Health and Social Care (Re-committed) Bill

Debate between Grahame Morris and Pat Glass

Tuesday 6th September 2011 Commons Chamber

[Grahame M. Morris]

I am grateful to my hon. Friend for raising that issue, which I will return to later. There were assurances that there would be no top-down reorganisations, but we should note the scale and complexity of this huge, top-down reorganisation. The Government alluded in Committee to the costs of administration, as did other members of the Committee. During Health questions and in Committee, I raised the question of the huge costs of administering Monitor, which have grown exponentially. We have had various estimates from the Government about the true cost, but over the lifetime of a Parliament it could be as much as £500 million, once we know the full extent of the legal challenges that Monitor will be expected to defend. That is a colossal sum.

I wanted to intervene when the Secretary of State referred to clause 60 of the original Bill and the intention to extend the duties of Monitor into the social care element of health and social care, but he would not allow me to do so. I wanted to ask whether any estimate has been made of the cost of such an extension of Monitor’s remit, which I suspect will be considerable.

[Pat Glass (North West Durham) (Lab)]

The Secretary of State mentioned 38 Degrees, which clearly has touched a raw nerve. Quite apart from the people from 38 Degrees who have contacted me, huge numbers of my constituents have contacted me to express real worries about this issue. Given the concerns of the Opposition, the press and, most importantly, the voting public, how does my hon. Friend think that we all got so out of step with the Prime Minister and the Secretary of State?

[Grahame M. Morris]

I am grateful to my hon. Friend for expressing that concern, which many people share—even among the Government, although perhaps they conceal it. Such concerns are not restricted just to 38 Degrees and Opposition politicians. Lord Tebbit of Chingford, an outspoken man who could hardly be described as a left-wing agitator, raised real concerns about what he described as these privatising reforms. He said that there is something seriously wrong, and that

“What worries me about the reforms…is the difficulty of organising fair competition between the state-owned hospitals and those in the private sector. In my time I have seen many efforts to create competition between state-owned airlines, car factories and steel makers. They all came unstuck. The unfairnesses were not all one way and they spring from the fact that state-owned and financed businesses and private sector ones are different animals”.

I have rarely found myself in agreement with Lord Tebbit, but on this occasion his analysis is extraordinarily insightful. His comments underline many of the basic contradictions in the Bill and in the subsequent amendments, which number more than 1,000.

Health and Social Care Bill

Debate between Grahame Morris and Pat Glass

Monday 31st January 2011 Commons Chamber

[Grahame M. Morris]

I agree completely with my hon. Friend’s point. According to evidence given to the Select Committee on Health, specialists in secondary care and the nursing and other professions could add their expertise to the commissioning process.

The shake-up of the NHS goes far beyond simply involving clinicians in spending decisions. GP commissioning is a red herring. We were told by the Secretary of State that these reforms are needed because productivity has fallen since Labour’s increased investment. However, after 18 years of mismanagement and under-investment under the Conservative party, it was obvious that on a crude measurement of productivity—inputs versus outputs—there was going to be a decline in supposed productivity, because obviously money had to be directed towards clearing up the mess left by the previous Tory government, to building new hospitals, accident and emergency units and maternity units, and to reducing waiting lists, which in many areas of the country were 18 months and longer.

The Secretary of State raised the satisfaction survey. Indeed, in December 2010, the National Centre for Social Research released its most recent report on British social attitudes. It found that public satisfaction with the NHS was at an all-time high, whereas in 1997, when Labour came to power, only 34% of people surveyed were satisfied with the NHS—the lowest level since the survey began in 1983. By 2009, satisfaction had nearly doubled to two thirds—to 64%. Given that most health unions, professional bodies, think tanks and the public did not call for such reforms, where did the Secretary of State’s motivation come from? These are not patient-led reforms; they are private health care-led reforms.

[Pat Glass (North West Durham) (Lab)]

Does my hon. Friend share my concerns that these plans will lead to high and low-tariff services, and cherry-picking, and that services such as child and adolescent mental health services, children’s health services and adult mental health services will lose out?

