as appears to be the Government’s position at the moment, how will the two systems closely interact? Is there any possibility of a joint adjudication process? Operating alone in our own separate market would be not only extremely costly, but inevitably disastrous for patients. If pharmaceutical companies are forced to go through a separate regulatory system, as well as the NICE process, just to access what will be, in the big scheme of things, a fairly small market, we could find ourselves at the bottom of the list when new medicines are released. Pharmaceutical companies might view the UK as a lower priority than getting drugs into the bigger markets of the US, the EU or Japan. That might be a particular concern where the potential market for medicines is naturally small, such as with those for rare diseases. As already stated, we are already becoming a less attractive market for the life sciences sector, both for companies in the UK and for future investment decisions.

That is a very serious and bleak picture, and I hope that when the Minister responds he can reassure the House that ideology will not trump the best interests of our economy and our health service. My hon. Friend the Member for Bishop Auckland had seven questions—I lost count of the number asked by my hon. Friend the Member for Lewisham East, but there were many. I have a few of my own, and hopefully they will be a little more straightforward to answer—yes or no will probably do for most of them. In particular, I would like the Minister to guarantee today that after 1 April 2019 patients will have the same access to medicines as they do now, and that they will not face longer waits to access new treatments. Can he also guarantee that another part of the Department of Health’s budget will not be used to make up any shortfall in MHRA’s finance?

The Minister may not be aware that we held a debate on this subject just over a year ago, and many of the concerns raised then have been raised again today. All Members today have spoken with one voice about the need for clarity and certainty, and I hope that the Minister can provide us with that now.

[Geraint Davies (in the Chair)]

A lot of questions have been asked, and fortunately we have the time for a lot of answers.

--- Later in debate ---

[John Woodcock]

On a point of order, Mr Davies. If the Minister is struggling and feeling unwell, is there a way in which we could bring the debate to an earlier close and he could write to us in response to our questions? I am concerned by how he seems.

[Geraint Davies (in the Chair)]

The Minister is the last speaker. He can stop the debate at any time, at which point I will ask Helen Goodman to make her closing remarks for two minutes. Feel free to end whenever you feel is appropriate, Minister.

[Steve Brine]

Thank you; I am not feeling unwell at all.

In the event that it is not possible to reach a deal that secures ongoing, close collaboration between the UK and Europe, we will set up a regulatory system in the UK that protects the best interests of patients and supports industries so that they can grow and flourish, as set out in the letter in the Financial Times. We will ensure that our system is robust and does not impose any additional bureaucratic burdens. Our successful past should give us confidence in achieving a prosperous future, whatever form that takes. I want to be clear that that is not a threat to the EU27. I must be honest and transparent in saying that if it is not possible to secure close collaboration, we will of course look to put in place an effective system and work with international partners in a way that best protects patients and supports industry and innovation.

I will attempt to answer some of the many questions that the hon. Member for Bishop Auckland put to me. I can rule out a free-standing structure incorporated into the FDA. She asked how much the EU expects us to pay towards the cost of relocating the EMA. The arrangements for withdrawing from the EU, including any financial settlement, is a matter for the withdrawal agreement, as she knows, as part of the ongoing article 50 process. The Government are absolutely committed to working with the EU to determine a fair settlement for Britain’s exit and the best deal for UK taxpayers. As part of the exit negotiations, the Government will discuss with the EU and other member states how best to continue co-operation in the field of medicines regulation, in the best interests of business, citizens and patients in the UK and the EU. I do not think that it would be appropriate, nor is it possible, for me to prejudge the outcome of those negotiations. There are many who would love that crystal ball, but I do not have it.