Breast Cancer Screening (Young Women)

Debate between Grahame Morris and Pat Glass

Tuesday 30th November 2010 Westminster Hall

[Pat Glass]

I absolutely agree.

Going back to the risk factors—obesity, HRT, oral contraceptives and alcohol—all of them are likely to affect women under 50 more than women over 50, and yet women under 50 are not routinely offered screening of any kind. About 1.5 million women in the UK are screened for breast cancer each year, and we must congratulate those involved in the routine screening programme on the many lives they save. The previous Government extended the screening programme so that from 2012, all women aged 47 to 73 will be invited for routine screening. That extension will save many more lives, but it will do nothing to help identify breast cancer in younger women.

Concerns have been expressed that wider screening could lead to over-diagnosis, but recent research is showing that the benefits of mammographic screening in terms of lives saved are greater than the harm caused by over-diagnosis. Those same arguments about over-diagnosis were used in the past to argue against extending screening for womb cancer and cervical cancer, but the response to those arguments has always been that it is better to be safe than sorry, and that, in the case of breast cancer screening, between two and two and a half lives are saved for every over-diagnosed case. Despite that, however, women under 50 are not currently offered routine screening.

It is also argued that film mammograms are not as effective for pre-menopausal women as for post-menopausal, as the greater density of breast tissue in pre-menopausal women makes it more difficult to detect problems. That is absolutely right. Screening of women under 50 may not be as effective as screening of women over 50, but it can still be effective, certainly in the absence of any other screening programme.

It is also argued that routine screening of women under 50 is not necessary, because the incidence of breast cancer is lower in that age group. I would say, “Tell that to the hundreds or thousands of young women battling this disease”, who say that any arguments about numbers are outweighed by the increased virulence of the disease in the young.

We are told that, because breast cancer is less common in women under 50, research trials have shown that regular screening of young women does not help to save lives. It is even argued that in other trials, regular mammogram screening is more of a risk than not screening. However, I say to the Minister, “Tell that to the young women currently undergoing chemotherapy”.

It is absolutely clear that mammogram screening is most effective among women who have gone through the menopause, but recent research shows that it can also be effective among those aged 35 to 50 and that, despite all the counter-arguments, there is now increasing evidence that there are significant gains to be made by routine screening of women from the age of 35 upwards.

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

I compliment my hon. Friend on securing time for this important debate. On routine screening and the value of targeting a particular age group, I, too, have received information from Breakthrough Breast Cancer—an excellent organisation—pointing out that 1,400 lives a year are saved by routine breast screening. However, Breakthrough Breast Cancer also says that any woman aged 70 or over is not routinely invited to attend for breast screening. It may well be advantageous, in terms of improving the health outcomes of those women, if a screening programme targeted them, too, in view of the high incidence of breast cancer among post-menopausal women.

[Pat Glass]

I thank my hon. Friend for that intervention.

I ask the Minister to consider the arguments that have been put forward and the increasing weight of medical evidence calling for routine screening from the age of 35 onwards. In his response, I ask him not to pull out the one argument that the coalition Government seem to have for everything: that there is no money. If we could set aside £9 billion last week to build more trains to make commuting more comfortable, surely we can consider routine screening. If we can find £9 billion to lend to the Irish in their hour of need, surely we can find the money to save young lives.

I understand that the Minister is unable to announce that routine screening for breast cancer will start tomorrow, but he could consider a long-term plan—over five years, for example—to reduce the age of screening to 45 in year one, 42 in year two, 40 in year three, 38 in year four, and to 35 within five years. Such a policy would be universally welcomed and could save precious lives.

I am aware of the Breakthrough Breast Cancer campaign. In particular, it seeks early breast screening for women from the age of 35 where there is a history of breast cancer. We must learn lessons from the highly successful cervical cancer screening programme. Early intervention is cost-effective—it saves the country money in the longer term, and it saves lives.